Independent Risk Factor For Mortality Research Articles

Is it time to Reassess The Role of Preoperative HypoalbuminemiaAmong Geriatric Distal Femur Fracture Patients?

Hypoalbuminemia, blanketly defined as Albumin < 3.5g/dL, is often utilized as a threshold associated with postoperative complications and mortality among orthopedic and non-orthopedic surgical procedures. Albumin level is influenced by a myriad of factors including liver function, malnutrition, and inflammation. This study evaluates the role preoperative albumin as an independent risk factor for mortality and increased length of stay (LOS) among distal femur fracture (DFF) patients. Between 2010 and 2019, the National Surgical Quality Improvement Program (NSQIP) identified isolated closed distal femur fractures preoperative albumin levels using International Classification of Diseases 9th and 10th revisions (ICD9/ICD10) codes [S72.4*; 821.2*]. Albumin was categorized as both continuous and categorical variables: marked hypoalbuminemia (< 2.5g/dL), mild hypoalbuminemia (2.5-3.5g/dL), normal albuminemia (3.5-4.5g/dL) or hyperalbuminemia (> 4.5g/dL). Primary outcomes included in-hospital mortality and LOS. The incidence rate of hypoalbuminemia was 54.6% (419/767). Multivariable logistic regression analysis demonstrated that when compared to patients with baseline marked hypoalbuminemia, patients with mild hypoalbuminemia and normal serum albumin reported a respective 82% (OR 0.18, 95% CI [0.04, 0.71], p = 0.014) and 80% (OR: 0.20, 95% CI [0.05, 0.89], p = 0.034) decreased odds of in-hospital mortality. Similarly, a 53.7% (OR 0.46, 95% CI [0.23, 0.94], p = 0.033), 71.1% (OR 0.29, 95% CI [0.14, 0.60], p = 0.001), and 82.8% (OR 0.17, 95% [0.04, 0.75], p = 0.020) decreased odds of exceeding mean LOS was observed among mild hypoalbuminemic, normal, and hyperalbuminemic patients compared to patients with baseline marked hypoalbuminemia. Preoperative hypoalbuminemia is an independent risk factor for increased LOS and mortality among DFFs, controlling for confounding factors. Prospective investigation of albumin risk stratification is warranted to differentiate contributable effects of chronic malnutrition and traumatic inflammatory albumin downregulation among geriatric trauma patients. Prognostic Level III.

Serotype distribution and clinical characteristics of Group B Streptococcus Bacteremia in nonpregnant adults: a 15-Year Multicenter Study in Korea

BackgroundGroup B Streptococcus (GBS) bacteremia in nonpregnant adults is of increasing concern, particularly among the elderly in underlying conditions. This study analyzed the serotype distribution, antimicrobial resistance patterns, and clinical characteristics of GBS bacteremia in nonpregnant adults over a 15-year period in two tertiary hospitals in Korea.MethodsFrom 2007 to 2021, patients aged ≥ 19 years with GBS bacteremia were identified via retrospective electronic medical record review. GBS isolates were collected through a hospital-wide surveillance system and confirmed via MALDI-TOF-MS. Multilocus sequence typing (MLST) was conducted for serotype VIII and undetermined serotype isolates. Clinical and laboratory data were analyzed to assess trends and mortality risk factors.ResultsA total of 264 episodes of GBS bacteremia were identified, with 147 isolates successfully re-cultured and 125 isolates and patients included in the clinical characteristic analysis. Serotype VIII emerged as the most common serotype (42.1% in 2019–2021) with a significant increase in prevalence over time (P = 0.02). MLST of serotype VIII revealed ST2 as the dominant sequence type (87.8%). Antimicrobial resistance rates for erythromycin, clindamycin, and levofloxacin were 27.2%, 30.4%, and 23.2%, respectively, with notable variability among serotypes. The 30-day mortality rate was 12.8%. Male sex (aOR: 2.18; 95% CI: 1.15–4.13, P = 0.02) and SOFA score (aOR per unit increase: 1.25; 95% CI: 1.12–1.38, P < 0.001) were significantly associated with mortality.ConclusionsThis study highlights the emergence of serotype VIII as a predominant cause of GBS bacteremia and its association with ST2 in South Korea. Male sex and higher SOFA scores were independent risk factors for mortality. The findings emphasize the need for ongoing surveillance and consideration of serotype-specific strategies in clinical management and vaccine development.

