1-year Mortality Rates Research Articles

Association between lactate dehydrogenase levels and all-cause mortality in ICU patients with heart failure: a retrospective analysis of the MIMIC-IV database

BackgroundHeart failure (HF) patients admitted to the intensive care unit (ICU) often face high short-term mortality rates. This study aims to investigate the relationship between lactate dehydrogenase (LDH) levels and all-cause mortality in critically ill patients with HF.MethodsData from the MIMIC-IV database were extracted for subjects eligible for HF diagnosis. We utilized the restricted cubic spline (RCS) method, Kaplan-Meier (K-M) survival curves, and Cox regression analysis to assess the association between lactate dehydrogenase (LDH) levels and all-cause mortality in HF patients. Overlap weighting (OW) and subgroup analysis were employed to enhance the robustness and reliability of the study.ResultsA total of 3,065 subjects were enrolled in this study. RCS analysis revealed a nonlinear relationship between LDH levels and the risk of all-cause mortality in critically ill patients with HF, with a hazard ratio (HR) > 1 when LDH exceeded 315 U/L. The K-M survival curve indicated lower survival rates and shorter survival times in subjects with LDH ≥ 315 U/L. Elevated LDH levels were independently associated with increased in-hospital and 1-year mortality rates, with adjusted HR of 1.39 (95% CI: 1.16, 1.67) and 1.29 (95% CI: 1.14, 1.45), respectively. The results remained consistently robust in the OW analyses.ConclusionsElevated LDH levels were significantly associated with an increased risk of all-cause mortality in ICU-admitted HF patients. Further randomized trials are needed to confirm this association.

Epidemiology, treatment, and mortality of femoral neck fractures in patients over the age of 65 years: a nationwide retrospective cohort study of 83,789 cases in Turkey.

A population-based study delineating the epidemiologic, clinical, and treatment characteristics of femoral neck fractures (FNFs) in elderly patients has not yet been conducted in Turkey. In this nationwide study, the epidemiologic, clinical, and treatment characteristics of patients aged ⩾65 years with FNFs who underwent osteosynthesis, hemiarthroplasty (HA), or total hip arthroplasty (THA) were examined. Patients aged ⩾65 years with FNFs were identified in this retrospective, nationwide study. Then, the patients who underwent osteosynthesis or total/hemiarthroplasty from 2016 to 2021 were included. All the outcome variables were collected from patient medical records stored in the e-health database of the Republic of Turkey Ministry of Health. A total of 83,789 FNFs treated surgically were analysed. Osteosynthesis was performed on 21,130 FNFs (25.2%), HA on 56,378 FNFs (67.3%), and THA on 6281 FNFs (7.5%). From 2016 to 2021, the overall revision rates for THA and HA were 14.6% (914/5367 patients) and 5.9% (3301/53,077 patients), respectively. The rate of revision prosthetic surgery was significantly higher after THA than after HA (p < 0.001). Mortality rates at 1 year were 25% (n = 5293) for osteosynthesis, 14.7% (n = 924) for THA, and 71.1% (n = 40,109) for HA (p = 0.001). The multivariate model of 1-year postoperative mortality revealed 7 independent predictors: male sex (odds ratio [OR] 1.694; 95% confidence interval [CI], 1.640-1.751), use of a cemented femoral stem (OR 1.182; 95% CI, 1.117-1.250), acute myocardial infarction (AMI) (OR 1.317; 95% CI, 1.240-1.400), cerebrovascular accident (CVA) (OR 1.379; 95% CI, 1.333-1.425), chronic liver disease (CLD) (OR 2.188; 95% CI, 1.802-2.489), diabetes mellitus (DM) (OR, 1.160; 95% CI, 1.122-1.200), and age >81.50 years (OR 2.654; 95% CI, 2.569-2.742). Our study suggested that a hemiarthroplasty is the most common treatment modality for FNF followed by osteosynthesis (25.2%) and THA (7.5%) in Turkey. Revision rates after THA for FNF are concerning. The 1-year mortality rates are highest after HA, followed by osteosynthesis and THA. Male sex, cemented fixation, CVA, CLD, liver failure, DM, and age >81.50 are the independent predictive factors for postoperative 1-year mortality in this specific group of patients.

