Independent Marker Of Mortality Research Articles

Role of Serial change in Serum Procalcitonin Levels as a Marker to Predict 28th Day Mortality in Patients with Sepsis and Septic Shock

Objectives Worldwide, the estimated incidence of sepsis is >30 million cases every year with approximately 6 million deaths annually. Studies have shown that procalcitonin can be a reliable marker for diagnosis and predicting mortality in sepsis patients. In this study, we have tried to determine the role of serial changes in procalcitonin levels in predicting 28th day mortality in patients with sepsis and septic shock. Methods A prospective observational study was conducted at ABVIMS and Dr RML Hospital from 1st November 2017 to 31st March 2019. Adults who were diagnosed with sepsis or septic shock and admitted to ICU, emergency or ward of the hospital were included. Sample for procalcitonin was taken at admission (day-1), and on day-5. Patients were followed telephonically to record final outcome at 28 days. Results Fifty-seven patients were enrolled in the study. 35(61.4%) patients had sepsis and 22 (38.6%) were in septic shock. 10 (17.54%) patients died over a period of 28 days follow up. The level of serum procalcitonin on day-1 was significantly higher in non survivors as compared to survivors (7.66±2.07 vs. 5.78±2.48, p-value-0.029). Percentage change in procalcitonin (ΔPCT) from day 1 to day 5 was significantly low among non survivors as compared to survivors (29.94 ± 38.29 vs 70.33±34.56, p- value-0.006). Of 10 patient who died, 8(32%) had ≤80% decrease in (ΔPCT) and only 2 (6.25%) had >80%decrease in (ΔPCT) (p= 0.016). SOFA, q-SOFA and serum lactate were significantly higher among non survivors and were also significant in predicting mortality on univariate analysis. But multivariate analysis showed that only (ΔPCT) had significant correlation with mortality (OR: 0.972, p=0.022) and hence can hence can be used as an independent marker of mortality in sepsis patient. Conclusion This study determined that more than baseline values of procalcitonin, the change in serial procalcitonin (ΔPCT) was significant in predicting mortality in patients with sepsis and septic shock.

Abstract 14575: Pupillary Reflex as an Independent Marker of Mortality in Decompensated Heart Failure. A Longitudinal and Prospective Study

Introduction: In heart failure (HF) compensatory mechanisms are triggered to maintain adequate cardiac output. Among them, hyperactivation of sympathetic nervous system (SNS) is one of the main ones and carries a worse prognosis. The pupillary reflex depends on the SNS. Aims: The aim of the study is to analyze whether changes in the pupillary reflex in HF are useful in the prognostic stratification of these patients. Hypothesis: Pupillary reflex may be a prognostic marker in patients with decompensated HF. Methods: We prospectively and consecutively included 107 patients admitted with decompensated HF. Quantitative pupillometry was performed with the NeuroOptics pupillometry during the first 24 hours after admission and prior to discharge. The basal maximum pupillary diameter (BMPD) before contraction, was measured. Results: Of the 107 patients, 51% were women and 49% men, mean age was 79 +/- 10 years, 77% had hypertension, and 34% Diabetes.6 patients died during admission, 11 died in the first month after discharge and 4 patients were readmitted in the first month.Of the patients who died, all had on admission BMPD > 3.8 mm. No patient with a BMPD < 3.7 mm died. The area under curve ROC for predicting the combined endpoint of 1- month mortality and admissions for HF using BMPD was 0.823. The BMPD presented a weak correlation with heart rate and ejection fraction. It did not correlate with age, gender, BNP, mean E/e, left atrial volume indexed, creatinine, hematocrit, sodium. Conclusions: Patients with decompensated HF presented at admission a higher BMPD. This supports the hypothesis that decompensated HF present a hyperactivation of the SNS that promotes mydriasis. BMPD is provides a good independent predictor marker of in-hospital and 1-month mortality in patients admitted with HF. Pupillometry may be a new, non-invasive and simple tool that helps in the prognostic stratification of acute HF patients.

Significance of Hypocapnia in the Risk Assessment of Patients with Pulmonary Hypertension.

