Independent Predictor Of In-hospital Mortality Research Articles

Clinical characteristics and outcomes among critically ill patients with cancer and COVID-19-related acute respiratory failure

BackgroundCoronavirus disease 2019 (COVID-19) has affected individuals worldwide, and patients with cancer are particularly vulnerable to COVID-19-related severe illness, respiratory failure, and mortality. The relationship between COVID-19 and cancer remains a critical concern, and a comprehensive investigation of the factors affecting survival among patients with cancer who develop COVID-19-related respiratory failure is warranted. We aim to compare the characteristics and outcomes of COVID-19-related acute respiratory failure in patients with and without underlying cancer, while analyzing factors affecting in-hospital survival among cancer patients.MethodsWe conducted a retrospective observational study at Taipei Veterans General Hospital in Taiwan from May to September 2022, a period during which the omicron variant of the severe acute respiratory syndrome coronavirus 2 was circulating. Eligible patients had COVID-19 and acute respiratory failure. Clinical data, demographic information, disease severity markers, treatment details, and outcomes were collected and analyzed.ResultsOf the 215 enrolled critically ill patients with COVID-19, 65 had cancer. The patients with cancer were younger and had lower absolute lymphocyte counts, higher ferritin and lactate dehydrogenase (LDH) concentrations, and increased vasopressor use compared with those without cancer. The patients with cancer also received more COVID-19 specific treatments but had higher in-hospital mortality rate (61.5% vs 36%, P = 0.002) and longer viral shedding (13 vs 10 days, P = 0.007) than those without cancer did. Smoking [odds ratio (OR): 5.804, 95% confidence interval (CI): 1.847–39.746], elevated LDH (OR: 1.004, 95% CI: 1.001–1.012), vasopressor use (OR: 5.437, 95% CI: 1.202–24.593), and new renal replacement therapy (OR: 3.523, 95% CI: 1.203–61.108) were independent predictors of in-hospital mortality among patients with cancer and respiratory failure.ConclusionCritically ill patients with cancer experiencing COVID-19-related acute respiratory failure present unique clinical features and worse clinical outcomes compared with those without cancer. Smoking, elevated LDH, vasopressor use, and new renal replacement therapy were risk factors for in-hospital mortality in these patients.

The Systemic Immune-Inflammation Index Predicts In-Hospital Mortality in Patients Who Underwent On-Pump Cardiac Surgery.

Systemic immune-inflammation index (SII), a new inflammatory index calculated using platelet, neutrophil, and lymphocyte counts, has been demonstrated to be an independent risk factor for the identification of high-risk coronary artery disease in patients undergoing percutaneous coronary intervention and cardiovascular surgery with cardiopulmonary bypass (CPB). The relationship between SII and CPB-related mortality rates remains unclear. This research was designed to investigate the use of SII to predict in-hospital mortality in patients undergoing cardiac surgery with CPB. Four hundred eighty patients who underwent a cardiac procedure involving CPB over 3 years, were obtained from the hospital's database. The demographic data, comorbidities, hematological and biochemical profiles, and operative data of the groups were compared. Multiple logistic regression analyses were done to determine independent predictors of mortality. Prognostic factors were assessed by multivariate analysis, and the predictive values of SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) for mortality were compared. A p-value <0.05 was considered significant. Of 480 patients, 78 developed in-hospital mortality after cardiac surgery. SII was an independent predictor of in-hospital mortality (Odds ratio: 1.003, 95% confidence interval: 1.001-1.005, p<0.001). The cut-off value of the SII was >811.93 with 65% sensitivity and 65% specificity (area under the curve: 0.690). The predictive values of SII, PLR, and NLR were close to each other. High preoperative SII scores can be used for early determination of appropriate treatments, which may improve surgical outcomes of cardiac surgery in the future.

Clinical Characteristics and Prognostic Predictors of Pneumocystis Jirovecii Pneumonia in Patients with and without Chronic Pulmonary Disease: A Retrospective Cohort Study.

