Increased Hospital Mortality Research Articles

Comparison of Standard and Extended Dexamethasone Duration on Mortality in Patients with Severe COVID-19.

Current guidelines recommend dexamethasone 6 mg/day for up to 10 days in patients with severe coronavirus disease 2019 (COVID-19) requiring supplemental oxygenation or mechanical ventilation. The practice has significant variation, however, and dexamethasone has been used for >10 days for many patients with severe COVID-19. The aim of this study was to assess the benefits and risks associated with standard versus extended use of dexamethasone in patients with severe COVID-19. A multicenter retrospective cohort study was conducted from January 2021 to December 2021. All of the consecutive patients with severe COVID-19 receiving 6 mg/day dexamethasone were eligible for inclusion. The primary outcome was the incidence of in-hospital mortality for patients treated with dexamethasone 6 mg/day for the standard duration of 10 days versus an extended duration of >10 days. A total of 1294 patients met the inclusion criteria: 803 received the standard duration of dexamethasone and 491 received the extended duration. The incidence of in-hospital mortality was significantly higher (P = 0.003) in the extended duration group (36.5%) compared with the standard duration group (28.5%), with no significant difference in in-hospital major adverse cardiac events (16.1% for extended vs 13.2% for the standard duration; P = 0.15). The results show that extended duration of dexamethasone compared with standard duration is associated with a significant increase in in-hospital mortality in patients with severe COVID-19. These findings need to be confirmed in well-designed and performed randomized controlled trials.

Hospital and Post-Discharge Mortality in Patients With Acute Coronary Syndrome and Ventricular Ectopy.

Ventricular premature depolarizations (VPDs) in the setting of acute coronary syndrome (ACS) were associated with increased hospital mortality in the early revascularization era. Examine the predictive value of VPDs and their morphology for hospital and post-discharge mortality in patients admitted for ACS. We identified patients admitted with ACS across 13 Northwell Health Hospitals from 2015 to 2021 and had VPDs captured on a 12-lead ECG or full disclose telemetry. We characterized and reported descriptively the VPDs based on bundle branch block pattern (right or RBBB vs. left or LBBB), frontal (inferior vs. superior) and horizontal (leftward vs. rightward) axis, QRS width, and coupling interval (CI). Hierarchical generalized linear mixed modeling was used to assess the association between VPDs and hospital mortality, while Cox regression was used for post-discharge mortality. Of 18 009 patients admitted for ACS, we identified 627 patients with VPDs with complete data (65.7% RBB, 49.9% superior, and 63.4% leftward axis). Mean VPD QRS width and CI were 175 ± 30 and 523 ± 157 ms, respectively. Hospital mortality was higher in the VPD group (7.8% vs. 4.9%, p < 0.001) with most common mode of death being arrhythmic (28.1% vs. 14.5%). After adjusting for clinical covariates, only VPDs with RBBB patterns were associated with hospital mortality (OR 2.26, 95% CI 1.06-4.82). Conversely, age-adjusted post-discharge mortality was higher only for patients with superior axis VPDs (HR 1.59, 95% CI 1.13-2.24). Among patients with VPDs during an ACS admission, presence of RBBB pattern predicts hospital mortality, whereas superior axis is associated with post-discharge mortality.

Abstract 4137274: Optimal Timing of Pharmacoinvasive Strategy and its Impact on Clinical in Patients with ST-Elevation Myocardial Infarction: a Real-World Perspective

Background: Pharmacoinvasive strategy remains the cornerstone therapy for ST-elevation myocardial infarction (STEMI) where primary percutaneous coronary intervention (PCI) is unfeasible. Guidelines recommend PCI within 2 to 24 hours post-fibrinolysis. However, meta-analysis suggests that a shorter interval (&lt;4h) between fibrinolysis and PCI (lysis-PCI time) significantly reduces the 30-day risk of death and reinfarction. Real-world applicability is limited due to trial exclusions of elderly patients and those with chronic kidney disease. This study aims to evaluate the impact of lysis-PCI timing on in-hospital mortality and major adverse cardiovascular events (MACE). Hypothesis: We hypothesize that shorter lysis-PCI times (&lt;9h) increase in-hospital mortality and MACE, especially in patients over 80 years. Goals: To determine the impact of lysis-PCI timing on in-hospital mortality and MACE in STEMI patients. Methods: This retrospective cohort study of 1,043 STEMI patients in Brasília, Brazil, used multivariable categorical logistic regression models to assess the association of three lysis-PCI intervals (&lt;9h; 9-18h; &gt;18h) with in-hospital mortality and 4p-MACE (death, acute myocardial infarction, stroke, heart failure). Propensity score matching (1:1) was used to adjust for cardiovascular risk factors. Statistical significance was set at p&lt;0.05. Results: The lysis-PCI timing groups showed no significant differences in admission Killip class, GRACE score, or age. However, the &lt;9h group had higher incidences of in-hospital mortality (p=0.004), heart failure (p=0.002), cardiogenic shock (p=0.001), cardiac arrest within 24 hours (p=0.003), minor bleeding (p=0.006), and MACE (p=0.002). Multivariable categorical logistic regression revealed that each 4-h delay in lysis-PCI time reduced the risk of death (HR 0.560, 95% CI 0.381-0.771; p=0.001) and MACE (HR 0.877, 95% CI 0.811-0.948; p=0.001). These findings remained consistent after propensity score analysis (death: HR 0.721, 95% CI 0.516-0.956; p=0.034). Among patients older than 80, shorter lysis-PCI times were associated with increased mortality and MACE, even after propensity adjustment (Figure 1). Conclusion(s): Shorter lysis-PCI times (&lt;9h) are associated with higher in-hospital mortality and MACE across all age groups, with a pronounced effect in patients over 80 years. These findings underscore the need for careful consideration of lysis-PCI timing, especially in elderly populations.

