Case Fatality In Patients Research Articles

Intracranial haemorrhage following treatment for pulmonary embolism: analysis of the german nationwide inpatient sample

Abstract Background Intracranial haemorrhage (ICH) can be a life-threatening complication of pulmonary embolism (PE) and its treatment during the acute phase. Purpose To characterize patients hospitalized with PE and ICH by identifying risk factors across different treatment groups, and to detect temporal trends in a large nationwide sample. Methods The German nationwide inpatient sample was screened for patients admitted with PE during the period 2005-2020. All hospitalizations were stratified based on the occurrence of ICH and accordingly, risk factors for ICH were investigated (source: Research data center [RDC] of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005-2020, own calculations). Results Overall, 816,653 hospitalizations were included in the present study; among them, 2516 (0.3%) experienced an ICH event and 84,810 (10.4%) died in-hospital. The annual number of hospitalizations of patients admitted due to PE increased steadily from 38,749 in 2005 to 54,966 in 2020, whereas the incidence of ICH remained, despite annual fluctuations, largely stable over time, both in the entire study population and in the subgroup of patients with severe PE as defined by clinical and haemodynamic parameters (n=270,980 [33.2%]). ICH was overall more frequent after the seventh decade of life but, interestingly, no correlation with age was found amongst patients with severe PE (Figure 1). ICH in hospitalized PE patients was associated with an aggravated comorbidity burden mirrored by a higher Charlson Comorbidity Index (5.0 [interquartile range 4.0-7.0] vs. 4.0 [2.0-5.0], P<0.001). This was mainly driven by the higher prevalence of heart failure (27.3% vs. 19.4%, P<0.001) and acute or chronic kidney disease (27.6% vs. 18.1%, P<0.001) in patients with ICH. In addition, severe PE (OR 3.09 [95% CI 2.84-3.35], P<0.001), acute kidney injury (OR 3.60 [3.09-4.18], P<0.001), and particularly ischaemic stroke (OR 14.64 [12.61-17.00], P<0.001) were identified as independent predictors of ICH by multivariable logistic regressions. Overall, 27% of the ICH cases were related to systemic thrombolysis. In PE patients treated with systemic thrombolysis, age ≥70 years as well as female sex were independent predictors of ICH. Finally, ICH was independently associated with a substantial increase in case-fatality in patients hospitalized with PE (univariate OR: 5.38 [4.97-5.84], P<0.001; multivariable OR: 6.16 [5.64-6.72], P<0.001). Conclusions In this healthcare dataset of the German nationwide inpatient sample, the overall incidence of ICH remained low at 0.3% over the 15-year study period. Severe PE, age, comorbidity burden, kidney disease, heart failure and ischaemic stroke were independent risk factors for ICH.

Low Prognostic Nutritional Index Predicts In-Hospital Complications and Case Fatality in Patients with Spontaneous Intracerebral Hemorrhage: A Retrospective Study.

Spontaneous intracerebral hemorrhage (ICH) is associated with high case fatality and significant healthcare costs. Recent studies emphasize the critical role of nutritional status in affecting outcomes in neurological disorders. This study investigates the relationship between the Prognostic Nutrition Index (PNI) and in-hospital complications and case fatality among patients with ICH. A retrospective analysis was performed using data from the Changhua Christian Hospital Clinical Research Database between January 2015 and December 2022. Patients under 20 or over 100 years of age or with incomplete medical data were excluded. We utilized restricted cubic spline models, Kaplan-Meier survival analysis, and ROC analysis to assess the association between PNI and clinical outcomes. Propensity score matching analysis was performed to balance these clinical variables between groups. In this study, 2402 patients with spontaneous ICH were assessed using the median PNI value of 42.77. The cohort was evenly divided between low and high PNI groups, predominantly male (59.1%), with an average age of 64 years. Patients with lower PNI scores at admission had higher in-hospital complications and increased 28- and 90-day case fatality rates. Our study suggests that PNI could serve as a valuable marker for predicting medical complications and case fatality in patients with spontaneous ICH.

