Independent Predictor Of Short-term Outcome Research Articles

B-Lines by Lung Ultrasound Can Predict Worsening Heart Failure in Acute Myocardial Infarction During Hospitalization and Short-Term Follow-Up.

BackgroundAcute myocardial infarction (AMI) with pulmonary edema shows a worse prognosis. Lung ultrasound (LUS) is a new tool for evaluating subclinical pulmonary congestion. It has been proved to predict prognosis in heart failure; however, whether it can be used as a short-term prognostic marker in AMI and provide incremental value to Killip classification is unknown.MethodsWe performed echocardiography and LUS by the 8-zone method in patients enrolled in Guangdong Provincial People's Hospital undergoing percutaneous coronary intervention for AMI from March to July 2021. The lung water detected by LUS was defined as B-lines, and the sum of the B-line number from 8 chest zones was calculated. Besides, the classification into LUS according to the pulmonary edema severity was as follows: normal (B-line numbers <5), mild (B-line numbers ≥5 and <15), moderate (B-line numbers ≥15 and <30), and severe (B-line numbers ≥30). The NT-proBNP analysis was performed on the same day. All patients were followed up for 30 days after discharge. The adverse events were defined as all-cause death, worsening heart failure in hospitalization, or re-hospitalization for heart failure during the follow-up.ResultsSixty three patients were enrolled consecutively and followed up for 30 days. The number of B-lines at admission (median 7[3–15]) was correlated with NT-proBNP (r = 0.37, p = 0.003) and negatively correlated with ejection fraction (r = −0.43; p < 0.001) separately. In the multivariate analysis, B-line number was an independent predictor of short-term outcomes in AMI patients (in-hospital, adjusted OR 1.13 [95% CI: 1.04–1.23], P = 0.006; 30-day follow-up, adjusted OR 1.09 [95% CI: 1.01–1.18], P = 0.020). For in-hospital results, the area under the receiver operating characteristic curves (AUCs) were 0.639 (P = 0.093), 0.837 (P < 0.001), and 0.847 (P < 0.001) for Killip, LUS and their combination, respectively. For the diagnosis of 30-day adverse events, the AUCs were 0.665 for the Killip classification (P = 0.061), 0.728 for LUS (P = 0.010), and 0.778 for their combination (P = 0.002).ConclusionB-lines by lung ultrasound can be an independent predictor of worsening heart failure in AMI during hospitalization and short-term follow-up and provides significant incremental prognostic value to Killip classification.

Preoperative Anemia is Associated With Worse Long-Term Survival After Lung Cancer Resection: A Multicenter Cohort Study of 5,029 Patients

Although some evidence to suggest an association between preoperative anemia and reduced overall survival exists, contemporary studies investigating the impact of preoperative anemia on outcomes after resection for primary lung cancer are lacking. A multicenter retrospective review. Two tertiary cardiothoracic surgery centers in the Northwest of England. A total of 5,029 patients between 2012 and 2018. All patients underwent lung resection for primary lung cancer. Patients were classified as anemic based on the World Health Organization definition. Men with hemoglobin <130 g/L and women with hemoglobin <120 g/L were considered to be anemic. Outcomes assessed included perioperative mortality, 90-day mortality, and overall survival. Multivariate logistic and Cox regression analyses were used to assess the impact of preoperative anemia on 90-day mortality and overall survival, respectively. Overall, preoperatively, 24.0% (n=1207) of patients were anemic. The 90-day mortality for anemic and nonanemic patients was 5.6% and 3.1%, respectively (p < 0.001). After multivariate adjustment, preoperative anemia was not associated with increased 90-day mortality. However, a log-rank analysis demonstrated reduced overall survival for anemic patients (p < 0.001). After multivariate adjustment, preoperative anemia was found to be independently associated with reduced overall survival (hazard ratio 1.287, 95% confidence interval 1.141-1.451, p < 0.001). Although anemia was not an independent predictor of short-term outcomes, it was independently associated with significantly reduced survival for patients undergoing resection for lung cancer. Further work is required to understand why anemia reduces long-term survival and whether pathways for anemic patients can be adapted to improve long-term outcomes.

