Early Mortality In Patients Research Articles

The Metastatic Early Prognostic (MEP) score.

The early mortality in patients with hip fractures from bony metastases is unknown. The objectives of this study were to quantify 30- and 90-day mortality in patients with proximal femoral metastases, and to create a mortality prediction tool based on biomarkers associated with early death. This was a retrospective cohort study of consecutive patients referred to the orthopaedic department at a UK trauma centre with a proximal femoral metastasis (PFM) over a seven-year period (2010 to 2016). The study group were compared to a matched control group of non-metastatic hip fractures. Minimum follow-up was one year. There was a 90-day mortality of 46% in patients with metastatic hip fractures versus 12% in controls (89/195 and 24/192, respectively; p < 0.001). Mean time to surgery was longer in symptomatic metastases versus complete fractures (9.5 days (SD 19.8) and 3.4 days (SD 11.4), respectively; p < 0.05). Albumin, urea, and corrected calcium were all independent predictors of early mortality and were used to generate a simple tool for predicting 90-day mortality, titled the Metastatic Early Prognostic (MEP) score. An MEP score of 0 was associated with the lowest risk of death at 30 days (14%, 3/21), 90 days (19%, 4/21), and one year (62%, 13/21). MEP scores of 3/4 were associated with the highest risk of death at 30 days (56%, 5/9), 90 days (100%, 9/9), and one year (100%, 9/9). Neither age nor primary cancer diagnosis was an independent predictor of mortality at 30 and 90 days. This score could be used to predict early mortality and guide perioperative counselling. The delay to surgery identifies a potential window to intervene and correct these abnormalities with the aim of improving survival. Cite this article: Bone Joint J. 2020;102-B(1):72-81.

Research progress of hyperleukocytic acute leukemia

Acute hyperleukocytic leukemia (AHL) refers to acute leukemia patients whose peripheral white blood cell count(WBC) is more than 100×109/L. It is called hyperleukocytosis (HL), when peripheral WBC is more than 100×109/L. It is common in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). AHL has a rapid onset, rapid progress, high early mortality and poor prognosis, which is a critical disease in hematology department. Because of its complications such as leukostasis, tumor lysis syndrome (TLS), disseminated intravascular coagulation (DIC), patients′ lives are threatened and need urgent intervention. Therefore, how to reduce the early mortality of patients with AHL is an important research topic. This article reviews the epidemiology, pathophysiology and clinical manifestations of AHL, especially the current treatment options. Key words: Leukocytosis; Leukemia; Tumor lysis syndrome; Acute hyperleukocytic leukemia; Lyperleukocytosis; Early mortality; Epidemiologic studies; Leukostasis

ACTR-16. MATRix REGIMEN FOR NEWLY DIAGNOSED PRIMARY DIFFUSE B-CELL LYMPHOMA OF THE CENTRAL NERVOUS SYSTEM: PRELIMINARY RESULTS

Abstract We report our preliminary experience treating 9 patients with newly diagnosed primary diffuse B-cell lymphoma of the central nervous system with the MATRix regimen as reported by Ferreri, et al in 2016. The median age was 63 y; 5 patients were men and 4 were women. Seven had cerebral mass lesions, 1 a paraspinal mass, and 1 leptomeningeal disease. Five patients underwent biopsy; 2 imaging total resection; 1 subtotal resection; and in 1 the extent of resection was indeterminate. Treatment consisted of 4 cycles of rituximab 375 mg/sq m (Days 1, 6); methotrexate 4 g/sq m (Day 2); cytarabine 2 g/sq m every 12 h (Days 3, 4); and thiotepa 30 mg/sq m (Day 5). Patients without disease progression received carmustine 400 mg/sq m and thiotepa 5 mg/kg followed by autologous bone marrow transplantation. Two patients were switched to MATRix after 6 cycles of methotrexate and rituximab and received 2 additional cycles that included cytarabine and thiotepa. Overall, 7 patients completed initial chemotherapy, with 5 complete responses and 2 partial responses. Six of these 7 went on to transplantation and remain alive without disease progression after a median follow-up of 470 days. One patient with initial PR progressed and did not proceed to transplantation. Two patients died after 1 cycle; they were both over 70 y (76 and 84) and succumbed to sepsis with neutropenic fever. No serious acute toxicity occurred in the 6 patients who completed the entire regimen including transplantation; 1 patient has experienced symptomatic leukoencephalopathy. Overall progression free survival was 394 days. These preliminary data suggest that the MATRix regimen in safe and highly effective in the newly diagnosed setting. However, the high early mortality in patients over 70 years in this group suggests that the regimen may be too toxic for very elderly individuals.

