Higher Risk Of Fatal Outcome Research Articles

Immediate and distant results of liver and bile duct resections for portal cholangiocarcinoma in elderly and senile patients

Aim. Evaluation of surgical outcomes in elderly and senile patients with portal cholangiocarcinoma.Materials and methods. The immediate and long-term results of surgical treatment of 170 patients with portal cholangiocarcinoma performed in 2013–2023 were analyzed. A comparison of the outcomes in patients aged below 60, 60–74, and over 74 years old was carried out. Factors prognostically associated with a high risk of fatal outcome in elderly and senile patients were determined by multivariate logistic regression analysis.Results. The senile patient group was more likely to develop severe complications (p = 0.089) and had a higher 90-day mortality (p = 0.042). The combination of such factors as the Charlson comorbidity index, Comprehensive Risk Score (CRS), resection volume, and surgery duration showed high prognostic significance with respect to hospital mortality, with an area under the ROC curve (AUC) of 0.895 (p < 0.001). The overall and recurrence-free survival of patients did not differ among all age groups (p = 0.886).Conclusion. In the absence of appropriate patient selection based on risk factors, the surgical outcomes in senile patients deteriorate. When planning a surgical intervention in senile patients, attention should be paid to minimizing surgical trauma and surgery duration, especially in patients with a high comorbidity index.

Association of cardiovascular disease with hospital mortality in COVID-19 patients

Aim. To evaluate the relationship between the in-hospital mortality of patients with COVID-19 and the history of cardiovascular disease (CVD) using data from the Russian registry of patients with COVID-19.Material and methods. This study included 758 patients with COVID-19 (403 men, 355 women) aged from 18 to 95 years (median, 61 years), successively hospitalized in the COVID hospital of the Chazov National Medical Research Center of Cardiology from April through June 2020. Death predictors were studied using single- and multivariate regression analyses with the SPSS Statistics, Version 23.0 software.Results. During the stay in the hospital, 59 (7.8 %) patients with COVID-19 died, 677 (89.3 %) were discharged, and 22 (2.9 %) were transferred to other hospitals. The univariate regression analysis showed that the increase in age per decade was associated with a 92% increase in the risk of death [relative risk (RR), 1.92; 95% confidence interval (CI), 1.58-2.34; p <0.001], and an increase in the number of CVDs increases the risk of death by 71% (RR 1.71; 95% CI 1.42–2.07; p<0.001). The presence of one or more CVDs or specific diseases [atrial fibrillation, chronic heart failure (CHF), ischemic heart disease, myocardial infarction, history of cerebrovascular accidents], as well as diabetes mellitus were associated with a higher risk of fatal outcome during the hospitalization for COVID-19. The presence of any CVD increased the risk of in-hospital death by 3.2 times. However, when the model was adjusted for age and sex, this association lost its strength, and only the presence of CHF was associated with a 3-fold increase in the risk of death (RR, 3.16; 95 % CI, 1.64-6.09; p=0.001). Age was another independent predictor of death (RR, 1.05; 95 % CI, 1.03-1.08; p < 0.001).Conclusion. A history of CVD and the CVD number and severity are associated with a higher risk of death during the hospitalization for COVID-19; the independent predictors of in-hospital death are an age of 80 years and older and CHF.

Pathomorphological Features of the Novel Coronavirus Disease in Patients with Systemic Amyloidosis.

Amyloidosis is one of the rare systemic illnesses characterized by the deposition of amyloid fibrils in various organs and tissues. There is a common point between COVID-19 and systemic amyloidosis regarding the multiorgan involvement in the pathological process which leads to a heightened risk for severe morbidity and mortality in amyloidosis patients who contracted COVID-19. We performed a pathomorphological analysis of the autopsy records of 22 patients who had COVID-19 and pre-existing systemic amyloidosis. The premortem diagnosis of systemic amyloidosis was established in 55% of patients, and in other 45% of cases, amyloidosis was found at autopsy. Based on the results of immunohistochemical amyloid typing, amyloid A (AA) amyloidosis was detected in 23%, amyloid light chain (AL) lambda in 32%, AL kappa-in 9%, and transthyretin (ATTR) amyloidosis-in 36% of observations. Immunohistochemical staining with an antibody against SARS-CoV-2 Spike (S) protein revealed positive immune reactions in type II alveolocytes in 59% of deceased persons. The analysis of autopsy findings indicates that patients with systemic amyloidosis are more likely to experience an aggressive clinical course of COVID-19 which leads to a multiorgan failure and a higher risk of fatal outcome.

