Hospital Mortality Research Articles

Association between inflammatory biomarkers and postoperative acute kidney injury after cardiac surgery in patients with preoperative renal dysfunction: a retrospective pilot analysis

BackgroundAcute kidney injury (AKI) represents a significant post-cardiac surgery complication, particularly prevalent among individuals with pre-existing renal dysfunction. Chronic kidney disease (CKD) is frequently accompanied by persistent, low-grade inflammation, which is known to exacerbate systemic stress responses during surgical procedures. This study hypothesizes that these inflammatory responses might influence the incidence and severity of postoperative acute kidney injury (AKI), potentially serving as a protective mechanism by preconditioning the kidney to stress.MethodsThis retrospective study enrolled patients with preoperative renal dysfunction (eGFR between 15 and 60 ml/min/1.73 m²) who underwent cardiac surgery between January 2020 and December 2022. Preoperative inflammatory biomarkers were evaluated. The primary outcome was the incidence of postoperative AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Multivariate regression models and sensitivity analyses were conducted to ascertain the relationship between inflammatory biomarkers and AKI. Restricted cubic spines (RCS) was conducted to explore nonlinear associations between inflammatory biomarkers and AKI.ResultsAKI occurred in 53.4% (392/734) of patients, accompanied by significant mortality and length of hospital stay increases in cases of AKI (P < 0.005). After full adjustment of confounders, neutrophil percentage-to-albumin ratio (OR = 0.28), systemic inflammation response index (OR = 0.70), systemic immune inflammation index (OR = 0.69), neutrophil-to-lymphocyte ratio (OR = 0.70), monocyte/high-density lipoprotein cholesterol ratio (OR = 0.53), neutrophil/high-density lipoprotein cholesterol ratio (OR = 0.43) demonstrated an inverse association with AKI. Sensitivity analyses revealed that patients in the highest quartile of these biomarkers exhibited a significantly lower prevalence of AKI compared to those in the lowest quartile (p for trend < 0.05). The RCS analysis suggested an “Inverted U-shaped” association of both LnNPAR and LnSIRI with AKI.ConclusionsThis study identified an inverse association between preoperative inflammatory biomarkers and postoperative AKI in patients with preoperative renal dysfunction. The findings implied that preoperative inflammation may play a protective role against postoperative AKI in this patient population undergoing cardiac surgery.

Laparoscopic versus open repair for peptic ulcer perforation: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials. Time to conclude!

The aim of this study was to investigate comparative outcomes of laparoscopic and open repair for peptic ulcer perforation (PUP). A PRISMA-compliant systematic review with a PROSPERO-registered protocol (registration number CRD42024529286) was conducted. All randomised controlled trials (RCTs) involving PUP patients managed by laparoscopic or open repair were identified and their risk of bias assessed. Outcome syntheses for perioperative mortality and morbidities, need for reoperation, procedure time and length of hospital stay were conducted using random-effects modelling to calculate risk ratios (RR) or mean difference (MD) with 95% confidence intervals (CI). Nine RCTs met the inclusion criteria, enrolling 670 patients of whom 317 were randomised to receive laparoscopic surgery and 353 were managed with open surgery. Laparoscopic repair of PUP significantly reduced mortality (RR 0.37, p = 0.03), total complications (RR 0.57, p = 0.0009), ileus (RR 0.43, p = 0.04), wound complications (RR 0.36, p < 0.0001) and length of hospital stay (MD -2.37, p = 0.0003) compared with the open approach. There were no significant differences in rate of postoperative leak (RR 2.00, 95% CI 0.74-5.41, p = 0.17), abdominal collection (RR 1.19, 95% CI 0.46-3.07, p = 0.72), sepsis (RR 1.17, 95% CI 0.39-3.52, p = 0.65), respiratory complications (RR 0.68, 95% CI 0.32-1.46, p = 0.32), reoperation (RR 1.74, 95% CI 0.57-5.30, p = 0.33) and operating time (MD 15.31, 95% CI -4.86 to 35.47, p = 0.14) between the two groups. Laparoscopic repair of PUP is associated with significantly lower mortality and morbidity and shorter length of stay compared with the open approach. The laparoscopic approach should be the management of choice subject to the existence of laparoscopic expertise.