Sex difference in survival status among antiretroviral therapy users in Yirgalem general hospital, Sidama zone, south nations nationalities and peoples\u2019 region (SNNPR), Ethiopia: retrospective cohort study

BackgroundAntiretroviral treatment (ART) has been shown to enhance the survival of people living with HIV worldwide. In Ethiopia, the number of ART users has increased from 47,422 in 2005 to 703,516 in 2017; yet, early mortality of patients has presented challenges to the success of the ART program. Because of gender roles, it is assumed that females are at risk of dying earlier after the start of the medications. Hence, this study aimed to assess the sex difference in the survival status among the ART users.MethodsA retrospective cohort study was conducted in March 2017 among sample of 687 ART users registered from 2010 to 2015. Data were extracted from patient records by using a structured checklist. The extracted data were analyzed by STATA version 13. Survival analysis and Cox regression were used to determine survival status and identify associated factors.ResultsAmong 685 reviewed records of ART users, 20 males and 64 females died in the 5 years period of ART initiation. This makes the overall 5 years survival rate of 84.23%. Females had lower survival probability (80.10%) as compared to males (91.18%) (Adjusted Hazard Ratio (AHR) = 1.79; 95% CI: 1.04, 3.06). Divorced individuals as compared to married (AHR = 2.09; 95% CI: 1.10, 3.97), individuals with less education (AHR = 2.54 95% CI: 1.29, 4.98) or those who attended only primary education (AHR = 2.07; 95% CI: 1.18, 3.65) as compared to those who attended secondary or above had low survival probability. Those who never disclosed their HIV status (AHR = 3.62; 95% CI: 1.25, 10.46) as compared to disclosed, bedridden individuals as compared to normal functional status (AHR = 2.7; 95% CI: 1.24, 5.89) and those who had tuberculosis (TB)-co infection (AHR = 2.60; 1.48, 4.45) had lower rates of survival.ConclusionFemales were at higher risk of dying within 5 years of ART initiation as compared to males. Hence, intervention to further reduce mortality should take sex differences into account. Behavioral interventions and HIV counseling service should also be strengthened to improve rate of disclosure and functional status as well as reduce TB co-infections.

Venous Thromboembolism and Renal Impairment: Insights from the SWIss Venous ThromboEmbolism Registry (SWIVTER).