Pathogenic spectrum of infective endocarditis and analysis of prognostic risk factors following surgical treatment in a tertiary hospital in China

BackgroundThis study aimed to summarize the pathogenic spectrum of infective endocarditis (IE) and analyze the risk factors for poor prognosis in surgical patients in a tertiary hospital in China.MethodsWe retrospectively included patients diagnosed with IE between January 2013 and January 2022. The pathogenic spectrum was summarized; the risk factors for early postoperative mortality and embolic events were analyzed using multivariate logistic regression.ResultsAmong 630 patients who underwent blood cultures, the positivity rate was 56.83%. The most prevalent pathogens were viridans streptococci, Staphylococcus aureus, enterococci, and coagulase-negative staphylococci (CoNS). The prevalence of viridans streptococci significantly increased in the surgically treated group, compared to the medically treated group (50.80% vs. 27.78%, P < 0.001), while that of CoNS decreased (5.60% vs. 12.04%, P = 0.034). There has been a declining trend in the blood culture positivity in recent years compared to earlier years (2018–2022 vs. 2013–2017 = 60.95% vs. 47.30%, P = 0.037), with an increasing trend in viridans streptococci and a decreasing trend in CoNS. Multivariate logistic regression analysis identified male gender, coronary artery disease, platelet count < 100 × 109/L, albumin < 35 g/L, elevated creatinine, and prosthetic valve as independent risk factors for early postoperative mortality. Risk factors for embolic events included recent cerebral infarction within 3 months, history of peripheral vasculopathy, and hemoglobin (Hb) < 90 g/L.ConclusionsViridans streptococci predominates as the most common IE pathogen, with its incidence rising recently, especially among surgical patients. Blood culture positivity is decreasing. Understanding risk factors for early postoperative mortality and embolic events is crucial for optimizing patient management and prognosis.Clinical trial numberNot applicable.

Exploring the prognostic impact of triglyceride-glucose index in critically ill patients with first-ever stroke: insights from traditional methods and machine learning-based mortality prediction

BackgroundThe incidence and mortality of first-ever strokes have risen sharply, especially in the intensive care unit (ICU). Emerging surrogate for insulin resistance, triglyceride-glucose index (TyG), has been linked to stroke prognosis. We aims to explore the relationships between TyG with ICU all-cause mortality and other prognosis, and to develop machine learning (ML) models in predicting ICU all-cause mortality in the first-ever strokes.MethodsWe included first-ever stroke patients from the eICU Collaborative Research Database in 2014–2015 as the primary analysis cohort (then divided into training and internal validation cohorts) and from local hospital’s ICUs as the external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the association between TyG and ICU/hospital all-cause mortality. Linear regression and correlation analyses were performed to examine the relationships between TyG with length of ICU/hospital stay and Glasgow Coma Score.ResultsThe primary analysis cohort included 3173 first-ever strokes (median age 68.0 [55.0–68.0] years; 63.0% male), while the external validation cohort included 201 first-ever strokes (median age 71.0 [63.0–77.0] years; 62.3% male). Multivariate Cox proportional hazards models revealed that the high TyG group (TyG ≥ 9.265) was associated with higher ICU (HR 1.92, 95% CI 1.38–2.66) and hospital (HR 1.69, 95% CI 1.32–2.16) all-cause mortality, compared with low TyG group (TyG < 9.265). TyG was also correlated with ICU length of stay (r = 0.077), hospital length of stay (r = 0.042), and Glasgow Coma Score (r = -0.132). TyG and other six features were used to construct ML models. The random forest model performed best in internal validation with AUC (0.900) and G-mean (0.443), and in external validation with AUC (0.776) and G-mean (0.399).ConclusionTyG (optimal cut-off: 9.265) was identified as an independent risk factor for ICU and hospital all-cause mortality in first-ever strokes. The ML model incorporating TyG demonstrated strong predictive performance. This emphasises the importance of insulin resistance (with TyG as a surrogate measure) in the prognostic assessment and early risk stratification of first-time stroke patients.

Association between red cell distribution width and 30-day mortality in patients with sepsis-associated liver injury: a retrospective cohort study

BackgroundSepsis-associated liver injury (SALI) is a critical component of sepsis-induced multiple organ dysfunction with high mortality. Identifying biomarkers for risk stratification is essential. Red cell distribution width (RDW), indicating variation in red blood cell volume, has been linked to adverse outcomes in various diseases. This study aimed to evaluate the association between RDW and 30-day mortality in SALI patients.MethodsA retrospective cohort study was conducted using data from the Medical Information Mart for Intensive Care-IV database. Patients admitted to the intensive care unit (ICU) with SALI were included. RDW was recorded within the initial 24 h. The primary outcome was 30-day mortality. A multivariable Cox regression analysis was performed to examine the relationship between RDW and mortality.ResultsAmong 529 SALI patients (mean age 68.7 years, 61.8% male), 46.1% had RDW &amp;gt; 15.5%. The 30-day mortality rate was 35.5%. RDW was significantly higher in non-survivors compared to survivors (17.2 ± 3.0 vs. 15.4 ± 2.3, P &amp;lt; 0.001). Cox regression identified RDW as an independent risk factor for 30-day mortality (HR 1.14, 95% CI 1.09 to 1.19, P &amp;lt; 0.001). Subgroup analyses demonstrated that the findings were consistent across the various groups.ConclusionElevated RDW is independently associated with higher 30-day mortality in patients with SALI, suggesting its potential role in risk stratification and clinical management.