Evaluation of inflammatory markers and mean platelet volume as short-term outcome indicators in young adults with ischemic stroke

BackgroundStudying outcome predictors in patients with onset of cerebral infarction in early adult life may enhance our knowledge of disease pathophysiology and prognosis.AimThe aim is to identify independent predictors of short-term outcome of first-ever ischemic stroke in young adults with special emphasis on inflammatory and thrombogenic markers.MethodsWe enrolled 33 patients aged 19–44 years with first-ever ischemic stroke admitted to Kasr Alainy Stroke Unit and 33 matched controls. Clinical, radiological, and laboratory (adhesion molecules, C-reactive protein, prolactin, and mean platelet volume) evaluations were carried out. Functional outcome at 7 days after stroke onset was assessed using the modified Rankin scale, and independent predictors were identified.ResultsThe most frequently identified risk factor was cardiac abnormality. Patients exhibited significantly higher levels of baseline inflammatory and thrombogenic markers compared with controls. These markers were significantly correlated with the stroke severity. Logistic regression model showed that high National Institutes of Health Stroke Scale (NIHSS) score (odds ratios [OR] = 0.13; 95% confidence interval [CI], 0.04–0.24; P = 0.01) and large infarction size (OR = 0.11; 95% CI, 0.09–0.17; P = 0.04) but not the laboratory markers were independent predictors of unfavorable outcome.ConclusionOur data suggested that higher NIHSS scores and large infarction size served as independent predictors of short-term unfavorable outcome, while inflammatory and thrombogenic markers did not.

Factors associated with elevated cardiac troponin levels in patients with acute pulmonary thromboembolism

PurposeWe aimed to investigate the factors that are associated with increased cardiac troponin I (cTnI) leakage in the acute pulmonary embolism (PTE) setting and their alignment with patient outcome. MethodsAdult patients with a diagnosis of PTE were enrolled in this prospective cohort study. The primary endpoint of interest was major adverse cardio-pulmonary events (MACPE), defined as the composite of in-hospital all-cause mortality, need for thrombolysis and mechanical ventilation and surgical embolectomy during index hospitalization. Multivariable regression analysis is used to assess factors associated with MACPE. Results16.6% of 627 patients with acute PTE, had elevated serum cTnI. MACPE occurred in 56.7% of patients with positive cTnI and in 28.8% of patients with negative cTnI (p<0.001). Blood urea nitrogen (BUN) (OR 1.048; 1.001–1.096), alanine transaminase (ALT) (OR 1.007; 1.001–1.014), and neutrophil-lymphocyte ratio (NLR) (OR 0.829; 0.698–0.984) were independent predictors of elevated cTnI. Elevated cTnI increased the risk of MACPE 2.72 times (p<0.001). ConclusioncTnI was an independent predictor of short-term outcome following an episode of PTE. BUN and ALT were directly and NLR was inversely associated with the leakage of cTnI and therefore, they could potentially serve as useful markers of risk assessment after PTE.

Infarction Size, Interleukin-6, and Their Interaction Are Predictors of Short-Term Stroke Outcome in Young Egyptian Adults

A trend of increasing incidence of first-ever cerebral ischemic stroke in young adults has been recently reported. The current study was conducted with the objective of identifying independent predictors of short-term outcome of first-ever cerebral ischemic stroke affecting young Egyptian adults. The present hospital-based study included 50 patients, 23 males and 27 females, aged 18-45 years, with first-ever ischemic stroke confirmed by computed tomography (CT) and magnetic resonance imaging. Twenty healthy age- and sex-matched random control subjects were included to set the reference laboratory values. Detailed medical, neurological, and laboratory data were collected. Stroke severity and short-term stroke outcome were assessed using the Canadian Neurological Scale and the National Institutes of Health Stroke Scale (NIHSS), respectively. High prevalence of modifiable risk factors was observed in young Egyptian adults affected with first-ever ischemic cerebral stroke. Although all studied risk factors were significantly correlated with NIHSS score, multiple regression analysis revealed that only infarction size (CT size), interleukin-6 (IL-6), and their synergistic interaction were the most important predictors of NIHSS stroke outcome. IL-6 and infarction size were independent predictors of short-term stroke outcome in young Egyptian adults. Synergistic interaction of IL-6 with infarction size suggests an investigative value for assessing serum IL-6 level and a therapeutic benefit for its reduction during the course of early ischemic stroke treatment.

Prognostic significance of admission levels of cardiac indicators in patients with acute ischaemic stroke: prospective observational study.

The performance of cardiac indicators as determinants of stroke outcomes remains debatable, therefore the present study focused on the short-term prognostic value of cardiac indicators in patients who had experienced acute ischaemic stroke. Consecutive patients with acute ischaemic stroke were enrolled in a prospective stroke registry. Data on demographics, clinical characteristics and cardiac indicator levels (including troponin I, creatine kinase-MB, myoglobin and brain natriuretic peptide) were prospectively collected. Receiver operating characteristic curves and binary logistic regression models were used to examine the performance of variables in predicting poor functional outcomes (modified Rankin Scale score 2-6). Out of 337 patients with acute ischaemic stroke, myoglobin had the greatest power for predicting poor outcomes among the cardiac indicators. Forward stepwise multivariate logistic regression analysis revealed that myoglobin could independently predict short-term outcomes. Spearman's rank correlation tests indicated a positive correlation between myoglobin levels and stroke severity. Among cardiac indicators, myoglobin may be an independent predictor of short-term outcomes in patients with acute ischaemic stroke.