Anticoagulation management during veno-venous ECMO support because of ARDS: Single-center experience

BackgroundPatients with severe acute respiratory distress syndrome (ARDS) show a high mortality rate of up to 60 %. In such cases, extracorporeal membrane oxygenation (ECMO) support is often required, which would necessitate anticoagulation therapy, predominantly with heparin. Some bleeding events occurred more frequently in patients during the COVID-19 pandemic who were on venovenous (V-V) ECMO, so it is necessary to investigate whether anticoagulation management should be adjusted. MethodsWe collected data on 90 patients with severe ARDS who underwent ECMO support at the University Hospital Magdeburg between 2014 and 2022. In order to estimate the role of anticoagulation therapy as a cause of bleeding, patients were divided into two groups based on their mean activated partial thromboplastin time (aPTT): one group with a mean aPTT of more than 58 s (45 patients) and another with a mean aPTT of less than 58 s (45 patients). Demographic data, data before, during ECMO support, and bleeding complications were retrospectively recorded. We compared laboratory parameters before ECMO, essential coagulation parameters on days 3, 7, 10 of ECMO support, before the bleeding event occurred, and analyzed hospital survival in both groups. ResultsThe incidence of major bleeding complications was significantly higher in the group of patients with higher aPTT (68.9 % vs 33.3 %, p < 0.001), the differences in the occurrence of hemothorax were especially significant (28.9 % vs 2.2 %, p < 0.001). We observed better hospital patients’ survival in the group with lower aPTT (40.0 % vs 68.9 %, p = 0.006). The results of the bivariate analysis indicate that the independent predictors of hospital mortality in adult patients receiving V-V ECMO support due to severe ARDS were COVID-19 (OR: 3.504; 95 % confidence interval [CI]: 1.415–8.681, p = 0.007) acute liver failure (OR: 8.0000; 95 % CI: 1.692–37.822; p = 0.009), high antithrombin level (%) (OR: 1.036; 95 % CI: 1.003–1.071, p = 0.035). A high mean aPTT level increased the risk of major bleeding (OR: 1.080; 95 % CI: 1.016–1.148, p = 0.014) without a significant increase in mortality. ConclusionProlonged aPTT during V-V ECMO support in patients with ARDS significantly impacts the risk of major bleeding, especially hemothorax, without significant increase in hospital mortality.

Microbiological profile of antimicrobial sensitivity and resistance in a general hospital in the Peruvian jungle 2021

Introduction: Antimicrobial resistance increases hospital mortality and is a public health problem. Objective: to determine the characteristics of microorganisms isolated from hospitalized patients and to detail antimicrobial sensitivity profiles. Methodology: cross-sectional study Cross-sectional study in a hospital in the Peruvian jungle during 2021. The type of microorganism, antimicrobial sensitivity (VITEK ® 2 bioMérieux), source of isolation, patient age and hospitalization service were identified. Results: 477 positive cultures were included in 453 patients. The samples came from bronchial secretion 54.9%, blood 35.2%, urine 6.5% and others 3.4%. The hospital services of origin were emergency 49.9%, intensive care unit 40.0%, medicine 9.6% and surgery 0.5%. Gram negative bacteria (74.6%), Gram positive bacteria (16.4%) and fungi (9%) were isolated. The most frequently isolated microorganisms were Acinetobacter baumannii complex (32.7%), Klebsiella pneumoniae ssp. (16.8%) and Pseudomonas aeruginosa (13.4%). Antimicrobial resistance for the most frequently isolated microorganisms was: Acinetobacter baumannii complex, XDR in 88.5%; Klebsiella pneumoniae ssp., MDR in 56.3%; Pseudomonas aeruginosa, XDR in 54.7%; Staphylococcus epidermidis, MDR in 92.3%; and Staphylococcus haemolyticus, MDR in 100%. Conclusions: Gram-negative bacteria are the most prevalent, being more affected hospital critical areas, finding a high percentage of antimicrobial resistance.

