30-day Survival Research Articles

Diagnostic and Prognostic Values of KLF5 and RUNX1 in Acute Kidney Injury in Septic Patients.

Diagnostic and prognostic values of Kruppel-like factor 5 (KLF5) and Runt-related transcription factor 1 (RUNX1) were determined in sepsis-induced acute kidney injury (SI-AKI). The study included 120 septic patients and set two groups: SI-AKI group (n = 60) or non-AKI group (n = 60). Fasting venous blood was drawn, and KLF5 and RUNX1 levels were measured. The receiver operating characteristic curve was plotted for diagnostic evaluation of KLF5 and RUNX1 in SI-AKI. The correlation between KLF5 and RUNX1 and serum creatinine (Scr), cystatin C (Cys-C), and kidney injury molecule 1 (KIM-1) were assessed by Pearson method. Predictive values of KLF5 and RUNX1 in 28-day survival of SI-AKI patients were considered by Kaplan-Meier survival curves and multivariate Cox regression analysis. Serum KLF5 and RUNX1 in SI-AKI patients were upregulated. Serum KLF5 and RUNX1 were of high diagnostic value in distinguishing SI-AKI patients from non-AKI patients. KLF5 and RUNX1 were in a positive correlation with Scr, Cys-C, and KIM-1, respectively. The 28-day survival of SI-AKI patients with high serum KLF5 or RUNX1 expression was poor, and serum KLF5 and RUNX1 expression were independently correlated with SI-AKI patients' survival. KLF5 and RUNX1 have diagnostic and prognostic values in SI-AKI patients.

Microbial Composition of the Laryngotracheal Region: A Systematic Review.

Microbiome research has predominantly focused on the oral cavity and oropharynx's role in disease, while the upper airway, specifically the larynx and trachea, has been relatively overlooked. Examining the microbial communities in these regions can shed light on how dysbiosis influences diseases and their management. This review evaluates laryngotracheal microbial compositions in both healthy and diseased patients. We conducted a systematic review in EMBASE, MEDLINE, and Cochrane Central databases, yielding 1383 studies in the initial search. Inclusion criteria involved participants aged over 18 years and the use of next-generation 16s ribosomal sequencing methods. We included 10 studies-seven focused on larynx sequencing and four on trachea sequencing (one investigated both sites). In a healthy larynx, diverse species such as Streptococcus, Cloacibacterium, Prevotella, and Helicobacter were found. Benign laryngeal diseases exhibited reduced microbial diversity, mainly dominated by Streptococcus. Subglottic stenosis patients showed diminished diversity in both idiopathic and iatrogenic scars. Laryngeal squamous cell carcinoma displayed increased diversity, primarily featuring Fusobacterium. Among non-respiratory-compromised surgery patients, the tracheal microbiome was more diverse in diabetics and those later developing lower respiratory infections. Pneumonia patients exhibited an abundance of Prevotella and Streptococcus, linked to an increased 28-day survival rate, while Streptococcus and Haemophilus abundance correlated with successful extubation. The laryngotracheal region hosts a unique microbial community influenced by both benign and malignant conditions. Many lesions remain unexplored, underscoring the need for future studies encompassing diverse laryngotracheal conditions. Clinical trials assessing microbiome modifications may unveil novel therapeutic avenues. NA Laryngoscope, 2024.

Perfusion index and mean arterial pressure after return of spontaneous circulation in out-of hospital cardiac arrest (OHCA) and their relationship with perfusion and survival