Efficacy of Hemoadsorption combined with Continuous Renal Replacement Therapy in Patients with Rhabdomyolysis and Acute Kidney Injury: A Retrospective Study

Abstract Background Clearance of circulating myoglobin is crucial to prevent further damage in patients with rhabdomyolysis (RM) and acute kidney injury (AKI). The objective of the present study is to evaluate the efficacy and safety of hemoadsorption (HA) combined with continuous renal replacement therapy (CRRT) in critically ill patients with RM and AKI. Methods RM with AKI patients who received CRRT+HA or CRRT with concomitant creatine kinase (CK) greater than 10 000 IU/L in our intensive care unit between May 2021 and December 2023 were retrospectively included. The primary outcome was 90-day mortality; secondary outcomes were kidney function recovery and CK decline rate. Adverse events were also evaluated including hypotension, circuit clotting, albumin leakage, and blood loss. Propensity score matching (PSM) and Cox retrospective analysis were performed. Results A total of 111 RM patients with AKI were ultimately included. The ICU and in-hospital mortality were significantly lower in the CRRT+HA group compared with the CRRT group (ICU mortality: 18% vs. 42%, P = .025; in-hospital mortality: 21% vs. 42%, P = .048). However, the CRRT+HA group only showed a non-significant reduction in 90-day mortality compared with the CRRT group (47% vs. 68%, P = .063). After treatment for 90 days, the number of patients with kidney function recovery was not significantly different between CRRT+HA and CRRT groups (95% vs. 84%, P = .639). Moreover, the incidence of hypotension and circuit clotting events did not increase during CRRT+HA treatment. In addition, the CRRT+HA group also appeared to have a higher rate of CK reduction and reduction of CK than the CRRT group at 24 and 48 hours after the initiation of CRRT. Multivariate Cox regression model demonstrated that CRRT+HA (HR 0.477, 95% confidence interval (CI) 0.234-0.972; P = .042), mean arterial blood pressure (MAP) (per 1 mmHg, HR 0.967,95% CI 0.943-0.992; P=.009) and CRRT treatment duration (per 1 h, HR 0.995,95% CI 0.992-0.998; P = .002) played a favorably important role in the survival prognosis of RM and AKI patients. In contrast, serum phosphate before RRT (per 1mmol/L, HR 1.531, 95% CI 1.113-2.106; P = .009) and McMahon score (per 1 score, HR 1.15, 95% CI 1.006-1.313, P = .04) were independent risk factors for 90-day mortality. Conclusions CRRT combined with HA therapy reduced ICU and in-hospital mortality in patients with RM and AKI and also had a cleansing effect on creatine kinase without significant adverse events.

Early Pacemaker Dependency After Heart Transplantation Is Associated with Permanent Pacemaker Implantation, Graft Failure and Mortality

Aims: Patients after heart transplantation (HTX) often experience post-transplant bradycardia, but little is known about the outcomes of early pacemaker dependency after HTX. We compared post-transplant mortality, graft failure, and the requirement for the permanent pacemaker implantation of patients with and without early pacemaker dependency after HTX. Methods: We screened all adult patients for early pacemaker dependency after HTX (defined as immediately after surgery) who underwent HTX at Heidelberg Heart Center between 1989 and 2022. Patients were stratified by diagnosis and type of early pacemaker dependency after HTX (sinoatrial or atrioventricular conduction disturbance). Results: A total of 127 of 699 HTX recipients (18.2%) had early pacemaker dependency after HTX, including 52 patients with sinoatrial conduction disturbances (40.9%) and 75 patients with atrioventricular conduction disturbances (59.1%). Patients with early pacemaker dependency after HTX showed both increased 1-year overall mortality after HTX (55.9% vs. 15.2%, p &lt; 0.001) and higher mortality due to graft failure (25.2% vs. 4.2%, p &lt; 0.001). Multivariate analysis revealed early pacemaker dependency after HTX (HR: 5.226, 95% CI: 3.738–7.304, p &lt; 0.001) as an independent risk factor for 1-year mortality after HTX. Patients with early pacemaker dependency after HTX had a higher rate of 30-day (7.1% vs. 0.4%, p &lt; 0.001) and 1-year (11.8% vs. 0.5%, p &lt; 0.001) permanent pacemaker implantation after HTX compared to patients without early pacemaker dependency after HTX. Conclusions: Patients with early pacemaker dependency after HTX had a significantly higher rate of post-transplant mortality, graft failure, and the requirement for permanent pacemaker implantation.

