Higher All-cause Mortality Research Articles

Effects of routine invasive management on reinfarction risk in older adults with frailty and non-ST-segment elevation myocardial infarction: a subanalysis of a randomised clinical trial

BackgroundClinical trials and meta-analyses indicate a reduced reinfarction risk with invasive management in older patients with non-ST-segment elevation myocardial infarction (NSTEMI). This study investigated whether similar benefits might be observed...

Infectious complications associated with immune and targeted anti-cancer therapies: a retrospective study of the FDA adverse events reporting system (FAERS)

ABSTRACT Background Immune and targeted anti-cancer therapies are associated with an increased risk of infectious complications. The objectives of the present study were to evaluate the infectious complications associated with immune and targeted anti-cancer drugs. Research design and methods This was a retrospective study for immune and targeted anti-cancer drugs submitted to the FDA Adverse Event Reporting System (FAERS) from 1996 to 20 March 2024. The primary outcome was the rate of infectious disease events, and the secondary outcomes were the incidence of febrile neutropenia (FN), all-cause mortality, and the top 10 infections in each class. Results Our study included 14 drug classes comprising 44 drugs. The incidence of infectious complications was 14.31% (110,671/773,130). The highest incidence rate was reported with IL-6 inhibitors (30.89%), the highest incidence of FN was reported with Histone deacetylase inhibitors (8.43%), and the highest all-cause mortality was reported with BCR-ABL tyrosine kinase inhibitors (17.17%). Conclusion Immune and targeted anti-cancer therapies vary in the incidence of infectious complications. Pirtobrutinib, copanlisib, sirolimus, vorinostat, and tocilizumab were associated with high infectious complications (>30%) that warrant emphasis in the clinical guidelines. Thus, clinicians should vigilantly monitor patients undergoing immune and targeted therapies for infectious complications and use antimicrobial prophylaxes when indicated.

Short- and long-term outcomes of percutaneous left atrial appendage occlusion in cancer patients.

Percutaneous left atrial appendage occlusion (LAAO) is a viable option to mitigate bleeding and stroke risks in patients with atrial fibrillation (AF) who are not eligible for oral anticoagulation. Its safety and efficacy in cancer patients remain unclear due to their exclusion from trials. This study aimed to compare short- and long-term LAAO outcomes between cancer and non-cancer patients. Retrospective single centre study of 361 consecutive patients who underwent LAAO between april-2010 and december-2023 were included. Short-term outcomes included periprocedural complications, 30-day hospital readmission and mortality. Long-term outcomes included the composite of stroke, bleeding, and mortality and each component assessed separately. The study included 93 cancer patients (54% active, 46% in remission) and 268 non-cancer patients. Baseline characteristics were similar, including ischemic and bleeding risk profiles (CHA2DS2-VASc: 4.5±1.4 vs. 4.4±1.5; HAS-BLED: 3.3±0.9 vs. 3.2±0.9), previous stroke and total bleeding events. Short-term outcomes showed no significant differences in periprocedural complications (7% vs. 6%), 30-day readmission (2% vs. 3%), or 30-day mortality (0% vs. 1.5%). Over 32months, there was no significant difference regarding the composite endpoint (p=0.067), stroke (SHR 0.54; p=0.25) or bleeding events (SHR 1.36; p=0.35). LAAO was effective in terms of stroke reduction in cancer and non-cancer patients (p=0.027 and p=0.006, respectively). All-cause mortality rates were higher in cancer patients (p=0.002), mainly due to cancer progression and infections. LAAO procedure was safe and effective in both populations. Cancer patients experienced higher rates of all-cause mortality, with no differences in stroke and bleeding outcomes between groups.

The sex differences in diseases progression and prognosis among persons with HIV and HBV coinfection

