Good Predictor Of Mortality Research Articles

Comparison of Different Prognostic Scoring Systems in Predicting the Severity and Outcome in Alcoholic Hepatitis in Indian Patients

Abstract Introduction: Alcohol abuse causes a variety of liver diseases including alcoholic steatosis, alcoholic hepatitis (AH), liver fibrosis, cirrhosis, and hepatocellular carcinoma. AH is a clinical syndrome which typically occurs after the harmful use of alcohol. There are mild forms that are likely to improve with conservative management, whereas severe cases are associated with a high mortality rate and have a high risk of death despite treatment. The identification of severe AH is important, as this can be associated with 30%–50% short-term mortality. Existing prognostic scores have been validated in the western population, and the data of application in the Indian population are scant. Materials and Methods: It is a prospective observational study conducted for 2 years at Tertiary Care Hospital Army Hospital (Research and Referral) Delhi. The sample size was kept to be 45. For each patient, clinical and laboratory values were obtained on the day of admission and used to calculate the prognostic models according to their formulas. The various scores – Maddrey’s discriminant function (mDF), Glasgow AH score (GAHS), age, bilirubin, international normalized ratio (INR), creatinine score, and model of end-stage liver disease (MELD) including its modification MELD-sodium were calculated. For patients started on steroids, early changes in bilirubin level and Lille score were calculated. Results: All the prognostic scores were found to be good predictors of mortality. When compared with each other, MELD was most indicative of mortality with maximum area under the receiver operating characteristic curve. All the scores were significantly higher in the nonsurvivors than the survivors (P < 0.0001). Conclusion: AH is a clinical syndrome that occurs after the harmful use of alcohol and confers a high mortality. Effective treatment and support for patients with AH is dependent on a proper assessment of the disease severity and estimation of the risk of death as early in the course of the disease as possible.

Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study

Background: Major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care. Methods: This was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression. Results: A total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and probability of survival scores. Factors independently predictive of mortality were increasing age (OR 1.06, p <0.001) and GCS <15 on admission (OR 7.21, p <0.001). Ps19 was the best predictor of mortality (p <0.001 for each score category), with an AUROC of 0.90. Conclusions: The significant mortality predictors were age, fall from <2 metres, injury of head or limbs, GCS <15 and Ps19. Contrary to previous studies CCI and APACHE II did not significantly predict mortality. Although Ps19 was found to be the best current prognostic score, trauma prognostication would benefit from a single validated scoring system incorporating both physiological variables and injury patterns.

Evaluating the conservation benefit of circle hooks for the Atlantic Striped Bass recreational fishery

AbstractObjectiveThe Striped Bass Morone saxatilis is one of the most sought‐after recreational fish species along the US Atlantic coast. Regulations and a strong conservation ethic among anglers make Striped Bass among the most frequently released coastal marine fishes. A recent rule requires anglers to use circle hooks when targeting Striped Bass with natural baits, yet the conservation benefit of this action remains unclear.MethodsWe used acoustic telemetry to monitor the fate of Striped Bass that were recreationally caught with baited hooks (n = 349) and to estimate the influence of various biological (fish size), fishery (fight time, handling time, hook location, bait type, and hook type), and environmental (water temperature and air temperature) variables on postrelease survival.ResultA semi‐quantitative score of fish release condition was the single best predictor of mortality. A broader dataset that included untagged fish (n = 716) was used to identify the best predictors of fish release condition, which included hook location and handling time.ConclusionContrary to expectations, the circle hooks used in this study did not result in lower release mortality than conventional J‐hooks.

Utility of computed tomography in assessing caustic ingestion damage to the esogastric tract

BackgroundIngestion of corrosive substances represents a frequent and consequential medical scenario, significantly impacting both vital and functional prognoses through the emergence of acute complications or stenosis, which pose considerable therapeutic challenges. Currently, endoscopy remains the cornerstone modality for diagnostic assessment and management. Nevertheless, recent research highlights computed tomography (CT) as a promising alternative, avoiding the risks associated with endoscopy and reducing the unnecessary surgical interventions based on its findings.MethodsOur retrospective study, spanning three years, encompassed 28 patients who had ingested corrosive substances. Among them, 24 underwent both CT scanning and endoscopic evaluation using CT and endoscopic scores.ResultsEmploying Standardized CT scoring criteria alongside the Zargar’s endoscopic classification, our findings revealed significant concordance between the two modalities, particularly in discerning trans-parietal necrosis within the esophagus and stomach. Notably, radiographic evidence of digestive tract injury was found to be predictive of complications in over 80% of cases, demonstrating high sensitivity and negative predictive value. Furthermore, CT scores indicating moderate to severe injury were significantly associated with stenosis, with slightly inferior performance compared to endoscopy. Of particular note, a CT score indicative of severe injury was found to be a good predictor of mortality, further underscoring the prognostic value of CT in these cases.ConclusionWhile the utility of CT in this context is undeniable, its integration with endoscopic findings remains imperative. We advocate for a systematic approach incorporating CT scanning, with further prospective research warranted to explore the feasibility of CT as a standalone diagnostic tool, as suggested by some scholars.

