Early estimated pulse wave velocity as a prognostic marker in critically ill patients with hemorrhagic stroke: A retrospective analysis of the MIMIC-IV database.

BackgroundThe relationship between the anion gap (AG) level, represented by the time-weighted average AG (TWA-AG), and outcomes of septic shock patients remains unclear. This study aimed to investigate the relationship between TWA-AG and all-cause mortality in septic shock patients.MethodsThis study included septic shock patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Participants were categorized into four quartiles based on their TWA-AG values. The primary outcome was 30-day mortality, and the secondary outcomes were in-hospital and 1-year mortality. Cox regression models, logistic regression models, and restricted cubic spline analyses were conducted to evaluate the relationship between TWA-AG and mortality.ResultsAfter adjustment for all potential confounders, the association of TWA-AG, as a continuous variable, with 30-day mortality remained significant, with an adjusted hazard ratio (HR) of 1.06 (95% confidence interval [CI]: 1.04–1.07, P < 0.001). Compared to the first quartile group, the HR with 95% CI for the second, third, and fourth quartile groups were 1.25 (1.06–1.48), 1.44 (1.22–1.69), and 1.89 (1.58–2.27), respectively. A similar relationship was also found for in-hospital mortality and 1-year mortality. A linear relationship was observed between the TWA-AG and mortality. When TWA-AG was integrated into the conventional disease severity scoring systems, the predictive ability of these systems was significantly enhanced.ConclusionsElevated TWA-AG is independently associated with increased all-cause mortality in septic shock patients. TWA-AG may be a promising prognostic marker for septic shock patients.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12879-025-11329-z.

BackgroundThe estimated pulse wave velocity (ePWV) is a recently developed, simple and useful tool to measure arterial stiffness and to predict long-term cardiovascular mortality. However, the association of ePWV with mortality risk in patients with subarachnoid hemorrhage (SAH) is unclear. Herein, this study aims to assess the potential prediction value of ePWV on short- and long-term mortality of SAH patients.MethodsData of adult patients with no traumatic SAH were extracted from the Medical Information Mart for Intensive Care (MIMIC) III and IV database in this retrospective cohort study. Weighted univariate and multivariable Cox regression analyses were used to explore the associations of ePWV levels with 30-day mortality and 1-year mortality in SAH patients. The evaluation indexes were hazard ratios (HRs) and 95% confidence intervals (CIs). In addition, subgroup analyses of age, the sequential organ failure assessment (SOFA) score, surgery, atrial fibrillation (AF), renal failure (RF), hepatic diseases, chronic obstructive pulmonary disease (COPD), sepsis, hypertension, and diabetes mellitus (DM) were also performed.ResultsAmong 1,481 eligible patients, 339 died within 30 days and 435 died within 1 year. After adjusting for covariates, ePWV ≥ 12.10 was associated with higher risk of both 30-day mortality (HR = 1.77, 95%CI: 1.17–2.67) and 1-year mortality (HR = 1.97, 95%CI: 1.36–2.85), compared to ePWV < 10.12. The receiver operator characteristic (ROC) curves showed that compared to single SOFA score, ePWV combined with SOFA score had a relative superior predictive performance on both 30-day mortality and 1-year mortality, with the area under the curves (AUCs) of 0.740 vs. 0.664 and 0.754 vs. 0.658. This positive relationship between ePWV and mortality risk was also found in age ≥ 65 years old, SOFA score < 2, non-surgery, non-hepatic diseases, non-COPD, non-hypertension, non-DM, and sepsis subgroups.ConclusionBaseline ePWV level may have potential prediction value on short- and long-term mortality in SAH patients. However, the application of ePWV in SAH prognosis needs further clarification.

