Early Mortality In Patients Research Articles

A Combination of Heart Rate-Corrected QT Interval and GRACE Risk Score Better Predict Early Mortality in Patients with Non-ST Segment Elevation Acute Coronary Syndrome.

This study aimed to evaluate whether the addition of heart rate-corrected QT inter- val prolongation to the Global Registry of Acute Coronary Events risk score improves the pre- dictive value for early mortality in patients with non-ST segment elevation acute coronary syndrome. We retrospectively screened our database for consecutive non-ST-segment eleva- tion acute coronary syndrome patients between January 2017 and July 2019. The demographic and clinical parameters were acquired via chart review. All electrocardiograms were reviewed by 2 physicians. QT interval was measured using the tangent method. Early mortality was defined as all-cause death observed during the hospital stay or within 30 days after discharge. The final study population consisted of 283 patients, there were 17 early deaths. Ten of 59 patients with prolonged corrected QT intervals died (16.9%, P < .001). Both the Global Registry of Acute Coronary Events risk score (odds ratio: 1.032; 95% CI: 1.012-1.053; P = .002) and corrected QT interval (odds ratio: 1.026; 95% CI: 1.007-1.045; P = 0.007) independently predicted early mortality. The area under value was 0.769 (95% CI: 0.674-0.863, P < .001) for the corrected QT interval and 0.780 (95% CI:0.681-0.878; P < .001) for the Global Registry of Acute Coronary Events risk score alone. However, when the corrected QT interval and the Global Registry of Acute Coronary Events risk score were combined, it was found to be 0.808 (95% CI: 0.713-0.904, P < .001). This study is the first to report that prolonged corrected QT and the Global Registry of Acute Coronary Events risk score independently predict early mortality and a combina- tion of these 2 factors may improve the predictive value for early mortality in patients with ST-segment elevation acute coronary syndrome.

Predictors of early mortality in multiple myeloma: Results from the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR).

SummaryThe frequency and causes of early mortality in patients with newly diagnosed multiple myeloma (NDMM) have not been well described in the era of novel agents. We investigated early mortality in a prospective cohort study of all patients with NDMM registered on the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR) at 36 institutions between July 2011 and March 2020. Early mortality was defined as death from any cause within the first 12 months after diagnosis. A total of 2377 patients with NDMM were included in the analysis, with a median (interquartile range) age of 67.4 (58.9–74.60 years, and 60% were male. Overall, 216 (9.1%) patients died within 12 months, with 119 (4.5%) having died within 6 months. Variables that were independent predictors of early mortality after adjustment in multivariable regression included age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.05–1.08; p < 0.001), Eastern Cooperative Oncology Group performance status (OR 1.50, 95% CI 1.26–1.79; p < 0.001), serum albumin (OR 0.95, 95% CI 0.93–0.98; p < 0.001), cardiac disease (OR 1.96, 95% CI 1.35–2.86; p < 0.001) and International Staging System (OR 1.40, 95% CI 1.07–1.82; p = 0.01). For those with a primary cause of death available, it was reported as disease‐related in 151 (78%), infection 13 (7%), other 29 (15%). Infection was listed as a contributing factor for death in 38% of patients.

PD-1/PD-L1 pathway is related to infection development and early mortality in patients with cirrhosis

PD-1/PD-L1 pathway is related to infection development and early mortality in patients with cirrhosis

Lipocalin-2: a novel link between the injured kidney and the bone.

