30-day Mortality Research Articles

ABC score is a better predictor for 30-day mortality in upper gastrointestinal bleeding: A prospective single-center study.

Acute upper gastrointestinal bleeding (UGIB) still has a mortality rate of about 10%. Several pre-endoscopy scoring systems have been developed to predict the outcome, but none accurately predict mortality. The present study was aimed at comparing the new ABC score (age, blood tests and comorbidities) with other pre-existing scoring systems to predict mortality. This prospective single-center study was done at a tertiary hospital in India in 2022-2023. Patients > 18years presenting with UGIB within 48hours were included in the study. They were divided into variceal and non-variceal UGIB cohorts and were followed for 30days after receiving standard-of-care treatment. Out of 296 patients, 168 (56.7%) had variceal (V) bleed, while 128 (43.2%) individuals had a non-variceal (NV) type of GI bleed. The mortality rate was 9.8% (n = 29), which was higher among the V bleed group compared to the NV bleed group (8.7% vs. 1.1%). The area under the receiver operating characteristics(AUROC) for ABC score was the highest (0.75) compared to other scoring systems and was also more significant among deaths related to V bleed (0.76) than NV bleed (0.64). Hypoalbuminemia and > 3 blood transfusions are significant factors in predicting mortality. Our study demonstrates that the ABC score is superior to other scores in predicting 30-day mortality in patients with UGIB. ABC score may be a better predictor of mortality among V bleed patients than NV bleeds.

Clinical significance of lactate-to-albumin ratio in patients with influenza A virus-induced acute respiratory distress syndrome: a single-center retrospective study

BackgroundThe lactate-to-albumin ratio (LAR) is predictive of disease prognosis in some cases. However, the clinical significance of LAR in patients with influenza A virus-induced acute respiratory distress syndrome (ARDS) has yet to be explored. This study aims to investigate whether LAR can be used as a predictor of influenza A virus-induced ARDS.MethodsIn this single-center retrospective study, we enrolled 105 patients with influenza A virus pneumonia into the study and divided the patients into an ARDS group (74 patients) and a non-ARDS group (31 patients) during hospitalization. Clinical characteristics and laboratory data were collected within 24 h after admission. We explored the risk factors for ARDS using logistic regression analysis. The predictive performance of potential risk factors for ARDS and ARDS-associated complications were evaluated by receiver operating characteristic (ROC) curves, and Pearson’s correlation analysis was used to evaluate the correlations between risk factors and clinical and laboratory variables.ResultsLAR was an independent predictor for the development of ARDS in patients with influenza A virus pneumonia and was significantly predictive for ARDS. LAR’s area under the curve (AUC) was higher than that of lactate and albumin alone; its AUC was 0.878, with a sensitivity of 71.6% and a specificity of 96.8%. The optimal ROC threshold for distinguishing ARDS from non-ARDS cases was 44.81 × 10− 3. Correlation analysis indicated that LAR was positively associated with duration of invasive ventilation, and APACHE II and SOFA scores in ARDS patients but was negatively associated with PaO2/FiO2 (p < 0.001). Subsequent ROC curve analysis determined that LAR was a robust predictor for the 14-day invasive ventilation (AUC = 0.924), septic shock (AUC = 0.860), and hepatic injury (AUC = 0.905) in hospitalized ARDS patients. It also showed a promising predictive value for 28-day mortality (AUC = 0.881).ConclusionLAR strongly predicted ARDS development in patients with influenza A virus pneumonia. It showed a significant correlation with disease severity and provided promising predictive efficiency for extrapulmonary complications and 28-day mortality in patients with influenza A virus-induced ARDS.

Ramelteon exposure and survival of critically Ill sepsis patients: a retrospective study from MIMIC-IV

BackgroundThe effect of ramelteon, a melatonin receptor agonist, on survival in septic patients remains unknown. The purpose of this retrospective cohort study was to explore the relationship between ramelteon exposure and survival outcomes in septic patients.MethodsData from septic patients admitted to the intensive care unit (ICU) were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, with patients categorized into ramelteon exposure and non-exposure groups based on the use of ramelteon. The primary outcome was 30-day mortality, and secondary outcomes included 90-day mortality, in-hospital mortality, length of ICU stay, and hospital stay. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were employed to address confounding variables. Kaplan–Meier (K-M) analysis and Cox proportional hazards regression models for stepwise regression were utilized to assess the impact of ramelteon exposure on survival.ResultsThis study included 22,152 unexposed patients and 2,708 exposed patients, resulting in 2,607 matched pairs after PSM. Following PSM, ramelteon exposure was associated with significantly lower in-hospital mortality (11.6% vs.19.7%, p < 0.001), 30-day mortality (13.4% vs. 23.2%, p < 0.001), and 90-day mortality (22.1% vs. 30%, p < 0.001).K-M curves demonstrated a significant difference in 30-day and 90-day mortality between the two groups (P < 0.001), irrespective of PSM application. Both PSM (hazard ratio [HR] = 0.53, 95% confidence intervals [CIs] 0.47–0.61, p < 0.001) and IPTW models (HR = 0.59, 95% CI 0.50–0.70, p < 0.001) indicated a significant positive effect of ramelteon usage on 30-day mortality among septic patients compared to the non-exposure group.ConclusionsThis exploratory, retrospective study suggests an association between ramelteon exposure and reduced 30-day and 90-day mortality in septic patients compared with the non-exposure group. Considering the limitations of the retrospective design and the potential for unmeasured confounding, well-designed prospective studies and randomized controlled trials will be needed to confirm these findings.

