Cause Of Adverse Outcomes Research Articles

Comorbid conditions in pediatric practice

The comorbidity is an urgent scientific and practical problem of modern pediatrics. The practical significance of combined pathology in children is determined by its widespread occurrence and universal impact on all aspects of a child’s health and treatment options. In patients with congenital heart defects, outcomes are influenced by numerous non-cardiac and genetic factors. In childhood and adolescent bronchial asthma, concomitant diseases are a common cause of adverse outcomes, such as poor disease control, frequent seizures, decreased quality of life and increased healthcare costs. A stable interdependence between the state of the gastrointestinal tract and the development of allergic or autoimmune diseases has been proven. The article describes a clinical case of late diagnosis of concomitant pathology in a child with chronic gastritis with clinical symptoms, diagnostic criteria and drug treatment options. The understanding the etiology and pathogenesis of concomitant conditions in children will help identify risk groups for the formation of chronic noncommunicable diseases and develop a plan for their prevention.

Разработка прогностической математической модели травматических повреждений печени

Intra-abdominal bleeding is a leading cause of adverse outcomes in liver trauma, underscoring the critical importance of timely surgical intervention and optimal hemostasis strategies. This study investigates the impact of liver model segmentation on the distribution of mechanical stresses during impact simulation using the finite element method. By discretizing a computer-aided design (CAD) model into finite elements of two types – 4-node linear isoparametric elements for the parenchyma and 3-node Kirchhoff plate elements for intersegmental partitions – we developed a computational liver model adequately captures the organ's anatomy. Our results show that incorporating segmentation significantly affects the simulation outcomes, enabling a more realistic assessment of tissue damage patterns upon impact. This approach facilitates the simulation of a wide range of real-world traumatic effects, allowing for arbitrary specification of impact direction, speed, and affected area. By accounting for liver segmentation, our study provides a more accurate and comprehensive understanding of traumatic liver injuries, ultimately informing clinical decision-making and improving patient outcomes.

Modulation of the intestinal microbiota as a new strategy for the prevention and treatment of comorbid chronic cardiovascular diseases and colorectal cancer in one patient. Review

To date, the etiological causes of adverse outcomes associated with cardiovascular diseases and concomitant colorectal cancer in one patient, especially over 60 years of age, are multifactorial: from undiagnosed timely above-mentioned pathological conditions to poor adherence to treatment. It is a multi-level approach that is the future guarantee of reducing the burden on public health as a result of these most common nosologies.The aim of the work is to evaluate discussions between different experts with an analysis of fundamental and clinical studies based on world literature in the search for new prospects for the treatment of patients with cardiovascular pathology and comorbid colorectal cancer based on the composition and function of the intestinal microbiota.A literature search was conducted in the PubMed electronic database using the keywords: intestinal microbiota, cardio-oncology, oncosurgery, colorectal cancer, cardiovascular diseases. Additional sources were identified through literature cross-referencing. Search period: 2023.The gut microbiome is a potential marker for better risk stratification of cardiovascular diseases, colorectal cancer, and prediction of shortand long-term major adverse cardiovascular and cancer events. To develop clear recommendations and conclusions, additional research is required.

Management and Outcomes of Delayed Cerebral Ischemia Associated with Vasospasm Post Nontraumatic Subarachnoid Hemorrhage: A Retrospective Cohort Study in the National Neurosurgical Center in Ireland

