Admission Mortality Research Articles

Impact of seasonal variation on hospital admission and in-hospital mortality of acute cardiovascular diseases: a contemporary nationwide database study

PurposeWhether acute cardiovascular diseases (CVDs), such as acute heart failure (AHF), acute myocardial infarction (AMI), and acute aortic dissection (AAD), have distinct seasonal variations in the number of hospitalizations and in-hospital mortality was investigated using a nationwide database in Japan. MethodsThe hospitalized patients with AHF, AMI, and AAD between April 2012 and March 2020 were identified. Multilevel mixed-effects logistic regression was conducted and adjusted odds ratio (aOR) was calculated. Also, the Poisson regression model was conducted to calculate the peak-to-trough ratio (PTTR) with peak month. ResultsPatients identified were as follows: 752,434 AHF patients (median age, 82 years; male, 52.2%), 346,110 AMI patients (median age, 71 years; male, 72.2%), and 118,538 AAD patients (median age, 72 years; male, 58.0%). The monthly proportion of hospitalized patients was the highest in winter and the lowest in summer in all three diseases. Based on aOR, 14-day mortality was the lowest in spring for AHF, summer for AMI, and spring for AAD. Furthermore, the PTTRs with peak month were 1.24 for AHF in February, 1.34 for AMI in January, and 1.33 for AAD in February. ConclusionsA clear seasonal pattern was observed in the number of hospitalizations and in-hospital mortality of all acute CVDs, independent of confounders.

Evaluation of electronic measurement of capillary refill for Sepsis screening at ED triage

ObjectiveTo evaluate the association between capillary refill time (CRT) measured by a medical device and sepsis among patients presenting to the Emergency Department (ED). MethodsThis prospective observational study enrolled adult and pediatric patients during ED triage when sepsis was considered a potential diagnosis by the triage nurse. Patients were enrolled at an academic medical center between December 2020 and June 2022. CRT was measured by a research assistant using an investigational medical device. The outcomes included sepsis and septic shock defined using sep-3 criteria, septic shock defined as IV antibiotics and a vasopressor requirement, ICU admission, and hospital mortality. Other measures included patient demographics and vital signs at ED triage. We evaluated univariate associations between CRT and sepsis outcomes. ResultsWe enrolled 563 patients in the study, 48 met Sep-3 criteria, 5 met Sep-3 shock criteria, and 11 met prior septic shock criteria (IV antibiotics and vasopressors to maintain mean arterial pressure of 65). Sixteen patients were admitted to the ICU. The mean age was 49.1 years, and 51% of the cohort was female. The device measured CRT was significantly associated with the diagnosis of sepsis by sep-3 criteria (OR 1.23, 95% CI 1.06–1-43), septic shock by sep-3 criteria (OR 1.57, 95% CI 1.02–2.40), and septic shock defined as receipt of IV antibiotics and a vasopressor requirement (OR 1.37, 95% CI 1.03–1.82). Patients with CRT >3.5 s measured by the DCR device had an odds ratio of 4.67 (95%CI 1.31–16.1) of septic shock (prior definition), and an odds ratio of 3.97 (95% CI 1.99–7.92) of ICU admission, supporting the potential for the 3.5-s cutoff of the DCR measurement. ConclusionsCRT measured by a medical device at ED triage was associated with the diagnosis of sepsis. Objective CRT measurement using a medical device may be a relatively simple way to improve sepsis diagnosis during ED triage.

Association of Serum Vit D level with in-Hospital Outcome in Patients with Acute Myocardial Infarction