The choice of tactics for surgical treatment of abdominal aortic aneurysm in octogenarians

Currently, the treatment of abdominal aortic aneurysm does not pose significant difficulties, with modern cardiovascular surgery offering the possibility of both open and endovascular repair (EVAR) techniques. However, the personalized selection of the most optimal surgical intervention for each patient remains a relevant question. In some cases, one of the important factors influencing the choice of surgical method is the patient’s age and accompanying diseases. Abdominal aortic aneurysm is an age-related condition with a high risk of fatal outcomes. In our practice, we encountered a rare case of abdominal aortic aneurysm in an octogenarian woman with severe somatic status, poorly controlled arterial hypertension, and complex anatomical enlargement of the aneurysm. The question arose regarding the choice of optimal tactics and surgical treatment method. According to the MSCT, the diameter of the expansion was 67 mm, posing a 20% risk of rupture in the first year. In this clinical case, EVAR technique was unsuitable due to the anatomical features of the aneurysm, as the length of the neck in the infrarenal segment of the aorta was 2.5–3 cm, and the angle of inclination to the right exceeded 85°. Additionally, considering gender-specific factors, particularly female gender, indications for EVAR need to be carefully determined, as women have a higher likelihood of complications following the operation, as shown in several studies. After a detailed analysis of the re-evaluation results and assessment of surgical risk factors, we determined an individual surgical strategy and minimized risks, ultimately achieving a good outcome.

Newborn screening for severe combined immunodeficiency: changing the landscape of post-transplantation survival

Severe combined immunodeficiency (SCID) represents a group of rare monogenic immune disorders resulting from defects of the adaptive immune system. Affected patients have a high risk of fatal outcome in infancy mainly due to early overwhelming infections. 1 Tangye SG Al-Herz W Bousfiha A et al. Human inborn errors of immunity: 2022 update on the classification from the International Union of Immunological Societies Expert Committee. J Clin Immunol. 2022; 42: 1473-1507 Crossref PubMed Scopus (134) Google Scholar Hence, timely diagnosis and therapeutic interventions shortly after birth are vital. The gold standard of treatment for SCID is allogeneic haematopoietic stem cell transplantation (HSCT), which can provide a functional immune system and is lifesaving. Measuring the effect of newborn screening on survival after haematopoietic cell transplantation for severe combined immunodeficiency: a 36-year longitudinal study from the Primary Immune Deficiency Treatment ConsortiumPopulation-based newborn screening has facilitated the identification of infants with SCID early in life, in turn leading to prompt HCT while avoiding infections. Public health programmes worldwide can benefit from this definitive demonstration of the value of newborn screening for SCID. Full-Text PDF

Increased Circulating CD62E+ Endothelial Extracellular Vesicles Predict Severity and in- Hospital Mortality of COVID-19 Patients.

COVID-19 and infectious diseases have been included in strategic development goals (SDG) of United Nations (UN). Severe form of COVID-19 has been described as an endothelial disease. In order to better evaluate Covid-19 endotheliopathy, we characterized several subsets of circulating endothelial extracellular vesicles (EVs) at hospital admission among a cohort of 60 patients whose severity of COVID-19 was classified at the time of inclusion. Degree of COVID-19 severity was determined upon inclusion and categorized as moderate to severe in 40 patients and critical in 20 patients. We measured citrated plasma EVs expressing endothelial membrane markers. Endothelial EVs were defined as harboring VE-cadherin (CD144+), PECAM-1 (CD31 + CD41-) or E-selectin (CD62E+). An increase in CD62E + EV levels on admission to the hospital was significantly associated with critical disease. Moreover, Kaplan-Meier survival curves for CD62E + EV level showed that level ≥ 88,053 EVs/μL at admission was a significant predictor of in hospital mortality (p = 0.004). Moreover, CD62E + EV level ≥ 88,053 EV/μL was significantly associated with higher in-hospital mortality (OR 6.98, 95% CI 2.1–26.4, p = 0.002) in a univariate logistic regression model, while after adjustment to BMI CD62E + EV level ≥ 88,053 EV/μL was always significantly associated with higher in-hospital mortality (OR 5.1, 95% CI 1.4–20.0, p = 0.01). The present findings highlight the potential interest of detecting EVs expressing E-selectin (CD62) to discriminate Covid-19 patients at the time of hospital admission and identify individuals with higher risk of fatal outcome.Graphical abstract

