Independent Risk Factor For Mortality Research Articles

Metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes: risk of heart failure

Background and aimsThe association between metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) is unclear. This study aimed to investigate the impact of spectrum of SLD on the risk of heart failure and cardiovascular (CV) mortality in patients with T2DM.MethodsIn a nationwide cohort study, 2,745,689 adults with T2DM were followed from 2009 to 2012 until 2018. Participants were categorized into no steatotic liver disease (no SLD) and SLD groups. The SLD group was stratified based on metabolic risk factors, alcohol consumption and viral hepatitis. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for heart failure (HF) and CV mortality risk.ResultsThe prevalence of MASLD, metabolic alcohol-associated liver disease (MetALD), alcohol-associated liver disease with metabolic dysfunction (ALD with MD) and MASLD with viral hepatitis (VH) was 49.6%, 7.2%, 2.3%, and 2.0%. Individuals with MASLD (adjusted HR [aHR], 1.11), MetALD (aHR, 1.14), ALD with MD (aHR, 1.32) and MASLD with VH (aHR, 1.12) had a higher risk of developing HF compared with the no SLD group. The risk of CV mortality was also increased in those with SLD groups compared to those with no SLD. The risk of new-onset HF and CV mortality showed a J-shaped association with alcohol consumption regardless of SLD status.ConclusionSLD is independent risk factor of new-onset HF and CV mortality in persons with T2DM, and alcohol consumption has a J-shaped association with risk of HF and CV mortality, regardless of SLD status.

Preoperative nutritional scores to predict mortality after liver transplantation: a retrospective cohort study.

Malnutrition is a well-known risk factor for mortality and morbidity. We investigated whether preoperative malnutrition, diagnosed using an objective nutritional index, was associated with postoperative mortality in patients undergoing liver transplantation (LT). This retrospective cohort observational study assessed the preoperative nutritional status of 440 patients who underwent LT, using the Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) score. We evaluated the association between preoperative malnutrition and 3-year postoperative mortality using the Kaplan-Meier curve and log-rank test. In addition, we identified prognostic factors for mortality using Cox proportional hazard analysis. Malnutrition was identified in 72.7% (n = 320), 66.1% (n = 291), and 97.3% (n = 428) of patients as assessed by the NRI, PNI, and CONUT score, respectively. The Kaplan- Meier survival curve demonstrated that mortality increased with the presence and severity of malnutrition risk, as assessed by the NRI and PNI, respectively; however, NRI was the only index identified as an independent risk factor for mortality, along with preoperative renal replacement therapy, platelet count, and C-reactive protein. After adjustment, lower NRI was associated with a higher risk of mortality (hazard ratio 0.97, 95% confidence interval 0.95- 0.99, P = 0.009). The malnutrition group (NRI ≤ 100) had a significantly greater incidence of postoperative acute kidney injury than that of the normal group. Preoperative NRI is an independent risk factor for mortality after LT, and therefore it would be a helpful tool for mortality risk stratification in patients undergoing LT.

Impact of renal-adjusted ceftazidime/avibactam in patients with KPC-producing Klebsiella pneumoniae bloodstream infection: a retrospective cohort study.

Bloodstream infections (BSIs) caused by KPC-producing Klebsiella pneumoniae (KPC-Kp) are still associated with high mortality, and the game-changing drug ceftazidime/avibactam has shown suboptimal pharmacokinetics in some clinical settings. Ceftazidime/avibactam renal dose adjustment has recently been identified as an independent risk factor for mortality. To investigate the effect of ceftazidime/avibactam renal dose adjustment on mortality. Patients with KPC-Kp BSI treated with a ceftazidime/avibactam-based regimen were retrospectively collected and analysed. The primary outcome was mortality at 7, 14 and 30 days after the start of definitive ceftazidime/avibactam antibiotic therapy. Renal function was estimated using the CKD-EPI equation. One hundred and ten patients with KPC-Kp BSI treated with a ceftazidime/avibactam-based regimen were included. Full-dose ceftazidime/avibactam (7.5 g daily) was prescribed to 82 patients (74.5%), while 28 patients (25.5%) received a renal-adjusted dose (17 patients due to chronic renal disease or haemodialysis, 11 patients due to infection-related acute kidney injury), with a median of 1.9 g daily. At multivariable analysis, receiving a reduced dose of ceftazidime/avibactam was independently associated with mortality (HR 4.47, 95% CI 1.09-18.03, P = 0.037), along with intra-abdominal or lower respiratory tract infections as source of BSI (HR 5.42, 95% CI 1.77-16.55, P = 0.003), septic shock (HR 6.99, 95% CI 1.36-35.87, P = 0.020) and SARS-CoV-2 coinfection (HR 10.23, 95% CI 2.69-38.85, P = 0.001). Dose reduction of ceftazidime/avibactam according to renal function in patients with KPC-Kp BSI seems to be independently associated with higher mortality. This may be possibly due to inadequate exposure provided by the recommended doses for renal impairment.

