Death Outcomes In Patients Research Articles

Blood Features Associated with Viral Infection Severity: An Experience from COVID-19-Pandemic Patients Hospitalized in the Center of Iran, Yazd.

Pandemics such as coronavirus disease 2019 (COVID-19) can manifest as systemic infections that affect multiple organs and show laboratory manifestations. We aimed to analyze laboratory findings to understand possible mechanisms of organ dysfunction and risk stratification of hospitalized patients in these epidemics. Methods. This retrospective study was conducted among patients admitted to COVID-19 referral treatment center, Shahid Sadoughi Hospital, Yazd, Iran, from April 21 to November 21, 2021. It was the fifth peak of COVID-19 in Iran, and Delta (VOC-21APR-02; B.1-617.2) was the dominant and most concerning strain. All cases were positive for COVID-19 by RT-PCR test. Lab information of included patients and association of sex, age, and outcome were analyzed, on admission. Results. A total of 466 COVID-19 patients were included in the study, the majority of whom were women (68.9%). The average age of hospitalized patients in male and female patients was 57.68 and 41.32 years, respectively (p < 0.01). During hospitalization, abnormality in hematological and biochemical parameters was significant and was associated with the outcome of death in patients. There was incidence of lymphopenia, neutrophilia, anemia, and thrombocytopenia. The changes in neutrophil/lymphocyte (N/L) and hematocrit/albumin (Het/Alb) ratio and potassium and calcium levels were significant. Conclusion. Based on these results, new biochemical and hematological parameters can be used to predict the spread of infection and the underlying molecular mechanism. Viral infection may spread through blood cells and the immune system.

Portal vein thrombosis in patients with liver cirrhosis

Background/Aim. Portal vein thrombosis (PVT) in patients with liver cirrhosis (LC) has a prevalence of 0.6- 26%. It is most commonly discovered incidentally as part of the evaluation of LC or in the context of acute decompensation of LC due to portal hypertension. The aim of the study was to determine the prevalence of PVT in patients with LC in relation to the severity of the disease and individual elements of portal hypertension. Methods. A total of 326 patients treated for LC decompensation were included in a retrospective study. Standard laboratory analyses, abdominal ultrasonography and/or computed tomography, and esophagogastroduodenoscopy were performed. Results. The diameter of the portal vein (PV) differed between patients without esophageal varices (12.2 mm) and those with large varices (13.6 mm), p = 0.026. PVT was identified in 6.1% of patients with LC. The patients were classified according to the Child-Pugh scoring system, which has the A, B, and C categories used to assess the severity of liver disease. PVT was present in 3.0% of patients in class C and 12.0% in class B, while none of the patients in class A had PVT (p = 0.005). PVT was present in 4.4% of patients with small varices and 16.7% with large varices (p &lt; 0.001). There was no difference in the presence of PVT between the groups of patients with and without variceal bleeding nor between groups with different degrees of ascites. A fatal outcome occurred in 29.4% of patients, but there was no difference between patients with and without PVT. Conclusion. PVT is present in more advanced stages of LC and predominantly in patients with large esophageal varices. There was no higher prevalence of PVT observed with the occurrence of variceal bleeding or with the death outcome in patients with LC.

Obesity contributes to mortality and displays alterations in calcium, urea and hemoglobin levels in SARS-CoV-2 infected individuals.

