Death In Hospitalized Patients Research Articles

Does False Lumen Thrombosis Lead to Better Outcomes in Patients with Aortic Dissection: A Meta-Analysis and Systematic Review.

For a long time, the association of the false lumen status and the outcomes of patients suffering from aortic dissection has been unclear, so this review article aims to study whether the unobstructed of the false lumen is related to the outcome of patients suffering from aortic dissection. We performed this systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta Analyzes Protocols (PRISMA) statement 2009 and registered with PROSPERO (CRD42022381869). We searched PubMed, the Cochrane library, Web of Science and Embase to collect potential studies. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. The main outcome is long-term survival. Data included in the study were summarized using the risk ratio or mean difference and 95% confidence interval. There were 16 trials, 2829 patients in total, with a mean age of 62.1 years. Compared with completely thrombosed false lumen, patent group has better long-term survival (risk ratio (RR), 0.88; 95% CI, 0.79 to 0.97; p = 0.01; I2 = 58%) and smaller yearly aortic growth rate (mean difference (MD), 1.03; 95% CI, 0.23 to 1.82; p = 0.01; I2 = 98%). In addition, patients with a patent false lumen had a lower risk of aortic event (RR, 0.81; 95% CI, 0.68 to 0.97; p = 0.02; I2 = 37%), but higher risk of aortic rupture (RR, 7.02; 95% CI, 2.55 to 19.3; p = 0.0002; I2 = 0) and hospital death (RR, 2.72; 95% CI, 1.45 to 5.08; p = 0.002; I2 = 0). Completely thrombosed of the false lumen is more beneficial to the long-term survival of patients with aortic dissection. And the risk of aortic rupture and hospital death in patients with patent false lumen is 7 times and 3 times that of patients with complete thrombosed false lumen. It is expected to provide individualized medical care for different types of patients according to different false lumen status to minimize death and related complications.

RV size may predict death in unstable patients with PE.

Pulmonary emboli (PE) is a life threatening condition that discovered in many patients only "post mortem". Sub massive and massive PE that led to hemodynamic collapse characterized by right ventricular (RV) dysfunction, leading to a higher risk of death. To assess the ability to predict in hospital death of patients with acute PE, using a non-gated computed tomography pulmonary angiography (CTPA), based on the dimensions of the right ventricle. A retrospective study that analyzed CTPA images of patients admitted with acute PE during the years 2012-2017. The cohort study included 300 patients with documented acute PE, among them 255 hospitalized in medical (non-intensive care unit) wards, 45 were hospitalized in an intensive care unit (ICU). Among the 45 patients admitted to the ICU 8% died. Larger RV diameters predicted mortality (OR = 10.14, 95% CI [1.09-93.86]) as well as lower systolic and diastolic blood pressure measurements (p = 0.001 and 0.01). Among the 255 patients admitted to the Internal Medicine Ward 7% died. Older age (p = 0.028), sepsis and cancer (both p < 0.001), high WBCs count (p < 0.001), and renal failure (p < 0.001) predicted death. Lower blood pressure (systolic and diastolic) (p < 0.001, 0.008), older age (p < 0.007), sepsis (p < 0.001), cancer (p = 0.006), higher WBCs count (p < 0.001), and impaired renal function (p < 0.001) predicted death in patients admitted with acute PE. Clinical parameters and hematological parameters could predict death of patients admitted with acute PE. RV diameter, measured by the non-ECG gated CTPA, had an additive predictive value for patients who admitted to the ICU.

Differences in trends in discharge location in a cohort of hospitalized patients with cancer and non-cancer diagnoses receiving specialist palliative care: A retrospective cohort study