Abstract Funding Acknowledgements None. Background Current guidelines for post-cardiac arrest care recommend targeting mean arterial pressure (MAP) to restore adequate perfusion indicated by adequate urine output (UO) and normal or decreasing lactate, avoiding hypotension (MAP < 65 mmHg). The peripheral perfusion index (PI) is the ratio of the pulsatile blood flow to the non-pulsatile blood flow measured peripherally by a standard pulse-oximeter, and it represents a promising non-invasive tool to assess perfusion. The goal of this study is to assess whether prehospital PI and MAP measurements are associated with lactate clearance (LC), adequate UO and 30-days survival with good neurological outcome. Methods A retrospective analysis of prospectively collected data (January 2018 - March 2023) in two cardiac arrest registries located in Italy and Belgium was performed. PI was automatically and continuously measured by the manual monitor/defibrillator. The mean PI value of each minute after ROSC was extracted from the monitor data report and the mean value of 30 min of PI monitoring (MPI30) was calculated and categorized in tertiles (MPI30 T1-T3). The lowest prehospital value for MAP recording was considered. LC was defined by a serum lactate level <2 mmol/L at 6 hours. Inadequate UO was defined as < 0.5mL/kg/h averaged at 12 hours. Neurological outcome was assessed with the Cerebral Performance Category (CPC) at 30 days. Results Out of the 397 OHCA patients admitted to the ICU after ROSC enrolled over the study period 206 had a MPI30 value available and were included in this study; MAP value was available in 186 patients. In the subgroup of patients with hypotension, patients with MPI30 in T1 showed higher incidence of inadequate UO at 12 hours (78.9% vs 25.8%, p<0.001). At multivariable logistic regression, after adjusting for MAP, shockable rhythm, age, and dosage of adrenaline administered, MPI30 was independently associated with inadequate UO (OR 0.68, 95% CI 0.50-0.91, p=0.01). Patients with hypotension and MPI30 in T1 showed lower LC at 6h (15.8% vs 43.4%, p=0.02) when compared to the remaining population. At multivariable Cox proportional-hazard regression, after correction for shockable rhythm, age, and total amount of adrenaline administered, patients with hypotension and MPI30 in T1 showed lower survival with CPC 1-2 at 30 days (HR 2.61, 95% CI 1.52-4.51, p=<0.001) when compared to patients without hypotension or with hypotension but MPI30 in T2-T3. No difference in LC, adequate UO and survival with good neurological outcome was found between patients with hypotension and MPI30 in T2-T3 compared to patients without hypotension. Conclusion PI is a useful indicator of perfusion in patients with hypotension after OHCA. Patients with hypotension and reduced PI showed higher incidence of inadequate UO and lower incidence of LC, as well as association with lower survival at 30 days with CPC 1-2.Lactate clearenceSurvival at 30days with CPC 1-2

Long-term outcome of COVID-19 patients with acute kidney injury requiring kidney replacement therapy

BackgroundLimited data existed on the burden of coronavirus disease 2019 (COVID-19) renal complications and the outcomes of the most critical patients who required kidney replacement therapy (KRT) during intensive care unit (ICU) stay. We aimed to describe mortality and renal function at 90 days in patients admitted for COVID-19 and KRT.MethodsA retrospective cohort study of critically ill patients admitted for COVID-19 and requiring KRT from March 2020 to January 2022 was conducted in an Italian ICU from a tertiary care hospital. Primary outcome was mortality at 90 days and secondary outcome was kidney function at 90 days.ResultsA cohort of 45 patients was analyzed. Mortality was 60% during ICU stay and increased from 64% at the time of hospital discharge to 71% at 90 days. Among 90-day survivors, 31% required dialysis, 38% recovered incompletely, and 31% completely recovered renal function. The probability of being alive and dialysis-free at 3 months was 22%.ConclusionsCritically ill patients with COVID-19 disease requiring KRT during ICU stay had elevated mortality rate at 90 days, with low probability of being alive and dialysis-free at 3 months. However, a non-negligible number of patients completely recovered renal function.

