30-day Mortality Research Articles

Utility of systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio as a predictive biomarker in pediatric traumatic brain injury

Background: Traumatic brain injury (TBI) remains the predominant cause of mortality and disability among the pediatric population. At present, there are no radiation-free, simple, and cost-effective tools available to assess the severity and prognosis of pediatric TBI. The systemic immune-inflammation index (SII), neutrophilto-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) serve as inflammatory biomarkers that may assist in predicting the outcome of pediatric TBI. This research aims to assess the utility of SII, NLR, and PLR as a predictive biomarker in children with TBI. Methods: A retrospective analysis was conducted on SII, NLR, and PLR by reviewing the medical records of all pediatric (age ≤18 years) TBI cases who came to the emergency department in the period from January 2023 to August 2024. Patients were categorized according to 28-day mortality and the severity of TBI. The correlation between the biomarkers and outcomes was analyzed. Results: A total of 206 patients were included in this study. The mean age was 13.81 (1–18). The 28-day mortality rate was 5.3% (n = 11). There were no significant differences in SII, NLR, and PLR between the survivor and mortality groups (P = 0.317, P = 0.288, and P = 0.200, respectively). Based on the TBI severity, there was a significant difference in the SII, NLR, and PLR across mild, moderate, and severe TBI (P = 0.006, P = 0.002, P = 0.001, respectively). Conclusion: The findings of our study did not reveal a significant predictive relationship between SII, NLR, and PLR to 28-day mortality. Nonetheless, there were significant differences in SII, NLR, and PLR among mild, moderate, and severe TBI groups. Further research under more controlled conditions is essential to facilitate the use of SII, NLR, and PLR as predictive biomarkers in pediatric TBI.

Bacteraemia over 4 years in a Greater Western Sydney Metropolitan Local Health District: a retrospective descriptive study.

Bacteraemia is associated with significant morbidity and mortality. Understanding local patterns of bacteraemia including pathogen distribution, infection source, clinical speciality team burden, susceptibility data and mortality rates can inform empiric antibiotic choices, prevention approaches and education strategies. To obtain descriptive data from positive blood cultures identified from Nepean Blue Mountains Local Health District in Greater Western Sydney. A retrospective descriptive study was performed from August 2018 to March 2023 with data extracted from electronic medical records. A total of 6720 isolates were identified from positive blood cultures, of which 71.2% were clinically significant. The median age was 69 years. A total of 74.6% of clinically significant isolates were acquired in the community. The most commonly isolated pathogen was Escherichia coli (31.3%), followed by Staphylococcus aureus (14.3%), and 8.6% of patients with clinically significant positive blood cultures were neutropenic. Neutropenic patients were more likely to have Pseudomonas aeruginosa as the causative pathogen (11.4%) compared to the entire study population (3.9%). The most commonly identified source of infection was the urinary tract. The 30-day all-cause mortality rate for clinically significant positive blood cultures was 16.8%, with higher mortality rates seen with Candida species (and species previously known as Candida), P. aeruginosa and Enterococcus species. 94% of bacteraemia from Enterobacterales tested susceptible in vitro to ampicillin and/or gentamicin. The rate of methicillin resistance in S. aureus was 24%. This study provides valuable insight into the local epidemiology of bacteraemia,which will allow for targeted prevention, management and educational strategies to improve outcomes.

Temporal Transitions of the Hyperinflammatory and Hypoinflammatory Phenotypes in Critical Illness.

Systemic molecular phenotypes of critical illness are prognostically informative, yet their temporal kinetics and implications of changing phenotypes remain incompletely understood. To determine the temporal nature of the Hyperinflammatory and Hypoinflammatory phenotypes and assess the impact of transition between the phenotypes on mortality. We used data from one prospective observational cohort (MARS) and two randomized controlled trials in ARDS (ALVEOLI) and sepsis (CLOVERS). Critically ill patients having biomarkers available at multiple timepoints (Day 0-4) were included. We employed a validated classifier model incorporating plasma interleukin-8, protein C and serum bicarbonate to assign phenotypes on each day. We determined the association of longitudinal phenotype transition and 90-day all-cause mortality. Data from 2407, 527 and 868 patients were included in MARS, ALVEOLI and CLOVERS, respectively. In MARS, 36.0% were classified by the parsimonious model as Hyperinflammatory at day 0, decreasing to 15.6% by day 2 and 6.3% by day 4. In ALVEOLI and CLOVERS, 26.4% and 24.8% of patients were Hyperinflammatory at day 0, decreasing to 13.4% and 5.7% at day 3, respectively. In all three cohorts, switching classification from Hyperinflammatory (Day 0) to Hypoinflammatory over time was associated with significantly improved mortality compared to persistently Hyperinflammatory patients. Mediation analysis indicated that only a minor proportion of this improvement could be attributed to ameliorating organ failure. The prevalence of the Hyperinflammatory phenotype, as assigned by a parsimonious biomarker classifier model, decreases over the first several days of critical illness, irrespective of ARDS diagnosis. The transition from Hyperinflammatory to Hypoinflammatory mediates a trajectory towards recovery beyond the resolution of organ failure.