Abstract Background Delayed cerebral ischemia (DCI) is the leading cause of adverse outcome in patients who survive the initial phase of subarachnoid hemorrhage (SAH). While guidelines recommend induced hypertension as a first-line treatment for DCI, there is no high-level evidence confirming outcome benefit. Methods Patients admitted with nontraumatic SAH over 3 years period were identified. Demographics, clinical/radiological presentation, aneurysm repair method, and Glasgow outcome score (GOS) 3 months postdischarge were recorded. A subgroup of patients who suffered clinically significant vasospasm were identified, and their hypertensive therapy and outcomes were examined. Results A total of 532 patients were admitted with SAH; 68 developed vasospasm. The vasospasm subgroup was divided based on vasopressor treatment—norepinephrine alone (n = 27) versus norepinephrine plus vasopressin (n = 35). No correlation was found between percentage of days that mean arterial pressure (MAP) targets were met and GOS outcome. Patients treated with both agents had worse GOS outcomes at than those treated with norepinephrine alone. Conclusion In our study, 12.8% of patients SAH developed vasospasm. Twenty-seven patients were treated with norepinephrine alone and 35 were treated with norepinephrine plus vasopressin to achieve augmented MAP targets. There was no correlation between percentage of days that MAP targets were met and improved patient outcome. The 68 patients stayed a total of 783 days in ICU, with a mean length of stay of 11.5 days. Patients who required dual therapy to achieve MAP targets had significantly worse neurological outcomes.

HSPA12A maintains aerobic glycolytic homeostasis and Histone3 lactylation in cardiomyocytes to attenuate myocardial ischemia/reperfusion injury.

Myocardial ischemia/reperfusion (MI/R) injury is a major cause of adverse outcomes of revascularization following myocardial infarction. Anaerobic glycolysis during myocardial ischemia is well studied, but the role of aerobic glycolysis during the early phase of reperfusion is incompletely understood. Lactylation of Histone H3 (H3) is an epigenetic indicator of the glycolytic switch. Heat shock protein A12A (HSPA12A) is an atypic member of the HSP70 family. In the present study, we report that, during reperfusion following myocardial ischemia, HSPA12A was downregulated and aerobic glycolytic flux was decreased in cardiomyocytes. Notably, HSPA12A KO in mice exacerbated MI/R-induced aerobic glycolysis decrease, cardiomyocyte death, and cardiac dysfunction. Gain- and loss-of-function studies demonstrated that HSPA12A was required to support cardiomyocyte survival upon hypoxia/reoxygenation (H/R) challenge and that its protective effects were mediated by maintaining aerobic glycolytic homeostasis for H3 lactylation. Further analyses revealed that HSPA12A increased Smurf1-mediated Hif1α protein stability, thus increasing glycolytic gene expression to maintain appropriate aerobic glycolytic activity to sustain H3 lactylation during reperfusion and, ultimately, improving cardiomyocyte survival to attenuate MI/R injury.

Chronic lung allograft dysfunction is associated with an increased number of non-HLA antibodies

BackgroundChronic Lung Allograft Dysfunction (CLAD) is the major cause of adverse outcomes in lung transplant recipients. Multiple factors, such as infection, alloimmunity, and autoimmunity, may lead to CLAD. Here, we aim to examine the role of non-HLA antibodies in CLAD in a large retrospective cohort. MethodsWe analyzed non-HLA antibodies in the pre-and post-transplant sera of 226 (100 CLAD, 126 stable) lung transplant recipients from 5 centers, and we used a separate cohort to confirm our findings. ResultsA panel of 18 non-HLA antibodies was selected for analysis based on their significantly higher positive rates in CLAD vs. stable groups. The panel-18 non-HLA antibodies (n>3) may be positive pre- or post-transplant; the risk for CLAD is higher in the latter. The presence of both non-HLA antibody and HLA donor-specific antibody (DSA) was associated with an augmented risk of CLAD (HR=25.09 [5.52–14.04], p <0.001), which was higher than that for single-positive patients. In the independent confirmatory cohort of 61 (20 CLAD, 41 stable) lung transplant recipients, the risk for CLAD remained elevated in double-positive patients (HR=10.67 [0.98–115.68], p=0.052). After adjusting for non-standard immunosuppression, patients with double-positive DSA/Non-HLA antibodies had an elevated risk for graft loss (HR=2.53 [1.29–4.96], p=0.007). ConclusionsCirculating non-HLA antibodies (n>3) were independently associated with a higher risk for CLAD. Furthermore, when non-HLA antibodies and DSA were detected concomitantly, the risk for CLAD and graft loss was significantly increased. These results show that humoral immunity to HLA and non-HLA antigens may contribute to CLAD development.