Blood gas analysis is part of the diagnostic work-up for pulmonary hypertension (PH). Although some studies have found that the partial pressure of carbon dioxide (PaCO2) is an independent marker of mortality in individuals with pulmonary arterial hypertension (PH Group 1), there is a lack of data regarding the significance of PaCO2 in individuals with different types of PH based on the new 2022 definitions. Therefore, this study analyzed data from 157 individuals who were undergoing PH work-up, including right heart catheterization, using PH definitions from the 2022 European Society of Cardiology/European Respiratory Society guidelines. At diagnosis, N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels were significantly higher, but the time-course of NT-pro-BNP levels during treatment was significantly more favorable in individuals with pulmonary arterial hypertension (PH Group 1) who did versus did not have hypocapnia (p = 0.026 and p = 0.017, respectively). These differences based on the presence of hypocapnia were not seen in individuals with PH Groups 2, 3, or 4. In conclusion, using the new definition of PH, hypocapnia may correlate with worse risk stratification at diagnosis in individuals with pulmonary arterial hypertension. However, hypocapnic individuals with pulmonary arterial hypertension may benefit more from disease-specific therapy than those without hypocapnia.

Blood urea nitrogen - independent marker of mortality in sepsis.

This retrospective study examines the relationship between admission Blood Urea Nitrogen (BUN) levels and clinical outcomes in patients with sepsis from two separate cohorts in the Czech Republic and the United States. The study included 9126 patients with sepsis between January 2014 and December 2018. Kaplan-Meier survival curves and Cox regression were used to analyse the data. An optimal cut-off was calculated by means of the Youden-Index. BUN at ICU admission was categorized as 10-20, 20-40 and >40 mg/dL. Comparing the group with the highest BUN levels to the one with lowest levels, we found HR for 28 days mortality 2.764 (CI 95% 2.37-3.20; P<0.001). We derived an optimal cut-off for prediction of 28 days mortality of 23 mg/dL. The association between BUN and 28 days mortality remained significant after adjusting for potential confounders - for APACHE IV (HR 1.374; 95%CI 1.20-1.58; P<0.001), SAPS2 (HR 1.545; 95%CI 1.35-1.77; P<0.001), eGFR (HR 1.851; 95%CI 1.59-2.16; P<0.001) and several other variables in an integrative model. Our findings support the BUN level as an independent and easily available predictor of 28 days mortality in septic critically ill patients admitted to an ICU.

Kidney Disease as Risk of In-Hospital Mortality in Patients With Acute Coronary Syndrome.

BackgroundAn acute coronary syndrome (ACS) event can be linked to several risk factors, including kidney disease. Currently, it is unknown if kidney disease is associated with the in-hospital mortality of patients admitted with ACS, regardless of the main confounders. In this study, we aimed to determine if kidney disease predicts in-hospital mortality among ACS patients.MethodologyThis is a retrospective cohort study that included patients who were admitted to the cardiology center with ACS. The patients were analyzed for their clinical characteristics, previous diseases, risk factors, and blood samples for laboratory analysis. Continuous variables were analyzed using Student’s t-test, and categorical variables using the chi-square test. A p-value of <0.05 was considered statistically significant.ResultsOf the 340 patients who were included in the study, 59 had ST-elevation myocardial infarction. The mean age of the patients was 62.17 years, 59.41% were male, 67.9% were Caucasian, 26% had diabetes, and 20% had a history of coronary artery disease. Age, systolic blood pressure, and a history of myocardial infarction and chronic kidney disease were linked with a higher mortality rate. In the multivariate analysis, only kidney disease was shown to be an independent marker of mortality.ConclusionsAmong individuals admitted with ACS, kidney disease at hospital admission is associated with increased chances of in-hospital mortality, regardless of other major and minor cardiovascular comorbidities and inflammation at baseline.

Prognostic value of myocardial injury biomarker in COVID-19: a systematic review and meta-analysis