This study aims to investigated the associations between estimated plasma volume status (ePVS) and 30-day and 1-year mortality in intracerebral hemorrhage (ICH) patients, providing insights into the management in ICH. Data of adult ICH patients were extracted from both the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and the Hospital Information System (HIS) in this retrospective cohort study. Univariate and multivariate Cox regression analyses, and restricted cubic spline plots (RCS) were conducted to explore the associations between ePVS levels and both 30-day and 1-year mortality, with hazard ratios (HR) and 95% confidence intervals (CI) used for evaluation. Subgroup analyses were performed to further investigate these associations. Among 2,512 eligible patients from the MIMIC-IV database, 655 (26.07%) died within 30 days, with 1,254 (49.92%) had died by the 1-year follow-up. After adjusting for covariates, elevated ePVS was independently associated with both 30-day mortality (HR = 1.05, 95%CI: 1.01-1.09) and 1-year mortality (HR = 1.09, 95% CI: 1.06-1.13). Compared to patients with ePVS levels of [4.63-5.79), those with ePVS levels ≥5.79 had a higher risk of 30-day mortality (HR: 1.36, 95%CI: 1.12-1.64) and 1-year mortality (HR = 1.24, 95% CI: 1.08-1.42). Among 515 eligible patients from the HIS, 132 (25.60%) died within 30 days, with 288 (55.90%) mortality observed at 1-year follow-up. After adjusting for covariates, elevated ePVS was independently associated with both 30-day mortality (HR = 1.33, 95%CI: 1.23-1.43) and 1-year mortality (HR = 1.26, 95% CI: 1.18-1.35). Comparing to patients with ePVS levels of [4.63-5.79), those with ePVS levels of ≥5.79 had a higher risk of 30-day mortality (HR:2.21, 95%CI: 1.48-3.30) and 1-year mortality (HR = 2.75, 95% CI: 2.04-3.72). Additionally, subgroup analyses demonstrated that ePVS was significantly associated with 30-day mortality or 1-year mortality derived from MIMIC-IV and HIS in most subgroups (p < 0.05). And RCS analysis indicates that, whether using MIMIC-IV or HIS data, ePVS was linearly associated with 30-day or 1-year mortality. Higher ePVS levels may be a potential risk factor for 30-day and 1-year mortality in ICH patients, suggesting that timely monitoring and stabilization of ePVS could improve prognosis in this population. However, further studies are needed to validate these fingings.

This study evaluated the association and prognostic significance of the systemic inflammation response index (SIRI) with mortality in sepsis. In this cohort study, the sepsis patients were retrieved from the Medical Information Mart for Intensive Care III (MIMIC-III) and MIMIC-IV intensive care unit (ICU) databases. SIRI was calculated by using the neutrophil, monocyte, and lymphocyte counts. The outcomes were 28-day mortality, 1-year mortality, and 28 days to 1-year mortality. The Cox proportional hazards model with a hazard ratio (HR) and a 95% confidence interval (CI) was used to investigate the association and prognostic value of SIRI with mortality in sepsis. Subgroup analyses of the associations of SIRI with 28-day and 1-year mortality in sepsis were based on age, gender, Simplified Acute Physiology Score II (SAPSII), Sequential Organ Failure Assessment (SOFA), and presence or absence of septic shock. The receiver operating characteristic (ROC) curve was used to compare the predictive performances of SIRI, SOFA and SAPS II for mortality in sepsis. Of the 4239 patients included, 1339 patients suffered from 28-day mortality, 2085 patients suffering from 1-year mortality, and 746 (25.72%) suffered from 28 days to 1-year mortality. High SIRI levels exhibited higher risks of 28-day mortality (HR: 1.15, 95% CI: 1.03-1.29, P = .010), 1-year mortality (HR: 1.14, 95% CI: 1.04-1.24, P = .003), and 28 days to 1-year mortality (HR: 1.16, 95% CI: 1.01-1.35, P = .047) in sepsis. A higher SIRI was reported related to 28-day mortality and 1-year mortality in sepsis patients with female gender, with SOFA < 8, with SAPS II < 44, and in sepsis patients without sepsis shock. The AUC of SIRS, SOFA, and SAPS II in predicting 28-day mortality in sepsis were 0.726, 0.591, and 0.644, respectively. The AUC of SIRI in predicting 1-year mortality in sepsis was 0.761, higher than the AUC values of SOFA and SAPS II. A higher AUC value of SIRI compared with SOFA, and SAPS II in predicting 28 days to 1-year mortality was observed. Elevated SIRI was associated with an increased risk of mortality in sepsis. SIRI is an independent prognostic biomarker of mortality in sepsis.