Unloading the left ventricle in VA-ECMO: a comparative analysis of outcomes

Abstract Funding Acknowledgements None. Introduction Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) has radically changed the way we see and treat cardiogenic shock, despite the challenges it presents. The retrograde delivery of oxygenated blood to the aorta via the arterial cannula imposes increased afterload on an already strained left ventricle (LV). Unloading techniques aim to reduce the preload and afterload caused by VA-ECMO on the LV. Purpose Our study aims to compare the clinical outcomes of patients on VA-ECMO where additional invasive techniques were employed to unload the LV, against those without unloading strategies. Methods Patients treated with VA-ECMO in our hospital since 2012 were categorized into two groups: the Venting Group (VG) that received LV unloading interventions and the Non-Venting Group (NVG) without such interventions. We collected comprehensive clinical data, including demographics, baseline characteristics, ECMO-related parameters, in-hospital complications, and patient outcomes. Statistical analyses involved chi-square tests for categorical variables and independent samples t-tests for continuous variables to assess the impact of unloading strategies on patient outcomes. Results Our hospital treated 100 patients with VA-ECMO (mean age 58.4 ± 11.9 years, 60% male). Approximately 39% of patients received LV unloading support. The choice of unloading device was guided by our center's expertise. Most commonly, Intra-Aortic Balloon Pump (IABP) was used (61.5%), followed by Impella CP (23.1%), percutaneous atrial septostomy (2.6%) and surgical LV venting (12.8%). Unloading techniques were implemented either concurrently with VA-ECMO cannulation (58.9%), before (17.9%), or after its insertion (23.2%). Most patients (68%) received inotropic drugs, predominantly dobutamine. The mean duration of venting device use was 4.2 ± 3.8 days. Airway bleeding (3.3% NVG vs. 17.9% VG, p=0.032) and thromboembolic complications (19.7% NVG vs. 41.0% VG, p=0.036) were significantly more prevalent in the VG. There were no significant differences in the others reported ECMO-related complications. No significant differences were observed in the mean duration of support with VA-ECMO (3 days NVG vs. 4 days VG, p=0.147) or in the mean duration of hospitalization (13 days NVG vs. 12 VG, p=0.619) between the two groups. The 30-day survival rates were 42% (95% CI, 0.30-0.59) in NVG and 29% (95% CI, 0.18-0.49) in VG, which did not display statistical significance, p=0.24 [Figure 1]. Conclusions In our cohort, incorporating unloading devices alongside VA-ECMO did not yield major differences in survival rates, yet led to a considerable increase in airway bleeding and thromboembolic complications. The precocity of unloading device implantation occurred either as an initial strategy or to prevent increased afterload in hearts with limited contractile reserve.Characteristics and Clinical OutcomesSurviving Curves VG vs. NVG

Markers of hemophagocytic lymphohistiocytosis are associated with survival in critically ill patients

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): This work was supported by the Association for the Promotion of Research on Arteriosclerosis, Thrombosis and Vascular Biology (ATVB) and the Ludwig Boltzmann Cluster for Cardiovascular Research Background/Introduction Patients admitted to the intensive care unit (ICU) often show systemic immune dysregulation paired with significantly increased inflammatory activity. Haemophagocytic lymphohistiocytosis (HLH) represents a rare syndrome characterized by fever, inflammation, cytopenia, and organ dysfunction. Inappropriate survival of cytotoxic T cells as well as histiocytes triggers cytokine storm, accompanied by the occurrence of hemophagocytosis and multi-organ failure. prevalence of HLH in critical illness continues to be a topic of discussion but most certainly remains underreported. This circumstance often leads to delays in the necessary immunosuppressive therapy due to difficulty in early diagnosis. Purpose In the present study, we aimed to illuminate the prospective value of the individual HLH criteria in a cohort of critically ill patients. Although the prevalence of this syndrome might be low, isolated markers of HLH could help to assess the extent of inflammatory activation and further be of use in predicting the outcome of patients admitted to the ICU. Methods This was a prospective, observational cohort study. 176 consecutive patients admitted to a cardiac ICU were included over the course of one year. Available HLH criteria were recorded except for biopsy samples of bone marrow and measurements of low or absent natural killer cell activity. For soluble CD25 (sCD25) a specific ELISA kit was used according to the manufacturer's instructions. Results The median age was 67.51 years (IQR: 57.50-77.41) and 38.64% of the included patients were female. The total 30-day mortality was calculated to be 25.57% and positivity for two or more criteria of HLH was found to be associated with depicted mortality (p = 0.033). Analyzing the individual parameters, only sCD25 was found to be a predictor of death within the first 30 days (p < 0.001). The combination of triglycerides and fibrinogen did not predict outcomes. However, low fibrinogen values were found to possess prognostic merit in regard to mortality (p= 0.019). In multivariate analysis, both sCD25 and fibrinogen remained a significant predictor of 30-day survival after adjustment for age, sex, and BMI (sCD25 p < 0.001, fibrinogen p = 0.042). Finally, the addition of fibrinogen was able to improve the prognostic value of the SAPS II score significantly (ROC curve, SAPS II – AUC: 0.790, SAPS II & fibrinogen – AUC: 0.827, p = 0.045). Conclusion We provided evidence for the prognostic value of certain markers of HLH in critically ill patients. Positivity for two or more criteria was found to be associated with an increased 30-day mortality. Moreover, sCD25 and fibrinogen independently predicted outcomes in multivariate analysis after adjustment for age, sex, and BMI. The addition of fibrinogen was able to improve the prognostic properties of the SAPS II score.Figure 1Figure 2

