Independent Predictor Of In-hospital Mortality Research Articles

Evaluation of Relationship between Modified ATRIA Risk Score and Mortality in Hospitalized Patients with COVID-19

Aim: The ATRIA score was developed to assess the probability of an ischemic stroke in patients with atrial fibrillation (AF). The modified ATRIA (M-ATRIA) risk score incorporates predictive risk variables for coronavirus disease 2019 (COVID-19). As a result, we looked into the association between the M-ATRIA risk score and the risk of in-hospital death in COVID-19 patients.Materials and Methods: The data of 595 inpatients in the COVID-19 research were evaluated retrospectively and separated into three groups based on the M-ATRIA scoring system. The M-ATRIA score used the troponin I level as a parameter in place of the proteinuria criterion in the ATRIA score. Those with a score between 0 and 5 were classified as group 1 (n = 269), those with a score of 6 as group 2 (n = 64), and those with a score of 7 and above were classified as group 3 (n = 162). In-hospital death, mechanical ventilation, and admission to the critical-care unit were all considered adverse clinical events.Results: The M-ATRIA risk score associated with adverse clinical events (all, p < 0.001). An M-ATRIA score of 6, an M-ATRIA score greater than 7, procalcitonin, and C- reactive protein were found to be independent predictors of in-hospital mortality in the multivariate logistic regression analysis. In the ROC analysis, an M-ATRIA score of 4.5 or above predicted in-hospital mortality with a sensitivity of 90.2% and a specificity of 58.9%. Conclusion: Regardless of the status of AF, the M-ATRIA risk score computed at admission may be a valuable tool for predicting in-hospital mortality in COVID-19 patients.

Association between atherogenic index of plasma and in-hospital mortality in patients with STEMI undergoing primary percutaneous coronary intervention

Aim: Dyslipidemia is an established risk factor for cardiovascular disease. Increased triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) levels, and decreased high lipoprotein cholesterol (HDL-C) levels were associated with increased cardiovascular risk. Recently, comprehensive lipid profile indices derived from these conventional parameters have attracted to attention. Atherogenic index of plasma (AIP) is one of the indices calculated as the logarithm of TG/HDL-C levels and it is accepted as an alternative and simple marker of plasma atherogenicity. Although various studies demonstrated that their relationship with these lipid indices and clinical outcomes in patients with acute coronary syndrome, this situation is not yet clear in acute ST-elevation myocardial infarction (STEMI) patients undergoing primer percutaneous coronary intervention (pPCI). In this study, we aimed to investigate the relationship of AIP with early mortality in STEMI patients undergoing pPCI.Material and Method: This is a retrospective, single center, hospital-based study carried out between January 2019 and April 2021. A total of 873 consecutive STEMI patients (705 men; median age 59 years), whose undergoing pPCI, were enrolled. The patients were divided into two groups according to in-hospital mortality status namely survivors vs non-survivors. Conventional lipid values were measured and non-traditional lipid indexes including non-HDL-C [Total cholesterol minus HDL-C], Total cholesterol/HDL-C, LDL-C/HDL-C, atherogenic index (AI) [non-HDL-C/HDL-C], lipoprotein combine index (LCI) [Total cholesterol*TG*LDL-C/HDL-C] and atherogenic index of plasma (AIP) [Log(TG/HDL-C)] were calculated. Angiographic images of the patients were evaluated through the hospital automation system. Results: AIP was significantly higher in non-survivors compared to survivor group (0.59, 0.47, p=0.006, respectively). AI, non-HDL-C, Total cholesterol/HDL-C ratio, LDL-C/HDL-C ratio and LCI measurements were similar between two groups. The cut-off value of the AIP (0.50) was associated with 70% sensitivity and 52% specificity for predicts in-hospital mortality. Multivariate logistic regression model indicated AIP (OR: 3.77, 95% CI: 1.34–10.6, p < 0.012) as independent predictor of in-hospital mortality in STEMI patients undergoing pPCI. Conclusion: AIP predicts in-hospital mortality in patients with STEMI undergoing pPCI. AIP, which can be calculated easily by complete blood can be beneficial in evaluating the prognosis of these patients.