There are currently no specialized risk scoring systems for critically ill patients with coronary heart disease (CHD). Arterial stiffness, as measured by estimated pulse wave velocity (ePWV), has emerged as a potential indicator of mortality or adverse cardiovascular events in individuals with CHD. This study aimed to evaluate the association between ePWV and all-cause mortality among critically ill patients with CHD beyond traditional risk scores. This study included 11 001 participants with CHD from the Medical Information Mart for Intensive Care IV, with a 1-year follow-up. The primary endpoint was 1-year all-cause mortality, and the secondary endpoint was in-hospital mortality. Elevated ePWV was significantly associated with higher risks of in-hospital [odds ratio 1.15, 95% confidence interval (CI) 1.12-1.17, P<0.001] and 1-year (hazard ratio 1.21, 95% CI 1.20-1.23, P<0.001) mortality. These associations remained consistent when adjusted for traditional risk scores and potential confounders. When ePWV was integrated into traditional risk scoring models (Oxford Acute Severity of Illness Score, Sequential Organ Failure Assessment score, Acute Physiology Score III, Systemic Inflammatory Response Syndrome score, Simplified Acute Physiology Score II, and Logistic Organ Dysfunction System score), the predictive accuracy (area under the curve: 64.55-70.56, 64.32-72.51, 72.35-75.80, 55.58-67.68, 71.27-73.53, and 67.24-73.40, P<0.001) and reclassification (net reclassification index: 0.230, 0.268, 0.257, 0.255, 0.221, and 0.254; integrated discrimination improvement: 0.049, 0.072, 0.054, 0.068, 0.037, and 0.061, P<0.001) of these models significantly improved for 1-year mortality. Similar results were also found for in-hospital mortality. Estimated pulse wave velocity is a strong independent predictor of both short- and long-term mortality in critically ill patients with CHD. Importantly, integrating ePWV into traditional risk scores significantly boosts the predictive accuracy for 1-year and in-hospital all-cause mortality.

ObjectiveTo explore the values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), neutrophil to albumin ratio (NAR), prognostic nutritional index (PNI), systemic immune inflammatory index (SII) and red cell distribution width to albumin ratio (RA) for evaluating the risk of 30-day mortality of ischemic stroke or hemorrhagic stroke patients.MethodsIn this cohort study, the data of 1,601 patients diagnosed with stroke were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Among them, 908 were hemorrhagic stroke patients and 693 were ischemic stroke patients. Demographic and clinical variables of patients were collected. Univariate and multivariable Cox regression were performed to evaluate the predictive values of NLR, PLR, SII, NAR, RA, and PNI for 30-day mortality in hemorrhagic stroke or ischemic stroke patients. The receiver operator characteristic (ROC) curves were plotted to assess the predictive values of NLR, NAR, and RA for 30-day mortality of hemorrhagic stroke patients.ResultsAt the end of follow-up, 226 hemorrhagic stroke patients and 216 ischemic stroke patients died. The elevated NLR level was associated with increased risk of 30-day mortality in hemorrhagic stroke [hazard ratio (HR) = 1.17, 95% confidence interval (CI): 1.06–1.29]. The increased NAR level was associated with elevated risk of 30-day mortality in hemorrhagic stroke (HR = 1.16, 95% CI: 1.02–1.30). The high RA level was linked with increased risk of 30-day mortality (HR = 1.44, 95% CI: 1.23–1.69). No significant correlation was observed in these inflammation biomarkers with the risk of 30-day mortality in ischemic stroke patients. The area under the curves (AUCs) of NLR, RA, and NAR for evaluating the risk of 30-day mortality of hemorrhagic stroke patients were 0.552 (95% CI: 0.503–0.601), 0.644 (95% CI: 0.590–0.699) and 0.541 (95% CI: 0.490–0.592).ConclusionNLR, NAR, and RA were potential prognostic biomarkers for predicting 30-day mortality of hemorrhagic stroke patients, which might provide clinicians an easy and cheap way to quickly identify patients with high risk of mortality.