Background: Patients with and without cancer are frequently hospitalized, and have specialist palliative care needs. In-hospital mortality can serve as a quality indicator of acute care. Trends in acute care outcomes have not previously been evaluated in patients with confirmed specialist palliative care needs or between diagnostic groups. Aim: To compare trends in discharge location between hospitalized patients with and without cancer who received specialist palliative care. Design: Retrospective cohort study. Association between diagnosis (cancer, non-cancer) and in-hospital mortality was assessed using multivariable logistic regression, controlling for demographic, clinical, and admission-specific information. Setting/participants: Patients who received specialist palliative care at an academic tertiary hospital in Toronto, Canada from 2013 to 2019. Results: The cohort comprised 6846 patients, 5024 with and 1822 without cancer. A higher proportion of patients without cancer had a Palliative Performance Scale score <30%, anticipated prognosis of <1 month, and were referred for end-of-life care (all p < 0.001). The adjusted odds of dying in hospital was 1.24-times higher among patients without cancer (95% CI: 1.05–1.46; p = 0.011). Though the proportion of patients without cancer who died in hospital decreased by 8.4% from 2013 to 2019, this proportion (41.2%) remained substantially higher compared to patients with cancer (14.0%) in 2019. Conclusions: Hospitalized patients without cancer were referred to specialist palliative care at a lower functional status, a poorer anticipated prognosis, and more likely for end-of-life care; and were more likely to die in hospital. Future studies are required to determine whether a proportion of hospital deaths in patients without cancer represent goal-discordant end-of-life care.

The Trends of In-Patient Mortality between 2018 and 2019 at Kisumu County Level Four Hospital, Kenya

Introduction: Due to a lack of information on patient mortality, healthcare planners rarely use local data for resource allocation and hospital management. This results in missed opportunities to build hospital capacity to address common causes of death, as well as a poor hospital reputation, fewer patients seeking hospital care, increased medical errors, and increased inpatient mortality.&#x0D; Objective: To determine trends of hospital mortality between 2018 and 2019 at Level Four Kisumu County Hospital, Kenya.&#x0D; Methods: The study was a cross sectional retrospective study design. The study targeted files of patients who died between January 2018 and December 2022. Systematic sampling was used in which every file per ward was given a serial number. Each department formed a stratum. Sample size was determined using Yamane Taro formula (N/1+N(e2) which yielded 203 as sample size from population of 680. The risk of death based on the presence or absence of doctor and nurse was analyzed by odds ratio. Chi-square was used to check association of appropriateness of facility, delay of care and distance and mortality. Variation in ward mortalities was analyzed using ANOVA to assess and data presented as line graphs.&#x0D; Results: According to the current study, the medical ward had the highest 2-year in-hospital mortality rate of 13.86%, while obstetrics and gynecology (reproductive health) had the lowest mortality rate of 0.47 percent. Infections were responsible for 42% of hospital deaths in patients under the age of 35, while noncommunicable diseases were responsible for 41% of hospital deaths in patients over the age of 60. According to the study, 3% of hospital deaths could have been avoided. When a nurse and a doctor were all present, there was a significant difference in the odds of a patient dying (OR=0.697). Comorbidity was a significant risk factor for death among patients who died in 2018 and 2019 (p=0.05). Patient characteristics such as age, education level, and gender were not associated with hospital deaths (p&gt;0.05).&#x0D; Conclusion: The study found that 3% of hospital deaths were avoidable. More deaths occurred in medical ward from infectious diseases such as pneumonia and pulmonary TB among patients aged &lt;35 years while non-communicable diseases such as cancer, hypertension and diabetes mellitus were important causes of death among the people aged &gt;60 years. The results seem to suggest that more deaths occurred during rainy season between February and August. Patient factors such as age, sex and education level were not significantly associated with hospital mortality. Comorbidities particularly the non-infectious diseases were associated with more deaths.

Factors associated with relapse and hospital death in patients coinfected with visceral leishmaniasis and HIV: a longitudinal study