To investigate sex differences in liver disease development and prognosis in individuals with HIV and HBV co-infection. This study comprised 752 HIV/HBV co-infected people who were diagnosed with HIV and started on combination antiretroviral therapy (cART) between January 31st, 2015 and January 31st, 2023. Their clinical data, including CD4+ T lymphocyte counts, HBV-DNA, and FIB-4 scores, were tracked once a year. The prognosis was determined during the long-term surveillance period. Risk factors related with the progression of liver diseases were included in both univariable and multivariable logistic regression. Then, sex differences in CD4+ T lymphocyte counts, HBV-DNA, FIB-4 scores, changes in liver fibrosis levels, and prognosis were investigated. Multivariable logistic regression analysis identified male as an independent risk factor for liver disease progression. Compared to the male group, the female group had a significantly greater decline of HBV DNA levels at years 1, 2, 3, 3–5, and > 5 post-cART. At each assessment point, the female group showed a significantly greater rise in CD4+ T lymphocyte counts than the male group based on their respective baseline values. Furthermore, females had greater CD4+ T lymphocyte counts and a lower prevalence of liver cirrhosis than males throughout the study period. Compared to female, higher incidence of end-stage-liver disease (1.190/100 person-years vs 0.714/100 person-years), higher all-cause mortality (0.440/100 person-years vs 0.148/100 person-years) and higher mortality associated with end-stage-liver diseases (0.273/100 person-years vs 0.074/100 person-years) were found in male. Among individuals with HIV and HBV coinfection, males had a worse therapeutic effect of HBV-active therapy and poorer prognosis than females.

Adipose tissue content of n-6 polyunsaturated fatty acids and all-cause mortality: a Danish prospective cohort study.

N-6 polyunsaturated fatty acids (PUFAs) may exert divergent biological effects, but limited knowledge exists about their associations with mortality. We have investigated the associations between adipose tissue content of individual n-6 PUFAs - a long-term marker of the endogenous exposure to these fatty acids - and all-cause mortality. We used a prospective cohort study design. We followed a random sample of 4,663 participants from the Danish Diet, Cancer and Health cohort, which was established between 1993 and 1997. Information on all-cause mortality was retrieved from the nationwide Danish Civil Registration System. An adipose tissue biopsy was collected from the buttock at recruitment and analysed for fatty acid composition using gas chromatography. Hazard ratios (HR) were obtained using Cox proportional hazard regression. During a median of 21 years of follow-up, 1,160 participants died. The median adipose tissue contents of linoleic acid and arachidonic acid were 10.60% and 0.36%, respectively. In multivariable continuous analyses, we observed a statistically significant inverse association between adipose tissue content of linoleic acid and all-cause mortality (p < 0.001). In contrast, a statistically non-significant positive association was found in continuous analyses of adipose tissue content of arachidonic acid and all-cause mortality (p = 0.078). Comparing the highest with the lowest quartile, the HR for mortality was 0.76 (95% CI: 0.64, 0.90) for linoleic acid and 1.28 (95% CI: 1.07, 1.53) for arachidonic acid in adipose tissue, respectively. Adipose tissue content of linoleic acid was inversely associated with all-cause mortality, whereas adipose tissue content of arachidonic acid was associated with a higher all-cause mortality.

Prevalence, characteristics and outcomes of patients with metabolic and alcohol related/associated liver disease (MetALD): a systematic review and meta-analysis.

In light of the new nomenclature of steatotic liver disease (SLD), we aimed to enhance the existing knowledge on the epidemiology and clinical outcomes of metabolic and alcohol related/associated liver disease (MetALD). A systematic review and meta-analysis were performed in Medline/PubMed, Embase, Scopus and Cochrane databases to evaluate the prevalence and outcomes of MetALD within the SLD population and to compare the characteristics between MetALD patients and those with metabolic dysfunction associated steatotic liver disease (MASLD) and alcohol-related liver disease (ALD). Nineteen studies from nine countries that evaluated 4,543,341 adult participants with SLD were included. The pooled overall prevalence of MetALD among the SLD population was 10% (95%CI:7-13%) without significant difference between Asian and non-Asian populations. However, MetALD was more frequent in men than women (86% vs 14%, p<0.01), while Asian MetALD patients, were more frequent men (92% vs 66%, p<0.01) compared to non-Asians. Additionally, in terms of metabolic characteristics there were no significant differences between MetALD, MASLD and ALD patients. Regarding outcomes, patients with MetALD, compared to non-SLD, were at increased risk of all-cause [HR 1.44 (95%CI:1.24-1.66)], cardiovascular disease (CVD) [HR 1.17 (95%CI:1.12-1.21)] and cancer-related mortality [HR 2.07 (95%CI:1.32-3.25)]. Finally, patients with MetALD, had increased incidence of CVD and liver decompensating events, compared to non-SLD participants [HR 1.49 (95%CI:1.03-2.15); HR 10.55 (95%CI:3.46-32.16) respectively]. Based on the existing literature, patients with MetALD consist a significant part of the SLD population, with high all-cause, CVD and cancer-related mortality and increased risk for CVD and hepatic decompensation.