Does atrial fibrillation affect prognosis in hospitalised COVID-19 patients? A multicentre historical cohort study in the Netherlands

ObjectivesThe aim of this multicentre COVID-PREDICT study (a nationwide observational cohort study that aims to better understand clinical course of COVID-19 and to predict which COVID-19 patients should receive which...

ЧАСТОТА ВОЗНИКНОВЕНИЯ И ТЕЧЕНИЕ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ НА ФОНЕ ИНФЕКЦИИ COVID-19

Purpose of the study: Estimating the prevalence of AF in the general population and during the COVID-19 pandemic. Materials and methods: A review of scientific articles on the features of the course and prevalence of AF against the background of COVID-19 was carried out using a search in the Medline database (PubMed) and an interdisciplinary, scientific-practical, peer-reviewed journal for physicians CONSILIUM MEDICUM 2021.The literature found was analyzed and summarized by the authors of this literature review. Conclusion: Thus, new-onset AF is both a marker of disease severity and a likely cause of adverse outcomes, similar to other manifestations of organ dysfunction during critical illness

Increased Risk of Preterm Birth in a Native American Population Concurrent With the COVID-19 Pandemic [ID: 1377321

INTRODUCTION: The objective of this study was to evaluate changes in obstetric outcomes in a Native American population compared with other racial groups. METHODS: An electronic birth certificate based system was used to obtain data for all singleton births in the Central New York region from January 2012 to June 2022 after IRB exemption. Race was self-identified and categorized as White, Black, Native American, or other. We compared delivery before or after January 2020. The primary outcome was premature birth. Secondary outcomes included prenatal care adequacy, fetal growth restriction, neonatal outcome, diabetes, hypertension, and obesity. Analysis was preformed using χ2 and logistic regression including body mass index (BMI), smoking, hypertension, and diabetes. RESULTS: Out of 178,420 singleton births, 2,647 (1.4%) identified as Native American, 143,743 (77.7%) as White, and 15,476 (8.4%) as Black. Compared to patients before 2020, no racial group had a higher rate of inadequate or late prenatal care, and all groups had increased obesity (BMI &gt;30) and decreased smoking. Preterm birth increased in the Native American population before 37, 34, and 28 weeks of gestation: adjusted odds ratio (95% CI) 1.42 (1.02–1.99), 1.81 (1.02–3.22), and 3.68 (1.39–9.77). No other population had increased preterm birth before 34 or 28 weeks of gestation. CONCLUSION: There was a significant increase in all categories of preterm birth in the Native American population during the COVID-19 pandemic without a differential increase in known risk factors compared to other racial groups. This highlights the need for more research on the causes of adverse outcomes in Native American populations.

Results of endoscopic hemostasis methods in treatment of gastrointestinal bleeding in patients with SARS-CoV-2

The development of gastrointestinal bleeding from erosive and ulcerative defects of the mucous membranes of the upper gastrointestinal tract, which, according to the world literature, occurs in 2–13 % of hospitalized patients with COVID-19, is a multifaceted problem that is still relevant, but has not been adequately reflected in scientific publications. The aim of the work was to study the clinical characteristics of patients with gastrointestinal bleeding on the background of SARS-CoV-2 and evaluate the methods of endoscopic hemostasis. The article analyzed cases of bleeding from the upper gastrointestinal tract in 115 patients suffering from the novel coronavirus infection. The severity of the course of COVID-19 was assessed according to the criteria of the NEWS scale, the degree of respiratory failure, and radiological data. 114 out of 115 patients had comorbidities; the most common diseases were cardiovascular diseases, endocrine pathology, chronic kidney disease, and oncopathology. The most common sources of bleeding (82 %) were acute or chronic ulcers of the stomach and/or duodenum against the background of erosive hemorrhagic lesions of the mucosa. The following methods of endoscopic hemostasis were used: endoscopic clipping, endoscopic injections, applications of hemostatic agents and solutions, and combined methods which were used more often. Hemostasis was achieved in all cases. Repeated bleeding occurred in 22 cases (19.1 %) with subsequent achievement of endo-hemostasis. Mortality was 66.95 % (77 patients), with such causes of adverse outcomes as increasing multiple organ failure, respiratory distress syndrome, and septic shock.