Background & aimsObesity courses with metabolic and inflammatory changes that include, among others, higher expression of the renin-angiotensin-aldosterone system. The pathophysiology of the new coronavirus suggests an affinity for angiotensin-2 converting enzyme receptors, cytokine storm, and systemic hypercoagulability. Thus, obesity could contribute to the worse evolution of individuals with COVID-19. Here we evaluated the clinical outcome and age of SARS-CoV-2 infection in patients with higher BMI compared with normal BMI at the São Francisco de Assis University Hospital (HUSF), in Bragança Paulista, SP.MethodsRetrospective observational study with a review of medical records from June of 2020 to May of 2021 of patients positive for SARS-CoV-2 from HUSF. Demographic, anthropometric, and metabolic data were collected for correlation analysis. The study was approved by the Ethical Committee under CAAE: 34121820.3.0000.5514.Results360 medical records were analyzed, of which 125 were included. The mean age of patients with obesity was significantly lower than overweight and normal weight, both in the overall mean (p-value 0.002–66 versus 56 and 56) and in the mean age of mortality (p-value 0.003–59 versus 61 and 76). The mean plasma calcium in the last sample collected during hospitalization of patients with obesity was significantly higher than that of overweight and normal weight (p-value < 0.001–7.8 versus 8.1 and 8.6). The mean hemoglobin in the first admission sample was also significantly higher in patients with obesity compared to the other groups (p-value 0.041–12.5 versus 12.9 and 13.6). On the other hand, the plasma concentration of urea in the first sample of hospitalization of patients with normal weight was higher than in patients with overweight and obesity (p-value 0.036–90.4 versus 64.8 and 57.1).ConclusionOur findings suggest that age is not a determining factor for the death outcome in patients with obesity. However, obesity contributes to metabolic changes and mortality in SARS-CoV-2 infected patients.

Association of disease severity and death outcome with vaccination status of admitted COVID-19 patients in delta period of SARS-COV-2 in mixed variety of vaccine background

To understand the effectual role of COVID-19 vaccination, we must analyze its effectiveness in dampening the disease severity and death outcome in patients who acquire infection and require hospitalization. The goal of this study was to see if there was an association between disease progression in admitted COVID-19 patients and their prior vaccination exposure. A prospective cohort study based on 1640 admitted COVID-19 patients were carried between June 2021 and October 2021. Depending on vaccination exposure they were divided into vaccinated (exposed) and unvaccinated (unexposed) groups, excluding partially vaccinated patients. Disease severity was assessed at admission on severity index scale. Disease progression to mortality or need of mechanical ventilation and survival were taken as outcome. Absolute difference with 95%CI and Risk Ratio were calculated using cross tabulation, Chi square test and multivariable logistic regression analysis. Among 1514 total analyzed cohort (median age, 53 years [IQR, 17,106]; 43.7% from 46 to 65 years of age group, 56.2% males,33.4% with no comorbid factor for disease progression) 369(24.4%) were vaccinated breakthrough cases and 1145(75.6%) were unvaccinated controls. 556(36.7%) progressed to death or mechanical ventilation, 958(63.3%) patients survived and were discharged home. Disease progression to death or mechanical ventilation was significantly associated with decreased likelihood of vaccination (24.9% among vaccinated breakthrough vs 40.5% unvaccinated controls, [Absolute difference −15.6% 95%CI (−10.2% to −20.6%); RR 0.615 95%CI (0.509, 0.744); p <.001]). This association was stronger for old age population and for increase time span between second dose of vaccine and onset of symptoms. There was no statistically significant difference among different types of vaccination and occurrence of outcome when compared to unvaccinated controls (RR 0.607(0.482, 0.763); 0.673(0.339, 1.33) and 0.623(0.441, 0.881) for Inactivated virus vaccine, mRNA and Adenovirus vector-based vaccine respectively. The patients who were fully vaccinated against SARS-COV-2 die or shift to mechanical ventilation less frequently than unvaccinated COVID-19 admitted patients.

Ispitivanje uticaja različitih determinanti na smrtni ishod od akutnog koronarnog sindroma pacijenata lečenih u koronarnoj jedinici opšte bolnice u Valjevu i njihove razlike