Microbiological profile of antimicrobial sensitivity and resistance in a general hospital in the Peruvian jungle 2021

Introduction: Antimicrobial resistance increases hospital mortality and is a public health problem. Objective: to determine the characteristics of microorganisms isolated from hospitalized patients and to detail antimicrobial sensitivity profiles. Methodology: cross-sectional study Cross-sectional study in a hospital in the Peruvian jungle during 2021. The type of microorganism, antimicrobial sensitivity (VITEK ® 2 bioMérieux), source of isolation, patient age and hospitalization service were identified. Results: 477 positive cultures were included in 453 patients. The samples came from bronchial secretion 54.9%, blood 35.2%, urine 6.5% and others 3.4%. The hospital services of origin were emergency 49.9%, intensive care unit 40.0%, medicine 9.6% and surgery 0.5%. Gram negative bacteria (74.6%), Gram positive bacteria (16.4%) and fungi (9%) were isolated. The most frequently isolated microorganisms were Acinetobacter baumannii complex (32.7%), Klebsiella pneumoniae ssp. (16.8%) and Pseudomonas aeruginosa (13.4%). Antimicrobial resistance for the most frequently isolated microorganisms was: Acinetobacter baumannii complex, XDR in 88.5%; Klebsiella pneumoniae ssp., MDR in 56.3%; Pseudomonas aeruginosa, XDR in 54.7%; Staphylococcus epidermidis, MDR in 92.3%; and Staphylococcus haemolyticus, MDR in 100%. Conclusions: Gram-negative bacteria are the most prevalent, being more affected hospital critical areas, finding a high percentage of antimicrobial resistance.

Biomarkers of cardiohepatic syndrome in the cardiac intensive care unit

Abstract Introduction Non-cardiovascular end-organ dysfunction is an important determinant of outcomes in cardiac intensive care unit (CICU) patients. We examined the association between in-hospital mortality with the severity and extent of admission liver function test (LFT) abnormalities in a heterogeneous CICU population. Purpose We hypothesized that a greater severity or extent of LFT abnormalities would be associated with higher in-hospital mortality. Methods We included consecutive unique adult CICU patients with available data for one or more of the admission LFT values of interest. Admission laboratory values were defined as those closest to CICU admission. We used the NIH Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 to categorize the severity of each LFT abnormality from Grade 0 (normal) to Grade 4 (life-threatening). We defined the extent of LFT abnormality as the number of individual LFTs meeting criteria for CTCAE Grade 1 or greater. The primary outcome of interest was all-cause in-hospital mortality. Odds ratio (OR) and 95% confidence interval (CI) values for in-hospital mortality were estimated using logistic regression, before and after multivariable adjustment. Results Of 12,428 unique CICU patients, 5,144 were excluded due to a lack of available data for any admission LFT values. The remaining 7,284 patients comprised the final study population. Among patients with available data for each individual LFT, abnormal values were present in: AST, 2,743/5,733 (47.8%); ALT 1,576/5,512 (28.6%); ALK 611/3,684 (16.6%); and TB 898/5,155 (17.4%). A total of 864 (11.9%) patients died during hospitalization. In-hospital mortality was higher for patients with one or more LFTs meeting criteria for CTCAE Grade 1 or greater (17.9% vs. 6.4%, adjusted OR 1.54 [1.27-1.86], p &amp;lt;0.001). A stepwise increase in in-hospital mortality was observed with increasing CTCAE grade, both overall (adjusted OR 1.25 per each higher CTCAE grade [1.16-1.34], p &amp;lt;0.001); (Figure 1A), and for each individual LFT (Figure 1B). Conclusion Cardiohepatic syndrome is an important predictor of prognosis in CICU patients, as the extent and severity of LFT abnormalities are strongly associated with in-hospital mortality. This is the first large-scale study to examine the association between the magnitude of hepatic biomarker derangement with in-hospital mortality in unselected CICU patients. Patients with markedly elevated LFT values exhibited the highest risk of in-hospital mortality. This analysis advocates for the inclusion of commonly obtained LFTs in future risk-prediction tools for enhanced prognostication.

