In-hospital Mortality Outcomes Research Articles

Red cell distribution width to albumin ratio and mortality in acute pulmonary thromboembolism.

The red cell distribution width (RDW)/albumin ratio (RAR) is an inflammation-based prognostic biomarker. To date, its prognostic value in patients with pulmonary thromboembolism (PTE) has been investigated in only one study. This study aimed to assess the effect of RAR on mortality in patients with PTE. Patients admitted for PTE between 2017 and 2023 were retrospectively reviewed. The data collected included demographic information, comorbidities, clinical findings, RDW, albumin, troponin, D-dimer levels, and in-hospital and 30-day mortality outcomes. RAR was calculated by dividing the RDW by albumin. A total of 190 patients were included in the study, of whom 83 (43.7%) were male. The mean age was 63 years (range: 23-89), and the mean RAR was 4.48% ± 1.68% /g/dL. A positive correlation was observed between RAR and both age and troponin level, whereas inverse correlations were noted with systolic blood pressure (sBP), diastolic blood pressure (dBP), and oxygen saturation (SpO2). Using a cutoff value of 5.294 determined by ROC analysis, patients with RAR ≥ 5.294 had a significantly shorter mean survival time than those with RAR value < 5.294 (16.310 months vs35.163 months; log-rank test, P < 0.001). Multivariate Cox regression analysis identified malignancy (hazard ratio [HR], 4.213; 95% confidence interval [CI], 1.103-16.090; P = 0.035) and RAR (HR: 1.295, 95% CI: 1.035-1.621, P = 0.024) as independent predictors of survival. In conclusion, an RAR value ≥ 5.294 was associated with significantly shorter survival, underscoring its potential utility as a prognostic marker in clinical practice for non-massive PTE.

Analysis of outcomes of penetrating colonic injuries managed with or without fecal diversion

Traumatic colorectal injuries can be managed by either fecal diversion or primary repair / resection and anastomosis. We aimed to study differences in outcomes in adult patients managed with or without fecal diversion at time of initial operation. The National Trauma Databank (NTDB) was used to identify adult patients (ages 18–64 years) with penetrating colonic injuries for the years 2013–2015. We included patients with Injury Severity Score (ISS) of 9–24 excluding patients with concomitant extra-abdominal Abbreviated Injury Scale (AIS) score of 3 or more. Subjects arriving without signs of life, expiring in ER or with missing data were excluded. Data was collected for age, gender, vital signs on presentation, discharge disposition and length of stay (LOS). Patients were divided into two groups based on whether or not fecal diversion was performed within 1 day of presentation. Primary outcome assessed was in-hospital mortality and unplanned return to OR. Secondary outcomes were acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), deep vein thrombosis (DVT), pulmonary embolism (PE), pneumonia, organ surgical site infection (SSI), deep SSI, severe sepsis and unplanned intubation. Statistical analysis was conducted using SPSS for windows. P-value < 0.05 was considered statistically significant. Of 2,598,467 patients, 5344 (0.21%) sustained a penetrating colonic injury. 2339 (43.8%) patients met criteria for age, ISS, AIS, signs of life and ED outcome. 173 patients underwent fecal diversion within 24 h of presentation (Group 1) while 708 did not (Group 2). Patients with missing data were excluded leaving 162 patients in Group 1 and 657 patients in Group 2. Groups 1 and 2 were noted to be similar in terms of ISS (median of 10 in both), age (median of 31 vs 29 years), percentage of male patients (85.2% vs 87.8%; p = 0.44), mean systolic blood pressure (127 mmHg vs 126 mmHg; p = 0.54), mean pulse rate (95.4 vs 94.5; p = 0.60) and mean respiratory rate (20.4 vs 20.1; p = 0.56) respectively. Median LOS was 10 days in both groups. No statistically significant differences were found between groups 1 and 2 in the primary outcomes of in-hospital mortality (2.4% vs 3.5%; OR: 1.43; 95% confidence interval (CI): 0.49–4.20) or unplanned return to OR (4.3% vs 7.8%; OR: 1.86; 95% CI: 0.83–4.19). No statistically significant differences were noted between groups 1 and 2 in the secondary outcomes of AKI (3.7% vs 3.8%; OR: 1.03; 95% CI 0.41–2.55), ARDS (1.2% VS 1.7%; OR: 1.36; 95% CI 0.30–6.21), DVT (1.9% vs 4.0%; OR: 2.18; 95% CI 0.65–7.31), PE (1.9% vs 2.0%; OR: 1.07; 95% CI 0.30–3.80), pneumonia (4.9% vs 5.3%; OR: 1.08; 95% CI 0.49–2.38), organ SSI (3.7% vs 7.0%; OR: 1.96; 95% CI: 0.82–4.67), deep SSI (3.7% vs 4.4%; OR: 1.20, 95% CI 0.49–2.94), severe sepsis (3.7% vs 3.3%; OR: 0.90; 95% CI: 0.36–2.26) or unplanned intubation (1.9% vs 1.7%; OR: 0.90; 95% CI 0.25–3.27). Adult patients with penetrating colonic injuries with ISS 9–24 in the absence of serious extra-abdominal injury who undergo surgery within 24 h of presentation do not seem to derive a statistically significant benefit from fecal diversion in terms of post-operative complications and mortality. In more severely injured patients fecal diversion may continue to provide a benefit.