Fibroblast growth factor 23 (FGF23) excess is associated with left ventricular hypertrophy (LVH) and early mortality in patients with chronic kidney disease (CKD) and in animal models. Elevated Lipocalin-2 (LCN2), produced by the injured kidneys, contributes to CKD progression and might aggravate cardiovascular outcomes. The current review aims to highlight the role of LCN2 in CKD, particularly its interactions with FGF23. Inflammation, disordered iron homeostasis and altered metabolic activity are common complications of CKD, and are associated with elevated levels of kidney-produced LCN2 and bone-secreted FGF23. A recent study shows that elevated LCN2 increases FGF23 production, and contributes to cardiac injury in patients and animals with CKD, whereas LCN2 reduction in mice with CKD reduces FGF23, improves cardiovascular outcomes and prolongs lifespan. In this manuscript, we discuss the potential pathophysiological functions of LCN2 as a major kidney-bone crosstalk molecule, linking the progressive decline in kidney function to excessive bone FGF23 production. We also review associations of LCN2 with kidney, cardiovascular and bone and mineral alterations. We conclude that the presented data support the design of novel therapeutic approaches to improve outcomes in CKD.

Frequency of elevated systolic blood pressure and early mortality in patients with Intracerebral hemorrhage.

Objective: To determine the frequency of elevated systolic blood pressure and early mortality in patients with Intracerebral hemorrhage. Study Design: Descriptive Case Series study. Setting: Department of Medicine, Unit IV of Jinnah Hospital Lahore. Period: 6th April 2018 to 7th October 2018. Material &amp; Methods: Total 335 patients of intracerebral hemorrhage, fulfilling inclusion criteria were recruited for the study. Blood pressure levels was measured by researcher using random-zero sphygmomanometers with the subject lying quietly. Two readings of blood pressure 5 minutes apart were taken and average of the two readings was noted in the proforma. CT scan brain was done and analyzed by consultant radiologist. These study cases were followed till discharge to note outcome (mortality). Data was entered and analyzed in SPSS version 20. Frequency and percentages were used for expressing qualitative variables while quantitative variables were expressed in the form of mean and standard deviation. Results: The mean age of the study participants was 64.39 + 8.50 years. Majority of the cases were males with the frequency of 285(85.1%). Early mortality was noted in 132(39%) of cases. Diabetes Mellitus was noted in 144(43%) of cases. There was significant difference noted with p-value&lt;0.05 for early mortality in elevated versus normal blood pressure people. Conclusion: Significant proportion of patients with intracerebral hemorrhage patients have elevated blood pressure and suffer from early mortality.

Marshall Computed Tomography Scoring System in Predicting Early Mortality in Patients with Traumatic Brain Injury.

Traumatic brain injury is common neurological emergency worldwide associated with high rates of morbidity and mortality. Marshall scoring system is one of the several scoring systems that uses initial computed tomography findings to predict outcome. This study aims to determine the role of Marshall scoring system in predicting early mortality in patients with Traumatic brain injury in Nepalese patient population. Patients admitted with diagnosis of Traumatic brain injury between August 2017 and July 2018 in our institution were studied prospectively. Clinical status of patient was noted and computed tomography scan of head was interpreted according to Marshall scoring system. Patients were monitored during the hospital stay and in-hospital mortality was correlated with different components of Marshall scoring system at discharge. The most common cause of Traumatic brain injury was road traffic accident (45%). Severe Traumatic brain injury was noted in 17% of patients and commonest intracranial mass lesion was contusion (24%). Surgery was performed in 29% of patients. There was significant correlation between increase in Marshall score and mortality (p<0.001). Degree of midline shift (p<0.016), status of basal cisterns (p<0.001), and combination of mass lesions (p=0.005) were independent predictors of early mortality. Marshall scoring is highly reliable scoring system to predict early mortality in patients with Traumatic brain injury. Degree of midline shift, status of basal cisterns, and combination of mass lesions are independent parameters predicting early mortality in patients with traumatic brain injury.

Clinical Outcomes in Patients With ST-Segment Elevation MI and No Standard Modifiable Cardiovascular Risk Factors.