In-hospital outcomes of acute myocardial infarction patients without standard modifiable cardiovascular risk factors across varying body mass index

Abstract Background Individuals who present with acute myocardial infarction (AMI) in the absence of standard modifiable cardiovascular risk factors (i.e., SMuRF-less) seem to have a significantly increased risk of mortality; however, it remains unclear whether the ‘SMuRF paradox’ would be influenced by patients’ baseline body mass index (BMI) status. Purpose To assess the disparities in the prevalence and prognostic implications of SMuRF-less among patients with newly diagnosed AMI across varying body mass index (BMI). Methods Using data from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome (CCC–ACS) project, we retrospectively analyzed AMI patients with and without SMuRFs and categorized their baseline BMI as underweight (&amp;lt;18.5kg/m2), normal weight (18.5-24kg/m2), overweight (24-28kg/m2), and obese (&amp;gt;28kg/m2). The primary outcome was in-hospital all-cause mortality. Multivariable logistic regression models were used to estimate BMI-stratified associations between SMuRF-less and each outcome, sequentially adjusting for demographic, clinical characteristics, and prevention strategies. Results Between 2014 and 2019, 44,538 adult patients hospitalized for first-presentation AMI were included, of which 4,454 (10.0%) were SMuRF-less. The incidence of SMuRF-less declined from 16.2% to 6.5% as BMI increased by category, and it prevailed more frequently among females and elders regardless of their BMI status. During the median hospital stay of 9 days, SMuRF-less patients had a significant increase in in-hospital mortality than patients with one or more SMuRF (2.1% vs. 1.0%, adjusted odds ratio [OR], 1.750 [95% CI 1.057–2.896], P&amp;lt;0.001). The highest mortality rate was observed in the SMuRF-less underweight group (3.5%). Took ≥1 SMuRF and obese as the reference group as they presented the finest outcome, SMuRF-less underweight group exhibited the highest increase in mortality (3.5% vs 0.5%, adjusted odds ratio [OR], 3.854 [95% CI 2.130–6.973], P&amp;lt;0.001). However, interaction analyses provided no evidence that BMI significantly modifies SMuRF-less’s association with in-hospital mortality (P for interaction=0.247). Conclusion Approximately one-tenth of first-presentation AMI patients had no SMuRF, who were more frequently women, elders, and underweight. Compared with those with at least one SMuRF, SMuRF-less patients have a significantly higher risk of in-hospital mortality, especially in those underweight, while in-hospital survival was the most favorable among ≥1 SMuRF and obese patients.

Impact of PM2.5 exposure on mortality and tumor recurrence in resectable non-small cell lung carcinoma

This study aimed to explore the impact of PM 2.5 exposure on survival, post-operative outcomes, and tumor recurrence in resectable non-small cell lung cancer (NSCLC) patients. The study cohort comprised 587 patients at Chiang Mai University Hospital between January 1, 2010, and December 31, 2017. Patients were categorized based on their residents’ average PM 2.5 concentration into two groups: exposed (PM 2.5 ≥ 25 µg/m3 annual mean) and unexposed (PM 2.5 < 25 µg/m3 annual mean). The exposed group had 278 patients, while the unexposed group had 309 patients. Baseline differences in gender and surgical approach were observed between the groups. Multivariable regression analysis revealed that patients in the exposed group had a higher risk of death (HR 1.44, 95% CI, 1.08–1.89, p = 0.012). However, no significant associations were found between PM 2.5 and post-operative pulmonary complications (RR 1.12, 95% CI, 0.60–2.11, p = 0.718), in-hospital mortality (RR 1.98, 95% CI, 0.40–9.77, p = 0.401), and tumor recurrence (HR 1.12, 95% CI, 0.82–1.51, p = 0.483). In conclusion, a PM 2.5 concentration ≥ 25 µg/m3 annual mean was associated with decreased overall survival and a potential increase in in-hospital mortality among resectable NSCLC patients. Larger studies with extended follow-up periods are required to validate these findings.

Value of cardiac enzyme spectrum for the risk assessment of mortality in critically ill children: a single-centre retrospective study

ObjectivesIdentifying high-risk paediatric patients with a poor prognosis and providing timely and adequate treatment are critical. This study aimed to evaluate the effects of different types of cardiac enzyme spectrum...

Optic Nerve Diameter and Elevation in Acute Large Stroke Patients

Abstract Background Elevated intracranial pressure (ICP) is a potentially devastating condition resulting from various neurological and non-neurological disorders. Aim of the Work To assess the correlation between optic nerve diameter, optic disc elevation and increased intracranial tension due to intracranial heamorrhage or large stroke and to compare it with control group. Patients and Methods This study was conducted on 51 patients diagnosed with acute large stroke, admitted in stroke unit neurology department at Ain Shams university hospitals and 56 Controls diagnosed with lacunar stroke or healthy individuals age and sex matched. Results A significant positive correlation between Peak systolic velocity and both optic disc elevation and optic nerve sheath diameter. There was also significant positive correlation between Pulsatility index and optic nerve sheath diameter while there was no significant correlation between the Pulsatility index and optic disc elevation. A significant positive correlation between NIH stroke scale and both optic disc elevation and optic nerve sheath diameter. There was also significant positive correlation between Size of infarction and both optic nerve sheath diameter and optic nerve sheath diameter. Conclusion Increase in ONSD measurement was associated with increased hospital mortality and poor functional outcomes at 6 months. ONSD measurements may be performed using just one eye and one probe orientation to make the serial examinations easier to adopt and perform. ONSD may be used to screen stroke patients at risk of poor prognosis, especially when used in conjunction with abnormal clinical examination and CT imaging.