Trajectories and predictive significance of inflammatory parameters for clinical outcome in COVID-19 patients treated with tocilizumab.

The IL-6 receptor inhibitor tocilizumab reduces mortality and morbidity in severe cases of COVID-19 through its effects on hyperinflammation and was approved as adjuvant therapy. Since tocilizumab changes the levels of inflammatory markers, we aimed to describe these changes in patients treated with tocilizumab, analyse their value in predicting death and bacterial superinfection and determine their influence on mortality rates. A retrospective analysis of 76 patients who were treated with tocilizumab for severe COVID-19 in 2020 and 2021 was conducted. Inflammatory markers (IL-6, C-reactive protein (CRP), procalcitonin) were documented before and up to seven days after tocilizumab administration. The overall mortality was 25% and 53.8% in patients who required invasive respiratory support. Deceased patients had higher baseline IL-6 (p = 0.026) and peak IL-6 levels after tocilizumab vs those who survived (p < 0.0001). A peak IL-6 value > 1000pg/dl after tocilizumab administration was a good predictor of mortality (AUC = 0.812). Of the deceased patients 41.1% had a renewed CRP increase after an initial decrease following tocilizumab administration, compared to 7.1% of the surviving patients (p = 0.0011). Documented bacterial superinfections were observed in 35.5% (27/76) of patients, of whom 48.1% (13/27) died. CRP-decline and IL-6 increase after tocilizumab treatment occurs regularly. An increase of IL-6 levels exceeding tenfold of baseline IL-6 levels, an absolute peak of 1000pg/ml or a renewed increase of CRP are associated with higher mortality. Suppressed CRP synthesis can impede the diagnosis of bacterial superinfections, thus increasing the risk for complications.

Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study

Background: Major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care. Methods: This was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression. Results: A total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and probability of survival scores. Factors independently predictive of mortality were increasing age (OR 1.06, p &lt;0.001) and GCS &lt;15 on admission (OR 7.21, p &lt;0.001). Ps19 was the best predictor of mortality (p &lt;0.001 for each score category), with an AUROC of 0.90. Conclusions: The significant mortality predictors were age, fall from &lt;2 metres, injury of head or limbs, GCS &lt;15 and Ps19. Contrary to previous studies CCI and APACHE II did not significantly predict mortality. Although Ps19 was found to be the best current prognostic score, trauma prognostication would benefit from a single validated scoring system incorporating both physiological variables and injury patterns.

Assessment of systemic immune-inflammatory index and other inflammatory parameters in predicting mortality in patients with acute cholecystitis: A retrospective observational study

Objective: To investigate the effectiveness of the systemic immune- inflammatory (SII) index and other inflammatory parameters in predicting mortality among patients with acute cholecystitis (AC). Methods: 279 Patients presented to the emergency department with abdominal pain and diagnosis of AC between September 2021 and September 2023 were included in the study. Demographic data, laboratory parameters, clinical follow-ups, and outcomes of the patients were recorded. Results: The mean age of the patients was (55.0±16.3) years and 36.6% were male. 63.8% Had gallbladder/choledochal stones and 49.5% underwent surgery. The mortality rate was 6.1%. Advanced age (P=0.170) and prolonged hospitalization (P=0.011) were statistically significant risk factors for mortality. Decreased lymphocyte count (P=0.020) and increased C-reactive protein (CRP) levels (P=0.033) were found to be risk factors for mortality. According to the mortality predictor ROC analysis results, the cut-off for SII index was 3 138 (AUC=0.817, sensitivity=70.5%, specificity=84.7%), the cut-off for neutrophil count was 15.28×103/ mm3 (AUC=0.761, sensitivity=52.9%, specificity=95.0%), the cut-off for leukocyte count was 19.0×103/mm3 (AUC= 0.714, sensitivity=52.9%, specificity=98.0%), cut-off for CRP was 74.55 (AUC=0.758, sensitivity=70.5%, specificity=79.0%), cut-off for aspartate transaminase (AST) was 33.0 IU/L (AUC=0.658, sensitivity=82.3%, specificity=50.3%). Conclusions: The SII index may be a good predictor of mortality with high sensitivity and specificity. Elevated levels of neutrophils, leukocytes, CRP, and AST are other inflammatory parameters that can be used to predict mortality associated with AC.