Analysis of risk factors affecting the HIV epidemic process in the penitentiary system

Introduction. For more than 10 years, the Tumen Region has been reporting steadily high rates of HIV infection prevalence. Among the groups at risk for HIV infection, a special place is occupied by the group of incarcerated individuals. This group is mostly represented by drug users, men who have sex with men, commercial sex workers. Diseases acquired during imprisonment or exacerbated in a prison setting become a problem not only for released inmates, but also for communities outside the prison system. Epidemiologically, it is critically important to identify the prison-related factors contributing to HIV progression, considering their unequal significance among incarcerated individuals and civilian population.The aim of the study is to identify and assess the risk factors affecting the HIV epidemic process in the high riskgroup density areas.Materials and methods. The study was performed using epidemiological study and stepwise logistic regression methods.Results. Since 2008, the epidemiological situation in prison settings has become increasingly severe, being characterized by higher rates of detection of HIV cases and HIV prevalence among inmates. The situation has also been aggravated by high death rates among HIV-infected inmates. Our study found that the high risk of fatal outcomes in HIV-infected inmates was associated with multiple parameters: the male gender, parenteral (injection drug use) HIV transmission, existing comorbidities – viral hepatitis and thoracic diseases.

Bronchial Aspirate-Based Profiling Identifies MicroRNA Signatures Associated With COVID-19 and Fatal Disease in Critically Ill Patients.

BackgroundThe pathophysiology of COVID-19-related critical illness is not completely understood. Here, we analyzed the microRNA (miRNA) profile of bronchial aspirate (BAS) samples from COVID-19 and non-COVID-19 patients admitted to the ICU to identify prognostic biomarkers of fatal outcomes and to define molecular pathways involved in the disease and adverse events.MethodsTwo patient populations were included (n = 89): (i) a study population composed of critically ill COVID-19 and non-COVID-19 patients; (ii) a prospective study cohort composed of COVID-19 survivors and non-survivors among patients assisted by invasive mechanical ventilation (IMV). BAS samples were obtained by bronchoaspiration during the ICU stay. The miRNA profile was analyzed using RT-qPCR. Detailed biomarker and bioinformatics analyses were performed.ResultsThe deregulation in five miRNA ratios (miR-122-5p/miR-199a-5p, miR-125a-5p/miR-133a-3p, miR-155-5p/miR-486-5p, miR-214-3p/miR-222-3p, and miR-221-3p/miR-27a-3p) was observed when COVID-19 and non-COVID-19 patients were compared. In addition, five miRNA ratios segregated between ICU survivors and nonsurvivors (miR-1-3p/miR-124-3p, miR-125b-5p/miR-34a-5p, miR-126-3p/miR-16-5p, miR-199a-5p/miR-9-5p, and miR-221-3p/miR-491-5p). Through multivariable analysis, we constructed a miRNA ratio-based prediction model for ICU mortality that optimized the best combination of miRNA ratios (miR-125b-5p/miR-34a-5p, miR-199a-5p/miR-9-5p, and miR-221-3p/miR-491-5p). The model (AUC 0.85) and the miR-199a-5p/miR-9-5p ratio (AUC 0.80) showed an optimal discrimination value and outperformed the best clinical predictor for ICU mortality (days from first symptoms to IMV initiation, AUC 0.73). The survival analysis confirmed the usefulness of the miRNA ratio model and the individual ratio to identify patients at high risk of fatal outcomes following IMV initiation. Functional enrichment analyses identified pathological mechanisms implicated in fibrosis, coagulation, viral infections, immune responses and inflammation.ConclusionsCOVID-19 induces a specific miRNA signature in BAS from critically ill patients. In addition, specific miRNA ratios in BAS samples hold individual and collective potential to improve risk-based patient stratification following IMV initiation in COVID-19-related critical illness. The biological role of the host miRNA profiles may allow a better understanding of the different pathological axes of the disease.