Mortality and rate of hospitalization stratified by patients’ BMI in a colonoscopy screening – a cross sectional analysis of data from Polish Colonoscopy Screening Platform

Background Currently, it remains unknown whether there is an association between body mass index (BMI) and complications during screening colonoscopy; hence, it remains unclear whether BMI should be considered a risk factor in pre-procedural assessments. The aim of this study was to compare mortality and unplanned hospitalization rates before and after colonoscopy stratified by patients’ BMI. Material and methods This was a retrospective cohort study of individuals who underwent screening colonoscopy as part of the Polish Colonoscopy Screening Program (PCSP). The included individuals were followed up for mortality and hospitalization episodes from 42 days prior to colonoscopy to 30 days after the procedure. Rates for the endpoints were calculated, compared, and adjusted for available data. Weighted averages of stratum-specific rates were calculated. Additional subanalyses were performed for sex and procedure type (screening colonoscopy without biopsy, colonoscopy with biopsy, or colonoscopy with polypectomy). Results A total of 55390 individuals who underwent colonoscopy between years 2012–2015 were included. Obese individuals had significantly more hospitalizations than non-obese patients (1.94% versus 0%, p = .038). Analysis of adjusted hospitalization rates stratified by sex revealed that obese males had significantly higher related hospitalizations’ rates before or after and after colonoscopy. Unadjusted and adjusted mortality rates after screening colonoscopy did not reveal significant differences between BMI categories. Conclusions Overweight and obesity are not clinically relevant risk factors for mortality and hospitalization six weeks before or 30 days after screening colonoscopy. Obese males may be more likely to require hospital care after colonoscopy.

Prehospital Delta Shock Index Predicts Mortality and Need for Life Saving Interventions in Trauma Patients

ABSTRACT OBJECTIVES The delta shock index (ΔSI), defined as the change in shock index (SI) over time, is associated with hospital morbidity and mortality, but prehospital studies about ΔSI are limited. We investigate the association of prehospital ΔSI with mortality and resource utilization, hypothesizing that increases in SI among field trauma patients are associated with increased mortality and blood product transfusion. METHODS We performed a multicenter, retrospective, observational study from the Linking Investigators in Trauma and Emergency Services (LITES) network. We obtained data from January 2017 to June 2021. We fit logistic regression models to evaluate the association between an increase ΔSI > 0.1 and 28-day mortality and blood product transfusion within 4 hours of emergency department (ED) arrival. We used negative binomial models to evaluate the association between ΔSI > 0.1 and days in hospital, intensive care unit (ICU), and on ventilator (up to 28 days). RESULTS We identified 33,219 prehospital patients. We excluded burn patients and those without documented prehospital or ED heart rate or blood pressure, resulting in 30,511 cases for analysis. In adjusted analysis for the primary outcome of 28-day mortality, patients who had a ΔSI > 0.1 based on initial vital signs were 31% more likely to die (adjusted odds ratio (AOR) of 1.31, 95% CI 1.21-1.41) compared to those patients who had a ΔSI ≤0.1. These patients also spent 16% more days in hospital (adjusted incident rate ratio (AIRR) 1.16, 95% CI 1.14-1.19), 34% more days in ICU (AIRR 1.34, 95% CI 1.28-1.41), and 61% more days on ventilator (ARR 1.61, 95% CI 1.47-1.75). Additionally, patients with a ΔSI > 0.1 had higher odds of receiving blood products (AOR 2.00, 95% CI 1.88-2.12) within 4 hours of ED arrival. Models fit excluding hypotensive patients performed similarly. CONCLUSIONS An increase of greater than 0.1 in the ΔSI was associated with increased 28-day mortality; increased days in hospital, in ICU, and on ventilator; and increased need for blood product transfusion within 4 hours of ED arrival. This association held true for initially normotensive patients. Validation and implementation are needed to incorporate ΔSI into prehospital and ED triage.

Development of an Electronic Clinical Surveillance Measure for Unnecessary Rapid Antibiotic Administration in Suspected Sepsis.