Association between red cell distribution width and 30-day mortality in patients with sepsis-associated liver injury: a retrospective cohort study

BackgroundSepsis-associated liver injury (SALI) is a critical component of sepsis-induced multiple organ dysfunction with high mortality. Identifying biomarkers for risk stratification is essential. Red cell distribution width (RDW), indicating variation in red blood cell volume, has been linked to adverse outcomes in various diseases. This study aimed to evaluate the association between RDW and 30-day mortality in SALI patients.MethodsA retrospective cohort study was conducted using data from the Medical Information Mart for Intensive Care-IV database. Patients admitted to the intensive care unit (ICU) with SALI were included. RDW was recorded within the initial 24 h. The primary outcome was 30-day mortality. A multivariable Cox regression analysis was performed to examine the relationship between RDW and mortality.ResultsAmong 529 SALI patients (mean age 68.7 years, 61.8% male), 46.1% had RDW &amp;gt; 15.5%. The 30-day mortality rate was 35.5%. RDW was significantly higher in non-survivors compared to survivors (17.2 ± 3.0 vs. 15.4 ± 2.3, P &amp;lt; 0.001). Cox regression identified RDW as an independent risk factor for 30-day mortality (HR 1.14, 95% CI 1.09 to 1.19, P &amp;lt; 0.001). Subgroup analyses demonstrated that the findings were consistent across the various groups.ConclusionElevated RDW is independently associated with higher 30-day mortality in patients with SALI, suggesting its potential role in risk stratification and clinical management.

Association between red cell distribution width-to-lymphocyte ratio and 30-day mortality in patients with ischemic stroke: a retrospective cohort study

ObjectivesIschaemic stroke (IS) has become a major health problem globally as it is one of the leading causes of long-term disability and death. This study aimed to evaluate the association between red cell distribution width (RDW) to lymphocyte (LYM) ratio (RLR) and 30-day mortality risk in patients with IS.MethodsThe present study employed a retrospectively cohort study design with the adult data extracted from the Medical Information Mart for Intensive Care (MIMIC-III, MIMIC-IV) databases between 2001 and 2019. The RLR was measured using RDW and LYM. Confounders were adjusted in Cox proportional hazards model. The outcome was 30-day mortality. Univariable and multivariable Cox proportional hazards models were establised. A further analysis was conducted on the basis of subgroup stratification by heart failure (HF) (yes or no), atrial fibrillation or flutter (yes or no), hypertension (yes or no), dyslipidemia (yes or no), sepsis (yes or no), and age (≥ 65 years and < 65 years).ResultsIn this study, 1,127 adult patients with IS were finally identified. Among them,818 patients survived (the survival group) and 309 patients died (the death group). The mean age was older in individuals from the death group than those from the survival group (70.19 years vs. 64.56 years). The elevated levels of RLR were linked to an increased risk of mortality within 30 days in patients with IS, with an HR of 1.70 (95% CI: 1.34–2.17). Subgroup analyses showed that high RLR levels was a significant risk factor for mortality at 30 days particularly in IS patients aged ≥ 65 years, HF, no atrial fibrillation or flutter, no hypertension, no dyslipidemia, and no sepsis.ConclusionOur study shows that high levels of RLR were associated with an increased risk of 30-day mortality in patients with IS, providing additional prognostic information for the treatment and supportive care of these patients.

Continuous renal replacement therapy with adsorbing filter oXiris in the treatment of sepsis associated acute kidney injury: a single-center retrospective observational study

Background and objectiveCritical bedside ultrasound is widely used in clinical practice, and it can monitor renal perfusion. The reduction of renal perfusion and inflammatory injury are two contributing factors to sepsis-associated acute kidney injury (SA-AKI).The aim of this study was to examine whether the oXiris filter was useful in the continuous renal replacement therapy(CRRT) treatment of SA-AKI patients.Design, setting, participants, and measurementsWe performed a retrospective single-center observational study and enrolled two hundred and forty-three SA-AKI patients from January 2022 to December 2023, who were divided into the oXiris group (n = 88) and the control group (n = 155). The primary endpoints were the 28-day recovery of renal function and 28-day all-cause mortality. The secondary endpoints included renal Doppler markers (RRI, RVSI, and PDU), SOFA, vasoactive-inotropic score (VIS), inflammatory markers (PCT, CRP, IL-10 and TNFα), lactate level, and length of stay in ICU and hospital.ResultsFor the primary endpoint, the rates of complete recovery, partial recovery, and dialysis dependence were observed to be 60.3%, 13.6%, and 26.1% in the oXiris group, respectively, compared to 63.9%, 15.5%, and 20.6% in the control group. The 28-day all-cause mortality was not different in the two groups (22.7% vs. 27.1%). For the secondary endpoint, the oXiris group exhibited greater reductions in VIS scores compared to the control group within the first 24 h (p = 0.001) and 48 h (p < 0.001) of CRRT. Following 48-h of CRRT, lactate levels in the oXiris group were significantly lower than those in the control group (p = 0.014). Prior to CRRT, levels of IL-6 were higher in the oXiris group (p = 0.036), but these differences were not significant after CRRT (p > 0.05). The levels of RRI at T1 (p = 0.002) and T2 (p = 0.001) were lower in the oXiris group than in the control group. Even after adjusting for AKI stage, multivariable Cox regression analysis showed that SOFA and inflammatory factors (TNFα, IL-10, and IL-6), oXiris were significantly associated with a lower 28-day mortality among SA-AKI patients when compared to M150 [HR = 0.466, 95%CI 0.233–0.934, p = 0.031].ConclusionOur findings suggest that the use of the oXiris filter in CRRT is associated with reduced inflammatory injury and improvement in renal perfusion. However, it is not associated with improved 28-day recovery of renal function and 28-day all-cause mortality.

Risk factors and comorbidities associated with cardiac arrests and medical emergencies in interventional radiology patients

PurposeTo investigate the incidence, predictors, and outcomes of medical emergencies in patients undergoing IR procedures at a tertiary care center.Materials and methodsSeven-year retrospective review of all medical emergencies in patients undergoing IR procedures at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Medical emergencies included Cardiopulmonary arrest (CPA), or emergencies that required activation of the critical care response team (CCRT). Variables included demographics, procedure details and outcome data including complications and 30-day mortality. Multivariate logistic regression analysis was conducted to identify independent predictors of CPA and 30-day mortality.ResultsNinety-four patients (50% male) were included with a median age of 60.5 years. Recent or current ICU admission was recorded in 39 patients (43.8%). Comorbidities included diabetes (50%), hypertension (59.6%), coronary artery disease (25.5%), heart failure (21.5%), ESRD (28.7%), active infection 28 (31%), with ASA3 in 64 patients (68%) and ASA4 in 23 (24.5%).The incidence of CPA and CCRT activation was 0.045% and 0.049%, respectively, among 100,000 patients who underwent IR procedures during the study period. Half the events were with venous procedures, followed by non-vascular (33%) and arterial procedures (10.6%). 30-day mortality was 30.5%. Independent predictors of CPA included pulmonary disease (aOR 16.79, 95% CI 2.334–195.3, p = 0.0097), emergency procedures (aOR 11.63, 95% CI 2.517–72.46, p = 0.0035), general anesthesia (aOR 19.41, 95% CI 1.854–491.8, p = 0.0254), and sedation (aOR 13.04, 95% CI 2.081–118.8, p = 0.0108). Predictors of 30-day mortality were CPA (aOR 9.830, 95% CI 2.439–66.66, p = 0.0045) and hypotension as a complication (aOR 16.81, 95% CI 3.766–122.3, p = 0.0009).ConclusionOur findings highlight the complexity of patients undergoing IR procedures and the importance of identifying high-risk patients to prevent adverse events in the IR setting.

Presentation and Outcomes of Histoplasmosis in Transplant Recipients: A Retrospective Single-Centre Cohort Study.

Histoplasmosis is an important infection among transplant recipients. Few studies have described its epidemiology and outcomes in the modern era. We conducted a retrospective analysis using medical records from a single center in the United States. We included patients 18 years or older with histoplasmosis. We divided the cohort into transplant recipients and immunocompetent groups to assess the outcomes in both groups. We utilized Cox hazard models to assess 90-day all-cause mortality. The study included 137 patients; with 28 (20%) transplant recipients. After the first year post-transplant, patients with lung transplant (30%) had a diagnosis of histoplasmosis. Transplant recipients exhibited a significantly higher incidence of disseminated histoplasmosis than immunocompetent patients (64%vs. 34%, p = 0.001), higher admission to ICU (39%vs. 16%; p = 0.01) and higher but not significant 90-day crude all-cause mortality (14%vs. 11%, p = 0.71). Patients with transplants had a higher, but not significant hazard of all-cause mortality at 90 days (hazard ratio: 1.5; 95% confidence interval: 0.4-3.9) when compared to immunocompetent patients. Transplant recipients were more commonly diagnosed with histoplasmosis after the first year post-transplantation, and although they exhibited a higher hazard for death at 90 days, this increase was not statistically significant.

Low vs. conventional intra-abdominal pressure in laparoscopic colorectal surgery: a prospective cohort study.

