Journal article
Delineating Pathways to Death by Multisystem Organ Failure in Patients With a Left Ventricular Assist Device
The Annals of thoracic surgery, v 111(3), pp 881-888
Mar 2021
PMID: 32739256
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
This study delineates the sequences of adverse events (AEs) preceding mortality attributed to multisystem organ failure (MSOF) in patients with a left ventricular assist device (LVAD).
We analyzed 3765 AEs after 536 LVAD implants recorded in The Society of Thoracic Surgeons Intermacs data registry between 2006 and 2015 that resulted in MSOF death. Hierarchical clustering identified and visualized quantitatively unique clusters of patients with similar AE profiles. Markov modeling was used to illustrate the AE sequences that led to MSOF death within the clusters. Cox proportional hazard models determined the risk-adjusted, preimplant predictors of MSOF.
We identified 2 distinct MSOF clusters based on their proportion of AE types and survival time. The early-death cluster (418 patients, 2304 AEs) had a median survival of 1 month (interquartile range, 3-6 months), whereas the late-death cluster (118 patients, 1,461 AEs) had a median survival of 11 months (interquartile range, 6-22 months). The predominant AE sequences in the early-death and late-death clusters were renal failure, to respiratory failure, to death (62%) and bleeding, to infection, to respiratory failure, to death (45%), respectively. Significant risk-adjusted preimplant predictors of MSOF included line sepsis (hazard ratio [HR] 3.0; 95% confidence interval [CI], 1.1-8.2), extracorporeal membrane oxygenation (HR, 2.2; 95% CI, 1.2-3.9), and dialysis or ultrafiltration (HR, 2.1; 95% CI, 1.5-3.0).
This analysis identified 2 AE clusters and the predominant sequences that result in MSOF-associated mortality. MSOF develops in 1 cluster of patients after chronic bleeding and repeated infections but has prolonged survival, while another group dies early after renal and respiratory complications.
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Details
- Title
- Delineating Pathways to Death by Multisystem Organ Failure in Patients With a Left Ventricular Assist Device
- Creators
- Laura Seese - University of Pittsburgh Medical CenterFaezeh Movahedi - University of PittsburghJames Antaki - Cornell UniversityArman Kilic - University of Pittsburgh Medical CenterRema Padman - Carnegie Mellon UniversityYiye Zhang - Cornell UniversityManreet Kanwar - Allegheny General HospitalSarah Burki - University of Pittsburgh Medical CenterChristopher Sciortino - University of Pittsburgh Medical CenterMary Keebler - University of Pittsburgh Medical CenterSameer Hirji - Brigham and Women's HospitalRobert Kormos - University of Pittsburgh Medical Center
- Publication Details
- The Annals of thoracic surgery, v 111(3), pp 881-888
- Publisher
- Elsevier
- Grant note
- R01 HL122639 / NHLBI NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiology
- Web of Science ID
- WOS:000637766100048
- Scopus ID
- 2-s2.0-85094177642
- Other Identifier
- 991021932190704721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery