Independent Predictor Of In-hospital Mortality Research Articles

Abstract 18575: Impact of Mechanical Circulatory Support on In-Hospital Mortality in Ventricular Tachycardia Ablation: A United States Nationwide Analysis

Background: Mechanical circulatory support (MCS) devices have emerged as a valuable tool in ventricular tachycardia (VT) ablation procedures, offering potential benefits such as improved hemodynamic stability, preserved organ perfusion, and optimized coronary perfusion during prolonged VT induction and mapping. However, the impact of different MCS modalities on in-hospital mortality following VT ablation remains unclear. Objective: This study aimed to investigate the impact of various MCS modalities on in-hospital mortality in those undergoing VT ablation during hospitalization. Method: We analyzed data from the National Inpatient Sample to identify patients who underwent VT ablation and received transient mechanical cardiac support between 2019 and 2020. The primary endpoint was in-hospital mortality, stratified by different MCS modalities. Additionally, we explored independent predictors of in-hospital mortality. Result: A total of 850 patients underwent VT ablation and required MCS from January 2019 to December 2020. Among these patients, extracorporeal membrane oxygenation (ECMO), percutaneous left ventricular assist device (PLVAD), intra-aortic balloon pump (IABP), and a combination of more than one MCS modality were utilized in 5.8%, 64.7%, 18.8%, and 10.5% of cases, respectively. The in-hospital mortality rates for these groups were 40%, 16%, 22%, and 61%, respectively (p<0.01). Notably, the use of multiple MCS modalities, female sex, other races, and self-payment were independent predictors of mortality, with adjusted odds ratios (aOR) of 21.9 (p=0.008; 95% confidence interval [CI]: 2.2-217.1), 9.27 (p=0.045; 95% CI: 1.1-82.1), 27 (p=0.038; 95% CI: 1.1-29.4), and 27.6 (p=0.041; 95% CI: 1.2-660.8), respectively. Conclusion: Our study highlights that the use of multiple MCS modalities, female sex, other races, and self-payment are independent predictors of in-hospital mortality, highlighting the need for careful consideration and selection of MCS for VT ablation patients.

Abstract 14896: Age is a Predictor of In-Hospital Mortality for Left Ventricular Assist Device: Implication in Post-2018 Donor Heart Allocation System

Background: The introduction of the new heart allocation system in 2018 has significantly changed the landscape of heart transplantation and trends of durable left ventricular assist device (LVAD) utilization. Although the quality of durable LVAD has improved, the impact of age on in-hospital mortality for LVAD implantation remains unknown under the new allocation system. Objective: We aimed to investigate the influence of age on the outcome following the LVAD implantation under the new heart allocation system. Method: We utilized the National Inpatient Sample to investigate patients who underwent LVAD implantation between 2019 and 2020. The primary endpoint was in-hospital mortality following LVAD implantation, stratified by different age groups. We also investigated independent predictors of in-hospital mortality. Result: A total of 7,375 patients underwent LVAD implantation between January 2019 and December 2020. Among these patients, individuals aged 18-49, 50-59, 60-69, and over 70 years old accounted for 26%, 26%, 31%, and 17%, respectively. In-hospital mortality rates in the aforementioned age groups were 7%, 6%, 12%, and 17%, respectively. Notably, the age groups of 60-69 and over 70 compared to age <59 exhibited independent predictors of mortality, with an adjusted odds ratio (aOR) of 1.99 (p=0.02; 95% confidence interval [CI), 1.12-3.57) and 2.88 (p=0.002; 95% CI 1.45-5.71), respectively. Charlson Comorbidity Index (aOR, 1.39; p=0.02; 95% CI, 1.05-1.84) was also associated with increased risks of mortality. Conclusion: Our findings indicate that individuals over 60 years-old or with higher Charlson Comorbidity Index face a higher risk of in-hospital mortality following LVAD implantation.

FRAIL Scale: an independent predictor of in-hospital mortality among older adults.

To screen for geriatric syndromes in older in-hospital patients and investigate their relationship with mortality. Demographic data, comorbidities, and medical history of the patients were recorded. Anthropometric measurements were obtained at 72 hours after hospital admission. The Mini Nutritional Assessment-Short Form, strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) sarcopenia screening questionnaire, Katz Activities of Daily Living scale, Lawton-Brody instrumental activities of daily living scale, the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale and the Eating Assessment Test-10 (EAT-10) screening test were used to assess geriatric syndromes. All patients were evaluated for delirium, pain, falls, polypharmacy, sleep disorders, incontinence, and pressure injury by the same researcher. A total of 85 patients were included in the study. The mean age was 75±7 years (range: 66-97). During hospital follow-up, 15.3% (n=13) of the patients died and 84.7% (n=72) were discharged. The median length of stay was 19 days (range: 3-126 days). In the multivariate analysis, frailty (hazard ratio: 2.67, 95% CI: 1.41-5.06, p=0.003) was found to be associated with in-hospital mortality. Frailty is an independent risk factor for in-hospital mortality in older adults.

In-Hospital Mortality Prediction Model for Critically Ill Older Adult Patients Transferred from the Emergency Department to the Intensive Care Unit.

Studies on the prognosis of critically ill older adult patients admitted to the emergency department (ED) but requiring immediate admission to the intensive care unit (ICU) remain limited. This study aimed to develop an in-hospital mortality prediction model for critically ill older adult patients transferred from the ED to the ICU. The training cohort was taken from the Medical Information Mart for Intensive Care IV (version 2.2) database, and the external validation cohort was taken from the Affiliated Dongyang Hospital of Wenzhou Medical University. In the training cohort, class balance was addressed using Random Over Sampling Examples (ROSE). Univariate and multivariate Cox regression analyses were performed to identify independent risk factors. These were then integrated into the predictive nomogram. In the validation cohort, the predictive performance of the nomogram was evaluated using the area under the curve (AUC) of the receiver operating characteristic curve, calibration curve, clinical utility decision curve analysis (DCA), and clinical impact curve (CIC). In the ROSE-balanced training cohort, univariate and multivariate Cox regression analysis identified that age, sex, Glasgow coma scale score, malignant cancer, sepsis, use of mechanical ventilation, use of vasoactive agents, white blood cells, potassium, and creatinine were independent predictors of in-hospital mortality in critically ill older adult patients, and were included in the nomogram. The nomogram showed good predictive performance in the ROSE-balanced training cohort (AUC [95% confidence interval]: 0.792 [0.783-0.801]) and validation cohort (AUC [95% confidence interval]: 0.780 [0.727-0.834]). The calibration curves were well-fitted. DCA and CIC demonstrated that the nomogram has good clinical application value. This study developed a predictive model for early prediction of in-hospital mortality in critically ill older adult patients transferred from the ED to the ICU, which was validated by external data and has good predictive performance.

Traumatic Brain Injury: in-hospital Survival Rates and the Main Predictors of in-hospital Mortality in Northeastern Brazil*

Abstract Introduction Upper middle-income countries have epidemiological peculiarities that should be considered to identify the main predictive factors of intrahospital mortality regarding traumatic brain injury (TBI) to address modifiable problems. Objective To assess the in-hospital survival of patients with TBI and to identify the predictors of in-hospital death. Methods This is a retrospective dynamic cohort study of victims of TBI who were admitted to the Hospital de Urgência de Sergipe (HUSE, in the Portuguese acronym) between March 1, 2017 and April 29, 2018. The outcome considered was in-hospital death from any cause. Cox regression was used to assess predictors of in-hospital mortality. Results The sample comprised 596 patients, with a median age of 31.0 (12–94) years old, 504 (84%) of whom were men. Regarding TBI severity, 250 had mild TBI; 121 had moderate TBI; and 225 had severe TBI. The average follow-up was 20.6 ± 4.0 days, with 60 in-hospital deaths and a 30-day mortality of 22.9%. Four independent predictors of in-hospital death were identified: acute subdural hemorrhage (ASDH) (risk ratio [RR] = 1.926; 95% confidence interval [CI] = 1.15–3.22; p = 0.013), swelling (risk ratio [RR] = 3.706; 95%CI = 2.21–6.19; p < 0.001), skull fracture (RR = 2.551; 95%CI = 1.36–4.75; p = 0.003), and severe TBI (RR = 2.039; 95%CI = 1.29–4.12; p = 0.005). Conclusions Acute subdural hemorrhage, swelling, skull cap fracture, and a Glasgow Coma Scale score of < 9 at admission were independent predictors of in-hospital mortality in patients with TBI.

Donor/recipient ascending aortic diameter ratio as a novel potential metric for donor selection and improved clinical outcomes in heart transplantation: a propensity score-matched study.