Low intraabdominal pressure (IAP) during laparoscopy is associated with improved post-operative outcomes across a variety of surgical specialties. A prospective cohort study was undertaken to assess post-operative outcomes in patients undergoing laparoscopic colorectal surgery (LCRS) with low (8mmHg) versus conventional (15mmHg) IAP. A prospective real-world observational study of patients undergoing LCRS in a single-centre, between June 2020 and June 2023 was performed. Operative procedures for diverse colonic pathology such as diverticular disease, inflammatory bowel disease (IBD), and colorectal cancers (CRC) were included. The evaluated primary outcomes were post-operative pain, return of gastrointestinal motility, and length of hospital stay. Secondary outcomes were the overall safety profile including intra- and post-operative complications and morbidity. Outcomes of interest were investigated using multivariate analysis. A total of 120 patients were included of which 69 (57.5%) were male. Median age and BMI of the cohort was 67 years (51-75 years) and 27kg/m2 (24-32kg/m2), respectively. 61 (50.8%) patients were categorised as an ASA grade 3. Two (1.7%) patients had diverticular disease; 31 (25.9%) had IBD, and 87 (72.4%) were operated on for colonic malignancy. Low IAP (8mmHg) was used in 53 (44.2%) cases, whilst the remainder (55.8%) had IAP set at 15mmHg (conventional). Low-pressure surgery was associated with improved intraoperative lung compliance (p < 0.001) and peak inspiratory pressures up to 6h (p < 0.001); reduced analgesic requirement (p ≤ 0.028), and decreased postoperative pain both at rest (p = 0.001) and on exertion (p < 0.001). Moreover, low IAP was associated with an earlier time to pass flatus postoperatively (p = 0.047) with no significant difference in length of hospital stay (p = 0.574). Additionally, no significant difference was observed between the groups for outcomes including median operating time (p = 0.089), conversion to open surgery (p = 0.056), overall complication rate (p = 0.102), and 90-day mortality (p = 0.381). Low IAP use during LCRS is feasible with a comparable safety profile to conventional laparoscopy. Intra-operative respiratory physiology is improved with reduced postoperative pain and analgesic requirement, and earlier time to pass flatus. Future rationally designed; well-powered, randomised trials are needed to understand the benefits of low intra-peritoneal pressure during laparoscopic colorectal resections.

Acute kidney injury in elderly patients receiving invasive mechanical ventilation: early versus late onset

BackgroundAcute kidney injury (AKI) is a severe complication in critical patients receiving invasive mechanical ventilation (MV). However, AKI which occurs in the first 48 h after MV (early AKI) and thus likely associated with the MV settings is probably different from AKI occurring following 48 h (late AKI). This study is aimed at exploring the incidence of early and late AKI in elderly patients receiving MV and identifying their different risk factors and outcomes.MethodsThis retrospective, observational, multicenter cohort study consecutively included 3271 elderly patients (≥ 75 years) receiving invasive MV at four medical centers of Chinese PLA General Hospital from 2008 to 2020. The diagnosis of AKI was made following the 2012 KDIGO criteria and categorized into early (≤ 48 h) or late (> 48 h-7 days) according to the time from MV.ResultsThere were totally 1292 cases enrolled for the final analysis. Among them, 376 patients (29.1%) developed early AKI versus 132 (10.2%) developed late AKI. The 28-day mortality rates of the non-AKI, early AKI, and late AKI patients were 14.4, 46.8, and 61.4%, respectively. After 90 days, mortality rates of three groups were 33.2, 60.6, and 72.7%, respectively. Risk factors for early AKI included PaO2/FIO2, serum creatinine, hemoglobin, and positive end-expiratory pressure at the beginning of MV, while those for late AKI were PaO2/FIO2, serum creatinine, and hemoglobin. In the multivariable adjusted analysis, both early AKI (HR = 4.035; 95% CI = 3.166–5.142; P < 0.001) and late AKI (HR = 6.272; 95% CI = 4.654–8.453; P < 0.001) were related to the increased 28-day mortality relative to non-AKI. AKI was significantly related to 90-day mortality: early AKI (HR = 2.569; 95% CI = 2.142–3.082; P < 0.001) and late AKI (HR = 3.692; 95% CI = 2.890–4.716; P < 0.001).ConclusionsAKI mostly develops in the initial 48 h following MV, which is related to the health and MV settings; while AKI occurring following 48 h is not associated with MV settings. Therefore, a strategy for kidney protection in patients with MV should take these differences into consideration.

Australian Group on Antimicrobial Resistance (AGAR) Australian Staphylococcus aureus Surveillance Outcome Program (ASSOP) Bloodstream Infection Annual Report 2023.