Analysis of influence of background therapy for comorbidities in the period before infection on the risk of the lethal COVID outcome. Data from the international ACTIV SARS-CoV-2 registry («Analysis of chronic non-infectious diseases dynamics after COVID-19 infection in adult patients SARS-CoV-2»).

Aim To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients' privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 visits, 3 in-person visits during the acute period and 3 virtual visits (telephone calls) at 3, 6, and 12 mos. Patient enrollment started on June 29, 2020 and was completed on October 29, 2020. The registry completion is scheduled for October 29, 2022. The registry ID: ClinicalTrials.gov: NCT04492384. In this fragment of the study of registry data, the work group analyzed the effect of therapy for comorbidities at baseline on severity and outcomes of the novel coronavirus infection. The study population included only the patients who took their medicines on a regular basis while the comparison population consisted of noncompliant patients (irregular drug intake or not taking drugs at all despite indications for the treatment).Results The analysis of the ACTIVE registry database included 5808 patients. The vast majority of patients with COVID-19 had comorbidities with prevalence of cardiovascular diseases. Medicines used for the treatment of COVID-19 comorbidities influenced the course of the infectious disease in different ways. A lower risk of fatal outcome was associated with the statin treatment in patients with ischemic heart disease (IHD); with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists and with beta-blockers in patients with IHD, arterial hypertension, chronic heart failure (CHF), and atrial fibrillation; with oral anticoagulants (OAC), primarily direct OAC, clopidogrel/prasugrel/ticagrelor in patients with IHD; with oral antihyperglycemic therapy in patients with type 2 diabetes mellitus (DM); and with long-acting insulins in patients with type 1 DM. A higher risk of fatal outcome was associated with the spironolactone treatment in patients with CHF and with inhaled corticosteroids (iCS) in patients with chronic obstructive pulmonary disease (COPD).Conclusion In the epoch of COVID-19 pandemic, a lower risk of severe course of the coronavirus infection was observed for patients with chronic noninfectious comorbidities highly compliant with the base treatment of the comorbidity.

The risk score for in-hospital mortality in patients with ST-segment elevation myocardial infarction

Aim To develop a scale (score system) for predicting the individual risk of in-hospital death in patients with ST segment elevation acute myocardial infarction (STEMI) with an account of results of percutaneous coronary intervention (PCI).Material and methods The analysis used data of 1 649 sequential patients with STEMI included into the hospital registry of PCI from 2006 through 2017. To test the model predictability, the original sample was divided into two groups: a training group consisting of 1150 (70 %) patients and a test group consisting of 499 (30 %) patients. The training sample was used for computing an individual score. To this purpose, β-coefficients of each variable obtained at the last stage of the multivariate logistic regression model were subjected to linear transformation. The scale was verified using the test sample.Results Seven independent predictors of in-hospital death were determined: age ≥65 years, acute heart failure (Killip class III-IV), total myocardial ischemia time ≥180 min, anterior localization of myocardial infarction, failure of PCI, SYNTAX scale score ≥16, glycemia on admission ≥7.78 mmol/l for patients without a history of diabetes mellitus and ≥14.35 mmol/l for patients with a history of diabetes mellitus. The contribution of each value to the risk of in-hospital death was ranked from 0 to 7. A threshold total score of 10 was determined; a score ≥10 corresponded to a high probability of in-hospital death (18.2 %). In the training sample, the sensitivity was 81 %, the specificity was 80.6 %, and the area under the curve (AUC) was 0.902. In the test sample, the sensitivity was 96.2 %, the specificity was 83.3 %, and the AUC was 0.924.Conclusion The developed scale has a good predictive accuracy in identifying patients with acute STEMI who have a high risk of fatal outcome at the hospital stage.

