Mortality Factors Research Articles

Effect of low muscle mass on total mortality related to metabolic disease in chronic kidney disease patients

Low muscle mass is a risk factor for mortality in patients with chronic kidney disease (CKD). However, it is not clear to what extent low muscle mass contributes to this risk, either independently or in combination with metabolic abnormalities and frailty. This study used data from the National Health and Nutrition Examination Survey 1999–2006 and 2011–2018. Low muscle mass was defined as Appendicular Skeletal Mass Index < 7 kg/m2 in men or < 5.5 kg/m2 in women. The follow-up duration was from the first anthropometric and clinical measurements to death or the last follow-up. This study enrolled 2072 patients with CKD. Low muscle mass was associated with a lower risk of metabolic abnormalities, but was associated with an elevated mortality risk. Conversely, central obesity was associated with a higher likelihood of metabolic abnormalities and frailty, yet showed no significant association with mortality risk. Subsequently conducted mediation analysis indicated that the effect of low muscle mass on mortality was direct, not mediated by frailty and metabolic abnormalities. In spite of the inverse relationship between low muscle mass and metabolic abnormalities, low muscle mass are directly associated with an increased risk of all-cause mortality. Low muscle mass may directly contribute to mortality in patients with CKD, independent of metabolic abnormalities and frailty in these patients.

The value of C-reactive protein velocity (CRPv) on mortality in sepsis patients who are emergently hospitalized in the ICU: A retrospective single-center study

PurposeThe C-reactive protein (CRP) velocity (CRPv) is an indicator of the change in CRP over time. In individuals with sepsis, the second values of CRP and CRPv have been shown to have more importance than the first CRP value measured at admission. This study examined the importance of CRPv for mortality among individuals who were hospitalized in the intensive care unit (ICU). MethodsThe study was conducted between January 2021 and December 2022. CRPv was calculated according to the change in the second CRP value compared to the first. ResultsThe median age of the patients was 79 years (interquartile range (IQR), 69–85 years), and 53.2 % were male. The in-hospital mortality rate was 45.5 %. The presence of diabetes increased the odds of mortality by 2.17 times (confidence interval (CI): 1.06–4.4, p=0.032). Each increase in CRPv by 1 mg/dl/hour increased the odds of mortality by 1.07 times (CI: 1.01–1.14, p=0.015), while each one-point increase in the Sequential Organ Failure Assessment (SOFA) score increased the odds of mortality by 1.21 times (CI: 1.07–1.35, p=0.002). The SOFA score had the highest area under the curve (AUC) value for in-hospital mortality (AUC = 0.699 p=<0.001). When the SOFA was >7, its sensitivity in predicting mortality was 46.7 %, and its specificity was 85.1 %. The AUC value of CRPv in predicting mortality was 0.629 (p=0.006). When CRPv was >0.75, its sensitivity in predicting mortality was 68.2 %, and its specificity was 57 %. ConclusionCRPv performed well in predicting mortality and had satisfactory discriminative ability. Additionally, diabetes, SOFA score, and CRPv elevation were significant risk factors for mortality.

Is the hemoglobin, albumin, lymphocyte, and platelet (HALP) score a novel biomarker for predicting mortality in patients with middle cerebral artery infarctions undergoing mechanical thrombectomy?