Exploring the impact of polychlorinated biphenyls on comorbidity and potential mitigation strategies.

Polychlorinated Biphenyls (PCBs) persist in the environment and accumulate in humans. Currently, there is a lack of understanding about the overall impact of PCBs on human health, and effective interventions for exposed populations are insufficient. Our study aimed to assess the impact of PCBs on various diseases and mortality risks using data from the National Health and Nutrition Examination Survey, while proposing lifestyle adjustments, particularly dietary modifications, to mitigate mortality risk. Statistical analyses employed principal component analysis, multifactorial logistic regression, multifactorial Cox regression, comorbidity network analysis, and machine learning prediction models. Results indicated significant associations between 7 types of PCBs and 12 diseases (p < 0.05), with 6 diseases showing significant positive correlations (OR > 1, p < 0.05), along with listing the 25 most relevant diseases, such as asthma and chronic bronchitis (OR [95% CI] = 5.85 [4.37, 7.83], p < 0.0001), arthritis and osteoporosis (OR [95% CI] = 6.27 [5.23, 7.55], p < 0.0001). This suggested that PCBs may be intimately involved in the development and progression of multiple diseases. By constructing multidimensional machine learning models and conducting multiple iterations for precision and error measurement, PCBs may have the potential to become specific biomarkers for certain diseases in the future. Building upon this, we further suggested that controlling dietary intake to reduce dietary inflammatory index (DII) could lower mortality and disease risks. While PCBs were independent risk factors for mortality, substantial evidence suggested that adjusting DII might mitigate the adverse effects of PCBs to some extent. Further physiological mechanisms require deeper exploration through additional research.

Predictors for 1-year mortality in geriatric patients following fragile intertrochanteric fracture surgery

ObjectiveTo investigate the risk factors influencing 1-year mortality after intramedullary nail fixation for fragile intertrochanteric fracture in elderly individuals.MethodsThe medical records of 622 consecutive elderly patients (aged ≥ 65 years) with fragile intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA) and followed-up were retrospectively analyzed. The patients were divided into death and survival groups according to their survival status within 1 year after surgery, and the differences in age, sex, region of residence, tobacco use, alcohol use, body mass index (BMI), comorbidities (hypertension, diabetes mellitus, coronary heart disease, stroke, dementia, chronic obstructive pulmonary disease, pneumonia), preoperative hemoglobin, preoperative albumin, deep vein thrombosis, fracture type (AO classification), injury-to-surgery time, American Society of Anesthesiologists (ASA) score, anesthesia modality, duration of surgery, intraoperative blood loss, and blood transfusion were compared. The Kaplan–Meier method was used for univariate analysis to screen for statistically significant differences between the two groups, and the data were entered into the Cox proportional hazards model for multivariate analysis to determine independent risk factors affecting 1-year postoperative mortality. For subgroup analysis, we explored the varying effects of hypoproteinemia and being underweight in patients of different genders, as well as the effects of different age ranges, different injury-to-surgery times, and different blood transfusion volumes on 1-year postoperative mortality.ResultsThe mortality rates at 1, 3, and 6 months, and 1 year after surgery were 3.9%, 7.2%, 10.1%, and 15.3%, respectively. Univariate analysis showed that advanced age, male sex, tobacco use, underweight (BMI < 18.5), coronary heart disease, stroke, dementia, pneumonia, number of comorbidities ≥ 3, hypoproteinemia and injury-to-surgery time ≤ 2 days were associated with the 1-year postoperative survival status (P < 0.1). Multivariate analysis revealed that advanced age, male sex, dementia, number of comorbidities ≥ 3, hypoalbuminemia, and being underweight were independent risk factors for 1-year postoperative mortality. Subgroup analysis showed that being underweight was associated with 1-year postoperative mortality only in male patients but not in female patients, whereas hypoproteinemia was associated with 1-year postoperative mortality in both male and female patients. Furthermore, an injury-to-surgery time of less than 2 days improved patient survival, and patients more than 80 years old showed an elevated risk of postoperative mortality.ConclusionsPreoperative health status is a critical predictor of postoperative outcomes in elderly patients with fragile intertrochanteric fractures. Priority care should be given to the patients who are elderly, male, have dementia, have comorbidities, or are malnourished. Prompt nutritional reinforcement should be provided to patients with intertrochanteric fractures with comorbid hypoproteinemia and underweight. Furthermore, surgery should be performed as early as possible in patients with fewer comorbidities.