Red cell distribution width to albumin ratio and mortality in acute pulmonary thromboembolism.

The red cell distribution width (RDW)/albumin ratio (RAR) is an inflammation-based prognostic biomarker. To date, its prognostic value in patients with pulmonary thromboembolism (PTE) has been investigated in only one study. This study aimed to assess the effect of RAR on mortality in patients with PTE. Patients admitted for PTE between 2017 and 2023 were retrospectively reviewed. The data collected included demographic information, comorbidities, clinical findings, RDW, albumin, troponin, D-dimer levels, and in-hospital and 30-day mortality outcomes. RAR was calculated by dividing the RDW by albumin. A total of 190 patients were included in the study, of whom 83 (43.7%) were male. The mean age was 63 years (range: 23-89), and the mean RAR was 4.48% ± 1.68% /g/dL. A positive correlation was observed between RAR and both age and troponin level, whereas inverse correlations were noted with systolic blood pressure (sBP), diastolic blood pressure (dBP), and oxygen saturation (SpO2). Using a cutoff value of 5.294 determined by ROC analysis, patients with RAR ≥ 5.294 had a significantly shorter mean survival time than those with RAR value < 5.294 (16.310 months vs35.163 months; log-rank test, P < 0.001). Multivariate Cox regression analysis identified malignancy (hazard ratio [HR], 4.213; 95% confidence interval [CI], 1.103-16.090; P = 0.035) and RAR (HR: 1.295, 95% CI: 1.035-1.621, P = 0.024) as independent predictors of survival. In conclusion, an RAR value ≥ 5.294 was associated with significantly shorter survival, underscoring its potential utility as a prognostic marker in clinical practice for non-massive PTE.

Diabetes does not increase in-hospital or short-term mortality in patients undergoing surgical repair for type A aortic dissection: insight from the national readmission database

BackgroundPrevious studies have reported a protective effect of type 2 diabetes on the incidence and progression of aortic aneurysms. We investigated whether this protective effect extends to aortic dissections.MethodsData from the US Nationwide Readmission Database (2016–2019) were analyzed. Patients admitted for open surgery repair of acute type A aortic dissection (TAAD) were initially analyzed (index group). Those discharged alive were followed for up to 30 days (readmission group). The co-primary outcomes were in-hospital and 30-day mortality.ResultsBetween 2016 and 2019, 7,324 patients were admitted for open surgical repair of acute TAAD, of whom 965 (13.2%) had diabetes. Patients with diabetes were older and had a higher prevalence of obesity, hypertension, smoking, dyslipidemia, and chronic kidney disease (CKD). 15.2% of patients with diabetes and 14.6% without diabetes died; hence, diabetes did not have a significant impact on in-hospital mortality (adjusted odd ratio [aOR] = 1.02 [0.84–1.24]). Similarly, diabetes was not associated with a higher adjusted risk of atrial fibrillation (aOR = 1.03 [0.89–1.20]), stroke (aOR = 0.83 [0.55–1.26]), cardiogenic shock (aOR = 1.18 [0.98–1.42]), but increased the risk of acute renal failure (aOR = 1.20 [1.04–1.39]). Within 30 days of discharge, 154 (15.9%) patients with diabetes and 952 (15%) from the non-diabetes group were readmitted. Readmitted patients with diabetes were older and had a higher prevalence of cardiovascular comorbidities. We didn’t observe any significant difference in the adjusted risk of 30-day mortality between the diabetes and non-diabetes groups (adjusted hazard ratio [aHR] = 0.81 [0.41–1.60]). However, diabetes was associated with a lower risk of readmission (aHR = 0.81 [0.68–0.97]). Age was the most significant predictor of all outcomes. CKD was the most significant predictor of 30-day mortality, with the risk increasing five-fold in patients with diabetes (HR = 5.58 [2.58–6.62]. Cardiovascular-related conditions were the most common causes of readmission in both groups. However, respiratory-related conditions were more prevalent in the diabetes group compared to the non-diabetes group (19.5% vs. 13%, respectively, p = 0.032).ConclusionsDiabetes does not increase in-hospital or short-term mortality in patients undergoing surgical repair for Type A aortic dissection.Graphical abstract

Lactate, lactate clearance, and lactate-to-albumin ratio in predicting mortality in patients with critical polytrauma: A retrospective observational study.