Donor/recipient size matching is paramount in heart transplantation. Body weight, height, body mass index, body surface area, and predicted heart mass (PHM) ratios are generally used in size matching. Precise size matching is important to achieve better clinical outcomes. This study aims to determine the donor/recipient ascending aortic diameter (AAoD) ratio as a metric for donor selection and its effect on postoperative clinical outcomes in heart transplant patients. We retrospectively reviewed all consecutive patients who underwent heart transplantation from January 2015 to December 2018. A cutoff value of 0.8032 for the donor/recipient AAoD ratio (independent variable for the primary endpoint during unmatched cohort analysis) was determined for predicting in-hospital mortality. The patients were divided into two groups based on the cutoff value. Group A, AAoD < 0.8032 (n = 96), and Group B, AAoD > 0.8032 (n = 265). A propensity score-matched (PSM) study was performed to equalize the two groups comprising 77 patients each in terms of risk. A Cox regression model was developed to identify the independent preoperative variables affecting the primary end-point. The primary endpoint was all-cause in-hospital mortality. A total of 361 patients underwent heart transplantation during the given period. On the multivariate analysis, donor/recipient PHM ratio [HR 16.907, 95% confidence interval (CI) 1.535-186.246, P = 0.021], donor/recipient AAoD ratio < 0.8032 (HR 5.398, 95% CI 1.181-24.681, P = 0.030), and diabetes (HR 3.138, 95% CI 1.017-9.689, P = 0.047) were found to be independent predictors of in-hospital mortality. Group A had higher 3-year mortality than Group B (P = 0.022). The surgery time was longer and postoperative RBC, plasma, and platelets transfusion were higher in Group A (P < 0.05). Although not statistically significant the use of continuous renal replacement therapy (P = 0.054), and extracorporeal membrane oxygenation (P = 0.086), was realatively higher, and ventilation time (P = 0.079) was relatively longer in Group A. The donor/recipient AAoD ratio is a potential metric for patient matching and postoperative outcomes in heart transplantation. A donor/recipient AAoD ratio > 0.8032 could improve post-heart transplantation outcomes and donor heart utilization.

Study of mortality risk factors and outcomes in COVID-19 patients at a tertiary care hospital in West Bengal, India

Background: The risk of mortality is high in Coronavirus disease-19 (COVID-19)patients. The management of COVID-19 patients may be aided by the identification of variables associated with mortality. The aim of the study was to ascertain the outcomes and mortality risk factors in COVID-19 patients at a tertiary care facility in West Bengal, India. Method: A total of 94 patients with moderate to severe symptoms of COVID-19 were included in this observational descriptive study from April 2021 to June 2021. The patients with moderate to severe infection diagnosed by Indian Council of Medical Research (ICMR) guidelines admitted to the hospital, and those willing to participate in the study, were included. Those with mild symptoms and who refused to participate were excluded from the study. The severity of patient condition was determined by Ministry of Health &amp; Family Welfare (MoHFW) guidelines. Informed consent has been obtained from patients. Data was analyzed by Microsoft® Excel workbook 2007 into SPSS v 21.0 (IBM, USA). Results: Fifty-four percent of the patients had moderate, and 45.7% had severe infections. In-hospital mortality was 41.5% among moderate to severe infected COVID 19 positive patients. Non-survivors have significantly higher levels of neutrophils to lymphocyte ratio (NLR), blood urea, and sodium levels in comparison with survivors (P&lt;0.05). On multivariate logistic regression, only the severity of infection (determined by Ministry of Health &amp; Family Welfare guidelines) was an independent predictor of in-hospital mortality (adjusted OR, 3.73; 95% CI, 1.4717 to 9.4616; P=0.005). Conclusion: COVID-19 patients with severe infection on admission are more likely to die. Bangladesh Crit Care J September 2023; 11 (2): 103-108

Effectiveness of Lactate Clearance to Predict In-Hospital Mortality in Patients with Upper Gastrointestinal Bleeding.

