In-hospital Mortality Research Articles

Letter: Comparison of In-Hospital Mortality and Neurosurgical Intervention Between Intracranial Gunshot Wounds Arising from Long Guns and Handguns: A Propensity Score Matched Study.

Letter: Comparison of In-Hospital Mortality and Neurosurgical Intervention Between Intracranial Gunshot Wounds Arising from Long Guns and Handguns: A Propensity Score Matched Study.

Versatility of the Axillary Intra-Aortic Balloon Pump in Adult Cardiac Surgery

The axillary intra-aortic balloon pump (ax-IABP) has been proposed as an alternative to the femoral IABP, particularly for patients with comorbidities rendering them unsuitable for fem-IABP insertion. Patient mobilisation with the ax-IABP in situ is deemed an additional potential benefit. We reviewed our experience with the ax-IABP. A single-centre retrospective review of all adult patients undergoing cardiac surgery (including heart transplantation) in a UK quaternary cardiac surgery centre between 2017 and 2021 was undertaken. During the study period a total of 232 IABPs were inserted, of which 2.2% (n = 5) were ax-IABPs. Overall in-hospital mortality for this cohort was 19.9% (n = 46). Amongst the five patients who received an ax-IABP, the mean age was 57.4 years, and three patients were female. All patients received an ax-IABP through the right axillary artery via a Dacron side graft. Appropriate positioning was confirmed with real-time fluoroscopy and transoesophageal echocardiography. Operations included heart transplantation (n = 1), coronary artery bypass grafting (CABG) (n = 1), CABG & mitral valve surgery (n = 2) and CABG & mitral & aortic valve surgery (n = 1). No patient experienced IABP-related morbidity and three patients survived to discharge. In this limited series, ax-IABP has emerged as a reasonable alternative to fem-IABP. Several patients in this series who received an ax-IABP were not suitable for fem-IABP. The absence of IABP-related morbidity in this series supports the usage of ax-IABP as an appropriate alternative treatment for patients requiring IABP support.

Association between stress hyperglycemia ratio and all-cause mortality in critically ill patients with sepsis: results from the MIMIC-IV database

BackgroundThis study aimed to explore the association between the stress hyperglycemia ratio (SHR) and short- and long-term outcomes in critically ill patients with sepsis.MethodsThis retrospective observational cohort study was conducted using the Medical Information Mart for Intensive Care-IV (MIMIC-IV v2.2) database. Patients were categorized into 4 SHR quartiles. The main focus was on in-hospital mortality and 1-year all-cause mortality as primary endpoints, while intensive care unit and hospital stays were considered as secondary outcomes. Regression and subgroup analyses were used to assess the correlation between SHR and the primary and secondary outcomes. Restricted cubic spline analysis was utilized to explore the nonlinear relationships between SHR and in-hospital and 1-year all-cause mortality.ResultsThis study included two groups of patients, comprising 7456 and 6564 individuals. The in-hospital and 1-year mortality was 11.96% and 17.96% in Cohort 1 and 2, respectively. SHR was associated with an elevated risk of in-hospital mortality (OR: 2.08, 95%CI 1.66–2.61) and 1-year mortality (HR: 1.70, 95% CI 1.42–2.04). Patients in SHR quartile 4 had a higher risk of in-hospital (OR: 1.86, 95% CI 1.51–2.30) and 1-year (HR: 1.44, 95% CI 1.23–1.69) mortality than those in quartile 2. Restricted cubic spline analysis showed a “J-shaped” relationship between SHR and all-cause mortality in both cohorts. The relationship between high SHR and mortality remained consistent across almost all predefined subgroups.ConclusionsOur study suggests that high SHR is associated with increased in-hospital and 1-year mortality in critically ill sepsis patients. Further investigations are needed to validate these results.

Neutrophil to platelet ratio predicts in-hospital mortality in patients with acute myocardial infarction.