Substantial efforts focus on monitoring and reducing delays in antibiotic treatment for sepsis, but little has been done to characterize the balancing measure of sepsis overtreatment. We aimed to establish preliminary validity and usefulness of electronic health record (EHR) data-derived criteria for sepsis overtreatment surveillance (SEP-OS). We evaluated adults with potential sepsis (≥2 Systemic Inflammatory Response Syndrome criteria within 6 hours of arrival) presenting to the emergency department of 12 hospitals, excluding patients with shock. We defined SEP-OS as the proportion of patients receiving rapid IV antibiotics (≤3 hours) who did not ultimately meet the Centers for Disease Control Adult Sepsis Event "true sepsis" definition. We evaluated the frequency and characteristics of patients meeting overtreatment criteria and outcomes associated with sepsis overtreatment. Of 113 764 eligible patients, the prevalence of sepsis overtreatment was 22.5%. The measure met prespecified criteria for reliability, content, construct, and criterion validity. Patients classified by the SEP-OS overtreatment criteria had higher median antibiotic days (4 days [IQR, 2-5] vs 1 day [1-2]; P < .01), longer median length of stay (4 days [2-6] vs 3 days [2-5]; P < .01), higher hospital mortality (2.4% vs 2.1%; P = .01), and higher frequency of Clostridium difficile infection within 6 months of hospital discharge (P < .01) compared with "true negative" cases. We developed a novel, valid EHR metric for clinical surveillance of sepsis overtreatment. Applying this metric to a large cohort of potential sepsis patients revealed a high rate of overtreatment and provides a useful tool to inform sepsis quality-improvement targets.

Caregivers' and nurses' perceptions of the Smart Discharges Program for children with sepsis in Uganda: A qualitative study.

Sepsis arises when the body's response to an infection injures its own tissues and organs. Among children hospitalized with suspected sepsis in low-income country settings, mortality rates following discharge are high, similar to mortality rates in hospital. The Smart Discharges Program uses a mobile health (mHealth) platform to identify children at high risk of post-discharge mortality to receive enhanced post-discharge care. This study sought to explore the perceptions and experiences of the caregivers and nurses of children enrolled into the Smart Discharges Program and the program's effect on post-discharge care. We conducted an exploratory qualitative study, which included in-person focus group discussions (FGDs) with 30 caregivers of pediatric patients enrolled in the Smart Discharges Program and individual, semi-structured interviews with eight Smart Discharges Program nurses. The study was carried out at four hospitals in Uganda in 2019. Following thematic analysis, three key themes pertaining to the Smart Discharges program were identified: (1) Facilitators and barriers to follow-up care after discharge; (2) Changed caregiver behavior following discharge; and (3) Increased involvement of male caregivers. Facilitators included telephone/text message reminders, positive nurse-patient relationship, and the complementary aspects of the program. Barriers included resource constraints and negative experiences during post-discharge care seeking. With regards to behavior, when provided with relevant and well-timed information, caregivers reported increased knowledge about post-discharge care and improvements in their ability to care for their child. Enrolment in the Smart Discharges Program also increased male caregiver involvement, increased provision of resources and improved communication within the family and with the healthcare system. The Smart Discharges approach is an impactful strategy to improve pediatric post-discharge care, and similar approaches should be considered to improve the hospital to home transition in similar low-income country settings.

Impact of Consistent and Inconsistent Creatine Kinase-MB and Troponin Levels on Hospital lethality in Acute Coronary Disorder

Background: Serum CK-MB and cardiac troponin are important diagnostic predictors used to determine the prognosis of patients with acute coronary disorders (ACD). However, the effects of these biomarkers on hospital lethality remain underexplored. Objective: This research aimed to determine the effects of consistent and inconsistent CK-MB and troponin levels on hospital mortality in ACD patients. Methodology: This comparative study was conducted on patients with confirmed ACD admitted to a tertiary care hospital from January 2023 till June 2024. Patients were categorized into two groups based on the consistency of their CK-MB and troponin levels during hospitalization: consistently elevated or normal biomarkers versus those with variable levels. Hospital lethality was defined as mortality occurring during the hospital stay. SPSS version 26 was used for statistical analysis. The study utilized multivariate logistic regression to ascertain independent factors that are associated with hospital death. For continuous variables, t-tests or Mann-Whitney U tests were employed, and for categorical data, chi-square tests. Results: There were 500 patients in the trial; 250 were in the inconsistent group and 250 were in the consistent group. In the inconsistent group, the hospital fatality rate was 18%, while in the consistent group it was 10% (p &lt; 0.05). Variability in biomarker levels was an independent predictor of higher hospital mortality, according to multivariate analysis (OR 2.5, 95% CI 1.5–4.2). Conclusion: Inconsistent CK-MB and troponin levels were associated with higher hospital mortality in ACD patients. Monitoring and stabilizing these biomarkers may be essential for improving patient outcomes and guiding therapeutic interventions in acute care settings.

Ability of the SMART-COP score to predict the need for intensive care unit admission and mortality in older patients with non-ventilator-associated hospital-acquired pneumonia: A retrospective observational study.