Background: Low Vitamin D (Vit D) level is associated with disease severity amongst critical acute myocardial infarction (AMI) patients. This leads to the hypothesis that Vit D plays a role in the emergence of cardiac risk factors, contributing to worsening AMI patients' short- and long-term prognoses. Therefore, there is still unclear data showing the potential impact of Vit D insufficiency or deficiency on the morbidity and mortality of AMI patients. So far, there has been no research conducted in Pakistan examining whether or not Vit D status are association to the outcome of hospitalization for coronary artery disease. Objective: The objective of the study is to examine the relationship between Vit D status on hospital admission and subsequent mortality and morbidity among patients with acute myocardial infarction. Study Design: Cross sectional observational study Study Setting: This study was conducted in the department of Interventional Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi from Ist August 2022 to 31st January 2023. Methodology: Total 250 subjects were enrolled in the study and divided in to two groups. Group A with normal Vit D (30ng/ml or above) and Group B included lower Vit D level than 30ng/ml, all patients were suffering from AMI. Baseline demographic characteristics, including age, and gender (male/female), was recorded. The patients were tested for Vit D status and distributed in their respective groups. The history, complications, and clinical data were included. The stay in the hospital and any adverse outcomes that appeared during the stay were also recorded. The clinical results include HDL, TG, and troponin I of every patient were noted for the clinical correlation of AMI patients with adequate and deficiency of Vit D level. All the data was collected in the form of a questionnaire. The statistical analysis was done by using SPSS version 20. Results: Participants' mean ages were 53.8 and 5.9 years old. Group A (patients with low Vit D status) averaged 59.6 years of age, whereas Group B (58.9 years) had normal Vit D status. The analysis showed a statistically non- significant (p>0.05) difference in average age between the groups. There were 250 patients, with male 43.6% and female 56.4%. Men (63.2%) and women (36.8%) were in Group A. There were 71.4% males and 28.6% females in Group B. We found out the 137(60.6%) significant adverse hospital outcomes (p<0.001) in Group B and had a more significant proportion of patients with diabetes mellitus and who had smoked (p = 0.002 and 0.001, respectively). In a multivariate logistic regression smoking, diabetes, Troponin I and low vitamin showed the significant risk association (p<0.001). Practical Implication: There is still a lack of conclusive evidence on the relationship between vitamin D insufficiency or deficiency and the morbidity and mortality of AMI patients. Until far, there has been no research in Pakistan linking serum vitamin D levels to in-hospital outcomes for patients suffering from acute myocardial infarction. Conclusion: The research shows an association between low Vit D status, adverse outcomes, and clinical parameters after AMI. A low blood Vit D level is independently associated to an increased risk of developing severe clinical outcomes during hospitalization, including death after an AMI. Keyword: Vit D, AMI, Vit D deficiency, low Vit D, Cardiovascular disease

Abstract #1407267: In-hospital Outcomes of Myxedema Coma in Teaching Vs Non-teaching Hospitals

Many studies have analyzed current data on outcomes at teaching vs non-teaching hospitals, and the results have been found to be dissimilar in certain hospitalizations in the United States. this study set out to examine the differences in healthcare outcomes between teaching and non-teaching hospitals in patients who were admitted for myxedema coma using a nationally representative sample. We reviewed data from the National Inpatient Sample (NIS) of patients between 2016-2019. Using ICD-10 diagnosis codes, we identified patients who were admitted due to myxedema coma within the study period. We further categorized our study population into 2 groups based on teaching vs non-teaching status. Multivariate analysis was done to investigate the in-hospital outcomes between both groups and adjust for confounders. During the study period, 3,839 myxedema coma admissions were identified. Teaching hospitals received 70.7% (2,715) of these admissions, while non-teaching hospitals received 29.3% (1,124). The mean age of the cohort was 66 years, 70% were females and 69% were white. The mean length of stay (LOS) was 9.4 days and the average total hospital charge was 89,068 $. There was no significant difference in in-hospital mortality in both groups (OR 1.23, 95% CI 0.66 -2.27, p=0.507). The teaching hospital group had increased odds of acute respiratory failure (OR 1.6, 95% CI 1.07 – 2.4, p = 0.021), acute kidney injury (OR 1.48, 95% CI 1.04 – 2.1, p = 0.028), and bradycardia (OR 1.67, 95% CI 1.06 – 2.6, p = 0.025). No significant risk difference between the two groups in terms of hyponatremia (OR 0.91, 95% CI 0.6 – 1.36, p= 0.66), pericardial effusion (OR 0.87, 95% CI 0.41 – 1.8, p= 0.719) or sepsis (OR 1.38, 95% CI 0.69 – 2.7, p= 0.353). Hospital teaching status was associated with an increased mean LOS (10 vs 7.9 days, p=0.002) and mean total hospital charges (93,122 vs 79,336 $, p=0.035). The study clearly showed that patients admitted with myxedema coma in teaching hospitals have an increased risk of in-hospital outcomes including acute respiratory failure, acute kidney injury, and bradycardia compared to non-teaching hospitals. Teaching hospital status was not associated with increased in-hospital mortality in myxedema coma admissions.

Addition of platelet-lymphocyte ratio to risk factors to improve the early prediction of acute kidney injury and mortality in critically ill neonates.