Expiration-Triggered Sinus Arrhythmia Predicts Mortality Risk in the General Elderly Population

Reduced respiratory sinus arrhythmia, quantified as expiration-triggered sinus arrhythmia (ETA) from simultaneous electrocardiogram and respiration recordings, is a strong long-term mortality predictor in myocardial infarction survivors. Here, we investigated whether ETA also predicts mortality risk in the general elderly population. ETA was quantified from 30-min electrocardiogram and respiration recordings in 1788 general population subjects aged ≥60 years, who were then followed for a median of 4.0 years (median age 72 years, 58% female). Four-year all-cause mortality was 4.6%. Abnormal ETA using a predefined cutoff (≤0.19 ms) was associated with a 4-year mortality of 6.9%, compared to 3.7% in the remaining participants (p = 0.0022). ETA remained a significant mortality predictor in multivariable Cox analysis, also considering a modified Framingham score incorporating sex, age, smoking, cholesterol, blood pressure, antihypertensive medication, family history, diabetes and clinical atherosclerosis (multivariable hazard ratio 1.81; 95% confidence interval 1.17–2.81; p = 0.008). Combined risk prediction by ETA (using an optimized cutoff of ≤0.86 ms) and the Framingham score stratified patients into a low-risk (both parameters normal), an intermediate-risk (one parameter abnormal) and a high-risk group (both parameters abnormal), with 4-year mortality rates of 1.9%, 4.4% and 10.1%, respectively. We conclude that in elderly general population subjects, ETA is a mortality risk predictor that complements classical clinical risk stratification.

Association of Chronic Obstructive Pulmonary Disease and Mortality following Thoracic and Complex Endovascular Aortic Repair.

This study assessed the association between chronic obstructive pulmonary disease (COPD) severity and postoperative mortality among patients undergoing thoracic endovascular aortic repair (TEVAR) and complex endovascular aortic repair (CEVAR). A retrospective review of the Vascular Quality Initiative database identified elective TEVAR and CEVAR cases from 2013-2022 with endograft proximal landing zone ≥2 for thoracic or complex abdominal aortic disease. Symptomatic disease, ruptures, and urgent/emergent surgeries were excluded. Patients were stratified by COPD severity. The primary outcome was in-hospital mortality. Secondary outcomes included respiratory complications and 1-year mortality. Multivariable logistic regression was used for in-hospital mortality, respiratory complications, and 1-year mortality. Among 11,336 patients with TEVAR and CEVAR, 66% did not have COPD, 9% had COPD not on medications, 20% had COPD on medications, and 6% had COPD on home supplemental oxygen. In-hospital mortality was 2.3%, 3.7%, 3.2%, and 4.5% (P=.0004) respectively, and was not associated with increased odds of mortality. Respiratory complications occurred in 4.3%, 4.5%, 6.4%, and 7.3% (P<.0001) and was associated with increased odds for COPD on medications (OR 1.3) and COPD on home supplemental oxygen (OR 1.7). 1-year survival was 91%, 87%, 86%, and 80% and associated with increased risk for each COPD group (HR 1.4, HR 1.4, HR 1.9). Patients with COPD undergoing TEVAR and CEVAR, have increased rates of in-hospital mortality, respiratory complications, and 1-year mortality. COPD severity is independently associated with increased respiratory complications and 1-year mortality, which should be factored into preoperative decision making.

Impact of Body Mass Index on the Initial Phase of a Minimally Invasive Aortic Valve Program.