To evaluate the ability of SMART-COP (systolic blood pressure, multilobar infiltrates, albumin, respiratory rate, tachycardia, confusion, oxygen and pH) score to predict the need for intensive care unit (ICU) admission and mortality among patients with non-ventilator-associated hospital-acquired pneumonia (NV-HAP) and to compare ICU-hospitalized patients with those followed-up in the clinic, as well as the patients who survived with those who died in the ICU, in terms of clinical and laboratory parameters. A total of 203 patients (aged > 65 years) who were diagnosed with NV-HAP while staying in the geriatric clinic were enrolled in this retrospective observational study. Patient information was retrieved from hospital files. In a total of 203 patients with NV-HAP, the rate of ICU admission was 77.3% and the rate of mortality was 40.9%. The SMART-COP score was significantly higher in those admitted to the ICU and those died in the ICU (ICU nonsurvivors). The rate of ICU mortality was 52.9%. The SMART-COP score had significantly poor to moderate ability to predict the need for ICU admission (area under the curve [AUC] = 0.583) and both in-hospital mortality (AUC = 0.633) and ICU mortality (AUC = 0.617) with low sensitivity. The regression analysis revealed that a one-unit increase in SMART-COP score resulted in a 1.2-fold increase in both the hospital and ICU mortality (P < 0.05 for both) and 1.1-fold increase in ICU admission (P = 0.154). The SMART-COP score has poor to moderate ability to predict the need for ICU admission, in-hospital mortality and ICU mortality, and a one-unit increase in the SMART-COP score significantly increases the risk of both hospital and ICU mortality. Geriatr Gerontol Int 2024; ••: ••-••.

Endo-Aortic Clamping with the IntraClude® Device in Minimally Invasive Total Coronary Revascularization via Left Anterior Thoracotomy (TCRAT)

Minimally invasive, sternum-sparing total coronary revascularization in multivessel disease via left anterior mini-thoracotomy (TCRAT) was introduced recently. Intra-aortic balloon occlusion is a conceivable option to avoid manipulation of the ascending aorta, to reduce the risk of stroke and to be able to treat patients with severe calcifications and unfavorable aortic anatomies. Background/Objectives: The aim of our study was to show that the use of the IntraClude® device, as part of minimally invasive coronary artery bypass grafting (CABG) via left anterior mini-thoracotomy, is feasible. Methods: From May to December 2023, CABG via left anterior mini-thoracotomy on cardiopulmonary bypass and cardioplegic arrest was successfully performed in 20 patients (17 male, 67.6 ± 8.2 (51–82) years). All patients had significant coronary artery disease (three-vessel: n = 6; two-vessel: n = 11; one-vessel: n = 3) with indication for surgical revascularization. The mean EuroScore2 was 2.6. Results: All patients successfully underwent minimally invasive CABG using endo-aortic balloon occlusion. A total of 43 distal anastomoses (2.2 ± 0.6 (1–3) per patient) were performed by using left internal artery mammary (n = 20) and radial artery (n = 14) for grafting the left anterior descending (n = 19), circumflex (n = 15) and right (n = 6) coronary artery. There was no hospital mortality, no stroke, no myocardial infarction or repeat revascularization. A total of 15 out of 20 patients left hospital within 8 days after surgery. Conclusions: TCRAT by using the IntraClude® device is feasible without compromising surgical principles while avoiding the external manipulation of the ascending aorta. The use of intra-aortic balloon occlusion instead of transthoracic clamps further reduces the invasiveness of the procedure.

Clinical outcomes of antifungal therapy on Candida pulmonary colonisation in immunocompetent patients with invasive ventilation: a systematic review and meta-analysis

ObjectiveThis study aimed to use systematic review and meta-analysis to establish the influence of antifungal therapy on pulmonary Candida colonisation of patients with mechanical ventilation (MV).DesignSystematic review and meta-analysis.Data sourcesAn...