MO819RISK FACTORS FOR COVID-19 MORTALITY IN HEMODIALYSIS PATIENTS

Background and AimsThe global pandemic with SARS-CoV-2 virus and Covid-19 threatened hemodialysis patients as vulnerable category with high risk for fatal outcome. The aim of the study was to determine the prevalence and risk factors for mortality in hemodialysis (HD) patients with confirmed Covid-19.MethodThis study was retrospective, multicentric, and included all HD patients with positive PCR test for SARS-CoV-2 during the period of 10 months from March 1 – December 31/2020. The outcome of patients with positive PCR test for SARS CoV-2 was evaluated. The following clinical parameters were compared in two groups of patients (the deceased and alive): age, sex, hemodialysis vintage, type of vascular access, BMI, Hemoglobin, WBC, Platelets, CRP, LDH, D-dimer, s-albumin, radiological findings, smoking abuse, therapy with ACE and ARBs, presence of symptoms and comorbidities: hypertension (HTA), diabetes mellitus (DM), coronary artery disease (CAD), chronic pulmonary disease (CPD), dyslipidemia, atrial fibrillation (AFF), malignancy, treatment in hospital and intensive care unit (ICU) with oxygen support and mechanical ventilation, and anticoagulant therapy. Statistical analysis was performed by SPSS, continued variables with ANOVA and categorical variables with Pearson Chi- square test and logistic regression.ResultsOf total 631 hemodialysis patients during the period of 10 months 162 patients (113 M and 49 F) or 25,67% were with positive PCR test for SARS-CoV-2, they have had mean age 62,47±13,14 years and HD vintage 71,93±68,01 months. During the observed period 38 patients with Covid-19 (25 M and 13 F) deceased, that represents mortality of 23,45%, 8 patients deceased at home and 30 patients in hospital. The mortality in patients with age range 18-49 years was 8%, with 50-59 years 18,9%, with 60-69 years 22,2%, with 70-79 years 31,2% and in patients with ≥ 80 years was 50%. Clinical parameters showed that the deceased patients compared with alive patients have had statistically significant higher age (67,7±10,57 vs 60,85±13,46 years; p=0.004), biochemical findings WBC (9,13±4,07 vs 6,45±3,0; p<0.001), LDH (394±4,07 vs 294±143; p=0.032), D-dimer (3699±4,07 vs 2025±2628; p=0.041), lower s-albumin (25,03±4,0 vs 34,57±6,89; p<0.001), and less hospital days (9,87±12,15 vs 16,24±14,31; p=0.04). Regarding comorbidities the mortality in the deceased patients was significantly higher in patients with chronic pulmonary disease (CPD) in comparison to patients without CPD (56,3% vs 19,9%; p=0.001), and in patients with malignancy in comparison to patients without malignancy (57,1% vs 21,9%; p=0.032). The mortality in hospitalized patients was significantly higher in comparison to treated patients at home (25,8% vs 10,5%; p<0.001) and was significantly higher in patients treated in ICU in comparison to patients treated at hospital (40,7% vs 25%; p<0.001). By logistic regression model it was determined that presence of chronic pulmonary disease (HR=6,178; p=0.008), ICU treatment (HR=5,311; p=0.01) and malignancy (HR=16,766; p=0.01) were the most predictive risk factors for mortality.ConclusionOur study showed that mortality is high in HD patients with Covid-19 and amounts 23,45%, which is in accordance with other larger studies of ERACODA and ERA-EDTA registry regarding mortality of hemodialysis patients with Covid-19 (25% vs 20%). The mortality in HD patients with Covid-19 was associated with advanced age, high level of WBC, LDH and D-dimer, and low level of s-albumin. In contrast to general population, no association with gender, diabetes and cardiovascular disease, but significant association of mortality with presence of chronic pulmonary disease, malignancy, hospital and ICU treatment was found.