To determine whether early neutrophil, lymphocyte, and platelet ratio (NLPR), neutrophillymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR), calculated based on easily available parameters in complete blood count, are associated with the development of acute kidney injury (AKI) and mortality during neonatal intensive care unit (NICU) stay, and to evaluate whether these ratios could act as a predictor of AKI and mortality in neonates. The pooled data of 442 critically ill neonates from our previously published prospective observational studies of urinary biomarkers were analyzed. Complete blood count (CBC) was measured on NICU admission. The clinical outcomes included AKI developed during the first 7 days after admission and NICU mortality. Of the neonates, 49 developed AKI and 35 died. The association of the PLR, but not NLPR and NLR, with AKI and mortality remained significant after adjustment for potential confounders including birth weight and illness severity as assessed by the score for neonatal acute physiology (SNAP). The area under the curve (AUC) of the PLR for predicting AKI and mortality was 0.62 (P=0.008) and 0.63 (P=0.010), respectively, with additional predictive value when combined with other perinatal risk factors. The combination of PLR with birth weight, SNAP, and serum creatinine (SCr) had an AUC of 0.78 (P<0.001) in predicting AKI, and its combination with birth weight and SNAP had an AUC of 0.79 (P<0.001) in predicting mortality. Low PLR on admission is associated with increased risk for AKI and NICU mortality. Although the PLR alone is not predictive of AKI and mortally, it adds predictive value to other risk factors for AKI prediction in critically ill neonates.

Predicting short-term and long-term mortalities from sepsis in patients who receive allogeneic haematopoietic stem cell transplantation.

Patients who receive allogeneic haematopoietic stem cell transplantation (allo-HSCT) may develop sepsis, which result in a highly intensive care unit admission rate and mortality. Therefore, short-term and long-term prognostic models for sepsis after allo-HSCT are urgently needed. We enrolled patients receiving allo-HSCT who developed sepsis after allo-HSCT at Peking University People's Hospital between 2012 and 2021, including 287 patients who received allo-HSCT in 2018-2021 in the derivation cohort, and 337 patients in 2012-2017 in the validation cohort. Multivariate logistic regression analysis was used to identify prognostic factors, and these identified factors were incorporated into two scoring models. Seven independent factors (acute graft-versus-host disease (GVHD), chronic GVHD (cGVHD), total bilirubin, lactate dehydrogenase (LDH) and organ dysfunction [renal, lung and heart]) were included in the 6-month prognostic model, and six factors (cGVHD, C-reactive protein, LDH, organ dysfunction [lung, neurologic and coagulation]) were included in the 14-day prognostic model. The area under the receiver operating characteristic curves, calibration plots and decision curve analysis demonstrated the robust predictive performance of the models, better than the Sequential Organ Failure Assessment score. Early identification of patients with high risk of 6-month and 14-day death may allow clinicians to provide timely treatments and improve the therapeutic effects.

The relationship between micronutrient status, frailty, systemic inflammation, and clinical outcomes in patients admitted to hospital with COVID-19

BackgroundMicronutrients have been associated with disease severity and poorer clinical outcomes in patients with COVID-19. However, there is a paucity of studies examining if the relationship with micronutrient status and clinical outcomes is independent of recognised prognostic factors, specifically frailty and the systemic inflammatory response (SIR). The aim of the present study was to examine the relationship between micronutrient status, frailty, systemic inflammation, and clinical outcomes in patients admitted with COVID-19.MethodsRetrospective analysis of prospectively collected data was performed on patients with confirmed COVID-19, admitted to hospital between the 1st April 2020–6th July 2020. Clinicopathological characteristics, frailty assessment, biochemical and micronutrient laboratory results were recorded. Frailty status was determined using the Clinical Frailty scale. SIR was determined using serum CRP. Clinical outcomes of interest were oxygen requirement, ITU admission and 30-day mortality. Categorical variables were analysed using chi-square test and binary logistics regression analysis. Continuous variables were analysed using the Mann–Whitney U or Kruskal Wallis tests.Results281 patients were included. 55% (n = 155) were aged ≥ 70 years and 39% (n = 109) were male. 49% (n = 138) of patients were frail (CFS > 3). 86% (n = 242) of patients had a serum CRP > 10 mg/L. On univariate analysis, frailty was significantly associated with thirty-day mortality (p < 0.001). On univariate analysis, serum CRP was found to be significantly associated with an oxygen requirement on admission in non-frail patients (p = 0.004). Over a third (36%) of non-frail patients had a low vitamin B1, despite having normal reference range values of red cell B2, B6 and selenium. Furthermore, serum CRP was found to be significantly associated with a lower median red cell vitamin B1 (p = 0.029).ConclusionVitamin B1 stores may be depleted in COVID-19 patients experiencing a significant SIR and providing rationale for thiamine supplementation. Further longitudinal studies are warranted to delineate the trend in thiamine status following COVID-19.

Clinical Acuity in the Emergency Department and Injury Severity Determine Hospital Admission of Older Patients with Low Energy Falls: Outcomes from a Prospective Feasibility Study.