Pneumocystis jirovecii pneumonia (PJP) is a severe respiratory infection caused by Pneumocystis jirovecii in immunocompromised hosts. The role of P. jirovecii colonization in the development or progression of various pulmonary diseases has been reported. Our aim was to explore serial change in serum biomarkers and the independent risk factors for mortality in patients with and without chronic pulmonary diseases who developed PJP. We performed a retrospective study to select patients with Pneumocystis jirovecii pneumonia between January 1, 2012, and December 31, 2021. Information regarding demographics, clinical characteristics, underlying diseases, laboratory tests, treatment, and outcomes was collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of in-hospital mortality. A total of 167 patients diagnosed with PJP were included in the study: 53 in the CPD-PJP group and 114 in the NCPD-PJP group. The number of patients with PJP showed an increasing trend over the 10-year period. A similar trend was observed for in-hospital mortality. Independent risk factors associated with death in the NCPD-PJP group were procalcitonin level (adjusted OR 1.08, 95% CI 1.01-1.16, P=0.01), pneumothorax (adjusted OR 0.07, 95% CI 0.01-0.38, P=0.002), neutrophil count (adjusted OR 1.27, 95% CI 1.05-1.53, P=0.01) at 14 days, and hemoglobin level (adjusted OR 0.94, 95% CI 0.91-0.98; P=0.002) at 14 days after admission. The risk factor associated with death in the CPD-PJP group was neutrophil count (adjusted OR 1.19, 95% CI 0.99-1.43; P=0.05) at 14 days after admission. The risk factors for death were different between patients with PJP with and without chronic pulmonary disease. Early identification of these factors in patients with PJP and other underlying diseases may improve prognosis.

COVID-19 Related Acute Respiratory Distress Syndrome versus Classical Acute Respiratory Distress Syndrome Patients: Inflammatory Biomarkers as Predictors of Mortality in Pulmonary Septic Shock.

Coronavirus disease-2019 (COVID-19)-related severe acute respiratory distress syndrome (ARDS) differs pathophysiological from other pulmonary septic shock-related ARDS. Thus, we assessed whether all-cause in-hospital mortality differs for severe COVID-19-related and classical severe ARDS and which inflammatory biomarkers can predict mortality among these patients. This single-center, retrospective, observational cohort study included pulmonary septic shock patients (n = 114) with COVID-19-related and classical severe ARDS admitted in the Intensive Care Unit. Patients with a mean age of 73 (IQR 62-82), predominantly male (63%), were divided into two groups based on outcomes: survivors (n = 50) and non-survivors (n = 64). COVID-19-related severe ARDS (n = 48) accounts for 75% of deaths. Present comorbidities like heart disease (p = 0.043), neurologic disorders (p = 0.018), and liver disease (p = 0.038) were associated with in-hospital mortality, as well. Regarding inflammatory biomarkers, the AUC/c-statistic was 0.656 (95% CI: 0.53-0.759) for leukocytes, 0.613 (95% CI: 0.509-0.717) C-reactive protein (CRP) and 0.651 (95% CI: 0.548-0.753) for procalcitonin in predicting all-cause in-hospital mortality among patients with pulmonary septic shock and severe ARDS. Patients with pulmonary septic shock and with COVID-19-related severe ARDS had a higher incidence of in-hospital mortality than those with classical severe ARDS. The high value of leukocytes, C-reactive protein, and procalcitonin were predictive for all-cause in-hospital mortality in patients with pulmonary septic shock and ARDS. Infection with COVID-19 was an independent predictor of in-hospital mortality in the presence of ARDS.

Charlson and Elixhauser Comorbidity Indices for Prediction of Mortality and Hospital Readmission in Patients With Acute Pulmonary Embolism.

Several risk stratification systems aid clinicians in classifying pulmonary embolism (PE) severity and prognosis. We compared 2 clinical PE scoring systems, the PESI and sPESI scores, with 2 comorbidity indices, the Charlson Comorbidity Index (CCI) and the val Walraven Elixhauser Comorbidity Index (ECI), to determine the utility of each in predicting mortality and hospital readmission. Information was collected from 436 patients presenting with PE via retrospective chart review. The PESI, sPESI, CCI, and ECI scores were calculated for each patient. Multivariate analysis was used to determine each system's ability to predict in-hospital mortality, 90-day mortality, overall mortality, and all-cause hospital readmission. The impact of various demographic and clinical characteristics of each patient on these outcomes was also assessed. The PESI score was found to be an independent predictor of in-hospital mortality and 90-day mortality. The PESI score and the CCI were able to independently predict overall mortality. None of the 4 risk scores independently predicted hospital readmission. Other factors including hypoalbuminemia, serum BNP, coagulopathy, anemia, and diabetes were associated with increased mortality and readmission at various endpoints. The PESI score was the best tool for predicting mortality at any endpoint. The CCI may have utility in predicting long-term outcomes. Further work is needed to better determine the roles of the CCI and ECI in predicting patient outcomes in PE. The potential prognostic implications of low serum albumin and anemia at the time of PE also warrant further investigation.

Neutrophil/lymphocyte ratio as a predictor of mortality among aortic dissection patients in the emergency department.