PurposeAnion gap (AG) is a valuable and easily obtained clinical tool for differentially diagnosis of acid-base disorders. Current understanding of the prognostic impact of AG on mortality after acute myocardial infarction (AMI) is limited. We aimed to investigate whether AG is a predictor of short-term and long-term all-cause mortality after AMI.Patients and MethodsWe examined 1806 patients diagnosed with AMI in intensive care unit from the Medical Information Mart for Intensive Care III (MIMIC-III) database. We analyzed the association of AG with 30-day, 180-day and 1-year all-cause mortality on a continuous scale and in categories, using multivariable Cox regression. We utilized restricted cubic splines to evaluate the linearity between hazard ratio (HR) and AG concentrations.ResultsAG was associated with a higher risk of 30-day, 180-day and 1-year all-cause mortality, with adjusted HRs of 1.083 (95% CI 1.051 to 1.117), 1.077 (95% CI 1.049 to 1.105), and 1.074 (95% CI 1.047 to 1.101), respectively. The results were consistent in subgroup analyses. The association between AG and all-cause mortality was linear for 180-day and 1-year mortality, and near linear for 30-day mortality, as higher concentrations were associated with high all-cause mortality. When stratified according to quartiles, AG was associated with 30-day mortality (HR[95% CI]: second quartile, 2.243[1.273, 3.955]; third quartile, 3.026[1.763, 5.194]; top quartile, 4.402[2.573, 7.531]), 180-day mortality (HR[95% CI]: second quartile, 1.719[1.118, 2.645]; third quartile, 2.362[1.575, 3.542]; top quartile, 3.116[2.077, 4.676]), and 1-year mortality (HR[95% CI]: second quartile, 1.700[1.143, 2.528]; third quartile, 2.239[1.536, 3.264]; top quartile, 2.876[1.969, 4.201]) using bottom quartile as reference.ConclusionWe firstly demonstrated that higher AG was significantly associated with increased 30-day, 180-day and 1-year all-cause mortality in AMI patients. AG as an easily obtained marker is of strong and reliable predictive value for AMI mortality during follow-up.

Background This study compared eight scoring systems for predicting 28-day and 1-year all-cause mortality in critically ill patients with acute pancreatitis (AP). Methods Data from the Medical Information Mart for Intensive Care IV were used to conduct a comparative analysis of several predictive scoring systems. Predictive performance for 28-day and 1-year mortality was assessed using receiver operating characteristic (ROC) curves (area under the curve [AUC]), restricted cubic splines (RCS) for nonlinearity testing, and multivariable logistic regression for independent predictor analysis. Results A total of 694 patients were included (28-day mortality: 15.56%; 1-year mortality: 24.78%). Acute Physiology Score III (APSIII) demonstrated the highest accuracy for 28-day mortality (AUC: 0.847, 95% confidence interval (CI): 0.808–0.886), followed by Bedside Index for Severity in Acute Pancreatitis (BISAP) (AUC: 0.835, 95% CI: 0.794–0.875). Linear relationships between scores and 28-day mortality were confirmed (all p for nonlinear > 0.05). Multivariable regression identified APSIII and BISAP as independent 28-day mortality predictors. For 1-year mortality, APSIII, BISAP, and Simplified Acute Physiology Score II (SAPS II) were independent predictors. Conclusions Both APSIII and BISAP were identified as independent predictors of 28-day mortality, while APSIII, BISAP, and SAPSII were associated with 1-year mortality. Among them, APSIII showed the best overall discriminative ability for both short- and long-term outcomes. However, BISAP remains an attractive alternative for its simplicity and comparable performance.