Temporal and regional trends of case-fatality in patients hospitalized with acute respiratory distress syndrome in Germany

Abstract Funding Acknowledgements None. Aims Significant progress has been made in understanding the pathophysiology of acute respiratory distress syndrome (ARDS). However, ARDS it is still a life-threatening medical condition with a high mortality rate. Little is known about temporal trends and regional variations in Germany. Methods We analyzed data on the characteristics, comorbidities and in-hospital outcomes for all hospitalized patients with ARDS in Germany between 2005 and 2019. Diagnoses were coded according to the International Classification of Diseases and Related Health Problems, 10th Revision with German Modification (ICD-10-GM), and diagnostic, surgical or interventional procedures according to the German Procedure Classification (OPS, surgery and procedures codes. The computed study analyses were performed on our behalf by the Research Data Center of the Federal Statistical Office and the Statistical Offices of the federal states in Wiesbaden, Germany. Results Overall, 8,369,723 inpatients aged ≥18 years were included in this analysis; among these, 155,872 (1.9%) were codes with the diagnosis of ARDS. The annual number of ARDS cases increased from 7,286 in 2005 to 13,722 in 2019 in parallel with a significant decrease of in-hospital mortality. Overall, 74,751 (48.0%) patients with ARDS died during the in-hospital stay and in-hospital case-fatality grew exponentially with age. Independent predictors of in-hospital fatality with an OR >2 were age ≥70 years, necessity of ECMO, severe liver disease, acute renal failure, dialysis, shock and cardio-pulmonary resuscitation. Most patients with ARDS were treated in hospitals in urban areas (n=56,582) with a high case-fatality rate (49.7%), but also with concomitant high proportion rate of mechanical ventilation (23.7%) compared to hospitals in suburban or rural areas. Conclusion The number of patients with ARDS increased markedly in Germany between 2005 and 2019, in parallel with a decrease of in-hospital fatality. Our findings may suggest that general management of ARDS have improved over time and might draw more attention to predictors for in-hospital fatality in patients hospitalized with ARDS. The need for mechanical ventilation and a poor outcome was more likely in urban areas – this might be accentuated by patient transfer to specialized high care centers usually located in urban settings.

Categorization of Patients With Pulmonary Embolism by Charlson Comorbidity Index

BackgroundShort-term outcomes of pulmonary embolism are closely related to right ventricular dysfunction and patient's hemodynamic status, but also to individual comorbidity profile. However, the impact of patients’ comorbidities on survival during pulmonary embolism might be underrated. Although the Charlson Comorbidity Index (CCI) is the most extensively studied comorbidity index for detecting comorbidity burden, studies analyzing the impact of CCI on pulmonary embolism patients’ survival are limited. MethodsWe used the German nationwide inpatient sample to analyze all hospitalized patients with pulmonary embolism in Germany 2005-2020 and calculated CCI for each patient, compared the CCI classes (very low: CCI = 0 points, mild: CCI = 1-2 points, moderate: CCI = 3-4, high severity: CCI >4 points) and impact of CCI class on outcomes. ResultsOverall, 1,373,145 hospitalizations of patients with acute pulmonary embolism (53.0% females, 55.9% aged ≥70 years) were recorded in Germany between 2005 and 2020; the CCI class stratified them. Among these, 100,156 (7.3%) were categorized as very low; 221,545 (16.1%) as mild; 394,965 (28.8%) as moderate; and 656,479 (47.8%) as patients with a high comorbidity burden according to CCI class. In-hospital case fatality increased depending on the CCI class: 3.6% in very low, 6.5% in mild, 12.1% in moderate, and 22.1% in high CCI class (P < .001). CCI class was associated with increased in-hospital case fatality (odds ratio 2.014; 95% confidence interval, 2.000-2.027; P < .001). ConclusionOur study results may help practitioners to better understand and measure the association between an aggravated comorbidity profile and increased in-hospital case fatality in patients with pulmonary embolism.

Comorbidity burden assessed by the charlson comorbidity index and its influence on prognosis of patients with pulmonary embolism