Aortic dissection (AD) is a serious cardiovascular condition associated with high mortality rates. The systemic inflammatory response can influence the prognosis of AD, and in this context, the neutrophil-to-lymphocyte ratio (NLR) emerges as a simple and rapid inflammatory biomarker. This retrospective cohort study included 103 patients diagnosed with AD and treated in the emergency department between 2018 and 2023. Patient demographics, clinical features, and laboratory results were evaluated. Multivariate logistic regression analysis was performed to adjust for potential confounders such as age, mean systolic blood pressure, oxygen saturation, hemoglobin, lactate values, and the presence of coronary artery disease. The ability of NLR to predict mortality was analyzed using receiver operating characteristic (ROC) analysis. The study population was divided into two groups: non-survivors (68% mortality rate) and survivors (32% survival rate). The non-survivor group had significantly higher NLR values compared to the survivor group (median NLR 7.66 vs. 2.5, p<0.001). Multivariate logistic regression analysis identified NLR as an independent predictor of in-hospital mortality (adjusted odds ratio [OR] 2.33, 95% confidence interval [CI] 1.42-3.82, p<0.001). ROC analysis for NLR demonstrated high discriminative power with an area under the ROC curve (AUROC) of 0.851 (95% CI 0.768-0.914). The determined cut-off point was >5.08 with a sensitivity of 77.14% and specificity of 81.82%. The findings indicate that high NLR is strongly associated with increased mortality risk in patients with AD and can be used in emergency clinical settings to predict mortality.

O Índice de Imuno Inflamação Sistêmica Prevê Mortalidade Hospitalar em Pacientes Submetidos à Cirurgia Cardíaca com Circulação Extracorpórea

Abstract Background: Systemic immune-inflammation index (SII), a new inflammatory index calculated using platelet, neutrophil, and lymphocyte counts, has been demonstrated to be an independent risk factor for the identification of high-risk coronary artery disease in patients undergoing percutaneous coronary intervention and cardiovascular surgery with cardiopulmonary bypass (CPB). The relationship between SII and CPB-related mortality rates remains unclear. Objective: This research was designed to investigate the use of SII to predict in-hospital mortality in patients undergoing cardiac surgery with CPB. Methods: Four hundred eighty patients who underwent a cardiac procedure involving CPB over 3 years, were obtained from the hospital's database. The demographic data, comorbidities, hematological and biochemical profiles, and operative data of the groups were compared. Multiple logistic regression analyses were done to determine independent predictors of mortality. Prognostic factors were assessed by multivariate analysis, and the predictive values of SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) for mortality were compared. A p-value &lt;0.05 was considered significant. Results: Of 480 patients, 78 developed in-hospital mortality after cardiac surgery. SII was an independent predictor of in-hospital mortality (Odds ratio: 1.003, 95% confidence interval: 1.001-1.005, p&lt;0.001). The cut-off value of the SII was &gt;811.93 with 65% sensitivity and 65% specificity (area under the curve: 0.690). The predictive values of SII, PLR, and NLR were close to each other. Conclusion: High preoperative SII scores can be used for early determination of appropriate treatments, which may improve surgical outcomes of cardiac surgery in the future.

Risk factors of in-hospital mortality and discriminating capacity of NIVO score in exacerbations of COPD requiring noninvasive ventilation.

Noninvasive mechanical ventilation (NIV) is recommended as the initial mode of ventilation to treat acute respiratory failure in patients with AECOPD. The Noninvasive Ventilation Outcomes (NIVO) score has been proposed to evaluate the prognosis in patients with AECOPD requiring assisted NIV. However, it is not validated in Chinese patients. We used data from the MAGNET AECOPD Registry study, which is a prospective, noninterventional, multicenter, real-world study conducted between September 2017 and July 2021 in China. Data for the potential risk factors of mortality were collected and the NIVO score was calculated, and the in-hospital mortality was evaluated using the NIVO risk score. A total of 1164 patients were included in the study, and 57 patients (4.9%) died during their hospital stay. Multiple logistic regression analysis revealed that age ≥75years, DBP <60mmHg, Glasgow Coma Scale ≤14, anemia and BUN >7mmol/L were independent predictors of in-hospital mortality. The in-hospital mortality was associated with an increase in the risk level of NIVO score and the difference was statistically significant (p < .001). The NIVO risk score showed an acceptable accuracy for predicting the in-hospital mortality in AECOPD requiring assisted NIV (AUC: 0.657, 95% CI: 0.584-0.729, p < .001). Our findings identified predictors of mortality in patients with AECOPD receiving NIV, providing useful information to identify severe patients and guide the management of AECOPD. The NIVO score showed an acceptable predictive value for AECOPD receiving NIV in Chinese patients, and additional studies are needed to develop and validate predictive scores based on specific populations.

Blood glucose and lactate levels as early predictive markers in patients presenting with cardiogenic shock: A retrospective cohort study.