ObjectiveVisceral leishmaniasis (VL) is an endemic parasitic disease in Latin America, and its clinical picture is aggravated in coinfections with the human immunodeficiency virus (HIV). The objective of this study was to investigate clinical factors and laboratory variables associated with VL relapse and death in VL/HIV coinfected patients.MethodsA prospective longitudinal study was conducted from January 2013 to July 2020 among 169 patients coinfected with VL and HIV. The outcomes investigated were the occurrence of VL relapse and death. Chi-square test, Mann–Whitney test and logistic regression models were used for statistical analysis.ResultsThe occurrence rates were 41.4% for VL relapse and 11.2% for death. Splenomegaly and adenomegaly were associated with the increased risk of VL relapse. Patients with VL relapse had higher levels of urea (p = .005) and creatinine (p < .001). Patients who died had lower red blood cell counts (p = .012), hemoglobin (p = .017) and platelets (p < .001). The adjusted model showed that antiretroviral therapy for more than 6 months was associated with a decrease in VL relapse, and adenomegaly was associated with an increase in VL relapse. In addition, edema, dehydration, poor general health status, and paleness were associated with an increase in hospital death.ConclusionThe findings suggest that adenomegaly, antiretroviral therapy, and renal abnormalities can be associated with VL relapse, while hematological abnormalities, and clinical manifestations like paleness, and edema can be associated with an increased odds of hospital death.Trial registration number: The study was submitted to the Ethics and Research Committee of the Federal University of Maranhão (Protocol: 409.351).

A comparison of two frameworks for multi-state modelling, applied to outcomes after hospital admissions with COVID-19.

We compare two multi-state modelling frameworks that can be used to represent dates of events following hospital admission for people infected during an epidemic. The methods are applied to data from people admitted to hospital with COVID-19, to estimate the probability of admission to intensive care unit, the probability of death in hospital for patients before and after intensive care unit admission, the lengths of stay in hospital, and how all these vary with age and gender. One modelling framework is based on defining transition-specific hazard functions for competing risks. A less commonly used framework defines partially-latent subpopulations who will experience each subsequent event, and uses a mixture model to estimate the probability that an individual will experience each event, and the distribution of the time to the event given that it occurs. We compare the advantages and disadvantages of these two frameworks, in the context of the COVID-19 example. The issues include the interpretation of the model parameters, the computational efficiency of estimating the quantities of interest, implementation in software and assessing goodness of fit. In the example, we find that some groups appear to be at very low risk of some events, in particular intensive care unit admission, and these are best represented by using ‘cure-rate’ models to define transition-specific hazards. We provide general-purpose software to implement all the models we describe in the flexsurv R package, which allows arbitrarily flexible distributions to be used to represent the cause-specific hazards or times to events.

The effect of ambient temperature on in-hospital mortality: a study in Nanjing, China

To reduce the inpatient mortality and improve the quality of hospital management, we explore the relationship between temperatures and in-hospital mortality in a large sample across 10 years in Nanjing, Jiangsu. We collected 10 years’ data on patient deaths from a large research hospital. Distributed lag non-linear model (DLNM) was used to find the association between daily mean temperatures and in-hospital mortality. A total of 6160 in-hospital deaths were documented. Overall, peak RR appeared at 8 °C, with the range of 1 to 20 °C having a significantly high mortality risk. In the elderly (age ≥ 65 years), peak RR appeared at 5 °C, with range − 3 to 21 °C having a significantly high mortality risk. In males, peak RR appeared at 8 °C, with the range 0 to 24 °C having a significantly high mortality risk. Moderate cold (define as 2.5th percentile of daily mean temperatures to the MT), not extreme temperatures (≤ 2.5th percentile or ≥ 97.5th percentile of daily mean temperatures), increased the risk of death in hospital patients, especially in elderly and male in-hospital patients.

Epidemiology and risk factors for hospital acquired Clostridium difficile infection and colonization in emergency intensive care unit of a general hospital in Shanghai