Infarct-Related Artery as aDonor of Collaterals in ST-Segment-Elevation Myocardial Infarction With Concomitant Chronic Total Occlusion: Challenge of the Double-Jeopardy Thesis.

BACKGROUND In ST-segment-elevation myocardial infarction (STEMI), a concomitant chronic total occlusion (CTO) in a non-infarct-related artery (NIRA) is associated with adverse outcome. In the case of the infarct-related artery (IRA) as a donor vessel for collaterals to the CTO, the IRA occlusion may lead to an acute threat to both the immediate IRA and the collaterally supplied CTO area, which has been described as a double-jeopardy effect. METHODS AND RESULTS We investigated the role of preformed intercoronary collaterals to the CTO originating from either the IRA or NIRA. Data were obtained from 2 hospitals participating in the prospective FITT-STEMI (Feedback Intervention and Treatment Times in ST-Segment Elevation Myocardial Infarction) study. From a total cohort of 2102 patients with acute STEMI, 93 patients had single-vessel CTO in an NIRA and well-developed intercoronary collaterals to the CTO. In-hospital mortality differed significantly with respect to the origin of the collaterals. Mortality was 15.2% with collaterals originating from the NIRA, 29.4% with a collateral origin from the IRA proximal to the acute STEMI occlusion, and 3.3% with a collateral origin from the IRA distal to the acute occlusion (P=0.044). A multivariate regression model confirmed that a proximal collateral origin had a significant higher mortality compared with a branching in the distal position from the acute STEMI occlusion (P=0.027; odds ratio=20.8 [95% CI, 1.4-304.1]). CONCLUSIONS In STEMI with CTO in an NIRA, a CTO collateralization from the IRA distal to the acute occlusion is associated with a better prognosis. This finding challenges the double-jeopardy assumption as the main cause of adverse outcome in STEMI with CTO in an NIRA. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT00794001.

Immunization with Tp0954, an adhesin of Treponema pallidum, provides protective efficacy in the rabbit model of experimental syphilis.

Syphilis, a chronic multisystemic disease caused by spirochete Treponema pallidum subspecies pallidum infection, continues to be a serious global health problem and congenital syphilis remains a major cause of adverse outcomes in pregnancy in developing countries. The development of an effective vaccine is the most cost-effective way to eliminate syphilis, but so far has been elusive. Here, we evaluated the immunogenicity and protective efficacy of Tp0954, a T. pallidum placental adhesin, as a potential vaccine candidate in a New Zealand White rabbit model of experimental syphilis. Animals immunized with recombinant Tp0954 (rTp0954) produced high titers of Tp0954-specific serum IgG, high levels of IFN-γ from splenocytes and specific splenocyte proliferation response when compared to control animals immunized with PBS and Freund's adjuvant (FA). Furthermore, rTp0954 immunization significantly delayed the development of cutaneous lesions, promoted inflammatory cellular infiltration at the primary lesion sites, as well as inhibited T. pallidum dissemination to distal tissues or organs when compared with that of the control animals. In addition, the naïve rabbits receiving popliteal lymph nodes from Tp0954-immunized, T. pallidum-challenged animals were not infected by T. pallidum, confirming sterile immunity. These findings suggest that Tp0954 is a potential vaccine candidate against syphilis.