Acute myocardial infarction (AMI) is a critical medical emergency worldwide and a leading cause of mortality. This study aims to investigate the predictive utility of the neutrophil-to-platelet ratio (NPR) in identifying AMI patients at an increased risk of in-hospital mortality. We enrolled 664 patients, including 421 with ST-elevation myocardial infarction (STEMI) and 243 with non-ST-elevation myocardial infarction (NSTEMI), at Zhongshan Hospital, Fudan University, from January 2020 to September 2023. NPR was calculated as the neutrophil count divided by the platelet count. The primary outcome was defined as in-hospital mortality. The overall in-hospital mortality among AMI patients was 6.78%. Mortality was notably higher in the high NPR group compared to the low NPR group. Univariate analysis identified several variables significantly associated with in-hospital mortality, including age, left ventricular ejection fraction (LVEF), neutrophil-to-lymphocyte ratio (NLR), and NPR. NPR demonstrated a strong independent association with in-hospital mortality following adjustment for potential confounders. Receiver operating characteristic (ROC) curve analyses were performed to assess the discriminative power of NPR and NLR in predicting in-hospital mortality. NPR exhibited an area under the curve (AUC) of 0.755 (95% CI, 0.682-0.829, p < 0.001), indicating good discriminative ability. Similarly, NLR showed a discriminative AUC of 0.674 (95% CI, 0.586-0.762, p < 0.001). The optimal cutoff values for predicting mortality were determined as 0.042 for NPR (sensitivity 80%, specificity 62.2%) and 8.02 for NLR (sensitivity 62.2%, specificity 67.5%). Bootstrap validation with 1000 iterations confirmed the robustness of these findings, with validated AUCs of 0.755 (95% CI, 0.681-0.826) for NPR and 0.674 (95% CI, 0.587-0.766) for NLR. This study identifies NPR as an independent and valuable predictor of in-hospital mortality among AMI patients, The findings underscore NPR's potential utility in clinical practice for risk stratification and early intervention strategies aimed at reducing mortality rates in this high-risk patient population.

Racial/Ethnic Associations with Morbidity and Mortality in Adults with Acute Traumatic Cervical Spinal Cord Injury.

Retrospective cohort study. This study aimed to investigate the association of race with morbidity and mortality in acute cervical spinal cord injury (cSCI) patients. Racial disparities in spine surgery are associated with adverse outcomes, however, the impact of race on cSCI is understudied. We retrospectively reviewed the American College of Surgeons Trauma Quality Programs database to compare outcomes for acute cSCI patients between racial/ethnic identities: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino (HIS), and other (OTH). Demographics, comorbidities, injury type, treatment modality, and adverse events (AEs) were assessed. Multivariable logistic regression was used to identify independent predictors of AEs, non-routine discharge (NRD), and in-hospital mortality. There were 71,048 patients stratified by race/ethnicity: 44,639 (62.8%) NHW, 13,555 (19.1%) NHB, 5,820 (8.2%) HIS, and 7,034 (9.9%) OTH. NHB and HIS-identifying patients had the greatest rates of any AE (NHW: 20.7% vs. NHB: 25.0% vs. HIS: 24.6% vs. OTH: 22.0%, P<0.001) and the longest mean length of stay (NHW: 11.3±13.5d vs. NHB: 15.5±20.2d vs. HIS: 15.0±20.5d vs. OTH: 12.6±17.5d, P<0.001). NRDs were lowest for HIS-identifying patients (NHW: 74.8% vs. NHB: 75.5% vs. HIS: 69.5% vs. OTH: 75.4%, P<0.001), while in-hospital mortality was lowest for NHB-identifying patients (NHW: 12.8% vs. NHB: 10.1% vs. HIS: 12.4% vs. OTH: 13.4%, P<0.001). On multivariable analyses, NHB (OR: 1.16, P<0.001), HIS (OR: 1.22, P<0.001), and OTH (OR: 1.14, P=0.004) cohorts had significantly increased odds of AEs. The NHB cohort had significantly increased odds (OR: 1.25, P<0.001), while the HIS cohort had significantly decreased odds (OR: 0.78, P=0.001) of NRD. Only the NHB cohort had significantly decreased odds of in-hospital mortality (OR: 0.69, P<0.001). Our study suggests racial disparities in outcomes and discharge disposition for acute cSCI patients.

Analysis of etiology and short-term prognosis of childhood arterial ischemic stroke based on the COIST classification