To investigate the clinical features, risk factors and prognosis of Clostridium difficile infection/colonization (CDI/CDC) in emergency intensive care unit (EICU) of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, then provides theoretical basis for clinical treatment. A retrospective case-control study was conducted. The data of EICU patients admitted to Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from June 2016 to June 2020 were collected. Taking the CDI/CDC patients as research objects [Clostridium difficile (CD) positive group] and the CD negative patients with the same gender and age difference less than 5 years who were admitted to the hospital during the same period as the control (CD negative group). Demographic information, risk factors, prognosis and stool samples were collected. Single factor analysis and binary Logistic regression were used to analyze the CD positive infection rate, risk factors, and hospital death of patients with different clinical characteristics. About 487 patients in EICU were included, 76 cases were taken into CD positive group, CD positive rate was 15.6%, including CDI 11 cases, CDC 65 cases. Among the CD positive group, all of the cases used proton pump inhibitor (PPI), and 75 cases used at least one antibiotic. Seventy-six CD negative patients with or without diarrhea (CD negative group) were included in this study. Among them, 75 patients used PPI and 74 patients used at least one antibiotic. Univariate analysis showed that acute physiology and chronic health evaluation II (APACHE II), duration of hospitalization, and carbapenem use were the risk factors for CDI/CDC. There were significant differences in the above indicators between CD positive group and CD negative group [APACHE II: 18.0 (12.2, 25.8) vs. 10.0 (7.0, 14.0), duration of hospitalization (days): 46.0 (30.5, 72.5) vs. 18.5 (9.2, 37.0), proportion of carbapenems: 81.6% (62/76) vs. 64.5% (49/76), all P < 0.05]. Binary Logistic analysis regression analysis showed that APACHE II score [odds ratio (OR) = 0.802, 95% confidence interval (95%CI) was 0.730-0.882, P < 0.01] and duration of hospitalization (OR = 0.960, 95%CI was 0.942-0.978, P < 0.01) were independent risk factors for CDI/CDC. There was no difference in overall mortality between the CD positive group and CD negative group [27.6% (21/76) vs. 38.2% (29/76), P = 0.167]. Critically ill patients in EICU routinely use PPI and antibiotics, and the use of antibiotics does not affect the CD positive rate. The independent risk factors of CDI/CDC are the APACHE II score and the duration of hospitalization, but fecal CD positive has no obvious influence on death.

Negative effects of iodine-based contrast agent on renal function in patients with moderate reduced renal function hospitalized for COVID-19

BackgroundKidney disease and renal failure are associated with hospital deaths in patients with COVID − 19. We aimed to test if contrast enhancement affects short-term renal function in hospitalized COVID − 19 patients.MethodsPlasma creatinine (P-creatinine) was measured on the day of computed tomography (CT) and 24 h, 48 h, and 4–10 days after CT. Contrast-enhanced (n = 142) and unenhanced (n = 24) groups were subdivided, based on estimated glomerular filtration rates (eGFR), > 60 and ≤ 60 ml/min/1.73 m2. Contrast-induced acute renal failure (CI-AKI) was defined as ≥27 μmol/L increase or a > 50% rise in P-creatinine from CT or initiation of renal replacement therapy during follow-up. Patients with renal replacement therapy were studied separately. We evaluated factors associated with a > 50% rise in P-creatinine at 48 h and at 4–10 days after contrast-enhanced CT.ResultsMedian P-creatinine at 24–48 h and days 4–10 post-CT in patients with eGFR> 60 and eGFR≥30–60 in contrast-enhanced and unenhanced groups did not differ from basal values. CI-AKI was observed at 48 h and at 4–10 days post contrast administration in 24 and 36% (n = 5/14) of patients with eGFR≥30–60. Corresponding figures in the eGFR> 60 contrast-enhanced CT group were 5 and 5% respectively, (p < 0.037 and p < 0.001, Pearson χ2 test). In the former group, four of the five patients died within 30 days. Odds ratio analysis showed that an eGFR≥30–60 and 30-day mortality were associated with CK-AKI both at 48 h and 4–10 days after contrast-enhanced CT.ConclusionPatients with COVID − 19 and eGFR≥30–60 had a high frequency of CK-AKI at 48 h and at 4–10 days after contrast administration, which was associated with increased 30-day mortality. For patients with eGFR≥30–60, we recommend strict indications are practiced for contrast-enhanced CT. Contrast-enhanced CT had a modest effect in patients with eGFR> 60.

