Purpose While improved health-related quality of life (HRQOL) is an important durable left ventricular assist device (LVAD) implant outcome, 50% of HRQOL data are missing in the STS-Intermacs registry. Pre-implant HRQOL missingness may reflect patient and hospital characteristics and thus serve as a novel hospital quality metric. We hypothesized that hospital pre-implant HRQOL missingness independently predicts 90-day outcomes. Methods The study cohort included 14,063 patients receiving a primary LVAD (4/2012 - 8/2017) with or without RVAD at 169 hospitals. Patient risk factors of pre-implant HRQOL (using the EQ-5D visual analog scale) missingness were examined by a stepwise logistic model. Direct standardization method was used to calculate hospital adjusted missing rates using a mixed effects logistic model. Hospitals were dichotomized as low/high based on median adjusted missing rates. Cox models, adjusting for patient risk, were used to associate a hospital's pre-implant HRQOL adjusted missing rate with 90-day infection, renal dysfunction and mortality. Results Patients with missing pre-implant EQ-5D (47.1% of patients) were younger (mean age: 56.2 vs. 57.9), more often non-White (36.3% vs. 32.0%), with an Intermacs Profile 1 (25.1% vs. 7.3%), compared to those with complete EQ-5D (all p<.0001). Probability of 90-day composite outcome differed by high and low adjusted missing rate hospitals (p<.0001, Figure). A 10% increase in hospital EQ-5D adjusted missingness was significantly associated with 90-day infection (HR: 1.05; 95%CI: 1.03-1.07), infection mortality (HR: 1.09; 95%CI, 1.01-1.18), renal dysfunction (HR: 1.03; 95%CI: 1.004-1.05) but not all-cause mortality (adjusted HR: 1.01; 95%CI, 0.98-1.04). Conclusion Higher hospital adjusted pre-implant HRQOL missingness was predictive of higher 90-day infection, infection mortality and renal dysfunction. Hospital pre-implant HRQOL missingness may serve as a novel LVAD quality metric.

We describe a cluster of 4 bloodstream infections with Mycobacterium neoaurum and 5 additional cases from the literature. Infections occurred mainly in immunocompromised hosts who had central venous catheters. Fever was universal at presentation, but local signs of inflammation were rare. Combination antimicrobial therapy and catheter removal resulted in clinical cure.

A previously healthy 33-year-old female died of disseminated infection with Scedosporium apiospermum in association with Hemolysis, Elevated Liver enzymes, and Low Platelets (HELLP) syndrome following the delivery of twins. Her postpartum course was complicated by multisystem organ failure managed with extracorporeal membrane oxygenation (ECMO). She also developed bowel and left lower extremity ischemia requiring surgical resection. Blood cultures yielded S. apiospermum, and histologic findings revealed in vivo adventitious sporulation, an unusual occurrence with this pathogen. Autopsy showed extensive fungal infection of brain, lungs, thyroid, heart, and kidneys.