Alactic base excess is an independent predictor of death in sepsis: A propensity score analysis

PurposeAlactic base excess (ABE) is a novel biomarker defined as the sum of lactate and standard base excess and estimates the renal capability of handling acid-base disturbances in sepsis. The objective of this study is to see if ABE is an independent predictor of mortality in septic patients with and without renal dysfunction. Materials and methodsWe retrospectively studied 1178 patients with sepsis and septic shock. Patients were divided according to ABE values: 1) negative ABE (<−3 mmol/L); 2) neutral ABE (≥ − 3 and < 4 mmol/L); and 3) positive ABE (≥4 mmol/L). The effect of ABE on mortality was evaluated using Cox regression weight by inverse probability weighting (IPWT) analysis after propensity score assessment. Additionally, we performed a stratified analysis in patients with GFR > 60 mL/min/1.73 m2. ResultsNegative ABE patients had higher mortality than patients with neutral ABE (adjusted HR 1.43; 95%CI 1.02–2.01). Also, in patients with GFR > 60 mL/min/1.73 m2 (n = 493), we observed higher mortality in patients with negative ABE (adjusted HR 2.43; 95%CI 1.07–5.53). ConclusionsNegative ABE is an independent predictor of in-hospital mortality in septic patients with and without renal dysfunction.

Ischemia modified albumin can act as an independent predictor of inhospital mortality in patients with acute aortic dissection

Acute aortic dissection (AAD) is a serious disease characterized by high mortality. However, there are no accurate indicators to predict in-hospital mortality. The objective of this study was to identify the potential value of ischemia modified albumin (IMA) in prediction of in-hospital mortality of AAD patients. This was a single-center, prospective study involved 314 patients undergoing AAD, including 197 males and 117 females, aged 26–87 (57.14 ± 21.71) years old, 116 cases of TAAD and 198 cases of TBAD (37 cases of complicated, 114 cases of high risk, and 47 cases of uncomplicated), 228 cases were underwent surgery/intervention treatment (77 cases of TAAD,151 cases of TBAD) and 86 cases were underwent conservative therapy (39 cases of TAAD, 47 cases of TBAD). The basic data, on-admission IMA level, and the all-cause in-hospital mortality was recorded. IMA in the non-survivor group and TAAD group was found to be significantly higher than that in the survivor group and TBAD group (P < 0.001). Multivariate logistic regression analysis results revealed that age (OR = 1.923, 95%CI: 1.102–4.481, P = 0.020), conservative therapy (OR = 17.892, 95%CI: 7.641–24.748, P < 0.001), D-dimer level (OR = 3.517, 95%CI: 1.874–7.667, P = 0.011) and IMA level (OR = 5.406, 95%CI: 2.951–10.395, P = 0.004) served as independent risk factors for in-hospital mortality of TAAD patients. And D-dimer level (OR = 2.241, 95%CI: 1.475–5.663, P = 0.018), IMA level (OR = 3.115, 95%CI: 1.792–6.925, P = 0.009) also served as independent risk factors for in-hospital mortality of TBAD patients, whereas surgery (OR = 0.110, 95%CI: 0.075–0.269, P < 0.001) was the protective factor of in-hospital mortality of TAAD patients. After IMA prediction, the AUC, optimal cut-off value, sensitivity, and the specificity of in-hospital mortality of AAD patients were observed to be 0.801 (95%CI: 0.744–0.858), 86.55 U/mL, 79.1%, and 73.2%, respectively. In addition, it was found that AUC was 0.799 (95%CI: 0.719–0.880) in TAAD and 0.753 (95% CI: 0.641–0.866) in TBAD. Overall, it was concluded that on-admission IMA level acted as an independent prediction index for in-hospital mortality of AAD patients.

Circadian rhythms of vital signs are associated with in-hospital mortality in critically ill patients: A retrospective observational study

ABSTRACT Vital signs have been widely used to assess the disease severity of patients, but there is still a lack of research on their circadian rhythms. The objective is to explore the circadian rhythms of vital signs in critically ill patients and establish an in-hospital mortality prediction model. Study patients from the recorded eICU Collaborative Research Database were included in the present analyses. The circadian rhythms of vital signs are analyzed in critically ill patients using the cosinor method. Logistic regression was used to screen independent predictors and establish a prediction model for in-hospital mortality by multivariate logistic regression analysis and to show in the nomogram. Internal validation is used to evaluate the prediction model by bootstrapping with 1000 resamples. A total of 29,448 patients were included in the current analyses. The Mesor, Amplitude, and Peak time of vital signs, such as heart rate (HR), temperature, respiration rate (RR), pulse oximetry-derived oxygen saturation (SpO2), and blood pressure (BP), were significant differences between survivors and non-survivors . Logistic regression analysis showed that Mesor, Amplitude, and Peak time of HR, RR, and SpO2 were independent predictors for in-hospital mortality in critically ill patients. The area under the curve (AUC) and c-index of the prediction model for the Medical intensive care unit (MICU) and Surgical intensive care unit (SICU) were 0.807 and 0.801, respectively. The Hosmer-Lemeshow test P-values were 0.076 and 0.085, respectively, demonstrating a good fit for the prediction model. The calibration curve and decision curve analysis (DCA) also demonstrated its accuracy and applicability. Internal validation assesses the consistency of the results. There were significant differences in the circadian rhythms of vital signs between survivors and non-survivors in critically ill patients. The prediction model established by the Mesor, Amplitude, and Peak time of HR, RR, and SpO2 combined with the Acute Physiology and Chronic Health Evaluation (APACHE) IV score has good predictive performance for in-hospital mortality and may eventually support clinical decision-making. Abbreviations: ICU: Intensive care unit; MICU: Medical intensive care unit; SICU: Surgical intensive care unit; HR: Heart rate; RR: Respiration rate; SpO2: Pulse oximetry-derived oxygen saturation; BP: Blood pressure; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; APACHE: Acute Physiology and Chronic Health Evaluation; bpm: beats per min; BMI: Body mass index; OR: Odd ratio; CI: Confidential interval; IQR: Interquartile range; SD: Standard deviation; ROC: Receiver operating characteristic; AUC: area under the curve; DCA: Decision curve analysis; IRB: Institutional review board.