Comparison of the quality of logistic regression models and a classification tree in predicting hospital mortality in elderly patients with non-ST-elevation myocardial infarction

Aim. Using the CHAID (Chi Squared Automatic Interaction Detection) method to develop a classification tree for predicting hospital mortality in patients with non-ST-elevation myocardial infarction (non-STEMI) aged 75 years and older and compare the quality of the constructed model with the logistic regression model.Material and methods. A retrospective analysis of the case histories of 119 sequentially enrolled patients aged ≥75 years who were hospitalized in a cardiology department due to non-STEMI in 2020-2021 was carried out. The construction of a predictive model of probability of dying was carried out using the logistic regression method. To assess the impact of various predictors affecting the probability of dying during the of hospitalization period in patients with non-STEMI, a classification tree was developed using the CHAID method. To compare the quality of logistic regression models and the classification tree, the areas under the ROC curve and confidence intervals were estimated.Results. Based on the construction of a binary logistic regression, it was found that the factors increasing hospital mortality were cardiogenic shock (CS): odds ratio (OR) 47.55; 4.00-589.16; p=0.002; new-onset atrial fibrillation: OR 6.45; 1.39-30.42; p=0.018; and the number of points on the GRACE scale: for each increase by 1 point: OR 1.03; 1,00-1,05; p=0.046. Similar data were obtained when analyzing the classification tree: in patients with CS, the predicted mortality was 91.7%. The probability of an unfavorable outcome based on the constructed classification tree was higher than the average in the analyzed sample in persons without CS, 2-3 degree atrioventricular blocks, and pulmonary edema, but with right bundle branch block on the electrocardiogram (25.0%) and in persons without CS and atrioventricular blockages of 2-3 degrees, but with pulmonary edema and a Q wave on the electrocardiogram (50.0%). Both methods of predicting hospital mortality are applicable. There were no statistically significant differences in the quality of both constructed models; the difference in the areas under the ROC curves was 0.043±0.268 with a 95% confidence interval of -0.055-0.141, p=0.387.Conclusion. Both developed methods can be used to determine the probability of dying in a hospital. Currently, the recruitment of patients into a prospective study of a similar design has begun and is continuing, during which validation of the constructed forecasting models is planned.

Inpatient palliative care in metastatic adrenocortical carcinoma: a retrospective analysis using the National Inpatient Sample database.

The use of inpatient palliative care (IPC) in advanced cancer patients represents a well-established guideline recommendation. This study examines the utilization rates and patterns of IPC among patients with metastatic adrenocortical carcinoma (mACC). Relying on the Nationwide Inpatient Sample database (2007-2019), we tabulated IPC rates in mACC patients. Estimated annual percentage changes (EAPC) analyses as well as multivariable logistic regression models (MLRM) predicting IPC use were fitted. Of 2040 mACC patients, 238 (12%) received IPC. Overall, the rate of IPC increased from 3.7% to 19.1% between 2007 and 2019 (EAPC +9.6%, P=0.001). During the same period, in-hospital mortality remained unchanged from 12.1 to 13.8% (EAPC 0.1%; P=0.97). Younger age at admission (<60 years; MLRM OR=0.70, P=0.013), solitary metastatic site (OR=0.63; P=0.015), and non-brain metastases (OR=0.62; P=0.033) were all associated with lower IPC use. In mACC patients, IPC use has increased from a marginal 3.7% to a moderate annual value of 19.1% in the most recent study year. These rates were not driven by a concomitant increase in in-hospital mortality (12.1% to 13.8%; P=0.9). and may be interpreted as an improvement in quality of care. Despite this encouraging increase, some patient characteristics herald lower IPC use. In consequence, younger patients, those with solitary metastatic sites, and non-brain metastases should be carefully considered for IPC to decrease or completely reduce the IPC access barrier maximally.