The author recently reported ∼50% excess early mortality in patients with first-presentation ST-segment elevation myocardial infarction (STEMI) without standard modifiable cardiovascular risk factors (SMuRFs); the cause of this is not clear. The aim of this study was to examine differences in infarct characteristics and clinical outcomes in patients with versus without SMuRFs (dyslipidemia, hypertension, diabetes mellitus, and smoking). Individual-level data were pooled from 10 randomized percutaneous intervention (PCI) trials in which infarct size was measured within 1month by either cardiac magnetic resonance or technetium-99m sestamibi single-photon emission computed tomography imaging. First-presentation STEMI was classified into 2 groups according to the presence or absence of at least 1 SMuRF. Among 2,862 patients, 524 (18.3%) were SMuRF-less. After adjusting for study effect, SMuRF-less patients had more frequent poor pre-PCI flow Thrombolysis In Myocardial Infarction 0/1 compared with patients with at least 1SMuRF (72.0% vs 64.1%; OR: 1.35; 95%CI: 1.08-1.70). There were no independent associations between the presence or absence of SMuRFs at baseline and infarct size (estimate =-0.35; 95%CI:-1.93 to 1.23), left ventricular ejection fraction (estimate =-0.06; 95%CI:-1.33 to 1.20), or mortality at 30days (HR: 0.46; 95%CI: 0.19-1.07) and 1 year (HR:0.74; 95%CI: 0.43-1.29). First-presentation STEMI patients with no identifiable baseline SMuRFs had a higher risk of Thrombolysis In Myocardial Infarction flow grade 0/1 pre-PCI. However, after adjustment, there were no significant associations between SMuRF-less status and infarct size, left ventricle ejection fraction, or mortality.

Incidence and risk factors for bacterial infection in newly diagnosed multiple myeloma patients undergoing treatment with bortezomib, lenalidomide, and dexamethasone (RVD).

e20008 Background: Infection is an important cause of morbidity and mortality in newly diagnosed multiple myeloma (NDMM), but the risk of infection using novel treatment regimens is incompletely described in the literature. There are mixed trial results for antibacterial prophylaxis to reduce infection risk in newly diagnosed multiple myeloma and its use remains controversial. Methods: To evaluate the incidence of bacterial infection and early mortality in patients receiving bortezomib, lenalidomide, and dexamethasone (RVD) for NDMM, we performed a retrospective single-center cohort study of patients treated between 01/2014-01/2020. Demographic and clinical data were collected. Two cohorts were generated for those patients with or without bacterial infection during the follow-up period. A multivariate logistic regression was utilized to determine risk factors for bacterial infection. Variables with a P-value &lt;0.2 on univariate analysis were considered for the model. For co-linear variables with a P-value &lt;0.2 on univariate analysis, only one variable was included in the multivariable model. A receiver operating characteristic (ROC) curve was generated to assess the sensitivity and specificity of the model. Results: Of 144 patients, 21 patients (14.5%) experienced a bacterial infection of any grade. 11% of patients received pneumocystis prophylaxis, and 1 patient received levofloxacin prophylaxis. 11 (7.6%) patients experienced grade 3 (G3) or higher infection. One patient died in our cohort; there were no deaths from infection. G3 neutropenia occurred in 11% of patients with 2% experiencing any grade febrile neutropenia. Pneumonia and urinary tract infections were common, affecting 8(5.5%) and 6 (4.2%) patients, respectively. On multivariable analysis (Table), age, smoking history, history of diabetes, antibiotic use in the 60 days preceding 1st cycle of RVD, and high-risk cytogenetics (HR CG) were associated with a greater likelihood of experiencing a bacterial infection. The area under the ROC curve of the multivariable model was 0.829 (95% CI 0.729-0.934). Conclusions: The overall incidence of bacterial infection in NDMM patients receiving induction with RVD was low despite minimal use of antibacterial prophylaxis. Early mortality was uncommon and not attributable to infection. Clinical features may identify a subgroup of patients at greater risk of infection during induction therapy for MM and may impact clinical decisions to utilize antibacterial prophylaxis.[Table: see text]

Impact of activities of daily living on percutaneous coronary intervention and acute and long-term mortality in patients with acute myocardial infarction: Yamagata AMI registry