To determine the performance of lactate clearance to predict prognosis in patients with upper gastrointestinal bleeding (UGIB). Observational study. Place and Duration of the Study: Department of Emergency Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey, from January 2018 to 2022. This study was conducted with 141 patients with UGIB. Lactate clearance was calculated based on the lactate levels at the time of admission and 6th hour. The primary outcome was survival. The secondary outcomes were the need for intensive care unit, endoscopic intervention, blood transfusion, and length of hospital stay. The median age of the patients was 71 years and 65.2% were males. In the non-survivor group; systolic blood pressure, diastolic blood pressure, base deficit, delta lactate, and lactate clearance were significantly lower; however, heart rate, baseline lactate and final lactate were significantly higher. The median lactate clearance of survivors and non-survivors were 23.61 and -0.51, respectively (p = 0.002). A unit decrease in lactate clearance increased mortality 1.011-fold. The performance of lactate clearance in predicting mortality was followed as; sensitivity 76.4, specificity 51.4 (AUC = 0.673, p = 0.002), and the cut-off value was 21.51. Lactate clearance was not statistically significant in determining the need for intensive care (p = 0.110), endoscopic intervention (p = 0.152) and blood transfusion (p = 0.266) in UGIB. Lactate clearance was an independent predictor of in-hospital mortality in UGIB. It is thought that the study will guide clinicians in the differentiation of critically-ill patients and an effective treatment planning. Upper gastrointestinal haemorrhage, Lactate, Lactate clearance, Mortality, endoscopy, Blood transfusion, Intensive care.

Preoperative arterial lactate and outcome after surgery for type A aortic dissection: The ERTAAD multicenter study

BackgroundAcute type A aortic dissection (TAAD) is associated with significant mortality and morbidity. In this study we evaluated the prognostic significance of preoperative arterial lactate concentration on the outcome after surgery for TAAD. MethodsThe ERTAAD registry included consecutive patients who underwent surgery for acute type A aortic dissection (TAAD) at 18 European centers of cardiac surgery. ResultsData on arterial lactate concentration immediately before surgery were available in 2798 (71.7 %) patients. Preoperative concentration of arterial lactate was an independent predictor of in-hospital mortality (mean, 3.5 ± 3.2 vs 2.1 ± 1.8 mmol/L, adjusted OR 1.181, 95%CI 1.129–1.235). The best cutoff value preoperative arterial lactate concentration was 1.8 mmol/L (in-hospital mortality, 12.0 %, vs. 26.6 %, p < 0.0001). The rates of in-hospital mortality increased along increasing quintiles of arterial lactate and it was 12.1 % in the lowest quintile and 33.6 % in the highest quintile (p < 0.0001). The difference between multivariable models with and without preoperative arterial lactate was statistically significant (p = 0.0002). The NRI was 0.296 (95%CI 0.200–0.391) (p < 0.0001) with −17 % of events correctly reclassified (p = 0.0002) and 46 % of non-events correctly reclassified (p < 0.0001). The IDI was 0.025 (95%CI 0.016–0.034) (p < 0.0001). Six studies from a systematic review plus the present one provided data for a pooled analysis which showed that the mean difference of preoperative arterial lactate between 30-day/in-hospital deaths and survivors was 1.85 mmol/L (95%CI 1.22–2.47, p < 0.0001, I2 64 %). ConclusionsHyperlactatemia significantly increased the risk of mortality after surgery for acute TAAD and should be considered in the clinical assessment of these critically ill patients.

Impact of comorbid heart failure among hospitalized patients with sarcoidosis: A United States population-based cohort study

BackgroundThere is paucity of data regarding the impact of concomitant heart failure (HF) on the in-hospital outcomes among hospitalized sarcoidosis patients. We aim to investigate the factors associated with concomitant HF and its impact on in-hospital outcomes among hospitalized sarcoidosis patients. MethodsWe utilized the 2018–2020 National Inpatient Sample (NIS) Database in conducting this study. Multivariable logistic and linear regression models were used to examine the factors associated with HF and hospital-associated outcomes among patients with sarcoidosis. ResultsA total of 36,864 hospitalized patients with sarcoidosis were identified, of which 24.78 % (n = 9135/36,864) had concomitant HF. Factors associated with concomitant HF were age (aOR 1.03; 95 % CI: 1.02–1.03, p value ≤ 0.001), black race (aOR 1.74; 95 % CI: 1.47–2.05, p value ≤ 0.001), not being female (aOR 0.79; 95 % CI: 0.69–0.91, p value ≤ 0.001), and arrhythmias (aOR 2.50; 95 % CI: 2.10–2.98, p value ≤ 0.001) specifically atrial fibrillation and ventricular tachycardia. Comorbidities associated with concomitant HF in this population were hyperlipidemia, obesity, coronary artery disease, cardiac device implantation history, and chronic kidney disease stage 1–4. Concomitant HF was not an independent predictor of in-hospital mortality or length of stay (LOS). However, age (aOR 1.04; 95 % CI, 1.03–1.06; p ≤ 0.001) and arrhythmia burden (aOR 2.08; 95 % CI, 1.47–2.95; p ≤ 0.001), specifically ventricular tachycardia and fibrillation, were independently associated with in-hospital mortality among sarcoidosis patients. ConclusionTraditional cardiovascular risk factors were associated with concomitant HF among hospitalized sarcoidosis patients. Moreover, concomitant HF among sarcoidosis patients was not significantly associated with in-hospital mortality or LOS.