MO383COVID - 19 AND AKUTE KIDNEY INJURY- A SINGLE CENTER EXPERIENCE

Background and AimsThe new coronavirus disease (COVID 19) has become a worldwide health emergency with a wide spectrum of clinical presentation, from common cold symptoms to multiorgan failure. A great number of medical centers have reported that patients with COVID-19 have developed acute kidney injury. The kidney is a target organ for SARS - COV2 because of ACE2 receptor, the binding site for this virus, is expressed in kidney tissue. The potential mechanisms for kidney injury are direct kidney injury, inflammation, activation of coagulation and complement cascades. Data from centers worldwide reported a wide range of AKI incidence, from 0,5% in China to 46% in USA. The aim of this study was to analyze incidence, risk factors and outcomes of AKI in hospitalized patients with COVID 19 who were treated from 01.04. to 01.06.2020. at Nephrology Department of University Clinical Center Zvezdara, which was at the time transformed into COVID hospital.MethodThis retrospective observational study included 51 patients who had normal kidney function before the infection with SARS COV2, and 7 of them developed dialysis non-dependent AKI. Analysis included data collection from the patients’ history including demographic, clinical and administrative data. Statistical analysis has been performed using SPSS software version 20 (IBM Corporation, New York, USA).ResultsOut of 51 patients 7 (13.7%) developed AKI, mean age was 59 + 16 years and 53% were male. Diabetes mellitus was present in 27 of patients with AKI, hypertension in 6/7, obesity in 3/7, coronary artery disease in 1/7 and 1 of 7 patients was smoker. These risk factors except obesity (p= 0.05) didn’t vary significantly between two groups (AKI and non AKI patients with COVID-19). Our results showed significant correlation between AKI development and obesity (p= 0.05, OR 4.75), Charlston index score (p=0.01), D dimer score (p=0.01), and CT COVID score (p=0.03). Regarding the outcome, COVID 19 patients with AKI showed 7-fold higher risk for fatal outcome (p= 0.046).ConclusionObesity, higher D dimer values, worse CT findings and higher Charlston comorbidity score index were associated with acute kidney injury in patients with COVID 19. AKI proved to be significant risk factor for fatal outcome in patients with SARS COV2 infection.

Diabetes prevalence and mortality in COVID-19 patients: a systematic review, meta-analysis, and meta-regression.

BackgroundThe coronavirus disease 2019 (COVID-19) patients with diabetes mellitus (DM) are at high risk of fatal outcomes. This meta-analysis quantifies the prevalence of mortality among (1) diabetic and (2) non-diabetic, and (3) the prevalence of DM, in hospitalized COVID-19 patients.MethodsPublished studies were retrieved from four electronic databases (PubMed, Embase, Scopus, and medRxiv) and appraised critically utilizing the National Heart, Lung, and Blood Institute’s tool. Meta-analyses were performed using the random-effects model. The measures of heterogeneity were ascertained by I- squared (I2) and Chi-squared (Chi2) tests statistics. Predictors of heterogeneity were quantified using meta-regression models.ResultsOf the reviewed 475 publications, 22 studies (chiefly case series (59.09 %)), sourcing data of 45,775 hospitalized COVID-19 patients, were deemed eligible. The weighted prevalence of mortality in hospitlized COVID-19 patients with DM (20.0 %, 95 % CI: 15.0–26.0; I2, 96.8 %) was 82 % (1.82-time) higher than that in non-DM patients (11.0 %, 95 % CI: 5.0–16.0; I2, 99.3 %). The prevalence of mortality among DM patients was highest in Europe (28.0 %; 95 % CI: 14.0–44.0) followed by the United States (20.0 %, 95 % CI: 11.0–32.0) and Asia (17.0 %, 95 % CI: 8.0–28.0). Sample size and severity of the COVID-19 were associated (p < 0.05) with variability in the prevalence of mortality. The weighted prevalence of DM among hospitalized COVID-19 patients was 20 % (95 % confidence interval [CI]: 15–25, I2, 99.3 %). Overall, the quality of the studies was fair.ConclusionsHospitalized COVID-19 patients were appreciably burdened with a high prevalence of DM. DM contributed to the increased risk of mortality among hospitalized COVID-19 patients compared to non-DM patients, particularly among critically ill patients. Registration: PROSPERO (registration no. CRD42020196589).Supplementary InformationThe online version contains supplementary material available at 10.1007/s40200-021-00779-2.