BackgroundThe hemoglobin, albumin, lymphocyte, and platelet (HALP) score, easily calculated parameter, indicating systemic inflammation and nutritional status IntroductionIn this study, we used the HALP score in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT) to predict 90-day mortality. Method122 patients with AIS who underwent either MT or MT and tissue plasminogen activator (tPA) for middle cerebral artery (MCA) M1 occlusion. The HALP score was calculated, demographic data, modified Rankin Scale (mRS) score, and mortality status in retrospectively reviewed. The effectiveness of the HALP score in predicting mortality within 90 days was assessed using the receiver operating characteristic ( ROC) curves. The optimal cutoff value for HALP was 13.10. ResultsA HALP score <13.10 increased the risk of death within 90 days and was associated with a higher incidence of large artery thrombosis. Cardioembolism and hyperlipidemia were more common in patients with high (>13) HALP scores. In addition to the HALP score, the length of hospital stay, 24-h National Institutes of Health Stroke Scale score (NIHSS), number of days of intubation, acute physiologic assessment and chronic health evaluation (APACHE) II score, and symptom-to-groin time were statistically significant risk factors for mortality within 90 days. DiscussionThe HALP score is an easily calculated, inexpensive, and noninvasive parameter that can be used to predict mortality in patients with MCA M1 occlusion undergoing reperfusion therapy. Low HALP scores indicate a poor prognosis. Thus, there is a relationship between the HALP score and survival.

Surviving venoarterial extracorporeal membrane oxygenation (VA-ECMO): The roles of severity scores and post-operative lactate clearance

BackgroundThis study investigated the association of the Survival After VA-ECMO (SAVE) score, Sequential Organ Failure Assessment (SOFA) score, and post-cannulation lactate levels with mortality among patients treated with veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (CS). MethodsWe performed a retrospective review of adult patients who underwent peripheral VA-ECMO cannulation from January 2018 to September 2022 at a quaternary care center. All-cause in-hospital mortality was assessed and compared to predicted mortality by SAVE and SOFA scores prior to cannulation, with adjusted odds ratio of risk factors for mortality identified by multivariate logistic regression analysis. Additionally, the prognostic value of 8-h post-cannulation serum lactate levels was analyzed by receiver operating characteristic (ROC) curve and Kaplan Meier analysis of 30-day survival. Results244 patients were included in final analysis. All-cause in-hospital mortality was 70 %, and 54 % of patients died while on ECMO or within 24 h of decannulation. Pre-cannulation SAVE score (OR 0.93 per unit increase, 95 % CI 0.86–0.99, p = 0.008), SOFA score (OR 1.54 per unit increase, 95 % CI 1.32–1.75), and 8-h post-cannulation lactate levels (OR 1.20 per mmol/L increase, 95 % CI 1.04–1.36, p = 0.008) were independently associated with all-cause in-hospital mortality.8-h post-cannulation lactate levels ≥5.3 mmol/L demonstrated high specificity for in-hospital mortality (90.0 %), while levels ≥7.8 mmol/L were demonstrated high specificity for VA-ECMO death (91.1 %). These thresholds were significantly associated with 30-day all-cause mortality (p < 0.001). ConclusionPre-cannulation SAVE and SOFA scores are useful prognostic tools in patients with CS. 8-h post-cannulation serum lactate levels are a pragmatic biomarker and can further assist in prognostication of patients on VA-ECMO, and the cutoffs of 5.3 mmol/L and 7.8 mmol/L have high specificity for all-cause mortality and VA-ECMO mortality, respectively. The development of accurate prognostic tools is critical in managing and optimizing care for patients with CS.

The Association Between Elevated Myocardial Injury-Related Biomarker (TnI) and Increased Mortality in Patients With Severe Fever With Thrombocytopenia Syndrome.

The objective of this study was to investigate the dynamic profiles of myocardial injury biomarkers and their association with mortality in patients with severe fever with thrombocytopenia syndrome (SFTS). A retrospective cohort study. Union Hospital in Wuhan, China. A total of 580 patients with SFTS, observed between May 2014 and December 2021, were included in the final analysis. None. In total, 580 patients with SFTS were enrolled in the study, comprised of 469 survivors and 111 nonsurvivors, with a 21-day fatality rate of 19.1%. The elevation of troponin I (TnI) was observed in 61.6% patients (357/580) with SFTS upon admission, and 68.4% patients (397/580) developed an abnormal TnI level during hospitalization. Multivariate logistic regression identified age, viral load, platelet count, creatinine level, and TnI level as potential risk factors for mortality in patients with SFTS. The results of restricted cubic splines revealed that when the TnI level (baseline TnI: 1.55 [lg (ng/L+1)], peak value: TnI 1.90 [lg (ng/L+1)]) exceeded a certain threshold, the predicted mortality of patients with SFTS increased alongside the rise in TnI levels. Mortality rate surpassed 40% among patients with SFTS with TnI greater than or equal to 10 times the upper limit of normal at admission (43.8%) or during hospitalization (41.7%). Older age, a history of cardiovascular disease, and higher d -dimer levels were potential risk factors for elevated TnI levels in patients with SFTS. Elevated TnI levels were prevalent among patients with SFTS and were strongly associated with an increased risk of mortality.