Endoscopic Vacuum Therapy for Upper Gastrointestinal Leaks and Perforations: Analysis From a Multicenter Spanish Registry.

Endoscopic vacuum therapy (EVT) is a novel technique for closing upper gastrointestinal (UGI) defects. Available literature includes single-center retrospective cohort studies with small sample sizes. Furthermore, evidence about factors associated with EVT failure is scarce. We aimed to assess the efficacy and safety of EVT for the resolution of UGI defects in a multicenter study and to investigate the factors associated with EVT failure and in-hospital mortality. This is a prospective cohort study in which consecutive EVT procedures for the treatment of UGI defects from 19 Spanish hospitals were recorded in the national registry between November 2018 and March 2022. We included 102 patients: 89 with anastomotic leaks and 13 with perforations. Closure of the defect was achieved in 84 cases (82%). A total of 6 patients (5.9%) had adverse events related to the EVT. The in-hospital mortality rate was 12.7%. A total of 6 patients (5.9%) died because of EVT failure and 1 case (0.9%) due to a fatal adverse event. Time from diagnosis of the defect to initiation of EVT was the only independent predictor for EVT failure (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = 0.005). EVT failure (OR 24.5, 95% CI 4.5-133, P = 0.001) and development of pneumonia after EVT (OR 246.97, 95% CI 11.15-5,472.58, P = 0.0001) were independent predictors of in-hospital mortality. EVT is safe and effective in cases of anastomotic leak and perforations of the upper digestive tract. The early use of EVT improves the efficacy of this technique.

Predicting in-hospital mortality in patients admitted from the emergency department for pulmonary embolism: Incidence and prognostic value of deep vein thrombosis. A retrospective study.

Pulmonary embolism (PE) is one of the most common causes of death from cardiovascular disease. Although deep vein thrombosis (DVT) is the leading cause of PE, its prognostic role is unclear. This study investigated the incidence and prognostic value of DVT in predicting in-hospital mortality (IHM) in patients admitted from the emergency department (ED) for PE. This retrospective cohort study was conducted in the ED of a third-level university hospital. Patients over 18 years admitted for PE between 1 January 2018 and 31 December 2022 were included. Five hundred and thirty patients (mean age 73.13 years, 6% IHM) were included. 69.1% of cases had DVT (36.4% unilateral femoral vein, 3.6% bilateral, 39.1% unilateral popliteal vein, 2.8% bilateral, 45.7% distal vein thrombosis and 7.4% iliocaval involvement). Patients who died in hospital had a higher Pulmonary Embolism Severity Index (PESI) (138.6 vs. 99.65, p < 0.001), European Society of Cardiology risk class (15.6% vs. 1%, intermediate-high in 50% vs. 6.4%, p < 0.001) and more DVT involving the iliac-caval vein axis (18.8% vs. 6.6%, p = 0.011). PESI class >II, right ventricular dysfunction, increased blood markers of myocardial damage and involvement of the iliocaval venous axis were independent predictors of IHM on multivariate analysis. Although further studies are needed to confirm the prognostic role of DVT at PE, involvement of the iliocaval venous axis should considered to be a sign of a higher risk of IHM and may be a key factor in prognostic stratification.

Predictors of mortality and transfusion requirements in venoarterial extracorporeal membrane oxygenation patients.