Introduction: Cardiovascular diseases are the leading cause of morbidity and mortality in most countries of the world and are responsible for the death of 17.9 million people per year and for 11.8% of total DALYs. In Serbia, acute coronary syndrome (ACS) is the main cause of death among ischemic heart diseases, with a share of 49.9%. Aim: The aim of the study is to examine the association of various determinants (demographic, anthropometric, biological markers, risk factors, presence of comorbidities, and the pharmacotherapeutic approach) with the death outcome resulting from ACS patients treated at the Coronary Unit, as well as their differences. Materials and methods: This cross-sectional study included 384 adults with ACS, who were patients of the Cardiology Department with the Coronary Unit of the General Hospital in Valjevo, in 2020. The so-called Coronary Sheet was used as a research instrument. It was created, based on national needs, by the Institute of Public Health of Serbia "Dr. Milan Jovanović Batut", the Institute of Epidemiology, and the Cardiology Society of Serbia. This sheet is in the form of a questionnaire filled out by doctors working at the Coronary Unit, which is then submitted to the Institute of Public Health Valjevo. All respondents gave informed consent for anonymous participation in the research. The obtained data were analyzed using the methods of descriptive and analytical statistics, as well as the methods of univariate and multivariate linear regression. Results: The total sample consisted of 288 (75%) men and 96 (25%) women. The average age of patients who died of ACS was 72.9 ± 9.8 years, while the average age of patients who did not die of ACS was 65.0 ± 12.0 years. The difference was statistically significant (p &lt; 0.001). Statistically significantly more patients who had lower values of both systolic and diastolic blood pressure, when admitted to hospital, died than those who had somewhat higher values of systolic and diastolic pressure at admission (p &lt; 0.001). The mortality rate was lower for patients with ACS who were prescribed acetylsalicylic acid (p &lt; 0.001), beta blockers (p = 0.003), ACE inhibitors (p &lt; 0.001), and statins (p &lt; 0.001) during hospitalization, while all patients whose therapy included inotropes as one of the drugs died (p &lt; 0.001). Conclusion: Our research indicates the existence of a link between the examined determinants and the death outcome in patients suffering from ACS. It is necessary to improve the quality of data, maintain relevant and timely medical documentation and records, and continuously improve prevention programs, with the aim of reducing risk factors for the occurrence of ACS.

Outcome of treatment among chronic lymphocytic leukemia and its correlation to Rai staging system in Kurdistan region of Iraq

Background: Chronic lymphocytic leukemia is common adulthood leukemia with low incidence in Kurdistan region of Iraq. Staging of chronic lymphocytic leukemia is essential in treatment planning and the pattern of response is variable. Aim of study: To evaluate the Rai staging distribution of patients with chronic lymphocytic leukemia in Kurdistan region/Iraq and its correlation with the treatment outcome. Patients & Methods: A retrospective cross sectional review study conducted in three Hemato/oncology centers in Kurdistan for duration of eleven years through the period from 1st of January, 2010 to 31st of December, 2020 on convenient sample of 170chronic lymphocytic leukemia patients. Diagnosis of chronic lymphocytic leukemia was done according to the International Workshop on Chronic Lymphocytic Leukemia. The Rai staging was done by the clinical hematologist in Hemato/oncology center according to clinical evaluation and laboratory investigations. The pattern of the treatment response was determined according to the International Workshop on Chronic Lymphocytic Leukemia (iwCLL) Results: The Rai staging of our patients was 0 in 15.3% of them, stage I in 12.4%, stage II 30%, stage III 13.5% and stage IV 28.8%. The treatment response of studied sample was complete response (43.5%), partial response (17.6%), stable (14.1%), no response (21.8%) and progressive (2.9%).A highly significant association was observed between no response to treatment and advanced Rai staging and also a highly significant association was observed between death outcome of patients and advanced Rai staging. Conclusions: The treatment response of patients with chronic lymphocytic leukemia is directly related to Rai staging as patients with advanced Rai staging had lower treatment response rate.

Gut Microbiota Dysbiosis Is a Crucial Player for the Poor Outcomes for COVID-19 in Elderly, Diabetic and Hypertensive Patients.