An In-depth Single-center Retrospective Assessment of In-hospital Outcomes in Acute Myocardial Infarction Patients with and without Diabetes.

Objective This study examined variations in in-hospital mortality causes and identified independent mortality predictors among patients with acute myocardial infarction (AMI) with and without diabetes mellitus (DM). Methods We examined factors influencing in-hospital mortality in a single-center retrospective observational study. Separate multivariate analyses were conducted for both groups to identify independent predictors of in-hospital mortality. Patients This study included consecutive patients admitted to Iwate Medical University Hospital between January 2012 and December 2017 with a diagnosis of AMI. Results Of 1,140 patients meeting the AMI criteria (average age: 68.2±12.8 years old, 75% men), 408 (35.8%) had diabetes. The DM group had a 1.87-times higher 30-day mortality rate, a lower prevalence of ST-elevated MI (56.6% vs. 65.3% in non-DM, p=0.004), and more frequent non-cardiac causes of death (32% vs. 14% in non-DM, p=0.046) than the non-DM group. Independent predictors of in-hospital mortality in both groups were cardiogenic shock (CS) [DM: hazard ratio (HR) 6.59, 95% confidence interval (CI) 2.90-14.95; non-DM: HR 4.42, 95% CI 1.99-9.77] and renal dysfunction (DM: HR 5.64, 95% CI 1.59-20.04; non-DM: HR 5.92, 95% CI 1.79-19.53). Among patients with DM, a history of stroke was an additional independent predictor of in-hospital mortality (HR 2.59, 95% CI 1.07-6.31). Conclusion Notable disparities were identified in the causes of death and predictive factors of mortality between these two groups of patients with AMI. To further improve AMI outcomes, individualized management and prioritizing non-cardiac comorbidities during hospitalization may be crucial, particularly in patients with DM.

Phase angle as an independent risk factor for mortality in haematological cancer patients

Phase angle as an independent risk factor for mortality in haematological cancer patients

Air pollution below US regulatory standards and cardiovascular diseases using a double negative control approach

Growing evidence suggests that long-term air pollution exposure is a risk factor for cardiovascular mortality and morbidity. However, few studies have investigated air pollution below current regulatory limits, and causal evidence is limited. We use a double negative control approach to examine the association between long-term exposure to air pollution at low concentration and cardiovascular hospitalizations among US Medicare beneficiaries aged ≥65 years between 2000 and 2016. The expected values of the negative outcome control (preceding-year hospitalizations) regressed on exposure and negative exposure control (subsequent-year exposure) are treated as a surrogate for omitted confounders. With analyses separately restricted to low-pollution areas (PM2.5 < 9 μg/m³, NO2 < 75.2 µg/m3 [40 ppb], warm-season O3 < 88.2 μg/m3 [45 ppb]), we observed positive associations of the three pollutants with hospitalization rates of stroke, heart failure, and atrial fibrillation and flutter. The associations generally persisted in demographic subgroups. Stricter national air quality standards should be considered.