What is the best predictor of mortality in patients with type 2 diabetes and chronic kidney disease: mean, variability of HbA1c or HbA1c-Hemoglobin ratio?

AimLimitations in the measurement of glycated hemoglobin (HbA1c) in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) result in uncertainty about the best predictor of mortality among these patients. Our study aimed to determine the association between the mean and average real variability (ARV) of HbA1c, as well as HbA1c-hemoglobin (HH) ratio with mortality among patients with T2D and CKD.Materials and methodsWe identified 16,868 T2D patients with stage 3 or above CKD from outpatient visits during 2003–2018. We ascertained all-cause and cardiovascular mortality through linkage to Taiwan’s National Death Registry. Mortality rates were estimated using the Poisson distribution, and we conducted Cox proportional hazards regressions to assess relative risks of mortality corresponding to the mean HbA1c, ARV of HbA1c and HH ratio.ResultsCompared to patients with a mean HbA1c of 7.0–7.9%, a mean HbA1c < 7.0% was persistently associated with highest risk of all-cause but not cardiovascular mortality after adjusting for confounders. On the contrary, patients with HbA1c-ARV in the second to fourth quartiles and HH ratios in the higher quartiles showed increased risk of all-cause and cardiovascular mortality compared to those in the first quartiles.ConclusionsHbA1c-ARV was more effective than mean HbA1c or HH ratio in predicting mortality in T2D patients with CKD. Apart from optimal glucose control, multidisciplinary care focusing on glycemic variability is essential for reducing mortality in these patients.

Assessment of Albumin-Incorporating Scores at Hepatocellular Carcinoma Diagnosis Using Machine Learning Techniques: An Evaluation of Prognostic Relevance.

Hepatocellular carcinoma (HCC) presents high mortality rates worldwide, with limited evidence on prognostic factors at diagnosis. This study evaluates the utility of common scores incorporating albumin as predictors of mortality at HCC diagnosis using Machine Learning techniques. They are also compared to other scores and variables commonly used. A retrospective cohort study was conducted with 191 patients from Virgen de la Luz Hospital of Cuenca and University Hospital of Guadalajara. Demographic, analytical, and tumor-specific variables were included. Various Machine Learning algorithms were implemented, with eXtreme Gradient Boosting (XGB) as the reference method. In the predictive model developed, the Barcelona Clinic Liver Cancer score was the best predictor of mortality, closely followed by the Platelet-Albumin-Bilirubin and Albumin-Bilirubin scores. Albumin levels alone also showed high relevance. Other scores, such as C-Reactive Protein/albumin and Child-Pugh performed less effectively. XGB proved to be the most accurate method across the metrics analyzed, outperforming other ML algorithms. In conclusion, the Barcelona Clinic Liver Cancer, Platelet-Albumin-Bilirubin and Albumin-Bilirubin scores are highly reliable for assessing survival at HCC diagnosis. The XGB-developed model proved to be the most reliable for this purpose compared to the other proposed methods.

Biochemical Signals of Survival: A Study on Mortality Markers in Coronary Bypass Surgery Patients.

