Higher Risk Of In-hospital Mortality Research Articles

Perioperative Complications and In-Hospital Mortality in Paraplegic Radical Cystectomy Patients.

The aim of this study was to test for the association between paraplegia and perioperative complications as well as in-hospital mortality after radical cystectomy (RC) for non-metastatic bladder cancer. Perioperative complications and in-hospital mortality were tabulated in RC patients with or without paraplegia in the National Inpatient Sample (2000-2019). Of 25,527 RC patients, 185 (0.7%) were paraplegic. Paraplegic RC patients were younger (≤70years of age; 75 vs. 53%), more frequently female (28 vs. 19%), and more frequently harbored Charlson Comorbidity Index ≥3 (56 vs. 18%). Of paraplegic vs. non-paraplegic RC patients, 141 versus 15,112 (76 vs. 60%) experienced overall complications, 38 versus 2794 (21 vs. 11%) pulmonary complications, 36 versus 3525 (19 vs. 14%) genitourinary complications, 33 versus 3087 (18 vs. 12%) intraoperative complications, 21 versus 1035 (11 vs. 4%) infections, and 17 versus 1343 (9 vs. 5%) wound complications, while 62 versus 6267 (34 vs. 25%) received blood transfusions, 47 versus 3044 (25 vs. 12%) received critical care therapy (CCT), and intrahospital mortality was recorded in 13 versus 456 (7.0 vs. 1.8%) patients. In multivariable logistic regression models, paraplegic status independently predicted higher overall CCT use (odds ratio [OR] 2.1, p<0.001) as well as fourfold higher in-hospital mortality (p<0.001), higher infection rate (OR 2.5, p<0.001), higher blood transfusion rate (OR 1.45, p=0.009), and higher intraoperative (OR 1.56, p=0.02), wound (OR 1.89, p=0.01), and pulmonary (OR 1.72, p=0.004) complication rates. Paraplegic patients contemplating RC should be counseled about fourfold higher risk of in-hospital mortality and higher rates of other untoward effects.

SARS-CoV-2 RNAemia as a reliable predictor of long-term mortality among older adults hospitalized in pulmonary intermediate care units: a prospective cohort study

BackgroundSARS-CoV-2 viremia is associated with disease severity and high risk for in-hospital mortality. However, the impact of SARS-CoV-2 viremia on long-term outcomes in hospitalized patients with COVID-19 is poorly understood.MethodsWe conducted a prospective cohort study and recruited a group of older adult patients with COVID-19 admitted to pulmonary intermediate care units of Peking University Third Hospital during December 2022 and January 2023. The plasma level of SARS-CoV-2 RNA was determined by a standardized RT-PCR technique, and SARS-CoV-2 RNAemia was defined as a plasma viral load ≥ 50 copies/ml. In-hospital and follow-up (180-day) outcome data were collected.ResultsA total of 101 patients with an average of 80.4 years were recruited, and 63.4% of them were severe or very severe cases. Twenty-eight patients (27.7%) had SARS-CoV-2 RNAemia, with a median viral RNA load of 422.1 [261.3, 1085.6] copies/ml. Patients with SARS-CoV-2 RNAemia were more likely to develop critical cases and had a higher incidence of sepsis. Accordingly, they had a higher 180-day mortality (57.1% vs. 19.7%, P < 0.001), as well as in-hospital mortality (50.0% vs. 13.7%, P < 0.001), independent of age, disease severity, sepsis, lymphocyte count and C-Reactive protein. In addition, the risk for 180-day mortality increased with the SARS-CoV-2 RNA load in plasma. Plasma cytokines, including IL-6, IL-8 and IL-10, were higher in patients with SARS-CoV-2 RNAemia.ConclusionsOur study indicates that SARS-CoV-2 RNAemia serves as a useful biomarker for predicting mortality, especially long-term mortality, in older adult patients hospitalized in pulmonary intermediate care units.Trial registrationChinese Clinical Trial Registry website (No. ChiCTR2300067434).