Oral health and incidence of nosocomial infection and mortality in patients undergoing elective cardiac surgery

Objective: To analyze the relationship between oral disease and the risk of developing hospital pneumonia, mediastinitis, endocarditis, surgical site infection and hospital death in patients undergoing elective cardiac surgery. Assess which risk factors would be related to the risk of nosocomial infection and death after cardiac surgery. Methodology: It was an analytical, observational, prospective study, carried out from January to December 2018. The study included 46 patients candidates for elective cardiac surgery and evaluated as to the type of heart disease, type of surgery, associated comorbidities, age, NYHA classification, BMI, ICU stay days, oral health assessment by a dental surgeon, occurrence of infection and hospital death. The analysis was done through analysis of absolute and relative frequencies, estimation of odds ratios, chi-square test and Mann-Whitney test. Results: Of the 46 patients analyzed, 11 (23.9%) of them had hospital infections and 4 (8.7%) died, there was no statistically significant difference in the variables studied with the occurrence of infection or death. The heterogeneity of the findings in the oral evaluation that ranged from edentulous patients with partial or total dentures, partial edentulous with or without prosthesis and varying degrees of oral disease that ranged from gingivitis, periodontitis to abscesses. The prostheses had varying degrees of conservation and hygiene. This great variability of findings may have implied no statistical significance in the variables. Conclusion: There was no statistical difference in the occurrence of hospital pneumonia, mediastinitis, endocarditis, surgical site infection and hospital death according to the patients' oral health condition.

A Comprehensive Way to Access Hospital Death Prediction Model for Acute Mesenteric Ischemia: A Combination of Traditional Statistics and Machine Learning.

PurposeThis study aimed to use traditional statistics and machine learning to develop and validate prediction models for predicting hospital death in patients with AMI and compare these models’ performance.Patients and MethodsData were retrieved from the Medical Information Mart for Intensive Care (MIMIC III) electronic clinical database. A total of 338 eligible AMI patients were divided into a training cohort (n = 238) and a validation cohort (n = 100), and all patients were divided into survival groups and nonsurvival groups according to patients’ hospital outcomes. The performance of the traditional statistics prediction model and the optimal machine learning prediction model was evaluated and compared with respect to discrimination, calibration, and clinical utility in the validation cohort.ResultsUnivariate and multivariate logistic regression analyses identified the following independent risk factors associated with hospital death for AMI in the training cohort, including diastolic blood pressure, blood lactate, blood creatinine, age, blood pH, and red blood cell distribution width. Both the nomogram (AUC = 77.0%, 67.9–86.1%) and optimal machine learning model (AUC = 82.9%, 74.9–91.0%) achieved good discrimination and calibration in the validation cohort. Decision curves analysis showed that the optimal machine learning model has a greater net benefit than that of nomogram in this study.ConclusionThe nomogram achieved a concise and relatively accurate prediction of hospital death in patients with AMI, the machine learning model also has good discrimination and seems to have better clinical utility. Traditional statistics may help infer the relationship between risk factors and hospital death, while machine learning may contribute to a more accurate prediction. Traditional statistics and machine learning are complementary in developing the prediction model for hospital death of AMI. Therefore, a combination of nomogram–machine learning (Nomo-ML) predictive model may improve care and help clinicians make AMI management-related decisions.

Prediction of the Risk of Hospital Deaths in Patients with Hospital-Acquired Pneumonia Caused by Multidrug-Resistant Acinetobacter baumannii Infection: A Multi-Center Study.

PurposeTo predict the risk of hospital deaths in patients with hospital-acquired pneumonia (HAP) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) infection.Patients and MethodsA total of 366 patients who were diagnosed with HAP caused by MDR-AB infection were enrolled between January 2013 and December 2016. The sociological characteristics and clinical data of these cases were collected. Univariate and multivariate logistic analyses were used to explore the risk factors of hospital deaths before medication and after drug withdrawal. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were utilized to assess the predictive effectiveness of the models with or without the adjustment.ResultsHospital deaths occurred in 142 cases (38.80%). The results showed that acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores before medication and after drug withdrawal were associated with the risk of hospital deaths. Adjusting the covariants including the age, autoimmune disease, venous cannula, transfer of patients from other hospitals, and APACHE II score at admission, then no differences were discovered in predicting the hospital deaths between adjusted APACHE II and adjusted SOFA scores before medication (AUC: 0.808 vs 0.803, P =0.614) and after drug withdrawal (AUC: 0.876 vs 0.878, P =0.789).ConclusionBefore medication or after drug withdrawal, the adjusted APACHE II and adjusted SOFA scores all performed well in determining the predictive effectiveness of the hospital deaths in patients with HAP caused by MDR-AB infection, indicating that the appropriate infection control may reduce the occurrence of nosocomial deaths and improve the prognosis.