Early deep-to-light sedation versus continuous light sedation for ICU patients with mechanical ventilation: a cohort study

BackgroundSedation strategies have not been well established for patients being treated with invasive mechanical ventilation (MV). This study aimed to compare the potential effects of alternative sedation strategies – including early deep-to-light sedation (DTLS), continuous deep sedation (CDS) and continuous light sedation (CLS, the currently recommended strategy) – on ventilator, intensive care unit (ICU) or hospital mortality. MethodsA cohort study was conducted using two large validated ICU databases, including the Registry of Healthcare-associated Infections in ICUs in China (ICU-HAI) and the Medical Information Mart for Intensive Care (MIMIC). Patients who received MV for more than 3 days with one of three sedation strategies were included. Multivariable survival analyses with inverse probability-weighted competing risk models were conducted separately for ICU-HAI and MIMIC cohorts. Adjusted estimates were pooled using fixed-effects models. ResultsIn total, 6700 patients (2627 ICU-HAI, 4073 MIMIC) were included in the cohort study, of whom 2689 received CLS, 2079 CDS and 1932 DTLS. Compared to CLS, DTLS was associated with lower ICU mortality (9.3% vs. 11.0%; pooled adjusted HR 0.78, 95% CI 0.66-0.94) and hospital mortality (16.0% vs. 14.1%; 0.86, CI 0.74-1.00); and CDS was associated with higher ventilator mortality (32.8% vs. 7.0%; 4.65, 3.91-5.53), ICU mortality (40.6% vs. 11.0%; 3.39, 2.95-3.90) and hospital mortality (46.8% vs. 14.1%; 3.27, 2.89-3.71) than CLS. All HRs were qualitatively consistent in both cohorts. ConclusionsCompared to the continuous light sedation, early deep-to-light sedation strategy was associated with improved patient outcomes, and continuous deep sedation was confirmed with poorer patient outcomes.

Predicting the impact of stress-induced hyperglycemia on in-hospital mortality in patients with chronic kidney disease and acute coronary syndrome: A retrospective study

BackgroundStress hyperglycemia is prevalent in critical illnesses and has been associated with adverse short- and long-term outcomes in individuals with acute coronary syndrome (ACS). However, there is limited evidence for the predictive value of stress hyperglycemia and hospitalization mortality in patients with chronic kidney disease (CKD) and ACS. This study aimed to explore the association between hospitalized mortality, stress hyperglycemia ratio (SHR), and admission blood glucose (ABG) in patients with CKD and ACS. MethodsThis study included 655 hospitalized patients who were diagnosed with ACS and CKD. Patients with incomplete data were excluded, resulting in the analysis of 550 patients. The primary outcome measured was in-hospital mortality. ResultsThe median age of the cohort included in the analysis was 71 years, with a male proportion of 66.2 %, and a mean estimated glomerular filtration rate (eGFR) of 27.8 mL/min/1.73 m2. Patients classified as having stage 3, stage 4, and stage 5 chronic kidney disease (CKD) comprised 46.95 %, 17.1 %, and 36 % of the population, respectively. The overall in-hospital mortality rate was 10.7 % (n = 59). Both SHR (OR = 2.67; 95 % CI 1.51–4.74; p < 0.001) and ABG (OR = 1.09; 95 % CI 1.04–1.14; p < 0.001) were significantly associated with in-hospital mortality in CKD and ACS patients. SHR and ABG showed a linear relationship with in-hospital mortality, with SHR demonstrating superior reclassification ability over ABG. The inclusion of SHR or ABG, irrespective of diabetes mellitus status, substantially enhanced the predictive performance of the Global Registry of Acute Coronary Events (GRACE) score model. ConclusionsIn patients with ACS and CKD, a robust correlation was observed between SHR, ABG, and in-hospital mortality. Both SHR and ABG improved the predictive accuracy of the GRACE score in forecasting inpatient mortality in this population.

Palliative care resources utilized in patients with liver cancer with cirrhosis: Trend in National Inpatient Sample (NIS) study (2016–2020).