INVOLVEMENT OF THE LOCATION OF INTRAPARENCHYMAL EDEMA AFTER A CEREBROVASCULAR EVENT IN THE APPROACH OF A DECOMPRESSIVE CRANIECTOMY

Introduction: Decompressive craniectomy, introduced by Kocher in 1901, reduces intracranial pressure by removing part of the skull. It is used in severe neurological conditions such as brain injury and stroke, allowing the swollen brain to expand, thereby reducing mortality and improving function. Objective: To evaluate the effect of the location of intraparenchymal edema on the efficacy of decompressive craniectomy and postoperative clinical outcomes. Methods: A systematic search was performed in PubMed, Cochrane Library and Scopus. This search was focused on studies related to intracranial hypertension and its neurosurgical approach. Results: In this study, the following risk factors for mortality after decompressive craniotomy were identified: male sex, age over 50 years and late surgery. Operating between 12-24 hours improves results, especially in the non-dominant hemisphere. Correct surgical technique minimizes complications and improves the healing process of patients. Discussions: This study demonstrates that the location of intra-abdominal edema affects the results of craniectomy, with better results in the non-dominant hemisphere. A better understanding of brain anatomy and individualization of surgical techniques are essential to reduce complications and improve surgical outcomes after stroke. Conclusions: In conclusion, patient survival and functionality can be improved as seen from a modified Rankin scale by precise knowledge of the location of intraparenchymal edema and an approach with reduced damage to collateral structures.

Predictors of Inpatients Mortality in Patients with Liver Cirrhosis with Hepatic Encephalopathy

Background Hepatic encephalopathy has high risk of recurrence and is associated with advanced cirrhosis of liver. It features a spectrum of reversible neuropsychiatric abnormalities. The purpose of the research was to study the inpatients mortality and its predictors among cirrhotic patients with hepatic encephalopathy. MethodsA cross-sectional, hospital-based study comprising of 182 cirrhotic patients with hepatic encephalopathy were evaluated. West Haven Classification (Grade I to IV) was used for grading of hepatic encephalopathy. The data analysis was done using SPSS version 20 and p-value of ≤0.05 was considered significant. ResultsMajority of patients (39.6%) presented with Grade II encephalopathy followed by Grade III (26.4%). Inpatient mortality was 22.5%. Mortality was seen in 95% patients with HE of grade IV. Univariate analysis showed male sex [p-value=0.01, OR-0.37, CI (0.17-0.820)], shock at presentation [p-value=0.0001, OR-42, CI (16.05 -109.9)], CTP [p-value=0.03, OR-3.8, CI (1.1-13.3)], presence of more than two precipitating factors [P=0.0001, OR-48, CI (10.3-216.3)], presence of SBP [p-value=0.0001, OR-23.4, CI (9.1-60.4)] as statistically significant predictive factors. Multivariate analysis showed shock [P=0.0001, OR-85.3, CI (12.7-571.7)], presence of more than two precipitating factors [p-value=0.0001, OR-101.8, CI (3.32-3119.32)] and SBP [p-value=0.0001, OR-44.7, CI (6.49-309.5)] as statistically significant predictive factors for mortality in patients with liver cirrhosis with hepatic encephalopathy. Conclusions Inpatient mortality was high with increasing grades of encephalopathy among cirrhotic patients. Initial presentation with shock, presence of more than two precipitating factors and SBP were independent predictors of inpatient mortality in patients with liver cirrhosis with hepatic encephalopathy.

A STUDY ON THE DIFFERENT CLINICAL PRESENTATION PATTERNS OF BLUNT THORACIC TRAUMA AND ASSOCIATED MORBIDITY FOLLOWING ROAD TRAFFIC ACCIDENT IN A TERTIARY CARE CENTRE

