Admission Shock Index Is an Independent Predictor of In-Hospital All-Cause Mortality in Patients With Acute Aortic Dissection and Intramural Hematoma.

Soluble interleukin-2 receptor predicts acute kidney injury and in-hospital mortality in patients with acute myocardial infarction

PurposeRed cell distribution width (RDW) and albumin level are linked to adverse outcomes in patients with acute myocardial infarction (AMI). Nonetheless, it remains unknown whether the RDW/albumin ratio (RAR) is associated with the short-term prognosis of AMI. Using a large cohort, we aimed to explore the association between RAR and in-hospital all-cause mortality in intensive care unit (ICU) patients with AMI.Patients and MethodsThe patients’ data analyzed in this retrospective cohort investigation were obtained from the eICU Collaborative Research Data Resource. RAR was calculated based on the serum albumin level and RDW. The primary outcome was in-hospital all-cause mortality. Receiver operating characteristic curve, multiple logistic regression model, and Kaplan–Meier survival analysis were performed to explore the prognostic value of RAR.ResultsWe enrolled 2594 patients in this study. After correcting for confounding factors, the RAR was an independent predictor for in-hospital mortality in our model (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.12, 1.43). A similar relationship was observed with mechanical ventilation use. RAR showed a better predictive value with an area under the curve (AUC) of 0.738 (cutoff, 4.776) for in-hospital all-cause mortality compared to RDW or albumin alone. Kaplan–Meier estimator curve analyses for RAR demonstrated that the group with RAR ≥4.776%/g/dL had poorer survival than the group with RAR <4.776%/g/dL (p< 0.0001). The subgroup analysis revealed no significant interaction between RAR and in-hospital all-cause mortality in all strata.ConclusionRAR was an independent risk factor for in-hospital all-cause mortality in ICU patients with AMI. Higher RAR values corresponded to higher mortality rates. RAR is a more accurate predictor of in-hospital all-cause mortality in patients with AMI in the ICU than albumin or RDW. Thus, RAR may be a potential biomarker of AMI.

BackgroundDisturbances in serum osmolality are associated with poor prognosis in many diseases and are more likely to occur in patients with traumatic brain injury (TBI). However, studies correlating serum osmolality and patient prognosis are lacking. Therefore, this study investigated the correlation between serum osmolality and in-hospital all-cause mortality in patients with TBI based on a large sample of TBI patients from the Medical Information Mart for Intensive Care-IV (MIMIV-IV) database.MethodsPatients were categorized into 4 groups based on serum osmolality levels and the association between serum osmolality and in-hospital all-cause mortality was assessed by constructing univariate and multivariate logistic regression analyses. Restricted cubic spline (RCS) curves were plotted to further assess nonlinear associations between study variables and outcomes. Kaplan–Meier analysis was used to assess the survival of patients in each group, and differences between groups were assessed by the log-rank test. Sensitivity analysis was used to assess whether this association was established in different populations.ResultsThis study covered 1587 patients. The Q3 group had the lowest in-hospital mortality (7.6%). After fully adjusting for confounders, either lower or higher serum osmolality levels were associated with in-hospital all-cause mortality (Q1 vs. Q3: OR, 2.244 [1.333–3.857] p = 0.003; Q4 vs. Q3: OR, 2.160 [1.295–3.681] p = 0.004). The RCS curves showed a U-shaped correlation, with the inflection point located at a serum osmolality of 295.4 mmol/L level.ConclusionsThere was a U-shaped relationship between serum osmolality and in-hospital all-cause mortality in TBI patients. Patients had the lowest in-hospital mortality when serum osmolarity was maintained at 295.4 mmol/L.