Coronary bypass surgery remains a cornerstone treatment for advanced coronary artery disease. Identifying reliable predictors of postoperative mortality can significantly enhance patient care and outcomes. This study investigates the prognostic value of preoperative and postoperative amylase levels, creatinine, alanine aminotransferase, and aspartate aminotransferase as mortality markers in coronary bypass surgery patients. We conducted a retrospective analysis of 343 patients who underwent coronary bypass surgery. We compared the preoperative and postoperative biochemical markers (amylase, creatinine, alanine aminotransferase, and aspartate aminotransferase) of patients who died within the first week post-surgery (n = 52) and those who survived (n = 291). Statistical analyses included chi-square tests for categorical variables, t-tests for continuous variables, and receiver operating characteristic analysis for predicting mortality. No significant difference was observed in the distribution of blood groups between deceased and surviving patients. However, significant differences were noted in gender distribution and mean ages, with higher mortality observed in older and male patients. Preoperative creatinine levels were significantly higher in patients who died compared to survivors. Postoperatively, deceased patients exhibited significantly higher levels of amylase, creatinine, alanine aminotransferase, and aspartate aminotransferase. Receiver operating characteristic analysis revealed that postoperative amylase, creatinine, alanine aminotransferase, and aspartate aminotransferase values were good predictors of mortality, with amylase being the most significant predictor. This study highlights the importance of biochemical markers, particularly amylase, as predictors of mortality in patients undergoing coronary bypass surgery. The findings suggest that monitoring and managing amylase, creatinine, alanine aminotransferase, and aspartate aminotransferase levels pre- and post-surgery could improve patient outcomes. This study lays the groundwork for further research into the mechanistic links between these biochemical markers and patient survival, potentially leading to improved prognostic tools and therapeutic strategies.

Differences in healthcare use and mortality in older adults during the COVID-19 pandemic: Exploring long-term care users' vulnerability

BackgroundThe objective of our study is to analyze the health care received by older adults with COVID-19 according to their place of residence (whether or not they live in a long-term care [LTC] facility) and to find out the effect of health care on mortality. MethodsRetrospective cohort study based in Aragón (Spain) from March 2020 to March 2021 in patients aged 65 years or older with a confirmed COVID-19 infection. The population was classified according to their place of residence (living in a LTC or not). A propensity score was used to match individuals by sex and age. The effect of living in a LTC facility on healthcare delivery and mortality was conducted using adjusted multivariate models. Varimp was used to estimate the best predictors of mortality for both groups. ResultsHealthcare services utilization varied depending on whether the patients lived in a LTC facility or not. The time to diagnosis was shorter in institutionalized patients, but the time to hospital admission was longer. Length of hospital stays, risk of ICU admission and 30-day mortality were also different and remained statistically significant in the adjusted models. The variables that were more important in the association between healthcare utilization and mortality were those associated with greater severity of COVID-19. ConclusionsThere were differences in health care for older adults diagnosed with COVID-19 according to their place of residence. There is a need to strengthen collaboration between professionals in LTC centers and health services to provide equitable health care.

Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study

Background: Major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care. Methods: This was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression. Results: A total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and probability of survival scores. Factors independently predictive of mortality were increasing age (OR 1.06, p &lt;0.001) and GCS &lt;15 on admission (OR 7.21, p &lt;0.001). Ps19 was the best predictor of mortality (p &lt;0.001 for each score category), with an AUROC of 0.90. Conclusions: The significant mortality predictors were age, fall from &lt;2 metres, injury of head or limbs, GCS &lt;15 and Ps19. Contrary to previous studies CCI and APACHE II did not significantly predict mortality. Although Ps19 was found to be the best current prognostic score, trauma prognostication would benefit from a single validated scoring system incorporating both physiological variables and injury patterns.

Pneumonia in Geriatric Patients and Prediction of Mortality Based on the Pneumonia Severity Index (PSI), CURB-65, Frailty Index (FI), and FI-Lab21 Scores.

Background Elderly individuals have higher rates of morbidity, death, and financial burden due to community-acquired pneumonia (CAP). Objectives The study aimed to assess the outcomes of geriatric pneumonia patients and the prediction of mortality based on the pneumonia severity index (PSI), CURB-65 (confusion, urea, respiratory rate, blood pressure, and 65-year-old score), frailty index (frailty index), and FI-Lab21 (21-item frailty index based on laboratory) scores. Methods A prospective observational study was conducted on 100 elderly patients (≥ 65 years) with CAP. PSI, CURB-65, FI, and FI-Lab21 scores were determined. The outcome measures were 30-day mortality and the risk factors of mortality. The mortality predictive value of scores were compared. Results The mean age of the study subjects was 72.14 ± 6.1 years. Specifically, 76 (76%) were male, and 24 (24%) were females.During the follow-up, there was a 30-day mortality rate of 57%. On performing multivariate regression, the PSI score and severely frail were significant independent risk factors of mortality, with an odds ratio of 1.046 and 52.213, respectively. Area under the ROC curve (AUC) showed that the performance of the PSI score (AUC: 0.952; 95% CI: 0.910-0.994), CURB-65 score (AUC: 0.936; 95% CI: 0.893-0.978), and severely frail (AUC: 0.907; 95% CI: 0.851-0.962) was outstanding, while FI-Lab21 (AUC: 0.515; 95% CI: 0.400-0.631) was non-significant. Among all the parameters, the PSI score was the best predictor of mortality at the cutoff points of >121 with a diagnostic accuracy of 92%. Conclusion CAP in the elderly carries a high mortality rate. Out of PSI, CURB-65, FI, and FI-Lab21 scores, the PSI holds the best predicting ability for mortality.