59 Background: Liver cancer is the fourth cause of cancer death in the world. Hepatocellular carcinoma represents around 90% of all liver cancer, with an increase in incidence and a worsening survival rate over the years. Liver cirrhosis is the major risk factor for liver cancer development. Early involvement in palliative care/hospice care focusing on quality of life, is associated with improved physical and psychological symptoms and improvement in caregiver stress and bereavement. We examined as primary outcome the utilization and trend of palliative care (PC) among hospitalized patients with liver cancer and cirrhosis using the NIS. Methods: This is a retrospective study using NIS data from 2016 to 2021. We included patients aged 18 years or older who were admitted with a diagnosis of malignancy of the liver and the intrahepatic bile duct and who also had a diagnosis of fibrosis and cirrhosis of the liver. Patients who had a PC encounter during hospitalization were identified. The cohort was divided between patients with PC encounters and those without PC encounters. Cohorts were matched in a 1:1 ratio with no replacement using propensity scores. Total charges during hospitalization, length of stay (LOS), mortality, and disposition were measured as outcomes. Results: A total of 53,475 admissions with a diagnosis of liver malignancy and liver cirrhosis were identified. Of those, 20.8% had an encounter with a PC. The mean age of those with a PC encounter was 65.1 years (SD±7.86), while the mean age for those without was 64.5 years (SD±7.35). Sex and race were similar between both cohorts. Patients with PC encounters had a higher mean Elixhauser index (6.43 vs 5.58, p &lt; 0.001) than those without a PC encounter. Patients with PC encounters had lower total hospital charges ($70,988 vs $94,518, p &lt; 0.001), longer LOS (6.83 vs. 5.82 days, p &lt; 0.001), and higher odds of mortality (aOR 7.20, CI 5.56- 9.32, p &lt; 0.001) compared to those without a PC encounter. Patients with a PC encounter were more frequently discharged to a long-term facility (23.9% vs. 12.6%) or with home health care (36.1% vs. 18.4%) and less often had a routine hospital discharge (13.5% vs. 60.1%), compared to those without a PC encounter. Conclusions: This study highlights the impact of PC on patients hospitalized with liver malignancy and cirrhosis. Despite being underutilized, with only 20.8% of patients receiving PC, those who do experienced lower hospital charges, longer hospital stays, and higher in- hospital mortality. These findings suggest that PC focuses on symptom management and quality of life rather than extending life expectancy. Patients receiving PC are more frequently discharged to long-term care or home health care, indicating a shift towards supportive care. The results advocate for the broader and earlier integration of palliative care in treating liver cancer and cirrhosis to improve patient outcomes and support.

Multiarterial Grafting in Redo CABG: Type of Arterial Conduit and Patient Sex Determine Benefit

To evaluate whether multiarterial grafting provides incremental benefit above single arterial grafting in isolated redo CABG. From 1/1980 to 7/2020, 6559 adults underwent 6693 isolated CABG reoperations. Patients undergoing multiarterial grafting were propensity-score matched with those undergoing single arterial grafting, with or without additional vein grafts, yielding 2005 well-matched pairs. Endpoints were in-hospital postoperative complications, hospital mortality, and long-term mortality. Median follow-up was 10 years with 25% followed >17 years. Multivariable multiphase hazard modeling and nonparametric random survival forests for survival were used to identify patients for whom multiarterial grafting was most beneficial. Among propensity-matched patients, postoperative complications for multiarterial versus single arterial grafting were any reoperation, 50 (2.5%) versus 65 (3.2%); renal failure, 73 (3.6%) versus 55 (2.7%); stroke, 44 (2.2%) versus 38 (1.9%); and deep sternal infection, 36 (1.8%) versus 25 (1.2%). Hospital mortality was 1.7% (n=35) versus 2.8% (n=56) (P=.03). Comparing multiarterial to single arterial grafting, survival at 1 and 3 years was 95% versus 94% and 92% versus 88%, and at 5, 15, and 20 years, survival was 87%, 49%, and 31% versus 82%, 42%, and 25%. Better survival after multiarterial grafting was confined to males with 2 patent internal thoracic artery grafts (P<.0001). Redo CABG with multiarterial grafting can be performed with lower in-hospital mortality and similar major morbidity to single arterial grafting. It is associated with better long-term survival, particularly in males when 2 internal thoracic artery grafts are used.

The value of D-dimer-albumin ratio as a prognostic biomarker in critically ill patients with sepsis: A retrospective single-center study

BackgroundThis study aimed to examine the potential prognostic significance of the D-dimer-albumin ratio (DAR) in critically ill patients with sepsis. MethodsA retrospective cohort study was carried out at the Affiliated Hospital of Jiangsu University, involving 1123 patients diagnosed with sepsis from January 2015 to November 2023. The patients were categorized into four groups (Q1-Q4) based on their DAR levels. The primary outcomes measured were in-hospital mortality and ICU mortality. Survival analysis was conducted using Kaplan-Meier survival curves and the log-rank test. Additionally, Cox proportional hazards regression models were utilized to investigate the relationship between the DAR and all-cause mortality. ResultsThe study population had a median age of 75 years (interquartile range: 65–84), and the median DAR was 0.15 (interquartile range: 0.08–0.32). The rates of hospital mortality and ICU mortality were 33.7 % and 31.9 % respectively. There was an observed increase in the cumulative incidence of 30-/60-day mortality with higher DAR levels (log-rank test, P < 0.001). After accounting for other variables, the results from multivariable Cox proportional hazards analyses demonstrated that DAR independently predicted hospital death [HR (95%CI): 1.419 (1.205–1.670); P < 0.001] and ICU death [HR (95%CI): 1.437 (1.219–1.693); P < 0.001]. ConclusionsThe DAR was found to be an independent predictor of all-cause mortality in critically ill patients with sepsis.