Outcomes of infective endocarditis in patients with end-stage renal disease and dialysis in Spain: a population-based study

Abstract Background Patients with end-stage renal disease (ESRD), particularly those undergoing dialysis, have a significantly higher risk of developing infective endocarditis (IE) compared to the general population. ESRD is not only related to a higher risk of infection, but also to a worse prognosis in IE. However, most data regarding the epidemiology and outcomes of patients with ESRD and IE is derived from noncontemporary population-based studies with limited clinical variables and lack of complete microbiological information, or from retrospective single-center cohorts. Purpose The aim is to describe the clinical characteristics and outcome of patients with IE and ESRD in Spain, compared to patients without ESRD, and to investigate potential differences between patients undergoing dialysis and the rest of patients with ESRD. Methods Retrospective observational population-based study. A total of 9,008 episodes of IE between 2016 and 2019 were analysed using information from the Spanish Minimum Basic DataSet. 428 patients had ESRD, of whom 332 were undergoing dialysis. A multivariable and multilevel logistic model was developed to evaluate the association of different variables with in-hospital mortality in ESRD patients. Results Compared to patients without ESRD, those with ESRD were younger, had more comorbidities, and had a higher incidence of Staphylococcus aureus (31.8% vs. 18.4%; p &amp;lt;0.001) and coagulase-negative staphylococci infections (19.2% vs. 14%; p =0.006). In terms of in-hospital complications, septic shock was more frequent in patients with ESRD (12.1% vs. 8.9%; p=0.007). Furthermore, ESRD patients underwent cardiac surgery less frequently than patients without ESRD (12.6% vs. 19.6%; p &amp;lt;0.001) and had significantly higher in-hospital mortality (33.4% vs. 26.9%; p =0.003). When comparing patients undergoing dialysis with the rest of ESRD patients, it was observed that those on dialysis had more comorbidities and a higher proportion of Staphylococcus aureus infections (36.1% vs. 16.7%; p &amp;lt;0.001). No differences were found in observed in-hospital mortality between patients on dialysis and the rest of ESRD patients. The multilevel analysis revealed that dialysis was not an independent risk factor for in-hospital mortality in patients with ESRD. Cardiac surgery was also not independently associated with higher in-mortality in ESRD patients. Conclusions Patients with ESRD and IE have a different clinical and microbiological profile than other patients with IE. Moreover, they undergo cardiac surgery less frequently and have significantly higher in-hospital mortality. Dialysis treatment and cardiac surgery were not independent risk factors for mortality in ESRD patients with IE.

Risk factors of all-cause mortality in heart failure with mildly reduced ejection fraction patients with different post-discharge left ventricular ejection fraction variation patterns

Abstract Background The identification of risk factors for all-cause mortality in patients diagnosed with heart failure with mildly reduced ejection fraction (HFmrEF) and exhibiting varying post-discharge left ventricular ejection fraction (LVEF) patterns remains incomplete. This study aimed to determine the independent risk factors of all-cause mortality among HFmrEF patients with different LVEF variation patterns post-discharge. Methods This retrospective study analyzed data from 807 HFmrEF patients admitted to our hospital between January 2015 and August 2020. Patients were categorized into three groups based on LVEF variation patterns within 6 months to one year post-discharge: Group A (transitioning to heart failure with reduced ejection fraction [HFrEF], n=225), Group B (remaining as HFmrEF, n=335), and Group C (reverting to heart failure with preserved ejection fraction [HFpEF], n=227). Patients were followed up for a mean of 33 months, with all-cause mortality as the primary endpoint. Multivariate Cox regression analysis was conducted to identify independent risk factors for all-cause mortality in each group. Results The mortality rates for Groups A, B, and C were 43.11%, 23.94%, and 24.67%, respectively (P&amp;lt;0.001). Independent risk factors for all-cause mortality in Group A included age (HR=1.04, P=0.007), obesity (HR=1.76, P=0.040), higher creatinine (&amp;gt;100 µmol/L, HR=1.83, P=0.029), higher E/e’ (HR=1.06, P=0.001), absence of PCI (HR=0.51, P=0.019), and non-use of ACEI/ARB (HR=0.039, P=0.006). In Group B, independent risk factors for all-cause mortality were age (HR=1.06, P&amp;lt;0.001), higher NT-proBNP (&amp;gt;2505 pg/ml, HR=2.50, P=0.002), and absence of PCI (HR=0.040, P=0.005). Group C exhibited age (HR=1.04, P=0.002), pleural effusion (HR=2.38, P=0.007), higher creatinine (&amp;gt;100 µmol/L, HR=2.84, P&amp;lt;0.001), and non-use of ACEI/ARB (HR=0.42, P=0.021) as significant independent risk factors associated with increased all-cause mortality risk. Conclusion This study highlights distinct risk factors associated with all-cause mortality in HFmrEF patients exhibiting different post-discharge LVEF variation patterns. Age emerged as a consistent risk factor across all groups, underscoring the importance of age-related considerations in managing HFmrEF patients. Additionally, factors such as obesity, renal function, echocardiographic parameters, and medication adherence played varying roles in influencing mortality risk depending on the evolution of LVEF following discharge. These findings emphasize the need for personalized risk stratification and tailored management strategies for HFmrEF patients to improve outcomes and reduce mortality rates.