In obese patients, minimally invasive surgical aortic valve replacement (MIS-AVR) presents challenges, and the risk of patient-prosthesis mismatch (PPM) is elevated. This retrospective single-center study evaluates the impact of body mass index (BMI) on the outcome of an initial MIS-AVR program. A total of 307 patients underwent MIS-AVR between January 2013 and December 2015, the initial phase of our MIS-AVR program. They were divided into normal/overweight (BMI <30 kg/m2) versus obese patients (BMI ≥30 kg/m2). Primary endpoints included 30-day and 2-year mortality and stroke. Secondary endpoints comprised type 3 bleeding, PPM, paravalvular leakage, wound healing disorders (WHDs), and pacemaker rates. In all 191 patients exhibited a BMI <30 kg/m2, while 116 patients had a BMI ≥30 kg/m2. The BMI groups did not differ in baseline characteristics, excepting a higher peripheral arterial disease incidence among obese patients (15.7% vs. 26.7%; p = 0.01). Aortic clamp time (75 ± 29 min vs. 87 ± 37 min; p = 0.001), cardiopulmonary bypass (104 ± 36 min vs. 124 ± 56 min; p = 0.0002), and ventilation times (26 ± 6 h vs. 44 ± 8 h; p = 0.03) were longer in obese patients. They demonstrated a higher risk for bleeding (2.6% vs. 9.5%; p = 0.008) but lower pacemaker rates (9% vs. 3%; p = 0.02). PPM, paravalvular leakage, and WHD exhibited no group differences. No BMI-related differences revealed in 30-day mortality (4.7% vs. 3.4%) and stroke rates (2% vs. 2.6%), as well as 2-year mortality (12.6% vs. 11.2%) and stroke rates (2.1% vs. 2.6%). In the initial phase of an MIS-AVR program, the 30-day mortality may be elevated. Despite longer operative times and an increased risk for bleeding in obese patients, no influence of BMI on postoperative morbidity, mortality, or stroke rates was observed.

Comparative study of HoLEP in elderly patients with indwelling catheters: a retrospective dual-center study.

This study aimed to evaluate the safety and efficacy of HoLEP in patients aged > 85 years with indwelling catheter (IDC). We retrospectively analyzed our bicentric HoLEP database to identify consecutive patients with IDC and trial without catheter (TWOC) failure who underwent surgery between June 2012 and April 2020. Our primary focus was on the population over 85 years of age; Patients under 70 years of age were used as controls. We evaluated the rate of postoperative spontaneous micturition, adverse events and mortality, as well as catheterization duration, hospital stay, and rate of urinary incontinence. In total, 144 patients were included, with 71 (49.3%) and 73 (50.8%) in the ≥ 85 and control group, respectively. The median [IQR] prostatic volume and Charlson score was 90 [70-130] vs. 90 [65-120] mL and 6 [5-7] vs. 3 [2-4] in the ≥ 85 and control groups, respectively. Postoperatively, the rates of major complications (2% vs. 3%) and transfusion (11% vs. 9%) were not significantly different. The median length of stay (2 [1-3] vs. 1 [1-2]; p = 0.03) and rate of TWOC failure during hospitalization (24% vs. 5%, p < 0.001) were significantly higher in the ≥ 85 group. At 3 months and one year follow-up visits, 0 and 10 patients (14.1%) in the ≥ 85 group and 0 and 2 patients (3%) in the control group died, respectively. One year after surgery, 69 (97%) and 73 (100%) (p = 0.2) patients in the ≥ 85 and control groups, respectively, could void spontaneously. HoLEP is a safe and effective procedure for elderly patients with indwelling catheters. At one year, 97% of patients achieved spontaneous voiding, while the urinary incontinence rate was 11%. The 1-year mortality rate was 14%, comparable to that of the general male population of the same age.

Identification of the Skip Phenomenon Among Patients With Staphylococcus lugdunensis Infective Endocarditis: A Retrospective Review.

The skip phenomenon (SP) is a pattern where blood cultures are intermittently positive before final clearance. We report that one-third of patients with Staphylococcus lugdunensis infective endocarditis experienced the SP. Patients with the SP experienced both a longer duration of bacteremia and hospital stay, with a higher 1-year mortality rate.

Outcomes After Standardized Burr-Hole Surgery for Chronic Subdural Hematomas: A Population-Based Consecutive Cohort Study of 2655 Patients.