A new infectious disease, named COVID-19, caused by the coronavirus associated to severe acute respiratory syndrome (SARS-CoV-2) has become pandemic in 2020. The three most common pre-existing comorbidities associated with COVID-19-related death are elderly, diabetic, and hypertensive people. A common factor among these risk groups for the outcome of death in patients infected with SARS-CoV-2 is dysbiosis, with an increase in the proportion of bacteria with a pro-inflammatory profile. Due to this dysbiosis, elderly, diabetic, and hypertensive people present a higher propensity to mount an inflammatory environment in the gut with poor immune editing, culminating in a weakness of the intestinal permeability barrier and high bacterial product translocation to the bloodstream. This scenario culminates in a low-grade, persistent, and systemic inflammation. In this context, we propose here that high circulating levels of bacterial products, like lipopolysaccharide (LPS), can potentiate the SARS-CoV-2-induced cytokines, including IL-6, being crucial for development of the cytokine storm in the severe form of the disease. A better understanding on the possible correlation between gut dysbiosis and poor outcomes observed in elderly, diabetic, and hypertensive people can be useful for the development of new therapeutic strategies based on modulation of the gut microbiota.

Clinical characteristics of patients undergoing coronary artery bypass surgery: Focus on gender differences

Background and Aims: The aim of the present study is to investigate whether the clinical characteristics of patients undergoing coronary artery bypass surgery (CAGB) differ by sex. Methods: This study was performed with a total of 58 patients who underwent CABG. The age, weight, height, systolic and diastolic blood pressure, HbA1c, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and total cholesterol values together with the demographic characteristics of patients undergoing CABG were collected and compared between male and female patients. Results: In the present study, 71% of patients undergoing CABG were men and 29% of them were women. There was no significant difference in weight, systolic and diastolic blood pressure, HbA1c, and total cholesterol values between male and female patients. Body mass index, LDL and HDL levels, the ratios of LDL/total cholesterol and HDL/total cholesterol were higher while height was lower in females compared to male patients. Conclusion: Our study highlights the need for sex-specific approaches in the prevention of coronary artery diseases. Risk factors including obesity, diabetes, hypertension, and dyslipidemia influence the outcome of death in patients undergoing CABG. Correct management of controllable risk factors with the focus on gender differences could be beneficial in reducing mortality and morbidity rates by altering the prognosis of coronary artery diseases.

Primary and acquired multidrug-resistant tuberculosis: Predictive factors for unfavorable treatment outcomes in Rio de Janeiro, 2000-2016.

ABSTRACTObjectiveTo identify clinical and demographic factors associated with unfavorable treatment outcomes in patients with primary and acquired multidrug-resistant tuberculosis (MDR-TB) in Rio de Janeiro State.MethodsRetrospective cohort study using data on 2 269 MDR-TB cases in 2000–2016. Factors associated with unsuccessful, loss to follow-up, and death outcomes in patients with primary and acquired resistance were investigated with bivariate and multivariate regression.ResultsPrimary resistance was 14.7% among MDR-TB cases. The unfavorable outcomes proportion was 30.3% in the primary resistance group and 46.7% in the acquired resistance group. There were significant differences in demographic and clinical characteristics between the two groups. Proportionally, the group with primary resistance had more cases among women (46.4% vs. 33.5% in the acquired resistance group), Caucasians (47.3% and 34%), and those with ≥8 years of schooling (37.7% and 27.4%). Extensively drug-resistant TB patients had 12.2-fold higher odds of unsuccessful outcome than MDR-TB patients, and comorbidities had 2-fold higher odds in the primary resistance group. Extensively drug-resistant TB had 5.43-fold higher odds in the acquired MDR-TB group. Bilateral disease and <8 years of schooling were associated with unsuccessful outcome in both groups. Being an inmate had 8-fold higher odds of loss to follow-up in the primary resistance group. Culture conversion by the sixth month was a protective factor for all outcomes.ConclusionsPrimary resistance cases of MDR-TB constitute a different transmission reservoir, which is related to other chronic diseases associated with higher acquisition of TB. The poor results observed in Rio de Janeiro State can contribute to increasing the transmission of primary MDR-TB, thus favoring drug resistance.

