In-hospital Mortality In Patients Research Articles

Comparing the ability of GRACE 2.0 and GRACE 3 scores for predicting in-hospital mortality in patients with and without diabetes

Abstract Background Sex-specific refinement of GRACE 2.0 was published as GRACE 3.0 (G3). The relative ability of G3 in predicting in-hospital mortality in diabetic patients has not been explored. Purpose Explore the ability of G3 in determining in-hospital mortality in patients with and without diabetes. Methods Retrospective cohort analysis of data on NSTEMI and UA patients admitted in two hospitals between 2010 and 2019 entered into the Myocardial Infarction National Audit Project database. All baseline characteristics and G2, G3 scores were recorded. In hospital death was recorded from hospital records. The discriminative power of the G2 score was determined by comparing the area under the receiver operating characteristic curve (c-statistics). Accuracy of calibration was evaluated by plotting the mean predicted vs observed mortality in each decile of predicted risk, Hosmer-Lemeshow (HL) goodness-off it test and the Nagelkerke R2 (NR2). Results G3 was calculated in 2768 patients (age 69±14yrs, 62.3% male, 877(31.7%) with diabetes. Median risk for the cohort was 1.3%, (95% CI 1.2 to 1.4). G3 risk was higher in patients with diabetes (median 2.0 IQR 0.6 to 5.5 vs 1.0 IQR 0.3 to 3.7, p<0.0001). In-hospital mortality occurred in 68 (2.5%) patients with no difference between the diabetes groups (3.1% and 2.2% died in the DM and non-DM groups respectively). In the whole cohort, G3 reclassified 139(7.5%) patients in low-intermediate to high risk-category and 159(17.4%) patients in high to low-intermediate category. 10.1% and 6.5% were upgraded and 16.1% and 18.1% were downgraded in DM and non-DM groups. Overall discriminatory power of G3 (AUC 0.87, 95% CI 0.86 to 0.88, p<0.0001) was excellent but no different from G2 (AUC 0.86 95% CI 0.85 to 0.88, p<0.0001) (δAUC 0.009, p=0.461). In patients with diabetes, G3 yielded higher AUC (AUC 0.85, 95% CI 0.83 to 0.87, p<0.0001) than G2 (AUC 0.82, 95% CI 0.79 to 0.84, p<0.00101) but this was not statistically significant (δAUC 0.031, p=0.142). In patients without DM, the difference was smaller (δAUC 0.002, p=0.906). Neither G2 (δAUC 0.061, p=0.185) nor G3 (δAUC 0.028, p=0.473) was better in discrimination in DM compared to non-DM groups (Fig1A,B). In the diabetic group, calibration plot for the G3 score showed suboptimal calibration with consistent overestimation of the risk across all risk deciles (Figure1C), with the HL test showing significant differences between the observed and predicted values (p <0.0001) and the NR2 was low 0.09. The GRACE 2 score showed better calibration (Fig1D) (HL: p=0.09, NR2 0.11). In patients without diabetes, calibration plot for the G3 (HL: p= 0.17; NR2 0.33) (Fig1E) and G2 (HL: p=0.15, NR2 0.25) (Fig1F) shows similar pattern of overestimation of the risk less so for latter. Conclusion G3 and G2 shows excellent discrimination for in-hospital mortality in both diabetic and non-diabetic patients. G2 seems to show better calibration than G3 for diabetic patients.

Subclinical left ventricular dysfunction detected by speckle tracking echocardiography predicts mortality in COVID-19 patients

Abstract In COVID-19 patients, both preexisting cardiovascular disease and cardiac injury resulting from SARS-CoV-2 infection are associated with increased mortality. In this patient population the value of speckle tracking echocardiography (STE) for detecting high-risk patients has not been evaluated thoroughly. Aim The aim of study was to determine the prevalence of subclinical myocardial dysfunction revealed by STE and its association with in-hospital and two-year mortality in patients with COVID-19 and preserved left ventricular ejection fraction (LVEF). Methods The study group comprised 163 consecutive patients with preserved LVEF(>/=50%) and maintained right ventricular function evaluated by assessment of tricuspid annular plane systolic excursion (TAPSE >14 mm) hospitalized in the cardiology department due to COVID-19 in 2020 and 2021. All patients underwent transthoracic echocardiographic examination with off-line analysis using STE. Left ventricular global longitudinal strain(GLS), right ventricular global longitudinal strain (RV-GLS), right ventricular free wall strain(RV-FWS) and myocardial work parameters: global work index(GWI), global wasted work(GWW), global constructive work(GCW) and global work efficiency(GWE) were measured. The primary outcome was in-hospital and two-year mortality. Results 96 patients (mean age 66 years, 59 [61%] male) had adequate image quality to evaluate deformation-derived parameters.19 patients (19.8%) died during hospitalization and 9 (9,4%) patients died within two years after discharge. In-hospital non-survivors were older, had lower baseline oxygen saturation(SpO2) and had higher NTproBNP. In non-survivors STE revealed significant impairment of LV and RV function compared to the group of survivors(Table 1). The independent predictors of in-hospital death were: age (OR 1.1 [95% CI 1.01 – 1.19]), SpO2 on admission (OR 0.83 [95% CI 0.75 – 0.93]), NTproBNP (OR 1.0003 [95% CI 1.0001 – 1.0006]) and LV-GLS (OR 1.45 (1.06 – 1.99)]. Based on the analysis of the ROC curves, the cut-off points optimal for predicting in-hospital death were identified: age >71 years (sensitivity [sens.] 74%, specificity [spec.] 68%) , baseline SpO2 value ≤ 89% (sens. 89%, spec. 74%,) NTproBNP >951 pg/ml (sens. 79%, spec. 58%) and GLS >-16% (sens. 63%, spec. 89%). The independent predictors of two-year mortality were: age (OR 1.10 [95% CI 1.02 – 1.19]), Sp02 on admission (OR 0.82 [95% CI 0.73 – 0.91]) and NTproBNP (OR 1.0006 [95% CI 1.0001 – 1.0011]).Based on the ROC curve analysis, the cut-off points optimal for predicting death within 24 months after COVID-19 were also identified: age>71 years (sens. 71%; spec. 72%), Sp02 <89% (sens. 69%, spec. 73%), NTproBNP >520 pg/ml (sens. 89%, spec. 48%). Conclusions STE allows for the detection of subclinical myocardial dysfunction in COVID-19 patients with preserved LVEF. However, LV GLS is the only independent STE-based predictor of in-hospital mortality in this patient population.