Objective: This study aims to analyze the etiology and short-term prognosis of childhood arterial ischemic stroke (AIS) in Chinese children, based on the COIST classification system. Methods: A total of 380 pediatric patients with a first-ever diagnosis of AIS treated at Beijing Children's Hospital between September 2015 and April 2024 were retrospectively included. Etiology was analyzed according to COIST classification. The patients were categorized into infant and toddler group with 117 cases (>28 days to≤3 years), preschool group with 90 cases (>3 years to≤7 years), school-age group with 90 cases (>7 years to≤11 years), and adolescent group with 83 cases (>11 years to≤18 years). The etiological distribution across age groups and the short-term prognosis of patients with different etiologies were further analyzed. Results: Among the 380 patients, 235 were male (61.8%) and 145 were female (38.2%), with a mean age at presentation of(6.6±4.6)years. Approximately 2/3 of the patients were admitted in the Department of Neurology, with a mean hospital stay of (13.2±6.7)days. (1) Etiological analysis: "Vascular structural abnormalities" were the most common cause, accounting for 38.2% (145/380), followed by "Inflammatory" causes at 31.1% (118/380), "Undetermined" at 11.1% (42/380), "Other identifiable causes" at 9.2% (35/380), "Cardiac diseases" at 6.3% (24/380), and "thrombophilia" at 4.2% (16/380). (2) Etiological distribution by age group: in the infant and toddler group, "vascular structural abnormalities" were 47.9% (56/117), with basal ganglia infarction following minor trauma(combined with basal ganglia calcification) being the most common (40/117). In the preschool group, there were 34 cases (34/90) of "inflammatory" and 33 cases (33/90) of "vascular structural abnormalities", with Moyamoya disease being the most frequent cause (15/90). In the school-age group, there were 37(37/90) cases of "vascular structural abnormalities", with arterial dissection (12/90)being the most common, followed by FCA-i (11/90), and Moyamoya disease (11/90). In the adolescent group, there were 34 cases of "inflammatory"(34/83), with the highest proportion of FCA-i (13/83) in the subgroup, followed by thrombophilia (9/83) and systemic lupus erythematosus (8/83). (3) Short-term prognosis: based on the PSOM scale, 188 cases had good prognosis, accounting for 49.5% (188/380), while 192 cases had poor prognosis, accounting for 50.5% (192/380). According to the mRS score, 207 cases had good prognosis (54.5%) and 173 cases had poor prognosis (45.5%). Subtypes such as "Inflammatory-noninfectious, " FCA-i, Moyamoya disease, and arterial dissection were associated with relatively better outcomes. Less than 1/3 of patients in the "other identifiable causes" group had favorable prognosis. The in-hospital mortality rate was 3.7% (14/380). Conclusions: Vascular structural abnormalities and inflammatory (including infectious and non-infectious) factors are the predominant causes of pediatric AIS; Approximately half of children with AIS had a favorable short-term outcome.

Selective Minimally Invasive Strategy for Acute Superior Mesenteric Artery Obstruction.

Acute mesenteric artery obstruction is a severe cause of acute mesenteric ischemia, associated with significant morbidity and mortality. However, there is limited guidance on choosing between traditional and minimally invasive techniques comprehensively. This study introduces a selective, minimally invasive strategy designed to improve the survival and prognosis of patients with acute superior mesenteric artery obstruction. In this prospective, single-arm trial conducted between 2020 and 2023, patients with acute mesenteric ischemia due to acute superior mesenteric artery obstruction were enrolled. A total of 42 patients were included, meeting the predetermined sample size. The primary outcome was the 30-day chronic intestinal failure (CIF)-free survival rate. Based on an algorithm incorporating preoperative radiographic findings, physical signs, and laboratory markers, patients were assigned to one of three therapeutic pathways: traditional laparotomy with thrombectomy, laparoscopy combined with endovascular therapy, or endovascular therapy alone. The CIF-free survival rates at 30 days and 2 years were 71% (30/42) and 60%, respectively. Short-term mortality, including 30-day and in-hospital mortality, was 11.9%, indicating an improvement compared to historical cohorts. The cumulative mortality rates at 6 months, 1 year, and 2 years were 26%, 32%, and 32%, respectively. The primary and assisted patency rates at 1 year were 90% and 97%, respectively. Transition to laparotomy was required in 43% of patients undergoing laparoscopic exploration. Improved blood supply was observed in 73% of the patients who underwent two laparoscopic procedures (15 patients), and bowel resection was avoided in 40% of cases. The median durations of hospitalization and intensive care unit stay were 19 days (IQR 11-31) and 2 days (IQR 0-6), respectively. This selective, minimally invasive strategy for managing acute mesenteric ischemia demonstrated high 30-day CIF-free survival rates and reduced short-term mortality. These findings suggest the potential advantages of this approach in improving outcomes for patients with acute mesenteric ischemia.

ASO Visual Abstract: Perioperative Complications and In-Hospital Mortality in Radical Nephroureterectomy Patients with Heart Valve Replacement.