Lactate and glucose are widely used biochemical parameters in current predictive risk scores for cardiogenic shock. Data regarding the relationship between lactate and glucose levels in cardiogenic shock are limited. Thus, we aimed to analyze glucose and lactate as early markers for in-hospital mortality in cardiogenic shock. In this retrospective cohort study, 312 patients presenting with cardiogenic shock to a tertiary-care hospital between 2016 and 2018 were included. Apparent cardiogenic shock was defined as hypoperfusion with hemodynamic compromise and biochemical marker increase due to diminished tissue perfusion, corresponding to SCAI shock stages. In-hospital mortality was assessed as the primary endpoint. The median age of the study population was 71 (60-79) years and the etiology of cardiogenic shock was acute myocardial infarction in 45.8%. Overall in-hospital mortality was 67.6%. In the receiver operating curve analysis, the area under the receiver-operating curve (AUC) for prediction of in-hospital mortality was higher for lactate (AUC: 0.757) than for glucose (AUC: 0.652). Both values were significantly associated with outcome (groups created with best cutoff values obtained from the Youden index). Correlation analysis showed a significant non-linear association of both values. In a multivariable stepwise Cox regression analysis, lactate remained an independent predictor for in-hospital mortality, whilst glucose, despite being implicated in energy metabolism, was not independently predictive for mortality. Together, these data suggest that lactate at admission is superior for mortality prediction in patients with apparent cardiogenic shock. Glucose was not independently predictive for mortality.

Association of Hypoalbuminemia within Hospital Mortality in Patients with Acute Decompensated Heart Failure

Background: Acute decompensated heart failure (ADHF) remains a leading cause of hospitalization with significant morbidity and mortality. Hypoalbuminemia has been identified as a potential prognostic factor in various medical conditions, including heart failure. Understanding its association with in-hospital mortality in ADHF patients could enhance risk assessment and management strategies. Objective: This study aimed to investigate the association of hypoalbuminemia with in-hospital mortality in patients admitted with ADHF. Methods: This was a retrospective observational study conducted at a tertiary cardiac care center in Rawalpindi between July and November 2023. A total of 480 patients with a confirmed diagnosis of ADHF were included. Inclusion criteria were age ≥ 18 years, confirmed ADHF diagnosis, and available serum albumin levels upon admission. Exclusion criteria included incomplete medical records, end-stage renal disease, active malignancies, acute liver disease, and acute infectious diseases. Data on demographics, clinical characteristics, and serum albumin levels were collected. Logistic regression analysis was used to assess the association between hypoalbuminemia (defined as serum albumin &lt;3.0 g/dL) and in-hospital mortality, adjusting for confounders like age, sex, and comorbidities. Results: The cohort comprised 60% males and 40% females, with a mean age of 68 years. Hypertension (78%), diabetes (42%), and chronic kidney disease (36%) were the most prevalent comorbidities. The mean serum albumin level was 3.2 g/dL (SD = 0.4). Hypoalbuminemia was observed in 42% of patients. In-hospital mortality was 15%. Patients with hypoalbuminemia had a 2.5-fold increased risk of in-hospital mortality (unadjusted HR = 2.5, p &lt; 0.001). The adjusted HR was 2.0 (p &lt; 0.01), indicating hypoalbuminemia as an independent predictor of in-hospital mortality. Conclusion: Hypoalbuminemia is significantly associated with increased in-hospital mortality in patients with ADHF, serving as an independent prognostic indicator. This finding highlights the importance of serum albumin in the risk assessment and management of ADHF patients.

Factors Associated With Hospital Mortality in Acute Myocardial Infarction

Aim To determine clinical and laboratory parameters associated with in-hospital mortality in patients with acute myocardial infarction and to develop a multifactorial prognostic model of in-hospital mortality.Material and methods This was a study based on the 2019-2020 Registry of acute coronary syndrome of the Tyumen Cardiology Research Center, a branch of the Tomsk National Research Medical Center. The study included 477 patients with ST-segment elevation acute myocardial infarction (AMI), 617 patients with non-ST segment elevation AMI, and 26 patients with unspecified AMI. In-hospital mortality was 6.0 % (n=67). Clinical and laboratory parameters were assessed on the day of admission. The separation power of indicators associated with in-hospital mortality was determined using a ROC analysis. The data array of each quantitative parameter was converted into a binary variable according to the obtained cut-off thresholds, followed by creation of a multifactorial model for predicting in-hospital mortality using a stepwise analysis with backward inclusion (Wald). The null hypothesis was rejected at p&lt;0.05.Results The multivariate model for prediction of in-hospital mortality included age (cut-off, 72 years), OR 3.0 (95 % CI: 1.5-5.6); modified shock index (cut-off threshold, 0.87), OR 1.5 (95 % CI: 1.1-2.0); creatine phosphokinase-MB (cut-off threshold, 32.8 U / L), OR 4.1 (95 % CI: 2.2-7.7); hemoglobin (121.5 g / l), OR 1.7 (95 % CI: 1.2-2.3); leukocytes (11.5×109 / l), OR 1.9 (95 % CI: 1.3-2.6); glomerular filtration rate (60.9 ml / min), OR 1.7 (95 % CI: 1.2-2.2); left ventricular ejection fraction (42.5 %), OR 4.1 (95 % CI: 2.0-8.3); and size of myocardial asynergy (32.5 %), OR 2.6 (95 % CI: 1.4-5.0).Conclusions Independent predictors of in-hospital mortality in AMI are age, modified shock index, creatine phosphokinase-MB, peripheral blood leukocyte count, hemoglobin concentration, left ventricular ejection fraction, size of myocardial asynergy, and glomerular filtration rate. The in-hospital mortality model had a high predictive potential: AUC 0.930 (95 % CI: 0.905-0.954; p &lt;0.001) with a cutoff threshold of 0.15; sensitivity 0.851, and specificity 0.850.

Effect of Comorbid Diseases on Hospitalization and In-Hospital Mortality of Elderly Patients Who Reapplied to the Emergency Department Within 72 Hours.

This study aimed to determine the effects of comorbidities on hospitalization and in-hospital mortality in patients aged 65 years and older who returned to the emergency department within 24, 48, and 72 hours of an initial visit. This study was conducted at the Department of Emergency Medicine, Firat University Faculty of Medicine, Elâzığ, Turkey. It has a retrospective design and received local ethics committee approval from the university. Patients aged 65 years and older who presented to the emergency department within a one-year period (2022) were examined to identify those who returned to the emergency department within 24, 48, and 72 hours of an initial visit. A total of 763 (3.2%) patients >65 years of age returned to the emergency department within the first three days of their initial visit. Of these returning patients, 349 returned within 24 hours (Group 1), 227 within 48 hours (Group 2), and 187 within 72 hours (Group 3). Being female, polypharmacy, the presence of at least one comorbidity, cancer, and chronic renal failure were found to be independent predictors of hospitalization, whereas polypharmacy was found to be an independent predictor of in-hospital mortality. Patients returning to the emergency department shortly after an initial visit should be assessed more diligently due to the risk of mortality.

A comparative analysis of the Vasoactive-Inotropic Score, the Vasoactive-Ventilation-Renal Score, and the Oxygenation Index as outcome predictors in infants with a congenital diaphragmatic hernia.

To date, different severity scores and indices are available to predict outcome in infants with a congenital diaphragmatic hernia (CDH). The Oxygenation Index (OI) and the Vasoactive-Inotropic Score (VIS) has already been evaluated in the CDH population. The Vasoactive-Ventilation-Renal (VVR) Score was recently evaluated as new severity score in several studies on infants with need for cardiac surgery. The score was shown to outperform the VIS and OI as outcome predictors in these infants, but no data are available regarding the evaluation of the VVR Score in CDH infants. This was a retrospective single-center analysis at the University Children's Hospital, Bonn, Germany, during the study period from January 2019 until December 2022. Of 108 CDH infants treated at our institution, a final cohort of 100 neonates met the inclusion criteria. diagnosis of CDH (right-sided, left-sided, or bilateral). early mortality (before surgical correction of the diaphragm), palliative care after birth, no available data for OI, VIS, and VVR Score calculation. The OI, the VIS, and the VVR Score were calculated at three selected timepoints: at 48-72 h after birth (T1), before surgery (T2), and after surgery (T3). The primary clinical endpoint (in-hospital mortality) was reached in 21% of the infants. Infants surviving to discharge were allocated to group A, infants with fatal outcome to group B. In the univariate analysis, the OI was significantly higher in infants allocated to group B at T2 (p < .001), and T3 (p < .001). The VIS was significantly higher only at T1 in infants allocated to group B (p = .001). The VVR Score was significantly higher at T1 (p = .017), and at T3 (p = .002) in infants not surviving to discharge. In the multivariate analysis, the OI at T2 + T3 (p < .001), the VIS at T1 (p = .048), and the VVR Score at T1 + T3 (p = .023, and p = .048, respectively) remained significantly associated with in-hospital mortality. The OI presented the highest area under the curve (AUC) at T2 and T3 (T2:0.867, p = .001; T3:0.833, p = .000) regarding the primary endpoint in the overall cohort. In the subgroup of infants without need for extracorporeal membrane oxygenation (ECMO) therapy (n = 60) the VVR Sore presented the best performance with an AUC of 0.942 (p = .000) at T3. The severity scores OI, VIS, and VVR-Score are independent predictors of in-hospital mortality in CDH infants. The OI seems to outperform the VIS and VVR-Score as outcome predictor immediately before and after CDH surgery, whereas the VVR Score presented the best performance in the subgroup of CDH infants without need for ECMO and mild-to-moderate CDH defects.