Outcomes of infective endocarditis in patients with end-stage renal disease and dialysis in Spain: a population-based study

Abstract Background Patients with end-stage renal disease (ESRD), particularly those undergoing dialysis, have a significantly higher risk of developing infective endocarditis (IE) compared to the general population. ESRD is not only related to a higher risk of infection, but also to a worse prognosis in IE. However, most data regarding the epidemiology and outcomes of patients with ESRD and IE is derived from noncontemporary population-based studies with limited clinical variables and lack of complete microbiological information, or from retrospective single-center cohorts. Purpose The aim is to describe the clinical characteristics and outcome of patients with IE and ESRD in Spain, compared to patients without ESRD, and to investigate potential differences between patients undergoing dialysis and the rest of patients with ESRD. Methods Retrospective observational population-based study. A total of 9,008 episodes of IE between 2016 and 2019 were analysed using information from the Spanish Minimum Basic DataSet. 428 patients had ESRD, of whom 332 were undergoing dialysis. A multivariable and multilevel logistic model was developed to evaluate the association of different variables with in-hospital mortality in ESRD patients. Results Compared to patients without ESRD, those with ESRD were younger, had more comorbidities, and had a higher incidence of Staphylococcus aureus (31.8% vs. 18.4%; p <0.001) and coagulase-negative staphylococci infections (19.2% vs. 14%; p =0.006). In terms of in-hospital complications, septic shock was more frequent in patients with ESRD (12.1% vs. 8.9%; p=0.007). Furthermore, ESRD patients underwent cardiac surgery less frequently than patients without ESRD (12.6% vs. 19.6%; p <0.001) and had significantly higher in-hospital mortality (33.4% vs. 26.9%; p =0.003). When comparing patients undergoing dialysis with the rest of ESRD patients, it was observed that those on dialysis had more comorbidities and a higher proportion of Staphylococcus aureus infections (36.1% vs. 16.7%; p <0.001). No differences were found in observed in-hospital mortality between patients on dialysis and the rest of ESRD patients. The multilevel analysis revealed that dialysis was not an independent risk factor for in-hospital mortality in patients with ESRD. Cardiac surgery was also not independently associated with higher in-mortality in ESRD patients. Conclusions Patients with ESRD and IE have a different clinical and microbiological profile than other patients with IE. Moreover, they undergo cardiac surgery less frequently and have significantly higher in-hospital mortality. Dialysis treatment and cardiac surgery were not independent risk factors for mortality in ESRD patients with IE.

Association of culprit lesions with in-hospital mortality in patients with acute coronary syndrome complicated by cardiogenic Shock

Abstract Background/Introduction The Society for Cardiovascular Angiography and Interventions (SCAI) shock stage is useful for stratifying short-term prognosis in patients with acute coronary syndrome (ACS). However, the impact of culprit lesion location for ACS on prognostic stratification by the SCAI shock stage remains insufficiently elucidated. Purpose This study aims to investigate the association between culprit lesion location for ACS and shock severity on in-hospital mortality. Methods We retrospectively investigated consecutive ACS patients who underwent percutaneous coronary intervention at a single center between January 2014 and October 2023. Patients were classified into five groups (No risk, Stage A, Stage B, Stage C, and Stage E) based on data at arrival in the emergency department using SCAI classification. The following culprit lesions were included in this analysis: left main coronary artery (LMCA), proximal right coronary artery (RCA), proximal left anterior descending artery (LAD), and proximal left circumflex artery (LCX). Results Of 1,665 patients included in the analysis, the mean age was 72±12 years, and females accounted for 26% overall. The distribution of SCAI shock stages by culprit lesions is shown in Figure 1. The proportion of stage B or higher in the LMCA, RCA, LAD, and LCX was 41%, 23%, 24%, and 24%, respectively. The corresponding in-hospital mortality was 20%, 3%, 5%, and 3%, respectively. The trend of in-hospital mortality stratified by shock severity and culprit lesions is demonstrated in Figure 2. LMCA and LAD showed increased in-hospital mortality with progressing shock severity. In contrast, this trend was not observed for RCA and LCX. Conclusions Except for LMCA, the proportion of shock stage B or higher was comparable. SCAI shock stage classification was useful in stratifying in-hospital mortality in patients where culprit lesions for ACS were LMCA and proximal LAD. Conversely, its validity in those with proximal RCA and LCX may be limited.