In-hospital and delayed mortality in patients with upper gastrointestinal bleeding on antithrombotic treatment: effects of withdrawal and resuming

ABSTRACT Background Antithrombotic drugs pose a dual challenge to acute upper gastrointestinal bleeding, with associated risks of bleeding complications and thromboembolic events upon withdrawal. We aimed to determine the impact of antithrombotic medications on in-hospital and delayed outcomes and whether suspension and resumption influenced delayed mortality. Methods This study was a prospective registry analysis of patients between 2013–2021. Anticoagulants and antiplatelets were classified as antithrombotic. The examined outcomes included in-hospital mortality and delayed 6-month cardiovascular, bleeding, and mortality events. Results A total of 1345 patients were included. 21.7% were taking anticoagulants and 19.1% were taking antiplatelets. Patients on antithrombotic therapy have a longer delay in endoscopic performance (11 ± 11 h vs. 9.6 ± 8 h; p = 0.027) and less need for therapy (38.5% vs. 48.1%;p = 0.002), with gastric erosion being more usual (14.2% vs. 9.1%; p = 0.006). In-hospital mortality was higher in patients not taking antithrombotic (12% vs. 8%;p = 0.022) and suspension < 72 h was associated with increased mortality (14.9% vs. 2.3%;p = 0.001). Delayed mortality was higher in patients taking antithrombotic (9.4% vs. 6%; p=0.034) and in those who suspended them for more than 7days (17% vs. 8.7%; p=0.033), with no differences when it lasted<72h. Patients on antithrombotic therapy exhibited more delayed cardiovascular (13.7% vs. 3.4%; p<0.0001) and hemorrhagic events (22.9% vs. 12.9%; p<0.0001), with no differences observed in patients who withheld antithrombotic medication. Multivariate analysis identified ASA, disseminated malignancy, and NSAIDs as independent risk factors for in-hospital mortality, whereas antithrombotic therapy and hemoglobin levels were protective factors. Conclusion Patients with upper gastrointestinal bleeding treated with antithrombotic drugs had lower in-hospital mortality despite increased comorbidities and older age. Conversely, delayed 6-month mortality was higher. Shorter antithrombotic suspension durations increased in-hospital mortality, whereas suspension for > 7 days increased delayed mortality.

Analysis of risk factors for sepsis-related liver injury and construction of a prediction model

BackgroundSepsis is a leading cause of mortality in critically ill patients, and the liver is a key organ affected by sepsis. Sepsis-related liver injury (SRLI) is an independent risk factor for multiple organ dysfunction syndrome (MODS) and mortality. However, there is no clear diagnostic standard for SRLI, making early detection and intervention challenging.ObjectiveThis study aimed to investigate the predictive value of serum indices for the occurrence of SRLI in adults to guide clinical practice.MethodsIn this study, we investigated the predictive value of serum indices for SRLI in adults. We retrospectively analyzed data from 1,573 sepsis patients admitted to West China Hospital, Sichuan University, from January 2015 to December 2019. Patients were divided into those with and without liver injury. Stepwise logistic regression identified independent risk factors for SRLI, and a predictive model was constructed. The model’s diagnostic efficacy was assessed using receiver operating characteristic (ROC) curve analysis.ResultsOur results showed that alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), carbon dioxide combining power (CO2-CP), antithrombin III (AT III), fibrin/fibrinogen degradation products (FDP), and red blood cell distribution width (RDW-CV) were independent predictors of SRLI. The area under the curve (AUC) of the predictive model was 0.890, with a sensitivity of 80.0% and a specificity of 82.91%, indicating excellent diagnostic value.ConclusionIn conclusion, this study developed a highly accurate predictive model for SRLI using clinically accessible serum indicators, which could aid in early detection and intervention, potentially reducing mortality rates.