Impact of Functional Status on Development of Clostridioides difficile Infection and Increase in Inhospital Mortality among Antibiotic Users

Introduction: Functional status is one of the surrogates of advanced age, an established risk factor for Clostridioides difficile infection (CDI). We aimed to investigate the usefulness of functional status in the clinical management of CDI. Methods: We enrolled all hospitalized adult patients receiving antibiotics from a retrospective hospital-based cohort in Japan between 2016 and 2020. Using the Barthel index (BI), which is an objective scale of functional status, we investigated the association of BI with developing CDI and its impact on inhospital mortality in patients with CDI. Results: We enrolled 17,131 patients with 100 cases of CDI. Multivariable analysis revealed that lower BI (≤25) was an independent risk factor for developing CDI (adjusted odds ratio, 4.11; 95% confidence interval, 2.62–6.46). Furthermore, a combination of BI and Charlson comorbidity index (CCI) showed an adjusted odds ratio of 36.40 (95% confidence interval, 17.30–76.60) in the highest risk group. A high-risk group according to the combination of BI and CCI was estimated to have significantly higher inhospital mortality in patients with CDI using the Kaplan-Meier method (p = 0.017). A combination of lower BI and higher CCI was an independent predictor of inhospital mortality even in the multivariable Cox regression model (adjusted hazard ratio, 3.00; 95% confidence interval, 1.01–8.88). Conclusions: Assessment of functional status, especially combined with comorbidities, was significantly associated with developing CDI and may also be useful in predicting inhospital mortality.

Predictive Value of the Naples Score for InHospital Mortality in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Introduction: ST-segment elevation myocardial infarction (STEMI) is a significant contributor to mortality. The identification of high-risk patients holds great importance for prognosis. The development of a scoring system that incorporates both inflammatory and nutritional status components can provide valuable insights into prognosis. Patients and Methods: This is a retrospective observational study comprising 570 consecutive ST-elevation myocardial infarction patients who underwent primary coronary intervention between 2018 and 2020. Patient data were obtained from the electronic database of the hospital. Results: The incidence of in-hospital mortality rate was 4.9%. The entire group was then divided into two groups based on the presence of in-hospital mortality: 542 patients without in-hospital mortality constituted group 1, while 28 patients with in-hospital mortality formed group 2. In the multivariate logistic regression analysis, the Naples score was identified as an independent predictor of in-hospital mortality. Conclusion: A higher Naples score is associated with increased in-hospital mortality in patients with STelevation myocardial infarction who undergo primary coronary intervention.

Clinical features and outcomes of patients with refractory out-of-hospital cardiac arrest and an initial shockable rhythm

Abstract Background Clinical features of patients presenting with refractory out-of-hospital cardiac arrest (OHCA) and initial shockable rhythms of ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) remain poorly described. Purpose This study evaluated clinical characteristics, angiographic findings, and short-term outcomes among patients with refractory OHCA (defined as incessant VF/pVT after ≥3 direct-current shocks) compared to those without refractory OHCA. Methods Of 761 consecutive patients hospitalized for OHCA between 2014–2018 at two large tertiary health services in Victoria, Australia, 204 (27%) had an initial shockable rhythm and were stratified by the presence (n=74, 36%) or absence (n=130, 64%) of refractory OHCA. Primary outcome was in-hospital mortality. Multivariable logistic regression was performed to evaluate independent predictors of in-hospital mortality. Results The majority of patients were male (77%) and the median age was 62 years [IQR 52–72]. Refractory OHCA patients had longer cardiopulmonary resuscitation (23 vs 15 minutes), more frequently required ≥450 mg of amiodarone (34% vs 3.8%), had cardiogenic shock (80% vs 55%) necessitating higher adrenaline dose (4.0 vs 1.0 mg) and higher rates of mechanical ventilation (92% vs 74%) (all p&amp;lt;0.01). A total of 167 patients (82%) underwent coronary angiography, and refractory OHCA patients were less likely to be selected (74% vs 86%, p=0.035). No difference in door-to-needle times between those with and without refractory OHCA was noted (103 vs 99 minutes, p=0.586). Significant coronary artery disease (≥1 major vessel with &amp;gt;70% stenosis) was present in &amp;gt;70% of patients. Refractory OHCA group frequently had acute coronary occlusion (64% vs 47%), especially of the left circumflex artery (20% vs 6.4%) and graft vessel (7.3% vs 0.9%), and often had complex coronary lesions (type B2 or C) (57% vs 39%) compared to those without refractory OHCA (all p&amp;lt;0.05). Patients with both refractory OHCA and ST-elevation on electrocardiogram had the highest prevalence of acute coronary occlusion (85%, 22/26). Refractory OHCA group had higher rates of in-hospital mortality (45% vs 30%) and new requirement for dialysis (18% vs 6.3%) (all p&amp;lt;0.05). After adjustment, refractory OHCA heightened the risk of in-hospital mortality by over two-fold (OR 2.28, 95% CI 1.06–4.89, p=0.034) (Figure 1). Among those with refractory OHCA, higher cumulative prehospital adrenaline dose (OR 1.38, 95% CI 1.01–1.89 per 1 mg increase), and increased number of direct-current shocks (1.13, 1.00–1.27 per 1 additional shock) were independent predictors of in-hospital mortality, whereas undergoing coronary revascularization (0.28, 0.09–0.94) diminished this risk (all p&amp;lt;0.05) (Figure 2). Conclusion Refractory VF/pVT OHCA was associated with more intensive resuscitation, higher rates of acute coronary occlusion and poorer in-hospital outcomes, underscoring the need for future studies in this extreme-risk subgroup.Figure 1Figure 2