Elevated high-sensitive cardiac troponin T in emergency department patients: insights from a retrospective descriptive cohort study

BackgroundHigh-sensitive cardiac troponin T (hs-cTnT) assessments are routinely conducted in German emergency departments (EDs). However, data describing a large number of ED patients with pathological hs-cTnT levels and subsequent clinical outcomes are limited.MethodsThis retrospective descriptive analysis included 141.892 patients who presented to the interdisciplinary ED at Klinikum rechts der Isar in Munich, Germany, between January 2019 and December 2021. Patients with trauma diagnoses were excluded, focusing on those with elevated hs-cTnT levels. These patients were categorized into three groups based on the International Classification of Procedures in Medicine (ICPM): those with elevated hs-cTnT who received no coronary angiography (NCA), those who underwent diagnostic coronary angiography (DCA), and those who received percutaneous coronary intervention (PCI). The objective of this study was to characterize a large emergency department patient cohort and assess their subsequent clinical outcomes.ResultsAfter initial Manchester Triage Sytem (MTS) categorization, 32.6% (46.307/141.892) of patients were identified as non-trauma cases. Of these, 9.9% (4.587/46.307) had hs-cTnT levels exceeding 14 ng/L. Within this subset, 70.4% (3.230/4.587) did not undergo coronary angiography, 15.4% (705/4.587) underwent DCA and 14.2% (652/4.587) received PCI. Chest pain occurred more frequently in the PCI group (28.0%, 160/652) compared to the DCA group (18.3%, 113/705) or NCA group (5.7%, 159/3230), p < 0.001. However, breathing problems occurred more frequently in the NCA group (23.2%, 647/3230) compared to the PCI group (17.7%, 101/652) or DCA group (21.8%, 135/705), p < 0.001. Also, collapse was more frequent in patients in the NCA group (4.0%, 112/3230) compared to the DCA group (3.4%, 21/705) or PCI group (3.5%, 20/652), p < 0.001. Overall, in-hospital mortality was significantly higher in the NCA group (7.9%, 256/3230) compared to the DCA group (2.3%, 16/705) or PCI group (4.1%, 27/652), p < 0.001.ConclusionEmergency patients with elevated hs-cTnT who did not undergo coronary angiography faced a higher risk of in-hospital mortality in our retrospective descriptive study. Given the heterogeneous nature of presenting complaints in emergency departments, identifying at-risk patients can pose challenges for treating physicians.

The Aftermath: Investigating Readmission And Mortality Trends In Older Adults

Abstract Background Acute hospital readmissions have significant implications for both the patient and the health service. Research has shown that up to 70 percent of hospital readmissions may be avoidable, while patients who are readmitted to hospital have a higher in-hospital mortality risk. The Health Service Executive has set a Key Performance Indicator of a readmission rate within 30 days of less than 11.1 percent. The purpose of this study is to identify the number of patients aged 75 years and older readmitted to a busy model four hospital within 30 days of their discharge. It will also quantify the number of deaths within this patient group. We aim to identify key areas where pathways for older adults could be developed to improve quality of care and reduce the overall burden on both the patient and acute hospital service. Methods Data was collected retrospectively for patients admitted between September 1st, 2023, and September 30th, 2023. Results In total 272 patients aged 75 years and older were admitted within a one-month period. 47 patients were admitted under the geriatric medicine service. The mean length of stay for all patients was 12.41 days. 160 patients were discharged directly home while 27 were discharged to long term care. The remaining patients were discharged to rehab, convalescence or hospice. 28 patients died during their inpatient stay. 6 patients died within one month of discharge. In total 13 patients were readmitted to hospital within one month following their discharge. 23 percent of patients died following readmission. The most common reason for readmission was a respiratory illness. Conclusion 4.7 percent of patients aged 75 years and older were readmitted to hospital within one month of discharge. This falls below the national target set by the HSE. However, there was a high mortality rate amongst those readmitted to hospital.

Comorbidity burden and outcomes of endoscopic ultrasound-guided treatment of pancreatic fluid collections:Multicenter study with nationwide data-based validation.

The appropriate holistic management is mandatory for successful endoscopic ultrasound (EUS)-guided treatment of pancreatic fluid collections (PFCs). However, comorbidity status has not been fully examined in relation to clinical outcomes of this treatment. Using a multi-institutional cohort of 406 patients receiving EUS-guided treatment of PFCs in 2010-2020, we examined the associations of Charlson Comorbidity Index (CCI) with in-hospital mortality and other clinical outcomes. Multivariable logistic regression analysis was conducted with adjustment for potential confounders. The findings were validated using a Japanese nationwide inpatient database including 4053 patients treated at 486 hospitals in 2010-2020. In the clinical multi-institutional cohort, CCI was positively associated with the risk of in-hospital mortality (Ptrend < 0.001). Compared to patients with CCI = 0, patients with CCI of 1-2, 3-5, and ≥6 had adjusted odds ratios (95% confidence intervals) of 0.76 (0.22-2.54), 5.39 (1.74-16.7), and 8.77 (2.36-32.6), respectively. In the nationwide validation cohort, a similar positive association was observed; the corresponding odds ratios (95% confidence interval) were 1.21 (0.90-1.64), 1.52 (0.92-2.49), and 4.84 (2.63-8.88), respectively (Ptrend < 0.001). The association of higher CCI with longer length of stay was observed in the nationwide cohort (Ptrend < 0.001), but not in the clinical cohort (Ptrend = 0.18). CCI was not associated with the risk of procedure-related adverse events. Higher levels of CCI were associated with a higher risk of in-hospital mortality among patients receiving EUS-guided treatment of PFCs, suggesting the potential of CCI in stratifying the periprocedural mortality risk. The research based on the clinical data from the WONDERFULcohort was registered with UMIN-CTR (registration number UMIN000044130).