Performance of ICD-10-based injury severity scores in pediatric trauma patients using the ICD-AIS map and survival rate ratios.

The performance of injury severity scores, used widely to quantify injury severity and predict outcomes, has not been investigated in German pediatric cases. This study aims to identify the most feasible and accurate injury score predictor of mortality in German children with trauma using International Classification of Diseases 10 (ICD-10). Between 2014 and 2020, a retrospective observational cohort study of hospital admissions cases aged < 18 years with injury-related ICD-10 codes using the German hospital database (GHD) was conducted. The maximum abbreviated injury scale and injury severity score were calculated using the ICD-AIS map provided by the Association for the Advancement of Automotive Medicine, adjusted to the German modification of the ICD-10 classification. The survival risk ratio was used to calculate the single worst ICD-derived injury (single ICISS) and a multiplicative injury severity score (multiplicative ICISS). Logistic regressions were conducted for each of the four above mentioned scores (predictors) to predict in-hospital mortality(outcome), in the selected trauma population and within four clinically relevant subgroups, using discrimination and calibration. 1,720,802 were trauma patients and ICD-AIS mapping was possible in 1,328,377 cases. Cases with mapping failure (n = 392,425;22.8%) were younger and had a higher mortality rate were excluded from the performance analysis. ICISS-derived scores had a better discrimination and calibration than ICD-AIS based scores in the overall cohort and all four subgroups (AUC ranges between 0.985-0.998 vs 0.886- 0.972 respectively). Empirically derived measures of injury severity were superior to ICD-AIS mapped scores in the GHD to predict mortality in pediatric trauma patients. Given the high percentage of mapping failure and high mortality among cases with single coded injury, the single ICISS may be the most suitable measure of injury severity in this group of patients.

"Awake" Cannulation of Patients for Venovenous Extracorporeal Membrane Oxygen: An Analysis of the Extracorporeal Life Support Organization Registry.

"Awake" cannulation for venovenous extracorporeal membrane oxygenation (ECMO), where patients remain spontaneously breathing without invasive mechanical ventilation during the cannulation procedure, may reduce lung injury from positive pressure ventilation and promote patient mobility. To examine the association between "awake" cannulation for venovenous ECMO and patient outcomes. Analysis of the prospectively collected by the multicenter Extracorporeal Life Support Organization registry. Patients 18 years old or older who were cannulated for venovenous ECMO between 2016 and 2022 were included. Propensity score matching techniques were used to examine the association between the primary exposure of "awake" cannulation and the primary outcome of hospital mortality. This study analyzed data from 28,627 patients who received venovenous ECMO, including 797 (2.8%) who underwent awake cannulation. Patients undergoing awake cannulation were older (52.2 vs. 47.8 yr), had greater prevalence of chronic lung diseases (50.6% vs. 48.9%), and ischemic heart disease (4.3% vs. 2.7%) compared with those cannulated while receiving mechanical ventilation. Hospital survival to discharge was did not differ significantly between awake and nonawake cannulation groups after propensity score matching (2.4% increased rate of survival for patients cannulated awake; 95% CI, -1.7% to 6.4%; p = 0.26). In this large, multicenter study, awake cannulation for venovenous ECMO was uncommon but increasingly used over time. Survival to hospital discharge was similar to patients cannulated while on mechanical ventilation. Future research should focus on identification of patient cohorts most likely to benefit from ""awake" cannulation.

Differential Outcomes and Treatment in Non-traumatic Carotid versus Vertebral Cervical Artery Dissection: A National Inpatient Sample Study.

Cervical artery dissection (CAD) involves the carotid or vertebral artery. However, limited studies have compared their clinical features and outcomes. We examined non-traumatic CAD patients from the National Inpatient Sample (2005-2019). Those diagnosed with both carotid and vertebral artery dissections were excluded. The evaluation included patient demographics, comorbidities, and treatment. Differences between carotid and vertebral dissections were assessed using survey-weighted stepwise backward logistic regression, followed by adjusted multivariable regressions for the primary outcomes of in-hospital mortality and routine discharge (to home or self-care). From 2005 to 2019, we included 123,224 non-traumatic CAD admissions without concurrent vertebral and carotid dissections. There were more carotid dissections than vertebral dissections (67,533 vs. 55,691). Compared to vertebral dissection, carotid dissection was associated with older age (54 [44-66] years vs. 49 [37-62] years, P<0.001), Black race (12.6% vs. 8.8%, P<0.001), White race (73.5% vs. 72.0%, P = 0.024), atrial fibrillation (10.8% vs. 6.3%, P<0.001), aortic dissection (7.7% vs. 0.3%, P<0.001), and fewer concurrent acute ischemic strokes (AIS) (47.8% vs. 56.7%, P<0.001).Within the concurrent AIS group, carotid CAD patients exhibited higher NIHSS (8 [2-17] vs. 2 [0-5], P<0.001), an increased utilization of intravenous thrombolysis (6.7% vs. 2.7% P<0.001), endovascular therapy (13.3% vs. 3.3%, P<0.001), and angioplasties (9.8% vs. 0.3%, P<0.001). Overall, carotid CAD was associated with more inpatient deaths (aOR 1.30, 95% CI 1.04-1.62, P=0.023) and less routine discharges (aOR 0.88, 95% CI 0.79-0.97, P=0.014) than vertebral CAD. Our study underscores distinct comorbidity profiles and treatment patterns between non-traumatic carotid dissection and vertebral dissection groups. These findings advocate for tailored treatment strategies based on dissection type to optimize patient outcomes.