205. Utilization of the Four Themes of the CDC/ATSDR SVI Interactive Map in Assessing Initial Clostridioides difficile Infection Outcomes

Abstract Background Social determinants of health (SDoH) (e.g., education, clean water, health care access) are external factors shown to impact health outcomes. Inequities in SDoH have been hypothesized to contribute to poorer Clostridioides difficile infection (CDI) outcomes. The Centers for Disease Control’s (CDC) Social Vulnerability Index (SVI) is a composite measure of neighborhood (census tract) based on four major themes: socioeconomic status (SES), housing characteristics (H&amp;C), race/ethnicity (REM) status, and housing and transportation (H&amp;T). There is a cessation of literature that describes the impact of each SVI theme on CDI outcomes. The objective of this study was to utilize the four themes of the CDC SVI to determine the impact of SDoH on initial CDI severity and all-cause mortality outcomes. Methods Adult patients admitted to Loma Linda University Medical Center (LLUMC) with an initial episode of CDI between January 2020 to June 2021 were included. Patient residential addresses were collected and input into the CDC/ATSDR SVI Interactive Map. Vulnerability groups were congregated into 2 main subgroups [patients with SVI scores of &amp;lt; 0.4999 are grouped as low vulnerability (LV) and patients with SVI scores of ≥ 0.5 are grouped as high vulnerability (HV)]. Results 206 patients were included, and those with an overall HV SVI score were more likely to have a higher all-cause mortality rate and to present with severe or fulminant initial CDI compared to those with a LV score. The frequency of initial severe CDI was 3x greater for the SVI themes of SES and H&amp;C [61/206 (29.61%) vs 19/206 (9.22%)] in patients with a HV score compared to those with LV scoring. Further, patients who presented with an HV score for the H&amp;T theme were more likely to present with initial severe (26.21% vs 12.62%) or fulminant CDI (13.11% vs 5.34%) versus those with a LV score. When considering the REM status theme, the initial fulminant CDI diagnosis was about 37x greater among individuals with a HV score (17.96% vs 0.49%) and mortality 9x greater when compared to those with LV scoring (8.74% vs 0.97%). Conclusion HV scores across SES, H&amp;C, REM status, and H&amp;T correlate with increased CDI severity and mortality rates. Further research and targeted interventions should be identified. Disclosures Anna Zhou, PharmD, Melinta Therapeutics: Honoraria Jacinda C. Abdul-Mutakabbir, PharmD, MPH, CSL Sequiris: Advisor/Consultant|CSL Sequiris: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria

Sex-related differences in cardiac damage associated with severe primary mitral regurgitation: impact on surgical outcomes

Abstract Background and Aim Previous research has shown that women with primary mitral regurgitation (MPR) have worse surgical outcomes, compared with men. Our aim was to evaluate whether cardiac damage prior to intervention for severe MPR differs according to gender. Methods Retrospective analysis of a prospective cohort of patients with PMR who underwent mitral valve surgery in a tertiary care center from 2014 to 2022. Echocardiographic parameters measured prior to surgery as well as outcomes at 1-year follow-up (all-cause mortality and heart failure admissions) were analyzed, and potential differences by sex were evaluated. Results 349 patients were included. The mean age was 69 (12) years and 154 (44%) were female. Women were older and had a history of atrial fibrillation more frequently than men. Regardind morphological echocardiographic parameters, left ventricular (LV) dimensions were slightly larger in male patients, as expected, and there were no significant differences in left atrial (LA) volume index (Table). Significant differences were found in functional echocardiographic parameters: women had more impaired LV and LA strain, higher values of LA stiffness, and worse right ventricular-arterial coupling. In addition, concomitant significant tricuspid regurgitation was significantly more frequent in female patients. At one-year follow-up, the incidence of heart failure hospitalization was significantly higher in women (1% vs 7%; p=0.005) and there was a non-significant trend towards higher all-cause mortality (6.2 vs 11%; p=0.101). Conclusions In our cohort of patients with severe PMR who underwent surgery, women had worse biventricular function and more impaired LA function. At one-year follow-up, heart failure hospitalizations rates were significantly higher in female patients. Earlier indication of surgical timing in women with PMR, taking into account deformation parameters, could improve surgical outcomes in this population. Clinical and echocardiographic features

P-874. Clinical Characteristics and Outcomes Associated with Enterococcal Bloodstream Infections at an Integrated Healthcare Network