Biochemical variables as predictors of in-hospital mortality in patients with acute coronary syndrome

Abstract Background There is a constant search of easily obtainable variables that can be put in relation with in-hospital mortality, enabling creation of prediction risk models in patients treated for acute coronary syndrome. Purpose The main goal of this study was to unravel what is the profile of the patients with acute coronary syndrome in risk of in-hospital mortality, based on simple biochemical variables acquired at the time of hospital admission. Methods This was a single-center cross-sectional cohort study on 3007 pts. treated for ACS (STEMI and NSTEMI). Venous blood sample at hospital admission was acquired for every patient. Patients were comparatively analyzed for their biochemical variables derived from venous blood sample, based on occurrence of in-hospital mortality. Results Out of 3007 pts, 988 (28.2%) were females, and 2519 (71.8%) males, at mean age 62.6 +/- 11.2 y. In-hospital mortality rate was 4.8% (145 out of 3007). We subjected to comparative analyzed hemogram, markers of renal function including sodium and potassium, glycemic profile, complete lipid panel (including ApoA1 and ApoB), and highly sensitive troponin. Significant association with in-hospital mortality was found for: hsTn, stress glycemia and glicated hemoglobin, BUN, creatinite, eGFR, sodium, potasium, full lipid panel [except for HDL-C and Lp(a)]. In the second step, markers proven to be significantly different were subjected to multivariate binary logistic regression (backward conditional). We designed two models, one that included ApoA1 and ApoB (including 1816 pts. for whom we had data), and the second without these two parameters (including 3007 pts.). With the first model we identified: Advanced age, stress glycemia, WBC, eGFR, HDL-C and ApoA1 as independent predictors. Surprisingly, HDL-C was found to be strong independent predictor in multivariate analyzis. While with second modeling we identified advanced age, hsTn, stress glycemia, RBC, WBC, BUN and eGFR as independent predictors. Conclusion Advanced age is a strong independent predictor in any modelling. When we have a possibility to obtain a complete lipid panel, beside stress glycemia and WBC as markers of the degree of neuro-hormonal activation and inflammation, and renal function, HDL-C and ApoA1 seems to be strong negative independent predictors. In the absence of this data beside aforementioned markers of neurohormonal activation and inflammation, and renal function, the degree of myocardial injury plays a significant role. According to our data it seems reasonable to obtain complete lipid panel at hospital admission.Multivariate logistic regression modelsAge distribution across genders

Vascular complications in patients with peripheral veno-arterial extracorporeal membrane oxygenation: clinical-echocardiographic characteristics and predictors

Abstract Introduction Veno-arterial Extracorporeal membrane oxygenation (VA ECMO) is a salvage intervention in patients with cardiogenic shock (CS), and cardiac arrest (CA) refractory to standard therapies. Lower limb ischemia associated with peripheral VA ECMO is frequent, and is considered a serious complication with a significant impact on the morbidity and mortality. Purpose The aim of this study was to describe the clinical-echographic parameters and analyze predictors related to vascular complications in patients with peripheral VA ECMO. Methods The study was a single-center cohort analysis. It included all consecutive adult patients with peripheral femoro-femoral VA ECMO due to refractory cardiogenic shock (CS) or cardiac arrest (CA) between March 2014 and December 2022. Patients with central cannulation were excluded. The primary endpoint was evidence of vascular complications resulting in surgical intervention. A multivariate logistic regression model was used to adjust for variables of interest. Results The study included 83 patients (65± 12 years, 54% male). The main previous diagnosis was necrotic ischemic cardiomyopathy (33%), and the most frequent indication was postcardiotomy (40.9%), mainly in SCAI D (85.5%). Cardiopulmonary resuscitation was performed in 18.1%. Femoro-femoral cannulation was percutaneuos in 95.2%. Most patients had intra-aortic balloon pump (87.1%) and distal percutaneous cannula (88.8%). A total of 18 patients presented vascular complications (21.7%): 2 patients (11.1%) amputation, 5 patients (27.7%) compartment syndrome requiring fasciotomy, 9 patients (50.0%) thrombectomy, and 2 patients (11.1%) a surgical resolution post decannulation due to AV fistula. The median duration of VA ECMO was 5 days (IQR 2-8). Among the ultrasound variables, the systolic peak velocity (SPV) in the distal territory (tibioperoneal segment) had a median of 22 cm/sec (IQR 10-30). Pulsatile spectral Doppler flow in the cannulated limb was evidenced in 42 patients (50.6%) of total population, and only in 3 patients (16.6%) with vascular complications. The survival rate from VA ECMO was 57.8%, and the survival rate to discharge 42.1%. In-hospital mortality of patients with or without vascular complications did not show statistically significant differences (54.2 % vs 58.2 %, p= 0.26). After multivariate analysis, distal territory SPV less than 20 cm/sec (OR: 2.1, 95%CI: 1.3 – 12.1, p: 0.03), as well as history of previous vascular disease, were associated with a higher number of vascular complications (OR: 2.5, 95% CI: 1.5 – 10.1, P; 0.02). Conclusions Vascular complications in patients with femoro-femoral VA ECMO remain frequent and constitute an important cause of morbidity. Decreased peak systolic velocities in the cannulated tibio-peroneal territory, as well as a history of previous vascular disease were significantly associated with a higher rate of vascular complications.