Venoarterial ECMO in cardiogenic shock: a decade-long single-center analysis

Abstract Funding Acknowledgements None. Introduction Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) has emerged as a salvage intervention in refractory cardiogenic shock, offering both circulatory and respiratory support as a bridge to recovery, a bridge to transplant, or a bridge to decision. Purpose This study aimed to assess the demographics, clinical characteristics, and outcomes of VA-ECMO patients with cardiogenic shock in a tertiary center. Methods We conducted a retrospective observational study, encompassing patients admitted with cardiogenic shock and treated with VA-ECMO up to October 2023, marking the milestone of the 100th VA-ECMO patient in our unit. Key patient data, including demographics, clinical presentation, ECMO-related complications, and outcomes, were extracted from medical records. Summary statistics were employed for data analysis. Results From 2012 to October 2023, our hospital treated 100 patients in VA-ECMO. The mean age was 58.4 ± 11.9 years, with a male predominance (60%). Approximately 50% of patients were admitted from the emergency room after sudden cardiac arrest. Acute coronary syndrome (ACS) accounted for 39% of cardiogenic shock cases, followed by complicated post-valvular replacement surgery (13%), myocarditis (10%), and acute decompensated heart failure (9%). The median hospital stay was 12.5 days (range: 0 to 114), with a median of 4.0 days on ECMO (range: 0 to 52). All VA-ECMO reported in this cohort were percutaneous, with 39% requiring left ventricular unloading. In 11% cases VA-ECMO served as a bridge to transplant. When it comes to VA-ECMO-related complications, hematological complications, including anemia and thrombocytopenia necessitating transfusion, were observed in 53% of patients, and thromboembolic complications, such as acute limb ischemia, affected 28% of patients. Bleeding complications were notable, with 12% experiencing significant access bleeding, 16% gastrointestinal bleeding, 9% airway bleeding, and 2% intracerebral hemorrhage. Additionally, 39% necessitated renal replacement therapy due to acute kidney failure. The 5-day survival rate stood at 69% (95% CI, 0.61-0.79), declining to 36% at 30 days (95% CI, 0.27-0.48) (see Figure 1). Of the 100 patients, 41 died while on VA-ECMO, with 36 either discharged or undergoing transplantation. Conclusions Our single-center experience illustrates VA-ECMO's predominant use in younger patients following ACS or cardiothoracic surgery. Despite associated complications, particularly thromboembolic events and severe bleeding, our observed mortality rate is slightly lower than reported for refractory cardiogenic shock. New research has emerged from global VA-ECMO registries, as well as clinical trials, however real-world data is lacking. This analysis provides a foundational understanding of cohort characteristics and sets the stage for future comparative studies.Table 1.Patient CharacteristicsFigure 1.Surviving Curve

Exploring the relationship between HCMV serostatus and outcomes in COVID-19 sepsis

BackgroundSepsis, a life-threatening condition caused by the dysregulated host response to infection, is a major global health concern. Understanding the impact of viral or bacterial pathogens in sepsis is crucial for improving patient outcomes. This study aimed to investigate the human cytomegalovirus (HCMV) seropositivity as a risk factor for development of sepsis in patients with COVID-19.MethodsA multicenter observational study enrolled 95 intensive care patients with COVID-19-induced sepsis and 80 post-surgery individuals as controls. HCMV serostatus was determined using an ELISA test. Comprehensive clinical data, including demographics, comorbidities, and 30-day mortality, were collected. Statistical analyses evaluated the association between HCMV seropositivity and COVID-19 induced sepsis.ResultsThe prevalence of HCMV seropositivity did not significantly differ between COVID-19-induced sepsis patients (78%) and controls (71%, p = 0.382) in the entire cohort. However, among patients aged ≤60 years, HCMV seropositivity was significantly higher in COVID-19 sepsis patients compared to controls (86% vs 61%, respectively; p = 0.030). Nevertheless, HCMV serostatus did not affect 30-day survival.DiscussionThese findings confirm the association between HCMV seropositivity and COVID-19 sepsis in non-geriatric patients. However, the lack of an independent effect on 30-day survival can be explained by the cross-reactivity of HCMV specific CD8+ T-cells towards SARS-CoV-2 peptides, which might confer some protection to HCMV seropositive patients. The inclusion of a post-surgery control group strengthens the generalizability of the findings. Further research is needed to elucidate the underlying mechanisms of this association, explore different patient populations, and identify interventions for optimizing patient management.ConclusionThis study validates the association between HCMV seropositivity and severe COVID-19-induced sepsis in non-geriatric patients, contributing to the growing body of evidence on viral pathogens in sepsis. Although HCMV serostatus did not independently influence 30-day survival, future investigations should focus on unraveling the intricate interplay between HCMV, immune responses, and COVID-19. These insights will aid in risk stratification and the development of targeted interventions for viral sepsis.