Sex differences at different ages in 30-day survival of COVID-19 hospitalized patients in Israel

Abstract Background Sex differences in mortality from COVID-19 have been described. It is not clear to what extent sex is an independent risk factor for mortality or is confounded by co-morbidities and whether it varies by age. It is also not clear whether it is constant over time since diagnosis. We studied sex differences in 30-day mortality rates in patients hospitalized with COVID-19, after controlling for co-morbidities. Methods Data on patients hospitalized with COVID-19 were extracted from the majority of general hospitals in Israel during 2020 to 2022. The outcome variables were death during 30 days from onset of hospitalization. Sex differences in survival rates were assessed using Cox proportional hazards models controlling for age, heart disease, cancer, respiratory disease, diabetes and hypertension. Results Mortality rates in women were significantly lower than in men in all age groups. There was an approximate 5-6 year lag in the mortality rates between men and women. Conclusions Sex was an independent predictor of 30 day mortality from COVID-19 with women experiencing better survival. This advantage was not explained by differences in co-morbidities or the magnitude of the differences in survival by age. The sex differences in the 30-day mortality of hospitalized patients are compatible with the male dominance in the incidence rates of many infectious diseases. Poorer survival of men hospitalized for COVID-19 is likely to be part of the disease mechanism and should be explored further. Key messages • Poorer survival of male COVID-19 patients seems to be part of the disease mechanism and should be explored further. • Sex differences in disease should be included in personalized management of disease.

Permanent and persistent atrial fibrillation are independent risk factors of mortality after severe COVID-19

Abstract Background New coronavirus disease (COVID-19), pandemic infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), had a deep global influence on morbidity and mortality profile. Comorbidities, especially cardiovascular diseases were identified to strongly modify the clinical course of COVID-19. However, the prognostic role of incident or prevalent atrial fibrillation has not been fully explained. Purpose The aim of this study was to evaluate the association between atrial fibrillation and outcomes following hospitalization in patients with severe COVID-19. Methods We analyzed 199 patients (72 female, median age 70 years) with severe COVID-19 hospitalized between November 2020 and February 2021, due to SARS-CoV-2 infection. Study cohort included 68 patients with a history of AF (34 patients with paroxysmal AF, 19 with permanent AF, 15 patients with persistent AF) and 51 patients presented with AF during hospitalization. Results Overall mortality during 90 days from the admission to hospital was 41% (n=82). Non-survivors were older, had significantly elevated inflammation markers (CRP, WBC, procalcitonin, IL-6), NT-proBNP and D-dimer on the first day of hospitalization, lower left ventricular ejection fraction and worse kidney function as compared to those who stayed alive during the follow-up. Among the hospitalized patients with COVID-19, a history of AF and the presence of AF during hospitalization contributed to higher mortality, p=0.001. The patients with permanent and persistent AF were at the greatest risk of death, p&amp;lt;0.001. In multivariate analysis, taking into account whether the patients had a history of AF, the subtypes of AF (paroxysmal, permanent, persistent) and whether the AF was present during hospitalization to identify the independent risk factors of death in the study period, we found that AF was related to worse prognosis and persistent or permanent form represented an independent predictor of mortality, p=0.035. Conclusions Different clinical presentations of AF have varying impact on survival in severe COVID-19. Mortality in hospitalized patients with severe COVID-19 was higher among patients with history of AF, especially with persistent and permanent type of AF, and with AF present during hospitalization.Figure.Survival depending on the type o.

The visceral adiposity index predicts cardiovascular events both in coronary artery disease patients with and in those without diabetes

Abstract The Visceral Adiposity Index (VAI) is calculated based on waist circumference, BMI, triglyceride and HDL-cholesterol levels and is a validated measure of visceral adiposity. In the general population, the VAI has been shown to be an independent risk factor for premature mortality. Its power to predict cardiovascular events in patients with coronary artery disease (CAD) with or without type 2 diabetes mellitus (T2DM) is not known and is addressed in the present study. We prospectively investigated 927 patients with angiographically diagnosed CAD over a mean follow-up time of 8.2±4.3 years. At baseline, the VAI was significantly higher in patients with T2DM (n=303) than in those who did not have diabetes (6.5±5.2 vs. 4.8±4.9; p&amp;lt;0.001). During follow-up, we recorded 385 cardiovascular events. The VAI significantly predicted the incidence of cardiovascular events both univariately (standardized HR 1.09 [1.02-1.16]; p=0.011) and after adjustment for age, gender, smoking, LDL cholesterol, hypertension and T2DM (standardized adjusted HR 1.11 [1.04- 1.18]; p=0.002); T2DM also significantly predicted cardiovascular events in this fully adjusted model (adjusted HR 1.26 [1.04-1.52]; p=0.018) independently from the VAI. We conclude that the VAI and T2DM are mutually independent predictors of cardiovascular events in patients with CAD.