Abstract Background An accurate prognostic tool that can help with risk stratification at first admission is crucial in COVID-19 patients, as severe complications and mortality rate can be reduced with prompt treatment and close follow up. The myocardial injury biomarker, Troponin, is reported to be a potential predictor of mortality in COVID-19 cases. Purpose This study aims to investigate the utility of cardiac troponin level as a prognosis tool in COVID-19 patients. Methods On March 12th, 2021, data was collected from PMC, PubMed, Google Scholar, Science Direct, and Scopus, using combination of keywords associated with myocardial injury biomarker, Troponin, and its prognostic value for mortality in COVID-19 patients. Included publications are original clinical trials, limited to those with English manuscripts, and all were reviewed and evaluated by 5 authors to minimise bias. Inclusion criteria for studies are original clinical trials with a study population of adults (≥18 years old) patients with confirmed SARS-CoV-2 infection through PCR. The quality of each studies included was assessed using the Newcastle-Ottawa Scale (NOS) and data synthesis and statistical analysis were carried out using Review Manager software. Results A total of 19 studies consisting of 13,789 COVID-19 patients were included. All 19 studies were good quality according to the NOS. Studies found that myocardial injury, indicated by the elevation of its biomarker, Troponin, is a strong predictor of in-hospital mortality. Furthermore, elevated troponin level itself is an independent marker of mortality, regardless of its concomitant cardiac disease. Meta-analysis of 9 included studies revealed a significant association between elevated cardiac troponin levels and mortality (HR 4.13; 95% CI 3.42 - 5.00; P&amp;lt;0.001). Based on GRADE, the result of this systematic review and meta-analysis proved to be moderate in quality as there are no inconsistency and variability in results and there are no publication biases. Conclusion Cardiac troponin level is found to be a strong predictor of mortality in COVID-19 patients and therefore should be treated both as an evaluation for cardiac involvement and as an important prognostic marker. Patients with elevated troponin levels within admission should be closely monitored and given prompt treatment to decrease mortality. Funding Acknowledgement Type of funding sources: None. Forest plot figure

Prognostic Value of Troponin-T and B-Type Natriuretic Peptide in Patients Hospitalized for COVID-19.

ResumoFundamento:A COVID-19 causa grave acometimento pulmonar, porém o sistema cardiovascular também pode ser afetado por miocardite, insuficiência cardíaca e choque. A elevação de biomarcadores cardíacos tem sido associada a um pior prognóstico.Objetivos:Avaliar o valor prognóstico da Troponina T (TnT) e do peptídeo natriurético tipo B (BNP) em pacientes internados por Covid-19.Métodos:Amostra de conveniência de pacientes hospitalizados por COVID-19. Foram coletados dados dos prontuários com o objetivo de avaliar a relação da TnT e o BNP medidos nas primeiras 24h de admissão com o desfecho combinado (DC) óbito ou necessidade de ventilação mecânica. Análise univariada comparou os grupos com e sem DC. Modelo multivariado de Cox foi utilizada para determinar preditores independentes do DC.Resultados:Avaliamos 183 pacientes (idade=66,8±17 anos, sendo 65,6% do sexo masculino). Tempo de acompanhamento foi de 7 dias (1 a 39 dias). O DC ocorreu em 24% dos pacientes. As medianas de TnT e BNP foram 0,011 e 0,041 ng/dl (p<0,001); 64 e 198 pg/dl (p<0,001) respectivamente para os grupos sem e com DC. Na análise univariada, além de TnT e BNP, idade, presença de doença coronariana, saturação de oxigênio, linfócitos, dímero-D, proteína C reativa titulada (PCR-t) e creatinina, foram diferentes entre os grupos com e sem desfechos. Na análise multivariada boostraped apenas TnT (1,12[IC95%1,03-1,47]) e PCR-t (1,04[IC95%1,00-1,10]) foram preditores independentes do DC.Conclusão:Nas primeiras 24h de admissão, TnT, mas não o BNP, foi marcador independente de mortalidade ou necessidade de ventilação mecânica invasiva. Este dado reforça ainda mais a importância clínica do acometimento cardíaco da COVID-19. (AArq Bras Cardiol. 2020; 115(4):660-666)

Longitudinal correlation of biomarkers of cardiac injury, inflammation, and coagulation to outcome in hospitalized COVID-19 patients