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. However, current evidence on postoperative outcomes exhibits variability due to small sample sizes, nonstandardized outcome assessment, and variations in surgical techniques. The aim of this study was to overcome these limitations by assessing standardized outcome measures after surgical intervention for CSDH at a high-volume population-based center favoring a uniform burr-hole craniotomy (BHC) approach. Adult patients (≥15 years) who underwent surgical treatment of a CSDH at the Karolinska University Hospital from 2006 to 2022 were retrospectively included. Outcome measures included 6-month ipsilateral hematoma reoperation, postoperative complications categorized by the Landriel-Ibanez grading system, neurological function, and mortality. Predictors of outcomes were assessed using multivariable logistic regression models. In total, 2655 patients were included, with 2407 evacuated using BHC and 248 requiring a minicraniotomy. Reoperation for a hematoma recurrence occurred in 11%. Independent predictors of reoperation were male sex, diabetes, preoperative antithrombotic therapy, midline shift, and bilateral surgery. Postoperative complications occurred in 11% of cases, with 3.9% classified as moderate to severe. A complication leading to death was reported in 22 patients (0.8%). The most common postoperative complications were urinary tract infections (1.5%), subdural empyema (1.4%), and seizures (0.7%). Independent predictors of moderate-to-severe complications were higher preoperative Charlson Comorbidity Index and lower Glasgow Coma Scale score. The 1-year postoperative mortality rate was 12%. This study provided standardized outcome measures in a large cohort of patients treated for CSDH at a center where BHC was consistently used. Most postoperative complications were mild and either did not require intervention or were managed with pharmacological treatment. The identified predictors of CSDH reoperation and moderate-to-severe postoperative complications offer considerations for clinical management and patient care.

Outcome of critically ill patients receiving systemic chemotherapy on the intensive care unit.

Analyze the outcomes of critically ill patients who developed new-onset organ dysfunction and received systemic chemotherapy during their ICU stay. Retrospective cohort study. A tertiary medical center in Germany with an Intensive Care Medicine department consists of 11 intensive care units comprising 140 beds, serving all subspecialties of adult intensive care medicine. 167 patients receiving systemic oncological treatment from January 1st, 2015 to December 31st, 2021, with a data cut-off on December 31st, 2022. None. A total of 167 patients were included. The primary reasons for ICU admission were respiratory failure and shock/sepsis, each accounting for 34% of cases, while complications associated with oncological therapy accounted for less than 8%. The median age of hematological patients (n = 129) was 62 years (IQR 50-70), and for solid tumor patients (n = 38), it was 60 years (IQR 52-65). Predominant disease entities included lymphoma (43%) and acute myeloid leukemia (29%) among hematological patients, and lung cancer (47%) and gastrointestinal malignancies (17%) among solid tumor patients. Hematological patients had a significantly higher median Simplified Acute Physiology Score II (47 vs. 39 points; p=0.013), a higher need for invasive mechanical ventilation (59% vs. 50%; p=0.3), renal replacement therapy (54% vs. 24%; p < 0.001), and a higher 1-year mortality rate (64% vs. 53%; p=0.2) compared to solid tumor patients. The hazard ratio for 1 year survival for male sex was 2.34 (1.31-3.49), for mechanical ventilation 2.01 (1.33-3.04), for vasopressor therapy 1.98 (1.27-3.10), and for renal replacement therapy 1.51 (1.03-2.23), respectively. Administering intravenous chemotherapy in an ICU setting remains challenging, and the experience to establish an indication for systemic chemotherapy is still challenging. However, the study demonstrates that, after careful interdisciplinary decision-making, a substantial number of patients can benefit from it.

Pre-infection anticoagulant exposure and SARS-CoV-2 infection outcomes - Differential mortality by age.