Combination of high-sensitivity C-reactive protein and homocysteine predicts the short-term outcomes of Chinese patients with acute ischemic stroke

Background: Ischemic stroke is one of the most common causes of death worldwide. Early and accurate prediction of outcome in acute ischemic stroke (AIS) is important and influences risk-optimized therapeutic strategies. We investigated the changes in high-sensitivity C-reactive protein (Hs-CRP) and homocysteine (HCY) levels, two of the risk factors, during the acute period of AIS and evaluated the relationship between these levels and short-term prognosis.Methods: We prospectively studied 189 patients with AIS who were admitted within 24 hours after the onset of symptoms. Serum Hs-CRP, HCY levels, and National Institutes of Health Stroke Scale (NIHSS) were measured at the time of admission. Short-term functional outcome was measured by the modified Rankin scale (mRS), 90 days after admission.Results: The median serum Hs-CRP and HCY levels were significantly higher in AIS patients as compared to normal controls (P < 0·0001, respectively). High-sensitivity C-reactive protein and HCY were independent prognostic markers of functional outcome and death (adjusted for age and the NIHSS) in patients with AIS. In receiver operating characteristic curve analysis, the prognostic accuracy of the combined model (HCY and Hs-CRP) was higher compared to all measured biomarkers individually and the NIHSS score.Conclusion: High-sensitivity C-reactive protein and HCY are independent predictors of short-term outcome and mortality after AIS. The combined model may provide additional general prognostic information.

Hemoglobin A1c and short-term outcomes in patients with acute myocardial infarction undergoing primary angioplasty

Several studies to date have examined whether admission levels of hemoglobin A1c (HbA1c) correlate with short-term and long-term outcomes in patients with acute myocardial infarction treated with primary percutaneous coronary intervention (PCI). However, the results have been ambiguous. We speculated that admission levels of HbA1c correlate with short-term outcomes of patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI. In this observational multicenter study, 608 patients with STEMI who underwent primary PCI between June 2001 and July 2004 were enrolled. Blood samples were collected upon admission to hospital for HbA1c measurement. Follow-up was carried out at 7 and 30 days after hospital admission. According to the new American Diabetes Association criteria, patients were stratified into three groups: I, HbA1c 5.6% or less (n=262); II, HbA1c 5.7-6.4% (n=182); and III, HbA1c at least 6.5% (n=164). The primary outcomes were all-cause mortality and major adverse cardiac events at follow-up. The 7-day mortality was similar (P=0.179) between groups I (1.9%), II (2.2%), and III (0.0%); the 30-day mortality was also similar (P=0.241) between groups I (3.8%), II (2.2%), and III (1.2%). MACE at the 7- day and 30-day follow-up were not significantly different between the three groups either (P>0.05). Rates of target vessel revascularization and rehospitalization, and MACE-free survival curves, at the 30-day follow-up were also similar among the three groups. After adjusting the baseline characteristics, HbA1c was not an independent predictor of short-term outcomes (hazards ratio: 0.431; 95% confidence interval: 0.175-1.061, P=0.067). Admission levels of HbA1c are not an independent prognostic marker for short-term outcomes in STEMI patients treated with primary PCI.

Diagnostic and Prognostic Value of Thrombocytosis in Admitted Medical Patients

IntroductionWhether secondary thrombocytosis is a distinguishing clinical biomarker of various diseases, and whether it is an independent predictor of short-term outcome of admitted medical patients is unknown and has never been examined. MethodsA cohort of all 138 patients with secondary thrombocytosis (platelets count ≥ 5 x 105/μL) admitted to the department of medicine during the last 2 years was analyzed. Epidemiological and clinical data, and the final diagnosis and outcome were recorded and compared with a cohort of 684 consecutive admitted patients without thrombocytosis. ResultsThrombocytosis was not a non-specific marker of inflammation, because uncomplicated infections and most admission causes were not associated with thrombocytosis, except for inflammatory rheumatic diseases (6% versus 1%), along with anemia (9.4% versus 2.5%) and tumor comorbidity (25% versus 14%). In contrast, thrombocytosis was a distinguishing biomarker for severe pyogenic infections, especially empyema (5% vs. 0%), any abscesses (14% versus 3%), and soft tissue infections (7% versus 3%). Moreover, the thrombocytosis group had significantly more admission days, infections (45% versus 33%), sepsis (21% versus 6%), in-hospital major complications (15% versus 3%) and mortality (19% versus 5%). Finally, thrombocytosis was found to be an independent predictor of mortality, in a multivariate regression analysis. ConclusionsThrombocytosis is not a simple marker of inflammation. Its presence warrants thorough investigation for the presence of severe underlying disease, mostly complicated pyogenic infections, inflammatory rheumatic diseases and malignancy. Moreover, thrombocytosis is a marker for major complications and is an independent predictor of mortality in admitted medical patients.