Low energy falls (LEF) in older adults constitute a relevant cause for emergency department (ED) visits, hospital admission and in-hospital mortality. Patient-reported outcome measures containing information about patients' medical, mental and social health problems might support disposition and therapy decisions. We investigated the value of a tablet-based (self-)assessment in predicting hospital admission and in-hospital mortality. Patients 65 years or older, consecutively presenting with LEF to our level I trauma center ED (from November 2020 to March 2021), were eligible for inclusion in this prospective observational study. The primary endpoint was hospital admission; secondary endpoints were in-hospital mortality and the use of the tablet for self-reported assessment. Multivariate logistic regression models were calculated to measure the association between clinical findings and endpoints. Of 618 eligible patients, 201 patients were included. The median age was 82 years (62.7% women). The hospital admission rate was 45.3% (110/201), with an in-hospital mortality rate of 3.6% (4/110). Polypharmacy (odds ratio (OR): 8.48; 95% confidence interval (95%CI) 1.21-59.37, p = 0.03), lower emergency severity index (ESI) scores (OR: 0.33; 95%CI 0.17-0.64, p = 0.001) and increasing injury severity score (ISS) (OR: 1.54; 95%CI 1.32-1.79, p < 0.001) were associated with hospital admission. The Charlson comorbidity index (CCI) was significantly associated with in-hospital mortality (OR: 2.60; 95%CI: 1.17-5.81, p = 0.03). Increasing age (OR: 0.94; 95%CI: 0.89-0.99, p = 0.03) and frailty (OR: 0.71; 95%CI: 0.51-0.99, p = 0.04) were associated with the incapability of tablet use. The severity of fall-related injuries and the clinical acuity are easily accessible, relevant predictors for hospital admission. Tablet-based (self-)assessment may be feasible and acceptable during ED visits and might help facilitate comprehensive geriatric assessments during ED stay.

Comparing twodefinitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample.

The number of children cared for in emergency departments (EDs) with medical complexity continues to rise. We sought to identify the concordance between 2 commonly used criteria of medical complexity among children presenting to a statewide sample of EDs. We conducted a retrospective cross-sectional study of children presenting to a statewide sample of Illinois EDs between 2016 and 2021. We classified patients as having medical complexity when using 2 definitions (≥1 pediatric Complex Chronic Condition [CCC] or complex chronic disease using the Pediatric Medical Complexity Algorithm [PMCA]) and compared their overlap and clinical outcomes. Of 6,550,296 pediatric ED encounters, CCC criteria and PMCA criteria were met in 217,609 (3.3%) and 175,708 (2.7%) encounters, respectively. Among patients with complexity, 100,015 (34.1%) met both criteria, with moderate agreement (κ=0.49). Children with complexity by CCC had similar rates of presentation to a pediatric hospital (16.3%vs 14.8%), admission (28.5%vs 33.7%), ICU stay (10.0%vs 10.1%), and in-hospital mortality (0.5%vs 0.5%) compared to children with complexity by PMCA. The most common visit diagnoses for children with CCCs were related to sickle cell disease with crisis (3.9%), abdominal pain (3.6%), and non-specific chest pain (2.7%). The most common diagnoses by PMCA were related to depressive disorders (4.9%), sickle cell disease with crisis (4.8%), and seizures (3.2%). The CCC and PMCA criteria of multisystem complexity identified different populations, with moderate agreement. Careful selection of operational definitions is required for proper application and interpretation in clinical and health services research.

Acute Intracerebral Hemorrhage (ICH) and Systemic Acidosis: Associations with Functional Outcomes and Mortality (P7-5.026)

<h3>Objective:</h3> With this study we aimed to assess the association of respiratory and metabolic acidosis in ICH with functional outcome and mortality. <h3>Background:</h3> Systemic Acidosis is common in critical care settings and patients with intracerebral hemorrhage (ICH) frequently require intubation and ICU admission. The association between ICH and systemic acidosis has not been investigated. <h3>Design/Methods:</h3> Retrospective single center cohort of patients with acute spontaneous ICH. We examined the relationship between acidosis on admission and (1) hospital mortality and (2) 90-day modified Rankin Scale (mRS) dichotomized as unfavorable (&gt;3) vs favorable (≤3). Metabolic acidosis was defined by the presence of one of the following: Serum bicarbonate &lt;22 mEq/L, lactic acid &gt;2 mmol/L or pH &lt;7.35. Respiratory acidosis was defined by pCO2 &gt;45 mmHg. We further stratified our analysis by ICU vs general ward admission and intubation status. <h3>Results:</h3> There was a total of 406 patients, average age 80.5 (±1.5) years, 174 (43%) females and 232 (57%) males. 134 (33%) patients were acidotic on admission, 42 (10%) had respiratory acidosis and the remaining 92 (23%) had metabolic acidosis. There was no statistically significant association between metabolic acidosis with either hospital mortality (p=0.21, 95% CI [0.37–1.24]) or 90-day favorable functional outcome (p=0.61, 95% CI [0.37–1.24]) after adjustment for hematoma volume and expansion, Glasgow Coma Scale, and presence of interventricular hemorrhage. There was no association between respiratory acidosis with either hospital mortality (p=1.00) or functional outcome (p=1.00) before the adjustment for confounders. There was no effect modification after stratifying by ICU and intubation status. <h3>Conclusions:</h3> In this retrospective cohort study, we found that systemic acidosis was present in one third of patients with spontaneous ICH. Unlike other critical neurological conditions such as traumatic brain injury, there was no significant association between metabolic and respiratory acidosis with mortality and 90-day functional outcome in ICH. <b>Disclosure:</b> Dr. Andreev has nothing to disclose. Dr. Wilson has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Forsman has stock in Eli Lilly and Co. Dr. Forsman has stock in Moderna Inc. Dr. McMillan has nothing to disclose. Dr. Sahni has nothing to disclose. Dr. Selim has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MedRhythms Inc.. Dr. Lioutas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Qmetis. Dr. Lioutas has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association.