Abstract Background Enterococcus spp. represent a frequent cause of blood stream infections in the United States. We wanted to gather data on clinical characteristics and outcomes associated with enterococcal bloodstream infections encountered at our quaternary care integrated health network.Table 1:Patient demographics and comorbiditiesBaseline characteristics of patients reviewed in the study, including their demographic data and underlying medical history Methods We conducted a multicenter retrospective chart review from 2022 to 2023 of patients hospitalized (community or healthcare acquired) with enterococcal bacteremia. Information on demographics, comorbidities, duration of treatment, readmission rates, and mortality were obtained.Figure 1:Prescribed treatmet duration Treatment duration in patients who completed their prescribed antimicrobial therapy course Results 146 patients (mean age 67.5 years) were identified with enterococcal bacteremia. Demographics and comorbidities are shown in Table 1. Prescribed treatment duration varied based on the underlying clinical presentation, and is outlined in Figure 1, which only includes patients who were able to complete the prescribed course. 30-day all-cause readmission was 34/146 (23.3%), with only 1 readmission due to recurrence of bacteremia. 30-day all-cause mortality was 51/146 (35%). Most of these patients (48/51; 94%) died prior to completing the antimicrobial therapy; 3/48 (6%) patients died following completion of an 11-14 day treatment course. Conclusion There was a significant burden of enterococcal bacteremia at our institution during the study period. Although 30-day readmission was seen in about 23% of patients, there was only 1 patient who was readmitted for recurrent bacteremia, notably in a patient who had not yet finished his prescribed course of antibiotics. Additionally, we encountered a high all-cause mortality rate of 35%, with the majority dying while on active antimicrobial therapy. These findings are congruent with other studies measuring the mortality rate of enterococcal bacteremia. This study highlights the importance of identifying high-risk comorbidities in patients that might portend a poor prognosis, and helps to educate both providers and patients on the overall prognosis of enterococcal bacteremia. Disclosures All Authors: No reported disclosures

Use of FGF-23 and sαKlotho for Risk Stratification in Patients with Acute Heart Failure

Background/Objectives: Soluble αKlotho (sαKlotho) and fibroblast growth factor 23 (FGF-23) are increased in acute heart failure (AHF). This study aimed to assess changes in serum sαKlotho and FGF-23 concentrations during an episode of AHF as well as the usefulness of both biomarkers for predicting long-term prognosis. Methods: The study included 104 consecutive patients hospitalized in t he intensive cardiac care unit due to AHF (mean age, 65.8 ± 14.6 years; mean ejection fraction, 31.4% ± 14). New-onset AHF was reported in 43.3% of the population. Blood samples were measured at entry and on discharge from hospital. The main clinical outcomes assessed in this study were all-cause mortality or rehospitalization due to HF during a 3-year follow-up. Results: At admission sαKlotho, FGF-23, and NT-pro BNP levels, compared with discharge, were significantly higher at p &lt; 0.001, p &lt; 0.001, and p &lt; 0.001 respectively. The 3-year Kaplan–Meier analysis, based on tertiles, revealed, for sαKlotho levels from Tertile 1 on admission and at discharge, a 2-fold higher rate of all-cause mortality or rehospitalization for HF compared with Tertile 3 (p = 0.006 and p = 0.028, respectively). One-third of patients showed an increase in FGF-23 and sαKlotho levels during hospitalization. Patients with the highest percentage increase in the levels of both biomarkers had an elevated risk of all-cause morality or hospitalization for HF (hazard ratio, 2.75; confidence interval, 1.19–6.35; p = 0.02). Conclusions: sαKlotho and FGF-23 levels are elevated during an episode of AHF. Low sαKlotho levels are associated with an increased risk of all-cause mortality or rehospitalization for HF. Increases in sαKlotho and FGF-23 values during hospitalization identify patients with poor prognosis.

Impact of family socio-economic status on the prognosis of heart transplantation in children