The risk of thrombosis increases after SARS-CoV-2 infection. This study aimed to assess associations between pre-infection anticoagulant exposure and SARS-CoV-2 infection-related outcomes in a population-based cohort. Members of the "Meuhedet" health maintenance organization aged >45years who tested positive for SARS-CoV-2 infection (03/2020-04/2022) were followed. Pre-infection anticoagulant exposure (PAE) was defined as any anticoagulant therapy prescribed ≥1month prior to SARS-CoV-2 testing. Univariate analyses, multivariable models adjusting for confounders, propensity-score matching, and an age-stratified analysis were performed to assess associations between PAE and hospitalization, intensive care unit (ICU) admission, 30-day and one-year mortality. Of the 127,801 patients included, 2951(2.3%) had PAE. Comorbidities including ischemic heart disease, diabetes mellitus, hypertension, heart failure, and atrial fibrillation were more common among anticoagulant-exposed than unexposed individuals (p<0.001). Patients with PAE experienced higher hospitalization (22.7% vs 5.6%), ICU admissions (1.9% vs 0.5%), 30-day and 1-year mortality rates (4.8% vs. 0.6, and 8.8% vs. 1.1%, respectively), than unexposed individuals, but similar lengths-of-stay. In the multivariable analysis, PAE was independently associated only with hospitalizations (adjusted odds ratio (aOR)=1.29 [95% confidence interval (CI): 1.13-1.47]), whereas in the propensity-matched analysis, none of the outcomes differed significantly between the groups. However, in the stratum aged >75years, 30-day and one-year mortality were significantly reduced in those with PAE (aOR=0.68 [CI:0.48-0.97], and aOR=0.73 [CI:0.55-0.97], respectively). SARS-CoV-2-infected individuals with prior exposure to anticoagulants have more comorbidities and experienced a higher incidence of hospitalization but not mortality compared to unexposed patients. Paradoxically, mortality risks decreased in the oldest stratum of anticoagulant-exposed individuals. Further research is required to assess mechanisms for this apparent protective effect.

Clinical features and prognostic nomogram for therapy-related acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation.

Therapy-related acute myeloid leukemia (t-AML), which develops after cytotoxic therapy, has a poorer prognosis. Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potential cure, its efficacy varies among patients. In this retrospective study, we analyzed 154 patients with t-AML who underwent hematopoietic stem cell transplantation (HSCT) at our institution to determine their clinical characteristics and develop a prognostic nomogram. The median ages at t-AML diagnosis prior disease diagnosis was 42 and 39 years, respectively. Multivariate analysis identified key prognostic indicators: leukocyte count at AML diagnosis ≥ 7 × 10ˆ9/L, genetic abnormalities before HSCT, platelet engraftment ≥ 28 days, age at prior disease ≥ 45 years, and relapse of prior disease. We developed a prognostic nomogram for LGPAR by categorizing patients into low, medium, and high-risk groups. The 3-year and 5-year overall survival (OS) rates for these groups were 92.6%, 84.4%, 14%, and 92.6%, 76.6%, and 7%, respectively. The 3-year and 5-year relapse-free survival (RFS) rates were 80%, 75.9%, 10.7% and 80%, 72.6%, and 10.7% for the respective risk groups. The 3-year and 5-year non-relapse mortality (NRM) rates were 0%, 5.6%, 63.3% and 0%, 9.3%, and 63.3% for these groups, respectively. This novel prognostic nomogram culminates in the development of a clinical decision-support tool for patients with t-AML undergoing allo-HSCT.

Outcomes of percutaneous endoscopic gastrostomy (PEG) in HIV patients

BackgroundPercutaneous Endoscopic Gastrostomy (PEG) tube insertion, a routine procedure for long-term enteral nutrition, serves as a crucial intervention for patients who are incapable of tolerating oral intake or meeting adequate nutritional requirements. PEG tube placement carries complications like bleeding and infection. Impact of PEG tubes on the 30-day and long-term mortality in HIV patients is unknown. Despite the ongoing utilization of PEG tubes in HIV patients, a comprehensive exploration of its outcomes is yet to be explored. We intended to study the impact of HIV positive status on post-PEG mortality and review other PEG tube related complications.MethodsOur study comprised a total of 639 PEG tubes placed on 461 unique patients, from which 85 patients (n = 18%) were HIV positive. We reviewed all these PEG tube patients at our institution and compared their complications and mortality outcome between the two groups of HIV positive as against HIV negative.ResultsOur findings reveal a statistically significant increase (p-value 0.001) in post-PEG insertion site bleeding in the HIV group (15.3%) compared to the non-HIV group (4.5%). This difference occurred despite no notable variations in laboratory parameters such as platelet count and (international normalized ratio), as well as similar usage of anticoagulant or antiplatelet medications between the two groups. Notably, the 1-year mortality rate in the HIV group stands at 37.6% (p < 0.001), contrasting sharply with the non-HIV group’s rate of 17.8%.ConclusionThis study underscores the need for heightened vigilance and tailored management strategies when considering PEG tube procedures in the context of HIV, given the observed elevated bleeding risks and increased 1-year mortality rates in this patient population. Further research is warranted to elucidate the underlying factors contributing to these outcomes, facilitating the development of targeted interventions to optimize the care of HIV patients undergoing PEG placement.