Atrial fibrillation in real clinical practice at the outpatient stage

The aim of the study was to analyze clinical and anamnestic data, the nature of anticoagulant therapy and the incidence of adverse events based on the data of the registry of atrial fibrillation (AF) patients at the outpatient stage (20192020).Methods. The study involved 638 people (56.7% of them women) included in the registry of patients with AF, 68.2±4.5 of age. Inclusion criteria: patients over the age of 18 who applied for a consultation with a cardiologist at a cardiodispensary polyclinic and signed an informed consent.Results. The analysis of clinical and anamnestic data of patients with tachyarrhythmia was carried out. Paroxysmal AF was registered in 311 (48.8%) patients, persistent in 138 (21.6%), long-term persistent in 44 (6.9%) and permanent in 142 (22.7%) patients. The average score on the CHA2DS2-VASc was 4.8±1.8 points, on the HAS-BLED score 2.8±1.6 points, on the 2MACE score 1.3±0.8 points. Compliance to treatment corresponded to 2.5±1.5 points. When analyzing the registry of AF patients, the characteristics of anticoagulant therapy are presented. In fact, 172 (27%) patients took rivaroxaban, 166 (25%) apixaban, 84 (13%) dabigatran and 210 (33%) patients took warfarin. Among those examined, the main cause of death in 30 (4.7%) patients was coronary artery disease, of which two had myocardial infarction.Conclusion. Based on clinical and anamnestic data, a ‘portrait’ of a patient with AF at the outpatient stage is presented, which is characterized by a predominance of the risk of thrombotic complications over the risk of hemorrhagic and coronary events, with low adherence to treatment and implementation of doctor’s recommendations. When analyzing the register of patients with AF, the characteristics of anticoagulant therapy and the causes of adverse outcomes are presented.

A retrospective analysis of the causes of an adverse outcome in COVID-19 and HIV coinfection in the stage of secondary diseases

The increased incidence of COVID-19 and HIV coinfection and the changes in the structure of HIV infection mortality during the pandemic necessitate an analysis of the causes of adverse outcomes in co-infection. Objective. To retrospectively analyze deaths in patients with COVID-19 and HIV coinfection in the stage of secondary diseases. Subjects and methods. The investigation involved the medical records of 56 patients with laboratorily confirmed COVID-19 and HIV infection who were hospitalized in January to December 2021. Results. A retrospective analysis of the medical reports showed that bilateral polysegmental pneumonia of mixed etiologies was the cause of death in the majority cases of COVID-19 and HIV coinfection in the stage of secondary diseases. Along with pneumonia, multiple opportunistic diseases and conditions, which aggravated the course of the underlying disease, were identified in these patients. Various somatic diseases are one of the reasons for the severe course of the coinfection. Conclusion. Stage IVB HIV infection was diagnosed in the majority of deaths. Bilateral polysegmental pneumonia of mixed etiologies was the most common cause of death in patients with COVID-19 and HIV coinfection in the stage of secondary diseases.

Prognostic biomarkers for cardiovascular injury in patients with COVID-19: a review

Investigations into the causes of adverse outcomes of the novel coronavirus infection (COVID-19) have been ongoing since the beginning of the pandemic. There is evidence that coronavirus-induced cardiovascular injury is as important to a risk of adverse outcome as respiratory injury. Many studies have shown that concomitant cardiovascular disease aggravates the course of COVID-19. However, in some patients who did not have cardiovascular diseases before COVID-19, they are detected during hospitalization or after discharge from the hospital. The review examines data on the effect of serum biomarkers of cardiovascular disease determined during COVID-19 on the risk of adverse outcomes in the near and long-term follow-up periods. Among such biomarkers are considered: troponins, N-terminal pro B-type natriuretic peptide, creatine phosphokinase-MB, lactate dehydrogenase, myoglobin, growth stimulation expressed gene 2, pentraxin 3, angiotensin II, as well as D-dimer and homocysteine. Threshold values have been set for some of these biomarkers, which allow predicting the risk of an unfavorable outcome. At the same time, in most prognostic models, these markers are considered in association with cytokine storm indicators and other risk factors.