BackgroundLow family socio-economic status is a known factor that can contribute to increased mortality for patients with cardiovascular disease. However, in developing countries, the prognostic impact of socio-economic level on pediatric HTx is unclear.MethodsWe conducted a retrospective cohort analysis of children younger than 18 years who underwent heart transplantation (HTx) at our center from October 1, 2005, to May 31, 2023. To assess the impact of socio-economic status, we followed up with the discharged children until September 30, 2023, monitoring for all-cause mortality and unplanned readmission events. To evaluate the relationship between socio-economic status and prognosis, we assigned a composite score based on an assessment of household income, parental education level, and occupation. The Cox proportional hazards model and the Kaplan-Meier method were utilized for this analysis.Results64 children (median age at operation 14 years, IQR 13–15) were enrolled and one case died in hospital due to primary graft dysfunction, 63 (98.4%) children had a median follow-up of 60 months (IQR 5.9-113.9). During the follow-up period, 10 (15.9%) children died, and 20 (31.7%) children had 25 unplanned readmissions. Children had higher all-cause mortality and more unplanned readmissions in families with low socio-economic status (n = 33) than middle (n = 10) or high (n = 20) family socio-economic status. Hazard ratios were 5.99,(95%CI:2.28–10.64, P = 0.003) for all-cause mortality for low versus high family socio-economic status, and 2.53 (95%CI:1.04–9.43, P = 0.029) for middle versus high family socio-economic status.ConclusionsLower family socio-economic status is associated with a worse prognosis than high family socio-economic status. Measures to alleviate economic disparities are needed to improve the prognosis of pediatric HTx.

Epicardial adipose tissue, cardiac damage, and mortality in patients undergoing TAVR for aortic stenosis.

Computed tomography (CT)-derived Epicardial Adipose Tissue (EAT) is linked to cardiovascular disease outcomes. However, its role in patients undergoing Transcatheter Aortic Valve Replacement (TAVR) and the interplay with aortic stenosis (AS) cardiac damage (CD) remains unexplored. We aim to investigate the relationship between EAT characteristics, AS CD, and all-cause mortality. We retrospectively included consecutive patients who underwent CT-TAVR followed by TAVR. EAT volume and density were estimated using a deep-learning platform and CD was assessed using echocardiography. Patients were classified according to low/high EAT volume and density. All-cause mortality at 4 years was compared using Kaplan-Meier and Cox regression analyses. A total of 666 patients (median age 81 [74-86] years; 54% female) were included. After a median follow-up of 1.28 (IQR 0.53-2.57) years, 11.7% (n = 77) of patients died. The EAT volume (p = 0.017) decreased, and density increased (p < 0.001) with worsening AS CD. Patients with low EAT volume (< 49cm3) and high density (≥-86 HU) had higher all-cause mortality (log-rank p = 0.02 and p = 0.01, respectively), even when adjusted for age, sex, and clinical characteristics (HR 1.71, p = 0.02 and HR 1.73, p = 0.03, respectively). When CD was added to the model, low EAT volume (HR 1.67 p = 0.03) and CD stages 3 and 4 (HR 3.14, p = 0.03) remained associated with all-cause mortality. In patients with AS undergoing TAVR, CT-derived low EAT volume, and high density were independently associated with increased 4-year mortality and worse CD stage. Only EAT volume remained associated when adjusted for CD.

The impact of body mass index on mortality according to age in hemodialysis patients: an analysis of the Korean Renal Data System.

The impact of age on the relationship between body mass index (BMI) and all-cause mortality in hemodialysis (HD) patients is not clearly understood. We analyzed the association between BMI and all-cause mortality, stratified by age, in patients undergoing HD using data from the Korean Renal Data System (KORDS). We analyzed 66,129 HD patients from the 2023 KORDS database, with data collected between 2001 and 2022. Patients were grouped by age: <65 years ("young" group, n = 24,589), 65-74 years ("younger-old" group, n = 17,732), and ≥75 years ("older-old" group, n = 23,808). Patients were further stratified into BMI quartiles. Kaplan-Meier curves and event time ratio for the relative change in the survival time were calculated. During the follow-up period, 14,360 (21.7%) of the patients died, with a median follow-up of 3.4 years. Kaplan-Meier curves revealed poorer outcomes in lower BMI quartiles across all age groups. The lowest BMI quartile was significantly associated with a shorter survival time compared to the highest BMI quartile, with a 15% reduction in the young group (p = 0.001) and a 12% reduction in the older-old group (p = 0.002). Predicted survival time increases with rising BMI in the young group, but the rate of increase slows in the younger-old group and plateaus in the older-old group after around a BMI of 25 kg/m2. The decline in survival time with age was more pronounced in the 7-year survival than the 2-year survival. Lower BMI is associated with higher all-cause mortality in HD patients, with a more pronounced impact in younger patients.