BackgroundThis study aimed to examine whether aspirin reduces mortality in patients with sepsis-induced coagulopathy (SIC).MethodsIn this retrospective cohort study, 1,194 patients with SIC were identified from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The primary outcome was 28-day all-cause mortality. Secondary outcomes included 90-day and 1-year all-cause mortality, as well as length of stay in the intensive care unit (ICU). Missing data were handled using multiple imputation, and baseline differences between groups were adjusted through propensity score matching (PSM). The association between aspirin therapy and mortality in SIC patients was evaluated using both univariate and multivariate Cox proportional hazards models. Additionally, subgroup analyses were performed to investigate the effect of aspirin across different populations and to assess the impact of aspirin dosage on clinical outcomes. External validation was subsequently conducted to confirm the robustness of the findings.ResultsAfter PSM, 280 aspirin-treated patients were matched with 280 non-aspirin patients. Aspirin use was associated with significantly lower 28-day mortality (11.8% vs. 29.3%, p < 0.001), 90-day mortality (16.8% vs. 33.6%, p < 0.001), and 1-year mortality (22.1% vs. 42.1%, p < 0.001), as well as a shorter median ICU stay (2.19 vs. 3.14 days, p < 0.001) among patients with SIC. Multivariate Cox regression further confirmed the protective effect of aspirin on 28-day (hazard ratio [HR]: 0.45, 95% confidence interval [CI]: 0.29–0.7), 90-day (HR: 0.55, 95% CI: 0.37–0.81), and 1-year mortality (HR: 0.59, 95% CI: 0.42–0.83). Additionally, when comparing the efficacy of low-versus high-dose aspirin therapy, the low-dose group demonstrated significantly lower 28-day, 90-day, and 1-year mortality rates. External validation further supported these findings, showing reduced 28-day mortality (15.3% vs. 35.9%, p = 0.01) and improved overall survival (p = 0.0037) in the aspirin-treated group.ConclusionAspirin use was associated with reduced 28-day, 90-day, and 1-year mortality, as well as a shorter ICU stay in patients with SIC. These findings were confirmed through external validation.

It has been demonstrated that lactate/albumin (L/A) ratio is substantially relevant to the prognosis of sepsis, septic shock, and heart failure. However, there is still debate regarding the connection between the L/A ratio and severe acute myocardial infarction (AMI). The aim of this study is to determine the prognostic role of L/A ratio in patients with severe AMI. Our retrospective study extracted data from the Medical Information Mart for Intensive Care III (MIMIC-III) database, included 1,134 patients diagnosed with AMI. Based on the tertiles of L/A ratio, the patients were divided into three groups: Tertile1 (T1) group (L/A ratio<0.4063, n=379), Tertile2 (T2) group (0.4063≤L/A ratio≤0.6667, n =379), and Tertile3 (T3) group (L/A ratio>0.6667, n =376). Uni- and multivariate COX regression model were used to analyze the relationship between L/A ratio and 14-day, 28-day and 90-day all-cause mortality. Meanwhile, the restricted cubic spline (RCS) model was used to evaluate the effect of L/A ratio as a continuous variable. Higher mortality was observed in AMI patients with higher L/A ratio. Multivariate Cox proportional risk model validated the independent association of L/A ratio with 14-day all-cause mortality [hazard ratio (HR) 1.813, 95% confidence interval (CI) 1.041-3.156 (T3 vs T1 group)], 28-day all-cause mortality [HR 1.725, 95% CI 1.035-2.874 (T2 vs T1 group), HR 1.991, 95% CI 1.214-3.266 (T3 vs T1 group)], as well as 90-day all-cause mortality [HR 1.934, 95% CI 1.176-3.183 (T2 vs T1 group), HR 2.307, 95% CI 1.426-3.733 (T3 vs T1 group)]. There was a consistent trend in subgroup analysis. The Kaplan-Meier (K-M) survival curves indicated that patients with L/A ratio>0.6667 had the highest mortality. Even after adjusting the confounding factors, RCS curves revealed a nearly linearity between L/A ratio and 14-day, 28-day and 90-day all-cause mortality. Meanwhile, the areas under the receiver operating characteristic (ROC) curve (AUC) of 14-day, 28-day and 90-day all-cause mortality were 0.730, 0.725 and 0.730, respectively. L/A ratio was significantly associated with 14-day, 28-day and 90-day all-cause mortality in critical patients with AMI. Higher L/A ratio will be considered an independent risk factor for higher mortality in AMI patients.