Relationship between changes in renal function after acute phase of tafamidis administration and left ventricular diastolic function at mid-term follow-up in transthyretin cardiac amyloidosis

Abstract Background A large number of heart failure (HF) patients present with various degrees of renal dysfunction, known as cardio-renal syndrome. Renal impairment in HF patients is also associated with an independent risk factor for morbidity and mortality. Transthyretin (TTR) amyloidosis (ATTR) is characterized by disintegrated liver-derived TTR that accumulates as amyloid fibrils in the myocardium, leading to initially presenting as left ventricular (LV) hypertrophy and LV diastolic dysfunction. Although there is no proven therapy for patients with ATTR cardiomyopathy (ATTR-CM), tafamidis meglumine, a TTR stabilizer, has been associated with favorable outcomes. Although the kidneys are also an important organ where amyloid deposition occurs, the effect of tafamidis on renal function and its relationship to LV diastolic function is unclear. Purpose The purpose of this study was to investigate the relationship between changes in renal function after the acute phase of tafamidis administration and LV diastolic function at mid-term follow-up in patients with ATTR-CM. Methods We studied 56 patients with biopsy-proven ATTR-CM who were treated with tafamidis. All patients underwent blood examinations before and 45.6 ± 23.0 days after the acute phase of tafamidis administration. Echocardiography was performed before and 15.6 ± 9.8 months after the mid-term of tafamidis administration. The primary endpoint was defined as a composite of cardiovascular death or HF hospitalization for 5.0 years. Results Twelve patients had improved renal function as assessed by estimated glomerular filtration rate in the acute phase after tafamidis administration, while 44 patients deteriorated. In the group with improved renal function in the acute phase after tafamidis administration, pulsed-wave Doppler-derived early diastolic velocity from the septal mitral annulus (E’) and left atrial volume index (LAVI) tended to improve at mid-term follow-up compared to the non-improved group. (E’: 0.8 ± 1.7 cm/s vs. 0.2 ± 1.1 cm/s, p=0.127, LAVI: -8.7 ± 12.0 mL/m2 vs. 0.2 ± 16.8 mL/m2, p=0.093). Furthermore, Kaplan-Meier curve indicated that the occurrence of cardiovascular events for patients with improved renal function in the acute phase after tafamidis administration tended to be lower than those without (log-rank P=0.137). Conclusions The improvement of renal function in the acute phase after tafamidis administration was associated with the improvement of LV diastolic function at mid-term follow-up, leading to favorable outcome. Our findings may provide new insights for the management of patients with ATTR-CM.

The admission inflammatory biomarkers profile of elderly hip fractures and its association with one-year walking independence and mortality: a prospective study.

Immune response plays an important role in the regulation of elderly hip fracture. This study aims to analyze the relationship between systemic inflammatory markers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) and mortality and walking independence, providing valuable references for the postoperative management of geriatric hip fracture. A retrospective analysis of prospective data on elderly patients who have undergone hip surgery and have been followed for at least one year. The receiver operating characteristic (ROC) curves and the optimum cutoff value were calculated. Univariate analysis and multivariate logistic regression analysis were used to identify the associations between admission four systemic inflammatory markers and one-year mortality and locomotion recovery. During the study period, respiratory disease was the most common cause of death, followed by cardiovascular disease. Multivariate analysis identified NLR (OR, 1.13; 95%CI: 1.09-1.17), SIRI(OR, 1.18; 95%CI: 1.08-1.28) and advanced age (OR, 1.06; 95%CI: 1.01-1.11) as independent risk factors for one-year mortality. In addition, 89 (rate, 31.8%) survivors had poor walking independence within one year. NLR (OR, 1.37; 95%CI: 1.26-1.50), SII(OR, 1.00; 95%CI: 1.001-1.003), SIRI(OR, 1.36; 95%CI: 1.18-1.57) and advanced age (OR, 1.08; 95%CI: 1.02-1.13) were associated with postoperative locomotion recovery. In summary, admission NLR and SIRI are correlated with a high risk of one-year walking independence and mortality, providing a basis for the clinical management of geriatric hip fractures.