Lactate is a product of anaerobic metabolism used to determine prognosis in critically ill trauma patients. This study investigates the mortality-predictive performance of lactate, lactate clearance, and lactate-to-albumin ratio (LAR) on admission in patients with polytrauma in a tertiary center's intensive care unit (ICU). Polytrauma patients in the ICU between June 2019 and June 2022 were evaluated. The diagnosis of polytrauma was made according to the Berlin criteria, a widely accepted and comprehensive system for classifying the severity of multiple injuries. Patients were classified into survivor and mortality groups. The predictive performance of lactate, lactate clearance (24th hour), and LAR for 28-day mortality was compared. The study included 176 patients. The median age of the entire population was 35 (24-50) years, and 78.4% (n = 138) were male. Motor vehicle accidents were the most common cause of polytrauma in patients (48.9%, n = 86). The most common head injuries were detected in the patients (59.1%, n = 104). In the mortality group, median lactate and lactate (24th hour) levels were significantly higher (P < .001). Median albumin and LAR values were significantly lower (P < .001). Although 24-hour lactate clearance was lower in the mortality group, no significant difference was detected (36.1% vs 42.3%, P = .052). In multivariate regression analysis, LAR was an independent predictor of mortality (P < .001). In receiver operating characteristics curve analysis, the cutoff value of lactate was ≥5.4, the area under the curve (AUC) was 0.75 (95% confidence interval [CI], 0.66-0.84), the cutoff value of lactate clearance was ≤39.2, AUC was 0.60, (95% CI, 0.51-0.69), and the cutoff value of LAR was value ≥1.50, AUC 0.83 (95% CI, 0.75-0.90). In critically ill polytrauma patients, LAR on ICU admission is an independent predictor of mortality and has acceptable prognostic value. LAR is superior to lactate and 24-hour lactate clearance in predicting mortality.

Clinical Implications of the Skip Phenomenon in Patients with Persistent Staphylococcus aureus Bacteremia.

Intermittent negative blood cultures, known as the skip phenomenon (SP), frequently occur in patients with Staphylococcus aureus bacteremia (SAB), yet the clinical implications of SP in persistent SAB are not well understood. In this retrospective cohort study conducted at four university hospitals, SP was observed in 25 (11.3%) of 221 patients with persistent SAB. Infections involving methicillin-resistant S. aureus (MRSA) were more prevalent in patients with SP, who also experienced longer durations of bacteremia and delayed active antibiotic therapy compared with those without SP. The 30-day in-hospital mortality was lower in patients with SP than in those without SP (12.0% vs. 30.6%, respectively, p = 0.052). The median time from the initiation of active antibiotic therapy to the occurrence of SP was 6 days, and from SP to the last positive blood culture was 7 days. The duration of bacteremia and MRSA were independent predictors of SP. These findings suggest that SP can cause the duration of bacteremia to be underestimated by more than 1 week, indicating that confirmation of serial negative blood cultures might be necessary to reliably rule out SP in patients with prolonged MRSA bacteremia.

Strategies to reduce 28-day mortality in adult patients with bacteremia in the emergency department