The impact of the complete atrioventricular block on in-hospital and long-term mortality in patients treated with primary percutaneous coronary intervention

Background/Aim. The prognostic impact of complete atrioventricular (AV) block on the long-term prognosis of patients with ST-elevation myocardial infarction (STEMI) has not been fully determined. The aim of the study was to analyze the incidence and prognostic impact of complete AV block on in-hospital mortality (IHM) and 6-year mortality in STEMI patients treated with primary percutaneous coronary intervention. Methods. The study included 3,044 consecutive STEMI patients. Results. Complete AV block was registered only on admission in 144 (4.73%) patients; 125 (86.8%) patients with complete AV block had inferior infarction. A temporary pacemaker was implanted in 72 (50%) patients with complete AV block. No patient under-went permanent pacemaker implantation. IHM was significantly higher in patients with complete AV block than in patients without complete A V b lock: 1 7.9% v s. 3 .6%, respectively, p &lt; 0.001. In patients with heart block and inferior infarction, IHM was 13%, whereas IHM was 53% in patients with heart block and anterior infarction. When we analyzed patients discharged alive from the hospital, we also found a significantly higher long-term (6-year) mortality rate in those with complete AV block vs. patients without AV block: 7.8% vs. 3.4%, respectively, p &lt; 0.001. Complete AV block was an independent predictor for IHM and 6-year mortality: IHM [odds ratio (OR) 2.94 95%, confidence interval (CI) 1.23?5.22; 6-year mortality hazard ratio (HR) 1.61, 95%, CI 1.10?2.37]. When subanalysis was performed in patients with inferior STEMI, complete AV block was an independent predictor of IHM and 6 -year mortality, while in patients with anterior STEMI, complete AV block was an independent predictor of IHM. Conclusion. In analyzed STEMI patients, complete AV block was transitory and was registered only on hospital admission. Although transitory, complete AV block remained a strong independent predictor of IHM and long-term mortality.

Acute myocardial infarction post-gastrointestinal bleeding: A clinical dilemma with poor prognosis.

Gastrointestinal bleeding (GIB) complicating acute myocardial infarction (AMI) is a severe clinical condition with treatment contradiction and poor prognosis. This study aimed to evaluate the rate of in-hospital mortality in patients with GIB who subsequently suffered from AMI and to explore the potential risk factors for this condition. In this retrospective study, a total of 77 patients diagnosed with GIB, who subsequently suffered from AMI, were enrolled from January 2013 to March 2022. Demographic, laboratory, and clinical data were collected. The in-hospital mortality was the outcome of interest. Logistic regression analysis was used to investigate the potential risk factors of in-hospital mortality. Among the 77 patients included in this study, 62 (80.52%) were males. The mean age of patients was 65.88 ± 12.15 years, and 48 patients (62.34%) were non-ST-segment elevation myocardial infarction (NSTEMI). There were 16 (20.78%) cases of in-hospital deaths. The subjects who died showed higher levels of white blood cell count (13.05 ± 5.76 vs. 9.31 ± 4.07 × 109/L, P = 0.003) and troponin I (TnI) (9.23 ± 9.17 vs. 4.12 ± 5.03 μg/L, P = 0.003). Besides, there were higher proportions of cardiogenic shock (81.25% vs. 26.23%, P < 0.001) and mechanical ventilator usage (75.0% vs. 11.48%, P < 0.001) among the patients who died. The multivariate logistic regression analysis showed that white blood cell count (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.02-1.39, P = 0.030), cardiogenic shock (OR 12.18, 95% CI 3.06-48.39, P = 0.017), and mechanical ventilator usage (OR 7.21, 95% CI 1.28-40.51, P = 0.025) were independently associated with in-hospital mortality. The in-hospital mortality of patients with GIB who subsequently develop AMI is high. White blood cell count, cardiogenic shock, and mechanical ventilator usage are independent predictors of in-hospital mortality.