Abstract Background Pulmonary embolism (PE) is an acute cardiovascular syndrome and can be associated with high morbidity and mortality. Short-term outcomes of PE are closely related to right ventricular dysfunction (RVD) and the patient’s haemodynamic status as well as age and comorbidity profile. According to the current ESC guidelines for management of acute PE patients, initial risk stratification is based on clinical symptoms and signs, whereby haemodynamic instability indicates a high-risk status with substantial increase of the risk for early death. However, the vast majority of PE patients are haemodynamically stable at presentation; they require further risk stratification with clinical, imaging, and laboratory indicators of PE severity as well as the patient’s comorbidity profile and other aggravating conditions. The pulmonary embolism severity index (PESI) and the simplified pulmonary embolism severity index (sPESI) are implemented for risk stratification in the ESC guidelines. However, other tools may be more suitable for characterizing the comorbidity profile of PE patients. One established approach to evaluate the comorbidity profile is the Charlson Comorbidity Index. Purpose The objective of the present study is to investigate the impact of the comorbid profile on prognosis of patients with acute PE in a large nationwide inpatient sample. Methods We used the German nationwide inpatient sample to analyse the Charlson Comorbidity Index score of all hospitalised patients with PE in Germany 2005-2020 (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005-2020, own calculations). The patients were categorized in the very-low severity (Charlson Comorbidity Index 0 points, mild severity (Charlson Comorbidity Index 1-2 points), moderate severity (Charlson Comorbidity Index 3-4 points) and severe severity (Charlson Comorbidity Index &amp;gt;4 points) and severity classes were compared. Results Overall, 1,373,145 hospitalizations of patients with acute PE (53.0% females, 55.9% aged ≥70years) were recorded in Germany between 2005 and 2020; they were stratified by the Charlson Comorbidity Index class. Among these, 100,156 (7.3%) were categorized as very-low, 221,545; (16.1%) as mild, 394,965 (28.8%) as moderate, and 656,479 (47.8%) as patients with a severe comorbidity burden. In-hospital case-fatality increased with the current Charlson Comorbidity Index class: 3.6% in very-low, 6.5% in mild, 12.1% in moderate and 22.1% in the severe Charlson Comorbidity Index class (P&amp;lt;0.001). The Charlson Comorbidity Index class was associated with increased in-hospital case-fatality (OR 2.014 [95%CI 2.000-2.027], P&amp;lt;0.001). Conclusion The results of our study may help to better understand and measure the association between an aggravated comorbidity profile and increased in-hospital case-fatality in patients with acute PE.

Initial antimicrobial therapy and case fatality in patients with community-acquired pneumonia

The health importance of community-acquired pneumonia is an unquestionable fact given its relationship with hospital and overall mortality. The objective of the investigation was to evaluate the relationship between selected antimicrobials used in the initial treatment (amoxicillin/sulbactam, cefuroxime, ceftriaxone and cefotaxime) and mortality from pneumonia. An observational study was carried out, with a descriptive design and a population of 1,809 patients with pneumonia hospitalized between 2012 and 2019; the necessary information was obtained from the clinical history. Statistical processing was performed using bivariate and multivariate analysis (logistic regression); the ratio of cross products (odds ratio) and its 95% confidence interval were used as a statistician. Among the results, the following stand out: significantly higher lethality values were found in those treated with cefotaxime (33%) than in those who received amoxicillin/sulbactam (24%, OR 1.6[1.0001;2.6]), as well as in those treated with ceftriaxone (30%) compared with those treated with amoxicillin/sulbactam (24%, OR 1.3[1.05;1.8]) and with cefuroxime (24%, OR 1.3[1.04;1.7]). A higher frequency of patients with extensive pneumonia, of patients in a critical state on admission, and of bedridden occurrence during hospitalization were identified in those treated with cefotaxime. In patients with “moderate pneumonia and high probability of unfavorable outcome”, treatment with ceftriaxone or cefotaxime was associated with death; as well as ceftriaxone treatment for all subjects. It is concluded that the initial treatment with amoxicillin/ sulbactam or cefuroxime was more favorable than the use of third generation cephalosporins. Also in the global analysis, the absence of differences in lethality between those treated with amoxicillin/sulbactam and with cefuroxime was recognized.

Temporal trends of case-fatality in patients undergoing dual-injection coronary chronic total occlusion recanalization.

Recently, interventional techniques and material to treat chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) have evolved significantly. Nevertheless, it is still unknown whether this progress improved treatment success and patients' outcome. In a nationwide sample, we sought to analyze trends of patients' characteristics, complications and in-hospital case-fatality of patients undergoing CTO revascularization in Germany. We analyzed data on characteristics, treatments, and in-hospital outcomes for all coronary artery disease (CAD) patients (ICD-code I25) undergoing dual-injection CTO recanalization (OPS procedural code: 8-839.9) in Germany from 2009 to 2020. Overall, 4,998,457 inpatients aged ≥ 18years with diagnosis of CAD were treated in German hospitals in this period. Among these, 52,879 patients (1.1%) underwent CTO recanalization. Annual number of CTO PCIs increased from 1263 in 2009 to 6435 in 2020 (β 3.48 [95% CI 3.44-3.52]; p < 0.001) in parallel with a significant decrease of case-fatality (2.2% in 2009 to 1.4% in 2020; β - 0.60 [95% CI - 0.82 to - 0.39]; p < 0.001). Overall, 754 (1.4%) patients with CTO recanalization died during the in-hospital stay and in-hospital case-fatality grew exponentially with age (β 0.82 [95% CI 0.73-0.90]; p < 0.001). Significant predictors of in-hospital case fatality with an OR > 3 were cancer, stroke, hemopericardium, acute renal failure, pulmonary embolism and shock. Annual number of CTO procedures performed in Germany increased from 2009 to 2020 with a concomitant anti-proportional decrease in the case-fatality. Our findings may help to draw more attention to predictors of in-hospital case fatality in patients hospitalized for CTO recanalization.