The influence of patient sex on pulmonary embolism evaluation, treatment modality, and outcomes.

Pulmonary embolism (PE) is the third-leading cause of cardiovascular mortality, accounting for 100,000 deaths per year in the United States. Although sex-based disparities have previously been described in this population, it is unclear if these differences have persisted with the expansion of PE evaluation and treatment approaches. The purpose of this study is to investigate sex-based differences in the evaluation, management, and outcomes of patients with acute PE. We performed a retrospective analysis of patients enrolled in the national Pulmonary Embolism Response Team (PERT) Consortium database between October 2015 and October 2022. We evaluated patient demographics, clinical characteristics, diagnostic imaging performed, treatment at several phases of care (pre-PERT, PERT recommendations, and post-PERT), and clinical outcomes. A total of 5722 patients with acute PE (2838 [49.6%] women) from 35 centers were included. There were no differences in PE risk category between male and female patients. Women were less likely to undergo echocardiography (76.9% vs 73.8%) and more likely to receive no anticoagulation prior to PERT evaluation (35.5% vs 32.9%). PERT teams were more likely to recommend catheter-based interventions for men (26.6% vs 23.1%), and men were more likely to undergo these procedures (21.9% vs 19.3%). In a multivariable analysis, female sex was a predictor of in-hospital mortality (OR 1.53, 95% CI 1.06 to 2.21). In this analysis, we identified sex-based differences in the evaluation and management of patients presenting with acute PE. Subsequently, women presenting with acute PE were at higher risk of in-hospital mortality.

The Respiratory Rate, Age, and Mean Arterial Pressure (RAM) Index: A Novel Prognostic Tool to Predict Mortality among Adult Patients with Acute Heart Failure in the Emergency Department.

Background and Objectives: Acute heart failure (AHF) is a life-threatening condition frequently encountered in the emergency department (ED). Identifying reliable prognostic indicators for in-hospital mortality is crucial for risk stratification and the appropriate management of AHF patients. This study aimed to assess the most effective method for predicting in-hospital mortality among various physiological parameters in patients with AHF presenting to the ED. Additionally, the study evaluated the effectiveness of the RAM index-respiratory rate (RR), age, and mean arterial pressure (MAP)-derived from the shock index (SI) by replacing heart rate with RR, as a novel prognostic tool. This was compared with the SI and its other derivatives to predict in-hospital mortality in adult patients with AHF presenting to the ED. Materials and Methods: This is a retrospective study conducted in the ED of an urban medical center, enrolling adult patients with signs and symptoms of AHF, who met the epidemiological diagnosis criteria, between January 2017 and December 2021. Baseline physiological parameters, including the RR, heart rate, systolic blood pressure, and diastolic blood pressure, were recorded upon ED admission. The RAM index was calculated as the RR multiplied by the age divided by the MAP. Statistical analysis was performed, including univariate analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: A total of 2333 patients were included in the study. A RAM index > 18.6 (area under ROC curve (AUROC): 0.81; 95% confidence interval (CI): 0.79-0.83) had a superior mortality discrimination ability compared to an SI > 0.77 (AUROC: 0.75; 95% CI: 0.72-0.77), modified shock index > 1.11 (AUROC: 0.75; 95% CI: 0.73-0.77), age shock index > 62.7 (AUROC: 0.74; 95% CI: 0.72-0.76), and age-modified shock index > 79.9 (AUROC: 0.75; 95% CI: 0.73-0.77). A RAM index > 18.6 demonstrated a 7.36-fold higher risk of in-hospital mortality with a sensitivity of 0.80, specificity of 0.68, and negative predictive value of 0.97. Conclusions: The RAM index is an effective tool to predict mortality in AHF patients presenting to the ED. Its superior performance compared to traditional SI-based parameters suggests that the RAM index can aid in risk stratification and the early identification of high-risk patients, facilitating timely and aggressive treatment strategies.