BackgroundCardiac injury, as measured by troponin elevation, has been reported among hospitalized coronavirus disease 2019 (COVID-19) patients and portends a poor prognosis. However, how the dynamics of troponin elevation interplay with inflammation and coagulation biomarkers over time is unknown. We assessed longitudinal follow-up of cardiac injury, inflammation and coagulation markers in relation to disease severity and outcome. MethodsWe retrospectively assessed 2068 patients with laboratory-confirmed COVID-19 between January 29 and April 1, 2020 at Tongji Hospital in Wuhan, China. We defined cardiac injury as an increase in high sensitivity cardiac troponin-I (hs-cTnI) above the 99th of the upper reference limit. We explored the dynamics of elevation in hs-cTnI and the relationship with inflammation (interleukin [IL]-6, IL-8, IL-10, IL-2 receptor, tumor necrosis factor-α, C-reactive protein) and coagulation (d-dimer, fibrinogen, international normalized ratio) markers in non-critically ill versus critically ill patients longitudinally and further correlated these markers to survivors and non-survivors. ResultsMedian age was 63 years (first to third quartile 51–70 years), 51.4% of whom were women. When compared to non-critically ill patients (N = 1592, 77.0%), critically ill (defined as requiring mechanical ventilation, in shock or multiorgan failure) patients (N = 476, 23.0%), had more frequent cardiac injury on admission (30.3% vs. 2.3%, p < 0.001), with increased mortality during hospitalization (38.4% vs. 0%, p < 0.001). Among critically ill patients, non-survivors (N = 183) had a continuous increase in hs-cTnI levels during hospitalization, while survivors (N = 293) showed a decrease in hs-cTnI level between day 4 and 7 after admission. Specifically, cardiac injury is an independent marker of mortality among critically ill patients at admission, day 4–7 and 8–14. Consistent positive correlations between hs-cTnI and interleukin (IL)-6 on admission (r = 0.59), day 4–7 (r = 0.66) and day 8–14 (r = 0.61; all p < 0.001) and d-dimer (at the same timepoints r = 0.54; 0.65; 0.61, all p < 0.001) were observed. A similar behavior was observed between hs-cTnI and most of other biomarkers of inflammation and coagulation. ConclusionsCardiac injury commonly occurs in critically ill COVID-19 patients, with increased levels of hs-cTnI beyond day 3 since admission portending a poor prognosis. A consistent positive correlation of hs-cTnI with IL-6 and d-dimer at several timepoints along hospitalization could suggest nonspecific cytokine-mediated cardiotoxicity.

Comparison of cardiac output, IVC diameters and lactate levels in prediction of mortality in patients in emergency department; An observational study.

Objective:Fluid overload is an independent marker for mortality in critically ill patients. Assessment of fluid status and fluid responsiveness is crucial for the management of these patients. In this study, we compared the lactate level, inferior vena cava (IVC) diameter and non-invasive cardiac output (CO) monitoring in prediction of mortality in emergency department.Methods:This was a cross sectional observational study which comprised of 68 patients and was performed in ED of Tabriz University of Medical Sciences, Iran, from Sept 2016 until Sept 2017. IVC diameter was measured before the P-wave on ECG to avoid interference with a-wave and v-wave on the venous pressure curve, and during maximal inspiration and expiration to avoid Valsalva-like maneuvers. An arterial lactate sample was taken from all patients before performing the initial resuscitation. All patients underwent non-invasive CO monitoring by CO2 rebreathing technique. Mortality was noted on day 28.Results:Deceased patients had a significantly low level of IVC diameters, less CO values and more lactate levels. However, based on ROC curve analysis, the prediction accuracy and validity of both CO values obtained by rebreathing CO2 and IVC diameter was poor and the highest accuracy was obtained by lactate level assessment.Conclusion:Initial lactate value is a reliable parameter for prediction of mortality in non-traumatic critically ill patients. IVC diameter changes during spontaneous ventilation and non-invasive CO monitoring does not possess acceptable accuracy for prediction of mortality in these patients.

Use of PRECISE-DAPT Score and Admission Platelet Count to Predict Mortality Risk in Patients With Acute Coronary Syndrome.

The PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Antiplatelet Therapy (PRECISE-DAPT) score has been validated to predict bleeding complications in patients undergoing stent implantation and dual antiplatelet therapy. This score does not include the platelet count (PC), which has been shown to be an independent marker of mortality in patients with acute coronary syndrome (ACS). We assessed the role of the PRECISE-DAPT score calculated on admission for mortality risk prediction and evaluated whether the predictive accuracy of this score improved by adding the PC. In a retrospective cohort study of 1000 patients with ACS, after adjustment for relevant covariates, a PRECISE-DAPT score ≥25 was independently associated with mortality (hazard ratio [HR]: 7.91; 95% confidence interval [CI]: 4.37-14.30). When this score was combined with PC, compared to patients with PRECISE-DAPT <25 and PC ≥150 × 109/L, the adjusted HR was 7.2 (95% CI 2.4-21.6) for those with PRECISE-DAPT <25 and PC <150 × 109/L; 10.7 (95% CI: 5.2-21.9) for those with PRECISE-DAPT ≥25 and PC ≥150 × 109/L; and 17.9 (95% CI 7.0-45.4) for those with PRECISE-DAPT ≥25 and PC <150 × 109/L. Selecting thresholds for high-risk designation, the PRECISE-DAPT score integrated with PC had a higher prediction value, compared to the PRECISE-DAPT and Global Registry of Acute Coronary Events scores.