BackgroundBacteremia, a common emergency department presentation, has a high burden of mortality, cost and morbidity. We aimed to identify areas for potential improvement in emergency department bacteremia management.MethodsThis retrospective cohort study included adults with bacteremia in an emergency department in 2019 and 2022. The primary outcome was 28-day mortality. Descriptive analyses evaluated demographics, comorbidities and clinical characteristics. Univariate and multivariate analyses identified mortality predictors.ResultsOverall, 433 patients were included [217 males (50.1%), mean ± SD age: 74.1 ± 15.2 years]. The 28-day mortality rate was 15.2% (n = 66). In univariate analysis, age ≥ 70 years, arrival by ambulance, arrhythmia, congestive heart failure, recent steroid use, hypotension (< 90/60 mmHg), mechanical ventilation, cardiac arrest, intensive care unit (ICU) admission, intravenous antibiotics, pneumonia as bacteremia source, non-urinary tract infections, no infectious disease consultation, no antibiotic adjustment and no control blood cultures were significantly associated with 28-day mortality (p < 0.05). Malignancy showed a statistical trend (0.05 < p < 0.15). The above-stated sixteen variables, identified in univariate analysis, were assessed via multivariate analysis. Primarily, clinical relevance and, secondarily, statistical significance were used for multivariate model creation to prioritize pertinent variables. Five risk factors, significantly associated with mortality (p < 0.05), were included in the model: ICU admission [adjusted OR (95% CI): 6.03 (3.08–11.81)], pneumonia as bacteremia source [4.94 (2.62–9.32)], age ≥ 70 [3.16 (1.39–7.17)], hypotension [2.12 (1.02–4.40)], and no infectious disease consultation [2.02 (1.08–3.78)]). Surprisingly, initial antibiotic administration within 6 h, inappropriate initial antibiotic regimen and type of bacteria (Gram-negative, Gram-positive) were non-significant (p > 0.05).ConclusionsWe identified significant mortality predictors among emergency department patients presenting with bacteremia. Referral to an infectious disease physician is the only modifiable strategy to decrease 28-day mortality with long-term effect and should be prioritized.

Association between endothelial activation and stress index and 30-day mortality risk in acute myocardial infarction patients: a study based on the medical information mart for intensive care-IV database

ObjectiveThis study aimed to evaluate the association between the Endothelial Activation and Stress Index (EASIX) and 30-day mortality risk in acute myocardial infarction (AMI) patients.MethodsUsing a retrospective cohort design, data were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database between 2008 and 2019. Patients diagnosed with AMI at intensive care unit (ICU) admission were included. EASIX score was calculated as follows: lactate dehydrogenase (LDH) level (U/L) × creatinine level (mg/dL)/platelet count (109/L). Cox regression models assessed the association between EASIX and 30-day mortality, with subgroup analyses based on age, gender, AMI subtype, and sepsis status.ResultsA total of 1,036 patients were analyzed, among whom 323 did not survive beyond 30 days post-ICU admission. Higher EASIX scores were associated with increased 30-day mortality in AMI patients [Hazard ratio (HR): 1.70, 95% confidence interval (CI): 1.17–2.46, P = 0.005). Subgroup analyses supported these findings and revealed significant interactions between EASIX and variables such as gender and AMI subtype (P < 0.05).ConclusionElevated EASIX scores are significantly correlated with increased 30-day mortality risk in AMI patients, suggesting EASIX as a valuable prognostic tool that may inform clinical management strategies to improve outcomes in AMI.Clinical trial numberNot applicable.

High level of systemic immune inflammation index elevates delirium risk among patients in intensive care unit

Evidence regarding the effect of systemic immune-inflammation index on delirium occurrence is limited. This study aimed to investigate the association between SII and delirium in intensive care unit (ICU) patients. Methods: Information was extracted from Medical Information Mart for Intensive Care-IV. Four logistic regression model was established and incorporated with subgroup analysis and restricted cubic spline (RCS). The cutoff value of SII was acquired from receiver operator characteristic curve (ROC), and propensity score matching (PSM) was utilized to attenuate the confounding effect. Survival analysis was utilized to evaluate the relationship between SII and 30-day or 90-day all-cause mortality. Results: Among the 7,518 participants, 1,685 cases of delirium occurred. Individuals in the highest quartile of SII exhibited a heightened delirium risk, with a significant multivariable-adjusted odds ratio (OR) of 3.12(2.24,4.33). Tendency analysis, subgroup analysis and PSM together confirmed the positive relationship. Results of Cox regression displayed the risk of both 30-day and 90-day mortality increased about 50% in the higher-SII group. Conclusion: Higher levels of SII is positively associated with the occurrence of delirium and increased all-cause mortality risk.

Association of Triglyceride glucose index with the outcomes of Ischemic stroke.