Does Chronic Obstructive Pulmonary Disease Impact Outcome after Coronary Artery Bypass Grafting? A Population-Based Retrospective Study in Germany.

Background: The interaction between chronic obstructive pulmonary disease (COPD) and coronary artery bypass grafting (CABG) is discussed controversial. Methods: In this population-based retrospective analysis including non-emergency CABG in Germany between 2015 and 2021, the aim was to compare in-hospital mortality, hospital length of stay (HLOS), and perioperative ventilation time (VT) in patients affected by COPD and not affected by COPD. In addition, we compared outcomes after off-pump coronary artery bypass (OPCAB) and on-pump coronary artery bypass (ONCAB) surgery and outcomes after CABG with a minimally invasive technique with and without cardiopulmonary bypass (CPB) in COPD patients. Results: Of the 274,792 analyzed cases undergoing non-emergency CABG, 7.7% suffered from COPD. COPD patients showed a higher in-hospital mortality (6.0% vs. 4.2%; p < 0.001), a longer HLOS (13 days (10-19) vs. 12 days (9-16); p < 0.001), and a longer VT (33 h (11-124) vs. 28 h (9-94); p < 0.001). In subgroup analyses, COPD patients undergoing OPCAB surgery showed a lower in-hospital mortality (3.5% vs. 6.4%; p < 0.001), a shorter HLOS (12 days (9-16) vs. 13 days (10-19); p < 0.001) and a shorter VT (20 h (10-69) vs. 36 h (11-135); p < 0.001) compared to ONCAB surgery. Regression analyses confirmed that using cardiopulmonary bypass in COPD patients is associated with a higher risk of in-hospital mortality (OR, 1.86; 95% CI: 1.51-2.29, p < 0.001), a longer HLOS (1.44 days; 95% CI: 0.91-1.97, p < 0.001), and a longer VT (33.67 h; 95% CI: 18.67-48.66, p < 0.001). In further subgroup analyses, COPD patients undergoing CABG with a minimally invasive technique without CPB showed a lower in-hospital mortality (3.5% vs. 16.5%; p < 0.001) and a shorter VT (20 h (10-69) vs. 65 h (29-210); p < 0.001) compared to CABG with a minimally invasive technique and CPB. Regression analyses confirmed that using CPB in COPD patients undergoing CABG with a minimally invasive technique is associated with a higher risk of in-hospital mortality (OR, 4.80; 95% CI: 2.42-9.51, p < 0.001). Conclusions: COPD negatively impacts outcomes after non-emergency CABG. According to our results, OPCAB surgery and CABG with a minimally invasive technique without CPB seem to be beneficial for COPD patients. Further studies should be performed to confirm this.

Association of alactic base excess with in-hospital mortality in patients with acute myocardial infarction: a retrospective cohort study

BackgroundAlactic base excess (ABE) is a novel biomarker to evaluate the renal capability of handling acid-base disturbances, which has been found to be associated with adverse prognosis of sepsis and shock patients. This study aimed to evaluate the association between ABE and the risk of in-hospital mortality in patients with acute myocardial infarction (AMI).MethodsThis retrospective cohort study collected AMI patients’ clinical data from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The outcome was in-hospital mortality after intensive care unit (ICU) admission. Univariate and multivariate Cox proportional hazards models were performed to assess the association of ABE with in-hospital mortality in AMI patients, with hazard ratios (HRs) and 95% confidence intervals (CI). To further explore the association, subgroup analyses were performed based on age, AKI, eGFR, sepsis, and AMI subtypes.ResultsOf the total 2779 AMI patients, 502 died in hospital. Negative ABE (HR = 1.26, 95%CI: 1.02–1.56) (neutral ABE as reference) was associated with a higher risk of in-hospital mortality in AMI patients, but not in positive ABE (P = 0.378). Subgroup analyses showed that negative ABE was significantly associated with a higher risk of in-hospital mortality in AMI patients aged>65 years (HR = 1.46, 95%CI: 1.13–1.89), with eGFR<60 (HR = 1.35, 95%CI: 1.05–1.74), with AKI (HR = 1.32, 95%CI: 1.06–1.64), with ST-segment elevation acute myocardial infarction (STEMI) subtype (HR = 1.79, 95%CI: 1.18–2.72), and without sepsis (HR = 1.29, 95%CI: 1.01–1.64).ConclusionNegative ABE was significantly associated with in-hospital mortality in patients with AMI.