Assessment of incidence rate and prognosis of metabolic syndrome among acute myocardial infarction: a longitudinal study

Background: The Metabolic Syndrome (METS) is a specific clustering of cardiovascular risk factors in the same person (abdominal obesity, atherogenic dyslipidemia, elevated Blood Pressure (BP), Insulin Resistance (IR), and a proinflammatory state. A recent review of insulin resistance syndrome revealed a rapid escalation of this syndrome among Indians and the prevalence of predominant component of METS varies from region to region. Hence the present study was undertaken to assess the incidence of Metabolic Syndrome and prognosis of metabolic syndrome among acute myocardial infarction patients.Methods: A longitudinal study was carried among Acute myocardial infarction patients, who were admitted to ICCU of Shri. B. M. Patil Hospital and Research Centre, Bijapur during November 2009 to March 2011. Sample size was calculated using the formula: n=4pq/L2. Sample size required was 92. Descriptive statistics and Inferential statistics were used to analyse the results.Results: The incidence rate of METS among AMI in our study was 48.7%. The complications were more common in METS group compared to those without METS groups. Recovery was better among those without METS group. There was a statistically significant association between complications and status of METS. The past history of DM was more common in METS. Hyperglycemia among the components of METS has strongest association with the outcome of death in patients of AMI.Conclusions: The metabolic syndrome is a highly prevalent condition among the patients with acute myocardial infarction and has detrimental impact on outcome Metabolic syndrome is also associated with a higher risk of severe heart failure and death.

Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study.

Rationale: Up to date, the exploration of clinical features in severe COVID-19 patients were mostly from the same center in Wuhan, China. The clinical data in other centers is limited. This study aims to explore the feasible parameters which could be used in clinical practice to predict the prognosis in hospitalized patients with severe coronavirus disease-19 (COVID-19).Methods: In this case-control study, patients with severe COVID-19 in this newly established isolation center on admission between 27 January 2020 to 19 March 2020 were divided to discharge group and death event group. Clinical information was collected and analyzed for the following objectives: 1. Comparisons of basic characteristics between two groups; 2. Risk factors for death on admission using logistic regression; 3. Dynamic changes of radiographic and laboratory parameters between two groups in the course.Results: 124 patients with severe COVID-19 on admission were included and divided into discharge group (n=35) and death event group (n=89). Sex, SpO2, breath rate, diastolic pressure, neutrophil, lymphocyte, C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), and D-dimer were significantly correlated with death events identified using bivariate logistic regression. Further multivariate logistic regression demonstrated a significant model fitting with C-index of 0.845 (p<0.001), in which SpO2≤89%, lymphocyte≤0.64×109/L, CRP>77.35mg/L, PCT>0.20μg/L, and LDH>481U/L were the independent risk factors with the ORs of 2.959, 4.015, 2.852, 3.554, and 3.185, respectively (p<0.04). In the course, persistently lower lymphocyte with higher levels of CRP, PCT, IL-6, neutrophil, LDH, D-dimer, cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and increased CD4+/CD8+ T-lymphocyte ratio and were observed in death events group, while these parameters stayed stable or improved in discharge group.Conclusions: On admission, the levels of SpO2, lymphocyte, CRP, PCT, and LDH could predict the prognosis of severe COVID-19 patients. Systematic inflammation with induced cardiac dysfunction was likely a primary reason for death events in severe COVID-19 except for acute respiratory distress syndrome.

Outcome of Trauma Patients Admitted to Emergency Department Based on Full Outline of Unresponsiveness Score.