Effect of symptoms recognition in patients with recurrent acute myocardial infarction: from KRAMI-RCC

Abstract Background Clinical significance of self-recognition for myocardial infarction symptom in the general population has been well-known. However, evidence of self-recognition for ischemic symptoms in patients with recurrent myocardial infarction is limited. The study is aimed to verify the association between self-recognition and clinical characteristics, and clinical outcomes in patients with recurrent myocardial infarction. Method From 2016 to 2019, the Korean Registry of Acute Myocardial Infarction for Regional Cardiocerebrovascular Centers (KRAMI-RCC), a web-based registry for myocardial infarction in South Korea, was used. We divided into two groups based on self-recognition in questionnaire. Patient characteristics and clinical outcomes were analyzed. Result Among 11,894 MI patients, the rate of recurrent MI was 9.7%. The rate of self-recognition in subjects with first MI and recurrent MI was 14.4% and 52.0%, respectively (p&amp;lt;0.001). Patients without responses to the self-recognition questionnaire were excluded (n=86). Finally, enrolled subjects were 1,050. Males had a higher rate of self-recognition (79.3% vs. 69.0%). Younger patients, higher graduation levels, and living with a spouse were associated with the well-recognized symptoms. Chest pain, cold sweating, and radiating pain were related to being noticed as a symptom of MI. However, no difference of respiratory difficulties and stomachache in both groups was observed. The unrecognized group had more frequently occurred with cardiogenic shock and heart failure. A history of stroke and malignancy was associated with a low incidence of recognition. Patients with dyslipidemia had a high recognition rate. There was no difference of symptom recognition between ST elevation MI and non-ST elevation MI. Interestingly, previously registered patients in KRAMI-RCC were significantly associated with higher recognition. The symptom recognition was related to prompt visit in regional cardiovascular centers (57% vs. 47%, p=0.002). The in-hospital mortality rate in the unrecognized group was higher at 6.7% compared to the recognized group (1.5%, p&amp;lt;0.000). Unrecognized MI symptoms and a presentation with cardiogenic shock were independent predictors in multivariate analysis to predict a model for in-hospital mortality. Conclusion The MI symptom recognition rate was still low in patients with recurrent MI. Self-recognition of MI symptoms was an independent predictor for in-hospital mortality. In this study, it is thought that rapid symptom recognition might help patients with myocardial infarction visit the hospital as soon as possible, thereby reducing cardiogenic shock and death.Multivariable analysisSelf-recognition and Outcomes

Right ventricular-pulmonary artery coupling and in-hospital mortality of patients with first acute coronary syndrome