In-hospital outcome of patients hospitalized for leukemia with comorbid acute decompensated heart failure: An analysis of National Inpatient Sample (NIS).

173 Background: Recent evidence found increase incidence of heart failure in leukemia patients, influenced by various factors such as the underlying disease and medication usage. Nevertheless, there remains a scarcity of data regarding the in-hospital outcome for individuals admitted for leukemia with comorbid acute decompensated heart failure. Thus, we aim to examine the impact of heart failure on clinical outcomes in leukemia patients. Methods: We utilized the 2020 U.S. National Inpatient Sample (NIS) to investigate patients admitted for leukemia with concurrent diagnosis of heart failure, identified through ICD-10 CM codes. Adjusted odds ratios (aORs) for predefined outcomes were determined using multivariable logistic and linear regression model, adjusting for comorbidities. The primary outcome assessed was inpatient mortality, while secondary outcomes included complications related to various body systems. Results: We identified 43,955 patients with a primary discharge diagnosis of leukemia. The mean age was 54.5 years; 49.7% were female. Caucasians accounted for 66%, followed by African Americans (13%). Of these, 11.86% (5,220/43,955) had a concurrent diagnosis of heart failure. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, comorbid acute decompensated heart failure was associated with higher in-hospital mortality (aOR 1.57, 95% CI: 1.2, 1.94, p &lt; 0.001), higher mean length of stay (Beta-coefficient 1.93; 95% CI: 0.65, 3.21, p = 0.003), mean total hospital cost (Beta-coefficient 9,472, 95% CI: 2,339, 16,604, p = 0.004), shock (aOR 2.41, 95% CI: 1.84, 3.15, p &lt; 0.001), sepsis (aOR 1.71, 95%CI: 1.38, 2.12, p &lt; 0.001), acute respiratory failure (aOR 2.37, 95% CI: 1.96, 2.87, p &lt; 0.001), and acute kidney injury (aOR 1.57, 95% CI: 1.32, 1.85, p &lt; 0.001). Conclusions: Our study revealed that hospitalized leukemia patients with concurrent heart failure experience higher risk of in-hospital mortality and various adverse in-hospital outcomes. Close monitoring of this factor during hospitalization is essential, and additional longitudinal research is warranted to fully understand this association.

Risk factors for in-hospital mortality among patients hospitalized with COVID-19 and end-stage kidney disease.

The mortality rate for -COVID-19 infection varies significantly depending on age and comorbidities but remains high in hospitalized patients overall. Several retrospective studies have identified patients with end-stage kidney disease (ESKD) to be at increased risk. The objective of this study was to study in-hospital outcomes of ESKD patients at an academic medical center and identify characteristics that place them at a higher risk for in-hospital mortality. A retrospective chart review was conducted including adult patients (≥ 18 years old) admitted to Loma Linda Medical Center for COVID-19 infection with a previous diagnosis of ESKD. Patients with prior kidney transplants were excluded. The main outcome of this study was the rate of in-hospital mortality. 21 of the 91 patients died with a mortality rate of 23%. Age, D-dimer > 0.4µg/mL, ejection fraction less than 50%, and ferritin > 300 ng/mL were predictors for mortality in unadjusted univariate analysis. Adjusted multivariable analysis demonstrated that only an ejection fraction of less than 50% was associated with increased mortality risk. Cardiovascular disease is the leading cause of mortality for ESKD patients and also places them at increased risk of mortality in the setting of severe COVID-19 infection.

Racial, ethnic and sex disparity in acute heart failure patients with COVID-19: A nationwide analysis

