Independent Prognostic Factor For Mortality Research Articles

Association of serum creatinine trajectories with 1-year mortality after valvular heart surgery: a retrospective cohort study.

Acute renal dysfunction is defined by the maximum increase in serum creatinine (sCr) without considering the pattern of change in sCr. We aimed to identify longitudinal patterns (trajectories) of postoperative sCr concentrations and investigate their association with long-term outcomes in patients undergoing valvular heart surgery. In this retrospective review of 3436 patients who underwent valvular heart surgery, we applied trajectory projection cluster analysis to identify the trajectories of sCr changes from baseline during the 7 postoperative days. Primary and secondary endpoints were to investigate the associations of sCr trajectories with mortality using Kaplan-Meier curves and Cox proportional hazards regression analysis and a composite of major adverse kidney events (MAKEs) at 1 year after surgery, respectively. Four clusters were identified: Clusters 1 and 2, a minimal change in sCr (90.1% of patients); Cluster 3, a significant and persistent increase in sCr (4.1% of patients); and Cluster 4, a significant but transient increase in sCr (5.8% of patients). The 1-year postoperative mortality rate was higher in Cluster 3 (18.4%) and Cluster 4 (11.6%) than in Cluster 1+2 (2.7%). The Kaplan-Meier survival curve demonstrated significant differences in mortality rates among the clusters (log-rank test, P <0.001). In the multivariable Cox analysis, the sCr trajectory cluster was an independent prognostic factor for mortality. Cluster 3 had a higher prevalence of MAKEs (37.6%) compared with Cluster 1+2 (6.8%, P <0.001) and Cluster 4 (24.1%, P =0.045). The cluster was an independent prognostic factor for MAKEs. The sCr trajectory clusters exhibited significantly different risks of mortality and MAKEs 1 year after surgery. Through these sCr trajectories, we confirmed that both the extent of sCr increase and its sustainability during the first 7 postoperative days were closely associated with the long-term prognosis after valvular heart surgery.

Inflammatory markers related to survival in breast cancer patients: Peru.

Breast cancer is a disease with high global prevalence. Clinical inflammatory biomarkers have been proposed as prognostic indicators in oncology. This research aims to determine the relationship between inflammatory markers and overall survival in breast cancer patients from four representative hospitals in Lima, Peru. This is a multicentric, analytical, longitudinal retrospective cohort study with survival analysis in female patients with breast cancer, from 2015 to 2020, who had received at least one complete treatment regimen. The dependent variable was overall survival, and the independent variables were inflammatory markers neutrophil lymphocyte ratio, platelet lymphocyte ratio (PLR), albumin, and red cell distribution width; intervening variables included age, clinical stage, molecular subtype, and other known prognostic factors. The Kaplan-Meier method was applied to generate survival curves with the Log-Rank test, and finally, Cox regression, to find crude and adjusted hazard ratios (HR). Of 705 evaluated patients, 618 were analyzed. The mean age was 56.6 ± 12.3 years, 18.0% of patients were pure HER2 positive, 39.3% luminal A, 29.9% luminal B, 11.0% triple-negative, and 81.4% showed overweight and obesity. The average overall survival was 51.1 months. In the multivariate analysis, factors significantly related to lower overall survival were PLR > 150 (adjusted HR: 2.33; 95% confidence interval (CI): 1.22, 4.44) and stage III (adjusted HR: 4.15; 95% CI: 1.35, 12.83). The Elevated Platelet-Lymphocyte Index and advanced clinical stage were associated with lower overall survival in breast cancer patients. Furthermore, PLR >150 proved to be an independent prognostic factor for mortality.

Clinical Profile and Prognostic Factors of Mortality in Elderly Covid-19 at Ansari Saleh Hospital