The impact of donor diabetes on recipient postoperative complications, renal function, and survival rate in deceased donor kidney transplantation: a single-center analysis

As the global incidence of diabetes rises and diagnoses among younger patients increase, transplant centers worldwide are encountering more organ donors with diabetes. This study examined 80 donors and 160 recipients, including 30 donors with diabetes (DD) and their 60 recipients (DDR). The control group comprised 50 non-diabetic donors (ND) and 100 recipients (NDR). We analyzed clinical, biochemical, and pathological data for both diabetic and control groups, using logistic regression to identify risk factors for delayed graft function (DGF) after kidney transplantation. Results showed that pre-procurement blood urea nitrogen levels were significantly higher in DD [18.20 ± 10.63 vs. 10.86 ± 6.92, p = 0.002] compared to ND. Renal pathological damage in DD was notably more severe, likely contributing to the higher DGF incidence in DDR compared to NDR. Although DDR had poorer renal function during the first three months post-transplant, both groups showed similar renal function thereafter. No significant differences were observed in 1-year or 3-year mortality rates or graft failure rates between DDR and NDR. Notably, according to the Renal Pathology Society (RPS) grading system, kidneys from diabetic donors with a grade > IIb are associated with significantly lower postoperative survival rates. Recipient gender [OR: 5.452 (1.330–22.353), p = 0.013] and pre-transplant PRA positivity [OR: 34.879 (7.698–158.030), p < 0.001] were identified as independent predictors of DGF in DDR. In conclusion, transplant centers may consider utilizing kidneys from diabetic donors, provided they are evaluated pathologically, without adversely impacting recipient survival and graft failure rates.

RISK FACTORS FOR MORBIDITY AND MORTALITY IN PROXIMAL FEMORAL FRACTURES

Proximal femoral fractures (hip fractures) are a major public health concern, particularly in the elderly, due to their high morbidity and mortality rates. This retrospective descriptive study, conducted at the Mohammed V Military Teaching Hospital between January 2018 and June 2021, aimed to identify risk factors for short- and long-term morbidity and mortality in patients over 50 years of age undergoing surgery for proximal femoral fractures. A total of 125 patients were included in the study. The analysis revealed several significant risk factors for morbidity and mortality, including age over 70, anemia, preoperative renal insufficiency, and delayed treatment beyond 48 hours. Multivariate analysis indicated that treatment delay was the only statistically significant factor associated with postoperative morbidity and mortality (p=0.015). Postoperative complications were found to be associated with neurological, cardiovascular, respiratory, thromboembolic, and chronic pain, with significant relationships to anesthesia techniques, prolonged hospitalization, and pre-existing comorbidities. In-hospital mortality was 4%, with a 3-month mortality rate of 8.8% and a 1-year mortality rate of 20.8%. The study highlighted the impact of early surgical intervention, revealing that a delay in treatment by more than 48 hours was associated with a higher risk of complications and mortality. Furthermore, the study explored the influence of anesthesia techniques on patient outcomes, noting a slightly higher incidence of mortality in patients receiving general anesthesia compared to spinal anesthesia, though the difference was not statistically significant. The findings emphasize the importance of early intervention, identification of risk factors, and the need for multidisciplinary care to improve patient outcomes and reduce the burden of these fractures on healthcare systems.

Seizing tumor factors for mortality and survival outcomes following liver resection in Indonesia's hepatocellular carcinoma patients.