Echocardiographic predictors of mortality in cardiac intensive care unit patients with pulmonary hypertension

Abstract Background Pulmonary Hypertension (PH) is a diverse condition associated with elevated mortality. We sought to determine the association of Transthoracic Echocardiography (TTE) parameters with in-hospital mortality in patients with PH admitted to Cardiac Intensive Care Unit (CICU). Methods We included 1 Clinic CICU admissions from 2007 to 2018, with available TTE parameters within the first day of CICU admission who had PH defined as an estimated right ventricular systolic pressure (RVSP) ≥36 mmHg. The primary outcome was in-hospital mortality, evaluated using logistic regression. Results We included 3085 unique CICU patients with PH, predominantly WHO group 2 and 3. Median age was 73.7 (63.8, 82.4) years, and 1343 (43.5%) were females. Heart failure (65.6%) and respiratory failure (34.0%) were the most common admission diagnoses. The median RVSP was 47 (41, 56) mmHg, and 1314 (42.6%) had RVSP ≥50 mmHg. A total of 337 (10.9%) patients died during hospitalization. In-hospital deaths had higher RVSP (51 versus 47 mmHg, p <0.001), reflecting higher right atrial (RA) pressure (14 versus 10 mmHg, p <0.001) (Figure). In-hospital mortality increased with worse TTE parameters reflecting Right Ventricle-Pulmonary Artery (RV-PA) coupling, such as Tricuspid Annular Plane Systolic Excursion/ Right Ventricular Systolic Pressure (RVSP), Tricuspid Annular Systolic Velocity (TASV)/RVSP and TASV/ Tricuspid Regurgitation velocity ratios. Conclusion In CICU patients with PH, we have identified the specific Doppler TTE parameters with strong associations with outcomes. Specifically, RA pressure and parameters of RV-PA coupling had the highest discrimination for in-hospital mortality. Comprehensive Doppler TTE is valuable for identification of high-risk PH patients to facilitate further investigation plans, management, and prognostication. Figure: In-hospital mortality in association with right ventricular (RV) function and right atrial pressure (RAP).In-hospital mortality in association wit

A practical nomogram and risk stratification system for predicting in-hospital mortality of patients with non-acute myocardial infarction related cardiogenic shock

Abstract Background The morbidity and mortality of Cardiogenic Shock(CS) remain high despite the advance in management these years1.As acute myocardial infarction (AMI) is considered to be the most common reason for cardiogenic shock,Non-AMI related CS is excluded from the majority of CS studies and remains largely understudied2. Considering its inherent complexity and hemodynamically multiplicity, it is needed to focusing on these patients to identify specific risk factors, which may be conducive to the promotion of critically CS patients with early decision and timely intervention. Purpose In this study,we sought to investigate the variables which are predictive of in hospital mortality in non AMI related CS patients, developed and validated a practical nomogram for risk quantification. Methods 1298 patients and 548 patients with cardiogenic shock from the MIMIC-IV (version 1.0) and MIMIC-III(version1.4) databaes were included in the study after excluding acute myocardial infarction. We used in-hospital death and 30 day survival as the end points. Lasson and logistic regression analysis were used to identify statistically significant predictors which were finally involved in the nomogram. The predictive performance of the nomogram was evaluated by Harrell’s concordance index (C-index) and calibration after comparing with commonly used ICU scores for in-hospital death.Lastly, we plotted Kaplan-Meier curves of three subgroup classified by the identified cutoff values of the nomogram to further assess the discriminative ability of the prognosis. Results The in-hospital mortality of patients with non-AMI related CS is about 36.6%.After the analysis of regression, age, heart rate, wbc, albumin, lactic acid, GCS score, urine volume, using vasopressor were identified as the most critical factors for the in-hospital death. Based on the these results, a nomogram for predicting in-hospital death was established.The calibration plot also shows good consistency between nomogram prediction and actual in-hospital mortality.In addition, compared with other scores, the AUC value of nomogram was 0.806 (95% CI = 0.799-0.831) in the training queue, 0.814 (95% CI = 0.771-0.852) in the internal validation queue and 0.730 (95% CI = 0.690-0.767) in the external validation set, which was significantly higher than other commonly used ICU scoring systems(SAPSII, APSIII and SOFA).Also, three risk subgroups were created using two boundary points (303 and 339) of the nomogram score and the survival curve shows that there were significant differences in the 30 day survival of each subgroup. Conclusion A prognostic nomogram and risk stratification system of non-AMI related CS were established and verified, which can provide a practical tool for individualized clinical management of patients.Workflow of the study.Nomogram for non-AMI related CS patients

Prognostic impact of the tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure ratio in acute pulmonary embolism

Abstract Background Currently available risk stratification models for acute pulmonary embolism (PE) include hemodynamic status, cardiac biomarkers, right ventricle (RV) dysfunction on imaging, and clinical scores. Focusing on length-tension relationship of the ventricle might have a superior predictive capability over RV dysfunction in terms of mortality and classification of patients with acute PE. In this study, our hypothesis suggests that tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP) ratio has superior predictive capability for in-hospital mortality in patients with acute PE compared to TAPSE or sPAP as distinct measures. Methods This single-center study comprised retrospectively evaluated 703 patients referred to our tertiary cardiovascular center with acute PE. We divided patients into quartiles by TAPSE/sPAP ratio. Different models were developed to quantify the predictive relationship between in-hospital death and echocardiographic measurements. A base model was created with variables including risk status and RV/LV ratio >1. Then, to evaluate the predictive contribution of each measurement; TAPSE/sPAP, TAPSE, and sPAP were sequentially added to the base model. After that, the performance of each model was evaluated. Results Predictive and discriminative power was the highest in model containing TAPSE/sPAP. There was still a significant inverse association between TAPSE/sPAP and risk of in-hospital death even after adjusting by risk status and RV/LV ratio >1. ROC curve analysis for TAPSE/sPAP revealed the best cut-off value as 0.34. Conclusion The outcomes of our study reveals that the ratio of TAPSE/sPAP serves as a more potent predictor of mortality than either of the two measurements taken separately. The interpretation and utilization of the TAPSE/sPAP cut-off value in acute PE can assist in identifying patients at risk of deterioration and guide the consideration of more intensive treatment options across all risk groups.