Morbidity and mortality of elderly with Covid-19 are higher than in adults. This study aimed to determine the prognostic factors of mortality in elderly with Covid -19. This research was a retrospective cohort study in patients aged 60 years and older with a PCR-confirmed diagnosis of Covid -19 admitted to Ansari Saleh Hospital, South Kalimantan, Indonesia between January to July 2021. Data on age, sex, comorbidities, symptoms, physical examinations, laboratory examinations, chest x-rays, and Covid severity degree were collected, univariate and multivariate analyses performed to determine the independent prognostic factors. The research results showed 209 samples met the criteria. The average age was 66,94 years, dominated by men (57.9%). The most common comorbidities were hypertension (48.8%), diabetes mellitus (35.4%), and chronic heart failure (8.1%). The most frequent symptoms were dyspnea (79.9%), cough (74.2%), and fever (56.5%). Patients treated mostly had severe/critical degree of Covid -19 (140 patients, or 67%). The results of multivariate logistic regression analysis on the variables of respiratory rate (p=0.009; OR=1.1), NLR level (p=0.002; OR=1.081), age (p=0.025; OR=2.479) and Covid severity degree (p=0.008; OR=8.206) showed significant results as independent prognostic factors of mortality. Covid severity degree variable has the highest prognostic level; patients with severe Covid degree have an 8.206 times higher chance of death than mild-to-moderate degrees. In conclusion, respiratory rate, NLR level, age, and Covid severity degree can act as prognostic factors of mortality in elderly suffering from Covid-19.

Influence of stage and age on survival of patients with vulvar cancer in Germany: a retrospective study

ObjectivesTo evaluate the 5-year survival rate of patients with vulvar cancer, taking into account prognostic factors (International Federation of Gynecology and Obstetrics (FIGO) stage and age) and the influence of...

Developing a predictive nomogram for mortality in patients with extrapulmonary acute respiratory distress syndrome: the prognostic value of serum soluble thrombomodulin, lung ultrasound score, and lactate.

Objective: This study aimed to elucidate the prognostic significance of serum soluble thrombomodulin (sTM), lung ultrasound score (LUS), and lactate levels in patients with extrapulmonary acute respiratory distress syndrome (ARDS), with the goal of refining mortality risk prediction in this cohort. Methods: In a prospective cohort of 95 patients with extrapulmonary ARDS admitted to the intensive care unit, we investigated the primary endpoint of 28-day mortality. Utilizing Lasso-Cox regression analysis, we identified independent prognostic factors for mortality. A predictive nomogram was developed incorporating these factors, and its performance was validated through several statistical measures, including the consistency index, calibration plot, internal validation curve, decision curve analysis, interventions avoided analysis, receiver operating characteristic curve analysis, and Kaplan-Meier survival analysis. We further conducted a subgroup analysis to examine the impact of prone positioning on patient outcomes. Results: The study identified baseline serum sTM, LUS, and lactate levels as independent predictors of 28-day mortality in extrapulmonary ARDS patients. The predictive nomogram demonstrated superior prognostic accuracy compared to the use of sTM, LUS, or lactate levels alone, and outperformed traditional prognostic tools such as the Acute Physiology and Chronic Health Evaluation II score and the partial pressure of arterial oxygen to fractional inspired oxygen ratio. The subgroup analysis did not show a significant impact of prone positioning on the predictive value of the identified biomarkers. Conclusion: Our study results support the development and validation of a novel prognostic nomogram that integrates key clinical biomarkers and ultrasound imaging scores to predict mortality in patients with extrapulmonary ARDS. While our research is preliminary, further studies and validation are required.

Should new organ involvement be included in Response Evaluation Criteria in PSMA Imaging?

The current study is intended to investigate the effect of new organ involvement on overall survival (OS) and modify the Response Evaluation Criteria in PSMA Imaging (RECIP) by including new organ involvement to RECIP 1.0. This retrospective study includes 114 patients diagnosed with metastatic castration-resistant prostate cancer (mCRPC) between September 2017 and June 2022 who had received docetaxel treatment and had baseline and post-treatment prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) images. The inclusion criteria were patients with pre- and post-treatment [18F]FDG PET/CT images and whose [18F]FDG PET images were negative. Those whose data were unavailable, who had additional malignancy, or who received abiraterone, enzalutamide, or Lutetium (Lu)-177 treatment were excluded. Age, Gleason score (GS), TPSA (total prostate-specific antigen) levels, surgical history, and OS information were recorded for each patient. The 114 patients herein had a median age of 72.5 (51-91) years and a median GS of 8 (7-10). New lesions were observed in 59 patients (51.7%) and new organ PSMA uptake was observed in 14 patients (12.2%). In the multivariate Cox regression analysis, volume-based treatment response (vTR)-total lesion PSMA (TLP), RECIP PSMA-VOL, modified RECIP (mRECIP) PSMA-VOL, and mRECIP TLP were independent prognostic factors for mortality (p < 0.001, p = 0.006, p = 0.003, and p = 0.003, respectively). The median OS of patients with new organ involvement and new lesion with PSMA uptake was 9.3months (95% CI 2.1-16.5months) and 11.8months (95% CI 7.4-16.2months), respectively. The study concluded that new organ involvement had a shorter OS than new lesion involvement. In the mRECIP that we developed, unlike RECIP, we demonstrated that both PSMA-VOL and TLP value were independent prognostic factors for mortality.