U-shaped correlation of lymphocyte count with all-cause hospital mortality in sepsis and septic shock patients: a MIMIC-IV and eICU-CRD database study

BackgroundIn sepsis, the relationship between lymphocyte counts and patient outcomes is complex. Lymphocytopenia and lymphocytosis significantly influence survival, illustrating the dual functionality of lymphocytes in responding to infections. This study investigates this complex interaction, focusing on how variations in lymphocyte counts correlate with all-cause hospital mortality among sepsis patients.MethodsThis retrospective cohort study analyzed data from two extensive critical care databases: the Medical Information Mart for Intensive Care IV 2.0 (MIMIC-IV 2.0) from Beth Israel Deaconess Medical Center, Boston, Massachusetts, and the eICU Collaborative Research Database (eICU-CRD), which was Multi-center database from over 200 hospitals across the United States conducted by Philips eICU Research Institute. We included adult patients aged 18 years and older who met the Sepsis-3 criteria, characterized by documented or suspected infection and a Sequential Organ Failure Assessment (SOFA) score of 2 or higher. Sepsis patients were categorized into quartiles based on lymphocyte counts. The primary outcome was all-cause mortality in the hospital, with 90 and 60-day all-cause mortality as the secondary outcomes. Univariable and multivariable Cox proportional hazard regressions were utilized to assess lymphocyte counts' impact on hospital mortality. An adjusted restricted cubic spline (RCS) analysis was performed to elucidate this relationship further. Subgroup analyses were also conducted to explore the association across various comorbidity groups among sepsis and septic shock patients.ResultsOur study included 37,054 patients, with an observed in-hospital mortality rate of 16.6%. Univariable and multivariable Cox proportional hazard regression models showed that lymphocyte counts were independently associated with in-hospital mortality (HR = 1.04, P < 0.01; HR = 1.06, P < 0.01). RCS regression analysis revealed a U-shaped relationship between lymphocyte levels and hospital mortality risk in sepsis and septic shock patients (P for overall < 0.001, P for nonliner < 0.01; P for overall = 0.002, P for nonliner = 0.014). Subgroup analyses revealed that elevated lymphocyte counts correlated with increased hospital mortality among sepsis patients with liver disease and requiring renal replacement therapy (P for overall = 0.021, P for nonliner = 0.158; P for overall = 0.025, P for nonliner = 0.759). These findings suggest that lymphocytes may have enhanced prognostic value in specific subsets of critically ill sepsis patients.ConclusionOur findings demonstrate that lymphocyte counts are a significant independent predictor of hospital mortality in sepsis and septic shock patients. We observed a U-shaped association between lymphocyte levels and mortality risk, indicating that high and low counts are linked to increased mortality. This result highlights the complex role of lymphocytes in sepsis outcomes and suggests the need for further investigation into the underlying mechanisms and potential therapeutic approaches. Integrating lymphocyte count assessment into risk stratification algorithms and clinical decision support tools could enhance the early identification of high-risk sepsis patients.

Navigating the Nexus: Acute Kidney Injury in Acute Stroke - A Prospective Cohort Study.

Acute kidney injury (AKI) is prevalent in patients with acute stroke. Although AKI is linked to poor clinical outcomes, data about its incidence and effect on stroke outcomes is limited. This was a prospective observational study carried out at a single tertiary care center that analyzed the data of 204 consecutive subjects with acute ischemic stroke and intracerebral hemorrhage. Considering serum creatinine at admission as the baseline, AKI was defined as a rise in serum creatinine value of 0.3 mg/dl over 48 h or a percentage increase of at least 50% from baseline over 7 days during hospitalization. The primary outcome was to measure the prevalence of AKI in patients with acute stroke. Secondary outcome measures were all-cause mortality, duration of hospital stay, need for dialysis, and comparison of outcomes in ischemic and hemorrhagic stroke. For both the stroke subtypes, we employed a multivariate logistic regression model, with AKI and hospital mortality being the outcomes. Covariates included gender, age, ventilatory requirement, duration of hospital stay, and National Institutes of Health Stroke Scale score at admission. There were 144 cases of ischemic stroke with 12 deaths (8.3%) and 60 cases of intracranial hemorrhage (ICH) with 22 deaths (36.7%). The mean age was 55 years, 72.6% were males, and AKI complicated 34% of ischemic stroke and 66.7% of ICH hospitalizations. AKI was linked to increased hospital mortality from ischemic stroke (odds ratio [OR] 27.21, 95% CI 3.39-218.13) and hemorrhagic stroke (OR 5.12, 95% CI 1.29-20.28) in multivariate analysis stratified by stroke type. AKI complicates stroke frequently and increases hospital mortality. Additional studies are required to assess if the association is causal and if remedies to prevent AKI would decrease mortality.

Prevalence and associated factors of atrial fibrillation among patients with rheumatic heart disease attending public referral hospitals in Bahir Dar city, Northwest Ethiopia, 2023