Survival in patients with chronic congestive heart failure and correlation of presence of risk factors and all-cause mortality

Abstract Background Right heart function is known to be an independent risk factor for early mortality in patients with acute and chronic heart failure (HF). The prognostic value of cardiopulmonary exercise testing (CPET) is established for risk stratification in patients with Heart Failure. Further, markers of inflammation may predict clinical outcomes. Purpose We performed a single-center retrospective analysis of a large single center cohort and assessed all-cause mortality. A simple score including presence of RVD, systemic inflammation and reduced O2 uptake was applied to all patients and a subgroup survival analysis was performed. Methods A total of 612 patients with HF across the whole spectrum of left ventricular ejection fraction (LVEF) were analyzed. We stratified patients according to RV function, peak relative oxygen consumption in ml/min/kg (VO2max) and CRP levels. Patients were classified as RV Dysfunction when a right ventricular dilation (RVEDD &amp;gt; 40 mm or RVOT &amp;gt; 30 MM) or decreased tricuspid annular systolic excursion (TAPSE &amp;lt; 17 mm) was seen in the echocardiography. All patients were followed up by phone or by hospital records if available. The primary end-point of all-cause mortality was assessed. Results For the primary analysis, 612 patients (mean age 59.8 ± 13.8 years, 71.41% male) were included. According to LVEF 248 (40.5%) patients had preserved LVEF (HFpEF), 82 (13.0%) had mid-range LVEF (HFmrEF) and 282 (46.0%) had reduced LVEF (HFrEF). HF etiology was in 27% ischemic. Mean BNP values were 514.1 ± 827.1 pg/l. Mean VO2max 15,9 ± 5,9 ml/min per kg. Patients were followed up for a median of 4.0 years (IQR: 3.4 - 4.9 years). Over this period, the primary end-point occurred in 17.6% of patients. 135 (22%) of patients had evidence of RV dysfunction, 26% had increased CRP-levels and 256 (41.8%) had a VO2max &amp;lt; 14 ml/min per kg. Patients with elevated CRP, VO2max &amp;lt; 14 ml/min/kg and RV-dysfunction showed worse survival according to the Kaplan-Meier-Estimate with a significant difference (Log Rank: Chi²: 1480, p = 0.013) compared to patients with only RV dysfunction low VO2 max or only increased CRP values. Conclusion A combined evaluation of systemic inflammation, cardiopulmonal exercise testing and right ventricular dysfunction is useful in predicting long-term outcomes of patients with HF. Patients with both risk factors show worse survival than patients with signs of inflammation or RV dysfunction only.Kaplan-Meier-Estimates

Risk factors for in-hospital mortality in older patients with acute respiratory distress syndrome due to COVID-19: a retrospective cohort study

BackgroundAdvancing age is associated with an increase in mortality among patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed to determine risk factors for in-hospital mortality in patients over 60 years old with COVID-19-related ARDS (C-ARDS).MethodsThis was an observational, analytical, retrospective study conducted on a cohort that included all patients aged 60 years or older diagnosed with COVID-ARDSwho were admitted to a high-complexity hospital in Bogotá, Colombia, between March 2020 and July 2021.ResultsA total of 1563 patients were included in the analysis, with a median age of 73 years (interquartile range [IQR]: 67–80) and 811 deaths (51.8%). Independent risk factors for in-hospital mortality were identified as follows: patients aged 71–80 [OR 1.87 (95% CI 1.33–2.64)], age > 80 [OR 8.74 (95% CI 5.34–14.31)], lactate dehydrogenase (LDH) [OR 1.009 (95% CI 1.003–1.0015)], severe C-ARDS [OR 2.16 (95% CI 1.50–3.11)], use of invasive mechanical ventilation (IMV) [OR 12.94 (95% CI 9.52–17.60)], and use of steroids [OR 1.49 (95% CI 1.09–2.03)]. In patients over 80 years of age (n = 388), the primary risk factor associated with in-hospital mortality was the use of IMV (n = 76) [OR 6.26 (95% CI 2.67–14.69)], resulting in an in-hospital mortality rate of 89.4% (n = 68) when this therapy was implemented.ConclusionsThe primary risk factors for in-hospital mortality in patients older than 60 years were age, the use of IMV, the severity of C-ARDS, use of steroids and elevated LDH values. Among patients older than 80 years, the main risk factor for in-hospital mortality was the use of IMV. In cases of C-ARDS in older patients, the decision to initiate IMV should always be individualized; therefore, the use of alternative oxygen delivery systems as the first-line approach can be considered.

Clinical Features and Prognosis of Acute Cholangitis in Octogenarians: A Prospective Comparative Study.