The aim of this study was to evaluate the prognostic impact of variables, including thrombocytopenia and the amount of platelet transfusion, for predicting survival in venoarterial extracorporeal membrane oxygenation (ECMO) recipients. Additionally, we aimed to identify the predictors of increased transfusion requirement during venoarterial ECMO support. All patients who received venoarterial ECMO between December 2008 and March 2020 were retrospectively analyzed. Univariate and multivariate Cox regressions were used to evaluate in-hospital mortality according to variables including thrombocytopenia and daily average of platelet concentrate transfusion. Stepwise multiple linear regression analysis was used to identify independent predictors for transfusion requirements. Analysis of 218 patients demonstrated severe thrombocytopenia as an independent predictor of in-hospital mortality (hazard ratio = 2.840, 95% CI: 1.593-5.063, P < .001), along with age, pre-ECMO cardiac arrest, and pH. In contrast, the amount of platelet transfusion was not associated with in-hospital mortality. Multiple variables, including the type of indication for ECMO were associated with transfusion requirements. Our findings identified severe thrombocytopenia as an independent prognostic factor of in-hospital mortality. However, daily average platelet transfusion was not associated with survival outcomes. Additionally, our study identified predictive variables of increased transfusion requirements.

Mortality and prognostic factors for spontaneous pneumothorax in older adults.

Spontaneous pneumothorax occurs predominantly in young males and older adults, often as a secondary condition, and can be refractory and fatal. This study aimed to investigate the mortality and prognostic factors for pneumothorax in older patients. We retrospectively cohort studied patients with pneumothorax aged ≥65 years who visited our department from October 2012 to January 2019. Data on sex, age, medical history, smoking history, underlying lung disease, treatment, and prognosis were extracted from medical records. Cox proportional hazards regression analysis was used to investigate pneumothorax mortality and prognostic factors. In total, 239 patients were included. Among them, 36 (15%) died during hospitalization. Respiratory disease was the direct cause of death in 30 patients (83.3%), and 211 (88.3%) patients had underlying lung disease. The incidence of pneumonia in our hospital was 22.6% (54 cases). On admission, the mortality rate was 33% (18/54) in patients with concomitant pneumonia; univariate analysis showed significant differences in the Charlson Comorbidity Index (CCI), activities of daily living (ADL), and concomitant pneumonia. In the Cox proportional hazards analysis of ADL (p = 0.09), CCI (p = 0.05), and concomitant pneumonia on admission (p = 0.02), concomitant pneumonia on admission was found to be an independent predictor of in-hospital mortality. This study suggests that concomitant pneumonia at admission may be a mortality risk factor for pneumothorax.

Predictors associated with critical care need and in-hospital mortality among children with laboratory-confirmed COVID-19 infection in a high HIV infection burden region.

Despite the extra mortality associated with COVID-19 death globally, there is scant data on COVID-19-related paediatric mortality in Sub-Saharan Africa. We assessed predictors of critical care needs and hospital mortality in South African children with laboratory-confirmed SARS-CoV-2 infection in region with high HIV infection burden. We conducted a secondary multicentre analysis of the AFREhealth cohort (a multinational, multicentre cohort of paediatric COVID-19 clinical outcomes across six African countries) of children admitted to the Inkosi Albert Luthuli, a quaternary hospital in KwaZulu-Natal, South Africa, with confirmed RT-PCR between March 2020 and December 2020. We constructed multivariable logistic regression to explore factors associated with the need for critical care (high care/ intensive care hospitalisation or oxygen requirement) and cox-proportional hazards models to further assess factors independently associated with in-hospital death. Of the 82 children with PCR-confirmed SARS-CoV-2 infection (mean ± SD age: 4.2 ± 4.4 years), 35(42.7%) were younger than one year, 52(63%) were female and 59(71%) had a pre-existing medical condition. Thirty-seven (45.2%) children required critical care (median (IQR) duration: 7.5 (0.5-13.5) days) and 14(17%) died. Independent factors associated with need for critical care were being younger than 1 year (aPR: 3.02, 95%CI: 1.05-8.66; p = 0.04), having more than one comorbidity (aPR: 2.47, 95%CI: 1.32-4.61; p = 0.004), seizure (aPR: 2.39, 95%CI: 1.56-3.68; p < 0.001) and impaired renal function. Additionally, independent predictors of in-hospital mortality were exposure to HIV infection (aHR: 6.8, 95%CI:1.54-31.71; p = 0.01), requiring invasive ventilation (aHR: 3.59, 95%CI: 1.01-12.16, p = 0.048) and increase blood urea nitrogen (aHR: 1.06, 95%CI: 1.01-1.11; p = 0.017). However, children were less likely to die from COVID-19 if they were primarily admitted to quaternary unit (aHR: 0.23, 95%CI: 0.1-0.86, p = 0.029). We found a relatively high hospital death rate among children with confirmed COVID-19. During COVID-19 waves, a timely referral system and rapid identification of children at risk for critical care needs and death, such as those less than one year and those with comorbidities, could minimize excess mortality, particularly in high HIV-infection burden countries.