The Longitudinal Effect of Sugar-Sweetened Beverage Consumption and Risk of All-Cause and Cause-Specific Mortality in Korean Adults: Results From the Health Examinees Study

Objective High consumption of sugar-sweetened beverages (SSBs) is associated with an increased risk of all-cause and cardiovascular disease (CVD) mortality; however, the data and results for Asian populations, particularly in Korea, are limited and unclear. Therefore, this research aimed to investigate the association between types of SSB consumption and risk of all-cause and cause-specific mortality in South Korean adults. Methods This prospective study included Korean adults aged 40 to 79 who participated in the Health Examinees Study. The baseline survey was conducted from 2004 to 2013, and death data were obtained until December 2022. A food frequency questionnaire was used to assess SSB intake, and all-cause, CVD, and cancer mortality were estimated. The SSB included total SSB, soda, and other drinks (Korean traditional SSB). Results A total of 126,856 participants were included (mean [standard deviation]: age, 53.1 [8.3] years; 82,311 [64.9%] women). During a mean follow-up of 11.0 years, 5741 all-cause, 936 CVD, and 2662 cancer deaths were recorded. Increased soda consumption was associated with higher all-cause mortality (1–3 servings/wk: hazard ratio [HR], 1.125; 95% confidence interval [CI], 1.003–2.263; ≥3 servings/wk: HR, 1.190, 95% CI, 1.011–1.401), compared with low soda intake (never–<1 serving/wk). However, there was no association between total SSB consumption and other drinks with all-cause and cause-specific mortality. In the dose–response analysis, a trend in which a higher risk of all-cause and CVD cancers was observed with increasing soda intake. Conclusion In this large prospective study, soda intake of >1 serving/wk was associated with an increased risk of all-cause mortality among Korean adults. However, there was no association between total SSB or other drinks and mortality. As the consumption of SSBs increases in the Korean population, appropriate control strategies are needed to reduce SSB consumption and the disease burden.

Intubation Practices in Community Emergency Departments

This study analyzes emergency medicine airway management trends and outcomes among community emergency departments. A multicenter, retrospective chart review was conducted on 11,475 intubations from 15 different community emergency departments between January 1, 2015, and December 31, 2022. Data collected included patient's age, sex, rapid sequence intubation medications, use of cricoid pressure, method of intubation, number of attempts, admission diagnosis, and all-cause mortality rates. Active cardiopulmonary resuscitation occurred in 11.4% of intubations. When rapid sequence intubation was employed, the most frequently used induction agents were etomidate (91.6%), propofol (4.3%), and ketamine (4.1%). From 2015 to 2022, the use of rocuronium (versus succinylcholine) increased from 33.9% to 61.9%, a difference of 28% (95% confidence interval [CI] 21.1% to 34.9%). During the same period, video laryngoscopy (versus direct laryngoscopy) increased from 27.4% to 77.7%, a difference of 50.3% (95% CI 44.2% to 56.4%). Only 46% of intubations used cricoid pressure. Physicians had a first-pass success rate of 80.5% and a failure rate of 0.2%. The most common documented admission diagnoses among intubated patients were respiratory etiologies (27.8%), neurologic causes (21.4%), and sepsis (16.0%). All-cause mortality rates were high for intubated patients at 24 hours (19.7%), 7 days (29.4%), 30 days (38.4%), and 1 year (45.4%). Physicians intubating in community emergency departments have similar rates of first-pass success and failure seen in academic Level-1 trauma centers despite treating medically sick patients with high all-cause mortality rates. Dramatic shifts in choice of paralytic and method for intubation were seen.

Constipation and risk of death and cardiovascular events in patients on hemodialysis.

Constipation is a common gastrointestinal disorder and is often accompanied by alteration in the gut microbiota. Recently, several studies have disclosed its association with an increased risk of cardiovascular disease and mortality in the general population. Despite the high prevalence of constipation, data on the clinical impact of constipation in patients with chronic kidney disease are limited. We aimed to explore the prevalence of constipation and its association with cardiovascular disease in chronic kidney disease using a nationally representative cohort of hemodialysis patients. This study used hemodialysis quality assessment and health insurance claims data from patients undergoing maintenance hemodialysis in South Korea. Chronic constipation was defined using the total number of laxatives prescribed during the 1-year baseline period. The primary outcome was a composite of acute ischemic stroke, hemorrhagic stroke, myocardial infarction, or all-cause death. Secondary outcomes were the individual components of the primary outcome. Among 35,230 patients on hemodialysis, 9,133 (25.9%) were identified as having constipation. During a median follow-up of 5.4 years, patients with constipation had a 15% higher incidence of the composite outcome, 16% higher incidence of ischemic stroke, and 14% higher all-cause mortality, after multivariate adjustment. Chronic constipation requiring laxatives was associated with a higher risk of the composite outcome of cardiovascular events or all-cause death in patients on hemodialysis. Further studies are needed to confirm whether constipation is an independent predictor or a possible causal factor of cardiovascular disease.