BackgroundA decrease in the activities of daily living (ADL) is an independent risk factor for cardiovascular disease. Although percutaneous coronary intervention (PCI) is known to prevent early mortality in patients with acute myocardial infarction (AMI), the relationship between ADL prior to myocardial infarction (MI), PCI implementation, and mortality in patients with AMI remains unknown. We investigated the impact of prehospital ADL on PCI implementation and on short- and long-term mortality in patients with AMI. MethodsWe investigated the prehospital ADL in 1479 patients with AMI using data from the Yamagata AMI registry (period: 2015–2017). The patients were divided into three groups (preserved ADL, mildly impaired ADL, and severely impaired ADL) and their clinical characteristics were compared. Multivariate regression analysis was performed to elucidate the association of ADL prior to MI with the PCI implementation and mortality in patients with AMI. ResultsPatients with impaired ADL were older, more likely to be female, less likely to have undergone PCI, and presented with higher acute mortality compared to those with preserved ADL. The proportion of patients with impaired ADL increased with age. Multivariate regression analysis showed that the lack of PCI implementation and prehospital ADL impairment were independent risk factors for acute death in patients with AMI after adjusting for confounding factors. Furthermore, univariate and multivariate analyses revealed that impaired ADL was associated with the PCI implementation. Cox proportional hazards analysis revealed that prehospital ADL impairment was an independent risk factor for long-term mortality in patients with AMI. ConclusionsDecreased levels of prehospital ADL were associated with lower PCI implementation and higher mortality in patients—especially older patients—with AMI.

Nomogram for Risk Prediction of Mortality for Patients with Critical Cardiovascular Disease Treated by Continuous Renal Replacement Therapy in Coronary Care Unit.

To establish a nomogram-scoring model for evaluating the risk of death in patients with critical cardiovascular disease after continuous renal replacement therapy (CRRT) in a coronary care unit (CCU). This retrospective cohort study included data collected on 172 patients, in whom CRRT was initiated in the CCU between January 2017 and June 2021. Predictors of mortality were selected using an adaptive least absolute shrinkage and selection operator logistic model and used to construct a nomogram. The nomogram was evaluated using the concordance index (C-index) and Hosmer-Lemeshow test. The number of patients who died in-hospital after CRRT was 91 (52.9%). The results of the multivariate logistic regression analyses clarified that age, history of hypertension and/or coronary artery bypass grafting, a diagnosis of unstable angina pectoris or acute myocardial infarction, ejection fraction, systolic blood pressure, creatinine, neutrophil, and platelet counts before CRRT initiation were significant predictors of early mortality in patients treated with CRRT. The nomogram constructed on these predictors demonstrated significant discriminative power with an unadjusted C-index of 0.902 (95% CI: 0.858-0.945) and a bootstrap-corrected C-index of 0.875. Visual inspection showed a good agreement between actual and predicted probabilities (Hosmer-Lemeshow 2 = 5.032, p-value = 0.754). Our nomogram based on nine readily available predictors is a reliable and convenient tool for identifying critical patients undergoing CRRT at risk of mortality in the CCU.

Role of electrocardiogram findings in predicting 48-h mortality in patients with traumatic brain injury

ObjectiveElectrocardiogram (ECG) patterns can change, especially in patients with central nervous system disorders such as spontaneous subarachnoid hemorrhage. However, the association between the prognosis of traumatic brain injury (TBI) and ECG findings is unknown. Therefore, this study aimed to compare and to analyze ECG findings to predict early mortality in patients with TBI.MethodsThis retrospective observational study included patients with severe trauma and TBI who were admitted to the emergency department (ED) between January 2018 and December 2020. TBI was defined as an abbreviated injury scale score of the head of ≥3. We examined ECG findings, including PR prolongation (≥ 200 ms), QRS complex widening (≥ 120 ms), corrected QT interval prolongation (QTP, ≥ 480 ms), ST-segment elevation, and ST-segment depression (STD) at ED arrival. The primary outcome was 48-h mortality.ResultsOf the total patients with TBI, 1024 patients were included in this study and 48-h mortality occurred in 89 patients (8.7%). In multivariate analysis, QTP (odds ratio [OR], 2.017; confidence interval [CI], 1.203–3.382) and STD (OR, 8.428; 95% CI, 5.019–14.152) were independently associated with 48-h mortality in patients with TBI. The areas under the curve (AUCs) of the revised trauma score (RTS), injury severity score (ISS), QTP, STD, and the combination of QTP and STD were 0.790 (95% CI, 0.764–0.815), 0.632 (95% CI, 0.602–0.662), 0.605 (95% CI, 0.574–0.635), 0.723 (95% CI, 0.695–0.750), and 0.786 (95% CI, 0.759–0.811), respectively. The AUC of the combination of QTP and STD significantly differed from that of ISS, QTP, and STD, but not RTS.ConclusionBased on the ECG findings, QTP and STD were associated with 48-h mortality in patients with TBI.