Survival comparison in adults with congenital systemic to pulmonary shunt and borderline elevated pulmonary vascular resistance versus Eisenmenger syndrome

Pulmonary arterial hypertension (PAH) associated with congenital heart disease (PAH-CHD) is a consequence of unrepaired large systemic-to-pulmonary shunts. The long-term data of adult patients who have PAH-CHD with elevated pulmonary vascular resistance (PVR) are limited. We aimed to investigate the survival of adults who had PAH-CHD with predominantly left-to-right (L-R) shunts with (1) borderline-to-high PVR and (2) treat-and-repair compared with those with Eisenmenger syndrome (ES). From 1995 to 2021, 99 adults with ES (age 34.1 ± 11.2 years) and 118 adults with PAH-CHD with predominantly L-R shunts (age 39.1 ± 13.7 years) were eligible. The PVR in the ES group was 21.0 ± 13.1 WU. Most ES patients (97%) received pulmonary vasodilator therapy. Among the 118 patients with PAH-CHD with predominantly L-R shunts, the baseline PVR was 7.6 ± 4.6 WU, and 78 patients (66.1%) had borderline to high PVR (≥ 5 WU). In the group, 105 patients (88.9%) underwent repair; 84 had defect closure, and 21 had fenestrated closure. Treat-and-repair was used to treat 53 patients with a preoperative final PVR of 3.58 ± 2.63 WU. No early postoperative deaths were reported. At a median follow-up time of 5.4 years (range 0.1–23.6 years), the 10- and 15-year survival rates of adults with borderline PVR were 82.3% and 82.3%, respectively, which were not inferior to the rates for patients with ES, which were 77.8% and 71.2%, respectively (p = 0.41). The survival rate of patients who underwent treat-and-repair was slightly better than that of patients who underwent ES, although the difference was not statistically significant (p = 0.19). Independent mortality risk factors were functional class III-IV at initial presentation (hazard ratio 5.7, 95% CI 1.2–26.6; p = 0.02) and oxygen saturation < 94% at the most recent visit (hazard ratio 9.4, 95% CI 2.1–42.9; p = 0.004).Trial registration: TCTR20200420004.

High neutrophil-to-lymphocyte ratio as a cost-effective marker of acute kidney injury and in-hospital mortality after cardiac surgery: a case-control study

Background Inflammation is one of the important pathophysiological characteristics of acute kidney injury (AKI) after cardiac surgery. The aim was to explore the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR), a simple and cost-effective maker of inflammatory response, and AKI after cardiac surgery. Furthermore, whether the NLR affected in-hospital mortality was also investigated. Methods The electronic medical records of patients from January 1, 2006 to December 31, 2018 undergoing cardiac surgery were utilized. The interest outcome was AKI, defined as the criteria of Kidney Disease Improving Global Outcomes (KDIGO), and other outcomes were severe AKI (KDIGO stage ≥2) and in-hospital mortality. Logistic regression was utilized to assess the association of preoperative NLR with outcomes while adjust for potential confounders. Results Totally, 23,638 patients were included. The incidence of AKI was 27.6%. The NLR was significantly greater in patients with AKI compared to those without. As the nonlinear relationship between NLR and AKI indicated by restricted cubic spline, NLR was analyzed as a categorical variable with the cutoff value of five. Multivariate analysis demonstrated that NLR > 5 was significantly associated with an increased risk of AKI, with an odds ratio of 5.046 (95% confidence interval, 4.589 to 5.548), when compared to patients with NLR ≤ 5. Furthermore, high NLR was also an independent risk factor for severe AKI and in-hospital mortality. Conclusions A higher preoperative NLR was increased the risk of AKI, severe AKI, and in-hospital mortality after cardiac surgery, which may be helpful for stratifying patients to develop individualized treatment.

Epidemiology and Risk Factors for Mortality in Clostridial Bacteremia in Japan: A Retrospective Multicenter Observational Study.

Clostridium species are ubiquitous in nature and commonly cause infections, including bacteremia. C. perfringens is often the causative species, while the epidemiology of other clostridial species remains unclear. This study aimed to examine the epidemiology and risk factors for mortality among patients with clostridial bacteremia in Japan. This multicenter, retrospective cohort study analyzed patients with Clostridium spp. in blood cultures from four tertiary hospitals in Japan. Data on demographics, underlying conditions, clinical and laboratory values, and in-hospital mortality were included. Multivariate logistic regression analysis identified independent risk factors for in-hospital mortality. Of 349 patients with Clostridium spp. in blood cultures, 278 (79.7%) had clinically significant clostridial bacteremia: C. perfringens was the most common species (52.9%), followed by C. ramosum (9.7%) and C. clostridioforme (4.3%). The median patient age was 77 years, and 61.9% were male. The in-hospital mortality rate was 25.9%, with 34.7% of deaths occurring within 3 days of the date of the positive blood culture. Independent risk factors for mortality were hepato-pancreato-biliary malignancy, chronic heart failure, acute renal failure, Pitt bacteremia score, and pneumonia. Mortality from clostridial bacteremia is high, particularly among patients with pneumonia, comorbidities, or severe acute conditions. To improve mortality, early-stage treatment strategies are needed.