Unveiling the Prognostic Power of HRR in ICU-Admitted COPD Patients: A MIMIC-IV Database Study.

This study sought to examine the potential relationship between Hemoglobin/Red Cell Distribution Width Ratio (HRR) and the all-cause mortality risk in critically ill patients with chronic obstructive pulmonary disease (COPD). In a retrospective analysis of the MIMIC-IV database, patients were divided into two groups based on a specific HRR threshold. Propensity score matching (PSM) was employed to address covariate imbalances. Logistic regression models was used to examine the association between HRR and mortality. A restricted cubic spline (RCS) model was employed to visualize the association between HRR and mortality. Receiver Operating Characteristic (ROC) curves were utilized to assess the predictive capability of HRR, and Decision Curve Analysis (DCA) was conducted for clinical evaluation. Furthermore, subgroup analyses were performed to explore potential variations within specific cohorts. A comprehensive analysis identified a total of 1,061 patients. The threshold value established for HRR is 5.395 g/L/%. Following the application of PSM, the matched cohort comprised 544 patients. Both the original and matched cohorts exhibited higher rates of all-cause mortality and extended hospital stays among individuals with low HRRs. Logistic regression analyses demonstrated that HRR is an independent risk factor of mortality. The RCS analysis demonstrated a significant linear relationship between HRR and mortality. The ROC curves yielded values of 0.58 for the original cohort and 0.60 for the matched cohort. DCA analysis indicated that HRR is clinically valuable. Subgroup analyses further validated the robustness of these core findings. A lower HRR is positively associated with all-cause mortality in critically ill patients with COPD.

Effects of stress hyperglycemia ratio upon long-lasting prognosis in coronary artery disease patients with or lacking chronic renal impairment: findings from a Chinese multi-center observational study

BackgroundLately, numerous researches have portrayed stress hyperglycemia ratio (SHR) is predominantly connected with short-term adverse prognosis among individuals who have acute coronary syndrome. Nevertheless, the relation of SHR with prolonged effects and the value of SHR in predicting in coronary artery disease (CAD) patients with or lacking chronic kidney disease (CKD) remain unclear. The present study was designed to elucidate the relation of SHR with prolonged prognosis and the value of SHR in predicting the long-term all-cause and cardiovascular death of CAD patients with CKD or non-CKD.MethodsWe assessed 45,780 adults with CAD from a Chinese multi-center registry. SHR was computed via a formula [SHR = (admission glucose) (mmol/L) / (1.59 * HbA1c [%] – 2.59)]. Based on the presence or absence of CKD and SHR levels, patients were categorized into four groups. Long-term all-cause and cardiovascular mortality were the primary endpoints. The Kaplan–Meier method, restricted cubic spline (RCS), cox regression analysis, subgroups analysis, and sensitivity analysis were employed to estimate the connection between SHR and all-cause as well as cardiovascular mortality.ResultsDuring a median follow-up of 5.2 years ( IQR 3.0–8.0), among 45,780 CAD patients (mean age [SD]: 62.8 ± 10.6 years; 23.9% female), the number of all-cause deaths was 7144(15.6%), and cardiovascular-related deaths was 3255 (7.1%). In cohorts with CKD, patients with high SHR had higher all-cause mortality (30.2% vs. 27.6%; adjusted hazard ratio HR 1.13, 95% CI 1.04–1.22; P = 0.003) and cardiovascular mortality (18.2% vs. 15.6%; HR adjusted 1.17, 95% CI 1.06–1.30; P = 0.002) compared to the individuals in low SHR. However, this was not the case in CAD cohorts without CKD [all-cause mortality (12.9% vs. 11.9%; HR adjusted 1.04, 95%CI 0.98–1.10, P = 0.206); cardiovascular mortality (5.1% vs. 4.4%; HR adjusted 1.09, 95%CI 0.99–1.20, P = 0.084)]. KM analysis revealed that high SHR is linked with all-cause mortality [CKD (log-rank P < 0.001); no-CKD (log-rank P = 0.024)] and cardiovascular mortality [CKD (log-rank P < 0.001); no-CKD (log-rank P = 0.01)] in CAD patients with or without CKD. RCS demonstrated that the relation between SHR and all-cause mortality was U-shaped after full modification, which was shown for CKD patients (P for non-linearity = 0.003) and also for patients without CKD (P for non-linearity = 0.001). Analogous effects were discovered for cardiovascular mortality, which was the case for CKD patients (P for non-linearity < 0.001) and also for patients without CKD (P for non-linearity = 0.001).ConclusionsAmong patients with CAD, an elevated stress hyperglycemia ratio (SHR) is implicated in a heightened risk of long-term outcomes, particularly in those with CKD. This signifies that SHR might have a latent function in the cardiovascular risk categorization of the CAD population.