Renal impairment (RI) has increased substantially over the last decades. In the absence of data from confirmatory research, real-life data on anticoagulation treatment and clinical outcomes of venous thromboembolism (VTE) in patients with RI are needed. In the SWIss Venous ThromboEmbolism Registry (SWIVTER), 2,062 consecutive patients with objectively confirmed VTE were enrolled. In the present analysis, we compared characteristics, initial and maintenance anticoagulation, and adjusted 90-day clinical outcomes of those with (defined as estimated creatinine clearance < 30 mL/min) and without severe RI. Overall, 240 (12%) patients had severe RI; they were older, and more frequently had chronic and acute comorbidities. VTE severity was similar between patients with and without severe RI. Initial anticoagulation in patients with severe RI was more often performed with unfractionated heparin (44 vs. 24%), and less often with low-molecular-weight heparin (LMWH) (52 vs. 61%) and direct oral anticoagulants (DOACs; 4 vs. 12%). Maintenance anticoagulation in patients with severe RI was more frequently managed with vitamin K antagonists (70 vs. 60%) and less frequently with DOAC (12 vs. 21%). Severe RI was associated with increased risk of 90-day mortality (9.2 vs. 4.2%, hazard ratio [HR]: 2.27, 95% confidence interval [CI]: 1.41-3.65), but with similar risk of recurrent VTE (3.3 vs. 2.8%, HR: 1.19, 95% CI: 0.57-2.52) and major bleeding (2.1 vs. 2.0%, HR: 1.05, 95% CI: 0.41-2.68). In patients with severe RI, the use of LMWH versus any other treatment was associated with reduced mortality (HR: 0.37; 95% CI: 0.14-0.94; p = 0.036) and similar rate of major bleeding (HR: 0.59, 95% CI: 0.17-2.00; p = 0.39). Acute or chronic comorbidities rather than VTE severity or recurrence may explain increased early mortality in patients with severe RI. The higher rate of VTE recurrence, specifically fatal events, than major bleeding reinforces the need for effective anticoagulation in VTE patients with severe RI.

The Metastatic Early Prognostic (MEP) Score: A Novel Scoring Tool For Predicting Early Mortality In Patients With Metastatic Proximal Femoral (HIP) Fractures

The Metastatic Early Prognostic (MEP) Score: A Novel Scoring Tool For Predicting Early Mortality In Patients With Metastatic Proximal Femoral (HIP) Fractures

Low Body Mass Index is a Predictor of Early Mortality in Patients with Newly Diagnosed Multiple Myeloma

Multiple myeloma (MM) is a common hematologic neoplasm in Taiwan. Some patients with MM have low body mass index (BMI) associated with their underlying conditions. We aimed to investigate the clinical impact of low BMI on newly diagnosed MM patients.

P4569Differential prognostic impact of blood glucose levels at the acute stage of myocardial infarction according to HbA1c. The FAST-MI programme

Abstract Background Hyperglycemia is a well-known prognostic marker in patients with acute myocardial infarction (AMI), associated with higher mortality compared with normoglycemia. Whether the prognostic impact of glycemic status at the acute stage of AMI is similar in patients with chronic dysglycemia has not been extensively explored. Aims and methods Using data from the nationwide French FAST-MI cohorts (2005, 2010 and 2015), we analysed the association between glycemia at entry and 30-day death, according to HbA1c level. From the 13,130 patients included, 5,452 had both glycemia and HbA1c assessed at entry. Of those, 1173 (21.5%) had an HbA1c ≥7%. Results In patients with HbA1c &lt;7%, LVEF was inversely correlated with glycemic levels (55±11% for glycemia &lt;100, 52±11% for glycemia 100–140, 50±12% for glycemia 140–160 and 49±12% for glycemia &gt;180 mg/dl); a graded association between admission glycemia and 30-day mortality was observed, ranging from 0.7% in normoglycemic patients to 6.3% in patients with admission glycemia &gt;180 mg/dl. In contrast, in patients with HbA1c ≥7%, LVEF was not correlated with glycemia (&lt;100 mg/dl: 49±14%, &gt;180 mg/dl 49±12%), and mortality was the highest in patients with normoglycemia (9.2%) and the lowest in patients with glycemia between 140 and 180 mg/dl (3.1%) (Figure). In multivariate analyses adjusting for baseline characteristics and early management, normoglycemia was associated with a decreased risk of 30-day mortality in patients with HbA1c &lt;7% (HR 0.27, 95% confidence interval 0.10–0.73, P=0.01), while it was associated with a two-fold increase in mortality in patients with HbA1c ≥7% (HR 2.49, 95% confidence interval 1.02–6.09, P=0.046). Figure 1. 30-day death Conclusion In AMI patients with high HbA1c levels on admission, normoglycemia is associated with higher early mortality than hyperglycemia. In contrast, a graded correlation is observed between admission glycemia and early mortality in patients with HbA1c &lt;7%. Management of glycemia at the acute stage of MI might require different measures according to the initial HbA1c level. Acknowledgement/Funding Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, Servier