Type B acute aortic dissection (AAD) and intramural hematoma (IMH) can both present as potentially catastrophic lesions of the descending aorta. IMH is distinguished from AAD by the absence of an intimal tear and flap. With short-term outcomes being similar to type B AAD, IMH is treated identically to AAD in the corresponding segment of the aorta. While all patients with any acute aortic syndrome of the descending aorta receive prompt anti-impulse therapy, thoracic endovascular aortic repair (TEVAR) is reserved for patients presenting with certain complications, namely malperfusion, rupture, or periaortic hematoma. Technical aspects of TEVAR for IMH include maximal endograft oversizing of 10% with 20 mm landing zones of the healthy aorta, revascularization of the left subclavian artery when covered, use of cerebrospinal fluid drainage with extensive coverage, and restoration of branch vessel perfusion. With respect to disease evolution, IMH may progress to classic AD, frank rupture, or aneurysmal dilation; yet, IMH may also regress and be completely resorbed. However, since the natural history of IMH is unpredictable, TEVAR is being used more aggressively to improve long-term survival, rates of secondary reintervention, and positive aortic remodeling. Much remains unknown for acute type B IMH, including the use of prophylactic TEVAR for stable uncomplicated presentations, as well as the optimal timing of intervention and certain technical aspects of TEVAR. As such, IMH remains a diagnostic and therapeutic challenge for cardiovascular surgeons.

ObjectivesIn recent years, several epidemiologic studies have shown that pulse pressure (PP) is a powerful predictor of mortality from many cardiovascular diseases. However, few studies have reported the association between PP and adverse events during hospitalization in patients with type A acute aortic dissection (TAAAD). The aim of this study was to evaluate the relationship between admission PP and in-hospital all-cause mortality, in patients with TAAAD of relatively stable patients.MethodsPatients with TAAAD of relatively stable patients admitted from January 2015 to December 2021 were included and divided into four groups according to the PP values measured at the time of admission: reduced group (PP ≤ 40 mmHg), normal group (40 < PP ≤ 56 mmHg), mildly elevated group (56 < PP ≤ 75 mmHg), and significantly elevated group (PP > 75 mmHg). A multivariate binary logistic regression model was constructed, plotted using nomogram and evaluated with ROC curve.ResultsAdmission PP and in-hospital all-cause mortality showed a "J-curve" correlation and in-hospital all-cause mortality was significantly higher in the significantly elevated group and reduced group (P = 0.002), respectively. Multivariate binary logistic regression analysis showed that significantly elevated PP (PP > 75 mmHg) (P < 0.001) and reduced PP (P = 0.043), D-dimer (P < 0.001), ascending aortic diameter (P = 0.037), Abdominal visceral vessels involved (P = 0.017), and coronary atherosclerosis (P = 0.003) and emergent surgery (P < 0.001) were independent predictive factors for in-hospital all-cause mortality. The AUC of ROC plotted was 0.827 (95% CI 0.774–0.880).ConclusionsOur findings demonstrated a "J-curve" association of admission PP with in-hospital all-cause mortality in TAAAD. Significantly elevated and reduced admission PP, D-dimer, ascending aortic diameter and coronary atherosclerosis were independent risk factors for in-hospital all-cause mortality in patients with TAAAD, and emergent surgery was a protective factor.

IntroductionPatients with spontaneous sub-arachnoid hemorrhage (SAH) might develop various cardiac abnormalities, however; the prognostic implications of these cardiac abnormalities are not well known. This study aimed to detect the cardiac abnormality that correlates best with in-hospital all-cause mortality in patients with SAH.MethodsIn this retrospective study, all patients admitted to our institution with a primary diagnosis of SAH, and underwent a transthoracic echocardiogram (TTE) from July 2011 until May 2014, were enrolled. Data gathered included patients’ demographics, Hunt and Hess clinical grading, computed tomography SAH Fisher grading, troponin T level, electrocardiographic (ECG) changes, TTE, and in-hospital all-cause mortality. Multivariate logistic regression of the cardiac abnormalities and in-hospital all-cause mortality was performed.ResultsA total of 247 patients were included in our analysis. In-hospital all-cause mortality was 15.6% (38 patients). The presence of elevated troponin T levels, resting segmental wall motion abnormalities, reduced ejection fraction (<35%), and prolonged corrected QT interval (QTc) on ECG were associated with increased in-hospital all-cause mortality on univariate analysis. On multivariable regression, QTc prolongation was the only independent predictor for in-hospital all-cause mortality (p = 0.04).ConclusionsProlonged QTc interval on ECG was independently associated with in-hospital all-cause mortality in patients presenting with spontaneous SAH. Whether this is a causative association or a marker of underlying severe clinical presentation of SAH remains unknown.