EVALUATION OF QUICK SOFA IN DIAGNOSIS AND PROGNOSIS OF SEPSIS PATIENTS TREATED AT HUE CENTRAL HOSPITAL (4/2018 - 3/2020)

Background: Sepsis is a life - threatening organ dysfunction. Previous consensuses defined sepsis as infection with systemic inflammation response syndrome (SIRS). The new 2016 consensus selected SOFA and Quick SOFA instead of SIRS in diagnosing sepsis. &#x0D; Objectives: 1. Describe clinical and subclinical characteristics of patients with sepsis. 2. Compare qSOFA and SIRS in the diagnosis and prognosis of the outcome of patients with sepsis. Subjects and method: Patients were diagnosed with sepsis based on the definition Sepsis - 2 (2001) or Sepsis - 3 (2016), treated at the Intensive Care Unit and the Department of Tropical Diseases, Hue Central Hospital. A prospective study.&#x0D; Results: There were 59 selected patients. The mean age was 60.22 ± 18.19 (28 - 90). Coagulation and cardiovascular dysfunction in patients with sepsis were the most common (61%), followed by kidneys (54%) and CNS (51%). Results of treatment: 44.1 % of patients had a septic shock; 28.8% died. In all patients, qSOFA ≥ 2 achieved rate was lower than SIRS ≥ 2 (72.9% compared to 98.3%). qSOFA0 had a high value in predicting ICU admission and had statistically significantly higher when compared to SIRS0. qSOFA0 had mean value in predicting in septic shock and had significantly higher when compared to SIRS0. qSOFA had a high value in predicting hospital mortality and had significantly higher when compared to SIR 0. &#x0D; Conclusion: SIRS is more noted than qSOFA in patients with sepsis. qSOFA0 has higher value than SIRS 0 in predicting ICU admission and hospital mortality in patients with sepsis.

Environmental factors are associated to hospital outcomes in COVID-19 patients during lockdown and post-lockdown in 2020: A nationwide study

ObjectiveThis study analyzed, at a postcode detailed level, the relation-ship between short-term exposure to environmental factors and hospital ad-missions, in-hospital mortality, ICU admission, and ICU mortality due to COVID-19 during the lockdown and post-lockdown 2020 period in Spain. MethodsWe performed a nationwide population-based retrospective study on 208,744 patients admitted to Spanish hospitals due to COVID-19 based on the Minimum Basic Data Set (MBDS) during the first two waves of the pandemic in 2020. Environmental data were obtained from Copernicus Atmosphere Monitoring Service. The association was assessed by a generalized additive model. ResultsPM2.5 was the most critical environmental factor related to hospital admissions and hospital mortality due to COVID-19 during the lockdown in Spain, PM10, NO2, and SO2and also showed associations. The effect was considerably reduced during the post-lockdown period. ICU admissions in COVID-19 patients were mainly associated with PM2.5, PM10, NO2, and SO2 during the lockdown as well. During the lockdown, exposure to PM2.5 and PM10 were the most critical environmental factors related to ICU mortality in COVID-19. ConclusionShort-term exposure to air pollutants impacts COVID-19 out-comes during the lockdown, especially PM2.5, PM10, NO2, and SO2. These pollutants are associated with hospital admission, hospital mortality and ICU admission, while ICU mortality is mainly associated with PM2.5 and PM10. Our findings reveal the importance of monitoring air pollutants in respiratory infectious diseases.