Non-traumatic subarachnoid hemorrhage (SAH), primarily due to the rupture of intracranial aneurysms, contributes significantly to the global stroke population. A novel biomarker, pan-immune-inflammation value (PIV) or called the aggregate index of systemic inflammation (AISI), linked to progression-free survival and overall survival in non-small-cell lung cancer and mortality in Coronavirus Disease 2019 (COVID-19) patients, has surfaced recently. Its role in non-traumatic SAH patients, however, remains under-researched. This study aims to determine the relationship between PIV and all-cause mortality in non-traumatic SAH patients. A retrospective analysis was conducted using data from the Medical Information Mart for Intensive Care (MIMIC-IV) database to examine the association between PIV and all-cause mortality in critically ill patients with non-traumatic SAH. PIV measurements were collected at Intensive Care Unit (ICU) admission, and several mortality measures were examined. To control for potential confounding effects, a 1:1 propensity score matching (PSM) method was applied. The optimal PIV cutoff value was identified as 1362.45 using X-tile software that is often used to calculate the optimal cut-off values in survival analysis and continuous data of medical or epidemiological research. The relationship between PIV and short- and long-term all-cause mortality was analyzed using a multivariate Cox proportional hazard regression model and Kaplan-Meier (K-M) survival curve analysis. Interaction and subgroup analyses were also carried out. The study included 774 non-traumatic SAH patients. After PSM, 241 pairs of score-matched patients were generated. The Cox proportional hazard model, adjusted for potential confounders, found a high PIV (≥ 1362.45) independently associated with 90-day all-cause mortality both pre- (hazard ratio [HR]: 1.67; 95% confidence intervals (CI): 1.05-2.65; P = 0.030) and post-PSM (HR: 1.58; 95% CI: 1.14-2.67; P = 0.042). K-M survival curves revealed lower 90-day survival rates in patients with PIV ≥ 1362.45 before (31.1% vs. 16.1%%, P < 0.001) and after PSM (68.9% vs. 80.9%, P < 0.001). Similarly, elevated PIV were associated with increased risk of ICU (pre-PSM: HR: 2.10; 95% CI: 1.12-3.95; P = 0.02; post-PSM: HR: 2.33; 95% CI: 1.11-4.91; P = 0.016), in-hospital (pre-PSM: HR: 1.91; 95% CI: 1.12-3.26; P = 0.018; post-PSM: 2.06; 95% CI: 1.10-3.84; P = 0.034), 30-day (pre-PSM: HR: 1.69; 95% CI: 1.01-2.82; P = 0.045; post-PSM: 1.66; 95% CI: 1.11-2.97; P = 0.047), and 1-year (pre-PSM: HR: 1.58; 95% CI: 1.04-2.40; P = 0.032; post-PSM: 1.56; 95% CI: 1.10-2.53; P = 0.044) all-cause mortality. The K-M survival curves confirmed lower survival rates in patients with higher PIV both pre- and post PSM for ICU (pre-PSM: 18.3% vs. 8.4%, P < 0.001; post-PSM:81.7 vs. 91.3%, P < 0.001), in-hospital (pre-PSM: 25.3% vs. 12.8%, P < 0.001; post-PSM: 75.1 vs. 88.0%, P < 0.001), 30-day (pre-PSM: 24.9% vs. 11.4%, P < 0.001; post-PSM:74.7 vs. 86.3%, P < 0.001), and 1-year (pre-PSM: 36.9% vs. 20.8%, P < 0.001; P = 0.02; post-PSM: 63.1 vs. 75.1%, P < 0.001) all-cause mortality. Stratified analyses indicated that the relationship between PIV and all-cause mortality varied across different subgroups. In critically ill patients suffering from non-traumatic SAH, an elevated PIV upon admission correlated with a rise in all-cause mortality at various stages, including ICU, in-hospital, the 30-day, 90-day, and 1-year mortality, solidifying its position as an independent mortality risk determinant. This study represents an attempt to bridge the current knowledge gap and to provide a more nuanced understanding of the role of inflammation-based biomarkers in non-traumatic SAH. Nevertheless, to endorse the predictive value of PIV for prognosticating outcomes in non-traumatic SAH patients, additional prospective case-control studies are deemed necessary.