The 3-year mortality rate for hepatocellular carcinoma (HCC) in Indonesia was 94.4%. This underscores a significant health issue in Southeast Asia, particularly in Indonesia due to its large population. This study aimed to characterize the outcomes of liver resection for HCC at a National Referral Center in Indonesia. Between 2010 and 2020, all patients with HCC undergoing liver resection were included as subjects. Variables collected included sex, age, hepatitis status, and tumor's characteristics. Mortality and survival were the primary outcomes of the study. Among seventy patients, the mortality rate was 71.4%, with a median overall survival of 19.0 months (95% confidence interval [95%CI]: 6.831.2). Thirty-one patients (44.3%) had extra-large HCC tumors (> 10 cm). Those with extra-large tumors had a lower median survival of 8.0 months. Child-Pugh B and Edmonson-Steiner grade 4 were associated with an increased mortality risk, with unadjusted hazard ratios (HRs) of 2.2 (95%CI: 1.14.3, p = 0.026) and 3.2 (95%CI: 1.37.7, p = 0.011), respectively. Multivariate analysis indicated that Child-Pugh class B significantly increased the risk of mortality, with an adjusted HR of 2.3 (95%CI: 1.05.2, p = 0.046). While surgical resection is feasible for tumors of any size, most clinical features are not statistically significantly associated with survival outcomes. The prevalence of extra-large tumors among Indonesian HCC patients highlights the importance of early diagnosis and intervention. Surgical intervention at an earlier stage and with better grade tumors could potentially enhance survival outcomes.

Efficacy and safety of low-dose TBI combined MAC regimen for HSCT in high-risk AML patients with active disease

Background The management of high-risk acute myeloid leukaemia (AML) remains challenging, highlighting the need for innovative conditioning strategies beyond current regimens. Methods In the present single-arm study, a FACT regimen comprised of low-dose total body irradiation (TBI) with fludarabine, cytarabine and cyclophosphamide was employed to treat cytogenetically high-risk AML patients exhibiting pre-transplant active disease. This clinical trial is registered in the Chinese Clinical Trial Registry with the registration number ChiCTR2000035111. Results In this study, 21 high-risk AML patients with pre-transplant disease statuses including primary induction failure, relapse and measurable residual disease positivity, were enrolled to undergo FACT conditioning. The FACT group demonstrated a 1-year non-relapse mortality (NRM) rate of 9.5%, indicating a similar level of safety and tolerability among the conditioning regimens. The estimated cumulative incidence of grade 2–4 acute graft-versus-host disease (GVHD) at one year was 30.7%. Additionally, the cumulative incidence of chronic GVHD was 36.0% at one year and increased to 43.0% at two years. Conclusions The FACT regimen is an effective myeloablative conditioning (MAC) strategy for high-risk AML patients, potentially reducing relapse risk without increasing NRM, warranting further research.

Predictive value of geriatric nutritional risk indexes for hospital readmission and mortality in older patients

The Geriatric Nutritional Risk Index (GNRI) plays a crucial role in assessing nutritional status and predicting clinical outcomes in older patients. This study explores the GNRI as a prognostic tool for clinical outcomes in older inpatients. Spanning from August 2013 to December 2020, the research involved 573 older patients at Tianjin Third Central Hospital, China. The study assessed the association of GNRI with 6-month hospital readmission and 3-year all-cause mortality rates. Our findings reveal that higher GNRI scores significantly correlate with reduced hospital readmissions and mortality, underscoring the utility of GNRI in predicting clinical outcomes and guiding interventions in geriatric care. The study highlights the potential of integrating GNRI assessments into routine clinical evaluations to enhance patient care and optimize resource utilization in healthcare settings.

Ten-Year Outcomes and Predictors of Mortality Following Catheter Ablation of Ventricular Tachycardia.

Catheter ablation is the primary treatment option for idiopathic ventricular tachycardia (VT). It plays a key role in acute therapy of electrical storm, treatment of VTs in patients with structural heart disease (SHD), and can reduce VT burden. Here we report on 10-year clinical outcomes following VT ablation from patients enrolled in the prospective German Ablation Registry. Long-term follow-up was conducted on 334 patients undergoing VT ablation (118/334, 35%) with structurally normal hearts and 216 out of 334 (65%) with SHD, including 161 out of 216 (75%) with ischemic heart disease at 38 centers. Follow-up was completed in 94.8% of patients. Median observation time was 10.8 (4.3-12.3) years, with a 10-year all-cause mortality rate of 39.4%. VT ablation in patients with SHD was associated with worse outcome when compared with patients with structurally normal hearts (estimated 10-year mortality for SHD 54.8% versus structurally normal hearts 12.1%). Estimated 10-year mortality following VT ablation was highest in patients with ischemic heart disease (62.4%). Significant predictors of mortality following VT ablation included age (hazard ratio [HR], 2.35 [1.90-2.92] per decade), left ventricular ejection fraction ≤30% (HR, 2.11 [1.44-3.10]), diabetes (HR, 1.73 [1.14-2.61]), incessant VT (HR, 2.96 [1.74-5.03]), linear lesion (HR, 1.46 [0.99-2.16]), and acute procedural failure (HR, 2.57 [1.39-4.77]). Procedural failure was the only statistically significant predictor for VT recurrence during follow-up (HR, 3.76 [1.59-8.91]). Within an all-comer patient cohort, estimated 10-year all-cause mortality following VT ablation is 39.4%. Mortality after VT ablation is worse in patients with SHD and highest for patients with ischemic heart disease. Acute procedural success plays a major role in predicting VT recurrence and long-term mortality.