Reperfusion therapy for ST-elevation myocardial infarction complicated by cardiogenic shock: the European Society of Cardiology EurObservational programme acute cardiovascular care-European association of PCI ST-elevation myocardial infarction registry.

To determine the current state of the use of reperfusion and adjunctive therapies and in-hospital outcomes in European Society of Cardiology (ESC) member and affiliated countries for patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). ESC EurObservational Research Programme prospective international cohort study of admissions with STEMI within 24 h of symptom onset (196 centres; 26 ESC member and 3 affiliated countries). Of 11 462 patients enrolled, 448 (3.9%) had CS. Patients with compared to patients without CS, less frequently received primary percutaneous coronary intervention (PCI) (65.5% vs. 72.2%) and fibrinolysis (15.9% vs. 19.0), and more often had no reperfusion therapy (19.0% vs. 8.5%). Mechanical support devices (intraaortic ballon pump 11.2%, extracoporeal membrane oxygenation 0.7%, other 1.1%) were used infrequently in CS. Bleeding definition academic research consortium 2-5 bleeding complications (10.1% vs. 3.0%, P < 0.01) and stroke (4.2% vs. 0.9%, P < 0.01) occurred more frequently in patients with CS. In-hospital mortality was 10-fold higher (35.5% vs. 3.1%) in patients with CS. Mortality in patients with CS in the groups with PCI, fibrinolysis, and no reperfusion therapy were 27.4%, 36.6%, and 62.4%, respectively. In this multi-national registry, patients with STEMI complicated by CS less frequently receive reperfusion therapy than patients with STEMI without CS. Early mortality in patients with CS not treated with primary PCI is very high. Therefore, strategies to improve clinical outcome in STEMI with CS are needed.

Acute glycemic variability and mortality of patients with acute stroke: a meta-analysis

BackgroundIncreased glucose fluctuation has been related to poor prognosis in patients with critical illnesses, while its prognostic role in patients with acute stroke remains unknown. The meta-analysis aimed to evaluate the association between the acute glycemic variation (GV) and mortality risk in patients with acute stroke.MethodsCohort studies were obtained by searching Medline, Web of Science, Embase, Wanfang and CNKI databases. A random-effect model which incorporates the intra-study heterogeneity was chosen to pool the results.ResultsTen cohort studies with 1433 patients were included, and 280 (19.5%) of them died within 90 days of disease onset. Results of the meta-analyses showed that a higher acute GV was associated with an increased risk of early mortality in patients with acute stroke, as indicated by GV measured with the coefficient of variation of blood glucose (CVBG, odds ratio [OR]: 2.24, 95% CI 1.40 to 3.58, p < 0.001, I2 = 73%), the standard deviation of blood glucose (SDBG, OR: 2.31, 95% CI 1.70 to 3.13, p < 0.001, I2 = 50%), and the mean amplitude of glycemic excursion (OR: 3.57, 95% CI 1.44 to 8.85, p = 0.006, I2 = 23%). For acute GV measured with CVBG and SDBG, subgroup analyses showed consistent results in patients with acute ischemic and hemorrhagic stroke, and for studies reporting 28-day and 90-day all-cause mortality (p for subgroup analysis all > 0.05).ConclusionsHigher acute GV may be an independent risk factor of early mortality in patients with acute stroke.