BackgroundPatients with acute heart failure (AHF) exacerbation are susceptible to complications in the setting of COVID-19 infection. Data regarding the racial/ethnic and sex disparities in patients with AHF and COVID-19 remains limited. ObjectiveWe aim to evaluate the impact of race, ethnicity, and sex on the in-hospital outcomes of AHF with COVID-19 infection using the data from the National Inpatient Sample (NIS). MethodsWe extracted data from the NIS (2020) by using ICD-10-CM to identify all hospitalizations with a diagnosis of AHF and COVID-19 in the year 2020. The associations between sex, race/ethnicity, and outcomes were examined using a multivariable logistic regression model. ResultsWe identified a total of 158,530 weighted AHF hospitalizations with COVID-19 infection in 2020. The majority were White (63.9 %), 23.3 % were Black race, and 12.8 % were of Hispanic ethnicity, mostly males (n = 84,870 [53.5 %]). After adjustment, the odds of in-hospital mortality were lowest in White females (aOR 0.83, [0.78–0.98]) and highest in Hispanic males (aOR 1.27 [1.13–1.42]) compared with White males. Overall, the odds of cardiac arrest (aOR 1.54 [1.27–1.85]) and AKI (aOR 1.36 [1.26–1.47] were higher, while odds for procedural interventions such as PCI (aOR 0.23 [0.10–0.55]), and placement on a ventilator (aOR 0.85 [0.75–0.97]) were lower among Black males in comparison to White males. ConclusionMale sex was associated with a higher risk of in-hospital mortality in white and black racial groups, while no such association was noted in the Hispanic group. Hispanic males had the highest odds of death compared with White males.

Sex differences in acute myocardial infarction - Preliminary results from an umbrella review

Abstract Background Cardiovascular disease (CVD) is the leading cause of premature death among women, and the negative impact on public health is profound. Women have higher rates of comorbidities, complications such as stroke, in addition to higher mortality compared to men (1-6) and targeting sex-related differences regarding the treatment of CVD in women is of great importance to prevent the number of CVD events. The purpose of this study was to get an overview of the systematic reviews and meta-analyses investigating sex differences in patients with acute myocardial infarction (AMI) the past 10 years. Methods A systematic search was carried out in Epistemonikos, the largest database of systematic reviews that screens PubMed, Cochrane, Embase, CINAHL, PsycInfo and others (i.e., currently nine databases) (7, 8). The search was conducted 12 January 2024, with the general search strings: (1) sex differences OR gender differences AND myocardial infarction, (2) sex differences OR gender differences OR women OR female AND myocardial infarction. The search was restricted to systematic reviews conducted the last 10 years. Results Forty-nine (search 1: 19, search 2: 30) systematic reviews and meta-analyses were identified, and five studies investigating sex differences in relation to AMI were included. Two systematic reviews, Babioakis (2021) and Meer (2015), reported of longer door-to-balloon (D2B) time and/or symptom-to-balloon (S2B) time in female patients presenting with STEMI and referred for PCI, compared to male patients (9). Chaudhary (2022) investigated adverse event of MINOCA (more commonly in women/ younger age (51-59 years) and reported higher risk of MACE among women than men (10.1% vs. 9.1%, OR 1.15, 1.04-1.23), in addition to higher incidence of stroke (3.5% vs. 2.2%, OR 1.3, 1.01-1.68), however no significantly differences were observed for all-cause mortality, non-fatal AMI, and cardiovascular readmissions between the groups (10). Three systematic reviews reported of higher risk of mortality after STEMI among women, compared to men (11-13). Xi (2022) reported of higher risk of short-term mortality (RR, 1.73; 95% CI 1.53 to 1.96)) (adjusted RR, 1.24; 95% CI 1.11 to 1.38) (13), Pancholy (2014) reported of higher risk of in-hospital mortality (RR, 1.93; 95% CI, 1.75-2.14) (adjusted RR, 1.48; 95% CI, 1.07-2.05) (11), and van der Meer (2015) reported of higher crude short- and long-term mortality in women, in addition to less use of GP IIb/IIIa inhibitors in women, compared to men (women 51%, men 57%) (12). Conclusions Our umbrella review revealed that women had longer timeline for treatment in AMI, had less use of medication and higher risk of mortality and MACE compared to men. Clinical practice needs further improvements in management in female patients.

Association between short-term changes in serum magnesium and in-hospital mortality following acute myocardial infarction: a cohort study based on the MIMIC database.

The association between short-term changes in serum magnesium level and risk of in-hospital mortality was investigated in patients with acute myocardial infarction (AMI). In this retrospective cohort study, data of 2,716 patients with AMI were extracted from the Medical Information Mart for Intensive Care (MIMIC-III and MIMIC-IV) database for 2001-2012. Univariate and multivariate Cox proportional hazards models were used to explore the association between serum magnesium level and short-term change and in-hospital mortality in patients with AMI. In addition, subgroups according to age, gender, Sequential Organ Failure Assessment (SOFA) score, and Simplified Acute Physiology Score (SAPS-II) were also analysed. In total, 504 (18.6%) patients died in hospital. After adjusting for covariates, all AMI patients with high magnesium levels at ICU admission (HR=1.03, 95%CI: 0.83-1.27) or 48 hours after ICU admission (all p<0.05), or those demonstrating a change in magnesium level within the first 48 hours of ICU stay (all p<0.05) were shown to have a high risk of in-hospital mortality. Moreover, this correlation was retained irrespective of age, gender, SOFA score, and SAPS-II (allp<0.05). Serum magnesium levels at different time points after ICU admission and change in serum magnesium level during the first 48 hours were associated with in-hospital mortality in patients with AMI, indicating that clinical attention should be paid to short-term changes in serum magnesium levels regarding treatment adjustment, which may further reduce the risk of mortality.