Opportunistic Infections, Is Non Hodgkin Lymphoma One of the Risk Factors for Mortality?

Background:Opportunistic infections (OI's) are defined as infections that are more frequent or more severe because of immunosuppression. Conditions like HIV infections, Hematopoietic stem cell transplantation, autoimmune diseases like SLE and RA have been established as risk factors for increased mortality in OI. Studies suggest that lymphomas are a risk factor for mortality associated with OI's like Tuberculosis and candida (Silva et al, 2005; Chen et al, 2014) probably due to underlying immunodeficiency and therapeutic exposures inducing prolonged lymphopenia. Data describing association of underlying Non-Hodgkin Lymphoma (NHL) on mortality associated with OI's is limited. Our objective was to study impact of NHL on in‐hospital mortality of patients hospitalized with OI's.Methods:We analyzed data from the Healthcare Cost and Utilization Project's (HCUP) National Inpatient Sample, between 2010 and 2014 using the ICD-9 codes for Opportunistic infections (OI) which included tuberculosis (010-018), non-tubercular mycobacteria (031), cytomegalovirus (078.5), Herpes Zoster( 053), Candidiasis(112.4), Toxoplasmosis (130), Pneumocystis (136.3), Cryptococcosis(117.5), Listerosis (027.0), Nocardiosis (039), Aspergillosis (117.3) coccidiomycosis (114), histoplasmosis (115), blastomycosis (116.0) . The subset of this cohort with NHL excluding lymphoid leukemias listed as a secondary diagnosis were collected for analysis. Baseline characteristics including age, race, gender, Charlson comorbidity index, and infection with HIV etc. were analyzed for patients with admitted with OI's, with and without underlying diagnosis of NHL. Our primary outcome was in-hospital mortality. Characteristics associated with in‐hospital mortality were identified using multivariable logistic regression.ResultsBetween 2010 and 2014, a total of 1,81,016 admissions were identified with a primary diagnosis of OI. A total of 4442 admissions had an underlying diagnosis of NHL. Mean age of patients hospitalized with OI's with NHL, was higher (65.4 ±0.52 years vs 58.9±0.14years, p<0.05 ), and 54.7% of the patients were males. Racial distribution of the patients with NHL was similar to those suggested in previous studies (Li et sl, 2016), with 73.19% patients being whites. Patient's median income, hospital bed-size and teaching status of hospital all were found to be significant risk factors (p<0.05) for mortality. When adjusted for the above mentioned factors, as well as HIV or Transplant status of patients, NHL was found to be an independent factor for mortality with an odds ratio of 1.34 (p=0.03).ConclusionOI's constitute a major cause of morbidity and mortality in immunocompromised patients. There is limited data from a nationwide analysis which evaluates association of opportunistic infections and lymphoma as an independent marker of mortality. Our study suggests that NHL is an independent risk factor for mortality in patients who were admitted in the hospital for OI's. Further studies should be considered to the role of primary prophylaxis for conditions like PCP to avoid morbidity and mortality associated with these conditions. This will help reduce health care cost burden associated with such hospitalizations. DisclosuresNo relevant conflicts of interest to declare.

Low-Circulating Homoarginine is Associated with Dilatation and Decreased Function of the Left Ventricle in the General Population.

Low homoarginine is an independent marker of mortality in heart failure patients and incident cardiovascular events. Whether homoarginine is related with healthier cardiac structure and function is currently unclear. We used data of the population-based “Study of Health in Pomerania” (SHIP-Trend) to assess this relation. Homoarginine was measured in serum using liquid chromatography-tandem mass spectrometry. Linear regression models assessed the relation between homoarginine and several structural as well as functional parameters and N-terminal pro B-type natriuretic peptide (NTproBNP). All models were adjusted for age, sex, body mass index, and renal function. A total of 3113 subjects (median age 48 (25th percentile 37 to 75th percentile 60) years, 46% male) were included. A standard deviation decrease in homoarginine was associated with a larger left ventricular diastolic diameter (0.3; 95%-confidence interval (CI): 0.2 to 0.5 mm; p < 0.001), left ventricular systolic diameter (0.38; 95%-CI: −0.22 to 0.54 mm; p < 0.001) as well as a less relative wall thickness (–0.003 95%-CI: −0.006 to −0.0008; p = 0.01), left ventricular ejection fraction (–0.47; 95%-CI: –0.79 to −0.15%; p < 0.01) and fractional shortening (−0.35; 95%-CI: −0.62 to 0.07%; p = 0.01). Low homoarginine was also related to higher NTproBNP (−0.02 95%-CI: −0.034 to −0.009 log pg/mL; p < 0.01). Lower serum homoarginine is associated with dilatation of the heart and decreased function. Prospective clinical studies should assess if homoarginine supplementation improves cardiac health in subjects with low serum concentrations.