Persistently High Serum Substance P Levels and Early Mortality in Patients with Severe Traumatic Brain Injury

Substance P is a neuropeptide belonging to the tachykinin family and is involved in neuroinflammation. In a previous study by our team, we found higher serum substance P levels on day 1 of traumatic brain injury (TBI) in nonsurviving than in surviving patients. Thus, the objective of this study was to determine whether serum substance P levels during the first week of TBI could predict early mortality. This was a multicenter, observational, and prospective study. We included patients with an isolated severe TBI, defining isolated as <9 points in non-cranial aspects of Injury Severity Score and severe as <9 points of Glasgow Coma Scale. We determined serum substance P concentrations at days 1, 4, and 8 of TBI. We performed receiver operating characteristic analyses to determine the capacity of serum substance P levels at day 1, 4, and 8 of TBI to predict 30-day mortality. Nonsurviving (n= 34) compared with surviving patients (n= 90) had greater serum substance P levels on day 1 (P < 0.001), 4 (P < 0.001), and 8 (P < 0.001) of TBI. The areas under curve of serum substance P concentrations at days 1, 4, and 8 of TBI to predict 30-day mortality were 76% (P < 0.001), 87% (P < 0.001), and 89% (P < 0.001), respectively. The new finding of our study is that the presence of elevated serum substance P levels during the first week of TBI is associated with increased mortality.

First assistant impact on early morbidity and mortality in bariatric surgery

BackgroundThe future of bariatric surgery depends largely on how effectively residents and fellows are trained. The challenge is to assure patient safety during training. Our study compares the impact of first assistants on patient outcomes after Roux-en-Y gastric bypass and sleeve gastrectomy. MethodsA retrospective review of primary, elective Roux-en-Y gastric bypass and sleeve gastrectomy procedures performed in 2015 and 2016 from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participant user files was performed. Patient cohorts were categorized by the level of training of the surgical first assistant (FA). Multivariate regression models were developed to determine the impact of the FA level on patient outcomes, adjusting for patient demographic characteristics and co-morbid conditions. ResultsCompared with an attending weight loss surgeon as FA, minimally invasive surgery fellows and general surgery residents were more likely to have an unplanned admission to the intensive care unit (ICU) within 30 days (odds ratio [OR] 1.422, 95% confidence interval [CI] 1.196–1.691; OR 1.206, 95% CI 1.034–1.406, respectively, P < .0001) and were more likely to have a 30-day hospital readmission (OR 1.143, 95% CI 1.056–1.236; OR 1.127, 95% CI 1.055–1.204, respectively, P < .0001). Compared with having a weight loss surgeon as FA, operative duration was significantly longer for all other assistant levels, or no assistant (P < .0001). ConclusionThe training level of the FA does not impact early patient mortality or reoperation rates after Roux-en-Y gastric bypass or sleeve gastrectomy. However, unplanned intensive care unit admissions and readmissions within 30 days were significantly associated with surgical resident or minimally invasive surgery fellow FAs. Further analysis is needed to understand this cause and effect; however, these data provide direction to redesign residency and fellowship training.

Maximum Norepinephrine Dosage Within 24 Hours as an Indicator of Refractory Septic Shock: A Retrospective Study.