Correlation of Cardiotocography with neonatal outcome in term pregnancies at a tertiary care centre in Bihar, India: A prospective observational study

Early recognition of foetal distress by intrapartum cardiotocography (CTG) has a pivotal role in the improvement of perinatal outcome. So, the aim of this study was to correlate the findings of CTG with neonatal outcome.This Prospective Observational study was conducted on 300 pregnant women in labour having singleton term pregnancy with cephalic presentation. Intrapartum cardiotocography was done. CTG pattern was correlated with neonatal outcomes by analysing Apgar score, NICU admission and neonatal mortality rate. Statistical analysis was done by using chi square test and Fisher Exact test and p value &amp;#60; 0.05 was considered as statistically significant.Out of 300 patients, reactive CTG pattern was observed in 67% while suspicious and pathological pattern was observed in 22% and 11% of pregnancies respectively. The percentage of caesarean deliveries were significantly more among abnormal CTG group as compared to reactive group (p value &amp;#60; 0.0001). The sensitivity and specificity of CTG for predicting foetal distress and NICU admission was 80 % and 78.75% respectively. There was high NPV of 94.03%, and the diagnostic accuracy of test was 79%.Reactive CTG is more predictive of favourable neonatal outcomes while Pathological CTG tracing requires immediate intervention. Suspicious CTG requires close observation during intrapartum period after correcting underlying causes and taking conservative measures and Immediate delivery is not required unless it became pathological and hence caesarean section rate can be reduced in this group Overall, intrapartum CTG is an important screening tool for early identification of foetal distress.

Trends in management and outcomes of COVID patients admitted to a Swiss tertiary care hospital

Two successive COVID-19 flares occurred in Switzerland in spring and autumn 2020. During these periods, therapeutic strategies have been constantly adapted based on emerging evidence. We aimed to describe these adaptations and evaluate their association with patient outcomes in a cohort of COVID-19 patients admitted to the hospital. Consecutive patients admitted to the Geneva Hospitals during two successive COVID-19 flares were included. Characteristics of patients admitted during these two periods were compared as well as therapeutic management including medications, respiratory support strategies and admission to the ICU and intermediate care unit (IMCU). A mutivariable model was computed to compare outcomes across the two successive waves adjusted for demographic characteristics, co-morbidities and severity at baseline. The main outcome was in-hospital mortality. Secondary outcomes included ICU admission, Intermediate care (IMCU) admission, and length of hospital stay. A total of 2′983 patients were included. Of these, 165 patients (16.3%, n = 1014) died during the first wave and 314 (16.0%, n = 1969) during the second (p = 0.819). The proportion of patients admitted to the ICU was lower in second wave compared to first (7.4 vs. 13.9%, p < 0.001) but their mortality was increased (33.6% vs. 25.5%, p < 0.001). Conversely, a greater proportion of patients was admitted to the IMCU in second wave compared to first (26.6% vs. 22.3%, p = 0.011). A third of patients received lopinavir (30.7%) or hydroxychloroquine (33.1%) during the first wave and none during second wave, while corticosteroids were mainly prescribed during second wave (58.1% vs. 9.1%, p < 0.001). In the multivariable analysis, a 25% reduction of mortality was observed during the second wave (HR 0.75; 95% confidence interval 0.59 to 0.96). Among deceased patients, 82.3% (78.2% during first wave and 84.4% during second wave) died without beeing admitted to the ICU. The proportion of patients with therapeutic limitations regarding ICU admission increased during the second wave (48.6% vs. 38.7%, p < 0.001). Adaptation of therapeutic strategies including corticosteroids therapy and higher admission to the IMCU to receive non-invasive respiratory support was associated with a reduction of hospital mortality in multivariable analysis, ICU admission and LOS during the second wave of COVID-19 despite an increased number of admitted patients. More patients had medical decisions restraining ICU admission during the second wave which may reflect better patient selection or implicit triaging.

Dysnatremia in COVID-19 Patients-An Analysis of the COLOS Study.

Sodium imbalance is one of the most common electrolyte disturbances encountered in the medical practice, and it may present with either hyponatremia or hypernatremia. Both sodium abnormalities are related with unfavorable outcomes. Elucidation of the prevalence of dysnatremia among COVID-19 patients and its impact on 30- and 90-day mortality and need for ICU admission was the goal. A single-center, retrospective, observational study was conducted. A total of 2026 adult, SARS-CoV-2 positive patients, admitted to Wroclaw University Hospital between 02.2020 and 06.2021, were included. On admission, patients were divided into groups: normonatremic (N), hyponatremic (L), and hypernatremic (H). Acquired data was processed, and Cox hazards regression and logistic regression were implemented. Hyponatremia on admission occurred in 17.47% (n = 354) of patients and hypernatremia occurred in 5.03% (n = 102). Dysnatremic patients presented with more comorbidities, used more drugs, and were statistically more often admitted to the ICU. Level of consciousness was the strongest predictor of ICU admission (OR = 1.21, CI: 1.16-1.27, p < 0.001). Thirty-day mortality was significantly higher in both the L and H groups (28.52%, p = 0.0001 and 47.95%, p < 0.0001, respectively), in comparison to 17.67% in the N group. Ninety-day mortality showed a similar trend in all study groups: 34.37% in the L group (p = 0.0001), 60.27% (p < 0.0001) in the H group, and 23.32% in the N group. In multivariable analyses, hypo- and hypernatremia were found to be independent predictors of 30- and 90-day mortality. Both hypo- and hypernatremia are strong predictors of mortality and disease severity in COVID-19 patients. Extraordinary care should be taken when dealing with hypernatremic, COVID-positive patients, as this group exhibits the highest mortality rates.