Survival, but not the severity of hypoxic–ischemic encephalopathy, is associated with higher mean arterial blood pressure after cardiac arrest: a retrospective cohort study

BackgroundThis study investigates the association between the mean arterial blood pressure (MAP), vasopressor requirement, and severity of hypoxic–ischemic encephalopathy (HIE) after cardiac arrest (CA).MethodsBetween 2008 and 2017, we retrospectively analyzed the MAP 200 h after CA and quantified the vasopressor requirements using the cumulative vasopressor index (CVI). Through a postmortem brain autopsy in non-survivors, the severity of the HIE was histopathologically dichotomized into no/mild and severe HIE. In survivors, we dichotomized the severity of HIE into no/mild cerebral performance category (CPC) 1 and severe HIE (CPC 4). We investigated the regain of consciousness, causes of death, and 5-day survival as hemodynamic confounders.ResultsAmong the 350 non-survivors, 117 had histopathologically severe HIE while 233 had no/mild HIE, without differences observed in the MAP (73.1 vs. 72.0 mmHg, pgroup = 0.639). Compared to the non-survivors, 211 patients with CPC 1 and 57 patients with CPC 4 had higher MAP values that showed significant, but clinically non-relevant, MAP differences (81.2 vs. 82.3 mmHg, pgroup < 0.001). The no/mild HIE non-survivors (n = 54), who regained consciousness before death, had higher MAP values compared to those with no/mild HIE (n = 179), who remained persistently comatose (74.7 vs. 69.3 mmHg, pgroup < 0.001). The no/mild HIE non-survivors, who regained consciousness, required fewer vasopressors (CVI 2.1 vs. 3.6, pgroup < 0.001). Independent of the severity of HIE, the survivors were weaned faster from vasopressors (CVI 1.0).ConclusionsAlthough a higher MAP was associated with survival in CA patients treated with a vasopressor-supported MAP target above 65 mmHg, the severity of HIE was not. Awakening from coma was associated with less vasopressor requirements. Our results provide no evidence for a MAP target above the current guideline recommendations that can decrease the severity of HIE.

Herpes virus entry mediator signaling blockade produces mortality in neonatal sepsis through induced cardiac dysfunction

IntroductionSepsis remains a major source of morbidity and mortality in neonates, and characterization of immune regulation in the neonatal septic response remains limited. HVEM is a checkpoint regulator which can both stimulate or inhibit immune responses and demonstrates altered expression after sepsis. We hypothesized that signaling via HVEM would be essential for the neonatal response to sepsis, and that therefore blockade of this pathway would improve survival to septic challenge.MethodsTo explore this, neonatal mice were treated with cecal slurry (CS), CS with Anti-HVEM antibody (CS-Ab) or CS with isotype (CS-IT) and followed for 7-day survival. Mice from all treatment groups had thymus, lung, kidney and peritoneal fluid harvested, weighed, and stained for histologic evaluation, and changes in cardiac function were assessed with echocardiography.ResultsMortality was significantly higher for CS-Ab mice (72.2%) than for CS-IT mice (22.2%). CS resulted in dysregulated alveolar remodeling, but CS-Ab lungs demonstrated significantly less dysfunctional alveolar remodeling than CS alone (MCL 121.0 CS vs. 87.6 CS-Ab), as well as increased renal tubular vacuolization. No morphologic differences in alveolar septation or thymic karyorrhexis were found between CS-Ab and CS-IT. CS-Ab pups exhibited a marked decrease in heart rate (390.3 Sh vs. 342.1 CS-Ab), stroke volume (13.08 CS-IT vs. 8.83 CS-Ab) and ultimately cardiac output (4.90 Sh vs. 3.02 CS-Ab) as well as a significant increase in ejection fraction (73.74 Sh vs. 83.75 CS-Ab) and cardiac strain (40.74 Sh vs. 51.16 CS-Ab) as compared to CS-IT or Sham animals.DiscussionWhile receptor ligation of aspects of HVEM signaling, via antibody blockade, appears to mitigate aspects of lung injury and thymic involution, stimulatory signaling via HVEM still seems to be necessary for vascular and hemodynamic resilience and overall neonatal mouse survival in response to this experimental polymicrobial septic insult. This dissonance in the activity of anti-HVEM neutralizing antibody in neonatal animals speaks to the differences in how septic cardiac dysfunction should be considered and approached in the neonatal population.