Impact of Center Procedural Volume on Mortality and Readmission Rates Following Pericardiectomy in the United States

Our study aimed to explore the national trends in the rates of perioperative complications, in-hospital mortality, and readmissions after pericardiectomy and the impact of center volume on these outcomes. Using the Nationwide Readmission Database, we identified patients who underwent isolated pericardiectomy from 2010 to 2019. In-hospital mortality and readmission rates were assessed using orthogonal polynomial contrasts, with the linear and nonlinear trends evaluated as needed. Multivariable logistic regression models were constructed to identify the independent predictors of mortality and readmission. All analyses accounted for the Nationwide Readmission Database sampling design and were performed using SAS version 9.4 (SAS Institute Inc. Cary, NC.) with p <0.05 used to indicate statistical significance. A total of 26,169 hospitalizations for pericardiectomy were identified during the study period. The median age was 59years and 44% were female. In-hospital mortality was 5.2%, and the median length of stay was 7days. Advanced age, higher co-morbidity index, and lower annual facility pericardiectomy volume were independent predictors of in-hospital mortality. The 30- and 90-day readmission rates after pericardiectomy were 18% and 28%, respectively. Previous cardiac surgery, diagnosis of constrictive pericarditis, and greater co-morbidity score were independent predictors of readmission. In conclusion, isolated pericardiectomy rates have remained mostly constant, with relatively small changes in in-hospital mortality and 30- and 90-day readmission rates over the last decade. Advanced age, lower facility pericardiectomy volume, and higher Elixhauser co-morbidity index are independent predictors of surgical mortality.

Acute hyperglycemia, a rabble-rouser or innocent bystander? A prospective analysis of clinical implications of acute hyperglycemia in STE-ACS patients

BackgroundAcute hyperglycemia is considered an independent prognosticator of both in-hospital and long-term outcomes in patients with acute coronary syndrome (ACS). This study aimed To analyze the incidence of acute hyperglycemia and its impact on the adverse in-hospital outcome in patients with STE-ACS undergoing primary percutaneous coronary intervention (PCI).MethodsIn this study, we enrolled patients presenting with STE-ACS and undergoing primary PCI at a tertiary care cardiac center. Acute hyperglycemia was defined as random plasma glucose (RBS) > 200 mg/dl at the time of presentation to the emergency room.ResultsOf the 4470 patients, 78.8% were males, and the mean age was 55.52 ± 11 years. In total, 39.4% (1759) were found to have acute hyperglycemia, and of these, 59% (1037) were already diagnosed with diabetes. Patients with acute hyperglycemia were observed to have a higher incidence of heart failure (8.2% vs. 5.5%; p < 0.001), contrast-induced nephropathy (10.9% vs. 7.4%; p < 0.001), and in-hospital mortality (5.7% vs. 2.5%; p < 0.001). On multivariable analysis, acute hyperglycemia was found to be an independent predictor of mortality with an adjusted odds ratio of 1.81 [1.28–2.55]. Multi-vessel disease (1.73 [1.17–2.56]), pre-procedure left ventricular end-diastolic pressure (LVEDP) (1.02 [1.0-1.03]), and Killip class III/IV (4.55 [3.09–6.71]) were found to be the additional independent predictors of in-hospital mortality.ConclusionsAcute hyperglycemia, regardless of diabetic status, is an independent predictor of in-hospital mortality among patients with STE-ACS undergoing primary PCI. Acute hyperglycemia, along with other significant predictors such as multi-vessel involvement, LVEDP, and Killip class III/IV, can be considered for the risk stratification of these patients.