Background Ischemic stroke is a primary contributor to both mortality and disability on a global scale. The triglyceride-glucose index (TyG index), which measures insulin resistance, has been found as a possible predictor of outcomes of cerebrovascular events. Objective To examine the correlation between TyG index and outcomes in patients diagnosed with ischemic stroke. Methods This retrospective analysis of 200 patients diagnosed with ischemic stroke was carried out at the department of medicine, Khyber Teaching Hospital, Peshawar between 1st August 2022 and 31st December 2023. Triglyceride/glucose ratio was determined using the formula TyG = ln [Fasting triglycerides (mg/dl)/Fasting glucose (mg/dl)]/2. Patients were categorized into two Group A (TyG index &lt; 8.8) and Group B (TyG index &gt; 8.8). Demographic data, clinical features, and stroke outcomes, such as death and functional status (assessed by the modified Rankin Scale [mRS]), were compared between the two groups. Results Group A contained (112) patients and Group B (88). Both Group A and Group B had 51.8% (n=58) and 51.1% (n=45) male patients respectively. The mean age of patients in Group A was 65.4 ± 10.2 years and 67.1 ± 11.5 years in group B. 30-day mortality in group A was 8.0% (n=9) and 18.2% (n=16) in group B (p value 0.03). The median mRS score at 3 months in group A was 2.5 versus 3.5 in group B (p value = 0.02). Patients in Group B had longer hospital stay (10.5 ± 3.1days vs. 8.2 ± 2.4days, p = 0.01) and higher frequency of major adverse cardiovascular events (MACE) (15% vs. 7%, p = 0.05). Conclusion In ischemic stroke patients, 30-day mortality was more common with TyG index &gt;8.8 and the modified Rankin Scale (mRS) functional status at 3 months was better in TyG index &lt;8.8.

Hemospray as first-line treatment option for malignant gastrointestinal bleeding: A cost-utility analysis in the United Kingdom.

For managing malignant upper gastrointestinal bleeding (MUGIB), randomised control trial data have shown the haemostatic powder; Hemospray (TC-325), results in greater immediate haemostasis and lower 30-day rebleeding rates than standard endoscopic therapy (SET). We sought to determine if using TC-325 as a first-line option for patients with MUGIB would be cost-effective compared with SET in the United Kingdom. A decision tree was developed among patients with MUGIB, assessing initial therapy with TC-325 or SET over a 30-day time horizon. Patients with failed initial haemostasis, or a rebleed within 30 days, underwent further endoscopic treatment, escalation to either transcatheter arterial embolisation or surgery, or radiotherapy. Overall, 30-day mortality was applied. Costs, in Great British Pounds, were based on the United Kingdom National Health Services costs for 2023/2024. Results are reported as incremental differences in cost, quality-adjusted life years, and net monetary benefit. Deterministic and probabilistic sensitivity analyses and scenario analyses were performed. The cost of treating MUGIB patients with TC-325 was £245.88 lower than SET, with an incremental increase of 0.001 Quality Adjusted Life Years (QALYs). TC-325 remained cost-saving for sensitivity and scenario analyses. Probabilistic sensitivity analysis revealed TC-325 as more effective and cost-saving in 82.0% of simulations (range 68.8-97.8%). Initial treatment of MUGIB with TC-325 compared to SET is more effective (higher primary haemostasis and lower 30-day rebleeding) and cost-saving due to requiring fewer interventions, readmissions, and length of stay. Additional studies are needed to address model uncertainties in the follow-up management of these complex patients.

Intestinal epithelial-specific occludin deletion worsens gut permeability and survival following sepsis.

Sepsis induces intestinal hyperpermeability, which is associated with higher mortality. Occludin is a tight junction protein that plays a critical role in regulating disease-associated intestinal barrier loss. This study examined the role of intestinal occludin on gut barrier function and survival in a pre-clinical model of sepsis. Intestinal epithelial-specific occludin knockout (occludin KOIEC) mice and wild type controls were subjected to intra-abdominal sepsis and sacrificed at pre-determined endpoints for mechanistic studies or followed for survival. Occludin KOIEC mice had a significant increase in intestinal permeability, that was induced only in the setting of sepsis as knockout mice and control mice had similar baseline permeability. The worsened barrier was specific to the leak pathway of permeability, without changes in either the pore or unrestricted pathways. Increased sepsis-induced permeability was associated with increased levels of the tight junction ZO-1 in occludin KOIEC mice. Occludin KOIEC mice also had significant increases in systemic cytokines IL-6 and MCP-1and increased bacteremia. Further, occludin KOIEC mice had higher levels of jejunal IL-1β and MCP-1 as well as increased MCP-1 and IL-17A in the peritoneal fluid although peritoneal bacteria levels were unchanged. Notably, 7-day mortality was significantly higher in occludin KOIEC mice following sepsis. Occludin thus plays a critical role in preserving gut barrier function and mediating survival during sepsis, associated with alterations in inflammation and bacteremia. Agents that preserve occludin function may represent a new therapeutic strategy in the treatment of sepsis.