The pressing need for better statistics on youth mortality

In their Article in The Lancet Global Health, Bruno Masquelier and colleagues1 show that over the past 30 years, we have been unable to substantially reduce mortality in youth aged 15–24 years. Even in peacetime, youth are disproportionately affected by deaths from violence, accidents, harmful lifestyle, and external causes, such as sexually transmitted diseases and other infectious diseases, compared with older age groups, especially in low-income countries. Young males are at a disproportionately high risk of fatal outcomes of interpersonal violence2 or traffic accidents.

First-Level Systematic Echocardiographic Evaluation in a COVID-19 Lombardy Hospital

Coronavirus Disease 2019 (COVID-19) is a global pandemic. Although cardiovascular (CV) morbidity has been associated to the clinical course of the disease, systematic data regarding CV implications during COVID19 are still lacking. The aim of this study is to report the echocardiographic features of COVID19 patients undergoing first-level echocardiographic screening in a COVID Hospital in Lombardy. In this retrospective study, 70 consecutive patients admitted to our Hospital with confirmed COVID-19 diagnosis, underwent a first-level echocardiographic screening. Of the 70 patients, 8 (11.4%) patients died; survivors had lower sPAP levels as compared to deceased subjects (25.4±9.4 vs 34.8±5.9 mmHg, p=0.008) and splitting the patients in four quartiles based on sPAP, mortality rate was significantly higher among patients with more elevated sPAP compared to the other groups (Q4 29.4% vs Q3 12.5% vs Q2 6.25% vs Q1 0%, p=0.026). A first-level echocardiographic screening might be helpful in the management of Covid-19 patients by identifying those at higher risk of fatal outcome.

Early risk markers for severe clinical course and fatal outcome in German patients with COVID-19.

BackgroundSome patients with Corona Virus Disease 2019 (COVID-19) develop a severe clinical course with acute respiratory distress syndrome (ARDS) and fatal outcome. Clinical manifestations and biomarkers in early stages of disease with relevant predictive impact for outcomes remain largely unexplored. We aimed to identify parameters which are significantly different between subgroups.Design125 patients with COVID-19 were analysed. Patients with ARDS (N = 59) or non-ARDS (N = 66) were compared, as well as fatal outcome versus survival in the two groups.Key resultsARDS and non-ARDS patients did not differ with respect to comorbidities or medication on developing a fatal outcome versus survival. Body mass index was higher in patients with ARDS versus non-ARDS (p = 0.01), but not different within the groups in survivors versus non-survivors. Interleukin-6 levels on admission were higher in patients with ARDS compared to non-ARDS as well as in patients with fatal outcome versus survivors, whereas lymphocyte levels were lower in the different subgroups (all p<0.05). There was a highly significant 3.5-fold difference in fever load in non-survivors compared to survivors (p<0.0001). Extrapulmonary viral spread was detected more often in patients with fatal outcome compared to survivors (P = 0.01). Further the detection of SARS-CoV-2 in serum showed a significantly more severe course and an increased risk of death (both p<0.05).ConclusionsWe have identified early risk markers for a severe clinical course, like ARDS or fatal outcome. This data might help develop a strategy to address new therapeutic options early in patients with COVID-19 and at high risk for fatal outcome.

An Artificial Neural Networks Model for Early Predicting In-Hospital Mortality in Acute Pancreatitis in MIMIC-III.