BackgroundAtrial fibrillation (AF) is a supraventricular arrhythmia associated with uncoordinated atrial activation. Atrial fibrillation is complication of rheumatic heart disease and is associated with substantial morbidity and mortality. It is a growing public health problem and economic and social burden. Studies investigating the prevalence and factors associated with atrial fibrillation among chronic rheumatic heart disease patients in Ethiopia are scarce. Therefore, this study aimed to determine the prevalence and factors associated with atrial fibrillation in patients with chronic rheumatic heart disease.Methods and materialsA hospital-based cross-sectional study was conducted. A total of 410 patients were selected using a systematic random sampling method. The data were entered into Epi-Data version 4.6 and subsequently exported to SPSS version 26 software for analysis. A binary logistic regression model was applied to identify significant variables related to AF.ResultsIn this study, 410 patient charts were reviewed. The prevalence of atrial fibrillation was 43% (95% CI of 38% up to 48%). Male (AOR = 3.81, 95% CI 2.00-7.26), age greater than 30 years (AOR = 7.26, 95% CI 3.93–13.41), heart failure (AOR = 4.65, 95% CI 2.39–9.04), mitral valve stenosis (AOR = 6.36, 95% CI 2.92–13.87), and left atrial diameter enlargement (AOR = 3.41, 95% CI 1.64–7.09) were associated with atrial fibrillation.Conclusions and recommendationsAtrial fibrillation leads patients to frequent hospital admission and increases hospital mortality. As a result, health care professionals need to pay more attention to and apply more clinical treatment for older patients, those with heart failure, those with mitral valve stenosis, and those with left atrial diameter enlargement-associated causes of atrial fibrillation.

Emergency Department Triage, Transfer Times, and Hospital Mortality of Patients Admitted to the ICU: A Retrospective Replication and Continuation Study.

This study aimed to provide new insights into the impact of emergency department (ED) to ICU time on hospital mortality, stratifying patients by academic and nonacademic teaching (NACT) hospitals, and considering Acute Physiology and Chronic Health Evaluation (APACHE)-IV probability and ED-triage scores. We conducted a retrospective cohort study (2009-2020) using data from the Dutch National Intensive Care Evaluation registry. Patients directly admitted from the ED to the ICU were included from four academic and eight NACT hospitals. Odds ratios (ORs) for mortality associated with ED-to-ICU time were estimated using multivariable regression, both crude and after adjusting for and stratifying by APACHE-IV probability and ED-triage scores. None. A total of 28,455 patients were included. The median ED-to-ICU time was 1.9 hours (interquartile range, 1.2-3.1 hr). No overall association was observed between ED-to-ICU time and hospital mortality after adjusting for APACHE-IV probability (p = 0.36). For patients with an APACHE-IV probability greater than 55.4% (highest quintile) and an ED-to-ICU time greater than 3.4 hours the adjusted OR (ORsadjApache) was 1.24 (95% CI, 1.00-1.54; p < 0.05) as compared with the reference category (< 1.1 hr). In the academic hospitals, the ORsadjApache for ED-to-ICU times of 1.6-2.3, 2.3-3.4, and greater than 3.4 hours were 1.21 (1.01-1.46), 1.21 (1.00-1.46), and 1.34 (1.10-1.64), respectively. In NACT hospitals, no association was observed (p = 0.07). Subsequently, ORs were adjusted for ED-triage score (ORsadjED). In the academic hospitals the ORsadjED for ED-to-ICU times greater than 3.4 hours was 0.98 (0.81-1.19), no overall association was observed (p = 0.08). In NACT hospitals, all time-ascending quintiles had ORsadjED values of less than 1.0 (p < 0.01). In patients with the highest APACHE-IV probability at academic hospitals, a prolonged ED-to-ICU time was associated with increased hospital mortality. We found no significant or consistent unfavorable association in lower APACHE-IV probability groups and NACT hospitals. The association between longer ED-to-ICU time and higher mortality was not found after adjustment and stratification for ED-triage score.

Redefining urine output thresholds for acute kidney injury criteria in critically Ill patients: a derivation and validation study

IntroductionThe current definition of acute kidney injury (AKI) includes increased serum creatinine (sCr) concentration and decreased urinary output (UO). Recent studies suggest that the standard UO threshold of 0.5 ml/kg/h may be suboptimal. This study aimed to develop and validate a novel UO-based AKI classification system that improves mortality prediction and patient stratification.MethodsData were obtained from the MIMIC-IV and eICU databases. The development process included (1) evaluating UO as a continuous variable over 3-, 6-, 12-, and 24-h periods; (2) identifying 3 optimal UO cutoff points for each time window (stages 1, 2, and 3); (3) comparing sensitivity and specificity to develop a unified staging system; (4) assessing average versus persistent reduced UO hourly; (5) comparing the new UO-AKI system to the KDIGO UO-AKI system; (6) integrating sCr criteria with both systems and comparing them; and (7) validating the new classification with an independent cohort. In all these steps, the outcome was hospital mortality. Another analyzed outcome was 90-day mortality. The analyses included ROC curve analysis, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and logistic and Cox regression analyses.ResultsFrom the MIMIC-IV database, 35,845 patients were included in the development cohort. After comparing the sensitivity and specificity of 12 different lowest UO thresholds across four time frames, 3 cutoff points were selected to compose the proposed UO-AKI classification: stage 1 (0.2–0.3 mL/kg/h), stage 2 (0.1–0.2 mL/kg/h), and stage 3 (< 0.1 mL/kg/h) over 6 h. The proposed classification had better discrimination when the average was used than when the persistent method was used. The adjusted odds ratio demonstrated a significant stepwise increase in hospital mortality with advancing UO-AKI stage. The proposed classification combined or not with the sCr criterion outperformed the KDIGO criteria in terms of predictive accuracy—AUC-ROC 0.75 (0.74–0.76) vs. 0.69 (0.68–0.70); NRI: 25.4% (95% CI: 23.3–27.6); and IDI: 4.0% (95% CI: 3.6–4.5). External validation with the eICU database confirmed the superior performance of the new classification system.ConclusionThe proposed UO-AKI classification enhances mortality prediction and patient stratification in critically ill patients, offering a more accurate and practical approach than the current KDIGO criteria.