Introduction:Chest trauma is a significant cause of morbidity and mortality following road traffic accidents (RTA). Given the significant potential for complications including respiratory failure and shock, blunt chest trauma following RTA remains a priority in trauma care and so this study aims to look into the clinical pattern of presentation of patients following chest trauma with/without associated injuries to other parts of body i.e. head/abdomen/extremities along with morbidity and mortality associated with it. Aims and objectives of the study : 1. To study the various clinical patterns of presentation of RTA patients with blunt chest trauma. 2. To study the disease burden and death rate of individuals with blunt chest trauma. Methodology: The study has been conducted in the Department of General Surgery, Silchar Medical College and Hospital from March 2024 to August 2024 after taking appropriate consent from 53 patients diagnosed with chest trauma following RTA with/without associated extra- thoracic injuries. Their data was analyzed and results published. Result and Analysis: Mean age in my study was 38.90 ± 6.57 years with male preponderance. Most patients had 3 rib fractures with pulmonary contusion being most common complication. Most common associated extra-thoracic trauma is abdominal injuries (24.5%) with mean ISS of 13.25 ± 7.73. most patients were managed conservatively with adequate pain control. Surgical intervention carried out were either tube thoracostomy (92.3%) or needle thoracostomy (7.2%). Most common secondary complication following blunt chest trauma is pneumonia (18.84%) while ARDS complication arose in 9.43% of the patients. Mortality rate was 5.6% and the most common cause that let to the demise was ARDS. Conclusion: To conclude, blunt thoracic injury is a major health problem as it carries significant mortality and morbidity more so, in case of RTA and association of other extra-thoracic injuries also play a pivotal role in the process of recovery of the patient. Presence of lung contusion, pneumothorax, hemothorax are to be dealt adequately with proper analgesia. Even though most cases of chest trauma can be dealt conservatively need for emergency surgical intervention needs to be assessed promptly. One must look for number of rib fractures as they may reflect the disease burden of the patient. Pneumonia and ARDS are a major mortality factor following chest trauma and its complications.

National Study of Fournier Gangrene in Spain (2016–2021): Gender/Sex Differences in Mortality and Risks

Background and Objective: The aim of this study was to analyze sex differences in risk factors associated with hospital mortality in patients with Fournier gangrene (FG). Materials and Methods: A retrospective population-based study (2016–2021) included FG hospitalizations in Spain. To identify the risk factors, we used multivariable logistic regression and reported adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: There were 3644 admissions for FG during the study period (82.5% men and 17.5% women). The mean hospitalization rate per 1000 admissions/year was 0.23 for men and 0.05 for women, and the mean hospitalization rate per 100,000 inhabitants/year was 2.7 for men and 0.4 in women. The most common comorbidities were hypertension (44.9%) and diabetes mellitus (35.6%). The main complications were sepsis (22.1%), 29.8% were admitted to the intensive care unit and 16.1% died. Mortality was higher in women (aOR 1.32, 95% CI 1.07–1.63). The main independent risk factors for mortality in the entire sample were older age, neoplasms, chronic kidney disease, heart failure, sepsis, acute kidney injury, and admission to the intensive care unit. In women, they were older age, leukemia, sepsis, acute kidney injury, and admission to the intensive care unit. Conclusions: The overall FG mortality rate was slightly higher in women than in men, people aged &gt;64 years, people with chronic kidney disease, sepsis, and acute kidney injury, and admission to the intensive care unit. The independent factors associated with mortality in women were similar in both sexes.

Time-To-Event Analysis Of Factors Influencing Delay In Discharge From A Subacute Complex Discharge Unit During The Pandemic