From 1 January to 31 December 2023, fifty-seven institutions across Australia participated in the Australian Staphylococcus aureus Surveillance Outcome Program (ASSOP). The aim of ASSOP 2023 was to determine the proportion of Staphylococcus aureus bacteraemia (SAB) isolates in Australia that were antimicrobial resistant, with particular emphasis on methicillin resistance, and to characterise the methicillin-resistant S. aureus (MRSA) molecular epidemiology. A total of 3,422 SAB episodes were reported, of which 77.0% were community-onset. Overall, 16.1% of S, aureus were methicillin resistant. The 30-day all-cause mortality associated with methicillin-resistant SAB was 14.8%, which was not significantly different to the 16.5% all-cause mortality associated with methicillin-susceptible SAB (p = 0.44). With the exception of the β-lactams and erythromycin, antimicrobial resistance in methicillin-susceptible S, aureus (MSSA) was infrequent. However, in addition to the β-lactams, approximately 33% of MRSA were resistant to ciprofloxacin; 30% to erythromycin; 13% to tetracycline; 13% to gentamicin; and 3% to co-trimoxazole. Two New South Wales daptomycin-resistant MRSA, with minimum inhibitory concentrations (MICs) of 3.0 and 4.0 mg/L, were identified as ST22-IV, with a V351E mprF mutation, and ST45-V with a T345I mprF mutation respectively. Three daptomycin-resistant MSSA were identified. One from Tasmania, with a daptomycin MIC of 1.5 mg/L, identified as ST9295 with a L341I mprF mutation; one from New South Wales, with a daptomycin MIC of 3.0 mg/L, identified as ST97 with a L776S mprF mutation; and one from Western Australia, with a daptomycin MIC of 2.0 mg/L, identified as ST5. No previously reported mutations in known loci were detected in the Western Australian isolate. When applying the European Committee on Antimicrobial Susceptibility Testing breakpoints, teicoplanin resistance was detected in three MSSA isolates and one MRSA isolate. Vancomycin or linezolid resistance was not detected. Resistance to non-β-lactam antimicrobials was largely attributable to the healthcare-associated MRSA (HA-MRSA) clone ST22-IV [2B] (EMRSA-15), and the community-associated MRSA (CA-MRSA) clone ST45-V [5C2&5] which has acquired resistance to multiple antimicrobials including ciprofloxacin, clindamycin, erythromycin, gentamicin, and tetracycline. ST22-IV [2B] (EMRSA-15) was the predominant HA-MRSA clone in Australia. Overall, 85% of methicillin-resistant SAB were caused by community-associated MRSA (CA-MRSA) clones. Although polyclonal, approximately 70.3% of CA-MRSA clones were characterised as ST93-IV [2B] (Queensland clone); ST5-IV [2B]; ST1-IV [2B]; ST45-V [5C2&5]; ST30-IV [2B]; ST8-IV [2B]; ST6-IV [2B]; ST97-IV [2B]; and ST953-IV [2B]. As CA-MRSA is well established in the Australian community, it is important to monitor antimicrobial resistance patterns in community- and healthcare-associated SAB as this information will guide therapeutic practices in treating S, aureus bacteraemia.

Day 3 neutrophil-to-lymphocyte ratio and its derived indices predict 90-day poor outcomes following mechanical thrombectomy in acute ischemic stroke patients

ObjectiveTo investigate the dynamic changes in neutrophil–to–lymphocyte ratio (NLR) and its derived indices following mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) and evaluate their predictive value for prognosis.MethodsThis single-center retrospective cohort study included AIS patients who underwent MT at Zhongshan Hospital of Xiamen University from January 2018 to February 2024. Peripheral blood samples were collected on admission, day 1, and day 3 after MT to determine the NLR, derived NLR (dNLR), and neutrophil–monocyte–to–lymphocyte ratio (NMLR). The primary endpoint was poor functional outcome at 90 days (modified Rankin scale score 3–6). The secondary endpoints included post-operative hemorrhagic transformation, malignant cerebral edema, in-hospital mortality, and 90-day all-cause mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate predictive performance, and multivariate logistic regression models were employed to explore the independent associations between inflammatory markers and prognosis.ResultsA total of 423 eligible patients were included. Both groups showed similar dynamic trends in inflammatory markers, peaking on day 1 post-MT and subsequently declining. However, the poor outcome group (n = 255, 60.28%) maintained higher levels on day 3, whereas the good outcome group showed a significant decreasing trend. ROC curve analysis revealed that the NLR (AUC = 0.85, 95% CI: 0.81–0.89), dNLR (AUC = 0.86, 95% CI: 0.82–0.89), and NMLR (AUC = 0.85, 95% CI: 0.81–0.89) on day 3 post-MT had the strongest predictive power for 90-day poor outcomes. After comprehensive adjustment for confounders, these inflammatory markers were independently associated with 90-day poor outcomes: for each unit increase in the NLR, the risk of poor outcome increased by 38% (OR = 1.38, 95% CI: 1.28–1.49, p &amp;lt; 0.001); for dNLR, it increased by 104% (OR = 2.04, 95% CI: 1.73–2.40, p &amp;lt; 0.001); and for NMLR, it increased by 35% (OR = 1.35, 95% CI: 1.26–1.45, p &amp;lt; 0.001).ConclusionInflammatory markers (NLR, dNLR, and NMLR) on day 3 post-MT can serve as independent predictors of prognosis in AIS patients treated with MT. Dynamic monitoring of inflammatory markers may facilitate early risk stratification and guide individualized treatment strategies.

Mortality Patterns in Candidemia: Insights from a Multispecies Analysis Using a Global Research Network.

Understanding the impact of different Candida species on patient outcomes is crucial for effective management and treatment strategies. This study aims to comprehensively analyze the association between Candida species and mortality in documented candidemia. We queried TriNetX, a global research network database, to identify patients diagnosed with candidemia through polymerase chain reaction from 2020-2023. The primary outcome was mortality in candidemia patients, categorized by Candida species at 90 days and one year. The time to death was assessed using Kaplan-Meier plots. Cox proportional hazard (PH) models were also used for comparative analysis, unadjusted and adjusted for demographic and comorbidity covariates. We captured 1,234 candidemia episodes during the study period. The 90-day and 1-year mortality rates for the various Candida species were as follows: C. tropicalis (33.9% and 35.6%), C. glabrata (28.3% and 34%), multispecies (27.7% and 36.4%), C. parapsilosis (25.8% and 31.8%), C. krusei (21.4% and 28.6%), C. albicans (21.1% and 23.9%), and C. auris (13.3% and 15.9%). The unadjusted Kaplan-Meier Survival analysis showed that multispecies candidemia, followed by C. tropicalis, had the lowest survival. The adjusted multivariable Cox PH model found that C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, and multispecies candidemia had significantly higher mortality rates than C. auris. Age and a higher Charlson comorbidity index value emerged as independent predictors of increased mortality. Among patients with candidemia, we found an overall 1-year mortality of 28%. Multispecies candidemia, C. tropicalis, older age, and a higher comorbidity burden were associated with the highest mortality rates.