Combination of D-dimer and simplified pulmonary embolism severity index to improve prediction of hospital death in patients with acute pulmonary embolism.

ObjectiveTo investigate whether the combination of D-dimer and simplified pulmonary embolism severity index (sPESI) could improve prediction of in-hospital death from pulmonary embolism (PE).MethodsPatients with PE (n = 272) were divided into a surviving group (n = 249) and an in-hospital death group (n = 23).ResultsCompared with surviving patients, patients who died in hospital had significantly higher rates of hypotension and tachycardia, reduced SaO2 levels, elevated D-dimer and troponin T levels, higher sPESI scores, and were more likely to be classified as high risk. Elevated D-dimer levels and high sPESI scores were significantly associated with in-hospital death. Using thresholds for D-dimer and sPESI of 3.175 ng/mL and 1.5, respectively, the specificity for prediction of in-hospital death was 0.357 and 0.414, respectively, and the area under the receiver operating characteristic curve (AUC) was 0.665 and 0.668, respectively. When D-dimer and sPESI were considered together, the specificity for prediction of in-hospital death increased to 0.838 and the AUC increased to 0.74.ConclusionsD-dimer and sPESI were associated with in-hospital death from PE. Considering D-dimer levels together with sPESI can significantly improve the specificity of predicting in-hospital death for patients with PE.

Neural Networks for Cause of Hospitalization and Final Cause of Death Extraction from Discharge Summaries.

Determining the cause of death of hospitalized patients with cardiovascular disease is of the utmost importance. This is usually recorded in free text form. In this study we aimed to develop a series of supervised natural language processing algorithms to extract cardiovascular causes of hospitalization and final causes of death.

Early Active Irrigation-Suction Drainage among Enterocutaneous Fistulas Patients with Chronic Critical Illness: A Retrospective Cohort Study

Enterocutaneous fistulas (ECFs) requiring admission to ICU is a serious surgical complication. A growing number of patients survive ECFs but remain chronically critically ill. The aim of our study was to investigate the risk factors of hospital death in patients with chronic critical illness attributed to ECFs. A retrospective single-center study was conducted in 163 ECF patients between 2013 and 2017. Patient-specific baseline characteristics, outcomes, and process of care variables were collected. Risk factors for hospital mortality were determined using univariate and multivariate analyses. Patients were divided into the following two groups according to the hospital discharge outcome: group survivors (n = 106) and group nonsurvivors (n = 57). Patients who received active irrigation-suction drainage (AISD) within 24 hours after the diagnosis of ECFs had a significantly lower hospital mortality rate than those who received AISD after more than 24 hours (17.9% vs 46.9%, P < 0.001). Multivariate logistic regression analysis demonstrated that delayed AISD (adjusted odds ratio [AOR], 10.24; 95% confidence interval [CI], 3.03-34.59; P < 0.001) and no rehabilitation therapy (AOR, 4.77; 95% CI, 1.43-15.98; P = 0.011) were independently associated with a greater risk of hospital mortality. The hospital mortality rate in patients with more than or equal to four risk factors was 92.6 per cent (n = 57), compared with a mortality rate of 9.4 per cent (n = 106) in patients who did not have these risk factors (P < 0.001). The risk of hospital death is exceptionally high among patients with chronic critical illness attributed to ECFs. Efforts aimed at early AISD and rehabilitation therapy are likely to be associated with improved clinical outcomes.

Association between long boarding time in the emergency department and hospital mortality: a single-center propensity score-based analysis.