Sarcopenia is associated with worse outcomes in patients with inflammatory bowel disease: insights from US national hospitalization data.

Inflammatory bowel disease (IBD) is an inflammatory disorder associated with significant morbidity and mortality. Recent studies have reported sarcopenia as a significant factor affecting the quality of life and outcomes of these patients. We used the National Inpatient Sample 2016-2020 to identify adult patients with IBD. The patients were stratified into two groups based on the presence of sarcopenia. Data were collected on patient demographics, hospital characteristics, and comorbidities. The outcomes studied were in-hospital mortality, sepsis, shock, ICU admission, and need for surgery. Multivariate logistic regression analysis was performed. A total of 1 524 820 IBD hospitalizations were included. Of these, 209 615 (9%) were noted to have sarcopenia. Patients with sarcopenia had a higher incidence of in-hospital mortality (4.2% vs. 1.2%, P < 0.001), ICU admission (6.5% vs. 2.4%, P < 0.001), and need for abdominal surgery (6.5% vs. 3.5%, P < 0.001). After adjusting for confounders, the presence of sarcopenia was associated with higher odds of in-hospital mortality (adjusted odds ratio: 2.83, 95% confidence interval: 2.66-3.02, P < 0.001) and additional worse outcomes. Our study reports that the presence of sarcopenia was associated with an increased risk of death and the need for abdominal surgery. Preventative measures aimed at improving sarcopenia should be taken to prevent worse outcomes in this patient population.

Predictive Value of Clinical and Dual-Energy Computed Tomography Parameters for Hemorrhagic Transformation and Long-Term Outcomes Following Endovascular Thrombectomy.

This study's objective was to explore whether certain parameters measurable by dual-energy computed tomography (DECT) performed 24 h after endovascular thrombectomy (EVT) can predict subsequent hemorrhagic transformation. We retrospectively reviewed patients with acute ischemic stroke (AIS) managed with EVT who had follow-up DECT within 24 h post-EVT between January 2019 and December 2023. Clinical and image parameters were recorded for predictive factor analysis. The primary outcome was hemorrhagic transformation, which was determined by using follow-up computed tomography (CT) or magnetic resonance imaging (MRI). The secondary outcomes were in-hospital mortality and 3-month post-EVT favorable functional outcome, as defined by a modified ranking scale (mRS) score of ≤2. A total of 152 patients were included in this study. Multivariable analysis showed that the VNC-ASPECT score (p = 0.002) and superior sagittal sinus density (p = 0.01) were significantly associated with hemorrhagic transformation. For in-hospital survival rate analysis, post-EVT NIHSS measured 24 h post-EVT was an effective predictor, with a cutoff value of 23 (≤23: 88% vs. >23: 52.1%; p < 0.001). For functional outcome analysis, age (p < 0.001), tPA prior to EVT (p = 0.017), NIHSS 24 h post-EVT (p = 0.001), and VNC-ASPECT score (p < 0.003) were associated with a favorable functional outcome 3 months after EVT. The VNC-ASPECT score was associated with both hemorrhagic transformation and a 3-month post-EVT favorable functional outcome, and could therefore be an useful predictor for the development of hemorrhagic transformation.

Forecasting heart failure: Seasonal alignment of heart failure outcomes in New York.