In-hospital outcomes of patients undergoing emergent surgical treatment in patients with infective endocarditis.

Infective endocarditis is a serious heart disease that may cause several different clinical conditions and can need urgent surgical therapy. In our study, we aimed to evaluate the patients with infective endocarditis undergoing acute surgical treatment results in-hospital mortality. A total of 107 consecutive patients with infective endocarditis undergoing acute surgical therapy were included in our retrospective study. The patients were divided into two groups according to the presence of in-hospital mortality as Group 1 without in-hospital mortality (n=89) and Group 2 with in-hospital mortality (n=18). The demographic, laboratory, and clinical parameters were evaluated in both groups. The mean age (50±14; 64±14, P<0.001) and the incidence of chronic renal failure (9 [10.1%]; 8 [44.4%], P=0.001) were higher in Group 2 while the ejection fraction was lower in Group 2 (50.0±9.3; 44.6±12.9, P=0.039). The incidence of positive blood culture was also higher in Group 2 (41 [46.1]; 14 [77.8], P=0.014). Aortic bioprosthesis operation (2 [2.2]; 6 [33.3], P<0.001) and mitral bioprosthesis operation (4 [4.5]; 5 [27.8], P=0.008) were higher in Group 2 as well as the incidence of septic shock was also higher in Group 2 (1 [1.1]; 3 [16.7], P=0.015). In addition, in multivariate logistic regression analyses, advanced age (odds ratio [OR]: 1.068, 95% confidence interval [CI]: 1.009-1.130, P: 0.024) and positive blood culture (OR: 4.436, 95% CI: 1.044-18.848, P: 0.044) were found to be independent predictors of in-hospital mortality. Advanced age, lower ejection fraction, high creatinine, positive blood culture, high systolic pulmonary artery pressure, and septic shock predicted in-hospital death in patients who have undergone emergent or urgent surgery due to infective endocarditis.

Risk Predictors for Mortality in Inpatients with Cancer and Coronavirus Disease 2019 during the Omicron Wave

Abstract Background: Patients with cancer are a high-risk population in the coronavirus disease 2019 (COVID-19) pandemic. We analyzed the characteristics and risk factors for mortality in hospitalized patients with cancer and laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the Omicron wave. Materials and Methods: We conducted a retrospective, single-center, cohort study of 206 patients with cancer and SARS-CoV-2 infection in southern Taiwan. Clinical characteristics, laboratory data, and cancer characteristics were compared between survivors and nonsurvivors. Risk factors for mortality were identified by univariable and multivariable logistic regression models. Results: The median patient age was 69.5 years. Male preponderance was noted (65%). Comorbidities were present in 186 (90%) cases. A total of 113 (54%) patients had active cancer. Metastatic disease accounted for 78 (38%) cases, of whom 19 (9%) had lung metastasis. Sixty-four (31%) patients had active and progressing cancer status. The overall inhospital mortality rate was 17.4%. Univariate logistic regression revealed the following factors to be significantly associated with a higher risk of inhospital mortality among the patients with cancer and COVID-19: nosocomial COVID-19 infection (P = 0.037), lung metastasis (P = 0.005), received anticancer therapy in the preceding 3 months (P = 0.083), active and progressing cancer (P = 0.008), and quick Sequential Organ Function Assessment (qSOFA) score ≥2 (P &lt; 0.001). However, only nosocomial infection (P = 0.021) and qSOFA score ≥2 (P &lt; 0.001) were independent predictors of inhospital mortality in the multivariate logistic regression analysis. Conclusion: Cancer patients are a population vulnerable to the Omicron variant with higher mortality rate, especially those with nosocomial COVID-19 infection and those with a qSOFA score of ≥2 immediately after confirmation of COVID-19 infection. Thus, the rapid recognition of high-risk groups and nosocomial infection control are critical to prevent COVID-19 in patients with cancer.

The Clinical Importance of C-Reactive Protein to Albumin Ratio (CAR) in Patients with Pulmonary Thromboembolism.