The study aims to examine the predictive value of arterial blood lactic acid concentration for in-hospital all-cause mortality in the intensive care unit (ICU) for patients with acute heart failure (AHF). We retrospectively analyzed the clinical data of 7558 AHF patients in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The exposure variable of the present study was arterial blood lactic acid concentration and the outcome variable was in-hospital all-cause death. The patients were divided into those who survived (n = 6792) and those who died (n = 766). The multivariate logistic regression model, restricted cubic spline (RCS) plot, and subgroup analysis were used to evaluate the association between lactic acid and in-hospital all-cause mortality. In addition, receiver operating curve (ROC) analysis also was performed. Finally, we further explore the association between NT-proBNP and lactic acid and in-hospital all-cause mortality. Compared with the lowest quartiles, the odds ratios with 95% confidence intervals for in-hospital all-cause mortality across the quartiles were 1.46 (1.07–2.00), 1.48 (1.09–2.00), and 2.36 (1.73–3.22) for lactic acid, and in-hospital all-cause mortality was gradually increased with lactic acid levels increasing (P for trend <0.05). The RCS plot revealed a positive and linear connection between lactic acid and in-hospital all-cause mortality. A combination of lactic acid concentration and the Simplified Acute Physiology Score (SAPS) II may improve the predictive value of in-hospital all-cause mortality in patients with AHF (AUC = 0.696). Among subgroups, respiratory failure interacted with an association between lactic acid and in-hospital all-cause mortality (P for interaction <0.05). The correlation heatmap revealed that NT-proBNP was positively correlated with lactic acid (r = 0.07) and positively correlated with in-hospital all-cause mortality (r = 0.18). There was an inverse L-shaped curve relationship between NT-proBNP and in-hospital all-cause mortality, respectively. Mediation analysis suggested that a positive relationship between lactic acid and in-hospital all-cause death was mediated by NT-proBNP. For AHF patients in the ICU, the arterial blood lactic acid concentration during hospitalization was a significant independent predictor of in-hospital all-cause mortality. The combination of lactic acid and SAPS II can improve the predictive value of the risk of in-hospital all-cause mortality in patients with AHF.

An unusual intraoperative finding: Left atrial dissecting intramural hematoma after aortic root replacement.

I have read with great enthusiasm the paper that Jian et al have submitted.While their findings regarding red cell distribution width-to-albumin ratio (RAR) and acute myocardial infarction (AMI) mortality are interesting and consistent with the existing literature, their manuscript contains a major epidemiological nomenclature flaw.Although the conclusion part of the main text is correct, the conclusion part of the abstract states that the RAR was an independent risk factor for in-hospital all-cause mortality in intensive care patients with AMI.A risk factor is a feature that has a "causal impact" on disease occurrence, progression, or severity, and the disease would not have occurred in its current form in the absence of the risk factor. 1 As the authors have mentioned in the manuscript, red cell distribution width (RDW) and albumin levels alter during inflammatory states.While the former is a negative acute phase reactant, the latter is known to increase in both acute and chronic inflammatory states. 2-4Albeit their levels change during inflammation, they are not the cause of inflammation but only the surrogate markers of various inflammatory conditions.Specifically, lower albumin or higher RDW levels in a patient only reflect that patient having a higher level of inflammation compared to a patient with higher albumin or lower RDW levels.Studies on these indexes always conclude that "RAR is a predictor of" or "RAR is associated with". 3,4Thus, the term "independent risk factor" is inappropriate in this context.I recommend authors make an erratum on the abstract.