Seasonal variations have been observed in heart failure (HF) hospitalization. Numerous explanatory mechanisms have been proposed, but no prior studies have examined potential contributors directly. Our objective was to identify specific factors that could contribute to seasonal variability using a large longitudinal dataset of HF hospitalizations. Hospital discharge data were obtained for all hospitals in the state of New York from 1994 to 2007. Records with a primary diagnosis of HF by the International Classification of Diseases-9 Clinical Modification (ICD-9-CM) code (428.xx and 425.xx) were included. Year and month of admission were used as predictors to evaluate outcomes of in-hospital mortality, population-adjusted daily rate of hospital admissions and length of stay (LOS) using univariable regression including a sinusoidal model to assess the seasonality of HF outcomes. Observations were then adjusted for multiple medical covariables as well as the average local monthly temperature and humidity at each hospital using data from the Global Historical Climate Network to identify potential modifiers of seasonal variability. Among 949907 records, the median age was 76 [inter-quartile range (IQR) 65-84years old], and the cohort was 54% female (510945 records). The population-adjusted rate of HF admissions per day increased by 1.1 admissions/day/year between 1994 and 2007, whereas in-hospital mortality and LOS decreased by -0.3%/year and -0.3days/year, respectively (P<0.001 for all). Seasonal trends were identified for daily HF admissions (February peak, P<0.0001), mortality (January peak, P<0.001) and LOS (January peak, P<0.01). Cosinor analysis revealed significant periodicity for HF admission rate (amplitude=±0.9 admissions/day/100000 people, P<0.001), in-hospital mortality (amplitude=±0.47%, P<0.001) and LOS (amplitude=±0.23days, P<0.01). No other patient characteristics were significant modifiers of seasonality. Odds of mortality were highest in July rather than January when adjusted for average local temperature but not humidity. Adverse outcomes in patients hospitalized with HF were significantly worse in the winter months even when adjusted for patient characteristics and concurrent acute diagnoses such as pneumonia. Local ambient temperature was the strongest modifier of the observed seasonality. Given the increasing frequency of extreme weather events, additional work to determine the mechanisms of this and other environmental risk factors is urgently needed.

Pre-admission opioid use disorder as a new predictor of in-hospital mortality and six-month outcomes in traumatic brain injury patients: a retrospective longitudinal cohort study.

The present study aimed to investigate the effect of pre-admission Opioid Use Disorder (OUD) on in-hospital mortality and 6-month follow-up TBI outcomes. This study included 2804 patients with TBI admitted to the Intensive Care Unit of Emtiaz (Rajaee) Hospital, a referral trauma center in Shiraz, Iran. Finally, 1087 eligible participants were selected from included patients. Then, 872 discharged patients were followed for six months. Subsequently, unfavorable neurological outcomes (Glasgow Outcome Scale-Extended ≤ 4) and the mortality rate were compared among the patients with and without OUD. The mean age of the patients was 38.0 ± 18.9 years old (84.7% men). About 9.2% of patients had OUD. Opioid users had a slightly lower risk of in-hospital mortality (OR = 0.62, 95% CI = [0.328, 1.183], P-value = 0.148). In contrast, 6-month follow-up mortality significantly increased in the survived patients with a history of pre-admission OUD (OR = 2.49, 95%CI= [1.29, 2.80], P-value = 0.007). Moreover, 6-month unfavorable outcomes were raised in OUD, though it was not significant (OR = 1.59, 95%CI= [0.89, 2.84], P-value = 0.121). Our results revealed that patients with OUD are at increased risk of 6-month follow-up complications and also death following moderate to severe TBI. Although OUD decreased in-hospital mortality, 6-month follow-up indicated that mortality and unfavorable outcomes were increased in the OUD group. Based on the existing evidence, this effect is probably not only due to the destructive impact of pre-admission OUD on brain physiology. However, it may also be due to an increase in opioid consumption to alleviate pain and withdrawal symptoms after hospital discharge.

Abstract 4138225: In-Hospital Outcomes of Percutaneous Coronary Intervention (PCI) in patients primarily admitted with ST-Elevation Myocardial Infarction (STEMI) at PCI centers versus patients transferred from non-PCI centers, a retrospective study involving the National Inpatient Sample (NIS 2016-2021) database.

Background: Timely transfer for PCI is paramount in the management of STEMI. This has been shown to reduce myocardial damage, optimize reperfusion therapy and mitigate the post procedural complications associated with PCI. This study's aim was to describe the in-hospital outcomes associated with acute inter-hospital transfer of patients with STEMI for PCI in comparison with patients directly admitted to a primary PCI center. Methods: The National Inpatient Sample (NIS) was used to identify patients who underwent PCI for STEMI between the years 2016-2021. Based on several transfer indicators, primarily admitted patients and patients with acute inter-hospital transfer were identified. Logistic and linear regression models were used to analyze the primary outcome of in-hospital mortality and secondary outcomes of length of hospital stay, hospital charge, and occurrences of post-procedure complications. Results: Observations were weighted to obtain a national estimate of 748,430 patients with known transfer status who underwent PCI for STEMI. Of these, 625,520 patients were primarily admitted at PCI centers and 122, 910 patients were transferred from non-PCI centers. The mean age of patients with STEMI undergoing PCI was 62 years, and 72 % of the patients were male. There was no significant difference in mortality between patients transferred and patients primarily admitted for PCI due to STEMI. However, patients transferred had longer hospital stay and significantly higher healthcare cost, with a mean difference of 0.72 days (95% CI: 0.65 - 0.81 days, p-value &lt;0.000) and $3,354 (95% CI: $339 - $6371, p-value &lt;0.029), respectively. Patients transferred also had significantly higher odds of post procedure complications, including cardiogenic shock (Odds ratio: 1.49, 95% CI: 1.08 - 2.06, p-value &lt;0.014), cerebrovascular accident (Odds ratio: 3.64 , 95% CI: 1.15 - 11.45, p-value &lt;0.014) and kidney failure (Odds ratio: 2.10 , 95% CI: 1.09 - 4.02, p-value &lt;0.026). Conclusion: Patients with STEMI who were transferred for PCI experienced longer hospital stay and incurred higher healthcare costs. These patients had significantly higher odds of post procedure complications including cardiogenic shock, cerebrovascular accidents and kidney failure.