ASO Visual Abstract: Perioperative Complications and In-Hospital Mortality in Radical Nephroureterectomy Patients with Heart Valve Replacement.

Is Intracranial Pressure Monitoring After Open Cranial Procedures Associated With Outcome?

It is unclear if intracranial pressure monitoring (ICPM) after open cranial procedures (craniotomy or craniectomy) (OC) for traumatic brain injury is associated with mortality. We hypothesized that ICPM placed early after OC was associated with lower mortality compared to no ICPM or delayed ICPM placement. Using 2020-2021 data from the American College of Surgeons Trauma Quality Improvement Program, patients ≥16y from level 1 and 2 trauma centers who underwent OC were divided into two groups: ICPM placed within 72h of OC (early) and no ICPM or ICPM placed after 72h (none/delayed). Outcome was in-hospital mortality. Logistic regression was used to elucidate predictors of mortality. A total of 19,830 patients (early ICPM, 29%) were included. Early patients were more likely to be from level 1 centers (63% versus 60%, P=0.004), younger (median age 47 versus 60, P<0.0001), to have a lower Glasgow Coma Score (median, 6 versus 14, P<0.0001), higher injury severity score (median, 26 versus 26, P<0.0001), an unreactive pupil (33% versus 18%, P<0.0001), midline shift >5mm (69% versus 60%, P<0.0001), received ≥2 units of blood/first 4h (14% versus 6%, P<0.0001) and higher mortality (31% versus 19%, P<0.0001) compared to none/delayed patients. Controlled for significant variables, early ICPM was associated with increased mortality (odds ratio 1.35, 95% confidence interval 1.24-1.47). Analysis of subjects with isolated brain injury found a similar association (odds ratio 1.32, 95% C1 1.15-1.52). ICPM placed within 72h of OC was associated with increased mortality. Indications for ICPM after OC should be investigated further in multicenter prospective studies.

Hospital Safety-Net Burden is Associated with Perioperative Outcomes in Primary Total Hip Arthroplasty: A Multistate Retrospective Analysis, 2015-2020.

Total hip arthroplasty (THA) is a widely performed surgical procedure in the United States, but disparities in THA outcomes related to hospital-level factors, such as safety-net burden, are underexplored. This study expands on previous research by analyzing multicenter, multistate data from 2015 to 2020 to investigate the impact of hospital safety-net burden-defined as the proportion of services billed to Medicaid and uninsured patients-on THA outcomes. This study is a retrospective analysis using data from the State Inpatient Databases for Florida, Kentucky, Maryland, New York, Washington, New Jersey, and North Carolina. The study cohort included 543,814 inpatient primary THA admissions, with patient demographics, comorbidities, and hospital characteristics analyzed across 3 categories of hospital safety-net burden (low, medium, and high). Generalized linear mixed models assessed the association between safety-net burden and in-hospital mortality and postoperative complications, whereas multilevel negative binomial regression evaluated the impact on hospital length of stay. The study findings indicate that patients undergoing THA at hospitals with high safety-net burden had significantly higher odds of in-hospital mortality (adjusted odds ratio [aOR]: 1.20, 95% confidence interval [CI]: 1.02-1.42), postoperative complications (aOR 1.33, 95% CI 1.20-1.48), and longer hospital stays (adjusted incidence rate ratio 1.15, 95% CI 1.10-1.21) compared with those at low-burden hospitals. These results suggest that hospitals with higher safety-net burden, often serving more vulnerable populations, may have suboptimal perioperative processes and protocols, leading to poorer outcomes. The study underscores the need for targeted interventions to improve THA outcomes in these hospitals.

Disease burden and clinical status of congenital heart disease combined with heart failure in China: a survey and analysis