#1579 The effectiveness and safety of sucroferric oxyhydroxide in the treatment of hyperphosphatemia in dialysis patients: a systematic review

Abstract Background and Aims Hyperphosphatemia is an independent prognostic factor for mortality in dialysis patients. The most widely used phosphate binders are sevelamer and lanthanum carbonate. Poor compliance may be due to high pill burden and gastrointestinal adverse reactions. Some previous studies on sucroferric oxyhydroxide showed a potential reduction of phosphorus levels and pill burden. This study aims to determine the effectiveness and safety profile of sucroferric oxyhydroxide in the control of hyperphosphatemia in dialysis-dependent patients. Method A systematic search was conducted in the Cochrane Library, MEDLINE, TRIP Database, and ClinicalTrials.gov until Jan 8, 2024. All randomized controlled trials on the use of sucroferric oxyhydroxide for the treatment of hyperphosphatemia in adult dialysis patients were included. The comparator groups considered were sevelamer or lanthanum. The outcomes of interest were post-treatment serum phosphorus level, the change of serum phosphorus level from baseline, hemoglobin level, ferritin level, transferrin saturation level, adverse events, serious adverse events, and all-cause mortality. Two authors independently searched for articles, screened the articles for inclusion, and appraised the articles using the REVMAN risk of bias table. The GRADE was used to assess the certainty of evidence. In case of a disagreement, the two authors discussed until a consensus was reached. If a consensus was not reached, an independent third-party reviewer was consulted. Meta-analysis was conducted using Review Manager 5.4.1 software. Results We included 7 RCTs represented by 11 records and a total of 2031 adult dialysis patients with hyperphosphatemia. The usual dose of sucroferric oxyhydroxide is 750 mg-3000 mg/day. Sucroferric oxyhydroxide reduces serum phosphorus levels comparable to that of sevelamer (MD = −0.03 mmol/L, 95% CI −0.10 to 0.03, I2 49%) and of lanthanum (MD = −0.02 mmol/L, 95% CI −0.36 to 33, I2 0%). The decrease in serum phosphorus level from the baseline is also comparable with sevelamer (MD = −0.06 mmol/L, 95% CI −0.13 to 0.00, I2 59%). Sucroferric oxyhydroxide significantly reduces the daily number of tablet intake (MD = −7.09 tablets/day, 95% CI −10.45 to −3.73, p-value &amp;lt; 0.0001, I2 = 99%) compared to sevelamer. The use of sucroferric oxyhydroxide shows significantly higher hemoglobin level (MD = 1.15; 95% CI 0.92 to 1.39, p-value &amp;lt; 0.0001, I2 = 0%), higher transferrin saturation level (MD = 8.33; 95% CI 6.06 to 10.59, p-value &amp;lt; 0.0001, I2 = 0%) and higher ferritin level (MD = 64.16; 95% CI 31.64 to 96.68, p-value 0.0001) compared with the use of sevelamer. Pooled analysis on sucroferric oxyhydroxide showed no significant differences in adverse events (RR = 1.05, 95% CI 0.95 to 1.17, I2 = 47%); serious adverse events (RR = 1.11, 95% CI 0.84 to 1.47, I2 = 0%) and all-cause mortality (RR = 0.94; 95% CI 0.38 to 2.31, I2 = 0%) compared to sevelamer. The most common adverse events reported were nausea, diarrhea, abdominal discomfort, fecal discoloration, and hyperphosphatemia. Conclusion Sucroferric oxyhydroxide is comparable with sevelamer and lanthanum in decreasing serum phosphorus levels. It is also associated with higher hemoglobin, ferritin, and transferrin saturation levels compared with the sevelamer group. Since there are no significant differences in the risks of adverse events, serious adverse events, and all-cause mortality, the decrease in pill burden with sucroferric oxyhydroxide may help improve patient compliance.

CD4 expression on monocytes correlates with recovery from multiple organ dysfunction syndrome and mortality in patients with septic shock.