Short-term exposure to ambient air pollution and severe COVID-19: mortality and hospital admission to COVID-19 in the Netherlands from february to december 2020

This study aimed to examine acute effects of exposure to ambient air pollution on COVID-19 hospital admissions and mortality in the Netherlands. We hypothesized that exposure to increased air pollution in the preceding week might trigger an exacerbation of health of infected individuals.Associations between daily concentrations of particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5) and ≤10 µm (PM10), nitrogen dioxide (NO2), ozone (O3) and risk of hospital admissions and mortality due to COVID-19 from February to December 2020 was analyzed across all 352 Dutch municipalities grouped into 12 provinces. Time-series models were used to fit province-specific estimates, followed by meta-analyses to produce national estimates. Analyses were based on daily averages of PM2.5, PM10, NO2, and maximum 8-hour running average of O3 on a 1×1 km grid and averaged on municipality level by population weight. Models were adjusted for spatiotemporal confounders, including government policies in response to the number of COVID-19 infections. Since there were only few COVID-19 cases during the summertime when O3 levels were highest, associations between O3 and COVID-19 health outcomes were not further explored.We found associations between exposure to air pollution in the preceding week (average of lag 0-7 days) and COVID-19 hospital admissions and mortality. On a national level, an interquartile range increase in PM2.5, PM10 and NO2 exposure was associated with 11-12% increased mortality risk; the risk for hospital admissions was higher: 19-25%. Observed associations were more robust for PM than NO2 in two-pollutant models.Our results suggest that short-term exposure to PM2.5 and PM10 may increase the risk of COVID-19 mortality and hospital admission. This indicates that, consistent with previous studies on air pollution and respiratory infections, the population at risk of being hospitalized or dying of COVID-19 is extra vulnerable to the adverse effects of short-term air pollution exposure.

Hospital admissions for pyoderma gangrenosum in Spain (1999-2021): Epidemiological and clinical characteristics, temporal trends, and factors associated with poor prognosis and higher cost.

Pyoderma gangrenosum (PG) is a neutrophilic inflammatory dermatosis that can be idiopathic or associated with other diseases. The aim was to analyze the epidemiological and clinical characteristics, temporal trends, risk factors for poor prognosis, and admission costs associated with PG in Spain. We conducted a retrospective study, based on the Hospital Discharge Registry of the Spanish National Health System in Spain from 1999 to 2021. Of 82,161,670 admissions during the study period, 4901 were for PG (hospitalization rate of 59.7/1,000,000 admissions). PG hospitalizations increased from 28.8/1,00,000 in 1999 to 91.9/1,000,000 in 2021. PG was a primary cause of admission in 60.5% of cases, and 58.4% of patients were women. The main PG-related comorbidities were inflammatory bowel disease (15.7%) and neoplasms (10%). There was a significant increase over the years in admissions for inflammatory bowel disease, monoclonal gammopathy of undetermined significance, and lymphoma, as well as an increase in diseases unrelated to PG, such as hypertension, diabetes, and chronic kidney disease. The hospital mortality rate was 5.6%. Death was associated with PG being a primary diagnosis, older age, leukemia, neoplasms, diabetes, and chronic kidney disease. The cost of treatment increased over the years and was higher in older people. PG cases in the inpatient setting in Spain over the past 23 years make up a tiny proportion of all hospital admissions, although the rate of hospitalization for PG has increased in the last two decades.