Driving Time to the Nearest Percutaneous Coronary Intervention-Capable Hospital and the Risk of Case Fatality in Patients with Acute Myocardial Infarction in Beijing.

Timely arrival at a hospital capable of percutaneous coronary intervention (PCI) is critical in treating acute myocardial infarction (AMI). We examined the association between driving time to the nearest PCI-capable hospital and case fatality among AMI patients. A total of 142,474 AMI events during 2013-2019 from the Beijing Cardiovascular Disease Surveillance System were included in this cross-sectional study. The driving time from the residential address to the nearest PCI-capable hospital was calculated. Logistic regression was used to estimate the risk of AMI death associated with driving time. In 2019, 54.5% of patients lived within a 15-min drive to a PCI-capable hospital, with a higher proportion in urban than peri-urban areas (71.2% vs. 31.8%, p < 0.001). Compared with patients who had driving times ≤15 min, the adjusted odds ratios (95% CI, p value) for AMI fatality risk associated with driving times 16-30, 31-45, and >45 min were 1.068 (95% CI 1.033-1.104, p < 0.001), 1.189 (95% CI 1.127-1.255, p < 0.001), and 1.436 (95% CI 1.334-1.544, p < 0.001), respectively. Despite the high accessibility to PCI-capable hospitals for AMI patients in Beijing, inequality between urban and peri-urban areas exists. A longer driving time is associated with an elevated AMI fatality risk. These findings may help guide the allocation of health resources.

The new combination of oxygen saturation with age shock index predicts the outcome of COVID-19 pneumonia.

Emergency departments around the world have been struggling to deal with patients with COVID-19 and presumed COVID-19. Triaging patients who need further medical support is the key matter to emergency physicians as the delay of proper treatment may worsen the results. The aim of this study was to validate the ability of age shock index and hypoxia-age-shock index at the time of presentation to the emergency department to predict case fatality in patients with COVID-19 pneumonia. We only included patients who had COVID-19-associated pneumonia who needed in-hospital treatment. The vital signs and oxygen saturation used in the study were collected, especially from the triage sector, before patients were given supplemental oxygen. A total of 241 patients enrolled in the study. The case fatality rate was 27%. The median age of the study samples was 78 (66-86) years with 133 male and 108 female patients. Hypoxia-age-shock index showed the best performance in analysis (odds ratio 15.1, 95% confidence interval: 5.1-44.4; adjusted odds ratio 8.6, 95% confidence interval: 2.8-26.8). The hypoxia-age-shock index was a strong predictor for in-hospital mortality of COVID-19 pneumonia. Furthermore, when it was compared with age shock index, hypoxia-age-shock index showed better performance in predicting fatality of the disease.

Case Fatality of Hospitalized Patients with COVID-19 Infection Suffering from Acute Respiratory Distress Syndrome in Germany.

Aims: Patients suffering from viral pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are at risk of developing acute respiratory distress syndrome (ARDS). ARDS is a serious complication of COVID-19 that requires early recognition and comprehensive management. Little is known about the concomitant prevalence of both entities in Germany. Thus, we sought to analyze predictors and regional trends of case fatality in patients with COVID-19 and ARDS in Germany. Methods: We analyzed data on the characteristics, comorbidities and in-hospital outcomes for all hospitalized patients with COVID-19 and compared those with and without ARDS in Germany in 2020. Results: Overall, 176,137 hospitalized patients with confirmed COVID-19 were included in this analysis; among these, 11,594 (6.6%) suffered from ARDS. Most patients with ARDS were treated in hospitals in urban areas (n = 6485); proportion rate of mechanical ventilation was higher (45.9%) compared to those treated in hospitals of suburban (36.1%) or rural areas (32.0%). Proportion of ARDS grew exponentially with age until the sixth decade of life. Case-fatality rate was considerably higher in COVID-19 patients with ARDS compared to those without (48.3% vs. 15.8%; p &lt; 0.001). Independent predictors of in-hospital case fatality with an OR &gt; 3 were age ≥ 70 years, severe ARDS, severe liver disease, acute renal failure, stroke, dialysis treatment, shock and necessity of ECMO. Conclusions: The case fatality of COVID-19 patients with ARDS is dramatically high and shows relevant regional disparities. Our findings may help to draw more attention to predictors for in-hospital case fatality in patients hospitalized with COVID-19 and suffering from ARDS.