Abstract 4125493: Is There an Obesity Paradox for Cardiovascular Outcomes in Patients Undergoing Transcatheter Edge-to-Edge Repair? A Pilot Meta-Analysis

Background: The impact of body mass index (BMI) on Transcatheter Edge-to-Edge Repair (TEER) outcomes remains uncertain, with studies showing conflicting results. Some suggest an 'obesity paradox' exists, favoring better outcomes for obese patients and worse outcomes for underweight patients, while others report no significant impact of BMI. Methodology: We conducted a systematic literature search using major databases to identify studies investigating the association between baseline BMI status and post-procedural outcomes in patients undergoing TEER. Patients were categorized into four BMI groups: underweight (BMI &lt; 18.5 kg/m 2 ), normal weight (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25-29.9 kg/m 2 ), and obese (BMI ≥ 30 kg/m 2 ). The endpoints included were the risk of in-hospital mortality, myocardial infarction, and stroke. Data were pooled using Review Manager with a random-effects model. Risk ratios (RRs) with their 95% confidence intervals (CIs) were used as the effect measure. Statistical significance was set at p&lt;0.05. Results: Our study included a total of six observational studies, encompassing 7,627 obese and 74,820 non-obese patients. The outcome of in-hospital mortality revealed no significant difference between the two groups (RR: 0.85; 95% CI: 0.57, 1.27; p=0.43). Subgroup analysis showed a trend towards higher in-hospital mortality risk for underweight patients compared to overweight (RR: 1.48; 95% CI: 1.11, 1.95; p=0.007) and obese patients (RR: 1.40; 95% CI: 1.02, 1.92; p=0.04). The comparison between underweight and normal-weight patients did not reach statistical significance (RR: 1.18; 95% CI: 0.91, 1.55; p=0.22). Additionally, the risk of myocardial infarction (RR: 1.10; 95% CI: 0.77, 1.58; p=0.59) and stroke (RR: 0.43; 95% CI: 0.13, 1.42; p=0.17) did not differ significantly between obese and non-obese patients. Conclusions: Our study found no significant difference in in-hospital mortality between obese and non-obese patients. However, underweight patients had a higher mortality risk compared to both overweight and obese patients. While myocardial infarction rates were similar across all groups, there was a non-significant trend suggesting a potentially lower risk of stroke in obese patients. These findings warrant further prospective studies to provide robust evidence.

Abstract 4134267: Effects of GLP-1 Receptor Agonists and SGLT2 Inhibitors on In-Hospital Mortality and 30-Day Readmission in Type 2 Diabetic Patients with Acute Coronary Syndrome

Background: The effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium–glucose cotransporter 2 inhibitors (SGLT2is) on reducing cardiovascular events in heart failure patients are well-established; however, less is known about their effects after a myocardial infarction. This study aims to investigate the effects of GLP-1RAs and SGLT2is on in-hospital mortality and 30-day readmission in type 2 diabetic patients with/without heart failure who were hospitalized for acute coronary syndrome (ACS). Methods: We conducted a multicenter retrospective cohort on type 2 diabetic patients who were admitted to the hospital for ACS from 01/01/2020 to 01/31/2024 across 16 West Florida hospitals. Patients receiving a GLP-1RA alone, SGLT2i alone, or both were compared to those taking neither. Chi-square and binary logistic regression were used to predict the clinical outcomes of in-hospital mortality, all-cause readmission within 30 days, and cardiac readmission within 30 days. Results: Among 7,481 type 2 diabetics with ACS, 392 (5.24%) were taking GLP-1RA monotherapy, 577 (7.71%) were taking SGLT2i monotherapy, 144 (1.92%) were taking both, and 6,362 (85.12%) were taking neither. The likelihood of in-hospital mortality was similar among patients on neither medication compared to patients on both (χ 2 = 0.06, p = 0.802), GLP-1RA monotherapy (χ 2 = 0.61, p = 0.435), and SGLT2i monotherapy (χ 2 = 0.002, p = 0.968). The odds of all-cause readmission within 30 days was similar among patients on neither medication compared to patients on both (χ 2 = 0.0004, p = 0.983), GLP-1RAs monotherapy (χ 2 = 0.07, p = 0.791), and SGLT2i monotherapy (χ 2 = 3.10, p = 0.078). The likelihood of cardiac readmission within 30 days was similar among patients on neither medication compared to patients on both medications (χ 2 = 1.63, p = 0.202), GLP-1RA monotherapy (χ 2 = 0.95, p = 0.329), and SGLT2i monotherapy (χ 2 = 0.94, p = 0.332). Conclusion: Our study found no significant differences in the odds of in-hospital mortality or 30-day readmission among type 2 diabetics with ACS who were taking GLP-1RAs, SGLT2is, or both, when compared to those taking neither. These findings further support the outcomes discovered in the EMPACT-MI trial.