Risk factors for mortality within 6 mo in patients with diabetes undergoing urgent-start peritoneal dialysis: A multicenter retrospective cohort study.

BACKGROUNDThe risk of early mortality of patients who start dialysis urgently is high; however, in patients with diabetes undergoing urgent-start peritoneal dialysis (USPD), the risk of, and risk factors for, early mortality are unknown.AIMTo identify risk factors for mortality during high-risk periods in patients with diabetes undergoing USPD.METHODSThis retrospective cohort study enrolled 568 patients with diabetes, aged ≥ 18 years, who underwent USPD at one of five Chinese centers between 2013 and 2019. We divided the follow-up period into two survival phases: The first 6 mo of USPD therapy and the months thereafter. We compared demographic and baseline clinical data of living and deceased patients during each period. Kaplan-Meier survival curves were generated for all-cause mortality according to the New York Heart Association (NYHA) classification. A multivariate Cox proportional hazard regression model was used to identify risk factors for mortality within the first 6 mo and after 6 mo of USPD.RESULTSForty-one patients died within the first 6 mo, accounting for the highest proportion of mortalities (26.62%) during the entire follow-up period. Cardiovascular disease was the leading cause of mortality within 6 mo (26.83%) and after 6 mo (31.86%). The risk of mortality not only within the first 6 mo but also after the first 6 mo was higher for patients with obvious baseline heart failure symptoms than for those with mild or no heart failure symptoms. Independent risk factors for mortality within the first 6 mo were advanced age [hazard ratio (HR: 1.908; 95%CI: 1.400-2.600; P < 0.001), lower baseline serum creatinine level (HR: 0.727; 95%CI: 0.614-0.860; P < 0.001), higher baseline serum phosphorus level (HR: 3.162; 95%CI: 1.848-5.409; P < 0.001), and baseline NYHA class III-IV (HR: 2.148; 95%CI: 1.063-4.340; P = 0.033). Independent risk factors for mortality after 6 mo were advanced age (HR: 1.246; 95%CI: 1.033-1.504; P = 0.022) and baseline NYHA class III-IV (HR: 2.015; 95%CI: 1.298-3.130; P = 0.002).CONCLUSIONTo reduce the risk of mortality within the first 6 mo of USPD in patients with diabetes, controlling the serum phosphorus level and improving cardiac function are recommended.

Ischemic Stroke Severity, Stroke Types and Early Mortality in Patients with End-stage Renal Disease

Ischemic Stroke Severity, Stroke Types and Early Mortality in Patients with End-stage Renal Disease

Pediatric heart transplantation in infants and small children under 3 years of age: Single center experience – “Early and long-term results”

ObjectivesWe analyzed the early and long-term survival after ABO-compatible heart transplantation in children under 3 years of age from 1991 to 2021 at our center. This retrospective and descriptive study aimed to identify serious adverse events associated with mortality after pediatric heart transplantation. Patients and methods46 patients with congenital heart failure (37%) in end-stage heart failure have undergone a pediatric heart transplantation. Primary outcome of interest was survival at follow-up time. ResultsMedian (IQR) follow-up time (y), age (y), body-weight (kg) and BMI (kg/cm2) were 13.2 (5.7–19.5), 0.9 (0.2–2.0), 6.8 (4.3–10.0) and 14.2 (12.3–15.7). Twenty-four (52%) patients were male. 15 patients (33%) had a single ventricle physiology. At 30- days survival rate was 94 ± 4%. Survival rate at 1, 5, 10 and 15 years post HTx was 87 ± 5%, 84 ± 6%, 79 ± 6% and 63 ± 8%. One child underwent re-transplantation after 4 years, and another one after 11 years – in both cases due to graft failure. Higher early mortality in patients under 3 months of age and in patients with single ventricle physiology. Transplant free survival at 15 years was in children with cardiomyopathy better (71 ± 10%) than in those with congenital heart disease (50 ± 13%). One or more previous heart surgeries prior to HTx (n = 21) were associated to more mortality. ConclusionPediatric heart transplantation has acceptable long-term results and is still the best therapeutic option in children with end-stage cardiac failure. Underlying anomalies and single ventricle physiology, age below 3 months had a significant impact on survival.