Lactate Profile Assessment-A Good Predictor of Prognosis in Patients with COVID-19 and Septic Shock Requiring Continuous Renal Therapy.

Lactate is a useful prognostic marker, as its level increases in hypoxic tissue and/or during accelerated aerobic glycolysis due to excessive beta-adrenergic stimulation and decreased lactate clearance. The Surviving Sepsis Campaign Bundle 2018 Update suggests premeasurement of lactate within 2-4 h so that physicians perform, assist, administer, and introduce lactate-guided resuscitation to reduce mortality due to sepsis. A total of 108 patients with septic shock who underwent continuous renal replacement therapy (CRRT) for acute kidney injury were enrolled in this observational study. Demographic, clinical, and laboratory data were collected, and patients were divided into two groups: survivors and non-survivors. Multivariate analysis demonstrated that lactate levels at 24 h after initiation of CRRT treatment, but not lactate levels at intensive care unit (ICU) admission, were associated with mortality. Lactate clearance was associated with lower mortality among the survivors (OR = 0.140) at 6 h after ICU admission and late mortality (OR = 0.260) after 24 h. The area under the ROC curves for mortality was 0.682 for initial lactate; 0.797 for lactate at 24 h; and 0.816 for lactate clearance at 24 h. Our result reinforces that the determination of lactate dynamics represents a good predictor for mortality, and serial lactate measurements may be more useful prognostic markers than initial lactate in patients with septic shock.

Comparison of SOFA and qSOFA Scores in Predicting Infection and Mortality in HDU and ICU Patients at a Tertiary Care Center

Objective: The objective of this study is to compare the sensitivity and specificity of the SOFA (Sequential Organ Failure Assessment) and qSOFA (Quick Sequential Organ Failure Assessment) in predicting infection and mortality in ICU (intensive care unit) and HDU (high dependency unit) patients admitted at a tertiary care center of excellence. Study Design and Setting: Prospective observational non-interventional study. Anesthesia Department of Combined Military Hospital, Rawalpindi from Jan 2023-Jun 2023. Methodology: Patients in both ICU (n=220) and HDU (n=220) setups admitted with a suspicion of sepsis were evaluated for onset of sepsis and mortality. Primary variables studied were the sensitivity and specificity for both scores for predicting infection and mortality in the ICU and HDU. Positive predictive value for both scores were calculated as secondary variable. Results: While assessing the primary variables, the sensitivity of SOFA for predicting infection in the ICU was 25.6% with a specificity of 85.3% versus a sensitivity of 76.8% and specificity of 59.0% for qSOFA. In the HDU, It showed sensitivity and specificity with PPV for SOFA being 64.7%, 95.1% and 64.7% versus 79.3%, 85.3% and 46.9% for qSOFA respectively. While assessing for mortality, SOFA values in the ICU for sensitivity, specificity and PPV were 81.8%, 93.5% and 69.2% versus 88.8%, 58.3% and 90.9% for qSOFA respectively. Conclusion: We conclude that qSOFA to be good predictor of mortality in the HDU and SOFA with good specificity for infection and mortality in the ICU

Interleuquina-6 como marcador pronóstico en el fracaso renal agudo y su regulación dependiente de klotho