Admission Heart Rate and Mortality in Critically Ill Patients with Acute Aortic Dissection.

The association between admission heart rate (HR) and the mortality of critically ill patients with acute aortic dissection (AAD) remains unclear.The data were extracted from the Medical Information Mart for Intensive Care (MIMIC-III) database. Cox regression models and Kaplan-Meier (KM) survival curve were used to explore the association between admission HR and 90-day, 1-year, and 3-year mortality in patients with AAD. Sensitivity analyses were conducted to assess potential bias.A total of 374 eligible AAD patients were included and divided in 4 groups according to admission HR (HR ≤ 70, 71-80, 81-90, and > 90 beats per minute (bpm) ). The patients with AAD in the group with HR > 90 bpm had higher 90-day, 1-year, and 3-year mortality than those in the groups with HR ≤ 70, 71-80, and 81-90 bpm. After adjusting for age, sex, BMI, systolic blood pressure, diastolic blood pressure, SOFA score, SAPSII score, Stanford type, hypertension, coronary artery disease, liver disease, atrial fibrillation, valvular disease, intensive care unit mechanical ventilation, aortic surgery, and thoracic endovascular aortic repair, patients with admission HR > 90 bpm had a higher risk of 90-day, 1-year, and 3-year mortality [adjusted hazard ratio, 95% confidence interval, 5.14 (2.22-11.91) P < 0.001; 4.31 (2.10-8.84) P < 0.001; 3.01 (1.66-5.46) P < 0.001] than those with HR 81-90 bpm. The 90-day, 1-year, and 3-year mortality were similar among the groups with HR ≤ 70, 71-80, and 81-90 bpm.Admission HR > 90 bpm was independently associated with all-cause mortality in critically ill AAD patients, either type A or B aortic dissection.

Association between lactate/albumin ratio and mortality in patients with heart failure after myocardial infarction.

Lactate/albumin ratio (L/A) is a recognized prognostic index of patients with heart failure (HF) after myocardial infarction (MI). We aim to evaluate the prognostic value of L/A ratio in predicting in-hospital mortality for those patients. We enrolled qualified patients from Medical Information Mart for Intensive Care IV database for retrospective study. A receiver operating characteristic (ROC) curve of the subjects was applied to determine the predicted value and the best cut-off value of L/A on admission. Univariate/multivariate Cox regression analysis and restricted cubic splines (RCS) were performed to identify the association between hospital admission and hospital mortality. The Kaplan-Meier (KM) method was used to draw the survival curve of the two groups with different L/A levels at admission. L/A values at admission were significantly higher in the death groups than the survival groups [1.36 (1.20) vs. 0.62 (0.36), P<0.05], and area under the ROC curve [0.780 (95% confidence interval, 0.772-0.827)] was better than other indicators, and the best the cut-off value was 0.671. Data of Cox regression analysis showed that higher L/A value supposed to be an independent risk factor for in-hospital mortality. RCS analysis showed evidence of an increasing trend and a non-linear relationship between L/A and in-hospital mortality (P value was non-linear <0.05). KM survival curves were significantly lower in the high L/A group than the low L/A group (P<0.001), and the former group had an increased risk of in-hospital mortality compared with the latter one (log rank P<0.001). Elevated L/A ratio on admission is an independent predictor of high in-hospital mortality in post-MI heart failure patients, which proved to be better than lactate, Sequential Organ Failure Assessment score and other related indicators.

Impact of Poorly Controlled Diabetes and Glycosylated Hemoglobin Values in Geriatric Hip Fracture Mortality Risk Assessment.