Classification of 90-day mortality risk among patients with cardiogenic shock requiring advanced mechanical circulatory support

Abstract Background The SCAI shock classification aims to provide a simple and practical stratification of the severity of patients with cardiogenic shock (CS) and to immediately offer them crucial treatments such as mechanical circulatory support (MCS). Additionally, the IABP shock II risk score is designed to predict 30-day mortality in patients with CS following acute coronary syndrome (ACS), and the SAVE score can also predict in-hospital mortality for patients after veno-arterial extracorporeal membrane oxygenation (V-A ECMO) insertion due to refractory CS. However, previous studies on SCAI staging in patients with MCS have been inconsistent, and the association with prognosis remains unclear. Purpose The aim of this study is to investigate the correlation between the SCAI shock stage and prognosis in ACS patients requiring advanced MCS, and to compare it with other prognostic scores. Methods From January 2012 to July 2023, 137 ACS patients with advanced MCS (excluding IABP) were evaluated. Upon ICU admission, patients were categorized into SCAI stages B to E. The IABP shock II score and the SAVE score were also calculated to serve as prognostic tools. The type of MCS was categorized as Impella, VA-ECMO with IABP, and ECPELLA (VA-ECMO with Impella). We compared the 90-day survival rates with the SCAI shock stage and other prognostic tools. Result The distribution for SCAI classifications stage B to E was 13 (10%), 38 (28%), 21 (15%), and 65 (47%), respectively. There were no significant differences among the groups regarding age, gender, comorbidities, the ratio of ST-elevation myocardial infarction, door-to-balloon time, and onset-to-reperfusion time. In SCAI Stage E, a significantly higher proportion of patients (86%) underwent extracorporeal cardiopulmonary resuscitation, exhibiting elevated lactate and peak CK-MB levels, along with higher IABP Shock II and lower SAVE scores, compared to other stages. A Kaplan-Meier analysis of 90-day mortality, based on the SCAI, the IABP Shock II, the SAVE categories, and the type of MCS, demonstrated that outcomes deteriorated as the stage advanced across all classifications. In the univariate Cox regression analysis for 90-day mortality, significant differences in outcomes were observed across the four classifications. However, in the multivariate Cox regression analysis that incorporated all four classifications, only the type of MCS (Impella vs. ECMO with IABP; hazard ratio [HR] 0.36; 95% confidence interval [CI], 0.16 - 0.78, p = 0.012) and the SCAI classification (stage E vs. stage C; HR 3.03; 95% CI, 1.51 - 6.08, p = 0.002) demonstrated a significant association with 90-day mortality. Conclusion The SCAI shock stage upon ICU admission suggests the potential for convenient prediction of mid-term outcomes in ACS patients who received advanced MCS.

The Prognostic Value of a Naples Score in Determining in-Hospital Mortality in Patients with Acute Ischemic Stroke Undergoing Endovascular Treatment

Background/Objectives: The Naples prognostic score (NPS), reflecting inflammation and nutritional status, has prognostic value, especially in cancer. This study evaluated its ability to predict in-hospital mortality in acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). Methods: We retrospectively studied 244 patients with AIS who were admitted between April 2020 and December 2023. Patients were included if they presented within 6 h of symptom onset with evidence of intracranial proximal arterial occlusion. The EVT was performed using aspiration catheters, stent retrievers, or both. The NPS was calculated based on the neutrophil–lymphocyte ratio, lymphocyte–monocyte ratio, and albumin and total cholesterol levels. Results: We found a significant association between higher NPS scores and in-hospital mortality. Patients with a high NPS (3 or 4) had a mortality rate of 41.6% compared to 21.0% in the low-NPS group (0, 1, or 2). The full model incorporating NPS showed superior predictive ability for in-hospital mortality compared with the baseline model (areas under the curve 0.881 vs. 0.808). A receiver-operating characteristic analysis at a cutoff of >2.5 for the NPS showed a sensitivity of 86.6% and specificity of 41.9%. This study demonstrated that incorporating the NPS into the predictive model improved the accuracy and calibration for predicting in-hospital mortality. A decision curve analysis showed the net benefit of using the full model incorporating NPS over the baseline model, emphasizing its potential clinical application in prognostication. Conclusions: NPS is a reliable predictor of in-hospital mortality in AIS patients undergoing EVT. Incorporating NPS into clinical practice could help to identify high-risk patients and improve outcomes through tailored interventions.