Development and Validation of a New Model Including Inflammation Indexes for the Long-Term Prognosis of Hepatitis B-Related Acute-On-Chronic Liver Failure.

Acute-on-chronic liver failure (ACLF) is a severe condition characterized by a systemic inflammatory response and associated with high mortality. Currently, there is no reliable prediction model for long-term prognosis in ACLF. This study aimed to develop and validate a prognostic model incorporating inflammation indexes to predict the long-term outcome of patients with hepatitis B virus-related ACLF (HBV-ACLF). A retrospective analysis of clinical data from HBV-ACLF patients (n = 986) treated at the Third Affiliated Hospital of Sun Yat-sen University between January 2014 and December 2018 was conducted. Patients were randomly divided into training (n = 690) and validation (n = 296) cohorts. The Least Absolute Shrinkage and Selection Operator (LASSO) and Cox regression analyses were used to identify independent risk factors for long-term mortality. The following variables were identified as independent predictors of long-term mortality: age, cirrhosis, hepatic encephalopathy, total bilirubin (TBIL), international normalized ratio (INR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-platelet ratio (NPR). A novel nomogram was established by assigning weights to each variable. The C-index of the nomogram was 0.777 (95% confidence interval [CI]: 0.752-0.802). In the training set, the area under the curve (AUC) for predicting mortality at 1, 3, and 12 months was 0.841 (95% CI: 0.807-0.875), 0.827 (95% CI: 0.796-0.859), and 0.829 (95% CI: 0.798-0.859), respectively. The nomogram demonstrated superior predictive performance for 12-month survival compared to the model for end-stage liver disease (MELD) score (0.767, 95% CI: 0.730-0.804, p < 0.001) and the clinical overt sepsis in acute liver failure clinical practice Guidelines-ACLF II score (0.807, 95% CI: 0.774-0.840, p = 0.028). Finally, calibration curves and decision curve analysis (DCA) confirmed the clinical utility of the nomogram. The novel inflammation-based scoring system, incorporating MLR and NPR, effectively predicts long-term mortality in HBV-ACLF patients.

The Impact of Platelet Transfusion on Prognosis in Adult Burn Patients with Thrombocytopenia: A Propensity Score Matching Analysis

Background and ObjectivesThrombocytopenia is common among burn patients. Platelet transfusion is frequently administered to increase platelet counts. However, it is not clear whether platelets affect the outcome after transfusion among adult burn patients with thrombocytopenia or not. Our aim is to explore whether platelet transfusion affects the prognosis of adult burn patients with thrombocytopenia. Materials and MethodsWe undertook a retrospective analysis of 368 adult burn victims with thrombocytopenia from the Department of Burn at the First Affiliated Hospital of Nanchang University, China, from January 2014 to July 2021. Propensity score matching (PSM) was utilized to reduce the selection bias and confounding factors. After PSM, both platelet transfusion group and no platelet transfusion group had 46 patients. Our primary outcome was 30-day all-cause mortality. ResultsLogistic multivariate regression analysis showed that third-degree burn area [β=-0.040, odds ratio (OR) =1.052, 95% confidence interval (CI) =1.015-1.091] and platelet transfusion (OR =2.227, 95% CI =0.473-10.483) were independent risk factors (P<0.05). KaplanMeier risk curve analysis showed that the 30-day mortality of patients in the platelet transfusion group and no platelet transfusion group were 47.8% and 19.6%, respectively (P<0.05) ConclusionPlatelet transfusion was an independent risk factor for 30-day mortality in adult burn patients with thrombocytopenia.

Risk Factors of Mortality and Clinical Characteristics in Descending Necrotizing Mediastinitis: A Retrospective Evaluation of 181 Patients.

Objectives: Descending necrotizing mediastinitis (DNM) is a serious infection with a high-mortality rate. However, large-scale studies analyzing the clinical characteristics and risk factors of mortality in DNM are rare. This study aimed to clarify the risk factors and some clinical characteristics of mortality of DNM in our hospital. Methods: We retrospectively analyzed the data, including clinical characteristics and mortality, of 181 patients diagnosed with DNM between 2008 and 2022 to clarify the mortality-related risk factors. Results: A total of 181 patients were evaluated, and the mortality rate was 21.55% (39/181 patients). Endo classification type IIB; advanced age; higher white blood cell count, neutrophil percentage, C-reactive protein (CRP) level on admission; and the incidence of septic shock, sepsis, hypoalbuminemia, and electrolyte disorders were significantly related to mortality. Logistic analysis showed that age (≥55 years old), Endo classification type IIB on computed tomography (CT), septic shock, and high CRP level on admission were independent risk factors of mortality. Conclusion: Old age and high CRP levels on admission increase the risk of mortality in DNM patients. Further, Endo classification type IIB on CT and septic shock were associated with poor prognosis.