Dysregulated platelet function in COVID-19 patients

More than two year-experience in monitoring patients with severe novel coronavirus disease revealed an increased risk of macroand microcirculatory thrombosis, clinically manifested by heart attack, stroke, thromboses of rare localizations (thrombosis of the hepatic veins, mesenteric veins, cerebral sinuses, portal vein), being the main cause of adverse outcomes. Thromboembolic complications, expressed as sepsis-induced coagulopathy, disseminated intravascular coagulation, venous and arterial thromboembolism, pulmonary embolism, microthrombosis, and thrombotic microangiopathy were noted to affect various organs such as the lungs, heart, kidneys, and brain. Earlier, we showed that hypercoagulability is closely related to inflammatory diseases and hemostasis dysregulation. Endothelial injury and dysfunction have been identified as critical pathways to thrombosis, and other mechanisms occurring in the microvasculature were described such as endothelial activation, cytokine storm, and formation of neutrophil extracellular traps (NETs). However, a role of platelets in severe COVID-19 has not been examined. Platelets are small non-nucleated cells most known as the central mediators of hemostasis. However, upon activation, platelets release a variety of immunomodulatory cytokines and chemokines involved in regulating immune response. Because platelets are involved in both immunity and coagulation, they play a central role in immunothrombosis, a physiological process wherein immune cells induce microthrombogenesis both to prevent spread of pathogens and facilitate their clearance. Moreover, platelets can directly interact with viral receptors including those related to SARS-CoV-2. Platelet dysfunction includes both thrombocytopenia and platelet hyperactivation. It should be noted that persistent thrombocytopenia is usually correlated with mortality being associated with thrombosis of the cerebral sinuses, splanchnic system, autoimmune reactions, as well as with administered heparin and vaccines. Therefore, here we review a role of platelets in the pathogenesis of COVID-19.

Mapping of machine learning approaches for description, prediction, and causal inference in the social and health sciences.

Machine learning (ML) methodology used in the social and health sciences needs to fit the intended research purposes of description, prediction, or causal inference. This paper provides a comprehensive, systematic meta-mapping of research questions in the social and health sciences to appropriate ML approaches by incorporating the necessary requirements to statistical analysis in these disciplines. We map the established classification into description, prediction, counterfactual prediction, and causal structural learning to common research goals, such as estimating prevalence of adverse social or health outcomes, predicting the risk of an event, and identifying risk factors or causes of adverse outcomes, and explain common ML performance metrics. Such mapping may help to fully exploit the benefits of ML while considering domain-specific aspects relevant to the social and health sciences and hopefully contribute to the acceleration of the uptake of ML applications to advance both basic and applied social and health sciences research.

Pre-discharge B-lines at bedside predicts 30-day and multiple 90-day hospital re-admission in patients admitted for acute decompensated heart failure

Abstract Background Inadequate decongestion at index admission for Acute Decompensation of Heart Failure (ADHF) is a common cause of adverse outcomes. A bedside 9-zone Lung and IVC ultrasound assessment (LUICA) may help to guide decongestion and reduce hospital readmission or mortality. Purpose To identify predictors of multiple 90-day hospital representations or mortality based on a bedside handheld 9-zone LUICA volume assessment obtained by HF nurses. Methods Patients admitted for ADHF, enrolled in the RISK-HF registry and undergoing pre-discharge LUICA, were assessed for 90-day readmission and/or mortality. The primary outcome of this observational report was prediction of multiple hospital representations based on pre-discharge volume status. The LUICA was performed with a hand-held ultrasound (HHU) device (Lumify, Philips) by trained HF-nurses. Functional capacity was measured with Duke Activity Status Index (DASI). Paired t-tests were used to compare mean differences. Logistic and linear regression were used to study relationships of outcomes with clinical characteristics. Cox regression was used to analyse time to repeated readmission or death. Analysis conducted with SPSS statistics V27 and STATA SE16. Results Of 302 ADHF patients, 67 readmitted within 30-days (age 76±8.5; men, 60%; HFrEF; 44%) and 235 did not readmit within 30-days (age 72±14; 57% men; 52% HFrEF). Readmission occurred in older patients (p=0.05), with pre-discharge signs of residual congestion that was based on the number of b-lines (p&amp;lt;0.01) (Table 1). Pre-discharge B-lines were predictive of DAOOH (β −0.41, −0.6, −0.22, p&amp;lt;0.01) and of multiple 90-day hospital readmissions (β 0.03, 0.018, 0.05, p&amp;lt;0.01), independently of 30-day event risk score, number of readmissions the preceding 12 months and age at index admission (Table 2). Number of B-lines at discharge was also associated with repeated readmission or death (HR=1.02 [1.01, 1.04]) in time-to-event analysis, independent of any other factors. Conclusion Pre-discharge residual congestion defined by the number B-lines increases the likelihood of multiple 90-day adverse outcomes. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The University of MelbourneBaker Heart &amp; Diabetes Institute

Effect of Dexmedetomidine Compared to Remifentanil During Bariatric Surgery on Postoperative Nausea and Vomiting: a Retrospective Study.