Abstract Background Length of stay (LOS) is the most common outcome measure of effectiveness in discharge planning. It refers to the time expressed in days between admission to and discharge from the hospital. During the COVID-19 pandemic, the average inpatient LOS was 5.8 days, representing a slight increase in the average inpatient LOS of 5.7 days between 2016–2019. Tackling delays in patient discharge is an ongoing challenge, and with the emergence of the COVID-19 pandemic, there has been significant disruptions in discharge planning, discontinuity and incoordination between subacute complex discharge units and community care. Methods Our study analysed delaying factors amongst patients with LOS &amp;gt; 15 days during the COVID-19 pandemic using time-to-event analysis. Kaplan–Meier’s plot compared factors causing a delay in discharge to the single factors: age, gender, and multimorbidity. A multivariate Cox regression analysis adjusted to age, gender, and multimorbidity predicted factors affecting LOS. Results A total of 390 patients were admitted between March 2020 – February 2021 to a subacute complex discharge unit in an Irish tertiary centre hospital: 326 (83.6%) were &amp;gt;65 years of age and 233 (59.7%) were female. The median (IQR) age was 79 (70–86) years with a median (IQR) of 19.4 (10–41) days. A total of 237 (60.7%) events were uncensored, with LOS &amp;gt; 15 days, of which 138 (58.2%) were female and 124 (52.32%) had &amp;gt; 4 comorbidities; 153 (39.2%) were censored into LOS ≤ 15 days, and death occurred in 19 (4.8%). Conclusion Our study is the first to analyse common factors delaying discharge from a complex discharge unit. Further research is required to explore multimorbidity as a risk factor for mortality in patients with prolonged LOS within a complex discharge unit and target gender-specific frailty measures to achieve high-quality patient management.

Linkages between consanguinity, pregnancy outcomes and offspring mortality in twenty-first century India.

We hypothesized that consanguineous marriage will remain a risk factor for pregnancy outcome and offspring mortality, but the development in demographic, socioeconomic conditions and increased utilization of maternal and child health care services during postglobalization era would work as a buffer in the reduction of child mortality rates. Data fromNational Family Health Surveys 4(2015-2016) and 5(2019-2021) were pooled and used for the analysis. Binary logistic regression and Cox proportional hazard regression models were used to examine the effects of close (CC) and distant (DC) consanguinity on spontaneous abortion, stillbirth, neonatal mortality, post-neonatal, and child mortality respectively compared to non-consanguinity (NC). The final model showed that the risk of spontaneous abortion (both CC and DC, p < 0.001) and neonatal mortality (DC, p < 0.001) were significantly higher compared to NC. No significant association was found between consanguinity and child mortality. We conclude that the endogenous effect of consanguinity still pose a serious challenge to the survival of fetus and new born; but exogenous effect reduces the risk of child death. We propose to incorporate socially entrenched practice of consanguinity explicitly into Mosley and Chen's (1984) framework for the aid in understanding child survival in developing countries.

Amikacin treatment in patients with Enterobacterales bacteraemia: impact of MIC on mortality.

Recently, breakpoints of Enterobacterales to amikacin were changed from MIC ≤ 16 mg/L to MIC ≤ 4 mg/L based mainly on laboratory data with little supporting clinical evidence. Our aim was to investigate the relation between MIC of Enterobacterales to amikacin and mortality among patients with Enterobacterales bacteraemia from a urinary tract source treated with amikacin. This retrospective, single-centre study included patients with Enterobacterales urinary source bacteraemia treated with amikacin, with Low (MIC ≤ 4 mg/L) and High (MIC 8 or 16 mg/L) MICs. A cohort of patients treated with ertapenem was used to assess if amikacin MIC is a marker of severity independent of antimicrobial treatment. The primary outcome was 30-day mortality. Multivariate logistic regression analysis was done to assess risk factors for mortality. We included 85 patients, 46 (54.1%) were male, and mean age was 79.0 years (SD 11.7). Sixty-one patients (71.8%) had Low MIC and 24 (28.2%) had High MIC. Thirty-day mortality was 8.2% and 29.2% in the Low and High MIC groups, respectively (P = 0.031). Risk factors for 30-day mortality were age, infection by Enterobacterales other than Escherichia coli and high amikacin MIC. In a cohort of 88 patients treated with ertapenem, amikacin MIC was not associated with 30-day mortality. We demonstrated a relation between higher amikacin MIC levels (8 and 16 mg/L) and increased 30-day mortality in patients treated with amikacin for bacteraemia secondary to a urinary source. These findings support the new CLSI breakpoint change of Enterobacterales to amikacin.