Statins, acknowledged for their ability to reduce cardiovascular risk, demonstrate a variety of pleiotropic effects, including anti-inflammatory, antithrombotic, endothelial stabilizing activity and prevention of acute kidney injury (AKI) post cardiac surgery. Patients in the intensive care unit (ICU) face heightened risks of cardiovascular disease, infections, and thrombotic complications, but the effect of statin therapy on ICU mortality remains controversial. The Medical Information Mart for Intensive Care IV (MIMIC-IV) database is a publicly available intensive care medicine information database that includes data on critically ill patients admitted to the ICU at Beth Israel Deaconess Medical Center from 2008 to 2019, with a large sample size. In this retrospective cohort study, the MIMIC-IV database was used to clarify the association between statin therapy and all-cause mortality in critically ill patients. An additional aim was to compare the effect of different statin types on mortality. Patients aged 18 years or older, with first-time admissions and complete data, were categorized based on their use of statins during their ICU stay. The primary outcome was 28-day mortality, analyzed through multivariable Cox regression and expressed as adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). The relationship between statin therapy and 28-day mortality in ICU patients was estimated using propensity score matching (PSM) and multivariable analysis to adjust for covariates. Among the 50,624 enrolled patients, 30.9% were treated with statins. Compared to patients not receiving statin therapy, those on statins were older, had a higher proportion of males (62.0% vs. 53.1%), a greater percentage with health insurance (50.2% vs. 39.5%), and a higher rate of concurrent aspirin use (70.8% vs. 18.2%). In terms of comorbidities, patients in the statin group had higher proportions of congestive heart failure (CHF), AKI, myocardial infarction, and chronic obstructive pulmonary disease (COPD). Statin treatment in patients in the ICU was correlated with reduced 28-day all-cause mortality in the multivariate Cox analysis (statins: HR =0.66, 95% CI: 0.61-0.70; atorvastatin: HR =0.71, 95% CI: 0.66-0.78; rosuvastatin: HR =0.57, 95% CI: 0.45-0.72; simvastatin: HR =0.54, 95% CI: 0.48-0.62; other statins: HR =0.68, 95% CI: 0.56-0.83). PSM confirmed these findings (statins: HR =0.69, 95% CI: 0.63-0.75). Statin use may correlate with a decreased risk of 28-day mortality in patients in the ICU, with simvastatin showing a more pronounced effect. The robustness of these findings remain unaffected in the subgroup analyses, sensitivity analyses, and PSM, indicating potential clinical significance. The high mortality rate among ICU patients means that any method capable of reducing mortality could have significant implications for ICU treatment.

Hemorrhagic stroke (HS) is a life-threatening condition with high mortality, particularly in intensive care unit (ICU) settings. The serum creatinine-to-albumin ratio (CAR) has emerged as a novel biomarker integrating renal dysfunction and systemic inflammation, but its prognostic value in HS remains underexplored. This retrospective cohort study analyzed data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. We included 1,046 adult ICU patients with HS (intracerebral or subarachnoid hemorrhage) and stratified them by CAR quartiles. The primary outcome was 28-day all-cause mortality (ACM). Multivariable Cox regression models adjusted for age, Glasgow Coma Scale (GCS) score, and comorbidities were used to assess associations. Predictive performance was evaluated using receiver operating characteristic (ROC) curves and restricted cubic spline (RCS) analysis. The 28-day mortality increased significantly across CAR quartiles (Q1-Q4: 21.8%, 19.1%, 36.0%, and 40.8%, respectively;Pfor trend < 0.001). In the fully adjusted model (Model 3), patients in the highest CAR quartile (Q4) had a 2.30-fold higher mortality risk (95% CI: 1.58-3.35;P < 0.001) compared to Q1. CAR demonstrated significantly higher discriminative ability (AUC = 0.612, 95% CI: 0.574-0.650) compared to isolated creatinine (AUC = 0.568) or albumin (AUC = 0.371) measurements (P < 0.01). RCS analysis revealed a nonlinear relationship, with CAR > 0.25 marking a critical threshold for increased mortality risk. CAR is an independent predictor of 28-day mortality in critically ill patients with HS, outperforming traditional single biomarkers. Its clinical accessibility and robust prognostic performance suggest potential utility for early risk stratification and personalized treatment strategies in HS management.