Predictive value of nesfatin-1 in heart failure mortality

Abstract Objectives Advanced heart failure is the last stage of heart failure in which the life expectancy of patients is significantly reduced. Many mortality markers have been identified in advanced heart failure. Although the nesfatin-1 molecule is known as a satiety hormone, it has also been shown to be associated with many cardiovascular diseases. This study aims to elucidate the association between in-hospital mortality and nesfatin-1 level in advanced heart failure patients. Methods The research included 74 cases of advanced heart failure. During the coronary intensive care surveillance of these patients, 22 patients had in-hospital mortality. The cases, divided into groups with and without in-hospital mortality, were compared using laboratory data, echocardiography, and demographic properties. Results The age of the cases with in-hospital mortality was older than the cases without mortality [(74 (66–95) vs. 67 (26–90); p=0.019)]. Serum nesfatin-1 level and tricuspid annular plane systolic excursion (TAPSE) were statistically lower in the in-hospital mortality group (43.8 ± 5.5 vs. 40.5 ± 6.1; p=0.027, 13.5 ± 1.9 vs. 16.2 ± 2.6 p=0.001, respectively). Serum nesfatin-1 level and TAPSE were detected as independent predictors for in-hospital mortality in advanced heart failure via multivariate analysis using parameters that were significant in the univariate analysis. Receiver operator characteristic curve analysis showed that the optimum cut-off level for nesfatin-1 in determining in-hospital mortality was ≤23.57 (pg/mL) with a specificity of 73.1 % and a sensitivity of 77.3 % (AUC=0.763, 95 % CI=0.647–0.879, p&lt;0.001). Conclusions This research revealed that in advanced heart failure patients, serum nesfatin-1 amounts are associated with mortality and seem to be an independent predictor of mortality.

The prognostic value of HALP score in predicting in-hospital mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Despite major advances in reperfusion therapies, morbidity and mortality rates associated with cardiovascular disorders remain high, particularly in patients with ST-segment elevation myocardial infarction (STEMI). Therefore, identifying prognostic variables that can be used to predict morbidity and mortality in STEMI patients is critical for better disease management. The HALP (hemoglobin, albumin, lymphocyte, and platelet) score, a novel index indicating nutritional status and systemic inflammation, provides information about prognosis. In this context, this study was carried out to investigate the relationship between HALP score assessed at admission and in-hospital mortality in STEMI patients. The population of this retrospective study consisted of 1307 consecutive patients diagnosed with STEMI and who underwent primary percutaneous coronary intervention (pPCI). The 1090 patients included in the study sample were divided into two groups based on the median HALP score value of 3.59. In-hospital and all-cause mortality rates during the follow-up were obtained from the registry. In-hospital mortality rate was significantly higher in patients with a HALP score of less than 3.59 compared to those with a HALP score of more than 3.59 (7.5% and 0.7%, respectively; P < 0.001). Univariate and multivariate Cox proportional hazard analyses revealed that the HALP score is independently associated with in-hospital mortality. The optimal HALP score cutoff value of <3.72 predicted in-hospital mortality with 95.56% sensitivity and 49.19% specificity. This study's findings indicate that HALP score may be a significant independent predictor of in-hospital mortality in patients with STEMI treated with pPCI.

Prognostic Implications of High-Degree Atrio-Ventricular Block in Patients with Acute Myocardial Infarction in the Contemporary Era.

High-degree atrioventricular block (HAVB) is a known complication of ST-segment elevation myocardial infarction (STEMI). We aimed to determine the prevalence and prognostic impact of HAVB in a contemporary cohort of STEMI. Data were collected from the DIAMANTE registry that included STEMI patients admitted to our cardiac intensive care unit treated with urgent reperfusion. We studied the clinical characteristics and evolution in patients with and without HAVB at admission. From 1109 consecutive patients, HAVB was documented in 95 (8.6%). The right coronary artery was the culprit vessel in 84 patients with HAVB (88.4%). The independent predictors of HAVB were: male sex (OR 1.9, 95% CI 1.2-2.9), age (OR 1.03, 95% CI 1.01-1.05), involvement of right coronary artery (OR 12.4, 95% CI 7.6-20.2), and creatinine value (OR 1.5, 95% CI 1.1-2.0). A transient percutaneous pacemaker was used in 37 patients with HAVB (38.9%). Patients with HAVB had higher mortality that patients without HAVB (15.8% vs. 4.1%, p < 0.001); however, in multivariate analysis, HAVB was not an independent predictor of in-hospital mortality. HAVB was seen in 9% of STEMI patients and was particularly frequent in elderly males with renal failure. Patients with HAVB had a poor prognosis during hospitalization, but HAVB was not an independent predictor of in-hospital mortality.