Survival of hospitalised COVID-19 patients in Hawassa, Ethiopia: a cohort study

The COVID-19 pandemic, caused by SARS-CoV-2, led to 622,119,701 reported cases and 6,546,118 deaths. Most studies on COVID-19 patients in hospitals are from high-income countries, lacking data for developing countries such as Ethiopia.This study assesses clinical features, demographics, and risk factors for in-hospital mortality in Hawassa, Ethiopia. The research cohort comprises 804 cases exhibiting clinical diagnoses and/or radiological findings and indicative of symptoms consistent with COVID-19 at Hawassa University Comprehensive Specialized Hospital from September 24, 2020, to November 26, 2021. In-hospital mortality rate was predicted using Cox regression. The median age was 45 years, with males making up 64.1% of the population. 173 (21.5%) fatalities occurred, with 125 (72.3%) among males. Male patients had higher mortality rates than females. Severe and critical cases were 24% and 21%. 49.1% had at least one comorbidity, with 12.6% having multiple. Common comorbidities were diabetes (15.9%) and hypertension (15.2%). The Cox regression in Ethiopian COVID-19 patients found that factors like gender, advanced age group, disease severity, symptoms upon admission, shortness of breath, sore throat, body weakness, hypertension, diabetes, multiple comorbidities, and prior health facility visits increased the risk of COVID-19 death, similar to high-income nations. However, in Ethiopia, COVID-19 patients were young and economically active. Patients with at least one symptom had reduced death risk. As a conclusion, COVID-19 in Ethiopia mainly affected the younger demographic, particularly economically active individuals. Early detection can reduce the risk of mortality. Prompt medical attention is essential, especially for individuals with comorbidities. Further research needed on diabetes and hypertension management to reduce mortality risk. Risk factors identified at admission play a crucial role in guiding clinical decisions for intensive monitoring and treatment. Broader risk indicators help prioritize patients for allocation of hospital resources, especially in regions with limited medical facilities. Government’s focus on timely testing and strict adherence to regulations crucial for reducing economic impact.

Mortality rates in people presenting with a new diabetes-related foot ulcer: a cohort study with implications for management.

People with diabetes-related foot ulcers (DFUs) have high mortality rates. This analysis assesses the impact of selected risk factors on short-term mortality using a population registered in the National Diabetes Foot Care Audit (NDFA). Mortality rates at 12, 26 and 52 weeks was assessed in people with a new DFU registered by a specialist diabetes footcare service in the NDFA in England and Wales between April 2017 and March 2022. Poisson regression models were created to explore risk factors for mortality. In 71,000 people registered with a new DFU, mortality rates at 12, 26 and 52 weeks was 4.2%, 8.2% and 14.4%, respectively. At 26 weeks, higher mortality rates was associated with older age (rate ratio 2.15; 95% CI 2.03, 2.28, for age ≥80 years vs age 65-79 years), certain ulcer characteristics (area ≥1 cm2 [1.50; 95% CI 1.42, 1.59], deep ulcers [1.26; 95% CI 1.18, 1.35] or hindfoot location [1.53; 95% CI 1.44, 1.62]) and recorded evidence of ischaemia in the lower limb (1.78; 95% CI 1.69, 1.88) and various comorbidities (heart failure [2.13; 95% CI 2.00, 2.26], myocardial infarction [1.45; 95% CI 1.29, 1.63], stroke [1.37; 95% CI 1.22, 1.53], renal replacement therapy [2.34; 95% CI 2.09, 2.61] and chronic kidney disease stage 3 or greater [1.20; 95% CI 1.12, 1.29]). The 26-week mortality rate exceeded 25% for 7.3% of all individuals, rising to 11.5% of those aged 65 years and older, and 22.1% of those aged 80 years and over. Short-term mortality rates in people with a DFU is high. Teams managing people with DFUs should consider modifying the burdensome interventions and care required to heal such ulcers so maximising the quality of residual life, rather than focusing exclusively on healing.