Two Decades of CABG in the UK: A Propensity Matched Analysis of Outcomes by Conduit Choice.

Background/Objectives: Grafting of LIMA to LAD has long been considered the gold-standard conduit choice for patients undergoing CABG. Despite this, the LSV remains the most used conduit by volume and some patients may not receive even a single arterial conduit. However, the outcomes in this group are not frequently explored. This study, therefore, compares in-hospital outcomes of patients who underwent CABG without any arterial conduits to those who received at least one arterial conduit. Methods: Retrospective propensity-matched database analysis of consecutive patients undergoing CABG in the UK between 1996 and 2019 using data from the National Adult Cardiac Surgery Audit. Results: 335,144 patients underwent CABG, with 6% receiving venous conduits only; matched outcomes are reported for 39,812 patients. In both unmatched and matched groups, we found a significant increase in mortality with the use of veins only (matched mortality 5.3% vs. 3.8%, p < 0.001) with estimated treatment effect for mortality OR 1.43, p < 0.001 (95% CI: 1.31-1.57). We also identified greater rates of post-operative dialysis, IABP insertion, and length of hospital stay in this group. Conclusions: We identified a significant increase in in-hospital mortality with the use of veins only compared to using at least one arterial graft to the LAD. While a single arterial graft should be prioritised wherever possible, venous revascularisation retains a critical role for specific patients. We must, therefore, continue to conduct research addressing the mechanisms underlying and propagating vein graft disease in order better to optimise outcomes for this niche patient group after CABG.

CLINICAL OUTCOMES OF PATIENTS WITH CARDIOGENIC SHOCK COMPLICATING ACUTE MYOCARDIAL INFARCTION: THE GULF-CARDIOGENIC SHOCK REGISTRY.

Background: There is a paucity of data regarding acute myocardial infarction (MI) complicated by cardiogenic shock (AMI-CS) in the Gulf region. This study addressed this knowledge gap by examining patients experiencing AMI-CS in the Gulf region and analyzing hospital and short-term follow-up mortality. Methods: The Gulf-Cardiogenic Shock registry included 1,513 patients with AMI-CS diagnosed between January 2020 and December 2022. Results: The incidence of AMI-CS was 4.1% (1,513/37,379). The median age was 60 years. The most common presentation was ST-elevation MI (73.83%). In-hospital mortality was 45.5%. Majority of patients were in SCAI (Society for Cardiovascular Angiography and Interventions shock classification) stage D and E (68.94%). Factors associated with hospital mortality were previous coronary artery bypass graft (odds ratio [OR]: 2.49; 95% confidence interval [CI]: 1.321-4.693), cerebrovascular accident (OR: 1.621; 95% CI: 1.032-2.547), chronic kidney disease (OR: 1.572; 95% CI: 1.158-2.136), non-ST-elevation MI (OR: 1.744; 95% CI: 1.058-2.873), cardiac arrest (OR: 5.702; 95% CI: 3.640-8.933), SCAI stage D and E (OR: 19.146; 95% CI: 9.902-37.017), prolonged QRS (OR: 10.012; 95% CI: 1.006-1.019), right ventricular dysfunction (OR: 1.679; 95% CI: 1.267-2.226), and ventricular septal rupture (OR: 6.008; 95% CI: 2.256-15.998). Forty percent had invasive hemodynamic monitoring, 90.02% underwent revascularization, and 45.80% received mechanical circulatory support (41.31% had intra-aortic balloon pump and 14.21% had extracorporeal membrane oxygenation/Impella devices). Survival at 12 months was 51.49% (95% CI: 46.44%-56.29%). Conclusions: The study highlighted the significant burden of AMI-CS in this region, with high in-hospital mortality. The study identified several key risk factors associated with increased hospital mortality. Despite the utilization of invasive hemodynamic monitoring, revascularization, and mechanical circulatory support in a substantial proportion of patients, the 12-month survival rate remained relatively low.