Objective: To investigate the disease burden, clinical characteristics and independent risk factors affecting in-hospital outcomes of children with congenital heart disease (CHD) combined with heart failure (HF) in China. Methods: (1) Descriptive study: based on the global burden of disease study 2021, available data on children under 15 years of age with CHD and HF in China from 1990 to 2021 were collected. The prevalence and trends in different age subgroups (<1 year, 1-<2 years, 2-<5 years, 5-<10 years, 10-<15 years) were analyzed, and the annual percentage change (EAPC) was estimated using linear regression. (2) Retrospective cohort study: a total of 1 062 children with CHD and HF from a multicenter study on pediatric HF in China were included. The children were divided into two groups:<2 years group and 2-<18 years group. Data on demographics, clinical features, diagnosis, treatments, and in-hospital outcomes were analyzed. Mann-Whitney U test and chi-square test were used for group comparisons.Multivariable Logistic regression was applied to identify factors influencing outcomes (in-hospital mortality and adverse cardiovascular events). Results: (1) From 1990 to 2021, the number of children with CHD and HF in China increased from 333 000 (95% uncertainty interval (UI) 271 000-405 000) to 368 000 (95%UI 296 000-459 000), a growth of 10.8% (95%UI 5.0%-16.6%). Concurrently the prevalence rate increased from 104.5 (95%UI 85.1-127.3) per 100 000 to 142.0 (95%UI 114.0-176.8) per 100 000, a growth of 35.9% (95%UI 28.7%-43.0%), with an EAPC of 1.5% (95%CI 1.2%-1.8%). Although the number of cases in the<1 year and 1-<2 years groups decreased by 41.0% and 25.6%, respectively, the prevalence in all age groups showed an upward trend:<1 year EAPC 0.6% (95%CI 0.5%-0.7%); 1-<2 years EAPC 0.9% (95%CI 0.8%-1.0%); 2-<5 years EAPC 1.2% (95%CI 1.0%-1.4%); 5-<10 years EAPC 1.5% (95%CI 1.2%-1.8%); 10-<15 years EAPC 2.1% (95%CI 1.9%-2.3%). (2) The multicenter study revealed that among 1 062 hospitalized children, 528 (49.7%) were male and 534 (50.3%) were female, with the age at admission of 5.4 (2.2,18.2) months. The majority of the children (77.9%, 827/1 062) were under 2 years of age, whereas 22.1% (235/1 062) were aged between 2-<18 years. Children with complex congenital heart defects accounted for the highest proportion (48.6%, 516/1 062), while those with isolated CHD made up 31.5% (335/1 062). Statistically significant differences were observed in several variables in demographics, clinical features, diagnosis, treatments, and outcomes between the two age groups (all P<0.05). The use of renin-angiotensin-aldosterone system inhibitors (41.1%, 436/1 062) and beta-blockers (8.7%, 92/1 062) was lower in hospitalized children with CHD and HF. Logistic regression identified complex CHD (OR=7.73, 95%CI 2.24-26.63; OR=3.17, 95%CI 1.92-5.23), pulmonary hyperperfusion (OR=2.15, 95%CI 1.01-4.18; OR=2.00, 95%CI 1.35-2.97), left ventricular ejection fraction<55% (OR=2.13, 95%CI 1.08-4.21; OR=2.80, 95%CI 1.45-5.56), arterial oxygen partial pressure (OR=0.99, 95%CI 0.98-0.99; OR=0.99, 95%CI 0.98-0.99), and serum calcium levels (OR=0.31, 95%CI 0.17-0.58; OR=0.42, 95%CI 0.28-0.62) as independent risk factors for in-hospital mortality and cardiovascular events. Conclusions: The disease burden of CHD combined with HF in China has shown a continuous upward trend from 1990 to 2021, with higher growth rates in older age groups. Complex CHD, pulmonary hyperperfusion, left ventricular ejection fraction <55%, arterial oxygen partial pressure, and serum calcium concentration are independent risk factors for in-hospital mortality and cardiovascular events.

Epidemiology of Coronavirus Disease 2019-Associated Fungal Infections in the Intensive Care Unit: A Single-Center Retrospective Study.

Invasive fungal disease (IFD) is a morbid superinfection that can arise in critically ill patients with COVID-19 infection. Studies evaluating the full spectrum of COVID-19-associated fungal infections remain limited. Single-center retrospective study assessing IFD in patients with COVID-19, hospitalized for ≥ 72h in the intensive care unit (ICU) between 02/25/20 and 02/28/22 (n = 1410). IFD was assessed using consensus criteria (EORTC/MSGERC or ISHAM/ECMM criteria). T- and chi-square tests compared demographic/clinical characteristics between IFD and non-IFD patients. Cox proportional hazards regression estimated risk factors for in-hospital mortality. Of 1410 patients with severe COVID-19, 70 (5%) had a diagnosis of COVID-19-associated fungal infection with invasive candidiasis occurring in 3%, and invasive aspergillosis in 2%. Other fungal infections were rare. Patients with IFD had longer ICU stays (26 vs. 13days; p < 0.001); increased rates of mechanical ventilation (99% vs. 70%; p < 0.001); and a higher risk of in-hospital death (69% vs. 36%; p < 0.001). On multivariable analysis, COVID-associated fungal infections were associated with an increased risk of in-hospital mortality. This real-world study of critically ill patients with COVID-19 demonstrated a low incidence of COVID-19-associated fungal infections with invasive candidiasis occurring most frequently. Fungal infections were associated with an increased risk of in-hospital mortality in this population.