Pulmonary thromboembolism (PTE) commonly arises from lower extremity thrombus and can be fatal if left untreated. To date, many laboratory biomarkers have been used for predicting the prognosis in patients with PTE. C-reactive protein (CRP) to albumin ratio (CAR) is a new biomarker of systemic inflammation. In this study, we aimed to evaluate the clinical importance of CAR in PTE patients. One hundred thirty-three eligible patients who were followed up with the diagnosis of PTE in our hospital between July 2016 and May 2020 were retrospectively evaluated in this study. The patients were divided into three groups as non-massive, sub-massive, and massive PTE. The results of complete blood counts (CBC) and biochemical analysis were evaluated among three groups. Neutrophil, neutrophil to lymphocyte ratio (NLR), D-dimer, troponin, CRP, albumin, and CAR were significantly different among groups. According to multivariate logistic regression analysis, CAR and troponin were determined as the independent predictors of massive PTE. Also, CAR was determined as the only independent predictor of in-hospital mortality in patients with PTE. CAR may be a reliable and easily accessible parameter to determine the severity and prognosis in PTE patients.

Associated Factors of In-hospital Mortality among Intubated Older Adults in Emergency Department; a Cross-sectional Study.

A decision-making guideline on when to intubate an older person based on predictors of intubation outcome would be extremely beneficial. This study aimed to identify the associated factors that could predict the outcomes of endotracheal intubation among older adults in the Emergency Department (ED). In this retrospective cross-sectional study, patients aged ≥65 years intubated at the ED of University of Malaya Medical Centre, Kuala Lumpur, Malaysia, from 2015 to 2019 were studied. The association between age, gender, place of inhabitation, Identification of Seniors at Risk (ISAR) score for frailty, Charlson Comorbidity Index (CCI), Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score, indication for intubation, and diagnosis on admission with in-hospital mortality (primary outcome) and duration of ventilation, and length of stay (secondary outcomes) were evaluated using univariate analysis and Cox's regression survival analysis. 889 cases aged 65 years and above were studied (61.5% male). The rate of in-hospital mortality was 71.4%. There was a significant association between age (p < 0.001), nursing home residency (p = 0.008), CCI≥ 5 (p = 0.001), APACHE-II (p < 0.001), pre-intubation Glasgow Coma Scale (GCS) (p < 0.001), cardiac arrest as indication of intubation (p < 0.001), diagnosis on admission (p < 0.001), length of stay (p < 0.001), and length of ventilation (p = 0.003) and in-hospital mortality. Age ≥ 85 years (HR= 1.270; 95%CI=1.074 to 1.502) and 75 to 84 years (HR=1.642; 95%CI=1.167 to 2.076), cardiac arrest as indication of intubation (HR: 1.882; 95% CI: 1.554 - 2.279), and APACHE-II scores 25 - 34 (HR: 1.423; 95% CI: 1.171 - 1.730) and ≥ 35 (HR: 1.789; 95%CI: 1.418 - 2.256) were amongst the independent predictive factors of in-hospital mortality. Nearly three out of four individuals aged ≥65 years intubated at the ED died during the same admission. Older age, cardiac arrest as indication of intubation, and APACHE-II score were independent predictors of in-hospital mortality.

A Novel Composed Index to Evaluate the Right Ventricle Free-Wall Adaptation Against Ventricular Wall Stress in Acute Pulmonary Embolism.

Pulmonary embolism severity index and simplified pulmonary embolism severity index have been utilized in initial risk evaluation in patients with acute pulmonary embolism. However, these models do not include any imaging measure of right ventricle function. In this study, we proposed a novel index and aimed to evaluate the clinical impact. Our study population comprised retrospectively evaluated 502 patients with acute pulmonary embolism managed with different treatment modalities. Echocardiographic and computed tomographic pulmonary angiography evaluations were performed at admission to the emergency room within maximally 30 minutes. The formula of our index was as follows: (right ventricle diameter × systolic pulmonary arterial pressure-echo)/(right ventricle free-wall diameter × tricuspid annular plane systolic excursion). This index value showed significant correlations to clinical and hemodynamic severity measures. Only pulmonary embolism severity index, but not our index value, independently predicted in-hospital mortality. However, an index value higher than 17.8 predicted the long-term mortality with a sensitivity of 70% and specificity of 40% (areas under the curve = 0.652, 95% CI, 0.557-0.747, P =.001). According to the adjusted variable plot, the risk of long-term mortality increased until an index level of 30 but remained unchanged thereafter. The cumulative hazard curve also showed a higher mortality with high-index value versus low-index value. Our index composed from measures of computed tomographic pulmonary angiography and transthoracic echocardiography may provide important insights regarding the adaptation status of right ventricle against pressure/wall stress in acute pulmonary embolism, and a higher value seems to be associated with severity of the clinical and hemodynamic status and long-term mortality but not with in-hospital mortality. However, the pulmonary embolism severity index remained as the only independent predictor for in-hospital mortality.