Background and objectiveIn acute kidney injury (AKI), a strong inflammatory component is activated in response to the renal damage, and one of the main mediators behind this process is the pro-inflammatory interleukin 6 or IL-6. Beside to this phenomenon, there are also alterations in different components of mineral metabolism, such as those dependent on fibroblast growth factor (FGF)23 and the anti-ageing cofactor klotho. The aim of this work was to explore the association between renal function and systemic levels of IL-6, as well as FGF23 and klotho in the early stages of AKI, analysing the predictive capacity of IL-6 in early mortality associated with AKI. Materials and methodsPlasma levels of IL-6, klotho and FGF23 were analysed in samples from 28 patients with AKI and related to renal function on hospital admission, and after 24 and 72hours. In addition, the predictive capacity of IL-6 on AKI-associated mortality was analysed at the three study time points. In an experimental nephrotoxic -AKI mouse model, systemic IL-6 and FGF23 values were also analysed 24 and 72hours after induction of kidney damage, as well as in mice overexpressing the anti-ageing protein, klotho. ResultsSystemic IL-6 levels increased in AKI patients, especially in hospital admission time, and decreased in parallel with improving renal function. At the same time as IL-6 values increased, there was an increase in FGF23 and a decrease in klotho levels, with a significant and positive correlation between IL-6 and FGF23 levels. In addition, we obtained that systemic IL-6 levels were a good predictor of mortality in these patients, with an area under the curve equal to one at 72hours after AKI. In the experimental mouse AKI model, we also observed an increase in plasma levels in both IL-6 and FGF23 after 24hours of kidney damage. Nevertheless, in transgenic mice overexpressing klotho, there was no such increase in any of them. ConclusionsThere is an association between renal damage and increased levels of IL-6 and FGF23 in patients with AKI, especially on hospital admission time. Moreover, IL-6 levels are able to predict mortality in these patients, being a promising prognostic biomarker at any study time with a strong prediction at 72hours after patient admission. Maintaining adequate klotho levels could prevent the IL-6 mediated inflammatory response and therefore also reduce the degree and severity of renal damage after AKI.

Early Vital Sign Thresholds Associated with 24-Hour Mortality among Trauma Patients: A Trauma Quality Improvement Program (TQIP) Study.

Identifying patients at imminent risk of death is critical in the management of trauma patients. This study measures the vital sign thresholds associated with death among trauma patients. This study included data from patients ≥15 years of age in the American College of Surgeons Trauma Quality Improvement Program (TQIP) database. Patients with vital signs of zero were excluded. Documented prehospital and emergency department (ED) vital signs included systolic pressure, heart rate, respiratory rate, and calculated shock index (SI). The area under the receiver operator curves (AUROC) was used to assess the accuracy of these variables for predicting 24-hour survival. Optimal thresholds to predict mortality were identified using Youden's Index, 90% specificity, and 90% sensitivity. Additional analyses examined patients 70+ years of age. There were 1,439,221 subjects in the 2019-2020 datasets that met inclusion for this analysis with <0.1% (10,270) who died within 24 hours. The optimal threshold for prehospital systolic pressure was 110, pulse rate was 110, SI was 0.9, and respiratory rate was 15. The optimal threshold for the ED systolic was 112, pulse rate was 107, SI was 0.9, and respiratory rate was 21. Among the elderly sub-analysis, the optimal threshold for prehospital systolic was 116, pulse rate was 100, SI was 0.8, and respiratory rate was 21. The optimal threshold for ED systolic was 121, pulse rate was 95, SI was 0.8, and respiratory rate was 0.8. Systolic blood pressure (SBP) and SI offered the best predictor of mortality among trauma patients. The SBP values predictive of mortality were significantly higher than the traditional 90mmHg threshold. This dataset highlights the need for better methods to guide resuscitation as initial vital signs have limited accuracy in predicting subsequent mortality.

Albumin-to-alkaline phosphatase ratio may be a better predictor of survival than sclerostin, dickkopf-1, osteopontin, osteoprotegerin and osteocalcin

ObjectivesThe value of biochemical markers of bone turnover (BTMs) in predicting survival and disease remains unclear. In a prospective study we evaluated the novel biomarkers for bone turnover sclerostin, dickkopf-1 (DKK-1), osteopontin (OPN), osteoprotegerin (OPG) and osteocalcin (OC), as well as a traditional biomarker, alkaline phosphatase (ALP) in relation to risk of mortality, cardiovascular events and fractures. Participantsand Methods:Routine blood tests and serum BTMs, including ALP, were analyzed in patients with hip fracture n = 97, stroke n = 71 and healthy volunteers n = 83 (mean age 86, 83 and 77, respectively), followed for 7 years. Hazard Ratios (HR) were calculated for mortality, cardiovascular events and fractures in relation to these biomarkers. After adding the albumin-to-ALP ratio (AAPR) a post hoc analysis was performed. Results120 participants died during the study. In the entire group of patients and volunteers (n = 251) higher AAPR (HR 0.28, 95 % CI 0.14–0.59, p < 0.001) was associated with decreased mortality. OPN and OPG were associated with mortality risk only in the univariate statistical analysis. HR for high AAPR in relation to new cardiovascular events was borderline significant (HR 0.29, 95 % CI 0.08–1.06, p = 0.061). None of the examined biomarkers were associated with new fractures, nor with an increased risk of a new cardiovascular event. ConclusionsAAPR may be a better predictor of mortality than the more novel BTMs, and higher AAPR could be associated with longer life expectancy. Further studies should determine the clinical usefulness of AAPR as a biomarker of mortality and cardiovascular disease.