To date, the correlation between CD4 on the monocytes (mCD4) expression and the prognosis of patients with septic shock remains unclear. The purpose of this study was to analyze the expression of mCD4 in these patients and further evaluate whether mCD4 expression correlates with either the recovery from multiple organ dysfunction syndrome (MODS) or mortality. The study participants were recruited from a tertiary general hospital in China (Affiliated Dongyang Hospital of Wenzhou Medical University). Sepsis and septic shock were diagnosed based on the diagnostic criteria of Sepsis-3. MODS was defined as a Sequential Organ Failure Assessment score of at least two organ systems ≥2. Persistent MODS was defined as the continual meeting of the MODS criteria when re-evaluated one week after admission (day 7). A logistic regression model was used to test whether mCD4 was an independent prognostic factor for mortality in patients with septic shock. A paired sample rank sum test was used to examine the correlation between mCD4 expression and MODS recovery. The study recruited 79 patients with septic shock as the study group, 74 patients with sepsis as the disease control group, and 56 volunteers as healthy controls. In the first 24 h after admission (day 1), mCD4 expression was significantly reduced in patients with septic shock compared to healthy controls and patients with sepsis. Moreover, mCD4 expression was an independent prognostic factor for in-hospital and 28 day mortality in patients with septic shock. mCD4 expression did not show significant differences in patients with persistent MODS on day 7 compared to day 1. However, mCD4 expression was significantly higher in patients without persistent MODS on day 7 than on day 1. mCD4 expression is significantly reduced in patients with septic shock, which is an independent prognostic factor for mortality and closely related to recovery from MODS.

Thoracic skeletal muscle mass predicts mortality in patients with surgery for pleural empyema: A case control study.

This study investigated the role of the thoracic skeletal muscle mass as a marker of sarcopenia on postoperative mortality in pleural empyema. All consecutive patients (n = 103) undergoing surgery for pleural empyema in a single tertiary referral center between January 2020 and December 2022 were eligible for this study. Thoracic skeletal muscle mass index (TSMI) was determined from preoperative computed tomography scans. The impact of TSMI and other potential risk factors on postoperative in-hospital mortality was retrospectively analyzed. A total of 97 patients were included in this study. The in-hospital mortality rate was 13.4%. In univariable analysis, low values for preoperative TSMI (p = 0.020), low preoperative levels of thrombocytes (p = 0.027) and total serum protein (p = 0.046) and higher preoperative American Society of Anesthesiologists (ASA) category (p = 0.007) were statistically significant risk factors for mortality. In multivariable analysis, only TSMI (p = 0.038, OR 0.933, 95% CI: 0.875-0.996) and low thrombocytes (p = 0.031, OR 0.944, 95% CI: 0.988-0.999) remained independent prognostic factors for mortality. TSMI was a significant prognostic risk factor for postoperative mortality in patients with pleural empyema. TSMI may be suitable for risk stratification in this disease with high morbidity and mortality, which may have further implications for the selection of the best treatment strategy.

Dynamic hyperinflation is a risk factor for mortality and severe exacerbations in COPD patients

ObjectiveTo assess if dynamic hyperinflation is an independent risk factor for mortality and severe exacerbations in COPD patients. MethodsA cohort of 141 patients with stable COPD and moderate to very severe airflow limitation, treated according to conventional guidelines, was followed for a median of 9 years. Clinical characteristics were recorded and arterial blood gases, pulmonary function tests, 6-min walk and incremental exercise test with measurement of respiratory pattern and operative lung volumes were performed. Endpoints were all-cause mortality and hospitalization for COPD exacerbation. Results58 patients died during the follow-up period (1228 patients x year). The mortality rate was higher in patients with dynamic hyperinflation (n = 106) than in those without it (n = 35) (14.6; 95% CI, 14.5–14.8 vs. 7.2; 95% CI, 7.1–7.4 per 1000 patients-year). After adjusting for sex, age, body mass index, pack-years and treatment with inhaled corticosteroids, dynamic hyperinflation was associated with a higher mortality risk (adjusted hazard ratio [aHR], 2.725; 95% CI, 1.010–8.161), and in a multivariate model, comorbidity, peak oxygen uptake and dynamic hyperinflation were retained as independent predictors of mortality. The time until first severe exacerbation was shorter for patients with dynamic hyperinflation (aHR, 3.961; 95% CI, 1.385–11.328), and dynamic hyperinflation, FEV1 and diffusing capacity were retained as independent risk factors for severe exacerbation. Moreover, patients with dynamic hyperinflation had a higher hospitalization risk than those without it (adjusted incidence rate ratio, 1.574; 95% CI, 1.087–2.581). ConclusionIn stable COPD patients, dynamic hyperinflation is an independent prognostic factor for mortality and severe exacerbations.