Association between Hospital Carotid Endarterectomy Procedure Volumes and In-Hospital Mortality in São Paulo State.

Previous studies indicate an inverse relationship between hospital volume and mortality after carotid endarterectomy. However, data at the level of Brazil are lacking. To assess the relationship between hospital carotid endarterectomy procedure volumes and mortality in the state of São Paulo. Data from the São Paulo State Hospital Information System on all carotid endarterectomies performed between 2015 and 2019 were analyzed. Hospitals were categorized into clusters by annual volume of surgeries (1-10, 11-25, and ≥26). Multiple logistic regression models were used to determine whether the volume of carotid endarterectomy procedures was an independent predictor of in-hospital mortality among patients undergoing this procedure. Crude in-hospital mortality was nearly 60 percent lower in patients who underwent carotid endarterectomy at the highest volume hospitals than among those who underwent endarterectomy at the lowest volume hospitals (unadjusted OR of survival to hospital discharge, 2.41; 95% CI, 1.11-5.23; p = 0.027). Although this lower rate represents 1.5 fewer deaths per 100 patients treated, high-volume centers are more likely than low-volume centers to perform elective procedures, thus the analysis did not retain statistical significance when adjusted for admission character (OR, 1.69; 95% CI, 0.74-3.87; p = 0.215). In a contemporary Brazilian registry, higher volume carotid endarterectomy centers were associated with lower in-hospital mortality than lower volume centers. Further studies are needed to verify this relationship considering the presence of symptoms in patients.

Investigation of inflammation marker ratios that can be used as predictors of in-hospital mortality in traumatic acute subdural hematoma

Purpose: The aim of the present study is to determine inflammatory mediators that may be used in predicting in-hospital mortality in a traumatic acute subdural hematoma (TASDH) patients and to evaluate their significance as prognostic markers. Methods: The medical records of adult patients with traumatic acute subdural hematoma admitted to the emergency department were reviewed retrospectively. The primary clinical outcome was in-hospital mortality. Univariate and multivariate Cox regression analyses were performed for the identification of independent predictors of in-hospital mortality. Besides, receiver operating characteristic (ROC) analysis was applied to determine the power of inflammatory mediators in predicting mortality. Results: According to the Cox hazard models, the mean platelet volume (MPV) /platelet count (PLT) ratio (MPR) (Hazard Ratio (HR) = 1.129; 95% CI = 1.059 – 1.204; p &lt; 0.001), C-reactive protein (CRP)/lymphocyte ratio (CLR) (HR = 1.011; 95% CI = 1.002 – 1.020; p = 0.022) and C-reactive protein(CRP)/albumin ratio (CAR) (HR =1.004; 95% CI = 1.001 – 1.007; p = 0.004 were risk factors for in-hospital mortality. The results of ROC analysis indicated that the MPR of 0.06 or above predicted in-hospital mortality with 67% sensitivity and 88% specificity (p = 0.001). In addition, the CLR of 39.12 and above predicted in-hospital mortality with 63% sensitivity and 93% specificity and the CAR of 8.79 (p = 0.001) and above predicted it with 66% sensitivity and 87% specificity (p = 0.002) Conclusion: Increased MPR, CLR and CAR values are strong predictors of in-hospital mortality in TASDH patients.

Prognosis of Patients with Acute Kidney Injury due to Type 1 Cardiorenal Syndrome Receiving Continuous Renal Replacement Therapy

Introduction: The prognosis of patients with acute kidney injury (AKI) caused by type 1 cardiorenal syndrome (CRS) requiring continuous renal replacement therapy (CRRT) is unclear. We investigated the in-hospital mortality and prognostic factors in these patients. Methods: We retrospectively identified 154 consecutive adult patients who received CRRT for AKI caused by type 1 CRS between January 1, 2013, and December 31, 2019. We excluded patients who underwent cardiovascular surgery and those with stage 5 chronic kidney disease. The primary outcome was in-hospital mortality. Cox proportional hazards analysis was performed to analyze independent predictors of in-hospital mortality. Results: The median age of patients at admission was 74.0 years (interquartile range: 63.0–80.0); 70.8% were male. The in-hospital mortality rate was 68.2%. Age ≥80 years (hazard ratio [HR], 1.87; 95% confidence interval [CI], 1.21–2.87; p = 0.004), previous hospitalization for acute heart failure (HR, 1.67; 95% CI, 1.13–2.46; p = 0.01), vasopressor or inotrope use (HR, 5.88; 95% CI, 1.43–24.1; p = 0.014), and mechanical ventilation at CRRT initiation (HR, 2.24; 95% CI, 1.46–3.45; p < 0.001) were associated with in-hospital mortality. Conclusion: In our single-center study, the use of CRRT for AKI due to type 1 CRS was associated with high in-hospital mortality.