Background: The data on acute cholangitis in the octogenarian population are very limited. This study aimed to examine the clinical characteristics of acute cholangitis and complications related to endoscopic retrograde cholangiopancreatography (ERCP) in octogenarians. Materials and Methods: This study was conducted prospectively between July 2022 and December 2023 and included 250 patients aged 65 years and older. Patients eligible for the study were divided into two groups: those aged ≥80 years (octogenarian) and those aged 65-79 years (non-octogenarian). These two groups were compared in terms of the clinical characteristics of cholangitis and ERCP-related complications. In addition, factors associated with in-hospital mortality were evaluated. Results: Out of 250 patients, 87 (34.8%) were octogenarians and 163 (65.2%) were non-octogenarians. The median age was 76 (69-82) years. Although the octogenarian group had higher rates of severe illness and intensive care unit admissions (p < 0.001 and p = 0.002, respectively), there were no significant differences in in-hospital mortality (p = 0.359) or ERCP-related complications (p = 0.417). Malignant etiology (odds ratio [OR]: 5.68, 95% confidence interval [CI]: 2.11-15.3), hypoalbuminemia (OR 0.18, 95% CI 0.07-0.45), and qSOFA score ≥ 2 (OR: 6.5, 95% CI: 1.7-24.5) were independent risk factors for in-hospital mortality. Conclusions: Being over 80 years old is not an indicator of poor outcomes, and ERCP can be safely performed on these patients. However, elderly patients with hypoalbuminemia, malignant etiology, or a qSOFA score of ≥2 should be closely monitored, regardless of their age.

Clinical characteristics and prognosis of bloodstream infections with carbapenem-resistant Gram-negative organisms in patients with hematological malignancies: A multicenter case-control study in China

To investigate clinical characteristics of hematological malignancy (HM) patients with carbapenem-resistant gram-negative organism (CRO) bloodstream infections (BSI) in China, and to elucidate the prognostic risk factors of CRO BSI. We conducted a multicenter case-control study of 201 HM patients with CRO BSI between 2018-2020. Antimicrobial susceptibility testing and whole genome sequencing were performed for CRO isolates. Independent risk factors for 28-day crude mortality of were analyzed using Cox proportional hazards regression models. The subgroups of major species were also evaluated. The pathogens responsible for CRO BSI in HM patients dominated by ST11 CRKP, ST167 CREC and ST463 CRPA. Most isolates produced carbapenemases with KPC and NDM being the main. CRO isolates had resistance rates to conventional antimicrobials ranging from 55%-100% and poor susceptibility to novel antimicrobials related to carbapenemases and species. The 28-day crude mortality was 24.2%. Non-Hodgkin lymphoma, heart disease, blaKPC-2 positive, empirical antibiotic therapy with linezolid, Pitt bacteremia score >3.5 were risk factors for 28-day mortality and appropriate definitive antibiotic therapy, tigecycline-containing therapy and aminoglycoside-containing therapy were protective factors. blaKPC-2 positive in CRKP and ST463 in CRPA were associated with Pitt bacteremia score > 3.5. Solid tumor and other site infections before BSI were risk factors for ST463 CRPA BSI and Pulmonary infection before BSI was risk factor for KPC-KP BSI. The antimicrobial resistance of CRO isolates for BSI in HM patients is critical. HM patients with CRO BSI should be treated with appropriate definitive antibiotic therapy based on early clarification of pathology and their antimicrobial susceptibility.

Prognosis of different hemodynamic classifications in patients with pulmonary hypertension due to left heart disease

Objective: To compare the prognostic values of different classification by using transpulmonary pressure gradient (TPG), diastolic pressure gradient (DPG) and pulmonary vascular resistance (PVR) in patients with pulmonary hypertension due to left heart disease (PH-LHD), and investigated hemodynamic and clinical factors associated with mortality in patients with PH-LHD. Methods: This was a single-center prospective cohort study. In-hospital patients diagnosed with PH-LHD via right heart catheterization at the Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, from September 2013 to December 2019 were enrolled. Patients were divided according to TPG (cutoff value 12 mmHg; 1 mmHg=0.133 kPa), DPG (cutoff value 7 mmHg), PVR (cutoff value 3 Wood Units), and the combination of TPG and PVR. Baseline characteristic was recorded. All patients were followed up until the occurrence of endpoint event, defined as all-cause death that occurred during the follow-up period, or until April 18, 2022. Receiver operating characteristic curves were used to compare the predictive value of 3 classification methods for all-cause death in PH-LHD patients. The optimal cutoff values were calculated using Jorden index. Survival analysis was performed using Kaplan-Meier analysis, and log-rank test was used to compare the predictive efficacy of classification methods based on optimal cutoff values or guidance-recommended thresholds for the survival of PH-LHD patients. Variables showing statistical significance in the univariate analysis were incorporated into multivariate Cox regression model to analyze the independent risk factors for all-cause mortality. Results: A total of 243 patients were enrolled, aged (54.9±12.7) years old, including 169 (69.5%) males. During a median follow-up of 57 months, there were 101 (41.6%) deaths occurred. Grouping results were as follows: (1) TPG: TPG≤12 mmHg group 115 patients, TPG>12 mmHg group 128 patients; (2) DPG: DPG<7 mmHg group 193 patients, DPG≥7 mmHg group 50 patients; (3) PVR: PVR≤3 Wood Units group 108 patients, PVR>3 Wood Units group 135 patients; (4) TPG and PVR: TPG≤12 mmHg and PVR≤3 Wood Units group 89 patients, TPG>12 mmHg and PVR>3 Wood Units group 109 patients. PVR (AUC=0. 698,95%CI:0.631-0.766) had better predictive value for all-cause mortality than TPG (AUC=0.596, 95%CI: 0.523-0.669) and DPG (AUC=0.526, 95%CI: 0.452-0.601) (all P<0.05). The optimal cutoff values for TPG, DPG, and PVR were13.9 mmHg, 2.8 mmHg, and 3.8 Wood Units, respectively. Kaplan-Meier analysis based on the optimal cutoff values or guidance-recommended thresholds showed that PVR and TPG were the predictors of survival (P<0.05), while DPG did not showed significance (P>0.05). Multivariate Cox regression analysis showed that age, PVR and log2N-terminal pro-B-type natriuretic peptide were independent risk factors for all-cause mortality in PH-LHD patients (all P<0.05). Conclusion: Classification according to PVR was most valuable in predicting all-cause death in PH-LHD patients, while TPG showed moderate predictive ability and DPG had no predictive value.