Prognostic factors and survival of breast cancer in patients over 40 years of age

Aims: Breast cancer is the cancer with the highest incidence and mortality in women. There are differences in prognosis and survival between women over and under the age of 40. In this article, we aimed to examine breast cancer prognostic factors and survival results in people over the age of 40. Methods: 1187 patients aged 40 and over who underwent surgery at the Ondokuz Mayıs University Department of General Surgery between August 2005 and April 2019 and whose data were accessible were retrospectively examined. Data were obtained from the hospital automation system, the Ministry of Health’s online database, hospital archives, patients, and/or their relatives. They were classified separately in terms of type of surgery, axillary metastasis status (according to radiological status if axilla surgery is not performed), type of axilla surgery performed, pathological tumor size, number of pathological lymph nodes, pathological stage, lymphovascular and perineural invasion status, hormone receptor positivity, C-erb B2 and Ki-67 status, neoadjuvant treatment status, and molecular subgroup. Variables were analyzed individually for recurrence, mortality, and survival. Results found to be significant were subjected to multivariate analysis testing. Statistical significance was accepted as p&lt;0.05. Results: As a result of multivariate analysis performed by excluding data that disrupted homogeneous distribution, perineural invasion, lymphovascular invasion, grade, and progesterone receptor status were determined to be independent prognostic factors in terms of recurrence. Lymphovascular invasion and progesterone receptor status were found to be independent prognostic factors for mortality. Conclusion: A lot of studies have been conducted, and criteria have been determined for breast cancer prognosis and survival. In our results, lymphovascular invasion and progesterone receptor status were found to be independent prognostic markers for both recurrence and mortality. More reliable results can be obtained with prospective study analyses.

Clinical impact of pre-existing acute exacerbation in patients with interstitial lung disease who underwent lung transplantation

BackgroundAcute exacerbation of interstitial lung disease (AE-ILD) significantly impacts prognosis, leading to high mortality rates. Although lung transplantation is a life-saving treatment for selected patients with ILD, its outcomes in those presenting with AE-ILD have yielded conflicting results compared with those with stable ILD. This study aims to investigate the impact of pre-existing AE on the prognosis of ILD patients who underwent lung transplantation.MethodWe conducted a single-center retrospective study by reviewing the medical records of 108 patients who underwent lung transplantation for predisposing ILD at Asan Medical Center, Seoul, South Korea, between 2008 and 2022. The primary objective was to compare the survival of patients with AE-ILD at the time of transplantation with those without AE-ILD.ResultsAmong the 108 patients, 52 (48.1%) experienced AE-ILD at the time of lung transplantation, and 81 (75.0%) required pre-transplant mechanical ventilation. Although the type of ILD (IPF vs. non-IPF ILD) did not affect clinical outcomes after transplantation, AE-ILD was associated with worse survival outcomes. The survival probabilities at 90 days, 1 year, and 3 years post-transplant for patients with AE-ILD were 86.5%, 73.1%, and 60.1%, respectively, while those for patients without AE-ILD were higher, at 92.9%, 83.9%, and 79.6% (p = 0.032). In the multivariable analysis, pre-existing AE was an independent prognostic factor for mortality in ILD patients who underwent lung transplantation.ConclusionsAlthough lung transplantation remains an effective treatment option for ILD patients with pre-existing AE, careful consideration is needed, especially in patients requiring pre-transplant mechanical respiratory support.

Differences in treatment and clinical outcomes in patients aged ≥75 years compared with those aged ≤74 years following acute coronary syndromes: a prospective multicentre study

ObjectiveThis study describes the differences in treatment and clinical outcomes in patients aged ≥75 years compared with those aged ≤74 years presenting with acute coronary syndrome (ACS) and undergoing invasive...

Influence of Pre-Transplant Estimated Glomerular Filtration Rate (eGFR) on Outcomes after Allogeneic Hematopoietic Cell Transplantation