Severe Outcomes of Pneumocystis Pneumonia: A 10-year Retrospective Cohort Study.

A considerable knowledge gap exists in predicting severe Pneumocystis pneumonia (PCP) outcomes following PCP diagnosis. In this retrospective cohort, we studied immunocompromised patients with PCP admitted to 5 University Health Network centers in Canada (2011-2022). The study outcome included severe PCP, a composite of 21-day ICU admission or 28-day all-cause mortality. Adjusted odds ratios (aOR) estimated the association between severe PCP and comorbidities as well as clinical and laboratory variables at diagnosis. A total of 44 out of 182 (24.2%) immunocompromised patients (19 [10.4%] HIV-infected, 55 [30.2%] hematologic malignancies, 32 [17.6%] hematopoietic stem cell transplants, 32 [17.6% solid tumors, 26 solid organ transplants [14.3%], 12 (6.6%) autoimmune diseases, and 6 (3.3%) other immunosuppressive conditions) developed composite outcomes (40 ICU admissions [21.9%], 18 deaths [9.9%]). Patients with composite outcomes more often had acute-onset PCP (< 7 days) (18/34 [52.9%] vs. 38/126 [30.1%], p = 0.013), shortness of breath (39/44 [88.6%] vs. 96/136 [70.6%], p = 0.002), chronic liver disease (15/44 [34.1%] vs. 9/138 [6.5%], p < 0.001), hypoalbuminemia (median [IQR] albumin (g/L): 27 [25-31] vs. 32 [29-35], p < 0.001), elevated lactate dehydrogenase (median [IQR] LDH (U/L): 537 [324-809] vs. 340 [237-475], p < 0.001), lymphopenia (median [IQR] absolute lymphocyte count [(10*9/L),]: 0.4 [0.2-0.6] vs. 0.7 [0.3-1.2], p < 0.001), or required supplemental oxygen (39/44 [88.6%] vs. 60/136 [44.1%], p < 0.001) than those without composite outcomes. In multivariable analysis, chronic liver disease (aOR: 11.6, 95% CI: 2.2-61.3) and requiring supplemental oxygen on admission (aOR: 19.7, 95% CI: 3.0-128.5) were significantly associated with severe PCP. Alongside hypoxemia upon admission, chronic liver disease appears to significantly predict severe PCP in immunocompromised patients. This biologically plausible finding warrants further investigation.

Long-Term Outcomes and Late Complications of Thoracic Endovascular Aortic Repair Using the GORE TAG or Conformable GORE TAG.

Previous clinical studies have reported on the short- and mid-term prognoses of thoracic endovascular aortic repair (TEVAR) using the GORE thoracic aortic graft (TAG) or conformable GORE TAG. We evaluated the long-term prognoses of patients who underwent TEVAR using the GORE TAG or conformable GORE TAG in a real-world setting. This retrospective observational study analyzed the data of all consecutive patients aged 20 years or older who underwent TEVAR using either the GORE TAG or the conformable GORE TAG at a single center. The surgical criteria did not deviate from global standards. In principle, TEVAR was performed with the TAG or conformable thoracic aortic graft (CTAG) according to the manufacturer's instructions. The primary outcomes of this study were the 10-year overall survival rate and the rate of freedom from aorta-related deaths at 10 years. Between January 2011 and December 2021, 331 patients underwent TEVAR, of whom 175 consecutive patients treated with TEVAR using either the GORE TAG or the conformable GORE TAG were enrolled. The mean age of the patients was 72.1 ± 9.3 years. In addition, the aneurysm and chronic dissection were 61.7% and 38.3%, respectively. Of all patients, 157 had a proximal landing zone ≥3, and 18 had a zone <3. The mean follow-up time was 46.5 ± 33.1 months. The 30-day mortality rate was 2.86%. The 3-, 5-, 7-, and 10-year overall survival rates were 76.9 ± 3.4%, 63.4 ± 4.1%, 55.9 ± 4.9%, and 42.4 ± 8.4%, respectively. The rate of freedom from aorta-related deaths at 3, 5, 7, and 9 years was 97.4 ± 1.3%, 95.0 ± 2.1%, 95.0 ± 2.1%, and 95.0 ± 2.1%, respectively. Late complications occurred in 23 (13.1%) patients. Endovascular re-intervention was performed because of endoleak, false lumen enlargement, or stent graft-induced new entry tear in 14 patients. Three patients required open conversion, and 6 were observed without re-intervention. Thoracic endovascular aortic repair using the GORE TAG or conformable GORE TAG is a safe and effective procedure for the treatment of thoracic aortic aneurysms and aortic dissection. Thoracic endovascular aortic repair using the GORE thoracic aortic graft (TAG) or conformable GORE TAG is a safe and effective procedure for the treatment of thoracic aortic aneurysms and aortic dissection. The 30-day mortality rate was 2.86%. During 10 years of follow-up, the overall survival rate was low; however, the risk of aorta-related deaths was also low. No significant differences in freedom from late complications and re-intervention are seen between the TAG and conformable thoracic aortic graft (CTAG) groups. Further investigations into the treatment of late complications are required.