The management of refractory septic shock remains a major challenge in critical care and its early indicators are not fully understood. We hypothesized that the maximum norepinephrine dosage within 24 hours of intensive care unit (ICU) admission may be a useful indicator of early mortality in patients with septic shock. In this retrospective single-center observational study, patients with septic shock admitted to the emergency ICU of an academic medical center between April 2011 and March 2017 were included. Individuals with cardiac arrest and those with do-not-resuscitate orders before admission were excluded. We analyzed if the maximum norepinephrine dosage within 24 hours of ICU admission (MD24) was associated with 7-day mortality. Among 152 patients with septic shock, 20 (15%) did not survive by day 7. The receiver operating characteristic curve analysis for predicting 7-day mortality revealed a cutoff of MD24 of 0.6 μg/kg/min (sensitivity 47%, specificity 93%). In the multivariable regression analysis, a higher MD24 was significantly associated with 7-day mortality (odds ratio: 7.20; 95% confidence interval [CI]: 2.02-25.7; P = .002) but not with 30-day mortality. Using the inverse probability of treatment weighting method in a propensity scoring analysis, a higher MD24 was significantly associated with 7-day (hazard ratio [HR]: 8.9; 95% CI: 3.2-25.0; P < .001) and 30-day mortality (HR: 2.7; 95% CI: 1.2-5.8; P = .012). An MD24 ≥0.6 μg/kg/min was significantly associated with 7-day mortality in patients with septic shock and may therefore be a useful indicator of refractory septic shock.

PS1586 EFFECT OF ORAL ANTICOAGULANT TREATMENT ON THE MORTALITY OF PATIENTS WITH ACUTE HEART FAILURE: ANALYSIS BY PROPENSITY SCORE MATCHING

Background:Heart failure is associated with activation of thrombin‐related pathways, which predicts a poor prognosis, this activation may contribute to disease progression by inducing inflammation, endothelial dysfunction, and arterial and venous thrombosis. Besides, Atrial Fibrillation, one of the most important indications of anticoagulant treatment appears frecuently in patients with heart failure.Aims:To analyse the influence of the previous treatment with oral anticoagulants in the early mortality in patients with acute heart failure.Methods:Multicenter, prospective cohort study of consecutive inclusion of patients with acute heart failure (AHF) attended in Spanish SUH. The diagnosis of AHF was made based on criteria of the European Society of Cardiology. They were divided according to whether they were receiving home treatment with oral anticoagulants (ANTICAGULATED group) or not (CONTROL group). The dependent variable was mortality at 30 days and a year. Variables: Age and sex, systolic blood pressure (PAS), cardiac and respiratory frequencies and oxygen basal arterial saturation, cardiovascular risk factors and previous cardiovascular diseases, basal NHYA and episode, clinical episode data, Analytical and ECG parameters, Troponins, natriuretic peptides, hospital admission and CHADS‐Vasc.Statistical analysis: Comparison of proportions by Chi‐square, averages by T‐student and multivariate analysis by logistic regression and survival through the Cox method and pairing through a propensity score between the two groups of Treatment, adjusting by the variables with p &lt; 0.05 in the Bivariate analysis and controlling the reference hospital.Results:13366 patients with AHF were included, in treatment with oral anticoagulants 5471 (39.7%). In the ANTICOAGULATED‐group there are more comorbility (hypertension, diabetes, ischemic cardiopathy, valvular cardiopathy, atrial fibrillation, cerebro‐vascular disease and previous heart failure). They have poor functional status to disnea (NYHA III‐IV) and more frailty.The clinical data of the acute episode were less severe in the anticoagulated group and had lower values of NT‐ProBNP and Troponins. OR (IC95%) Crude and adjusted mortality to 30 days is 0.64 (IC95% 0.54–0.77) and 0.69 (IC95% 0.54–0.89) and for the annual mortality 0.78 (IC95% 0.69–0.87) and 0.71 (IC95% 0.60–0.84) crude and adjusted respectively. After the propensity Score matching 2330 patients were matched without any difference between them in the analyzed variables. The Hazard Ratio (HR) (IC95%) For the 30‐day mortality of oral anticoagulant therapy is 0.66 (IC95% 0.50–0.85) and for annual mortality 0.79 (IC95% 0.68–0.92).Summary/Conclusion:Treatment with oral anticoagulants in patients with AHF is related to a lower early and annual mortality independently of the differences between the two groups of patients. This may be due to the effect of this treatment on the state of hypercoagulation described in patients with this pathology.