Case Fatality in Patients With Aneurysmal Subarachnoid Hemorrhage in Finland: A Nationwide Register-Based Study.

Although single-center studies have reported declining case fatality rates (CFRs) of aneurysmal subarachnoid hemorrhage (SAH), nationwide reports that also include sudden-death SAHs with long uninterrupted study periods have remained limited. Moreover, little is known about whether the time-dependent trends of SAH CFR differ by age and/or sex. Thus, we aimed to characterize the nationwide changes of SAH CFRs in Finland between 1998 and 2017. We used 2 externally validated nationwide registers to identify all hospitalized and nonhospitalized (sudden-death) aneurysmal SAH events in Finland during 1998-2017. In addition to overall 30-day CFRs, we determined annual proportions of sudden-death and 30-day CFRs among hospitalized patients with SAH. To estimate time-dependent trends, we calculated annual age-adjusted and sex-adjusted CFR changes (percent with 95% CIs). Between 1998 and 2017, we identified 9,443 cases with SAH (57.6% women), of which 2,245 (23.8%) died before hospitalization and 3,715 (39.3%) died within 30 days after SAH. Among the 7,198 hospitalized patients with SAH, the 30-day CFR was 20.4%. During the study period, the overall age-adjusted and sex-adjusted CFR declined by an average of 1.8% (1.1%-2.6%) per year. The decreases were especially notable in the proportion of sudden deaths among middle-aged (aged 40-64 years) and older (aged 65 years or older) women (2.9% [1.1%-4.7%] and 2.3% [0.7%-4.0%] per year, respectively) and in the CFRs of hospitalized young (younger than 40 years) and middle-aged women (9.1% [2.3%-15.7%] and 4.3% [2.3%-6.5%] per year, respectively). On the contrary, the 30-day CFR of older (aged 65 years or older) hospitalized men increased by 3.5% (0.7%-6.3%) per year, while the proportions of older men who died before hospitalization remained unchanged. The overall CFR of SAH seems to be decreasing, at least among women. The continued high CFR of hospitalized older men requires attention from clinicians and epidemiologists, especially if this trend is also common in other countries.

COVID-19 infection and its impact on case-fatality in patients with pulmonary embolism

Abstract Background Although a high prevalence of pulmonary embolism (PE) has been reported as a complication during severe COVID-19 infections in critical ill patients, nationwide data of hospitalized patients with COVID-19 with PE is still limited. Thus, we sought to analyze seasonal trends and predictors of in-hospital case-fatality in patients with COVID-19 and PE in Germany. Methods We used the German nationwide inpatient sample to analyze all data on hospitalizations for COVID-19 patients with and without PE in Germany during the year 2020 and to compare changes of PE prevalence to 2019. Results We analyzed data of 176,137 hospitalizations because of COVID-19 in 2020. Among those, PE was recorded in 1.9% (n=3,362) of discharge or death certificates. Almost one third of patients with COVID-19 and PE died during the in-hospital course (28.7%). The case-fatality rate increased with patients' age peaking in the 9th life-decade. Regardless of COVID-19, 196,203 inpatients were diagnosed with PE in Germany between 2019 and 2020. The number of PE hospitalizations were widely equally distributed between both years (98,485 vs. 97,718), while the case-fatality rate of all patients with PE was slightly lower in 2019 compared to 2020 (12.7% vs. 13.1%, P&amp;lt;0.001). In contrast, considerable differences in prevalence and case-fatality were demonstrated in 2020 regarding PE patients with and without COVID-19 infection (28.7% vs. 13.1%, P&amp;lt;0.001) (Figure 1). A COVID-19-infection was associated with a 2.8-fold increased risk of case-fatality in patients with PE (OR 2.81, 95% CI 1.66–2.12, P&amp;lt;0.001). Conclusions In Germany, the prevalence of PE events complicating hospitalizations was similar in 2019 and 2020. However, the fatality rate among patients with COVID-19-associated PE was substantially higher than that in those without either COVID-19 or PE, indicating an additive prognostic effect of these two conditions. Funding Acknowledgement Type of funding sources: None.

COVID-19 infection and its impact on case fatality in patients with pulmonary embolism.