Atorvastatin combined with imipenem alleviates lung injury in sepsis by inhibiting neutrophil extracellular trap formation via the ERK/NOX2 signaling pathway

Sepsis is a systemic inflammatory response syndrome caused by the invasion of pathogenic microorganisms. Despite major advances in diagnosis and technology, morbidity and mortality remain high. The level of neutrophil extracellular traps (NETs) is closely associated with the progression and prognosis of sepsis, suggesting the regulation of NET formation as a new strategy in sepsis treatment. Owing to its pleiotropic effects, atorvastatin, a clinical lipid-lowering drug, affects various aspects of sepsis-related inflammation and immune responses. To align closely with clinical practice, we combined it with imipenem for the treatment of sepsis. In this study, we used a cecum ligation and puncture-induced lung injury mouse model and employed techniques including western blot, immunofluorescence, and enzyme-linked immunosorbent assay to measure the levels of NETs and other sepsis-related lung injury indicators. Our findings indicate that atorvastatin effectively inhibited the formation of NETs. When combined with imipenem, it significantly alleviated lung injury, reduced systemic inflammation, and improved the 7-day survival rate of septic mice. Additionally, we explored the inhibitory mechanism of atorvastatin on NET formation in vitro, revealing its potential action through the ERK/NOX2 pathway. Therefore, atorvastatin is a potential immunomodulatory agent that may offer new treatment strategies for patients with sepsis in clinical settings.

Dual-layered micromesh stent technology for embolic prevention in carotid revascularization: technical experience and clinical outcomes from a high-volume interventional radiology center.

Carotid artery stenting (CAS) has become a cornerstone of carotid revascularization for stroke prevention. Despite the advantages of CAS, large-scale randomized trials involving prior (single-layer) generation of carotid stents demonstrated its higher risk of periprocedural cerebrovascular events compared to carotid endarterectomy (CEA). Dual-layer mesh-covered stents (DLSs) showed promising results in terms of 30-day embolic events. This study aims to evaluate 30-day clinical efficacy of DLS against a closed-cell single-layer stent, based on large-volume data. The study center is part of the Italian National Outcomes Evaluation Program (PNE). CAS procedures performed between November 2017 and September 2023 were retrospectively analyzed. Our primary endpoint was 30-day survival free of death, stroke, and myocardial infarction (MI). Periprocedural stroke rate, technical success and restenosis rate of CAS procedures performed with DLSs and first-generation stents (FGSs) were also evaluated. Over a total of 1101 CAS procedures (55 men; 745 males; mean age of 79±7.8 years), 80.2% were treated with DLS and 48.6% were symptomatic. The cumulative stroke-, MI- and death-free 30-day survival was 98.9%, Technical success was achieved in 98.9% of cases. The DLS group showed significantly lower 30-day death, stroke and death+stroke and periprocedural minor stroke rates compared to FGS group (P=0.04; P=0.04; P=0.003 and P=0.0002, respectively). The use of DLS in patients undergoing CAS in our large-volume center showed a high technical success rate and minimal cerebral embolic complications by 30 days. High volumes and an experienced interventional team may contribute to these favorable outcomes.

Standard cardiopulmonary resuscitation versus chest compressions only after out-of-hospital cardiac arrest: a protocol for a systematic review and meta-analysis

IntroductionThe 2020 American Heart Association guidelines encourage lay rescuers to provide chest compression-only cardiopulmonary resuscitation to simplify the process and encourage cardiopulmonary resuscitation initiation. However, recent clinical trials had contradictory...

Association of red blood cell distribution width with mortality among multiple trauma patients.

Identifying the severity of trauma to provide timely and adequate treatment and predict the prognosis are some of the significant challenges in trauma management. Increased red blood cell distribution width (RDW) is associated with several pathologies and associated mortality. This study aims to evaluate the RDW in predicting 24h and 30-day mortality among multiple trauma patients. In this retrospective study, multiple trauma patients with ISS ≤16 were included. Blood samples of the patients were collected at 1h and 24h of the referral to determine RDW. Demographic data, 24h and 30-day mortality, injury severity score (ISS), and RDW outcomes were evaluated for all the patients. Of the 300 patients included in the study, 52 patients died in the first 24h, and 85 patients within 30 days. One hour and 24h RDW were not significantly different in 30-day mortality patients, P=0.104 and P=0.156, respectively. RDW in 30-day mortality patients was not significantly different at 1h and 24h, P-value=0.875. The means ISS in 24h, 30-day mortality and survivors was significantly different, P<0.001. Our study does not report a significant increase in RDW among 24h and 30-day mortality and survivor patients. ISS was significantly different among the two groups.