Prognostic Value of Serum Albumin-to-Creatinine Ratio in Acute Coronary Syndrome

Background: The association between serum albumin-to-creatinine ratio (sACR) and in-hospital mortality remains unclear in patients with acute coronary syndrome (ACS). In this study we aimed to investigate the prognostic value of sACR in predicting in-hospital mortality in ACS. Methods: The study was conducted in a single tertiary center. Patients hospitalized with both ST Elevation Myocardial Infarction (STEMI) and Non-STEMI were retrospectively analyzed. The sACR and other clinically related parameters were recorded. The primary outcome was in-hospital mortality. Logistic regression (LR) models were used to investigate the association between sACR and in-hospital mortality. Receiver operating characteristic (ROC) curve was used to find out the cut-off level of sACR. Results: A total of 686 patients with ACS were enrolled, of whom 59 (%8.6) died in-hospital follow-up. The sACR was significantly lower in patients who died in hospital (2.9 (2.3-3.7) vs 3.9 (3.3-4.6)). Multivariable LR analysis showed that sACR is an independent predictor of in-hospital mortality in patients with ACS. Area under the curve value generated by ROC curve analysis was 0.719 (95% CI: 0.656-0.783). The sensitivity of sACR predicting in-hospital mortality was 77.5% with the specificity of 59.3%. Conclusions: In this study, lower sACR on admission was found significantly associated with in-hospital mortality in patients with ACS.

In-hospital treatment outcomes of acute stroke and determinant factors in a teaching hospital in eastern Ethiopia.

To assess the in-hospital mortality of acute stroke and determinant factors in a teaching hospital in eastern Ethiopia. A retrospective review of medical records of patients admitted to Hiwot Fana Specialized University Hospital was conducted. Adult patients aged 18 years and older with a diagnosis of either ischemic or hemorrhagic stroke were included. Data were analyzed using SPSS version 21.0 (SPSS Inc., Chicago, IL, USA). Multiple logistic regression analysis was used to identify predictors of in-hospital mortality. A total of 112 patients with acute stroke were included in the study and 56.0% of them were of hemorrhagic stroke. The mean age was 60.32 years and 61.6% were male. The mean length of hospitalization and the mean time of presentation from symptoms onset were 4.85 days and 33.64 h, respectively. The in-hospital mortality was 36.8% for ischemic stroke and 27% for hemorrhagic stroke. Aspiration pneumonia (35.0%), cerebral edema (17%), and seizure (14.3%) were the most common complications occurring during hospitalization. Atrial fibrillation (adjusted odds ratio = 15.45, 95% confidence interval: 1.089-219.2; p = 0.043) was the independent predictor of in-hospital mortality. Hemorrhagic stroke was predominant in the study sample. One-third of patients died in the hospital and the mortality rate was slightly higher in patients with ischemic stroke. Atrial fibrillation was the predominant risk factor for hospital mortality from acute stroke. There is a need to promote cardiovascular health, early recognition, and management of risk factors, and implement coordinated stroke care services to reduce premature death from stroke.

Predictors of In-hospital Death in Patients with Stanford Type B Acute Aortic Dissection

Background: Even with immediate surgical intervention, acute aortic dissection (AAD) is a cardiovascular emergency with a high mortality rate. The purpose of this study was to look at the relationship between in-hospital mortality and red cell distribution width (RDW)/lymphocyte ratio (RLR), monocyte/lymphocyte ratio (MLR), and systemic immune inflammation index (SII) in patients with type B acute aortic dissection (BAAD).&#x0D; Materials and methods: 59 BAAD patients who presented to the emergency room of a tertiary hospital were included in this cross-sectional study. The predictive ability and cut-off value of biomarkers for mortality were evaluated using Receiver Operating Characteristic (ROC) analysis. The variables believed to be connected to in-hospital mortality were subjected to multiple regression analysis, and the odds ratio was calculated.&#x0D; Results: The study consisted of 59 patients in total, 44 of whom (74.6%) were male. 17 of these patients died in the hospital. In terms of predicting in-hospital mortality in BAAD patients, MLR, and neutrophil/lymphocyte ratio (NLR) have excellent diagnostic power (AUC: 0.826, 0.822, respectively), while platelet/lymphocyte ratio (PLR), RLR, and SII have acceptable diagnostic power (AUC: 0.758-0.786). Increased NLR, PLR, MLR, RLR, and SII were found to be independent predictors of in-hospital mortality in patients with BAAD (odss ratio: 9.16, 7.68, 9.33, 6, 8.57, respectively).&#x0D; Conclusion: MLR, RLR, and SII are valuable parameters for estimating in-hospital mortality in adult BAAD patients. Increased NLR, PLR, MLR, RLR, and SII in BAAD patients are independent predictors of in-hospital mortality.