Predictive value of the Hemoglobin, Albumin, Lymphocyte and Platelet score for mortality in geriatric patients presenting to the emergency department.

The Hemoglobin, Albumin, Lymphocyte and Platelet (HALP) score, calculated as hemoglobin × albumin × lymphocytes / platelets, serves as a novel biomarker that can provide insights into a patient's nutritional status, anemia status and inflammatory processes. This study aimed to investigate the predictive value of the HALP score for mortality among geriatric patients presenting to the emergency department. This retrospective study was carried out at the emergency department of a tertiary hospital. Patients aged ≥65 years who presented to the emergency department between 1 January 2018 and 1 January 2024 were included in the study. A total of 62 262 patients who visited our emergency department were enrolled. Patient data, including hemoglobin, albumin, lymphocyte and platelet values; age; sex, the reason for hospital presentation; and outcome (mortality or discharge) were obtained from electronic medical records. HALP scores were calculated for the patients, and statistical analyses were carried out. Of the patients, 32 410 were men, and the mean age was 73 years. Within this cohort, in-hospital mortality occurred in 3093 of the patients. The HALP score was significantly lower in patients who died compared with those who were discharged (P < 0.001). Due to its cost-effectiveness and ease of calculation, the HALP score appears to be more feasible in predicting mortality in the emergency department compared with other scoring systems. Geriatr Gerontol Int 2025; ••: ••-••.

Intravenous beta-blockers versus amiodarone on in-hospital mortality and safety profile in adult septic patients.

In the present study, we aimed to compare in-hospital mortality and safety of intravenous beta-blockers and amiodarone in septic patients with new-onset atrial fibrillation (NOAF). The null hypothesis is that there is no significant difference in in-hospital mortality and safety of Beta-blocker (BBs) and amiodarone in treating NOAF in patients with sepsis. We conducted a retrospective analysis based on the MIMIC-IV database. Septic patients with NOAF were screened. Patients admitted to adult mixed ICU for septic patients with NOAF. A total of 34,789 patients were screened of whom 1394 patients were included for the analysis: 286 in the amiodarone group and 1108 in the BBs group. None. Cox proportional hazard model was used to examine the in-hospital mortality, ventilator-free days and duration of atrial fibrillation in patients receiving either amiodarone or intravenous BBs. Propensity score matching was applied to determine any association. After Propensity Score (PS) matching, a total of 244 patients were included in both the BB and amiodarone groups. In this cohort, BBs was significantly associated with lower in-hospital mortality [adjusted hazard ratio (HR) of 0.70 (95% CI 0,54-0,91; P = 0.008)]. On the other hand, patients who received amiodarone had a shorter duration of atrial fibrillation (54.17 h vs 72.81 h; P = 0.003). There was no significant difference in ventilator-free days between the BB group and the amiodarone group. In septic patients with NOAF, patients receiving BBs had lower in-hospital mortality than those who received amiodarone. On the other hand, amiodarone group had a shorter duration of atrial fibrillation. There was no significant difference in ventilator-free days between the BB group and the amiodarone group.

Prevalence of Respiratory Syncytial Virus Infection in Hospitalized COPD Patients in Spain Between 2018-2022.