Assessment of pre-transplant renal function as measured by estimated Glomerular Filtration Rate (eGFR) is a standard criterion for selection of patients for allogeneic hematopoietic cell transplantation (alloHCT). Despite refinements in alloHCT and reductions in toxicity over time, we hypothesized that baseline renal function is still independently associated with differences in outcomes in the contemporary era. The aim of this study was to identify an optimal eGFR cut point for identifying those at increased risk of HCT-related mortality. Patients who underwent first alloHCT from January 2012 to December 2021 were identified from our institutional database, excluding syngeneic and umbilical cord grafts. eGFR was calculated using the CKD-EPI Creatinine Equation (Inker et a. NEJM 2021). Optimal pre-HCT eGFR cut point for high-risk of non-relapse mortality (NRM) after alloHCT was identified using Cox restricted cubic spline plot. eGRF was grouped into multiple categories based upon the observed association in the spline plot alone with an established cut point of 90 ml/min/1.73 m² for abnormal kidney function. Associations of eGFR, demographics, prognostic factors, and HCT characteristics with NRM and overall survival (OS) were evaluated using survival analysis; non-HCT related death was considered as a competing risk in the NRM analysis. 724 adult patients were studied with a median age of 58 yrs (range, 18-79), 57% males, 92% Caucasian, and 76% KPS &amp;gt;90. HCT-CI: 52% high, 31% intermediate, and 17% low risk. Transplants included 43% myeloablative and 57% reduced-intensity conditioning; 64% peripheral blood and 36% bone marrow grafts. Donor type: 28% related, 55% unrelated and 17% haploidentical. The median (IQR) of pre-transplant eGFR was 96.7 ml/min/1.73 m² (79.6, 107.5). eGFR was categorized as &amp;lt;70 (15.8%), 70-89 (22.4%), 90-119 (52.4%), and &amp;gt;120 ml/min/1.73 m² (9.4%). NRM was significantly higher for the eGFR &amp;lt;70 ml/min/1.73 m² group compared to the others (3-year NRM: 44.9% in eGFR &amp;lt;70 vs 25.0% in 70-89, 23.6% in 90-119, and 13.8% in &amp;gt;120 ml/min/1.73 m²) which was confirmed on multivariate analysis (Figure and Table). Overall survival (OS) was also significantly worse for those with an eGFR &amp;lt;70 ml/min/1.73 m² on multivariate analysis (3-year OS: 34.1% in eGFR &amp;lt;70 vs 51.7% in 70-89, 52.4% in 90-119, and 64.8% in &amp;gt;120 ml/min/1.73 m²) (Table) along with baseline KPS and high ASBMT Request for Information (RFI). The most common causes of death for both the eGFR&amp;lt;70 and &amp;gt;70 ml/min/1.73 m² groups were relapse (44% vs 60%, respectively) and infection (25% vs. 19%, respectively). Both NRM and OS differences among the 3 higher eGFR groups were not statistically significant in multivariate analyses. eGFR was not associated with relapse. We conclude that pre-transplant eGFR &amp;lt;70 ml/min/1.73m 2 is an independent prognostic factor for mortality after alloHCT. Future investigation with larger subgroup analyses regarding specific diagnoses, conditioning regimens and transplant modalities may further identify which patients are more appropriate for transplant and those who may benefit from alternative treatment approaches. Our results also suggest that additional efforts to preserve renal function prior to transplant by limiting nephrotoxic exposures may have implications for optimizing outcomes after transplant, particularly in those with other comorbidities.

Soluble suppression of tumorigenicity 2 is a potential predictor of post-liver transplant renal outcomes.

Acute kidney injury is considered an independent prognostic factor for mortality in patients with liver cirrhosis. Non-treated acute kidney injury can progress to hepatorenal syndrome with a poor prognosis. As suppression of tumorigenicity 2 (ST2) is a member of the interleukin-1 receptor family that aggravates inflammation and fibrotic changes in multiple organs, we measured soluble ST2 (sST2) level in the serum and urine of liver-transplant recipients at the time of transplantation. The serum sST2 level significantly increased in liver-transplant recipients with suppressed kidney function compared with that in recipients with normal function. In recipients with severely decreased liver function (model for end-stage liver disease score ≥ 30), the serum sST2 level was higher than that in recipients with preserved liver function (model for end-stage liver disease score ≤ 20, P = 0.028). The serum sST2 level in recipients with hepatorenal syndrome was higher than that in liver-transplant recipients without hepatorenal syndrome (P = 0.003). The serum sST2 level in patients with hepatorenal syndrome was higher than that in recipients without a history of acute kidney injury (P = 0.004). Recipients with hepatorenal syndrome and recovered kidney function showed higher sST2 levels than those who did not recover (P = 0.034). Collectively, an increase in the serum sST2 level reflects a decrease in both kidney and liver functions. Thus, measuring sST2 level at the time of liver transplantation can help predict renal outcomes.

Clinical Characteristics and Prognostic Factors of Patients With Stenotrophomonas maltophilia Pneumonia: 10-Year Experience From a Single Center.