Mapping Patients' Perceived Facilitators and Barriers to In-Center Hemodialysis Attendance to the Health Belief Model: Insights from a Qualitative Study.

Previous research has shown that deliberate withdrawal, skipping, and/or shortening hemodialysis sessions has become a major health problem associated with poor clinical outcomes and early mortality in patients with end-stage renal disease (ESRD). However, patients' experiences with this treatment remain largely unexplored. This study aimed to explore patients' perceived facilitators and barriers to in-center hemodialysis attendance and map these findings to the Health Belief Model. A qualitative exploratory study was conducted with a purposive sample. Semi-structured interviews were conducted and submitted to thematic analysis. Twenty-four patients (66.2 ± 12.3years old; length of time on hemodialysis: 35.2 ± 51.5months) were interviewed. Five major facilitators (social support, perceived benefits, self-efficacy, time on dialysis, and risk/susceptibility perception) and two barriers (lack of knowledge about ESRD and hemodialysis, and psychosocial costs) were identified. Adherence to the prescribed regimen of hemodialysis attendance is a complex and multidimensional phenomenon that involves an interaction between modifying factors (social support, disease and treatment knowledge, time on dialysis) and patients' perceived benefits, perceived risks, self-efficacy, and treatment costs. This study findings expand knowledge by suggesting that perceiving health benefits from the beginning of treatment, self-efficacy to deal with dialysis demands, and purpose in life are important facilitators of adherence to in-center hemodialysis sessions. Furthermore, it suggests that the impact of the hemodialysis regimen on the emotional well-being of family members is an important barrier. Future interventions should focus on skills training to promote self-efficacy and family coping with the demands of in-center hemodialysis, improve disease and treatment knowledge, and help balance perceived benefits with dialysis costs.

Preoperative Predictors of Early Mortality Risk in People with Osteosarcoma of the Extremities Treated with Standard Therapy.

PurposeMore precise identification of osteosarcoma patients with high early death risk and enhanced early follow-up of these patients, such as increasing the frequency of postoperative chest computed tomography (CT) and local magnetic resonance imaging (MRI) examinations, may improve the overall survival of patients. The primary purpose of this research is to explore the risk factors related to early mortality in patients with osteosarcoma under standard treatment.Patients and MethodsOur research included 87 osteosarcoma patients who had undergone standard treatment and had a Karnofsky (KPS) ≥70. We define patients who die within 2 years of diagnosis as early death. The clinical characteristics and laboratory indicators of patients with osteosarcoma were collected and analyzed retrospectively.ResultsThe median follow-up time was 32 months (4–91 months). Early deaths occurred in 13 patients. Early death of patients with osteosarcoma is related to tumor metastasis (P < 0.001), tumor size >5cm (P = 0.049), high-level neutrophil–lymphocyte ratio (NLR) (P = 0.035), high-level fibrinogen (FIB) (P = 0.038), and higher D-dimer (DD) (P = 0.025). According to our results of multivariate Cox analysis, tumor metastasis status at diagnosis (P < 0.001), NLR (P = 0.039) and FIB (P = 0.023) are independent risk factors in predicting early mortality in osteosarcoma patients. The “Osteosarcoma Early Mortality Nomogram” has a C index of 0.871, and the calibration curve performs best compared with the ideal model in predicting mortality in 1 year.ConclusionTumor metastasis status, NLR, and FIB are independent risk factors in predicting early mortality in osteosarcoma patients. The early follow-up of patients with tumor metastasis, high NLR, and high FIB should be strengthened.

Incident cardiovascular events and early mortality in patients with revascularized critical limb ischemia.