Higher patient-to-physician ratios associated with worse outcomes in the emergency department

ObjectiveTo investigate the association between patient-to-physician ratios, a measure of physician workload, and various patient outcomes in the emergency department (ED). MethodsThis retrospective observational study analyzed 406,220 ED visits at a tertiary care center in Taipei, Taiwan, between January 2015 and December 2019. The dynamic patient-to-physician ratio was calculated using minute-by-minute data to reflect real-time physician workload. Multivariable regression models, adjusted for potential confounders, assessed the association between this ratio and 7-day mortality (primary outcome), ED length of stay, waiting time, and medical expenses (secondary outcomes). Generalized additive models were used to explore non-linear relationships. Sensitivity analyses evaluated alternative mortality timeframes, missing data handling, and a simplified patient-to-physician ratio. External validation was performed using data from two additional hospitals. ResultsHigher patient-to-physician ratios were significantly associated with increased odds of 7-day mortality. Compared to ratios of less than 10, the adjusted odds ratios were 1.46 (95% CI 1.16, 1.83) for ratios between 10 and 19, 1.79 (95% CI 1.43, 2.25) for ratios between 20 and 29, and 1.95 (95% CI 1.53, 2.49) for ratios of 30 and above. Similar trends of increased risk were observed for longer ED length of stay, prolonged waiting times, and higher medical expenses. Sensitivity analyses using alternative mortality timeframes, missing data handling methods, and the simplified patient-to-physician ratio yielded consistent results, supporting the main findings. ConclusionsHigher patient-to-physician ratios are associated with worse outcomes for ED patients. Our findings suggest that maintaining ratios below 10 may be ideal for optimizing care quality, while ratios exceeding 20 pose significant risks to patients.

Fostamatinib for Hospitalized Adults With COVID-19 and Hypoxemia: A Randomized Clinical Trial.

Fostamatinib, a spleen tyrosine kinase inhibitor, has been reported to improve outcomes of COVID-19. To evaluate the efficacy and safety of fostamatinib in adults hospitalized with COVID-19 and hypoxemia. This multicenter, phase 3, placebo-controlled, double-blinded randomized clinical trial was conducted at 41 US sites and 21 international sites between November 17, 2021, and September 27, 2023; the last follow-up visit was December 31, 2023. Participants were adults aged 18 years or older hospitalized with acute SARS-CoV-2 infection and hypoxemia. Data were analyzed between January 10 and March 8, 2024. Fostamatinib, 150 mg orally twice daily for 14 days, or placebo. The primary outcome was oxygen-free days, an ordinal outcome classifying a participant's status at day 28 based on mortality and duration of supplemental oxygen use. An adjusted odds ratio (AOR) greater than 1.0 was considered to indicate superiority of fostamatinib over placebo. A key secondary outcome was 28-day all-cause mortality. Safety outcomes included elevated transaminase values, neutropenia, and hypertension. Of the 400 participants randomized (median age, 67 years [IQR, 58-76 years]; 210 [52.5%] men), 199 received fostamatinib and 201 received placebo. The mean (SD) number of oxygen-free days was 13.4 (12.4) in the fostamatinib group and 14.2 (12.1) in the placebo group (unadjusted mean difference, -1.26 days [95% CI, -3.52 to 1.00 days]; AOR, 0.82 [95% credible interval (CrI), 0.58-1.17]). Mortality at 28 days occurred in 22 of 195 patients (11.3%) in the fostamatinib group and 16 of 197 (8.1%) in the placebo group (AOR, 1.44; 95% CrI, 0.72-2.90). Aspartate aminotransferase elevation occurred more commonly in the fostamatinib group (23 [11.6%]) than in the placebo group (11 [5.5%]; AOR, 2.28; 95% CrI, 1.07-4.84). Other safety outcomes were similar between groups. In this randomized clinical trial of adults hospitalized with COVID-19 and hypoxemia, fostamatinib did not increase the number of oxygen-free days compared with placebo. These results do not support the hypothesis that fostamatinib improves outcomes among adults hospitalized with hypoxemia during the Omicron era. ClinicalTrials.gov Identifier: NCT04924660.