Respiratory syncytial virus (RSV) infection is a common cause of hospital admission. The association between chronic obstructive pulmonary disease (COPD) exacerbation and RSV infection is not well studied. To analyze the hospitalizations of patients with COPD and RSV infection in Spain between 2018 and 2022. The data used were obtained from the Spanish Hospital Discharge Database. We selected subjects aged ≥40 years diagnosed with COPD, admitted to the hospital from 1 January 2018 to 31 December 2022. The COPD population that met the selection criteria was subdivided based on the presence of an ICD-10 code for RSV infection. To obtain comparable populations, for each subject with COPD and RSV infection, a subject without an RSV code was selected, with the COPD code in the same diagnostic position (1 to 20), as well as the same year of admission, sex, and age. Among subjects aged ≥40 years, 1,429,288 were identified as having COPD, of whom 5673 also had RSV infection. The number of hospitalizations with COPD and RSV infection increased during the study period. The proportion of RSV infection among patients admitted for COPD increased significantly over time, from 0.32% in 2018 to 0.65% in 2022, p < 0.001. In-hospital mortality (IHM) increased over time, but the differences were not significant (6.23% in 2018 vs. 6.79% in 2022). Patients with COPD and RSV infection had, compared with those without RSV infection, a higher use of mechanical ventilation, both invasive (3.44% vs. 1.34%, p < 0.001) and noninvasive (8.09% vs. 4.51%, p < 0.001) and a higher proportion of intensive care unit (ICU) admission (7.21% vs. 3.9%, p < 0.001). After multivariate adjustment, a significant increase in IHM was found from 2018 to 2022 in subjects with and without RSV infection. The presence of RSV infection was associated with a higher mortality (OR 1.22; 95% CI 1.01-1.46). The proportion of RSV infection among patients admitted for COPD increased significantly over time. Patients with COPD and RSV infection had, compared with those without RSV infection, a higher severity, a higher use of mechanical ventilation, and a higher proportion of ICU admission. The presence of RSV infection was associated with IHM. These results can help to identify patients at higher risk and make decisions to avoid the increased risk of hospitalization and mortality in this population.

In-hospital mortality of patients admitted to the intermediate care unit in hospitals with and without an intensive care unit: a nationwide inpatient database study

BackgroundIntermediate care units (IMCUs) provide care for patients who need more intensive treatment than general wards but less than intensive care units (ICUs). Although the concept of an IMCU requires co-location with an ICU, some hospitals have IMCUs but no ICUs, which potentially worsens patient outcomes. This study aimed to examine the annual trends and care processes, and compare the outcomes of patients admitted to IMCUs in hospitals with and without ICUs using a nationwide inpatient database in Japan.MethodsThis retrospective cohort study was conducted from 2016 to 2022 using the Diagnosis Procedure Combination Database and Hospital Bed Function Reports in Japan. The main exposure was admission to the IMCU in hospitals with and without ICUs. The primary outcome was in-hospital mortality rate in hospitals with and without ICUs that were compared using multilevel logistic regression models adjusted for confounders.ResultsThe number of IMCU beds in hospitals without ICUs increased by 59% from 3,388 in 2016 to 5,403 in 2022, and the IMCU beds in hospitals without ICUs represented 38% (n = 5,403/14,185) of all IMCU beds in Japan in 2022. Among the 3,061,960 eligible patients in the IMCUs, 2,296,939 (75%) and 765,021 (25%) were admitted to hospitals with and without ICUs, respectively. Transfer between IMCUs and ICUs occurred for 10.5% (n = 320,938/3,061,960) of patients, with a large variability between hospitals. After adjusting for potential confounders, patients admitted to IMCUs in hospitals without ICUs had significantly higher in-hospital mortality than those in hospitals with ICUs (adjusted odds ratio: 1.15; 95% confidence interval: 1.10–1.20; p < 0.001).ConclusionsAdmission in IMCUs in hospitals without ICUs increased, but was associated with higher in-hospital mortality. These findings suggest that IMCUs should be placed in hospitals with ICUs.

Comparison of non-invasive ventilation on bilevel pressure mode and CPAP in the treatment of COVID-19 related acute respiratory failure. A propensity score-matched analysis.

The purpose of this study was to analyze the differences in the effectiveness and complications of CPAP versus non-invasive ventilation on bilevel positive airway pressure (BiPAP) in the treatment of COVID-19 associated acute respiratory failure (ARF). Retrospective observational study. ICU. All COVID-19 patients, admitted to an ICU between March 2020 and February 2023, who required CPAP or BiPAP were analyzed. Use of CPAP or BiPAP in COVID-19 associated ARF. Initial clinical variables, CPAP and BiPAP failure rate, complications, in-hospital mortality. 429 patients were analyzed, of whom 328 (76.5%) initially received CPAP and 101 (23.5%) BiPAP. Initial respiratory rate was 30 ± 8 in the CPAP group and 34 ± 9 in BiPAP (p < 0.001), while PaO2/FiO2 was 120 ± 26 and 111 ± 24 mmHg (p = 0.001), respectively. The most frequent complication related to the device was claustrophobia/discomfort, 23.2% in CPAP and 25.7% in BiPAP (p = 0.596), while the most frequent complications not related to the device were severe ARDS, 58.6% and 70.1% (p = 0.044), and hyperglycemia, 44.5% and 37.6%, respectively (p = 0.221). After adjusting by propensity score matched analysis, neither failure of the device (OR 1.37, CI 95% 0.72-2.62) nor in-hospital mortality (OR 1.57, CI 95% 0.73-3.42) differed between both groups. Either non-invasive ventilatory device failure or mortality rate differed in patients initially treated with CPAP versus BiPAP.