Hemodynamic Characteristics and Prognostic Implication of Modified Society for Cardiovascular Angiography and Interventions Shock Classification in Comatose Patients With Out-of-Hospital Cardiac Arrest.

Cardiogenic shock complicating acute myocardial infarction is associated with a high mortality rate. Cardiogenic shock after out-of-hospital cardiac arrest (OHCA) can be due to transient myocardial stunning but also reflect the increasing severity of ongoing heart failure. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed a division of cardiogenic shock into 5 phenotypes, with cardiac arrest being a modifier. The objective was to apply SCAI shock classification to a well-characterized OHCA population and describe the hemodynamic characteristics and prognostic significance of increasing SCAI classes. This is a post hoc analysis of data from the BOX (Blood Pressure and Oxygenation Targets in Post Resuscitation Care) trial of comatose patients with OHCA. Patients were classified according to SCAI class upon hospital admission. Invasive arterial and pulmonary arterial measurements were obtained the first 72 hours after admission, and perfusion pressure, cardiac index and cardiac power output were calculated. Of 789 patients included, 31.6% were classified as SCAI class B/C, 29.9% as SCAI class D, and 38.5% as SCAI class E. The first recorded perfusion pressure differed between SCAI class B/C, D, and E being lower in higher SCAI classes. The difference was found only at the first measurement. Cardiac index and cardiac power output did not differ at any time point between classes. The 1-year mortality rate increased with SCAI Class B/C to E (21.3%, 34.3%, and 48.4%, respectively; P<0.001). The 1-year mortality rate after OHCA increased with increasing SCAI classes, but cardiac index, cardiac power output, and perfusion pressure remained notably similar in the first 72 hours after admission. This challenges whether all OHCAs should be recorded as SCAI class E by default. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03141099.

One-Year Follow-Up of Morbidity and Mortality in Mechanical Valve Replacement Patients at a Newly Established Cardiac Center in a Developing Country

Objective: To examine the morbidity and mortality rates associated with mechanical heart valve replacement in patients from a developing country at a 1-year follow-up. Methodology: This retrospective observational study was conducted on the patients who presented with Aortic Valve Replacement (AVR), Mitral Valve Replacement (MVR) and Dual Valve Replacement (DVR), at the Cardiac Surgery Department of Peshawar Institute of Cardiology (PIC). The data of 258 patients who underwent these cardiac procedures was collected between a period of two years i.e., from Jan 2021 till Dec 2022 from the hospital records. Results: Out of 258 patients, 37 (14.3%) were readmitted within one year of surgery due to complications such as pericardial effusion, pleural effusion, bleeding, endocarditis, hemorrhagic stroke, and stuck valve. The in-hospital mortality rate following the procedure was 2.7%, while the 1-year post-discharge mortality rate was 10.3%, with 14 cases (51.86%) attributed to warfarin-related complications. Within the first year after discharge, the average number of INR (International Normalized Ratio) tests conducted was 8.34 ± 8.268, and the average number of consultations for INR management was 2.53 ± 3.715. Conclusion: Warfarin-related complications are a major contributor to mortality and morbidity in patients with mechanical heart valves in developing countries. To address this, newly established cardiac centers in the developing world should adopt innovative strategies, such as establishing dedicated warfarin clinics, promoting the use of self-testing devices, and developing remote cardiac care centers to reduce these complications. Keywords: Cardiac valve replacement, Mitral valve replacement, Aortic valve replacement, Warfarin.