Morbidity and Mortality in Patients with Stage IV Pancreatic Adenocarcinoma and Acute Cholangitis: Outcomes and Risk Prognostication

BackgroundAcute cholangitis (AC) is a common complication of pancreatic ductal adenocarcinoma (PDAC). Herein, we evaluated outcomes after the first AC episode and predictors of mortality and AC recurrence in patients with stage IV PDAC. MethodsWe conducted a single-center, retrospective observational study using institutional databases. Clinical data and outcomes for patients with stage IV PDAC and at least one documented episode of AC, were assessed. Overall survival (OS) was estimated using the Kaplan-Meier method, and Cox regression model was employed to identify predictors of AC recurrence and mortality. ResultsOne hundred and twenty-four patients with stage IV PDAC and AC identified between 01/01/2014 and 10/31/2020 were included. Median OS after first episode of AC was 4.1 months (95% CI, 4.0 - 5.5), and 30-day, 6, and 12-month survival was 86.2% (95% CI, 80.3 – 92.5), 37% (95% CI, 29.3 - 46.6%) and 18.9% (95% CI, 13.1-27.3%), respectively. Primary tumor in pancreatic body/tail (HR 2.29, 95% CI: 1.26 to 4.18, p=0.011), concomitant metastases to liver and other sites (HR 1.96, 95% CI: 1.16 to 3.31, p=0.003) and grade 3 AC (HR 2.26, 95% CI: 1.45 to 3.52, p<0.001), predicted worse outcomes. Intensive care unit admission, sepsis, systemic therapy, treatment regimen, and time to intervention did not predict survival or risk of recurrence of AC. ConclusionsAC confers significant morbidity and mortality in advanced PDAC. Worse outcomes are associated with higher grade AC, primary tumor location in pancreatic body/tail, and metastases to liver and other sites.

Waiting list and Post-Transplant Outcome in Sweden after National Centralization of Heart Transplant Surgery

BackgroundPrevious studies have demonstrated an association between the annual transplantation rate per center and post-operative mortality after heart transplantation. In 2011, Sweden centralized heart transplants and waiting lists, reducing the number of centers from three to two. This study aimed to assess the active waiting time and pre- and post-transplant mortality rates before and after centralization. MethodsHeart transplantations performed in Sweden between January 1, 2001, and December 31, 2020, were included. Background and donor organ supply data were collected from national registries (Scandiatransplant, STRAX, and SWEDEHEART) and Scandiatransplant, respectively. The Fine and Gray methods were applied to visualize cumulative incidence curves and conduct competing risk regressions. A Cox model was used to adjust for factors influencing time to post-transplant death across eras. ResultsWhen comparing the 10 years before and after centralization, the median active waiting time increased from 54 to 71 days (p=0.015). A decreased risk of mortality on the waiting list was observed in the later era compared to the first (SHR 0.43; [95% CI 0.25-0.74]; p=0.002). The total number of heart transplantation procedures (including pediatric patients) increased by 53% from 377 (mean, 38/year) to 577 (mean, 58/year) in the second era. There was a statistically significant difference in organ utilization between the time eras (p=0.033; Chi2-test). The 30-day and 1-year survival post-transplant rates for adults increased from 90.8% to 97.8% (p<0.001) and from 87.9% to 94.6% (p<0.001), respectively. An adjusted Cox-regression analysis showed a 63% reduction in 1-year mortality between eras (HR 0.37 95%CI 0.22-0.61). ConclusionsThis nationwide retrospective registry study examined patients listed for and undergoing heart transplantation before and after centralization of waiting lists and surgeries in Sweden. Waiting list mortality decreased, and 1-year post-transplantation survival rates improved.