Effect of Preoperative Right Ventricular Dysfunction on Heart Transplantation Outcomes

We investigated if the occurrence of preoperative right ventricular dysfunction is capable of influencing heart transplant results in terms of in-hospital mortality, incidence of primary graft dysfunction, and follow-up mortality. We retrospectively analyzed 517 patients who underwent heart transplant between January 2000 and December 2020. We defined right ventricular dysfunction (RVD), as central venous pressure (CVP) > 15 mm Hg and CVP/pulmonary capillary wedge pressure ratio > 0.63. We identified 2 subgroups in our population: 33 patients with preoperative RVD and 484 patients without RVD. In-hospital mortality was 7.9%. Severe early graft failure occurred in 6.6% of patients, with 26 patients (5.1%) needing intra-aortic balloon pump and 17 patients (3.3%) needing extracorporeal membrane oxygenation support. Clinical variables that significantly influenced in-hospital mortality were age, peripheral artery disease, and bilirubin > 1.5 mg/dL, while hemodynamic variables influencing in-hospital mortality were CVP (odds ratio [OR], 1.09 [confidence interval {CI}, 1.03-1.15], P=.004], pulmonary artery systolic pressure (OR, 1.02 [CI, 1.00-1.04], P=.05), CVP/pulmonary capillary wedge pressure ratio (OR, 2.78 [CI, 1.14-6.80], P=.025), pulmonary vascular resistance (OR, 1.15 [CI, 1.01-1.32], P=.042), transpulmonary gradient (TPG) (OR, 1.11 [CI, 1.03-1.18], P=.003) , diastolic transpulmonary gradient (OR, 1.10 [CI, 1.02-1.20], P=.015], together with right ventricular dysfunction (OR, 3.56 [CI, 1.44-8.80], P=.011). On the other hand, clinical variables influencing the incidence of early graft failure were body mass index (calculated as weight in kilograms divided by height in meters squared) > 30, peripheral artery disease, bilirubin > 1.5 mg/dL, Model for End-Stage Liver Disease score excluding international normalized ratio before transplant, and preoperative extracorporeal membrane oxygenation support, while hemodynamic variables were pulmonary arterial systolic pressure (OR, 1.03 [CI, 1.00-1.05], P=.016), TPG (OR, 1.08 [1.01-1.17], P=.03), and right ventricular dysfunction (OR, 3.00 [CI, 1.07-8.40] P=.046). On the multivariable analysis, RVD and TPG were independent predictors of in-hospital mortality, while only TPG was a predictor of early graft failure. Follow-up mortality was 38.7% and was influenced by recipient age, recipient body mass index, and preoperative diabetes. Moreover, 1-, 5-, and 10-year survival of patients with preoperative RVD was significantly worse than patients without RVD (log-rank=0.001). In our population, RVD influenced both in-hospital and long-term results after heart transplant. For these reasons, it appears crucially important to optimize preoperative right ventricular function to improve these patients' outcomes.

HATCH Score for Predicting Mortality in COVID-19 Patients.

We aimed to evaluate the relationship between HATCH score [hypertension, age >75 yr, previous transient ischemic attack (TIA) or stroke (doubled), chronic obstructive pulmonary disease, heart failure (doubled)] and in-hospital mortality in COVID-19 patients. Overall, 572 COVID-19 patients hospitalized between Mar 15 and Apr 15, 2020, were included in this multicenter retrospective study, in Turkey. The HATCH score of each patient was calculated. Mortality results were followed for 50 days. The patients were divided into 2 groups developing mortality (n=267) and non-mortality (n=305). Clinical outcomes were defined as in-hospital mortality improvement status. HATCH scores in non-survivors of COVID-19 were significantly higher than in survivors (P<0.001). In logistic regression analysis, HATCH score (OR: 1.253, 95% CI: 1.003-1.565; P=0.047), platelet count (OR: 0.995, 95% CI: 0.993-0.998; P<0.001), C-reactive protein level (OR: 1.010, 95% CI: 1.007-1.013, P<0.001) and estimated glomerular filtration ratio (eGFR) level (OR: 0.963, 95% CI: 0.953-0.973; P<0.001) were independent predictors of in-hospital mortality in COVID-19 patients. The HATCH score is useful in predicting in-hospital mortality in patients hospitalized with COVID-19.