Abstract Background Right ventricular-pulmonary artery (RV-PA) coupling is a means of indexing RV performance to the existent RV afterload. Although non-invasive analysis of RV-PA coupling is a well-recognized prognosticator in chronic RV pressure overload conditions such as heart failure and pulmonary hypertension, its impact in patients with myocardial infarction and acute elevations in RV afterload remains undetermined. Aim This study sought to investigate the associations and short term prognostic value of RV-PA coupling in patients with first acute coronary syndrome (ACS), as assessed by two standard echocardiographic measurements: tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). Methods A total of 300 consecutive patients with first ACS (mean age 61.2±11.8 years, 74% males) were prospectively enrolled. A comprehensive transthoracic echocardiographic assessment was undertaken within 24 hours after revascularization. In-hospital mortality was the study endpoint. The study population was dichotomized according to the optimal TAPSE/PASP cut-off, as determined by receiver-operating characteristic curve analysis. Univariable and multivariable logistic regression analysis was performed to determine predictors of impaired TPASE/PASP and the association of TAPSE/PASP with in-hospital mortality. To further assess the incremental prognostic value of TAPSE/PASP over a baseline model the change in x² was assessed using the likelihood ratio test. Results A total of 23 (7.7%) patients died in-hospital despite successful revascularization. The optimal cut-off value of TAPSE/PASP to determine in-hospital mortality was 0.49. Among others, univariable associates of impaired TAPSE/PASP were the Global Registry of Acute Coronary event (GRACE) risk score, Killip Class &amp;gt;2, late presentation after symptoms onset, NT-pro-BNP, and left ventricular ejection fraction (LVEF). In multivariable analysis LVEF was the only independent predictor of impaired TAPSE/PASP (OR 0.889, 95% CI [0.821-0.963], p=0.004). The subgroup of patients with LVEF&amp;lt;40% and TAPSE/PASP&amp;lt;0.49mm/mmHg exhibited the worst in-hospital mortality rate (Abstract Picture 1). TAPSE/PASP was significantly associated with in-hospital mortality (OR 0.037, 95% CI [0.009-0.153], p&amp;lt;0.001), and retained this association after adjusting for GRACE risk score and LVEF (OR 0.137, 95% CI [0.032-0.578], p=0.007). The incremental prognostic value of TAPSE/PASP&amp;lt;0.49mm/mmHg for in-hospital mortality was evaluated by adding it to a model including the GRACE risk-score, LVEF&amp;lt;40% and TAPSE&amp;lt;17mm. The further addition of impaired TAPSE/PASP significantly increased the x² of the model from 21.627 to 86.213, p&amp;lt;0.001 (Abstract Picture 2). Conclusion RV-PA coupling assessed non-invasively by echocardiography 24 hours after revascularization was an independent predictor of in-hospital mortality in patients with first ACS and may improve risk stratification.In hospital mortality ratesIncremental prognostic value

Impact on mortality of a cardiogenic shock programme in a non-transplant hospital

Abstract Introduction Cardiogenic shock is associated with high in-hospital morbidity and mortality. Every hospital should take all possible measures to reduce it. Methods Quasi-experimental study in patients with cardiogenic shock comparing two periods: A period of a cardiogenic shock programme including the establishment of a multidisciplinary team (shock team), early alert to the transplant hospital, initiation of a VA ECMO programme and extension of continuous care by acute cardiovascular care specialist, and a previous period without the mentioned measures. The primary objective was whether there were differences in in-hospital mortality and mortality at follow-up. Predictors of in-hospital mortality were examined as a secondary objective. Results A total of 139 patients were enrolled, including 69 in the previous period and 70 in the cardiogenic shock programme period. There was a significant reduction in-hospital mortality (55.1% vs. 37.1%, p=0-03) and in the follow-up (62.7% vs. 44.6%, p=0.03) in the second period. Diabetes mellitus, ejection fraction, out-of-hospital cardiac arrest and implementation of the cardiogenic shock programme were independent predictors of in-hospital mortality. Conclusions Implementing a comprehensive cardiogenic shock programme in a non-transplanting hospital improved in-hospital and follow-up mortality of patients in cardiogenic shock.

Predictors on admission associated with successful weaning and in - hospital mortality in patients with refractory shock undergoing veno - arterial extracorporeal membrane oxygenation

Abstract Introduction In assessment of prognosis of patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO), considerable data have been focused on predictors just before or after VA-ECMO initiation. The aim of this study is to determine the prognostic factors on admission in patients with refractory shock undergoing VA-ECMO. Methods A total of 307 patients (median age 57; interquartile rate [IQR]: 48-68, male 220 (72%)) who underwent VA-ECMO due to refractory shock from 2015 to 2021 were retrospectively analyzed. Successful weaning was defined as successful removal of VA-ECMO without mechanical support over the following 30 days. In-hospital mortality (IHM) was defined as death occurred during the hospital stay. Results Median duration of weaning and hospital stay was 10 days (IQR: 7-14) and 24 days (IQR: 9-43), respectively. Of all patients, 115 patients (37%) were successfully weaned from VA-ECMO and 191 (62%) died before discharge. Patients with successful weaning and survived before discharge had lower prevalence of sepsis, higher cystatin C based estimated glomerular filtration rate (cyc-eGFR) and total cholesterol, and lower blood urea nitrogen, C-reactive protein and INR on admission than those with failed weaning and those who had died. In multivariate regression analyses, sepsis, cyc-eGFR and INR on admission were independently associated with successful weaning and only cyc-eGFR on admission was remained as independent predictor of IHM. In an incremental model, the addition of cyc-eGFR significantly increased the χ² of the clinical and laboratory data model including creatinine based eGFR (Cr-eGFR), from 22.3 to 33.7 (p&amp;lt;0.001) for prediction of successful weaning and from 22.2 to 33.6 (p&amp;lt;0.001) for prediction of IHM, respectively. Conclusion Cyc-eGFR on admission showed an incremental prognostic value beyond Cr-eGFR on admission for prediction of successful weaning and IHM in patients with refractory shock undergoing VA-ECMO.