Predictors of Renal Replacement Therapy in Cardiac Surgery-Associated Acute Kidney Injury Patients: A Single-Centered, Retrospective Study

Abstract Background: Studies have reported that cardiac surgery-associated acute kidney injury (CSA-AKI) patients requiring dialysis or renal replacement therapy (RRT) have a higher risk of in-hospital mortality. This study aimed to investigate the predictors contributing to postoperative RRT. Materials and Methods: This retrospective observational study was conducted at a single cardiovascular center. Patients who underwent cardiac surgery complicated with CSA-AKI in the intensive care unit (ICU) from January 2020 to December 2022 were included. They were categorized into two groups: those who required RRT (group A, n = 302) and those who did not (group B, n = 811). Bivariable and multivariable analyzes were conducted to compare the risk with odds ratio (OR) for in-hospital mortality between those groups. Results: We analyzed 1113 patients (29.4%) in the final analysis. The in-hospital mortality rate was 31.8% vs. 4.2% (OR = 10.6, P &lt; 0.001). Variables that significantly predicted postoperative RRT requirements in CSA-AKI patients included female sex (P = 0.038), coronary artery bypass graft (P = 0.001), multiple valves surgery (P = 0.032), diabetes (P = 0.01), renal disease (P = 0.005), postoperative serum creatinine &gt;3.0 mg/dL (P &lt; 0.001), mechanical ventilation use of ≥48 h (P &lt; 0.001), ICU length of stay of &gt;5 days (P &lt; 0.001), use of more than two inotropes and vasoactive agents, (P &lt; 0.001), and postoperative intra-aortic balloon pump (IABP) (P &lt; 0.001). Conclusion: CSA-AKI patients who require dialysis are associated with a higher mortality. Predictors of postoperative RRT included female sex, certain types of surgery, diabetes, postoperative serum creatinine &gt;3.0 mg/dL, mechanical ventilation use of ≥48 h, ICU length of stay of &gt;5 days, use of more than two inotropes and vasoactive agents, and postoperative IABP.

A novel clinical prediction model for in-hospital mortality in sepsis patients complicated by ARDS: A MIMIC IV database and external validation study

BackgroundSepsis complicated by ARDS significantly increases morbidity and mortality, underscoring the need for robust predictive models to enhance patient management. MethodsWe collected data on 6390 patients with ARDS-complicated sepsis from the MIMIC IV database. Following rigorous data cleaning, including outlier management, handling missing values, and transforming variables, we conducted univariate analysis and logistic multivariate regression. We employed the LASSO machine learning algorithm to identify risk factors closely associated with patient outcomes. These factors were then used to develop a new clinical prediction model. The model underwent preliminary assessment and internal validation, and its performance was further tested through external validation using data from 225 patients at a major tertiary hospital in China. This validation assessed the model's discrimination, calibration, and net clinical benefits. ResultsThe model, illustrated by a concise nomogram, demonstrated significant discrimination with an area under the curve (AUC) of 0.711 in the internal validation set and 0.771 in the external validation set, outperforming conventional severity scores such as the SOFA and SAPS II. It also showed good calibration and net clinical benefits. ConclusionsOur model serves as a valuable tool for identifying sepsis patients with ARDS at high risk of in-hospital mortality. This could enable the implementation of personalized treatment strategies, potentially improving patient outcomes.