Stenotrophomonas maltophilia bacteremia in adult patients with hematological diseases: clinical characteristics and risk factors for 28-day mortality.

Patients with hematological diseases are at high risk for Stenotrophomonas maltophilia (SM) bacteremia. This study retrospectively analyzed the clinical characteristics and risk factors for 28-day mortality among 140 adult hematological patients diagnosed with SM bacteremia from January 2012 to July 2023. he overall 28-day mortality was 31.43% (44/140), with a median age of 44 years. The median hospital stay before SM bacteremia onset was 25 days, and 69.29% of patients had unresolved neutropenia. All patients had received broad-spectrum antibiotics in the past month, and 69.29% developed breakthrough bacteremia during carbapenem therapy. Independent risk factors for mortality included a Sequential Organ Failure Assessment (SOFA) score ≥5, tigecycline exposure, age ≥60, and pulmonary infection. Patients with ≥2 risk factors were stratified into the high-risk group, with a significantly higher 28-day mortality compared with the low-risk group (56.52% vs 7.04%, P < 0.001). Treatment with trimethoprim-sulfamethoxazole (TMP/SMX) (P = 0.008) or TMP/SMX combined with cefoperazone/sulbactam (CSL) (P = 0.005) was associated with survival benefits among high-risk patients. Overall, SM bacteremia usually occurs in hematological patients with prolonged hospitalization, unresolved neutropenia, and extensive use of broad-spectrum antibiotics, especially carbapenems. Patients with high SOFA scores, advanced age, pulmonary infection, or recent tigecycline exposure are at higher risk of mortality. The preferred treatment is TMP/SMX rather than fluoroquinolones, with combination therapy of TMP/SMX and CSL considered a feasible treatment option.IMPORTANCEThis study, representing the largest cohort of adult hematological patients with SM bacteremia to date, strengthens the validity of existing findings and provides new insights into its clinical management. We identify risk factors for 28-day mortality, revealing that patients with two or more risk factors experience particularly high mortality rates. This highlights the importance of early identification and targeted management of high-risk individuals. Our findings also demonstrate that TMP/SMX is superior to fluoroquinolones and suggest that combining TMP/SMX with CSL may offer additional survival benefits.

All-cause and cardiovascular mortality in dual sensory impairment patients: A meta-analysis of cohort studies.

This meta-analysis is to determine the risk of all-cause mortality and cardiovascular mortality of dual sensory impairment (DSI). Relevant cohort studies were searched in Medline with PubMed, Cochrane Library, and EMBASE databases. The quality of the included studies was assessed based on the Newcastle-Ottawa Quality Assessment Scale (NOS). STATA software (USA) was used to conduct statistical analyses. To determine the source of heterogeneity, subgroup and sensitivity analyses were carried out. Funnel plots and the Egger's test were used for detecting publication bias. This meta-analysis incorporated 12 cohort studies (1992-2024), containing 310 211 patients. Pooled analysis showed that DSI patients had a higher risk of all-cause mortality (hazard ratio (HR) = 1.442; 95% confidence interval (CI) = 1.303-1.596, I2 = 49.5%, P < 0.001), and cardiovascular mortality (HR = 1.832; 95% CI = 1.343-2.500, I2 = 0%, P < 0.001). Subgroup analyses on sex and territory type revealed that DSI were all associated with an increased risk of all-cause mortality. This study shows that DSI is linked to higher risks of all-cause and cardiovascular mortality, suggesting that DSI should be regarded as an independent mortality risk factor. Physicians treating individuals with DSI should assess its impact on life expectancy. The protocol was previously registered on the International Prospective Register of Systematic Reviews (PROSPERO) platform (CRD42024527256).

Phase angle as a predictor of mortality in elderly patients with multimorbidity: a matched case-control study.

We aimed to investigate the value of phase angle (PhA) as a prognostic marker for mortality in elderly patients with multimorbidity using a matched case-control study. This study was conducted with patients 70 years of age or older with multimorbidity at Beijing Geriatric Hospital. The body composition parameters including PhA were determined using bioelectrical impedance analysis. Common hematological indices were determined using blood tests. The outcome was mortality 1 year after admission. A multivariate logistic regression analysis was employed to identify independent risk factors for death. A receiver-operating characteristic (ROC) curve analysis was used to evaluate the performance of risk factors in predicting death. A total of 30 deceased patients were included in the death group. The living patients were matched 1:1 with the deceased patients in age, gender, and Cumulative Illness Rating Scale-Geriatric score to generate a survival group of 30. The death group exhibited higher levels of blood urea nitrogen and extracellular water to total body water ratio and lower levels of PhA and prealbumin than the survival group. The multivariate logistic regression analysis identified PhA as the only independent risk factor for mortality (OR = 3.296, 95% CI [1.201-9.044], P < 0.05). For the ROC curve analysis, PhA had an area of 0.854 (95% CI [0.755-0.955], P = 000). The Youden index was 0.700, and the optimal cutoff value associated with the Youden index was 2.45°. PhA serves as a good prognostic marker for mortality in elderly patients with multimorbidity.