Risk factors for in-hospital mortality in patients with infective endocarditis

The assessment of risk factors for in-hospital mortality in patients with infective endocarditis is important for identifying variables associated with treatment regimens, aiming to improve outcomes. Early identification of high-risk patients may contribute to better outcomes through timely medical and surgical interventions. Objective: to study the clinical characteristics and risk factors associated with in-hospital mortality among patients with infective endocarditis. Materials and methods. A retrospective single-center study was conducted, which included clinical data of 311 consecutive patients from January 1, 2019, to October 22, 2021, at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The primary outcome of the study was in-hospital mortality among patients with infective endocarditis. Clinical and laboratory data, as well as the results of echocardiographic examinations and postoperative complications were recorded and statistically analyzed. Results. The overall in-hospital mortality rate was 13 cases (4.2 %), including 6 (1.9 %) patients with infective endocarditis who died at the preoperative stage despite medical treatment. Postoperative in-hospital mortality accounted for 7 cases (2.3 %), 298 patients (95.8 %) underwent successful surgery and were discharged under the supervision of a cardiologist in their locality. A univariate analysis of preoperative clinical and laboratory characteristics revealed the following risk factors for in-hospital mortality among patients with infective endocarditis at the preoperative stage: fever (p = 0.021), mechanical ventilation (p < 0.001), acute kidney injury (р < 0.001), heart failure (р < 0.001). Similarly, a univariate analysis of intraoperative and postoperative clinical and laboratory characteristics revealed risk factors for in-hospital mortality among patients with infective endocarditis at the postoperative stage to be aortic cross-clamping time (p = 0.010), duration of cardiopulmonary bypass (p = 0.006), ultrafiltration volume (p < 0.001) and N-terminal pro-B-type natriuretic peptide level (p = 0.017). Conclusions. Our study demonstrated that risk factors for in-hospital mortality among patients with infective endocarditis included fever, heart failure, respiratory failure, acute kidney injury, and duration of cardiac surgery. These findings underscore the necessity for a multidisciplinary approach to the treatment of infective endocarditis.

Risk factors for in-hospital mortality in older patients with acute respiratory distress syndrome due to COVID-19: a retrospective cohort study

BackgroundAdvancing age is associated with an increase in mortality among patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed to determine risk factors for in-hospital mortality in patients over 60 years old with COVID-19-related ARDS (C-ARDS).MethodsThis was an observational, analytical, retrospective study conducted on a cohort that included all patients aged 60 years or older diagnosed with COVID-ARDSwho were admitted to a high-complexity hospital in Bogotá, Colombia, between March 2020 and July 2021.ResultsA total of 1563 patients were included in the analysis, with a median age of 73 years (interquartile range [IQR]: 67–80) and 811 deaths (51.8%). Independent risk factors for in-hospital mortality were identified as follows: patients aged 71–80 [OR 1.87 (95% CI 1.33–2.64)], age > 80 [OR 8.74 (95% CI 5.34–14.31)], lactate dehydrogenase (LDH) [OR 1.009 (95% CI 1.003–1.0015)], severe C-ARDS [OR 2.16 (95% CI 1.50–3.11)], use of invasive mechanical ventilation (IMV) [OR 12.94 (95% CI 9.52–17.60)], and use of steroids [OR 1.49 (95% CI 1.09–2.03)]. In patients over 80 years of age (n = 388), the primary risk factor associated with in-hospital mortality was the use of IMV (n = 76) [OR 6.26 (95% CI 2.67–14.69)], resulting in an in-hospital mortality rate of 89.4% (n = 68) when this therapy was implemented.ConclusionsThe primary risk factors for in-hospital mortality in patients older than 60 years were age, the use of IMV, the severity of C-ARDS, use of steroids and elevated LDH values. Among patients older than 80 years, the main risk factor for in-hospital mortality was the use of IMV. In cases of C-ARDS in older patients, the decision to initiate IMV should always be individualized; therefore, the use of alternative oxygen delivery systems as the first-line approach can be considered.

Short- and long-term outcomes of patients with acute myocardial infarction complicated by cardiac arrest: A nationwide cohort study 2013-2022.

To assess short- and long-term outcomes of acute myocardial infarction (AMI) complicated by out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) in a nationwide cohort. Cohort study of AMI patients admitted to hospitals in Norway 2013-2022 registered in the Norwegian Myocardial Infarction Registry. Outcomes were in-hospital and long-term mortality. Cumulative mortality was assessed with the Kaplan-Meier and the Life-table methods. Cox regression was used for risk comparisons. Among 105,439 AMI patients (35% women), we identified 3,638 (3.5%) patients with OHCA and 2,559 (2.4%) with IHCA. The mean age was 65.7 (13.2), 70.9 (12.6) and 70.7 (13.6) years for OHCA, IHCA, and AMI without cardiac arrest (CA), respectively. The median follow-up time was 3.3 (25th, 75th percentile; 1.1, 6.3) years. In-hospital mortality was 28%, 49% and 5%, in OHCA, IHCA and AMI without CA, and estimated 5-year cumulative mortality was 48% (95% CI 46-50%), 69% (95% CI 67-71%), and 35% (95% CI 34-35%), respectively. Among patients surviving to hospital discharge, no significant difference in mortality during follow-up was found between OHCA and AMI without CA (adjusted Hazard Ratio (HR) 1.04, 95% CI 0.96-1.13), while the long-term mortality of AMI patients with IHCA was higher (age-adjusted HR 1.31, 95% CI 1.19-1.45). In this large, contemporary cohort of AMI patients, in-hospital mortality of patients with OHCA or IHCA was still high. Among patients surviving to hospital discharge, long-term mortality was comparable between OHCA and AMI without CA, while the outcome of patients with IHCA was significantly worse.