Prognostic implications of detectable cardiac troponin I below the 99th percentile in patients admitted to an emergency department without acute coronary syndrome.

Detectable troponin below the 99th percentile may reflect an underlying cardiac abnormality which might entail prognostic consequences. This study aimed to investigate the prognosis of patients admitted to an emergency department (ED) with detectable troponin below the 99th percentile reference limit who did not present with an acute coronary syndrome (ACS). We analysed the clinical data of all consecutive patients admitted to the ED during the years 2012 and 2013 in whom cardiac troponin was requested by the attending clinician (cTnI Ultra Siemens, Advia Centaur). Patients with troponin below the 99th percentile of the reference population (40 ng/L) and who did not have a diagnosis of ACS were selected, and their mortality was evaluated in a 2-year follow-up. A total of 2501 patients had a troponin level below the reference limit, with 43.9% of those showing detectable levels (>6 ng/L and <40 ng/L). Patients with detectable levels were elderly and had a higher prevalence of cardiovascular history and more comorbidities. The total mortality in the 2-year follow-up was 12.4% in patients with detectable troponin and 4.5% in patients with undetectable troponin (p<0.001). In the Cox multivariate regression analysis, the detectable troponin was an independent marker of mortality at 2 years (HR 1.62, 95% CI 1.07-2.45, p=0.021). Detectable troponin I below the 99th percentile is associated with higher mortality risk at 2-year follow-up in patients admitted to the ED who did not present with ACS.

Hyperglycemia and Hospital Transitions: Still A Long Road Ahead

Hyperglycemia, regardless of diabetes status, is present in over 30% of patients in an inpatient care setting and is an independent marker of mortality ( 1. Umpierrez G.E. Isaacs S.D. Bazargan N. You X. Thaler L.M. Kitabchi A.E. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002; 87: 978-982 Crossref PubMed Scopus (1551) Google Scholar ). As diabetes rates increase, appropriate transitions between care settings are needed for those with new-onset hyperglycemia and with diabetes mellitus (DM). Hospital discharges for DM increased from 2.8 million to 5.5 million between 2010 and 2014 ( 2. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. Statistics About Diabetes. 2014. Available at: http://www.cdc.gov/diabetes/statistics/hospitalization_national.htm. Accessed July 20, 2015 Google Scholar ). Antihyperglycemia treatments can pose risks to patients, as both insulin and oral agents have been identified as common medications leading to hospitalizations due to adverse drug events ( 3. Budnitz D.S. Lovegrove M.C. Shehab N. Richards C.L. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011; 365: 2002-2012 Crossref PubMed Scopus (1316) Google Scholar ). Acute-care transitions are considered particularly prone to medical error by the Joint Commission on Accreditation of Healthcare Organizations, as they result in complications and communication breakdowns that have consistently been at the root of a high percentage of reported events resulting in death or serious injury ( 4. Ong M.S. Coiera E. A systematic review of failures in handoff communication during intrahospital transfers. Jt Comm J Qual Patient Saf. 2011; 37: 274-284 Abstract Full Text Full Text PDF PubMed Google Scholar ).

PP.04.11

Objective:Left ventricular hypertrophy (LVH) in hypertensive patients (P) is an independent marker of mortality and it is important to evaluate the effect of treatment on this parameter. However, little is known about the relationship between LVH, central pressures and arterial stiffness.To evaluate

The Relationship Between Red Blood Cell Distribution Width (RDW CV) And C Reactive Protein (CRP) With The Clinical Outcomes In Non-St Elevation Myocardial Infarction And Unstable Angina Pectoris: A 6 Months Follow Up Study