Body mass index and mortality following primary graft dysfunction: A Lung Transplant Outcomes Group study

Higher body mass index (BMI) increases risk of developing primary graft dysfunction (PGD) after lung transplantation; whether BMI is associated with decreased survival after PGD is unknown. We utilized the Lung Transplant Outcomes Group (LTOG) cohort of 1,538 subjects from 2011-2018. We evaluated the association between pre-operative BMI and graft survival among subjects with severe PGD using Cox proportional hazards models with linear splines. Models were stratified by center and adjusted for sex, age, lung allocation score, and diagnosis. PGD developed in 383 subjects. Among subjects with PGD, low BMI was associated with increased mortality while high BMI was not associated with differential mortality, compared to normal BMI. Results were similar for 90-day and 1-year survival. While high BMI increases risk of developing PGD, it does not appear to be associated with survival after PGD. Future work should focus on PGD prevention rather than PGD management in patients with obesity.

Inhibition of Golgi stress alleviates sepsis-induced cardiomyopathy by reducing inflammation and apoptosis

BackgroundSepsis is often accompanied by multiple organ dysfunction, in which the incidence of cardiac injury is about 60%, and is closely related to high mortality. Recent studies have shown that Golgi stress is involved in liver injury, kidney injury, and lung injury in sepsis. However, whether it is one of the key mechanisms of sepsis-induced cardiomyopathy (SIC) is still unclear. The aim of this study is to investigate whether Golgi stress mediates SIC and the specific mechanism. MethodsSepsis model of male C57BL/6J mice was established by cecal ligation and puncture. To observe the effect of Golgi stress on SIC, mice were injected with Golgi stimulant (Brefeldin A) or Golgi inhibitor (Glutathione), respectively. The 7-day survival rate of mice were recorded, and myocardial injury indicators including cardiac function, myocardial enzymes, myocardial pathological tissue score, myocardial inflammatory factors, and apoptosis were detected. The morphology of Golgi was observed by immunofluorescence, and the Golgi stress indices including GM-130, GOLPH3 and Goligin97 were detected by WB and qPCR. ResultsAfter CLP, the cardiac function of mice was impaired and the levels of myocardial enzymes were significantly increased. Golgi stress was accompanied by increased myocardial inflammation and apoptosis. Moreover, the expressions of morphological proteins GM-130 and Golgin97 were decreased, and the expression of stress protein GOLPH3 was increased. In addition, Brefeldin A increased 7-day mortality and the above indicators in mice. The use of glutathione improves all of the above indicators. ConclusionGolgi stress mediates SIC, and the inhibition of Golgi stress can improve SIC by inhibiting apoptosis and inflammation.

Risk factors for invasive pulmonary aspergillosis in patients with severe fever with thrombocytopenia syndrome: A multicenter retrospective study.

Invasive pulmonary aspergillosis (IPA) is a life-threatening complication in patients with severe fever with thrombocytopenia syndrome (SFTS), yet SFTS-associated IPA (SAPA)'s risk factors remain undefined. A multicenter retrospective cohort study across Hubei and Anhui provinces (May 2013-September 2022) utilized least absolute shrinkage and selection operator (LASSO) regression for variable selection. Multivariable logistic regression identified independent predictors of SAPA, Cox regression highlighted mortality-related risk factors. Of the 1775 screened SFTS patients, 1650 were included, with 169 developing IPA, leading to a 42-day mortality rate of 26.6% among SAPA patients. Multivariable logistic regression revealed SAPA risk factors including advanced age, petechia, hemoptysis, tremor, low albumin levels, elongated activated partial thromboplastin time (APTT), intensive care unit (ICU) admission, glucocorticoid usage, intravenous immunoglobulin (IVIG) and prolonged hospital stays. Cox regression identified predictors of 42-day mortality, including ecchymosis at venipuncture sites, absence of ICU admission, elongated prothrombin time (PT), vasopressor and glucocorticoid use, non-antifungals. Nomograms constructed on these predictors registered concordance indexes of 0.855 (95% CI: 0.826-0.884) and 0.778 (95% CI: 0.702-0.854) for SAPA onset and 42-day mortality, respectively. Lower survival rates for SAPA patients treated with glucocorticoids (p < 0.001) and improved 14-day survival with antifungal therapy (p = 0.036). Improving IPA management in SFTS-endemic areas is crucial, with effective predictive tool.

Regional versus general anesthesia for total hip and knee arthroplasty: a nationwide retrospective cohort study

IntroductionWe aimed to determine whether regional anesthesia (RA) has any advantages over general anesthesia (GA) in total joint arthroplasty (TJA) in terms of mortality and postoperative complications.MethodsThis population-based retrospective cohort...