Community-acquired sepsis in the medical intensive care unit – an experience from a lower-middle-income country

Objective: To determine microbiological pathogens and in-hospital mortality in patients admitted with community-acquired sepsis to the intensive care unit in a tertiary-care setting in a low- and middle-income country. Methods: The retrospective, observational study was conducted at the medical intensive care unit of a large tertiary care hospital in Karachi, and comprised data from January 1 to December 31, 2019, and comprised data of patients with community-acquired sepsis who were assessed using the Sepsis-3 criteria. Data was compared between survivors and non-survivors, and independent factors associated with escalation to a higher level of care were identified. Data was analysed using SPSS 23. Results: Of the 135 patients with mean age 49.8±18.0 years, 91(67.4%) were males and 44(32.6%) were females. The most common primary site of infection was the respiratory tract 63(46.7%). In-hospital mortality was noted in 52(38.5%) cases, while there were 83(61.5%) survivors. Serum levels of lactate and bicarbonate as well as urine output, fungal pathogens, septic shock and sequential organ failure were significantly associated with mortality (p<0.05). Conclusions: Clinical and microbiological spectrum of community-acquired sepsis in a low- and middle-income country was found to be different from other regions of the world. Clinicians should keep these differences in mind while managing these critically ill patients. Key Words: Sepsis, Septic shock, Critical care, Drug resistance, Fungi.

Association between weekend admission and in-hospital mortality for patients with ischemic heart disease upon surgery treatment.

The existence and reasons for the weekend effect in patients with ischemic heart disease (IHD) were not yet fully identified. This study aimed to evaluate whether weekend admission was independently associated with in-hospital mortality and the possible mechanisms associated with the IHD patients. The study was a retrospective study, including IHD patients from 2015 to 2023. The International Classification of Diseases, tenth revision (ICD-10) codes were used to identify all admissions with a primary diagnosis of IHD. The sample was divided into weekday and weekend groups. We performed a multivariate logistic regression analysis and a mediation analysis to estimate the effect of weekend admission on hospital mortality. A total of 18,906 IHD patients were included in the study, with an average age of 63.8 ± 12.7. Of these patients, 21.7% (n = 4,102) were admitted over the weekend. The in-hospital 30-days mortality rate was significantly higher among the patients admitted at weekends compared with those admitted at weekdays (2.0% vs. 1.1%). Respectively, the 30-day mortality rate of patients admitted on weekends was higher compared to patients admitted on weekdays among patients with surgical treatment (2.34% vs. 1.06%, OR = 1.75; 95% CI: 1.23-2.42) and with emergency admission (3.48% vs. 2.59%, OR = 1.56; 95% CI: 1.05-2.28). Mediation analyses showed that the surgical scheduling had significant mediated effects on the associations of admission time with mortality risk. IHD patients with a surgical therapy or admitted from emergency department had a significantly higher risk of mortality when admitted on weekends compared to weekdays. These findings have potential implications for resource allocation and redistribution of surgery to weekends in hospitals.

Association between liver fibrosis and the in-hospital mortality in patients with sepsis-induced coagulopathy

BackgroundThe impact of liver fibrosis on the clinical outcomes of patients with sepsis-induced coagulopathy (SIC) is not well understood. This study aimed to evaluate the association between liver fibrosis scores and in-hospital mortality in SIC patients.MethodsIn this retrospective observational cohort study, data were collected from patients diagnosed with sepsis and admitted to the ICU at the First Affiliated Hospital of Wenzhou Medical University between January 2017 and December 2023. Liver fibrosis was evaluated using three scores: Fibrosis-4 (Fib-4), Aspartate Aminotransferase–to–Platelet Ratio Index (APRI), and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS). Patients were divided into tertiles according to their liver fibrosis scores, and the primary outcome was in-hospital mortality. Multivariable logistic regression and restricted cubic spline regression analyses were used to assess associations, complemented by sensitivity analyses through subgroup evaluations.ResultsThe cohort included 948 patients diagnosed with SIC with an in-hospital mortality of 26.16%. Multivariate logistic regression analysis revealed a significant association between higher liver fibrosis scores and increased in-hospital mortality. Specifically, patients in the highest tertile of Fib-4, APRI, and NFS scores had significantly higher odds of mortality (FIB-4: OR 3.62, 95% CI 1.03–12.69; APRI: OR 2.16, 95% CI 0.88–5.30; NFS: OR 6.80, 95% CI 2.11–21.93) compared to those in the lowest tertile. The restricted cubic spline regression model showed a linear increase in the risk of in-hospital mortality with increasing liver fibrosis score. Sensitivity analysis confirmed the consistency and stability of the results across the different subgroups.ConclusionOur study suggests that elevated liver fibrosis scores, particularly Fib-4 and NFS, are associated with higher in-hospital mortality in SIC patients. Further research, especially larger prospective studies, are needed to validate these findings.

Case-control study on risk factors for in-hospital mortality in patients with severe COVID-19.