&lt;p&gt;&lt;span style="font-family: Calibri;"&gt;&lt;strong&gt;&lt;span style="font-size: medium;"&gt;OBJECTIVES &lt;/span&gt;&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;&lt;span style="font-size: medium;"&gt;RDW CV&lt;/span&gt;&lt;strong&gt;&lt;/strong&gt;&lt;span style="font-size: medium;"&gt;is a marker of variation in size of rbc.&lt;/span&gt;&lt;span style="font-size: medium;"&gt;RDW has been reported to be a predictor of cardiac events in CAD . &lt;/span&gt;&lt;span style="font-size: medium;"&gt;CRP is a pentameric protein, an acute phase reactant and an independent marker of mortality in ACS .Here &lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;we hypothesized that RDW CV level on admission and CRP would be predictive of adverse outcomes in NSTEMI and USAP&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;patients.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;span style="font-family: Calibri; font-size: medium;"&gt;METHODS&lt;/span&gt;&lt;/strong&gt;&lt;span style="font-family: Calibri;"&gt;&lt;span style="font-size: medium;"&gt;319 patients with ACS (240 males and&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;79 females) were prospectively analyzed. Patients were divided into two groups based on the fiftieth percentile of admission RDW levels.&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;High RDW group (n=214) was defined as those patients having RDW levels of &amp;gt;14.0.Qualitative CRP positivity was observed in 113 patients.The relationship between RDW &lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;and CRP and primary endpoint (cardiovascular deaths), secondary end points (reinfarction, repeat TVR) and MACE were assessed. The median follow-up was 6 months.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;span style="font-family: Calibri; font-size: medium;"&gt; &lt;/span&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;span style="font-family: Calibri;"&gt;&lt;strong&gt;&lt;span style="font-size: medium;"&gt;RESULTS &lt;/span&gt;&lt;/strong&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;Patients in high RDW group were older (p=0.16), females with&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;history of HT diabetes and MI. They had higher admission creatinine , Killip class &amp;gt;1 ,TIMI risk score,&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;CK-MB,&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;peak creatinine Ldl and TLC and lower lvef . They had more &lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;killip&amp;gt;1 (p=0.020) in hospital and at 6-months significantly increased mortality,reinfarction rates and hospitalization for heart failure was seen.&lt;/span&gt;&lt;span style="font-size: medium;"&gt;Patients with positive crp and high rdw had&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;significantly increased adverse outcomes.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;span style="font-family: Calibri; font-size: medium;"&gt; &lt;/span&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;span style="font-family: Calibri;"&gt;&lt;strong&gt;&lt;span style="font-size: medium;"&gt;CONCLUSIONS&lt;/span&gt;&lt;/strong&gt; &lt;span style="font-size: medium;"&gt;Given the advantages of the RDW levels &lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;it may be used as a marker of cardiovascular risk management in NSTEMI and USAP&lt;/span&gt;&lt;span style="font-size: medium;"&gt; &lt;/span&gt;&lt;span style="font-size: medium;"&gt;along with crp and plan early invasive strategy.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

Hepatic microvascular changes in rat abdominal compartment syndrome

BackgroundAbdominal compartment syndrome (ACS) is associated with an increased rate of multiple organ dysfunction and is an independent marker for mortality. Our objective was to develop an animal model to study the mechanisms of tissue and microvascular injury associated with ACS at the microscopic level. Materials and methodsACS was established in rats with CO2 insufflation at 20 mm Hg for 2 h, with an abdominal cast. Sinusoidal perfusion, inflammatory response, and cell death were quantified in exteriorized livers. Respiratory and renal dysfunction were assessed biochemically and morphologically. Myeloperoxidase levels, a marker of neutrophil activation, were measured in the liver, lung, and small intestine. ResultsContinuously perfused sinusoids were significantly lower in the ACS group (81.4 ± 2.2% versus 99.6% ± 0.50), with an increase in nonperfused and intermittently perfused sinusoids (P < 0.05). Hepatocellular death and the number of activated leukocytes in postsinusoidal venules showed 7- and 18-fold increases, respectively, in the ACS group (P < 0.05). A significant increase in blood urea nitrogen levels in experimental rats was also observed. Myeloperoxidase levels were found to be 8-fold higher in lungs of ACS rats relative to control (P < 0.05), as well as statistically significant increase in the pCO2 and decrease in pH of ACS rats. ConclusionsWe have successfully developed a model of ACS with documented evidence of renal and respiratory dysfunction. In addition, we have microscopy-confirmed evidence of early inflammatory changes and perfusion deficits in the liver with a concomitant increase in cell death in the ACS group.

Elevated NT-pro-brain natriuretic peptide level is independently associated with all-cause mortality in HIV-infected women in the early and recent HAART eras in the Women's Interagency HIV Study cohort.