Association between base excess and mortality in septic older adults.

Septic older adults represent a vulnerable population with high mortality rates. Base excess (BE), an indicator of acid-base status, may serve as a prognostic marker in sepsis. This study aimed to investigate the association between BE and mortality in septic older adults. A retrospective analysis included septic older adults (age ≥ 65 years) from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The primary outcome was 30-day mortality. Multivariate Cox regression models and Kaplan-Meier analysis were used to assess the association between BE and 30-day mortality. A two-segment linear regression model with smooth curve fitting was employed to examine threshold effects of BE on clinical outcomes. The study comprised 7379 participants, with a 21.8% 30-day mortality rate and an 18.6% in-hospital mortality rate. A nonlinear, U-shaped relationship (P < 0.001) was observed between BE and 30-day mortality in septic older adults, indicating increased risk with higher or lower BE levels. Various BE groups showed different hazard ratios for mortality: 2.7 (2.26-3.22), 1.86 (1.65-2.09), 1.41 (1.19-1.67), and 1.9 (1.4-2.58), respectively, compared with the reference group (-3 mEq/L ≤ BE < 3 mEq/L). The inflection point was calculated as 0.5 mEq/L. Our findings suggest a U-shaped relationship between BE and mortality in septic older adults, emphasizing the importance of monitoring acid-base status in sepsis management for this population. Geriatr Gerontol Int 2025; ••: ••-••.

Damage Control Laparotomy in Trauma Patients: A Level I Trauma Center Experience

Introduction: The surgical management of traumatic injury is an evolving and controversial topic. We present outcomes of laparotomy performed for blunt and penetrating trauma at a level I trauma center over a nearly 10-year period. Material and Methods: Retrospective single-center cohort study of patients who received either damage control laparotomy or definitive laparotomy with fascial closure at the time of index procedure. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay, complications, intensive care requirements, and vasopressor use. Results: Out of 125 included patients, 69 received damage control laparotomy, and 56 received definitive laparotomy. Damage control laparotomy was associated with significantly higher mortality (20.9% vs 1.8%, p=.0015) and length of stay (16.1 vs. 9.3 days, p=.0005) than definitive laparotomy. Complications occurred significantly more frequently among damage control laparotomy patients (53.6% vs. 14.3%, p&lt;.0001). Damage control laparotomy patients were substantially more likely to require intensive care unit admission, mechanical ventilation, and vasopressor support. Conclusion: Patients undergoing damage control laparotomy are at significantly increased risk for adverse outcomes, including increased in-hospital mortality, prolonged length of stay, more significant complication burden, and increased need for mechanical ventilation and pressure support as compared to patients undergoing definitive laparotomy.

Evolution of the Quality of Care in Patients with Decompensated Heart Failure in a Venezuelan Hospital.

Background/Objectives: Several parameters have been proposed for the objective measurement of the quality of care (QoC) and breaches of care in patients with heart failure (HF). Therefore, the objective of this study was to evaluate the measures of QoC in inpatients with decompensated HF in the cardiology department of a tertiary Venezuelan hospital. Methods: An observational, descriptive, ambispective study was conducted with adults of all genders diagnosed with decompensated HF between 2022 and 2024. Sociodemographic, clinical, and therapeutic variables were assessed, as well as psychobiologic habits, measures of QoC, readmissions, and in-hospital mortality within the first 6 months of care. Results: Among the 131 subjects evaluated, the average age was 63.6 ± 14.1 years, with 58% (n = 76) being male. Among the in-hospital measures of QoC, the most common was the programming for follow-up consultations (98.5%; n = 129), followed by the prescription of beta-blockers (90.1%; n = 118). An upwards trend was also observed in the later years regarding the frequency of left ventricle ejection fraction (LVEF) assessment (p < 0.001), and the use of iSGLT2 (p = 0.03). During follow-up, 36.6% of the patients died within 6 months, with those in NYHA class IV showing a higher probability of death (OR: 3.84; CI95%: 0.89-16.55; 0.04). Conclusions: The in-hospital measures for QoC in this population were similar to those in previous reports, with LVEF assessment and iSGLT2 prescription showing a particularly significant increase in recent years.