Once diagnostic work-up and first therapy are completed in patients visiting the emergency department (ED), boarding them within the ED until an in-hospital bed became available is a common practice in busy hospitals. Whether this practice may harm the patients remains a debate. We sought to determine whether an ED boarding time longer than 4h places the patients at increased risk of in-hospital death. This retrospective, propensity score-matched analysis and propensity score-based inverse probability weighting analysis was conducted in an adult ED in a single, academic, 1136-bed hospital in France. All patients hospitalized via the adult ED from January 1, 2013 to March 31, 2018 were included. Hospital mortality (primary outcome) and hospital length of stay (LOS) were assessed in (1) a matched cohort (1:1 matching of ED visits with or without ED boarding time longer than 4h but similar propensity score to experience an ED boarding time longer than 4h); and (2) the whole study cohort. Sensitivity analysis to unmeasured confounding and analyses in pre-specified cohorts of patients were conducted. Among 68,632 included ED visits, 17,271 (25.2%) had an ED boarding time longer than 4h. Conditional logistic regression performed on a 10,581 pair-matched cohort, and generalized estimating equations with adjustment on confounders and stabilized propensity score-based inverse probability weighting applied on the whole cohort showed a significantly increased risk of hospital death in patients experiencing an ED boarding time longer than 4h: odds ratio (OR) of 1.13 (95% confidence interval [95% CI] 1.05-1.22), P = 0.001; and OR of 1.12 (95% CI 1.03-1.22), P = 0.007, respectively. Sensitivity analyses showed that these findings might be robust to unmeasured confounding. Hospital LOS was significantly longer in patients exposed to ED boarding time longer than 4h: median difference 2days (95% CI 1-2) (P < 0.001) in matched analysis and mean difference 1.15days (95% CI 1.02-1.28) (P < 0.001) in multivariable unmatched analysis. In this single-center propensity score-based cohort analysis, patients experiencing an ED boarding time longer than 4h before being transferred to an in-patient bed were at increased risk of hospital death.

Extracellular Vesicle-Mimetic Ghost Nanovesicles for Delivering Anti-Inflammatory Drugs to Mitigate Gram-Negative Bacterial Outer Membrane Vesicle-Induced Systemic Inflammatory Response Syndrome.

Sepsis is one of the major causes of death in hospital patients and is represented by systemic inflammatory response syndrome (SIRS) associated with infection. Gram-negative bacteria including Escherichia coli can provoke sepsis by stimulating the immune systems. Outer membrane vesicles (OMVs), nanosized vesicular structures derived from Gram-negative bacteria, contain several pathogen-associated molecular patterns, and are demonstrated to mediate SIRS. Here, extracellular vesicle-mimetic ghost nanovesicles loaded with dexamethasone, an anti-inflammatory drug, are developed using alkaline solution, sonication, and buoyant density gradient ultracentrifugation. These ghost nanovesicles have comparable physical features with naturally released extracellular vesicles but have 200-fold higher production yields than extracellular vesicles. Importantly, these ghost nanovesicles are devoid of potentially unwanted luminal cargos, including cytosolic proteins and nucleic acids. By maintaining the same topology as the parental cells, these dexamethasone-loaded ghost nanovesicles derived from human U937 monocytes reduce the release of interleukin-8 from OMV-treated endothelial cells in vitro, and mitigate the symptoms of OMV-induced SIRS in vivo. This study sheds light on using extracellular vesicle-mimetic ghost nanovesicles to deliver therapeutics to treat diseases such as bacterial sepsis.