Introduction:Full Outline of Unresponsiveness (FOUR) score is one of the existing scoring scales, which has been used for evaluating the level of consciousness in recent years. Objective:The present study has been done with the aim of evaluating the ability to predict the outcome of patients with head trauma based on FOUR score on admission to emergency department (ED). Methods:In the present prospective cross-sectional study, head trauma patients with any changes in alertness level presenting to ED were evaluated. FOUR score measurement was done on admission and 6 hours after that. The studied outcomes in the current study included discharge without sequel, discharge with neurologic sequel, brain death or death during 1 month after admission of the patients. To evaluate the correlation between FOUR score and the studied outcomes, area under the receiver operating characteristic (ROC) curve was used. Results:In the end, 52 patients with the mean age of 32.67 ± 15.20 years were evaluated (84.6% male). Traffic accident with the frequency of 39 (75.0%) patients was the most common mechanism of trauma among the studied patients and finally, after 1 month follow up it was determined that 13 (25%) patients were discharged without sequel and 31 (59.6%) died. Area under the ROC curve for prediction of the final outcome of death using FOUR score on admission and after 6 hours were 0.889 (95% confidence interval: 0.800 - 0.977) and 0.974 (95% confidence interval: 0.938 – 1.000), respectively. Best cutoff points for FOUR score were the scores 8 and 9 on admission of the patients, and the score 5, six hours after admission. Conclusion:Based on the findings of this study, it seems that FOUR score is applicable for prediction of probable death outcome in patients with head trauma presenting to ED.

The incidence of malignant arrhythmia and death outcomes in patients with ischemic and nonischemic dilated cardiomyopathy with implantable cardioverter defibrillator - results of a single center

The incidence of malignant arrhythmia and death outcomes in patients with ischemic and nonischemic dilated cardiomyopathy with implantable cardioverter defibrillator - results of a single center

Анализ летальных исходов пациентов противотуберкулезного диспансера с выделением случаев сочетания «ВИЧ – туберкулез»

Анализ летальных исходов пациентов противотуберкулезного диспансера с выделением случаев сочетания «ВИЧ – туберкулез»

Health-related quality of life as a predictor of mortality in patients on peritoneal dialysis.

Objective:to characterize deaths that occurred, and the association between socio-demographic, clinical, laboratory variables and health-related quality of life and the outcome of death in patients on peritoneal dialysis, over a two year period after an initial assessment. Method:observational, prospective population study with 82 patients on peritoneal dialysis. The instruments used for the first stage of data collection were the mini-mental state examination, a sociodemographic, economic, clinical and laboratory questionnaire and the Kidney Disease and Quality of Life-Short Form. After two years, data for characterization and occurrence of death in the period were collected. The relative risk of death outcome was calculated through statistical analysis; the risk of death was estimated by the survival Kaplan-Meier curve, and determined predictors of death by the Cox Proportional Hazards Model. Results:of the 82 original participants, 23 had as an outcome death within two years. The increased risk for the outcome of death was associated with a lower mean score of health-related quality of life in the physical functioning domain. Conclusion:the worst health-related quality of life in the physical functioning domain, could be considered a predictor of death.

Características clínico-demográficas de pacientes submetidos a cirurgia de revascularização do miocárdio e sua relação com a mortalidade

To describe the demographic and clinical characteristics and to test their relation to mortality in patients undergoing to coronary artery bypass graft surgery (CABG). It is a retrospective study developed from the medical records of 655 patients undergoing CABG from May 2002 to April 2010. Hospital mortality was 12.1%. Mortality was significantly (P<0.05) higher in females (17.3%), aged less than 70 years (22.8%), in emergency surgery (36.4%), in cases of readmission to the intensive care unit (ICU) (33.3%), when the stay in the ICU was less than three days (16.3%), undergoing longer cardiopulmonary bypass (CPB) and with more comorbidities (15.4%). Predictor variables of death identified with logistic regression analysis were: female (OR=2.04), age >70 years (OR=2.69), emergency surgery (OR=15.43) and urgency (OR=3.81), performance of CPB (OR=2.19) and re-admission to the ICU (OR=4.33). Variables such as gender, age, type of surgery, readmission to the ICU, ICU stay, comorbidities and time of CPB influence the outcome death in patients undergoing to CABG. Thus, such aspects should be considered to reduce hospital mortality in patients undergoing such surgery.