Stenotrophomonas maltophilia infection is gaining importance as an important cause of nosocomial pneumonia. S. maltophilia infection occurs especially in patients with a history of immunosuppression, comorbidity, or multiple antibiotherapy uses. A retrospective 10-year study was carried out to determine the clinical characteristics of all patients with S. maltophilia pneumonia, antibiotic resistance pattern, and risk factors associated with hospital mortality. Hospitalized pneumonia patients with S. maltophilia culture positivity were identified, and their medical records were reviewed. Risk factors associated with hospital mortality were analyzed. Any variable with a significant association with mortality in the univariate analysis was entered in a multivariate forward stepwise logistic regression model to identify independent risk factors for death. Seventy-two patients (mean age: 67.3 years, 65.2% males) with S. maltophilia pneumonia were included in the study. All patients had at least one comorbidity. The most common comorbidities were chronic obstructive pulmonary disease, diabetes mellitus, chronic renal failure, malignancy, and cardiac diseases. Percentage resistance to trimethoprim-sulfamethoxazole (5.5%) was lower than that for fluoroquinolones (12.5%). By using multivariate analysis, respiratory insufficiency needed mechanical ventilation, low hemoglobin level, age>65 years, previous antibiotic usage, and hypotension were the independent prognostic factors for mortality. S. maltophilia is emerging as an important pathogen with an increased risk of mortality in patients with respiratory insufficiency who need mechanical ventilation, a low hemoglobin level, >65 years of age, previous antibiotic usage, and hypotension. Empiric therapy should include agents active against S. maltophilia, such as newer fluoroquinolones and trimethoprim-sulfamethoxazole.

Association of N-terminal pro-B-type natriuretic peptide levels and mortality risk in acute myocardial infarction across body mass index categories: an observational cohort study

BackgroundThe prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) across body mass index (BMI) categories in patients with acute myocardial infarction (AMI) is unclear. We aimed to assess the predictive value of NT-proBNP levels and identify the best cutoff values for mortality risk prediction across BMI categories in AMI.MethodsWe analyzed 4677 patients with AMI from the Cardiovascular Centre Beijing Friendship Hospital Database Bank. Patients were classified into underweight (< 18.5 kg/m2), normal-weight (18.5–23.9 kg/m2), overweight (24–27.9 kg/m2), and obese (≥ 28 kg/m2) groups. The association between NT-proBNP (ln-transformed) and mortality was investigated using Cox regression and stratified by BMI.ResultsDuring follow-up (13,787 person-years of observation), 718 patients died, averaging 52.1 events per 1000 person-years. NT-proBNP levels were inversely correlated with BMI (β = − 0.096, P < 0.001). After adjustment, NT-proBNP was independently associated with all-cause mortality (hazard ratio [HR] per 1-SD: 1.82; 95% confidence interval [CI] 1.60–2.07) in patients with AMI. Similar findings were observed in analyses stratified by BMI category, except for the underweight group. Adding NT-proBNP to conventional risk models improved risk discrimination in normal-weight, overweight, and obese patients (C-index changes of 0.036, 0.042, and 0.032, respectively) and classification of patients into predicted mortality risk categories (net reclassification improvement 0.263, 0.204, and 0.197, respectively). The best NT-proBNP cutoff values for 5-year mortality risk prediction across BMI categories were 5710, 4492, 2253, and 1300 pg/ml.ConclusionNT-proBNP level was an independent prognostic factor for mortality in patients with AMI and varied according to BMI. The best NT-proBNP cutoff values for mortality risk prediction reduced as BMI increased.

Risk stratification model integrating nutritional and inflammatory factors for predicting 1-year mortality after valvular heart surgery: a retrospective cohort study.