Serotype distribution and clinical characteristics of Group B Streptococcus Bacteremia in nonpregnant adults: a 15-Year Multicenter Study in Korea

BackgroundGroup B Streptococcus (GBS) bacteremia in nonpregnant adults is of increasing concern, particularly among the elderly in underlying conditions. This study analyzed the serotype distribution, antimicrobial resistance patterns, and clinical characteristics of GBS bacteremia in nonpregnant adults over a 15-year period in two tertiary hospitals in Korea.MethodsFrom 2007 to 2021, patients aged ≥ 19 years with GBS bacteremia were identified via retrospective electronic medical record review. GBS isolates were collected through a hospital-wide surveillance system and confirmed via MALDI-TOF-MS. Multilocus sequence typing (MLST) was conducted for serotype VIII and undetermined serotype isolates. Clinical and laboratory data were analyzed to assess trends and mortality risk factors.ResultsA total of 264 episodes of GBS bacteremia were identified, with 147 isolates successfully re-cultured and 125 isolates and patients included in the clinical characteristic analysis. Serotype VIII emerged as the most common serotype (42.1% in 2019–2021) with a significant increase in prevalence over time (P = 0.02). MLST of serotype VIII revealed ST2 as the dominant sequence type (87.8%). Antimicrobial resistance rates for erythromycin, clindamycin, and levofloxacin were 27.2%, 30.4%, and 23.2%, respectively, with notable variability among serotypes. The 30-day mortality rate was 12.8%. Male sex (aOR: 2.18; 95% CI: 1.15–4.13, P = 0.02) and SOFA score (aOR per unit increase: 1.25; 95% CI: 1.12–1.38, P < 0.001) were significantly associated with mortality.ConclusionsThis study highlights the emergence of serotype VIII as a predominant cause of GBS bacteremia and its association with ST2 in South Korea. Male sex and higher SOFA scores were independent risk factors for mortality. The findings emphasize the need for ongoing surveillance and consideration of serotype-specific strategies in clinical management and vaccine development.

Efficacy of Hemoadsorption combined with Continuous Renal Replacement Therapy in Patients with Rhabdomyolysis and Acute Kidney Injury: A Retrospective Study

Abstract Background Clearance of circulating myoglobin is crucial to prevent further damage in patients with rhabdomyolysis (RM) and acute kidney injury (AKI). The objective of the present study is to evaluate the efficacy and safety of hemoadsorption (HA) combined with continuous renal replacement therapy (CRRT) in critically ill patients with RM and AKI. Methods RM with AKI patients who received CRRT+HA or CRRT with concomitant creatine kinase (CK) greater than 10 000 IU/L in our intensive care unit between May 2021 and December 2023 were retrospectively included. The primary outcome was 90-day mortality; secondary outcomes were kidney function recovery and CK decline rate. Adverse events were also evaluated including hypotension, circuit clotting, albumin leakage, and blood loss. Propensity score matching (PSM) and Cox retrospective analysis were performed. Results A total of 111 RM patients with AKI were ultimately included. The ICU and in-hospital mortality were significantly lower in the CRRT+HA group compared with the CRRT group (ICU mortality: 18% vs. 42%, P = .025; in-hospital mortality: 21% vs. 42%, P = .048). However, the CRRT+HA group only showed a non-significant reduction in 90-day mortality compared with the CRRT group (47% vs. 68%, P = .063). After treatment for 90 days, the number of patients with kidney function recovery was not significantly different between CRRT+HA and CRRT groups (95% vs. 84%, P = .639). Moreover, the incidence of hypotension and circuit clotting events did not increase during CRRT+HA treatment. In addition, the CRRT+HA group also appeared to have a higher rate of CK reduction and reduction of CK than the CRRT group at 24 and 48 hours after the initiation of CRRT. Multivariate Cox regression model demonstrated that CRRT+HA (HR 0.477, 95% confidence interval (CI) 0.234-0.972; P = .042), mean arterial blood pressure (MAP) (per 1 mmHg, HR 0.967,95% CI 0.943-0.992; P=.009) and CRRT treatment duration (per 1 h, HR 0.995,95% CI 0.992-0.998; P = .002) played a favorably important role in the survival prognosis of RM and AKI patients. In contrast, serum phosphate before RRT (per 1mmol/L, HR 1.531, 95% CI 1.113-2.106; P = .009) and McMahon score (per 1 score, HR 1.15, 95% CI 1.006-1.313, P = .04) were independent risk factors for 90-day mortality. Conclusions CRRT combined with HA therapy reduced ICU and in-hospital mortality in patients with RM and AKI and also had a cleansing effect on creatine kinase without significant adverse events.