Neutrophil-to-lymphocyte ratio (NLR) has been presented as a possible indicator associated with the outcomes of growing patients and an available predictor of inflammation. Nevertheless, just a handful of researches shed light on the association between NLR and the consequences of critical patients with coronary artery disease (CAD). The study aimed to investigate the correlation between NLR and all-cause mortality of short-term and long-term in patients with CAD. We obtained objective data from the Medical Information Mart for Intensive Care (MIMIC)-IV version 2.2, a comprehensive and large-scale single-center database. NLR was calculated separately. Patients were categorized by quartiles of NLR: Q1 group (NLR < 3.56), Q2 (NLR 3.56-5.54), Q3 group (NLR 5.54-9.05), Q4 group (NLR > 9.05). Kaplan-Meier survival curves based on NLR quartiles were created to compare all-cause mortality rates, and the log-rank test evaluated the differences between groups. The hazard ratio (HR) of NLR as a risk factor for outcome events was assessed using the Cox proportional risk model with the Q1 group serving as the reference group and restricted cubic spline (RCS) with the infection points of 5.54. A total of 3,692 patients were included in this study. The 30-day mortality rate among the patients was 8.85%, while the 365-day mortality rate was 16.98%. High NLR (NLR > 5.54) was significantly associated with 30-day mortality [HR, 3.99,95% confident interval (CI), (3.03-5.24); P < 0.001] and 365-day mortality [HR, 5.72, 95% CI (3.83-8.54); P < 0.001] in patients with critical CAD in the completely adjusted Cox proportional risk model. RCS analysis revealed a U-shaped relationship between NLR and outcome events. In patients diagnosed with critical CAD, a significant correlation was observed between NLR and all-cause mortality, particularly among individuals exhibiting elevated NLR levels. These findings suggest that NLR may serve as a valuable prognostic marker for evaluating both short-term and long-term mortality risk in this patient population.

BackgroundThe objective of this study was to evaluate the association between red cell distribution width/platelet ratio (RPR) and 30-day and 1-year mortality in acute ischemic stroke (AIS).MethodsData for the retrospective cohort study were collected from the Medical Information Mart for Intensive Care (MIMIC) III database. RPR was divided into two groups: RPR ≤ 0.11 and RPR > 0.11. The study outcomes were 30-day mortality and 1-year mortality from AIS. Cox proportional hazard models were utilized to assess the association between RPR and mortality. Subgroup analyses were applied based on age, tissue-type plasminogen activator (IV-tPA), endovascular treatment, and myocardial infarction.ResultsA total of 1,358 patients were included in the study. Short- and long-term mortality occurred in 375 (27.61%) and 560 (41.24%) AIS patients, respectively. A high RPR was significantly associated with increased 30-day [hazard ratio (HR): 1.45, 95% confidence interval (CI): 1.10 to 1.92, P = 0.009] and 1-year mortality (HR: 1.54, 95%CI: 1.23 to 1.93, P < 0.001) in AIS patients. Meanwhile, RPR was found to be significantly related to 30-day mortality in AIS patients aged < 65 years (HR: 2.19, 95% CI: 1.17 to 4.10, P = 0.014), without IV-tPA use (HR: 1.42, 95% CI: 1.05 to 1.90, P = 0.021), without using endovascular treatment (HR: 1.45, 95% CI: 1.08 to 1.94, P = 0.012), and without myocardial infarction (HR: 1.54, 95% CI: 1.13 to 2.10, P = 0.006). Additionally, RPR was associated with 1-year mortality in AIS patients aged < 65 years (HR: 2.54, 95% CI: 1.56 to 4.14, P < 0.001), aged ≥ 65 years (HR: 1.38, 95% CI: 1.06 to 1.19, P = 0.015), with (HR: 1.46, 95% CI: 1.15 to 1.85, P = 0.002) and without using IV-tPA (HR: 2.30, 95% CI: 1.03 to 5.11, P = 0.041), without using endovascular treatment (HR: 1.56, 95% CI: 1.23 to 1.96, P < 0.001), and without myocardial infarction (HR: 1.68, 95% CI: 1.31 to 2.15, P < 0.001).ConclusionElevated RPR is associated with a high risk of short-term and long-term mortality in AIS.