Aortic valve sclerosis is not a benign finding but progressive disease associated with poor cardiovascular outcomes

BackgroundAortic valve sclerosis (AVS) shares risk factors with atherosclerosis. However, the relationship between AVS progression with cardiovascular (CV) risk has not been researched. This study investigates CV outcomes according to progression of AVS.MethodsThis study included 2,901 patients with AVS (irregular leaflet thickening and peak aortic jet velocity < 2 m/sec) who underwent serial echocardiograms at least 1 year apart during 2011–2020. The primary outcome was defined as CV death, myocardial infarction, stroke, or revascularization.ResultsDuring a median follow-up period of 3.9 years, 439 of 2,901 AVS patients (15.1%) progressed to mild or greater aortic stenosis. Patients with progression were older and more likely to have atrial fibrillation than those without. In a stepwise regression, age (odds ratio [OR] per 1-year increase, 1.04; 95% confidence interval [CI], 1.01–1.07), peripheral artery disease (OR, 9.07; 95% CI, 3.12–26.4), and left ventricular mass index (OR per 1-g/m2 increase, 1.01; 95% CI, 1.00–1.02) were associated with AVS progression. Over a median of 6.3 years, the primary outcome occurred in 858 of 2,901 patients (29.6%). Patients with progression had higher frequency of CV death, myocardial infarction, stroke, or revascularization than those without progression (P < 0.0001). In Cox proportional hazards regression, AVS progression (hazard ratio, 1.33; 95% CI, 1.10–1.61) was a significant determinant of CV mortality.ConclusionsThe progression to aortic stenosis in AVS patients is an independent risk factor for CV mortality. These findings suggest that patients with AVS progression may benefit from stricter CV risk monitoring.

Prognostic effects of glycaemic variability on diastolic heart failure and type 2 diabetes mellitus: insights and 1-year mortality machine learning prediction model

BackgroundDiastolic heart failure (DHF) and type 2 diabetes mellitus (T2DM) often coexist, causing increased mortality rates. Glycaemic variability (GV) exacerbates cardiovascular complications, but its impact on outcomes in patients with DHF and T2DM remains unclear. This study examined the relationships between GV with mortality outcomes, and developed a machine learning (ML) model for long-term mortality in these patients.MethodsPatients with DHF and T2DM were included from the Medical Information Mart for Intensive Care IV, with admissions (2008–2019) as primary analysis cohort and admissions (2020–2022) as external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the associations of GV with 90-day, 1-year, and 3-year all-cause mortality. The primary analysis cohort was split into training and internal validation cohorts, then developing ML models for predicting 1-year all-cause mortality in training cohort, which were validated using the internal and external validation cohorts.Results2,128 patients with DHF and T2DM were included in primary analysis cohort (meidian age 71.0years [IQR: 62.0–79.0]; 46.9% male), 498 patients with DHF and T2DM were included in the external validation cohort (meidian age 75.0years [IQR: 67.0–81.0]; 54.0% male). Multivariate Cox proportional hazards models showed that high GV tertiles were associated with higher risk of 90-day (T2: HR 1.45, 95%CI 1.09–1.93; T3: HR 1.96, 95%CI 1.48–2.60), 1-year (T2: HR 1.25, 95%CI 1.02–1.53; T3: HR 1.54, 95%CI 1.26–1.89), and 3-year (T2: HR 1.31, 95%CI: 1.10–1.56; T3: HR 1.48, 95%CI 1.23–1.77) all-cause mortality, compared with lowest GV tertile. Chronic kidney disease, creatinine, potassium, haemoglobin, and white blood cell were identified as mediators of GV and 1-year all-cause mortality. Additionally, GV and other clinical features were pre-selected to construct ML models. The random forest model performed best, with AUC (0.770) and G-mean (0.591) in internal validation, with AUC (0.753) and G-mean (0.599) in external validation.ConclusionGV was determined as an independent risk factor for short-term and long-term all-cause mortality in patients with DHF and T2DM, with a potential intervention threshold around 25.0%. The ML model incorporating GV demonstrated strong predictive performance for 1-year all-cause mortality, highlighting its importance in early risk stratification management of these patients.