Existing risk-scoring systems for cardiac surgery include only standard preoperative factors, without considering nutritional and inflammatory status or intraoperative factors. The objective of this study was to develop a comprehensive prediction model for mortality incorporating nutritional, inflammatory, and perioperative factors in patients undergoing valvular heart surgery. In this retrospective review of 2,046 patients who underwent valvular heart surgery, Cox and LASSO regression analyses were performed to identify independent prognostic factors of 1-year postoperative mortality among various perioperative factors known to affect prognosis, including objective nutritional and inflammatory indices. A novel nomogram model incorporating selected prognostic factors was developed, and its discrimination ability was evaluated using the C-index. The model was validated in internal and external cohorts. The 1-year mortality rate after valvular heart surgery was 5.1% (105 of 2,046 patients) and was significantly associated with several preoperative objective inflammatory and nutritional indices. Cox and LASSO analyses identified the following five independent prognostic factors for mortality: monocyte-to-lymphocyte ratio (an objective inflammatory index), EuroSCORE II, Controlling Nutritional Status score, cardiopulmonary bypass time, and number of erythrocyte units transfused intraoperatively. Our nomogram model incorporating these five factors had a C-index of 0.834 (95% CI 0.791-0.877), which was higher than that of EuroSCORE II alone (0.744, 95% CI 0.697-0.791) (P<0.001). The nomogram achieved good discrimination ability, with C-indices of 0.836 (95% CI 0.790-0.878) and 0.727 (95% CI 0.651-0.803) in the internal and external validation cohorts, respectively, and showed well-fitted calibration curves. A nomogram model incorporating five inflammatory, nutritional, and perioperative factors, as well as EuroSCORE II, was a better predictor of 1-year mortality after valvular heart surgery than EuroSCORE II alone, with good discrimination and calibration power for predicting mortality in both internal and external validation cohorts.

The Clinical Frailty Scale (CFS) as an Independent Prognostic Factor for Patients ≥80 Years with Small Bowel Obstruction (SBO)

BackgroundSBO is a potentially life-threatening condition that often affects older patients. Frailty, more than age, is expected to play a crucial role in predicting SBO prognosis in this population. This study aims to define the influence of Clinical Frailty Scale (CFS) on mortality and major complications in patients ≥80 years with diagnosis of SBO at the emergency department (ED). MethodsAll patients aged ≥80 years admitted to our ED for SBO from January 2015 to September 2020 were enrolled. Frailty was assessed through the CFS, and then analyzed both as a continuous and a dichotomous variable. The endpoints were in-hospital mortality and major complications. ResultsA total of 424 patients were enrolled. Higher mortality (20.8% vs 8.6%, p<0.001), longer hospital stay (9 [range 5–14] days vs 7 [range 4–12] days, p=0.014), and higher rate of major complications (29.9% vs 17.9%, p=0.004) were associated with CFS ≥7. CFS score and bloodstream infection were the only independent prognostic factors for mortality (OR 1.72 [CI: 1.29–2.29], p<0.001; OR 4.69 [CI: 1.74–12.6], p=0.002, respectively). Furthermore, CFS score, male sex and surgery were predictive factors for major complications (OR 1.41 [CI: 1.13–1.75], p=0.002; OR 1.67 [CI: 1.03–2.71], p=0.038); OR 1.91 [CI: 1.17–3.12], p=0.01; respectively). At multivariate analysis, for every 1-point increase in CFS score, the odds of mortality and the odds of major complications increased 1.72-fold and 1.41-fold, respectively. ConclusionThe increase in CFS is directly associated with an increased risk of mortality and major complications. The presence of severe frailty could effectively predict an increased risk of in-hospital death regardless of the treatment administered. The employment of CFS in elderly patients could help the identification of the need for closer monitoring and proper goals of care.

Which factors are predicting the mortality in patients with COVID-19 in the intensive care unit?

Aims: COVID-19 infection is a global health problem; clinical and laboratory parameters have been developed to predict this disease-related mortality/morbidity. Some of these parameters are clinical parameters, while some are laboratory parameters. This study aims to determine whether Acute Physiology and Chronic Health Evaluation (APACHE) II, Glasgow Coma Scale (GCS), age, presence of comorbidity, and absolute lymphocyte count effectively predict mortality in patients admitted to intensive care unit (ICU) due to COVID-19.&#x0D; Methods: We have included 108 PCR-positive COVID-19 patients admitted to the ICU between 1 October and 31 November 2020 in our research. Demographic characteristics of all patients, APACHE II values within the first 24 hours of admission to ICU, the GCS, the presence of comorbidity, lymphocyte count during ICU admission, duration of ICU stay, and the mortality rates were recorded.&#x0D; Results: The average age of 108 individuals evaluated in the study was 67±13.61 years, and 56.5% of the patient group consisted of the geriatric age range. Seventy (64.8%) of the patients were female, eighty-nine (82.4%) patients had at least one comorbidity. In the multivariate analysis, it was determined that lymphocyte value, APACHE II score, and the presence of any comorbidity are independent prognostic factors for mortality when accepted to ICU.&#x0D; Conclusion: In our study, we have determined that age, APACHE II value, presence of comorbidity, and baseline lymphocyte counts are independent predictors of mortality.