Urinary Output as a Predictor of Mortality in Cardiogenic Shock: An Explorative Retrospective Analysis

Background/Objectives: Cardiogenic shock (CS) remains a critical condition with high mortality rates despite advances in treatment. This study aimed to evaluate the prognostic significance of urinary output at various time intervals during CS and its effectiveness as a predictor of 30-day mortality, particularly in comparison to the Simplified Acute Physiology Score 3 (SAPS 3). Methods: We conducted a retrospective analysis of 96 patients diagnosed with CS, assessing urinary output at different intervals (0–6 h, 6–12 h, 12–24 h, and 0–24 h) as potential predictors of 30-day mortality. SAPS 3 was calculated for all patients, and its predictive value was compared to that of urinary output using both univariate and multivariate analyses. Additional analyses included ROC curve assessment and Kaplan–Meier survival analysis. Results: Urinary output at 6–12 h was significantly associated with 30-day mortality in univariate analysis. Area under the receiver operating characteristic curves (AUROCs) for urinary output at 0–6 h, 6–12 h, and 12–24 h was 0.61 (p = 0.07), 0.63 (p = 0.04), and 0.61 (p = 0.08), respectively. These AUROCs did not differ significantly between the three urinary output parameters. Regarding the cumulative urinary output of 0–24 h, the most pronounced impact was observed in patients producing less than 0.5 mL/kg/h. In multivariate analysis, when combined with SAPS 3, the predictive power of urinary output diminished. SAPS 3 alone demonstrated significant predictive value with an AUROC of 0.77 (p &lt; 0.001). Conclusions: While early urinary output is a valuable predictor of 30-day mortality in patients with CS, its prognostic strength is limited when considered alongside comprehensive risk assessments like SAPS 3. These findings suggest that a multifaceted approach, incorporating both early and comprehensive indicators, is essential for accurately predicting outcomes in CS patients.

Associations of sarcopenia and malnutrition with 30-day in-hospital morbidity and mortality after cardiac surgery.

Sarcopenia and malnutrition often occur simultaneously in adults with cardiovascular diseases. Our objective was to determine the associations of preoperative sarcopenia and malnutrition with major adverse cardiac and cerebral events (MACCE) after cardiac surgery. We retrospectively analyzed 154 consecutive patients who underwent elective cardiac surgery between January 2015 and June 2018 at two institutions in Japan. Sarcopenia and nutritional status were preoperatively assessed by bilateral psoas muscle volume index (PMVI) using CT scans and the prognostic nutritional index (PNI), respectively. The median age in the total cohort was 69 years, and 43% were women. Within 30 days after surgery, 20 patients developed in-hospital MACCE and 7 patients died of any cause. Low PMVI (<72.25 cm3/m2) and low PNI (<48.15) were each independent predictors of postoperative MACCE occurrence with odds ratios (95% confidence interval) of 3.58 (1.22-10.53) and 3.73 (1.25-11.09) when adjusted for age and sex, and 3.25 (1.07-9.87) and 3.27 (1.08-9.89) when adjusted for preoperative left ventricular ejection fraction, angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker, and anticoagulant. In addition, the combination of low PMVI and low PNI conferred the highest risk of in-hospital MACCE among the 4 groups (ie, the low PMVI, low PNI, low PMVI+low PNI, and neither low PMVI nor low PNI groups). Preoperative low PMVI and low PNI were respectively associated with 30-day in-hospital MACCE occurrence after cardiac surgery. Notably, coexistence of these reductions further enhanced the risk of postoperative MACCE.

Reintervention for Acute Aortic Prosthesis Endocarditis: Early and Mid-Term Outcomes

Objective: This study aimed to analyze the outcomes and challenges associated with surgical redo procedures following aortic valve replacement for acute infective endocarditis. While transcatheter aortic valve implantation is growing in terms of its utilization for degenerative bioprostheses failure, valve-in-valve procedures are limited in acute aortic endocarditis. Surgical interventions for aortic prosthesis endocarditis carry a significant risk, with a higher mortality and morbidity, often requiring concomitant complex procedures. Methods: This was a retrospective, monocentric, observational study. We identified 352 patients with infective endocarditis from the institutional database. After applying the inclusion and exclusion criteria, 54 patients who underwent surgical re-operation between 2016 and 2023 were included. Endpoints included early and late mortality, complications, and major adverse cardiac and cerebrovascular events (MACCEs). Results: From the cohort, predominantly male and with an average age of 71.9 ± 12.1 years old (79.6%), the following notable findings were derived: isolated aortic valve replacement was feasible only in 34 patients (63%) while more complex procedures were demanded in the other cases; the overall 30-day mortality rate was 18.5%, post-operative ECMO occurred in 9.3% of cases, and post-operative new stroke in 2.7%; the 5-year overall survival rate was 58.3 ± 18.6%, while freedom from MACCEs was 41.7 ± 19.7%. Another re-intervention was required in three patients during follow-up, with one case attributed to re-endocarditis. Conclusions: Despite advancements in surgical and perioperative care, redo procedures for acute infective endocarditis pose significant risks, as evidenced by the high 30-day mortality rate. However, the 5-year survival suggests a relatively acceptable outcome, underscoring the complexities and challenges inherent in managing this condition surgically.