The purpose of this study was to identify independent risk factors affecting patient survival and explore predictors of severe cases of coronavirus disease 2019 (COVID-19). We conducted a retrospective, observational, case-control study on adult patients with severe COVID-19 who were admitted to affiliated hospitals in Tianjin between December 18, 2022, and January 31, 2023. We used univariate and multifactorial logistic regression analyses to analyze demographic indicators, comorbidity profiles, and laboratory parameters in two groups of patients (deceased and surviving) to identify independent risk factors for death in patients with severe COVID-19. Patients in the deceased group were older than those in the survival group (p = 0.018), and there were more cases of coexisting respiratory insufficiency in the deceased group (p = 0.002). Additionally, laboratory test results for white blood cell count (WBC) and creatine kinase (CK) showed significantly higher values in the deceased group (p = 0.047 and p = 0.029, respectively), while arterial oxygen partial pressure (PAO2) showed significantly lower values compared to the survival group (p = 0.021). Age, respiratory insufficiency, WBCH (highest WBC value), CKH (highest CK value), and PAO2F (first PAO2 value) had area under curve (AUC) values of 0.698, 0.838, 0.721, 0.744, and 0.633, respectively. The main risk factors for mortality in patients with severe COVID-19 that we identified in this study were the advanced age of patients, coexisting respiratory insufficiency, elevated levels of WBC and CK, and decreased levels of PAO2. Elevated WBC and CK laboratory parameters, in particular, demonstrated good predictive value for in-hospital mortality risk.

Association between PaO2/(FiO2*PEEP) ratio and in-hospital mortality in COVID-19 patients: A reanalysis of published data from Peru using PaO2/(FiO2*PEEP) ratio in place of PaO2/FaO2 ratio.

P/FP [PaO2/(FiO2*PEEP)] is associated with in-hospital mortality in patients with acute respiratory distress syndrome (ARDS). However, to the best of our knowledge, the association between P/FP after 24 hours of invasive mechanical ventilation (IMV) and in-hospital mortality in patients with ARDS due to Coronavirus Disease 2019 (COVID-19) remained unclear. This study aimed to evaluate the relationship between the P/FP after 24 hours of IMV and in-hospital mortality in patients with ARDS due to COVID-19. We reanalyzed previously published data from Peru. Hueda-Zavaleta et al conducted a retrospective cohort study between April 2020 and April 2021 in southern Peru. A total of 200 hospitalized COVID-19 patients requiring IMV were included in this analysis. We used Cox proportional hazard regression models and Kaplan-Meier survival analysis to investigate the effect of P/FP after 24 hours of IMV on in-hospital mortality. We used a restricted cubic spline regression and a two-piecewise Cox proportional hazards model to explore the relationship between P/FP after 24 hours of IMV and in-hospital mortality in patients with ARDS due to COVID-19. Of the 200 patients, 51 (25.50%) died in hospital. The median P/FP was 20.45 mm Hg/cmH2O [interquartile range 15.79-25.21 mm Hg/cmH2O], with a range of 5.67 mm Hg/cmH2O to 51.21 mm Hg/cmH2O. Based on the P/FP ratio, patients were equally divided into 2 groups (low group [P/FP < 20.50 mm Hg/cmH2O] and high group [P/FP ≥ 20.50 mm Hg/cmH2O]). In-hospital mortality was lower in the high P/FP group than in the low P/FP group (12 [12%] vs 39 [39%]; unadjusted hazard ratio [HR]: 0.33, 95% confidence interval [CI]: 0.17-0.63; adjusted HR: 0.10, 95% CI: 0.02-0.47). We also found a nonlinear relationship between P/FP and in-hospital mortality. After adjusting for potential confounders, the HR was 0.67 (95% CI: 0.56-0.79) for P/FP ≤ 22 mm Hg/cmH2O and 1.10 (95% CI: 0.83-1.47) for P/FP > 22 mm Hg/cmH2O. In addition, lymphocytes ≤ 1 × 109/L and acute kidney failure had a higher risk of death. After adjusting for potential confounders, the P/FP after 24 hours of IMV was nonlinearly associated with in-hospital mortality in patients with ARDS due to COVID-19.

Circulating T-lymphocyte subsets as promising biomarkers for the identification of sepsis-induced acute kidney injury.

This retrospective study investigated whether disturbances in circulating T-lymphocyte subsets could predict the incidence of acute kidney injury (AKI) and in-hospital mortality in patients with sepsis. Clinical data from patients with sepsis admitted to the intensive care unit were reviewed. Logistic regression analyses were used to identify independent predictors of in-hospital mortality and the development of AKI. Of 81 patients with sepsis, 50 developed AKI. Both non-survivors and patients with septic AKI exhibited dramatically higher Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Non-survivors exhibited more organ damage, with significantly lower levels of peripheral T-lymphocyte subsets, including total circulating lymphocytes, and CD3+, CD3+CD4+, and CD3+CD8+ T-lymphocytes. Patients with septic AKI exhibited fewer total peripheral lymphocytes and fewer CD3+, CD3+CD4+, and CD3+CD8+ T-lymphocytes, with higher serum lactate levels and lower nadir platelet counts. Independent predictors of 30-day hospital mortality included maximum SOFA and APACHE II scores, occurrence of encephalopathy, and peripheral CD3+ and CD3+CD8+ T lymphocyte counts. Moreover, the maximum SOFA score and CD3+ and CD3+CD8+ T-lymphocyte counts demonstrated good predictive power for AKI in receiver operating characteristic curve (ROC) analyses, with an area under the ROC curve of 0.810 (95% confidence interval [CI] 0.712-0.908) for SOFA score, 0.849 (95% CI 0.764-0.934) for CD3+ T-lymphocytes, and 0.856 (95% CI 0.772-0.941) for CD3+CD8+ T-lymphocytes. Patients with sepsis-induced AKI experienced T lymphopenia and increased in-hospital mortality. Higher maximum SOFA scores and reduced peripheral CD3+ and CD3+CD8+ T-lymphocyte levels were associated with in-hospital mortality and the development of AKI in patients with sepsis.