BackgroundHIV-infected individuals are at increased risk of right and left heart dysfunction. N-terminal-pro-brain natriuretic peptide (NT-proBNP), a marker of cardiac ventricular strain and systolic dysfunction, may be associated with all-cause mortality in HIV-infected women. The aim of this study was to determine if elevated levels of NT-proBNP is associated with increased mortality in HIV-infected women.DesignProspective cohort study.Methods and ResultsWe measured NT-proBNP in 936 HIV-infected and 387 age-matched HIV-uninfected women early (10/11/94 to 7/17/97) and 1082 HIV-infected and 448 HIV-uninfected women late (4/1/08 to 10/7/08) in the highly active antiretroviral therapy (HAART) periods in the Women’s Interagency HIV Study. An NT-proBNP >75th percentile was more likely in HIV-infected persons, but only statistically significant in the late period (27% vs. 21%, unadjusted p = 0.03). In HIV-infected participants, NT-proBNP>75th percentile was independently associated with worse 5-year survival in the early HAART period (HR 1.8, 95% CI 1.3–2.4, p<0.001) and remained a predictor of mortality in the late HAART period (HR 2.8, 95% CI 1.4–5.5, p = 0.002) independent of other established risk covariates (age, race/ethnicity, body mass index, smoking, hepatitis C serostatus, hypertension, renal function, and hemoglobin). NT-proBNP level was not associated with mortality in HIV-uninfected women.ConclusionNT-proBNP is a novel independent marker of mortality in HIV-infected women both when HAART was first introduced and currently. As NT-proBNP is often associated with both pulmonary hypertension and left ventricular dysfunction, these findings suggest that these conditions may contribute significantly to adverse outcomes in this population, requiring further definition of causes and treatments of elevated NT-proBNP in HIV-infected women.

Determinants of N-Terminal Pro-Brain Natriuretic Peptide Variation in Hemodialysis Patients and Prediction of Survival

Background/Aims: N-Terminal pro-brain natriuretic peptide (NT-proBNP) is a predictor of cardiac events and death in the general population and in chronic kidney disease. There is limited information on how natriuretic peptides vary in dialysis patients. The aim of this study was to analyze NT-proBNP variability, factors predicting its variability and survival related to NT-proBNP variability. Methods: A prospective 3-month observational study of prevalent hemodialysis patients with monthly measurements of NT-proBNP was carried out. A total of 211 hemodialysis patients were included, and mortality was recorded during 52 months of follow-up. Results: Inflammation was the strongest predictor of NT-proBNP variability. Patients with constantly high NT-proBNP had an increased risk of death adjusting for age, sex, dialysis vintage and comorbidity but not when also adjusting for nutritional status. Conclusions: Longitudinal changes in NT-proBNP are associated with changes in inflammation, nutritional status, age and comorbidity. Due to strong interactions with predictors of mortality such as nutritional status, we were unable to confirm NT-proBNP as an independent marker for mortality in dialysis patients.

Association of Phagocytic NADPH Oxidase Activity With Hypertensive Heart Disease

Left ventricular hypertrophy (LVH) is an independent marker of mortality in hypertension. Although the mechanisms contributing to LVH are complex, inflammation and oxidative stress may favor its development. We analyzed the association of the phagocytic NADPH oxidase-mediated superoxide anion release and LVH in patients with essential hypertension and the role of cardiotrophin-1 (CT-1) and interleukin-6 (IL-6), cytokines implicated in cardiac growth. Blood pressure, echocardiography data, and serum CT-1 and IL-6 levels were obtained in 140 subjects: 18 normotensives without LVH, 42 hypertensives without LVH, and 80 hypertensives with LVH. The NADPH oxidase-dependent superoxide production was assessed by chemiluminescence in peripheral blood mononuclear cells. Peripheral blood mononuclear cells were stimulated with CT-1 in vitro. Superoxide anion production by peripheral blood mononuclear cells associated with LVH and correlated with the left ventricular mass index. Serum CT-1 and IL-6 levels, which associated with the left ventricular mass index, correlated with superoxide production. Serum CT-1 and IL-6 levels were correlated. CT-1 stimulated NADPH oxidase superoxide production in peripheral blood mononuclear cells, which resulted in an increased release of IL-6. Our results show that superoxide anion production by the phagocytic NADPH oxidase associates with hypertensive heart disease, being significantly enhanced in hypertensive patients with LVH. This may be attributable to the activation of the NADPH oxidase by CT-1 and the subsequent release of IL-6. The phagocytic NADPH oxidase may be a therapeutic target in hypertensive heart disease.