Evaluation of SOFA score (Sequential Organ Failure Assessment score) in hospitalised patients with sepsis

Considering sepsis as a common illness the following study studied the score and extrapolated with survival benefits in medical emergency patients. The score was made to determine population level burden of disease.Various studies recommended SOFA for screening sepsis and determine prognosis. The score has been used to determine injury to organs in admitted patients with infection. The cross sectional study was conducted at Vivekananda Institute of Medical Sciences, Kolkata over a period of one year (2019 till 2020) on sepsis patients admitted in medical ICU. The study revealed that more the scores on the day of admission, the more is the risk of adverse outcomes and subsequent early mortality (within day 7 of admission). In this study, among 56 cases of total death within the first 7 days of admission, 53 patients (94.64%) had day 0 SOFA score of &amp;#62;9 making it a significant outcome in this study. Baseline SOFA scores ≥ 9 and rising SOFA scores as day progresses can predict mortality in sepsis. The mean SOFA score on admission to the ICU was 9.2. The 28-day mortality rate was 28%. Patients with a SOFA score of 9 or more on admission to the ICU had a significantly higher mortality rate than those with a score of less than 9 (42% vs. 14%, p &amp;#60; 0.01). The SOFA score on day 3 of ICU stay was also significantly associated with mortality (p &amp;#60; 0.01). The SOFA score is a simple and easy-to-use tool that can be used to assess the severity of organ dysfunction in patients with sepsis. It is a good predictor of mortality in patients with sepsis admitted to the ICU.

Vascular Reactivity Index as an Effective Predictor of Mortality in Patients With Septic Shock: A Retrospective Study.

Sepsis is a serious complication that occurs after trauma, burns, and infections, and it is an important cause of death in intensive care unit (ICU) patients. Despite many new measures being proposed for sepsis treatment, its mortality rate remains high; sepsis has become a serious threat to human health, and there is an urgent need to carry out in-depth clinical research related to sepsis. In recent years, it has been found that septic shock-induced vasoplegia is a result of vascular hyporesponsiveness to vasopressors. Therefore, this study intended to establish an objective formula related to vasoplegia that can be used to assess the prognosis of patients and guide clinical treatment. A retrospective cohort study was conducted using data from 106 septic shock patients admitted to the ICU of Jining No. 1 People's Hospital from January 2020 to December 2022. The patients were divided into mortality and survival groups based on 28-day survival, and hemodynamics were monitored by the pulse index continuous cardiac output system. The dose and duration of vasopressors, major hemodynamic parameters, lactic acid (Lac) levels, and Sequential Organ Failure Assessment scores were recorded within 48 h of hospital admission. Multifactorial logistic regression was used to analyze the independent risk factors affecting the prognosis of patients, and the predictive value of the vascular response index (VRI) was analyzed by the receiver operating characteristic (ROC) curve. The differences between the survival and mortality groups in terms of age, sex ratio, body weight, ICU length of stay, distribution of infection sites, underlying disease conditions, baseline Lac levels, and some hemodynamic parameters were not statistically significant (P > .05). The results of multifactorial logistic regression showed that the admission Acute Physiology and Chronic Health Evaluation II score, Lac level at 24 h of treatment, maximal vasoactive inotropic score at 24 h (VISmax24), maximal vasoactive inotropic score at 48 h (VISmax48), and VRI were independent risk factors affecting 28-day mortality. Within 48 h of receiving vasopressor therapy, the VRI was lower in the mortality group than in the survival group. The area under the ROC curve for the VRI was 0.86, and the best cutoff value of the VRI for predicting 28-day mortality was 32.50 (YI = 0.80), with a sensitivity of 0.90, a specificity of 0.90, and a better prediction of mortality than the other indicators. The VRI is a good predictor of mortality in patients with septic shock, and a lower VRI indicates more severe vasoplegia, poorer prognosis, and higher mortality in patients with septic shock.