Patients with critical limb ischemia (CLI) present a high risk of cardiovascular events and death. This study aimed to investigate the incidence of major adverse cardiovascular events (MACE) and one-year mortality in patients undergoing percutaneous revascularization procedure for CLI. This investigation is a retrospective analysis of an ongoing cohort study in patients with CLI undergoing endovascular revascularization, hospitalized in the vascular medicine department from November 2013 to December 2018. Major cardiovascular events were collected during the first year after revascularization procedure and were defined as heart failure, acute coronary syndrome, ischemic stroke and sudden death. Mortality and major limb amputations, defined as above-the-ankle amputation, were determined during the one-year follow-up period. Multivariate logistic regression analyses were performed to identify factors independently associated with the occurrence of MACE and one-year mortality after revascularization procedure. A P≤0.05 was considered as statistically significant. The study included 285 consecutive patients, 157 men (55%) and 128 women (45%), with a mean age of 77.8±12 years. Treated hypertension was present in 222 (78%) patients; diabetes was present in 137 (48%) patients; 112 (39%) patients had known coronary heart disease and 20 (7%) patients were dialysis dependent. During the one-year follow-up after revascularization procedure, 75 (26.3%) patients presented an incident cardiovascular event, of whom 19 (6.7%) patients in the perioperative period. Cumulative mortality rate was 26.7% (76 patients) mostly from cardiovascular causes. Twenty-five patients (8.8%) experienced major amputation. In multivariate analysis, the occurrence of MACE was associated with an increased mortality risk (HR 6.96 (2.99-16.94), P<0.001). Other variables associated with an increased mortality were living in a nursing home and malnutrition. Decompensated heart failure and coronary heart disease were both associated with incident MACE in multivariate analysis, independently of confounders. In the present study population, incident MACE were prevalent in the year following endovascular revascularization procedure in patients with CLI and were associated with an increased risk of mortality. Coronary heart disease and decompensated heart failure are important contributors for the occurrence of MACE. In this elderly patient population with CLI, these results should be taken into account during the multidisciplinary team meeting before consideration of revascularization procedure.

Superiority of Simplified Acute Physiologic Score II Compared with Acute Physiologic and Chronic Health Evaluation II and Sequential Organ Failure Assessment Scores for Predicting 48-Hour Mortality in Patients Receiving Continuous Kidney Replacement Therapy

Background: Predicting early mortality is important in patients undergoing continuous kidney replacement therapy (CKRT), especially in the first 48 h. This study aimed to determine the predictive performance of the Simplified Acute Physiologic Score (SAPS) II, the Acute Physiologic and Chronic Health Evaluation (APACHE) II, and the Sequential Organ Failure Assessment (SOFA) scores for early mortality in patients receiving CKRT. Methods: Data from patients with acute kidney injury receiving CKRT were consecutively and retrospectively obtained at a tertiary medical center between August 2017 and March 2021. The outcomes included 48-h and 7-day mortality. The scoring systems were evaluated via discrimination at the time of CKRT initiation (using area under the receiver operating characteristics curve [AUROC]) and calibration (via Hosmer-Lemeshow goodness-of-fit C statistics). Results: Among eligible 652 patients, 95 (14.6%) and 212 (32.5%) died within 48 h and within 7 days, respectively. The AUROC for SAPS II (0.71, 95% confidence interval [CI]: 0.65–0.77, p = 0.016 vs. APACHE II score, p = 0.044 vs. SOFA score) was significantly higher than that of the APACHE II (0.66, 95% CI: 0.60–0.72) and SOFA scores (0.66, 95% CI: 0.60–0.72) for 48-h mortality. However, no significant differences in the AUROCs for SAPS II, APACHE II, and SOFA scores for 7-day mortality were observed. The calibration of the SAPS II for 48-h and 7-day mortality was adequate (p = 0.507 and p = 0.141, respectively). Conclusions: The predictive performance of SAPS II for mortality within the first 48 h was superior to that of the APACHE II and SOFA scores in patients with acute kidney injury receiving CKRT.