BackgroundAlthough a high prevalence of pulmonary embolism (PE) has been reported in association with coronavirus disease (COVID)-19 in critically ill patients, nationwide data on the outcome of hospitalised patients with COVID-19 and PE is still limited. Thus, we investigated seasonal trends and predictors of in-hospital death in patients with COVID-19 and PE in Germany.MethodsWe used the German nationwide inpatient sample to analyse data on hospitalisations among COVID-19 patients with and without PE during 2020, and to detect changes in PE prevalence and case fatality in comparison to 2019.ResultsWe analysed 176,137 COVID-19 hospitalisations in 2020; PE was recorded in 1.9% (n=3362) of discharge certificates. Almost one third of patients with COVID-19 and PE died during the in-hospital course (28.7%) compared to COVID-19 patients without PE (17.7%). Between 2019 and 2020, numbers of PE-related hospitalisations were largely unchanged (98,485 versus 97,718), whereas the case-fatality rate of PE increased slightly in 2020 (from 12.7% to 13.1%, p<0.001). Differences in case fatality were found between PE patients with and without COVID-19 in 2020 (28.7% versus 12.5%, p<0.001), corresponding to a 3.1-fold increased risk of PE-related death (OR 3.16, 95% CI 2.91–3.42, p<0.001) in the presence of COVID-19.ConclusionsIn Germany, the prevalence of PE events during hospitalisations was similar in 2019 and 2020. However, the fatality rate among patients with both COVID-19 and PE was substantially higher than that in those with only one of these diseases, suggesting a life-threatening additive prognostic impact of the COVID-PE combination.

Case-Fatality and Temporal Trends in Patients with Psoriasis and End-Stage Renal Disease.

Background and Objectives: During the last decades, growing evidence corroborates that chronic inflammatory disease impairs the body beyond the cutaneous barrier. Linkage between psoriasis and kidney disease, and in particular between psoriasis and end-stage renal disease (ESRD), have not yet been elucidated. We sought to analyze the impact of concomitant psoriasis on the in-hospital outcomes of patients hospitalized with ESRD. Patients and Methods: We analyzed data on characteristics, comorbidities, and in-hospital outcomes of all hospitalized patients with ESRD stratified for concomitant psoriasis in the German nationwide in-patient sample between 2010 and 2020. Results: Overall, 360,980 hospitalizations of patients treated for ESRD in German hospitals were identified from 2010 to 2020 and among these 1063 patients (0.3%) additionally suffered from psoriasis. While the annual number of all ESRD patients increased within this time, the number of patients with ESRD and the additional psoriasis diagnosis decreased slightly. Patients with ESRD and psoriasis were five years younger (66 [IQR, 56–75] vs. 71 [59–79] years, p < 0.001), were more often obese (17.5% vs. 8.2%, p < 0.001) and more frequently had cancer (4.9% vs. 3.3%, p < 0.001), diabetes mellitus (42.7% vs. 38.5%, p = 0.005) and coronary artery disease (31.1% vs. 28.0%, p = 0.026). Multivariate regression models demonstrated that psoriasis was not associated with in-hospital case-fatality in patients with ESRD (OR 1.02 (95%CI 0.78–1.33), p = 0.915). Conclusions: ESRD patients with the concomitant psoriasis diagnosis were hospitalized on average 5 years earlier than patients without psoriasis. A higher prevalence of severe life-shortening comorbidities including coronary artery disease and cancer was detected in ESRD patients with psoriasis despite their younger age. Our findings support the understanding of psoriasis as an autoimmune skin disease crossing the boundary between dermatology and internal medicine.

Case Fatality of Patients With Type 1 Diabetes After Myocardial Infarction.

OBJECTIVEType 1 diabetes is a risk factor for myocardial infarction (MI). We aimed to evaluate the case fatality in patients with type 1 diabetes after MI.RESEARCH DESIGN AND METHODSConsecutive patients experiencing MI with type 1 diabetes (n = 1,935; 41% female; mean age 62.5 years) and without diabetes (n = 74,671) admitted to 20 hospitals in Finland from 2005 to 2018 were studied using national registries. The outcome of interest was death within 1 year after MI. Differences between groups were balanced by multivariable adjustments and propensity score matching.RESULTSCase fatality was higher in patients with type 1 diabetes than in propensity score–matched controls without diabetes at 30 days (12.8% vs. 8.5%) and at 1 year (24.3% vs. 16.8%) after MI (hazard ratio 1.55; 95% CI 1.32–1.81; P < 0.0001). Patients with type 1 diabetes had poorer prognosis in subgroups of men and women and of those with and without ST-elevation MI, with and without revascularization, with and without atrial fibrillation, and with and without heart failure. The relative fatality risk in type 1 diabetes was highest in younger patients. Older age, heart failure, peripheral vascular disease, renal failure, and no revascularization were associated with worse prognosis after MI. The case fatality among patients with type 1 diabetes decreased during the study period, but outcome differences compared with patients without diabetes remained similar.CONCLUSIONSPatients with type 1 diabetes are at higher risk of death after MI than patients without diabetes. Our findings call for attention to vigorous cardiovascular disease prevention in patients with type 1 diabetes.