Serum Caspase-3 Levels and Early Mortality of Patients with Malignant Middle Cerebral Artery Infarction.

Circulating caspase-3 levels at 24h of ischemic stroke were found to be associated with poorer functional neurological outcome in a previous study. The aim of this study was to determine whether there is an association between serum caspase-3 levels and early mortality in patients with malignant middle cerebral artery infarction (MMCAI). We included patients with MMCAI defined as computer tomography showing ischemic changes in more than 50% of the middle cerebral artery territory and Glasgow Coma Scale ≤ 8. Serum caspase-3 levels at days 1, 4, and 8 of MMCAI were determined. Non-surviving MMCAI (n = 34) showed higher serum caspase-3 levels at days 1 (p < 0.001), 4 (p = 0.001), and 8 (p = 0.01) than surviving patients (n = 34). We found that the area under the curve of serum caspase-3 levels for prediction of mortality at 30days was 88% (95% CI = 78-95%; p < 0.001). Multiple logistic regression showed that serum caspase-3 levels were associated with 30-day mortality (OR = 51.25; 95% CI = 8.30-316.31; p < 0.001). The novel and more important findings of our study were that high serum caspase-3 levels were associated with mortality in MMCAI patients.

In-hospital mortality in acute promyelocytic leukemia patients: A study of national inpatient sample.

e18521 Background: Acute Promyelocytic Leukemia (APL), a subtype of acute myeloid leukemia, has excellent outcomes, but continues to show high rates of early mortality. An epidemiologic study utilizing SEER between 1992 &amp; 2007 showed an early death rate of 17.3%. There is limited data on the incidence of inpatient mortality in APL patients in the United States and the factors that contribute to early death. Methods: National Inpatient Sample was utilized to identify adult patients (≥18 years) diagnosed with APL using International Classification of Diseases, 10th edition (ICD-10-CM) code C92.40. Since the United States transitioned from using ICD-9-CM to ICD-10-CM on October 2015, we included APL patients diagnosed between 2015 &amp; 2016. Clinical, sociodemographic and hospital characteristic data were examined; hospital volume was divided into quartiles. The association between overall inpatient survival &amp; receipt of chemotherapy was examined in a propensity score matched cohort of patients not discharged to another acute care facility. Statistical analyses were conducted utilizing SAS version 9.4. Results: In total, 433 APL patients were identified (median age 52 years, 52% males, 65% whites). The inpatient mortality rate was 9.93%. 59.5% (n = 258) of patients did not receive chemotherapy. On univariate-analysis, patients with younger age, black-race, transfer in from other hospital, elective admissions, private insurance, large bed size hospital &amp; large hospital volume were more likely to receive chemo. In the matched-cohort, receipt of chemo was associated with decreased mortality (Hazard Ratio 0.27, 95% CI: 0.12-0.60). We ran additional mortality analysis landmarked at 3 days and 7 days: 75% of chemo patients receiving treatment within 3 days had survival advantage with chemo (HR: 0.35 [0.15-0.82]). 90% of chemo patients receiving treatment within 7 days didn’t show any difference in survival (HR: 0.49 [0.18-1.32]) but the sample size was small. Conclusions: Our study showed an early survival benefit when patient with APL received chemotherapy within 3 days of admission. Early recognition &amp; prompt treatment initiation will help reduce the rate of early mortality in patients with APL.

Prediction of early mortality in patients with cancer-associated thrombosis in the RIETE Database.