Background/Objectives: Renal failure (RF) and systolic heart failure (sHF) are very often associated with each other, and their synergistic influence can affect the prognosis of acute pulmonary embolism (aPE) patients. The aim of this study is to evaluate the associations between RF, sHF, and in-hospital mortality in patients with normotensive aPE. Methods: We analyzed data from the Regional PE Registry (REPER), and 1968 patients with CT pulmonary angiography-confirmed aPE who had a systolic blood pressure of 100 mmHg and higher, and for whom creatinine blood levels and left ventricular ejection fraction (LVEF) were measured at admission to hospital were enrolled. The patients were divided into four groups: the first group comprised patients without renal and systolic heart failure, the second those with RF (creatinine clearance less than 60 mL/min), the third those with sHF (LVEF less than 50%), and the fourth those with both RF and sHF. The primary endpoint of this study was in-hospital all-cause mortality. Results: There are significant differences between in-hospital mortality among the groups: 38/1247 (3.0%) vs. 63/514 (12.9%) vs. 10/99 (10.1%) vs. 20/108 (18.5%) (p < 0.001). In the multivariable regression model adjusted for age, right ventricular dysfunction, and troponin levels, the presence of renal failure, sHF, and both were independently associated with in-hospital all-cause mortality with ORs of 3.59 (95%CI 2.04–6.30, p < 0.001) vs. 3.97 (1.71–9.25, p = 0.001) vs. 6.39 (3.15–12.99, p < 0.001), respectively. Conclusions: The association of renal failure and systolic heart failure has a deleterious prognosis in patients with normotensive aPE.

Acute aortic syndrome (AAS), a potentially fatal pathologic process within the aortic wall, should be suspected in patients presenting with severe thoracic pain and hypertension. AAS, including aortic dissection (approximately 90% of cases) and intramural hematoma, may be complicated by poor perfusion, aneurysm, or uncontrollable pain and hypertension. AAS is uncommon (approximately 3.5-6.0 per 100,000 patient-years) but rapid diagnosis is imperative as an emergency surgical procedure is frequently necessary. To systematically review the current evidence on diagnosis and treatment of AAS. Searches of MEDLINE, EMBASE, and the Cochrane Register of Controlled Trials for articles on diagnosis and treatment of AAS from June 1994 to January 29, 2016, were performed. Only clinical trials and prospective observational studies of 10 or more patients were included. Eighty-two studies (2 randomized clinical trials and 80 observational) describing 57,311 patients were reviewed. Chest or back pain was the most commonly reported presenting symptom of AAS (61.6%-84.8%). Patients were typically aged 60 to 70 years, male (50%-81%), and had hypertension (45%-100%). Sensitivities of computerized tomography and magnetic resonance imaging for diagnosis of AAS were 100% and 95% to 100%, respectively. Transesophageal echocardiography was 86% to 100% sensitive, whereas D-dimer was 51.7% to 100% sensitive and 32.8% to 89.2% specific among 6 studies (n = 876). An immediate open surgical procedure is needed for dissection of the ascending aorta, given the high mortality (26%-58%) and proximity to the aortic valve and great vessels (with potential for dissection complications such as tamponade). An RCT comparing endovascular surgical procedure to medical management for uncomplicated AAS in the descending aorta (n = 61) revealed no dissection-related deaths in either group. Endovascular surgical procedure was better than medical treatment (97% vs 43%, P < .001) for the primary end point of "favorable aortic remodeling" (false lumen thrombosis and no aortic dilation or rupture). The remaining evidence on therapies was observational, introducing significant selection bias. Because of the high mortality rate, AAS should be considered and diagnosed promptly in patients presenting with acute chest or back pain and high blood pressure. Computerized tomography, magnetic resonance imaging, and transesophageal echocardiography are reliable tools for diagnosing AAS. Available data suggest that open surgical repair is optimal for treating type A (ascending aorta) AAS, whereas thoracic endovascular aortic repair may be optimal for treating type B (descending aorta) AAS. However, evidence is limited by the paucity of randomized trials.