Comparison of Outcomes Between ST-Segment Elevation and Non-ST-Segment Elevation Myocardial Infarctions Based on Left Ventricular Ejection Fraction.

Background: This study was conducted to address the lack of reports comparing the clinical outcomes of non-ST-segment elevation myocardial infarction (NSTEMI) and STEMI based on left ventricular ejection fraction (LVEF). Methods: A total of 9854 patients from the Korea Acute Myocardial Infarction Registry-National Institute of Health dataset were classified into three LVEF categories: heart failure (HF) with reduced ejection fraction (EF) (HFrEF, n = 1250), HF with mildly reduced EF (HFmrEF, n = 2383), and HF with preserved EF (HFpEF, n = 6221). Each group was further divided into NSTEMI and STEMI groups. The primary clinical outcome was the incidence of patient-oriented composite outcomes, defined as all-cause death, recurrent myocardial infarction, any repeat coronary revascularization, hospitalization for HF, and stroke. Results: Following adjustment, in-hospital mortality rates were comparable between the NSTEMI and STEMI groups in the HFrEF and HFmrEF groups. However, 3-year mortality rates were higher in the NSTEMI group. In contrast, in the HFpEF group, the STEMI group had higher rates of in-hospital all-cause death (p = 0.001) and cardiac death (p < 0.001) compared to the NSTEMI group, which was associated with increased 3-year all-cause death (p = 0.026) and cardiac death (p < 0.001) in the STEMI group. When in-hospital mortality was excluded, no difference in 3-year mortality rates was observed between the NSTEMI and STEMI groups in the HFpEF group. Conclusions: In-hospital mortality and 3-year outcomes varied across LVEF groups. Therefore, comparing NSTEMI and STEMI based on LVEF provides valuable insights into the differences in patient outcomes.

Effect of increased systemic oxygen delivery on postoperative outcomes and quality of life in elderly undergoing major abdominal surgery: A randomised controlled trial.

Studies comparing the intentional increase in oxygen delivery and normal oxygen delivery during general anaesthesia in elderly patients undergoing major abdominal surgery are limited and have reported contradictory findings. Therefore, the study aimed to evaluate the effect of intraoperative increase in systemic oxygen delivery on postoperative outcomes and quality of life in elderly patients undergoing major abdominal surgery. This randomised, blinded, parallel-arm, pragmatic clinical trial included elderly patients of >60 years of age undergoing major abdominal surgery. The patients in the intervention arm received noradrenaline or increased fractional inspiration of oxygen to augment central venous oxygen saturation ⩾75%. The primary outcome measure was composite of in-hospital mortality and major organ complications. The secondary outcome measure included comparison of quality of life. A total of 160 patients were assessed for eligibility, and 146 were randomised in the study groups. The mean arterial and central venous oxygen saturation increased and were significantly higher in the intervention arm. The composite primary outcome occurred in 49.31% in the intervention arm and 57.53% in the usual care arm (relative risk; 95% confidence interval: 0.85; 0.63-1.16; absolute risk reduction; 8.22%; p = 0.32). Furthermore, quality of life at the end of three months was similar (0.658 ± 0.19 versus 0.647 ± 0.19; p = 0.771). In conclusion, central venous oxygen saturation-guided increase in systemic oxygen delivery during the intraoperative period of major abdominal surgery in elderly patients did not reduce predefined composite outcome of in-hospital mortality or organ-specific complications.

Effectiveness of an Impella versus intra-aortic balloon pump in patients who received extracorporeal membrane oxygenation: a nationwide inpatient database study

Abstract Background/Introduction Previous studies have suggested that left ventricular (LV) unloading with an intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (Impella) in combination with extracorporeal membrane oxygenation (ECMO) is associated with lower mortality; however, it is unclear which is better. Purpose This study aimed to evaluate the effectiveness of LV unloading with an Impella versus IABP on in-hospital mortality and other clinical outcomes. Methods Using the Japanese Diagnosis Procedure Combination database from September 28, 2016, to March 31, 2022, we identified inpatients who received an Impella or IABP in combination with ECMO (ECPella or ECMO+IABP group, respectively). The primary outcome was in-hospital mortality and the secondary outcomes were the length of hospital stay, length of ECMO, total hospitalization cost, and complications including major bleeding, an ischemic stroke, vascular complications, and renal replacement therapy during hospitalization. Propensity score matching was performed to compare the outcomes between the groups. We performed sensitivity analyses excluding patients who received extracorporeal cardiopulmonary resuscitation. Results Of 14,525 eligible patients, 603 (4.2%) received ECPella and 13,922 (96%) received ECMO+IABP. After propensity score matching, there was no significant difference in in-hospital mortality between the two groups (58.9% versus 56.6%; risk difference, 2.3%; 95% confidence interval, -3.9% to 8.5%). A Kaplan–Meier analysis with the log-rank test showed no significant difference in the 60-day in-hospital mortality between the two groups (P value = 0.114) (Figure 1). The ECPella group had a longer hospital stay (mean 42.8 days versus 33.7 days; risk difference, 9.1 days; 95% confidence interval, 2.6 to 15.6 days), a higher total hospitalization cost (12,573,000 yen versus 6,857,000 yen; risk differences, 5,716,000 yen; 95% confidence interval, 4,439,000 yen to 6,993,000 yen), and more frequent major bleeding (8.1% versus 5.8%; risk difference, 2.0%; 95% confidence interval, 0.007% to 4.0%), vascular complications (4.1% versus 2.2%; risk difference, 2.0%; 95% confidence interval, 0.04% to 3.9%), and renal replacement therapy during hospitalization (50.6% versus 41.1%; risk difference, 9.5%; 95% confidence interval, 3.0% to 15.9%) than the ECMO+IABP group (Figure 2). The results of the sensitivity analyses, excluding 6,360 patients (44%) who received extracorporeal cardiopulmonary resuscitation, showed similar results to those for the main analyses. Conclusions This nationwide inpatient database study showed that ECPella was not associated with a survival benefit but was associated with a longer hospital stay, a higher total hospitalization cost, and more complications than ECMO+IABP.Figure 1Figure 2