Background Early and accurate evaluation of severity and prognosis in acute pancreatitis (AP), especially at the time of admission is very significant. This study was aimed to develop an artificial neural networks (ANN) model for early prediction of in-hospital mortality in AP. Methods Patients with AP were identified from the Medical Information Mart for Intensive Care-III (MIMIC-III) database. Clinical and laboratory data were utilized to perform a predictive model by back propagation ANN approach. Results A total of 337 patients with AP were analyzed in the study, and the in-hospital mortality rate was 11.2%. A total of 12 variables that differed between patients in survivor group and nonsurvivor group were applied to construct ANN model. Three independent variables were identified as risk factors associated with in-hospital mortality by multivariate logistic regression analysis. The predictive performance based on the area under the receiver operating characteristic curve (AUC) was 0.769 for ANN model, 0.607 for logistic regression, 0.652 for Ranson score, and 0.401 for SOFA score. Conclusion An ANN predictive model for in-hospital mortality in patients with AP in MIMIC-III database was first performed. The patients with high risk of fatal outcome can be screened out easily in the early stage of AP by our model.

Risk factors of mortality and contribution of treatment in patients infected with COVID-19: a retrospective propensity score matched study

Background Coronavirus disease 2019 (COVID-19) has now brought major challenges to public health and the economy globally since December 2019, which requires effective treatment and prevention strategies to adapt to the impact of the pandemic. We, therefore, explored the prognostic factors for patients with COVID-19 and the contribution of immunomodulatory therapy on COVID-19 outcome. Methods From 1 February to 16 March 2020, consecutive cases with COVID-19 were analyzed in the West Campus of Wuhan Union Hospital, a tertiary care center that is designated to care for patients with COVID-19 in Wuhan, China. The observation was based on follow-up until in-hospital death or discharge. Logistic regressions were performed for prognostic factors associated with in-hospital death. Furthermore, a propensity score-matched analysis was done using a multivariable logistic regression model to analyze the contributions of multiple treatments on COVID-19 death. Results Three hundred and seventeen patients with COVID-19 were enrolled, of whom 269 were discharged and 48 died in hospital. After propensity score matching based on age, gender, symptoms and comorbidities, multivariable logistic regression was performed with the adjustment of other variables that were significant risk factors in the univariate regression. Treatments with glucocorticoids, immunoglobulin, thymosin, and ammonium glycyrrhizinate were significantly associated with a higher rate of COVID-19 death. Conclusions For in-hospital patients with COVID-19 of all severity levels, a high risk for fatal outcome was observed in those treated with glucocorticoids, immunoglobulin, thymosin, and ammonium glycyrrhizinate. The results of this study do not support immunomodulatory therapy in patients admitted to the hospital with COVID-19. Further prospective studies are essential to clarify our findings, especially for non-critically ill patients.

Correlation between thrombocytopenia and host response in severe fever with thrombocytopenia syndrome.

Severe Fever with Thrombocytopenia Syndrome (SFTS) is an emerging infectious disease caused by a novel bunyavirus, SFTS virus (SFTSV), with fatal outcome developed in approximately 17% of the cases. Thrombocytopenia is a hallmark feature of SFTS, and associated with a higher risk of fatal outcome, however, the pathophysiological involvement of platelet in the clinical outcome of SFTS remained under-investigated. In the current study, by retrospectively analyzing 1538 confirmed SFTS patients, we observed that thrombocytopenia was associated with enhanced activation of the cytokine network and the vascular endothelium, also with a disturbed coagulation response. The platelet phenotypes were also extensively altered in the process of thrombocytopenia development of SFTS patients. More importantly, all these disturbed host responses were related to the severity of thrombocytopenia, thus were considered to play in a synergistic way to influence the disease outcome. Moreover, the clinical effect of platelet transfusion was assessed by comparing two groups of patients with or without receiving this therapy. As a result, we observed no therapy effect in altering frequencies of fatal outcome, clinical bleeding development, or dynamic change of platelet count during the hospitalization. It’s suggested that platelet supplementation alone acted a minor role in improving disease outcome, therefore new therapeutic intervention to regulate host response should be proposed. The current results revealed some evidence of interrelationship between platelet count and clinical outcome of SFTS disease from the perspective of activation of the cytokine network, the vascular endothelium, and the coagulation/fibrinolysis system. These evaluations might help to attain a better understanding of the pathogenesis and therapy choice in SFTS.

Anticoagulation in atrial fibrillation

### Learning objectives One in three of us will be diagnosed with atrial fibrillation (AF) at some point in our lives.1 Over 1.2 million individuals in the UK have been...