Proper risk stratification of patients for early mortality after cancer-associated thrombosis may lead to personalized anticoagulation protocols. Therefore, we aimed to derive and validate a scoring system to predict early mortality in this population. To this end, we selected patients with active cancer and thrombosis from the Computerized Registry of Patients with Venous Thromboembolism database. The main outcome was all cause mortality within the month following a thrombotic event. We used a simple random selection to split are data in a derivation and a validation cohort. In the derivation cohort, we used recursive partitioning and binary logistic regression to identify groups at risk and to determine the likelihood of the primary outcome. The risk score was developed based on odds ratios from the final multivariate model, and then tested in the validation cohort. In 10,025 eligible patients, we identified 6 predictors of 30-day mortality: leukocytosis ≥11.5x109/L; platelet count ≤160x109/L, metastasis, recent immobility, initial presentation as pulmonary embolism and Body Mass Index <18.5. The model divided the population into 3 risk categories: low (score 0-3), moderate (score 4-6), and high (score ≥7). The AUC for the overall score was 0.74, and using a cutoff ≥7 points, the model had a negative predictive value of 94.4%, a positive predictive value of 23.1%, a sensitivity of 73.3%, and a specificity of 64.6% in the validation cohort. Our validated risk model may assist physicians in the selection of patients for outpatient management, and perhaps anticoagulant, considering expanding anticoagulation options.

Elevated Lactate Levels as a Predictor of Early Mortality in Patients with Severe LV Dysfunction without Shock or Hypoxemia

Abstract Background Hyperlactatemia in intensive coronary care unit (ICCU) admitted patients who are critically ill must be considered to be related to tissue hypoxia/hypoperfusion. The routine measurement of lactate levels and its significance is still unclear in ICCU patients with left ventricular ejection fraction (LVEF) &lt; 35% without hypotension and/or hypoxia. Methods and Materials A prospective study was conducted for six months between January 2018 and June 2018 in our institute. Age ≥18 years who admitted to the ICCU with LVEF less than 35% were included. Results Total of 104 patients were included after met inclusion and exclusion criteria and consented to enrolment in the study. The most common age group involved was between 50 and 70 years (46.2% of the patients) with a mean age of 52.5 ± 16.3 years. Mean lactate levels in the study population were 1.9 mmol/L. Mortality was noted in five patients (4%) in whom there were mean lactate levels of 2.58 ± 0.37 mmol/L. In the present study population, the patients with elevated lactate levels had early mortality with a p-value of 0.005 (95% CI for difference = 0.604–1.596). The average duration of stay in ICCU in the study population was 3.3 ± 1.2 days, which was in correlation with elevated serum lactate levels. The mean pH of the study population was 7.2 ± 0.19, and mean pH in the mortality group was 7.06 ± 0.21, which was not statistically significant with those of the study population. Conclusions From our study, patients without signs of heart failure and cardiogenic shock had increased mortality when blood lactate level was over or equal to 2.5 mmol/L. So it may be used as an adjunct in identifying patients with a higher risk of mortality even without signs of heart failure, cardiogenic shock. In conclusion, according to our data, ICCU admitted patients with LVEF &lt; 35%, blood lactate is a prognostic marker for early mortality.

Audit of Early Mortality among Patients Admitted to the General Medical Ward at a District Hospital in Botswana.