COVID-19 mortality in cirrhosis is determined by cirrhosis-associated comorbidities and extrahepatic organ failure: Results from the multinational LEOSS registry.

Background and ObjectiveInternational registries have reported high mortality rates in patients with liver disease and COVID‐19. However, the extent to which comorbidities contribute to excess COVID‐19 mortality in cirrhosis is controversial.MethodsWe used the multinational Lean European Open Survey on SARS‐CoV‐2‐infected patients (LEOSS) to identify patients with cirrhosis documented between March 2020 and March 2021, when the wild‐type and alpha variant were predominant. We compared symptoms, disease progression and mortality after propensity score matching (PSM) for age, sex, obesity, smoking status, and concomitant diseases. Mortality was also compared with that of patients with spontaneous bacterial peritonitis (SBP) without SARS‐CoV‐2 infection, a common bacterial infection and well‐described precipitator of acute‐on‐chronic liver failure.ResultsAmong 7096 patients with SARS‐CoV‐2 infection eligible for analysis, 70 (0.99%) had cirrhosis, and all were hospitalized. Risk factors for severe COVID‐19, such as diabetes, renal disease, and cardiovascular disease were more frequent in patients with cirrhosis. Case fatality rate in patients with cirrhosis was 31.4% with the highest odds of death in patients older than 65 years (43.6% mortality; odds ratio [OR] 4.02; p = 0.018), Child‐Pugh class C (57.1%; OR 4.00; p = 0.026), and failure of two or more organs (81.8%; OR 19.93; p = 0.001). After PSM for demographics and comorbidity, the COVID‐19 case fatality of patients with cirrhosis did not significantly differ from that of matched patients without cirrhosis (28.8% vs. 26.1%; p = 0.644) and was similar to the 28‐day mortality in a comparison group of patients with cirrhosis and SBP (33.3% vs. 31.5%; p = 1.000).ConclusionsIn immunologically naïve patients with cirrhosis, mortality from wild‐type SARS‐CoV‐2 and the alpha variant is high and is largely determined by cirrhosis‐associated comorbidities and extrahepatic organ failure.

Temporal Trends in Rural vs Urban Sepsis-Related Mortality in the United States, 2010-2019

Temporal Trends in Rural vs Urban Sepsis-Related Mortality in the United States, 2010-2019

The Effectiveness of Laboratory Parameters in Predicting the in-Hospital Mortality of Iranian Patients with Coronavirus Disease 2019 (COVID-19).

The novel coronavirus 2019-nCoV (now SARS-CoV-2) has spread globally and affected healthcare systems worldwide. Due to lack of long-term immunization and effective specific treatments for the COVID-19 disease, there is a need of identifying the patients who are at the risk of a fatal outcome, according to the available epidemiological data and laboratory parameters. Thus, we aimed to evaluate the prognostic value of epidemiological data and laboratory para-meters for in-hospital case fatality in patients with COVID-19. A retrospective cohort of patients with COVID-19 admitted to the Shahid Mostafa Khomeini Hospital of Ilam University of Medical Sciences from February 29 until March 29, 2020 was performed. Epidemiologic data and laboratory results were collected. Univariate and multivariate logistic regression models were performed to evaluate the prognostic value of the laboratory parameters for in-hospital death. A total of 256 Iranian COVID-19 patients were included in the evaluation; 38 of them died, resulting in a in-hospital case-fatality rate of 14.8%. The univariate analysis showed that advanced age [OR=1.04, 95% CI: 1.02, 1.06, P=0.001], smoking [OR=4.041, 95% CI: 1.546-10.563, P=0.004], white blood cells [OR=0.941, 95% CI: 0.904-0.980, P =0.003] and hematocrit [OR=1.060, 95% CI: 1.009-1.113, P=0.020] were positively associated with the risk of a fatal outcome. Multivariate logistic regression analysis revealed that COVID-19 patients with an elevated white blood cell count and elevated hemoglobin level had 1% and 9% greater risk of an in-hospital death for each elevated unit [OR=1.07; 95 %CI: 1.024-1.088, P =0.002 and OR=1.379; 95% CI 0.064-1.788, P =0.015, respectively]. An increase in white blood cell count and an increase in hemoglobin level might be indepen-dent risk factors for in-hospital death in Iranian patients with COVID-19. Further studies are necessary in order to conferm the prognostic value of the variables discussed.