Hyperdense basilar artery sign diagnoses acute posterior circulation stroke and predicts short-term outcome

It is well established that the hyperdense middle cerebral artery sign is a specific marker for early ischemia in anterior circulation. However, little is known about the hyperdense basilar artery sign (HDBA) in posterior circulation. Our aim was to determine whether the HDBA sign has utility in early diagnosis of acute posterior circulation stroke and prediction of short-term outcome. Three-blinded readers examined unenhanced computed tomography scans for the HDBA sign, and materials were classified into two groups according to this sign. Vascular risk factors, admission and discharge National Institute of Health Stroke Scale (NIHSS) scores, short-term outcome, and radiological findings between the two groups were compared. One hundred and twenty-six cases of acute posterior circulation stroke (PCS) were included in the study. No statistically significant differences were found in risk factors of ischemic stroke, except atrial fibrillation (P=0.025). Admission and discharge NIHSS scores for the positive HDBA group were significantly higher than scores for the negative HDBA group (P=0.001, 0.002, respectively). The infarction territory for the positive HDBA group was mainly multi-region in nature (51.6%, P<0.001), while the negative HDBA group showed mainly middle territory infarction. Significant independent predictors of short-term outcome included the HDBA sign (P<0.001) and admission NIHSS scores (P<0.001). Approximately half of the HDBA patients showed multi-region infarction and a serious neurological symptom. Based on our results, this sign might not only be helpful in early diagnosis of acute PCS but also be able to correlate with a poor short-term outcome.

Long-term outcome after stroke: does dysphagia matter?

swallowing problems (dysphagia) are common following acute stroke and are independent predictors of short-term outcome. It is uncertain as to whether these swallowing problems are associated with outcome in the longer-term. insert to determine whether dysphagia present in the first week of acute stroke associated with long-term outcome. a population-based long-term follow-up of people with first in a life-time stroke. Dysphagia was assessed within 1 week of stroke and patients were followed up at 3 months and yearly for 5 years by face-to-face interview. Outcome was defined by survival and place of residence, using multinomial logistic regression. Barthel Scores were divided into the two groups 15-20 and 0-14, and modelled using multiple logistic regression. there were 567 patients with dysphagia (mean age 74.3 years) and 621 with a safe swallow (mean age 69.6 years). Following multinomial logistic regression, residence in a nursing home was more likely to occur in those who failed the swallow test during the first week of their stroke; however, this only reached statistical significance at 3 months (relative risk ratio (RRR)=1.73; 95% confidence interval (CI) 1.02 to 2.95), and years 4 (RRR 3.35, 1.37-8.19) and 5 (RRR 3.06, 1.06-8.83). There was also a significant association with increased mortality only during the first three months (RRR 2.03, 1.12 to 3.67). this study confirms that the presence of dysphagia during the acute phase of stroke is associated with poor outcome during the subsequent year, particularly at 3 months, and is associated with increased institutionalisation rate in the long term.

Value of serial troponin T measures for early and late risk stratification in patients with acute coronary syndromes. The GUSTO-IIa Investigators.

The baseline cardiac troponin T (cTnT) level strongly predicts short-term mortality in acute coronary syndromes, but the added value of later measures to predict short- and long-term outcome and in the context of baseline clinical characteristics is unclear. Relations between baseline, peak, and 8- and 16-hour (late) cTnT results and outcomes were assessed in 734 patients in a GUSTO-IIa substudy. Proportional-hazards models assessed the prognostic information gained from late cTnT when added to a mortality model containing the baseline cTnT result and clinical factors. At baseline, 260 patients were cTnT-positive (>0.1 ng/mL), 323 became positive later, and 151 remained negative (</=0.1 ng/mL). Mortality at 30 days was 10% in the baseline-positive group, 5% in late-positive patients, and 0% in negative patients. After adjustment for baseline characteristics, any positive cTnT result predicted 30-day mortality (baseline, chi2=8.96, P=0.0113; 8-hour, chi2=6.51, P=0.0107; 16-hour, chi2=8.40, P=0.0038). Both the 8- and the 16-hour results added to the strength of the baseline result (baseline+8-hour, chi2=12.04, P=0.0072; baseline+16-hour, chi2=13.52, P=0.0036). Only age and ST-segment elevation were stronger predictors of 30-day mortality than baseline cTnT; results were similar for prediction of 1-year mortality. Most of the mortality difference between cTnT-positive and -negative patients occurred within the first 30 days. The cTnT level is a strong, independent predictor of short-term outcome in acute coronary syndromes. The addition of later samples to a baseline level is useful to evaluate the risk of serious cardiac events.