Long-Term Risk of Acute Myocardial Infarction in Patients With a Transient Ischemic Attack: A Danish Nationwide Cohort Study.

Sparse information regarding the long-term risk of acute myocardial infarction (MI) following a transient ischemic attack (TIA) emphasizes further research to guide preventive strategies and risk stratification in patients with a TIA. We conducted a nationwide cohort study to investigate the 5-year risk of MI and all-cause mortality in patients with a first-time TIA. Patients with a first-time TIA were identified in the Danish Stroke Registry (2013-2020), matched on age, sex, and calendar year (1:4) with the general population and (1:1) with patients with first-time ischemic stroke. The 5-year risks of MI and all-cause mortality were estimated by the Aalen-Johansen and Kaplan-Meier estimators. The groups were compared using Cox regression, while adjusting for cardiovascular comorbidities. We identified 21 743 patients with TIA, 86 972 matched individuals from the general population, and 21 743 matched control patients with ischemic stroke. Median age was 70 (25th to 75th percentile, 60-78) years; 52% were male. Comorbidity burden was the lowest in general population controls, intermediate in patients with TIA, and the highest in patients with ischemic stroke. The 5-year risk of MI was 2.0% in patients with TIA, 1.5% in the general population (P<0.001), and 2.2% in the ischemic stroke population (P<0.001). After adjustment, these differences in MI rate were similar (TIA versus general population; hazard ratio, 0.99 [95% CI, 0.98-1.02] and TIA versus ischemic stroke; hazard ratio, 0.99 [95% CI, 0.96-1.01]). The 5-year risk of mortality was 17.0% in patients with TIA compared with 14.0% in the general population (P<0.001) and 27.0% in ischemic stroke population (P<0.001). The differences in mortality persisted following adjustments for patients with TIA versus general population (hazard ratio, 1.25 [95% CI, 1.19-1.31]) and for patients with TIA versus ischemic stroke (hazard ratio, 0.43 [95% CI, 0.41-0.46]). Patients with first-time TIA had a low 5-year incidence of MI, which was not significantly different from that of the general population and patients with first-time ischemic stroke after adjustments for comorbidities. However, patients with TIA had a 25% higher all-cause mortality rate than the general population, which was not readily explained by MI risk. Hence, the findings do not endorse the need to raise further awareness regarding MI in patients with TIA.

Cardiometabolic risk factors and clinical course of liver cirrhosis.

The global prevalence of Metabolic Dysfunction-Associated Liver Disease is dramatically increasing with the diffusion of cardiometabolic risk factors (CMRFs). The aim of the present study was to assess the natural course of liver cirrhosis, in terms of decompensation, development of hepatocellular carcinoma and mortality, in relation to the presence of CMRFs (type 2 diabetes mellitus, obesity, arterial hypertension, low HDL levels, hypertriglyceridemia). 667 patients with liver cirrhosis (50 with CMRFs and without non-metabolic aetiological factors, 167 with non-metabolic aetiological factors and without CMRFs, and 450 with both non-metabolic aetiological factors and at least one CMRF) followed at the University and General Hospital of Padua, Italy, from 1998 to 2022, were included. No difference in the occurrence of cirrhosis decompensating events and development of hepatocellular carcinoma was observed, whereas patients in the metabolic or mixed group had 4-3-fold higher all-cause mortality and significantly lower 3-years survival compared to patients in the non-metabolic group, despite a better liver function at enrolment. Hypertriglyceridemia and low HDL levels were the less prevalent CMRFs, but those associated with the highest risk of cirrhosis decompensation. Hypertriglyceridemia was also associated with an increased risk of mortality. Arterial hypertension was associated with a reduced risk of cirrhosis decompensation, but a higher risk of mortality. Compared to patients without CMRFs, those with CMRFs had similar rates of liver cirrhosis decompensation but higher overall mortality. Hypertriglyceridemia was associated with a high risk of both liver decompensation and death.