Clinical features and outcomes of patients diagnosed with diabetic ketoacidosis (DKA) who were hospitalized for conditions outside of internal medicine

AimsTo assess the clinical features and outcomes of patients diagnosed with DKA who were hospitalized for conditions outside of internal medicine. MethodsRetrospective analysis of admissions for DKA in adult patients between 2005 and 2022 at a tertiary hospital in Israel. Patients with DKA were stratified into medical vs non-medical groups, the primary outcome was in-hospital mortality. Results429 patients were included in the study, 385 patients (89.7 %) were treated by an internal medicine team, while 44 patients (10.3 %) were hospitalized with surgical or obstetrical conditions. Patients in the non-internal medicine group were older (52 ± 18.9 vs 43.6 ± 20.4, p < 0.005) and had higher rates of diabetes complications such as chronic ischemic heart disease (20.5 % vs. 4.2 %, p < 0.0001) and chronic kidney disease (50 % vs. 3.4 %, p < 0.001). Glucose level on presentation was lower for non-internal medicine patients (398 ± 221 mg/dL vs 551 ± 180 mg/dL) and outcomes of mechanical ventilation and length of hospitalization were more severe (29.5 % vs. 6 %, p < 0.001 and 8.0 vs. 3.0, p < 0.001). Multivariate analysis demonstrated that composite outcome of in-hospital mortality, ICU admission and longer hospitalization was more likely in the non-internal medicine group (OR 3.99, CI 1.89–8.4, p < 0.001). ConclusionDKA is a universal pathology that concerns various medical fields. It is essential for every clinician to be familiar with this condition. Patients diagnosed with DKA who were hospitalized for conditions outside of internal medicine may be at high risk and may present with lower glycemic levels. Future research is needed to characterize the unique features of subgroups of patients with DKA.

Changing epidemiology and antimicrobial susceptibility of bloodstream infections at a Vietnamese infectious diseases hospital (2010–2020)

Bloodstream infection (BSI) poses a global health problem, with diverse organisms and rising antimicrobial resistance (AMR). Here, we characterized trends in BSI prevalence, AMR, and antibiotic use at a Vietnamese infectious diseases hospital from 2010 to 2020. Among 108,303 cultured blood samples, 8.8% were positive, yielding 7995 pathogens. Of 7553 BSI cases, 86.4% were community-acquired. BSI prevalence varied from 17 to 35 cases/1000 admissions/year, highest in HIV/hepatitis wards and patients >60. The in-hospital mortality or hospice discharge outcome was 21.3%. The top three pathogens, E. coli (24%), K. pneumoniae (8.7%) and S. aureus (8.5%) exhibited increasing prevalence and multidrug resistance. Pathogens like Cryptococcus neoformans (8.4%), Talaromyces marneffei (6.7%), and Salmonella enterica (6.5%) declined. E. coli and K. pneumoniae were prevalent in older adults with community-acquired BSIs. Antibiotic use reached 842.6 DOT/1000 PD and significantly reduced after an antibiotic control policy. Enhanced surveillance and antimicrobial stewardship are crucial for managing BSIs in Vietnam.

Modified furosemide responsiveness index and biomarkers for AKI progression and prognosis: a prospective observational study.