Chronic obstructive pulmonary disease affects outcome in surgical patients with perioperative organ injury: a retrospective cohort study in Germany

BackgroundThe impact of chronic obstructive pulmonary disease (COPD) on outcome in perioperative organ injury (POI) has not yet been investigated sufficiently.MethodsThis retrospective cohort study analysed data of surgical patients with POI, namely delirium, stroke, acute myocardial infarction, acute respiratory distress syndrome, acute liver injury (ALI), or acute kidney injury (AKI), in Germany between 2015 and 2019. We compared in-hospital mortality, hospital length of stay (HLOS) and perioperative ventilation time (VT) in patients with and without COPD.ResultsWe analysed the data of 1,642,377 surgical cases with POI of which 10.8% suffered from COPD. In-hospital mortality was higher (20.6% vs. 15.8%, p < 0.001) and HLOS (21 days (IQR, 12–34) vs. 16 days (IQR, 10–28), p < 0.001) and VT (199 h (IQR, 43–547) vs. 125 h (IQR, 32–379), p < 0.001) were longer in COPD patients. Within the POI examined, AKI was the most common POI (57.8%), whereas ALI was associated with the highest mortality (54.2%). Regression analysis revealed that COPD was associated with a slightly higher risk of in-hospital mortality (OR, 1.19; 95% CI:1.18–1.21) in patients with any POI.ConclusionsCOPD in patients with POI is associated with higher mortality, longer HLOS and longer VT. Especially patients suffering from ALI are susceptible to the detrimental effects of COPD on adverse outcome.

Higher risk of in-hospital mortality and hepatic encephalopathy during weekend admission in Transjugular Intrahepatic Portosystemic Shunt procedure

ObjectivesTransjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to alleviate portal hypertension in patients with decompensated liver cirrhosis. The weekend effect refers to a higher risk of adverse outcomes associated with procedures performed on weekends compared to weekdays. The goal of this study is to determine whether a weekend effect is evident in TIPS procedures. Materials and MethodThe study identified patients who underwent TIPS procedures in the NIS database from 2015 to 2020. Patients who were admitted on the weekday or weekends were classified into two cohorts. Preoperative variables, including demographics, comorbidities, primary payer status, and hospital characteristics, were noted. Multivariable analysis was used to assess outcomes. ResultsCompared to patients admitted on the weekdays, weekend patients had higher in-hospital mortality (12.87 % vs. 7.96 %, aOR = 1.62, 95 CI 1.32–1.00, p < 0.01), hepatic encephalopathy (33.24 % vs. 26.18 %, aOR = 1.41, 95 CI 1.23–1.63, p < 0.01), acute kidney injury (39.03 % vs. 28.36 %, aOR = 1.68, 95 CI 1.46–1.93, p < 0.01), and transfer out (15.91 % vs. 12.76 %, aOR=1.33, 95 CI 1.11–1.60, p < 0.01). It was also found that weekend patients had longer wait from admission to operation (3.83 ± 0.15 days vs 2.82 ± 0.07 days, p < 0.01), longer LOS (11.22 ± 0.33 days vs 8.38 ± 0.15 days, p < 0.01), and higher total hospital charge (219,973 ± 7,352 dollars vs 172,663 ± 3,183 dollars, p < 0.01). ConclusionOur research unveiled a significant relationship between weekend admission and a higher risk of mortality and morbidity post-TIPS procedure. Eliminating delays in treatment associated with the weekend effect may mitigate this gap to deliver consistent and high-quality care to all patients.

Preparing for future pandemics: frailty associates with mortality in hospitalised older people during the entire COVID-19 pandemic, a Dutch multicentre cohort study

Key summary pointsAimWe aim to investigate how associations of frailty with in-hospital mortality changed throughout the pandemic in older people hospitalised for COVID-19.FindingsOlder hospitalised COVID-19 patients with frailty had a higher in-hospital mortality risk over the entire course of the pandemic. Older hospitalised COVID-19 patients had a lower in-hospital mortality risk in each subsequent wave, which reflects the effects of improved prevention and treatment options.MessageFrailty is a relevant risk factor in all stages of a pandemic, which indicates that frailty is important to consider in prevention and treatment guidelines for future pandemics.

Screening Oropharyngeal Dysphagia in Older Adults

This study investigated the use of the Eating Assessment Tool 10 (EAT-10) in predicting clinical outcomes in older adults hospitalized with COVID-19 infections between February and June 2021. The EAT-10 was performed for all patients. Thirty one percent and 23% of the 153 patients had oropharyngeal dysphagia risk and in-hospital mortality, respectively. Older age (hazard ratio: 1.08; 95% confidence interval, 1.03-1.13; P = .003) and higher EAT-10 score (hazard ratio: 1.02; 95% confidence interval, 1.01-1.04; P = .043) were associated with in-hospital mortality. Older age and having increased risk of oropharyngeal dysphagia were independently associated with a higher risk of in-hospital mortality in older patients with COVID-19.