Assessment of brain-derived neurotrophic factor and irisin concentration in children with chronic kidney disease: a pilot study

Patients suffering from chronic kidney disease (CKD) are particularly placed at risk of multiorgan complications. One of them is malnutrition, which adds up to a higher mortality factor among them. This study was designed to determine the usefulness of brain-derived neurotrophic factor (BDNF) and irisin assays in the assessment of CKD development. The study group included 28 children with CKD at stages 2-5 treated conservatively. The outcome of our study revealed decreased serum BDNF and irisin levels in CKD patients, whereas urine concentrations were increased for BDNF and decreased for irisin, comparing to healthy controls. There was a positive correlation between anthropometric measures and urine BDNF concentration, as well as anthropometric measures and both serum and urine irisin levels in the study group, however no dependence of the tested markers on the stage of CKD was observed. In recent years, a role of myokines was described as vital for maintaining metabolic homeostasis therefore we suspect a potential role of these multifaceted markers in detecting malnutrition in CKD children.

Preoperative fibrinogen level predicts the risk and prognosis of patients with native valve infective endocarditis undergoing valve surgery.

The aim of this study was to assess the clinical significance and prognostic value of the preoperative fibrinogen (FBG) level in patients with native valve infective endocarditis (NVIE) who underwent valve surgery. This retrospective study included a total of 163 consecutive patients who were diagnosed with NVIE and underwent valve surgery from January 2019 to January 2022 in our hospital. The primary endpoint was all-cause mortality. All-cause mortality was observed in 9.2% of the patients (n = 15). Body mass index (BMI) was lower in the survival group (p = 0.025), whereas FBG (p = 0.008) and platelet count (p = 0.044) were significantly greater in the survival group than in the death group. Multivariate Cox proportional hazards analysis revealed that FBG (HR, 0.55; 95% CI, [0.32-0.94]; p = 0.029) was an independent prognostic factor for all-cause mortality. Furthermore, Kaplan‒Meier survival curve analysis revealed that patients with low FBG levels (<3.28 g/L) had a significantly greater mortality rate (p = 0.034) than did those with high FBG levels (>3.99 g/L). In the trend analysis, the FBG tertiles were significantly related to all-cause mortality in all three adjusted models, and the p values for trend were 0.017, 0.016, and 0.028, respectively. Preoperative FBG may serve as a prognostic factor for all-cause mortality, and an FBG concentration less than 3.28 g/L was associated with a greater risk of all-cause mortality in NVIE patients undergoing valve surgery.

The Neutrophil-to-Lymphocyte Ratio in Patients with Spinal Cord Injury: A Narrative Review Study.

Background and Objectives: Traumatic spinal cord injury (SCI) is a devastating condition that occurs in two phases: primary and secondary injury. These phases contribute to changes in blood vessels and the influx of inflammatory cells such as neutrophils and lymphocytes. The biomarker known as the neutrophil-to-lymphocyte ratio (NLR) has been suggested as being highly valuable in predicting outcomes for patients with traumatic brain injury, acute ischemic stroke, and traumatic spinal cord injury. Therefore, this review study aims to investigate the prognostic value of the NLR in predicting outcomes for patients with SCI. Materials and Methods: A thorough review of relevant articles was conducted using Mesh keywords in Medline via Embase, PubMed, Google Scholar, and Scopus from 2000 to 2023. The search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. After reviewing the articles and applying inclusion and exclusion criteria, only relevant articles were included in the study. Results: In the initial search, 41 papers were identified. After applying exclusion criteria, only three clinical studies remained for review. It is still debatable whether the NLR can serve as a cost-effective, readily available, and independent predictive factor for both mortality and recovery outcomes in patients with traumatic spinal cord injuries. Conclusions: Our study demonstrates that NLR, a readily available and inexpensive marker, can serve as an independent predictor of both mortality and recovery outcomes in patients with traumatic spinal cord injury. To reach a conclusive decision, additional data are required.