Behavior of C-reactive protein levels in medically treated aortic dissection and intramural hematoma

Endovascular Treatment of Two Penetrating Ascending Aortic Ulcers: A Case Report

Background and aimsLiver enzymes, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), are markers of hepatic dysfunction and fatty liver disease. Although ALT and AST have been suggested as risk factors for cardiovascular disease, their role as predictors of mortality after acute myocardial infarction (AMI) has not been established. The objective of this study was to investigate the predictive value of ALT and AST for mortality in patients with AMI.MethodsWe analyzed records of 712 patients with AMI and no known liver disease treated at the Department of Cardiovascular Center in the First Hospital of Jilin University. The primary outcome was all-cause in-hospital mortality. Relationships between primary outcome and various risk factors, including serum transaminase levels, were assessed using multivariate logistic regression analysis.ResultsAge (P < 0.001), hypertension (P = 0.034), prior myocardial infarction (P < 0.001), AST (P < 0.001), ALT (P < 0.001), creatinine (P = 0.007), blood urea nitrogen (P = 0.006), and troponin I (P < 0.001) differed significantly between ST-segment elevation myocardial infarction (STEMI) and non-STEMI. The following factors were associated with an increased risk of in-hospital all-cause mortality in patients with AMI: ALT ≥ 2ULN (adjusted odds ratio [AOR] 2.240 [95% confidence interval (CI), 1.331–3.771]; P = 0.002); age ≥ 65 year (AOR 4.320 [95% CI 2.687–6.947]; P < 0.001); increased fasting plasma glucose (FPG) (AOR 2.319 [95% CI 1.564–3.438]; P < 0.001); elevated D-dimer (AOR 2.117 [95% CI 1.407–3.184]; P < 0.001); elevated fibrinogen (AOR 1.601 [95% CI 1.077–2.380]; P = 0.20); and reduced estimated glomerular filtration rate (eGFR) (AOR 2.279 [95% CI 1.519–3.419]; P < 0.001).ConclusionsOur findings demonstrated that elevated ALT was independently associated with increased in-hospital all-cause mortality in patients with AMI. Other risk factors were increased age, FPG, D-dimer, and fibrinogen and decreased eGFR.

Fragmented QRS (fQRS) has been shown to be related to increased cardiovascular mortality and morbidity. However, limited data are available for evaluating the relationship between the number of leads with fQRS and in-hospital all-cause mortality in patients with acute ST segment elevation myocardial infarction (STEMI). The aim of our study is to investigate the prognostic importance of the number of leads with fQRS in acute STEMI patients treated by primary percutaneous coronary intervention (PCI). Two hundred ten eligible patients with acute STEMI that underwent primary PCI were enrolled in this study. Each patient's 12-lead electrocardiography (ECG) taken in the first 48 hours was analyzed and the number of leads with fQRS were recorded. The number derivations with fQRS were significantly higher in patients who developed in-hospital mortality than the patients who did not develop in-hospital mortality (2.6 ± 2.6 vs 0.9 ± 1.3; P = 0.002). Also, patients with ≥3 leads with fQRS had higher rate of in-hospital all-cause mortality (23.5% vs 7.4%, P = 0.009), higher frequency of Q wave (67.6% vs 36.9%, P = 0.001), and higher frequency of fQRS with Q wave (67.6% vs 15.9%, P < 0.001) than those patients with <3 leads with fQRS. By a multivariate regression analysis, the number of leads with fQRS was found to be an independent predictor of in-hospital all-cause mortality (odds ratio: 1.415, 95% confidence interval: 1.049-1.909, P = 0.023). The number of leads with fQRS on 12-lead ECG is an independent predictor of in-hospital all-cause mortality in patients with acute STEMI treated by primary PCI.