Utility of the PITT Bacteremia Score for Predicting Mortality in CRE Colonized and Infected Patients

Background: The Pitt Bacteremia Score (PBS) is used to predict 14-day inpatient mortality in bloodstream infections. This study evaluates whether PBS can also predict mortality in ICU patients colonized or infected with Carbapenem -resistant Enterobacterales (CRE). Methods: ICU patients with CRE were selected, and each PBS component was individually assessed. Outcomes were noted after 14 days, and a PBS cutoff score for mortality prediction was analyzed. Results: Of 30 patients, 26 (86%) expired and 4 (14%) survived. A PBS cutoff of ≥4 was associated with a significant increase in mortality. Conclusions: PBS ≥4 may be a valuable predictor of mortality in CRE-infected and colonized ICU patients."

Timing of Renal Replacement Therapy in Burn Patients With Acute Kidney Injury: A Retrospective Cohort Study.

Acute kidney injury (AKI) is common in severe burns with high mortality. Previous studies confirmed the renal replacement therapy (RRT) as an effective strategy in burn patients. However, the optimal timing of RRT initiation with AKI is rarely investigated. We conducted a single-center, retrospective cohort study at a large burn center in Chongqing, China, from 2010 to 2020. Patients were grouped into early (initiated at Kidney Disease: Improving Global Outcomes stage 1 or 2 of AKI) and delayed RRT (initiated at Kidney Disease: Improving Global Outcomes stage 3 of AKI). The primary outcome was in-hospital mortality. The secondary outcomes included renal function recovery, length of stay, and RRT-related complications. Of the included 79 patients, 42 and 37 were in early and delayed RRT group, respectively. The mean burn area was 68.82%. The in-hospital mortality tended to be higher in the early group (42.86%) than in the delayed group (29.73%, P = 0.227), although the difference was not statistically significant. The rate of partial remission of renal function at 48 hours after RRT discontinuation was significantly higher in the delayed group (78.26%) than early group (36.84%, P = 0.003). Furthermore, multivariable Cox and logistic regression analysis found that interval from AKI occurrence to RRT initiation was protective factors for 90-day mortality (hazard ratio 0.514, 95% confidence interval 0.349-0.756, P = 0.001), but fluid overload, acute respiratory distress syndrome, and multiple organ dysfunction syndrome were risk factors for mortality. Subgroup analysis revealed that patients with stage 1 or 2 AKI who received RRT within 24 hours after AKI had the lowest survival rate. In contrast, patients with stage 3 AKI who received RRT beyond 24 hours after AKI had the highest survival rate. The delayed group had higher rate of bleeding and lower rate of catheter-related infection than the early group. Delayed initiation of RRT seemed to have similar survival benefits to early RRT initiation in burn patients with AKI, needing further confirmation by large randomized clinical study in future.

Racial and Ethnic Disparities in Failure-to-Rescue After Postoperative Sepsis After Noncardiac Surgery.

Sepsis disproportionately affects marginalized communities. This study aims to evaluate racial and ethnic disparities in failure-to-rescue (FTR) after postoperative sepsis. This cross-sectional study used data from the American College of Surgeons National Surgical Quality Improvement Program for patients who underwent inpatient noncardiac surgery between 2018 and 2021. Patients were categorized as non-Hispanic White (hereafter, White), non-Hispanic Black (hereafter, Black), Asian, and Hispanic individuals. The association between (1) FTR after sepsis and (2) FTR after septic shock and race and ethnicity was evaluated using multivariable logistic regression. Failure-to-rescue was defined as 30-day mortality among patients who developed postoperative sepsis or postoperative septic shock. Among the 1388,977 patients (mean [SD] age 60.5 [16]); 783,056 (56.4%) were female, 1017,875 (73%) were White, 171,774 (12%) were Black, 138,457 (10%) were Hispanic, and 60,871 (4%) were Asian. Compared to White individuals, Black (adjusted odds ratio [aOR], 1.29; 95% CI, 1.23-1.35, P < .001) and Hispanic individuals (aOR, 1.15; 95% CI, 1.09-1.21, P < .001) were more likely to develop sepsis; Black individuals were more likely to develop septic shock (aOR, 1.28; 95% CI, 1.21-1.36; P < .001), and Asians were less likely to develop septic shock (aOR 0.84; 95% CI, 0.75-0.93, P = .002). Black individuals experienced lower rates of FTR after sepsis [Black: (aOR, 0.71; 95% CI, 0.54-0.94; P = .017), while Black (aOR, 0.93; 95% CI, 0.80-1.08; P = .35)], Hispanic (aOR, 0.87; 95% CI, 0.72-1.06; P = .16) and Asian Individuals (aOR, 1.06; 95% CI, 0.8-1.37; P = .67) experienced similar rates of FTR after septic shock compared to White individuals. Black and Hispanic individuals experienced higher rates of postoperative sepsis but did not experience higher rates of failure-to-rescue. Reducing inequity in surgical care should focus on efforts to prevent postoperative sepsis.