Background:Mortality among adult general medical admissions has been reported to be high across sub-Saharan Africa, yet there is a paucity of literature on causes of general medical inpatient mortality and quality-related factors that may contribute to the high incidence of deaths. Based on a prior study at our hospital as well as our clinical experience, death early in the hospitalization is common among patients admitted to the adult medical wards.Objective:Quantify early inpatient mortality and identify factors contributing to early in-hospital mortality of medical patients in a resource-limited hospital setting in Botswana.Methods:Twenty-seven cases of patients who died within 48 hours of admission to the general medical wards at Scottish Livingstone Hospital in Molepolole, Botswana from December 1, 2015–April 25, 2016 were retrospectively reviewed through a modified root cause analysis.Findings:Early in-hospital mortality was most frequently attributed to septic shock, identified in 20 (74%) of 27 cases. The most common care management problems were delay in administration of antibiotics (15, 56%), inappropriate fluid management (15, 56%), and deficient coordination of care (15, 56%). The most common contributing factors were inadequate provider knowledge and skills in 25 cases (93%), high complexity of presenting condition in 20 (74%), and inadequate communication between team members in 18 (67%).Conclusions:Poor patient outcomes in low-and middle-income countries like Botswana are often attributed to resource limitations. Our findings suggest that while early in-hospital mortality in such settings is associated with severe presenting conditions like septic shock, primary contributors to lack of better outcomes may be healthcare-provider and system-factors rather than lack of diagnostic and therapeutic resources. Low-cost interventions to improve knowledge, skills and communication through a focus on provider education and process improvement may provide the key to reducing early in-hospital mortality and improving hospitalization outcomes in this setting.

Evaluation and treatment of sepsis-induced myocardial dysfunction: a systematic study

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. The early mortality of patients with sepsis-induced myocardial dysfunction (SMD) is higher than those with normal cardiac function, and the long-term prognosis is worse. Therefore, early detection of SMD and timely intervention can reduce mortality and improve prognosis. This review focused on the progress in evaluation and treatment of SMD, with a view to provide some ideas for the diagnosis and treatment of SMD.

Leveraging Evidence-Based Public Policy and Advocacy to Advance Newborn Screening in California.

In 2016, the EveryLife Foundation for Rare Diseases, in partnership with Dr Pan, who is a pediatrician and state senator in California, launched legislation to advance and expand newborn screening. Researchers have shown that newborn screening can be cost-effective and can greatly improve health outcomes for patients with rare diseases. However, adding additional diseases in newborn screening is a long process, requiring legislative approval in addition to new state funding. Such process delays can lead to protracted diagnostic odysseys for patients, especially those with rare diseases. These delays can result in irreversible morbidity and, in some cases, early mortality for patients. To improve this process, legislation known as Senate Bill 1095 was introduced to require California to adhere to the latest federal recommendations for newborn screening within 2 years. We provide insight and describe the process of advancing state legislation, coalition building, and managing opposition. Senate Bill 1095 would become law in 2016, requiring California to screen for 2 new rare diseases by August 2018: mucopolysaccharidosis type I and Pompe disease. This case study can serve as a model for advocates looking to expand state newborn-screening programs.

The investigation of TIMI risk index for prediction of contrast-induced acute kidney injury in patients with ST elevation myocardial infarction

Objective: Contrast-induced acute kidney injury (CI-AKI) is a well-known and life-threating complication in patients with ST-elevation myocardial infraction (STEMI) after primary percutaneous coronary intervention (PCI). Several studies demonstrated that the Thrombolysis in Myocardial Infarction (TIMI) Risk Index (TRI) is a useful risk model in predicting early mortality in patients with acute coronary syndrome. The objective of the present study is to evaluate the predictive value of admission TRI for the occurrence of CI-AKI in patients with STEMI treated with primary PCI.Methods: This retrospective study was consisted of a total of 660 consecutive STEMI patients who had undergone primary PCI from December 2015 to March 2017.The primary end-point was CI-AKI incidence after primary PCI during the in-hospital course.Results: The TRI of CI-AKI group was higher than the non-CI-AKI group (24.2 (19.3–32.2) vs. 17.5 (12.9–24.3), p < .001, respectively). In multivariable logistic regression analysis, TRI was found to be an independent predictors of CI-AKI (OR: 1.055, 95% CI: 1.027–1.083, p < .001). The discriminative power of TRI with regards to occurrence of CI-AKI was superior compared to its components.Conclusion: This study is the first to demonstrate that TRI can be used to predict the development of CI-AKI in patients with STEMI who undergo primary PCI. Health professionals might be able to use the TRI risk score to predict CI-AKI due to the simplicity and accessibility of this risk index.