Mortality following elective and emergency colectomy in patients with cirrhosis: a population-based cohort study from England

BackgroundPatients with cirrhosis undergoing colectomy have a higher risk of postoperative mortality, but contemporary estimates are lacking and data on associated risk and longer term outcomes are limited. This study aimed to quantify the risk of mortality following colectomy by urgency of surgery and stage of cirrhosis.Data sources.Linked primary and secondary-care electronic healthcare data from England were used to identify all patients undergoing colectomy from January 2001 to December 2017. These patients were classified by the absence or presence of cirrhosis and severity. Case fatality rates at 90 days and 1 year were calculated, and cox regression was used to estimate the hazard ratio of postoperative mortality controlling for age, gender and co-morbidity.ResultsOf the total, 36,380 patients undergoing colectomy, 248 (0.7%) had liver cirrhosis, and 70% of those had compensated cirrhosis. Following elective colectomy, 90-day case fatality was 4% in those without cirrhosis, 7% in compensated cirrhosis and 10% in decompensated cirrhosis. Following emergency colectomy, 90-day case fatality was higher; it was 16% in those without cirrhosis, 35% in compensated cirrhosis and 41% in decompensated cirrhosis. This corresponded to an adjusted 2.57 fold (95% CI 1.75–3.76) and 3.43 fold (95% CI 2.02–5.83) increased mortality risk in those with compensated and decompensated cirrhosis, respectively. This higher case fatality in patients with cirrhosis persisted at 1 year.ConclusionPatients with cirrhosis undergoing emergency colectomy have a higher mortality risk than those undergoing elective colectomy both at 90 days and 1 year. The greatest mortality risk at 90 days was in those with decompensation undergoing emergency surgery.

English

BACKGROUND New corona virus respiratory syndrome is a health emergency due to high infectivity and high case fatality in patients with comorbid conditions like ischemic heart disease. The diagnostic methods of corona virus disease (Covid-19) are still in experimental stage. Hence, a sensitive and specific disease progression marker of Covid-19 is needed. CRP (C-reactive protein) is synthesised by liver. It is elevated in infection and inflammatory conditions as it is an acute phase protein. The purpose of this study was to evaluate CRP as a promising marker for predicting severity of Covid-19 in ischemic heart disease patients and to correlate the impact of CRP with other circulating cardiac biomarkers in different age groups and both sexes. METHODS This is a cross sectional study done among south Indian population mostly from Tamil Nadu and Andhra Pradesh. 232 cases were selected and divided into two groups based on age, sex and confirmed Covid-19 positive cases by RT-PCR (Reverse transcription-polymerase chain reaction), admitted and treated in Rajiv Gandhi Government General Hospital, Chennai. RESULTS In this study, CRP levels were elevated in the age group of 50 - 70 years (66.96 ± 70.09 mg/dL) than CRP levels of age group 30 - 50 years (82.31 ± 90.23 mg/dL) and P value was found to be significant in the age group of 50 - 70 years. Lactate dehydrogenase (LDH) levels were elevated in the age group of 30 - 50 years (380.77 ± 252.23 U/L) than the LDH levels of age group 50 - 70 years (393.53 ± 206.83 U/L) and P value was found to be significant in the age group of 30 - 50 years. Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and creatine kinase (CK) levels are the additional cardiac enzymes found to be elevated in this study. CRP showed a positive correlation with LDH (r = 0.221 P &lt; 0.001) in both males (r = 0.06 and P &lt; 0.001) and females (r = 0.45 and P &lt; 0.001) with a significant P value. Receiver operating characteristics (ROC) curves for CRP Vs age group shows a sensitivity of 91.15 % and specificity of 92.52 % and area under curve of 0.556. CONCLUSIONS CRP can be used as a promising marker for early detection and timely intervention of ischemic heart disease in Covid-19 patients especially in the age group of 50 - 70 years and thereby reduces the mortality. KEYWORDS Biomarkers, Heart Disease, Mortality, Prognosis