Optimal endoscopy timing in elderly patients presenting with acute non-variceal upper gastrointestinal bleeding

BackgroundTo evaluate the optimal endoscopy time in elderly patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) based on clinical outcomes.MethodsPatients over 65 years of age presenting with NVUGIB are three patient groups based on endoscopy timing: very early endoscopy (< 12 h), early endoscopy (12–24 h) and late endoscopy (> 24 h). Endoscopic intervention was undertaken during the first 12 h for patients who had unstable hemodynamic settings, ongoing bleeding, or a low hematocrit despite transfusion. The clinical outcomes investigated were: The primary endpoint was 30-day mortality, with the need for endoscopic intervention, rebleeding, and length of hospital stay considered as secondary endpoints.ResultsThe study population was 468, 260 of whom were ≥ 65 years. Based on the timing of endoscopy, very early endoscopy (within 12 h) was performed in 180 (69.2%) patients aged > 65 years and 150 (72.1%) younger patients (p > 0.05). Early endoscopy (12–24 h) was performed in patients aged > 65 years and younger patients 53 (20.4%) vs. 41 (19.7%), respectively, while late endoscopy (24–48 h) was performed in 27 (10.4%) vs. 17 (8.2%) patients, respectively (p > 0.05, for all parameters). The clinical results of subgroups based on endoscopy time in the ≥ 65 population and comparisons between groups. When groups were compared, it was found that the very early endoscopy group had a considerably lower likelihood of need for surgical/radiological intervention than the late endoscopy group [3 (1,7) vs. (3,7), p = 0.016], and 30-day mortality rates by the endoscopy timing were statistically significantly different in the very early group (15.6%), early endoscopy group (7.5%), and late endoscopy group (29.6%) (p < 0.05, for all groups). Endoscopy time within 24–48 h (late) (OR: 3.133, 95%Cl: 1.127–8.713, p: 0.029) was an independent predictor of rebleeding during the hospital stay.ConclusionsEarly endoscopy may benefit the management of acute UGIB, especially in the elderly population with high comorbidities and the severity of bleeding.

Hydrogen Peroxide Vapor Disinfection in Liver Transplantation: Effects on Multidrug-Resistant Organism Colonization and Recipient Outcomes

Introduction: The escalation of multidrug-resistant organism (MDRO) infections post-liver transplantation (LT) poses significant risks, with MDRO colonization amplifying infection susceptibility. Environmental disinfection is crucial in curbing healthcare-associated infections (HAI). Hydrogen peroxide vapor (HPV ) technology offers promise, yet its impact on MDRO infections and patient outcomes remains unclear. Methods: A cohort study enrolled 58 deceased adult LT recipients, comparing outcomes before and after routine HPV implementation. HPV disinfection followed terminal cleaning in surgical rooms and intensive care unit (ICU) boxes. Pathogen data included pre-transplant and post-discharge MDRO colonization. Clinical data covered recipient characteristics, disease severity, and donor-recipient relationships. Statistical analyses assessed associations and outcomes. Results: Twenty-seven patients were in the before-HPV group, 24 in the after-HPV group. Demographic and clinical characteristics were comparable between groups. HPV implementation significantly increased the likelihood of negative control swabs (odds ratio 2.33). Klebsiella pneumoniae carbapenemase was the most frequent pathogen, with surgical site infections being the primary site. Patients with negative swabs had shorter hospital stays (mean difference 10.54 days), notably diverging around the 8th day of hospitalization. HAI frequency and 90-day mortality were significantly lower in patients with negative swabs. Conclusion: HPV technology effectively reduced MDRO colonization in LT recipients. Negative swabs correlated with shorter hospital stays and lower HAI frequency, impacting 90-day mortality positively. Despite challenges in HPV implementation, its efficacy in reducing MDRO colonization suggests a valuable tool in infection control strategies for vulnerable populations like LT recipients.