Modified furosemide responsiveness index (mFRI) is a novel biomarker for assessing diuretic response and AKI progression in patients with early AKI. However, the comparative predictive performance of mFRI and novel renal biomarkers for adverse renal outcomes remains unclear. In a single-center prospective study, we aimed to evaluate the discriminatory abilities of mFRI and other novel renal biomarkers in predicting AKI progression and prognosis in patients with initial mild and moderate AKI (KDIGO stage 1 to 2). Patients with initial mild and moderate AKI within 48h following cardiac surgery were included in this study. The mFRI, renal biomarkers (including serum or urinary neutrophil gelatinase-associated lipocalin [sNGAL or uNGAL], serum cystatin C, urinary N-acetyl-beta-D-glycosaminidase [uNAG], urinary albumin-to-creatinine ratio) and cytokines (TNF, IL-1β, IL-2R, IL-6, IL-8, and IL-10) were measured at AKI diagnosis. The mFRI was calculated for each patient, which was defined as 2-hour urine output divided by furosemide dose and body weight. Of 1013 included patients, 154 (15.2%) experienced AKI progression, with 59 (5.8%) progressing to stage 3 and 33 (3.3%) meeting the composite outcome of hospital mortality or receipt of renal replacement therapy (RRT). The mFRI showed non-inferiority or potential superiority to renal biomarkers and cytokines in predicting AKI progression (area under the curve [AUC] 0.80, 95% confidence interval [CI] 0.77-0.82), progression to stage 3 (AUC 0.87, 95% CI 0.85-0.89), and composite outcome of death and receipt of RRT (AUC 0.85, 95% CI 0.82-0.87). Furthermore, the combination of a functional biomarker (mFRI) and a urinary injury biomarker (uNAG or uNGAL) resulted in a significant improvement in the prediction of adverse renal outcomes than either individual biomarker (all P < 0.05). Moreover, incorporating these panels into clinical model significantly enhanced its predictive capacity for adverse renal outcomes, as demonstrated by the C index, integrated discrimination improvement, and net reclassification improvement (all P < 0.05). As a rapid, cost-effective and easily accessible biomarker, mFRI, exhibited superior or comparable predictive capabilities for AKI progression and prognosis compared to renal biomarkers in cardiac surgical patients with mild to moderate AKI. Clinicaltrials.gov, NCT04962412. Registered July 15, 2021, https://clinicaltrials.gov/ct2/show/NCT04962412?cond=NCT04962412&draw=2&rank=1 .

Comparative Effectiveness of Albumin vs No Albumin on Renal Replacement Therapy and Mortality in Patients With Septic Shock and Renal Impairment

Albumin infusions may be renally protective or harmful in patients with septic shock who have kidney impairment. This can affect the need for renal replacement therapy (RRT) and in-hospital mortality. Does the early use of albumin mitigate the need for RRT or in-hospital mortality in patients with septic shock and kidney impairment on hospital admission? This was a retrospective, multicenter, inverse probability-of-treatment weighted cohort study conducted in 220 geographically diverse community and teaching hospitals across the United States. Adult patients were included if they had septic shock and kidney impairment on hospital admission. Patients were categorized as those who received albumin (within 24 hours of admission) or no albumin during hospitalization. Proportion of patients with RRT or in-hospital mortality were compared between groups. Of the 9,988 patients included in the final cohort, 7,929 did not receive albumin and 2,059 received albumin. Patients had a mean ± SD age of 67.8 ± 14.8 years, 46.3%were female, and the mean estimated glomerular filtration rate was 32 ± 12mL/min/1.73 m2 on the day of admission. In the weighted cohort, the composite outcome of RRT or in-hospital mortality occurred in 33.8%without albumin and 39.7%with albumin treatment (OR, 1.29; 95%CI, 1.14-1.47; P< .001). There was no significant difference with 5%albumin (OR, 1.07; 95%CI, 0.84-1.37), but there was a significantly increased risk with 25%albumin (OR, 1.43; 95%CI, 1.16-1.76). In patients with septic shock and kidney impairment on hospital admission, early albumin use may be associated with an increased composite outcome of RRT or in-hospital mortality. This increased risk is most associated with hyperoncotic albumin rather than iso-oncotic albumin.

Frailty and adverse outcomes in patients over 65 years old with acute coronary syndrome in a hospital cohort in Medellin, Colombia

Several studies have demonstrated an association between frailty and worse outcomes in patients with acute coronary syndrome (ACS); however, there is a lack of evidence from Colombia. This study aims to evaluate the association between frailty and the risk of adverse outcomes in patients over 65 years old diagnosed with ACS. A prospective cohort study was conducted, including patients over 65 years old who underwent coronary angiography due to an ACS diagnosis at a hospital in Medellín, Colombia. Frailty was assessed using the FRAIL scale. The primary outcome was all-cause mortality at 30 days. Secondary outcomes included length of hospital stay and a composite outcome of in-hospital or 30-day mortality, contrast-induced nephropathy (CIN), acute heart failure, cardiogenic shock, hemorrhagic complications, and vascular complications. A total of 112 patients were included. Frail patients (n=35, 31.3%) were older, had a lower socioeconomic status, higher GRACE scores, and more severely compromised coronary vessels. A significant association was observed between frailty and 30-day mortality (relative risk [RR] 19.00, 95% confidence interval [CI]: 5.04-72.61; p<0.001), the composite outcome (RR 4.57, 95% CI: 2.56-8.34; p<0.001), and longer hospital stays (9 days vs. 5 days in the non-frail group). A considerable number of patients over 65 years old with ACS were frail. Frailty was associated with adverse in-hospital and 30-day outcomes.