SINGLE-CENTER EXPERIENCE OF HEART TRANSPLANTATION AT THE HEART CENTER OF ASTANA

Background. Chronic heart failure is a major global health issue. As a complication of most cardiovascular diseases, it affects 4% of the population. Heart transplantation is the gold standard in the treatment of patients with end-stage heart failure. Objective of the study was to evaluate early and long-term outcomes of heart transplants performed at the Heart Center University Medical Center (Heart Center) over a 10-year period. Materials and methods. Cross-sectional study was conducted from 2012 to 2022, 86 orthotopic heart transplants were performed at the Heart Center. The analysis of the obtained results was conducted retrospectively. Results. From August 2012 to December 2022, 114 patients were on the waiting list for heart transplantation. Of these, 86 (75.4%) patients underwent transplantation; 10 (8.7%) patients were excluded. Among the 86 patients, 49 (56.9%) had previously undergone cardiac surgery. Of these, 42 (48.8%) had a left ventricular assist device implanted earlier, 3 (3.4%) had a fully artificial heart, and 2 (2.5%) were on temporary mechanical support (central veno-arterial Extracorporeal membrane oxygenation). Hospital mortality was 8 (9.3%) recipients. In 2.7% of cases, the cause of death was an acute cerebrovascular accident on the second day post-surgery. Postoperative renal dysfunction was noted in 28 (32.5%) patients. An analysis of all performed heart transplantation cases showed a 30-day survival rate of 94%, a 1-year survival rate of 84.3%, and a 5-year survival rate of 64.7%. Conclusion. In the hospital period and the first 6 months after heart transplantation, infectious-septic complications were predominant, whereas in later periods, rejection reactions were more common.

Mortality association with extremity trauma and transferring patients for higher level of care

Introduction: Rising healthcare costs and reduced Medicaid reimbursements pose lasting challenges for trauma centers. Various studies have highlighted the adverse effect of these cost-related circumstances on trauma center survival and the need for local hospitals to transfer patients to tertiary and quaternary care centers. Our study seeks to assess the relationship between patient transfer status to a higher level health center and association on mortality. Methods: A total of 19,417 patients were identified, of which 15,317 patients presented directly to the higher level health center, and 3,830 patients who transferred from 49 different outside hospitals within a 500 mile radius. Data collection was collected from the receiving higher level of care hospital trauma registry. IBM SPSS version 23 was used to analyze the data. A 1:1 propensity matched analysis based on age, gender, and injury severity score yielded 3,566 patients that presented directly to ARMC and 3,566 patients who were transferred to ARMC for higher level of care. Amongst various factors we considered mechanism of injury, response levels, arrival methods, and transfusion of blood products. Results: The univariate analysis of the propensity matched analysis demonstrated 88% blunt injury in the non-transferred group and 82% in the transferred group (P&lt;0.001). Overall, hospital mortality was 3% in non-transferred patients versus 4% in the transferred group (P&lt;0.001). A multivariate logistic regression demonstrated mortality is more likely in patients with higher injury severity scores (Odd Ratio (OD) 2.351 (1.029-1.082), P&lt;0.001) and lack of packed red blood cell (pRBC) transfusions received within first 4 hours (OD 6.852 (3.525-13.318), P=0.001). Conclusion: The transfer of trauma patients with extremity injuries to Level 1 trauma centers has significant implications on patient outcomes. In our retrospective observational cohort study, we noted increased mortality among patients with higher injury severity scores, penetrating injuries, pRBC administration within the first 4 hours of hospitalization, and among patient transfers.

Use of noninvasive measurement of the indocyanine green plasma disappearance rate in patients with septic shock.

Our aim was to analyse the relation between serial values of the indocyanine green plasma disappearance rate (ICG-PDR) with hospital mortality in the first 48 hours of ICU admission in patients with septic shock. A prospective observational study was carried out over 12 months of patients admitted to the ICU with septic shock. Each patient underwent noninvasive determination of ICG-PDR at 24 and 48 hours with the LiMON® module. Follow-up was performed until hospital discharge or exitus. 63 patients. Age 61.1±12.3 years. 60.3% men. SOFA score on admission 8.7±3.3, APACHE II score was 27.9±10.7 points. A total of 44.4% of patients died. The ICG-PDR values in the first 24 hours of ICU admission were lower in nonsurvivors: 10.5 (5.7-13.0)%/min vs. 15.9 (11.4-28.0)%/min, p <0.001. Furthermore, in nonsurvivors, there was no improvement in ICG-PDR between 24 h and 48 h, while in survivors, there was an increase of 25%: 15.9 (11.4-28.0)%/min and 20.9 (18.0-27.0)%/min, p=0.020. The silhouette measure of ICG-PDR cohesion and separation for the clusters analysed (nonsurvivors and survivors) was satisfactory (0.6). ICG-PDR<11.7%/min was related to in-hospital mortality, ICG-PDR> 18%/min to survival, and the interval between 11.7% and 18%/min covered a range of uncertainty. In the two-stage cluster, ICG-PDR, SOFA and APACHE II present satisfactory predictive scores 24 hours after patient admission. ICG-PDR in our setting is a useful clinical prognostic tool and could optimise the decision tree in patients with septic shock.