Transforming the landscape of liver disease in the UK

In 2014, The Lancet published the inaugural report of the Lancet Commission on Liver Disease in the UK. 1 Williams R Aspinall R Bellis M et al. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet. 2014; 384: 1953-1997 Summary Full Text Full Text PDF PubMed Scopus (405) Google Scholar With mortality from liver diseases having risen four-fold over the previous four decades, the report was timely and urgently needed. Led by Roger Williams of the UK's Foundation for Liver Research, Institute of Hepatology, King's College London, the Commission provided a comprehensive analysis of the disease burden in the UK and carefully examined access to, and quality of, care for patients with liver disease. Having accumulated a strong foundation of evidence, the Commission made ten recommendations aimed at reducing unacceptable premature mortality and improving care for patients. The recommendations addressed unmet needs of patients with liver disease, as well as areas in which the greatest population-wide impacts could be made. They covered the full spectrum of health care, including community, general practice, specialised services, and paediatric care. Obesity, alcohol, and hepatitis were identified as key modifiable risk factors. The need for a response to commercial drivers of poor liver health—the alcohol and food industries—was also highlighted as a priority area to focus political action. Gathering momentum for the way ahead: fifth report of the Lancet Standing Commission on Liver Disease in the UKThis report presents further evidence on the escalating alcohol consumption in the UK and the burden of liver disease associated with this major risk factor, as well as the effects on hospital and primary care. We reiterate the need for fiscal regulation by the UK Government if overall alcohol consumption is to be reduced sufficiently to improve health outcomes. We also draw attention to the effects of drastic cuts in public services for alcohol treatment, the repeated failures of voluntary agreements with the drinks industry, and the influence of the industry through its lobbying activities. Full-Text PDF Place of death and factors associated with hospital death in patients who have died from liver disease in England: a national population-based studyThe high risk of hospital death in patients with sepsis, hepatorenal syndrome, or peritonitis warrants further investigation, and the low chance of hospital death in patients with alcohol-related disorders also needs to be explored. Prevention strategies and end-of-life care services are urgently needed to prevent and tackle harms from liver disease. Full-Text PDF Alcohol drinking patterns and liver cirrhosis risk: analysis of the prospective UK Million Women StudyIn middle-aged women, cirrhosis incidence increases with total alcohol intake, even at moderate levels of consumption. For a given weekly intake of alcohol, this excess incidence of cirrhosis is higher if consumption is usually without meals, or with daily drinking. Full-Text PDF Open Access

Place of death and factors associated with hospital death in patients who have died from liver disease in England: a national population-based study

Liver disease is a major cause of mortality, with high numbers of hospital deaths, and disproportionately affects people younger than 65 years. This study aims to examine the place of death and factors associated with hospital death for people who died from liver disease. We did a national population-based, observational study using the National Death Registration Database from the Office for National Statistics, 2001-14. All non-accidental adult deaths (hospital and non-hospital) from liver disease in England were included. Explanatory variables were underlying cause of death, contributory causes of death (number and specific causes), age at death, sex, marital status, year of death, index of multiple deprivation, rural or urban settlement, and residential region. We applied modified Poisson regression models to assess the strength of association between hospital death and explanatory variables using an adjusted prevalence ratio (PR). 135 953 decedents were included, of whom 56 065 (41·2%) died from alcohol-related liver disease. Annual deaths from liver disease increased from 7811 in 2001, to 11 017 in 2014. Hospitals were the main place of death (66·9% [95% CI 66·6-67·1]) for patients who died from liver disease. The proportion of hospital deaths reduced from 71·5% in 2001 to 60·0% in 2014. After adjusting for sociodemographic factors, patients who died from alcohol-related liver disease had the highest chance of hospital death; people who died from liver cancer were less likely to die in hospital than people with alcohol-related liver disease (adjusted PR 0·61 [95% CI 0·60-0·61]). People with four or more contributory causes of death were more likely to die in hospital than those with no contributory causes (1·45 [1·42-1·47]). Patients with sepsis (1·24 [1·23-1·25]), hepatorenal syndrome (1·22 [1·21-1·22]), and peritonitis (1·18 [1·17-1·20]) had higher chances of hospital death than those without these respective contributory causes, and those with alcohol-related disorders (0·67 [0·66-0·69]) had lower chances of hospital death. The high risk of hospital death in patients with sepsis, hepatorenal syndrome, or peritonitis warrants further investigation, and the low chance of hospital death in patients with alcohol-related disorders also needs to be explored. Prevention strategies and end-of-life care services are urgently needed to prevent and tackle harms from liver disease. National Institute of Health Research Health Services and Delivery Research Programme, and Collaboration for Leadership in Applied Health Research and Care South London.

Application of the Caprini Risk Assessment Model in predicting the risk of venous thromboembolism

Venous thromboembolism (VTE) is one of the most important leading causes of death in hospitalized patients. It is often asymptomatic, leading to long-term complications and results in death. VTE prophylaxis can reduce the incidence rate of VTE and is an important component in the safety management of hospitalized patients. VTE risk assessment plays an important role in thrombosis prevention. Recently, the Caprini risk assessment model has been validated worldwide. In this study, the research progress of the Caprini risk assessment model were reviewed to provide reference for clinical application of the Caprini risk assessment model. Key words: Review; Venous thromboembolism; Caprini risk assessment model