Postoperative nausea and vomiting (PONV) occurs frequently after bariatric surgery and is a major cause of adverse outcomes. This retrospective study investigated whether opioid-restricted total intravenous anesthesia using dexmedetomidine as a substitute for remifentanil can reduce PONV in bariatric surgery. The electronic medical records of adult patients who underwent laparoscopic bariatric surgery between January and December 2019 were reviewed. The patients were divided into two groups according to the agents used for anesthesia: Group D, propofol and dexmedetomidine; Group R, propofol and remifentanil. A total of 134 patients were included in the analyses. The frequency of postoperative nausea was significantly lower in Group D than that in Group R until 2h after discharge from the postanesthesia care unit (PACU) (P = 0.005 in the PACU, P = 0.010 at 2h after PACU discharge) but failed to significantly reduce the overall high incidence rates of 60.5% and 65.5%, respectively (P = 0.592). Postoperative pain score was significantly lower in Group D until 6h after PACU discharge. The rates of rescue antiemetic and analgesic agent administration in the PACU were significantly lower in Group D than those in Group R. Opioid-restricted total intravenous anesthesia using dexmedetomidine reduces postoperative nausea, pain score, antiemetic, and analgesic requirements in the immediate postoperative period after bariatric surgery.

Prognostic Value of Mid-Region Proadrenomedullin and In Vitro Interferon Gamma Production for In-Hospital Mortality in Patients with COVID-19 Pneumonia and Respiratory Failure: An Observational Prospective Study.

Coagulopathy and immune dysregulation have been identified as important causes of adverse outcomes in coronavirus disease (COVID-19). Mid-region proadrenomedullin (MR-proADM) is associated with endothelial damage and has recently been proposed as a prognostic factor in COVID-19. In non-COVID-19 immunocompromised patients, low in vitro interferon gamma (IFNγ) production correlates with infection risk and mortality. This prospective, monocentric, observational study included adult patients consecutively admitted with radiologic evidence of COVID-19 pneumonia and respiratory failure. MR-proADM and in vitro IFNγ production were measured at T0 (day 1 from admission) and T1 (day 7 from enrollment). One hundred patients were enrolled. Thirty-six percent were females, median age 65 (Q1–Q3 54.5–75) years, and 58% had ≥1 comorbidity. Only 16 patients had received COVID-19 vaccination before hospitalization. At admission, the median PaO2:FiO2 ratio was 241 (157–309) mmHg. In-hospital mortality was 13%. MR-proADM levels differed significantly between deceased and survivors both at T0 (1.41 (1.12–1.77) nmol/L vs. 0.79 (0.63–1.03) nmol/L, p < 0.001) and T1 (1.67 (1.08–1.96) nmol/L vs. 0.66 (0.53–0.95) nmol/L, p < 0.001). In vitro IFNγ production at T0 and T1 did not vary between groups. When only the subset of non-vaccinated patients was considered, both biomarkers at T1 resulted significantly associated with in-hospital mortality. AUROC for MR-proADM at T0 to predict in-hospital mortality was 0.87 (95%CI 0.79–0.94), with the best cut-off point at 1.04 nmol/L (92% sensitivity, 75% specificity and 98% negative predictive value). In patients with COVID-19 pneumonia and different degrees of respiratory failure, MR-proADM at admission and during hospitalization resulted strongly associated with in-hospital mortality. Low in vitro IFNγ production after the first week of hospitalization was associated with mortality in non-vaccinated patients possibly identifying the subgroup characterized by a higher degree of immune suppression.