Introduction The presence of poorly-controlled diabetes in the setting of geriatric hip fractures has been shown to increase all-cause mortality and worsen outcomes. This study aimed to assess whether the addition of a patient's glycated hemoglobin (A1c) value to a validated geriatric inpatient risk tool improves the predictive capacity of the risk tool. Methods A cohort of 2430 patients >55 years old treated for low-energy mechanism hip fractures between October 2014 to November 2021 were reviewed for demographics (including diabetes diagnoses and their respective hemoglobin A1c values at the time of admission), injury details, hospital quality measures, and mortality. As past work demonstrated a hemoglobin A1c value above 8% to be the tipping point for worse outcomes, the baseline Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) tool for inpatient mortality in hip fractures (STTGMAHIP_FX_SCORE - Score for Trauma Triage in the Geriatric and Middle-Aged Hip Fracture Score) was modified to include a patient's hemoglobin A1c using an 8% cutoff (STTGMAHIP_8%A1c - Score for Trauma Triage in the Geriatric and Middle-Aged Hip 8% Hemoglobin A1c Cutoff Score). The new model's predictive ability (as measured by the area under the receiver operating curves (AUROCs)) for inpatient mortality was compared to the baseline tool using DeLong's test. Risk quartiles were generated for the new tool, and comparative analyses were conducted on hospital quality measures and outcomes. Results Five hundred and sixty-five patients (23%) were noted to have diabetes mellitus, and 76 patients had an A1c above 8%. Patients with a hemoglobin A1c above 8% had a higher rate of inpatient complications and mortality through one year.The STTGMAHIP_8%A1c score significantlyimproved the predictive capacity for inpatient mortality compared to STTGMAHIP_FX_SCORE(0.786 vs. 0.672, p=0.0456). Upon analysis of the risk quartiles,the highest risk cohort was found to have a longer length of stay (p<0.001), with higher rates of inpatient (p<0.001) and 30-day mortality (p<0.001) and need for admission to the intensive care unit (p<0.001) as compared to the minimal risk cohort. Patients in the lowest risk quartile were most likely to be discharged home (p<0.001). Conclusion Patients who present with a hemoglobin A1c above 8% experienced significantly worse outcomes than those below 8%. The inclusion of a patient's hemoglobin A1c as a cutoff score improves the STTGMAHIP_FX_SCOREtool to predict mortality and risk stratify patient outcomes. While diabetes presents another medical challenge to manage, providers may utilize this new variable to better highlight at-risk diabetic patients.

Association between admission systemic immune-inflammation index and mortality in critically ill patients with sepsis: a retrospective cohort study based on MIMIC-IV database.

Systemic immune-inflammation index (SII) has been identified as a prognostic biomarker for various diseases. Our study aimed to investigate the association between SII and mortality risk in critically ill patients with sepsis, thus exploring possible tools for rapid screening. This retrospective cohort study was conducted using clinical data extracted from the Medical Information Mart for Intensive Care Database. The study included only patients diagnosed with sepsis admitted to the intensive care unit for the first time. We used the restricted cubic splines to explore the relationship between SII and 28-day mortality. Kaplan-Meier curve and Cox regression models were performed to evaluate the association between SII and mortality. Subgroup analysis was performed to explore the stability of the primary results. A total of 16,007 patients with sepsis were eligible in the final analysis. We found a J-shaped relationship between SII and mortality risk. The SII level associated with the lowest mortality risk was 774.46*109/L. Compared with the reference group (second SII quartile), the 28-day mortality was increased in the highest quartile and third quartile groups of SII levels; fully adjusted HRs were 1.16 (1.02 to 1.32) and 1.40 (1.23 to 1.58), respectively. However, although the lower SII (Q1 group) also showed a trend toward a higher hazard of 28-day mortality, there was no statistical difference, with a fully adjusted HR of 1.05 (0.92 to 1.21). In the population of critically ill patients with sepsis, low and high SII levels were associated with an increased risk of short-term mortality. The 28-day mortality risk was lowest at SII levels of 774.46*109/L.

Hyponatremia and lower normal serum sodium levels are associated with an increased risk of all-cause death in heart failure patients.

To explore the relationship between the serum sodium level on admission and all-cause mortality in HF patients. A single-center retrospective cohort study. Patients hospitalized with HF at the Heart Failure Center, FuwaiHospital, from November 2008 to November 2018 were enrolled. A total of 3649 patients were included, and the mean sodium level was 137.19 ± 4.36 mmol/L, with a range from 115.6 to 160.9 mmol/L. During a median follow-up of 1101 days, mortality occurred in 1413 (38.7%) hospital survivors. After adjustment for age, sex, and other potential confounders, patients with sodium levels <135 mmol/L (hazard ratio [HR]: 1.67; 95% confidence interval [CI]: 1.29-2.16) and 135-137 mmol/L (HR: 1.34; 95% CI: 1.01-1.78) had an increased risk of all-cause mortality compared to those with sodium levels of 139-141 mmol/L.