Association of the 25-question Geriatric Locomotive Function Scale with all-cause mortality in older adults: The Nagahama study

BackgroundsLocomotive syndrome is a condition in which a person is at risk of requiring nursing care due to musculoskeletal disorders. The 25-question Geriatric Locomotive Function Scale (GLFS-25) was developed to determine the severity of locomotive syndrome. In this study, we aimed to determine the prognostic significance of the GLFS-25 for all-cause mortality. MethodsThe study participants consisted of 3,447 community residents aged ≥65 years. All-cause mortality was determined using residential registry records. Skeletal muscle mass assessed via bioimpedance methods was considered in the analysis as a confounding factor. ResultsDuring a mean follow-up period of 3,236 days (30,566 person–years), 288 cases of all-cause mortality occurred. When participants were categorized by the GLFS-25 score [grade 1: <7 points (n = 1,948); grade 2: ≥7 to <16 points (n = 894); grade 3: ≥16 points (n = 605)], their survival probability decreased linearly with increasing grade (log-rank test P = 0.014). In a Cox proportional hazards model adjusted for confounding factors, including low skeletal muscle mass, GLFS-25 grade 3 was identified as an independent risk factor for all-cause mortality (hazard ratio: 1.60; P = 0.007) in the subpopulation aged ≥70 years but not in the overall population (P = 0.062). The hazard ratio for all-cause mortality with GLFS-25 grade 3 and low skeletal muscle mass combined was 2.66 (P < 0.001). ConclusionThe GLFS-25 is independently associated with all-cause mortality in older adults. Using this questionnaire to assess locomotive syndrome could be useful for identifying individuals at risk.

The role of preoperative immunonutrition on morbidity and immune response after cystectomy: protocol of a multicenter randomized controlled trial (INCyst Trial)

IntroductionCancer, malnutrition, and surgery negatively impact patient’s immune system. Despite standardized surgical technique and the development of new perioperative care protocols, morbidity after cystectomy remains a serious challenge for urologists. Most common postoperative complications, such as infections and ileus, often lead to longer length of stay and worse survival. The immune system and its interaction with the gut microbiota play a pivotal role in cancer immunosurveillance and in patient’s response to surgical stress. Malnutrition has been identified as an independent and modifiable risk factor for both mortality and morbidity. Immunonutrition (IN) may improve the nutritional status, immunological function, and clinical outcome of surgical patients. Aims of the study are (1) to evaluate the impact of IN on morbidity and mortality at 30 and 90 days after cystectomy and (2) to determine immune and microbiota signature that would predict IN effect.MethodsThis is a randomized, multicentric, controlled, pragmatic, parallel-group comparative study, supported by the Swiss National Science Foundation. A total of 232 patients is planned to be enrolled between April 2023 and June 2026. Three participating centers (Lausanne, Bern, and Riviera-Chablais) have been selected. All patients undergoing elective radical and simple cystectomy will be randomly assigned to receive 7 days of preoperative IN (Oral Impact®, Nestlé, Switzerland) versus standard of care (control group) and followed for 90 days after surgery. For the exploratory outcomes, blood, serum, urine, and stool samples will be collected in patients treated at Lausanne. In order to determine the impact of IN on immune fitness, patients enrolled at Lausanne will be vaccinated against influenza and the establishment of the vaccine-specific immune response will be followed. Analysis of the microbiota and expression of argininosuccinate synthetase 1 as potential biomarker will also be performed.Discussion and conclusionStrengths of the INCyst study include the randomized, multicenter, prospective design, the large number of patients studied, and the translational investigation. This study will challenge the added value of preoperative IN in patients undergoing cystectomy, assessing the clinical effect of IN on the onset of postoperative morbidity and mortality after cystectomy. Furthermore, it will provide invaluable data on the host immune response and microbiota composition.Trial registrationClinicalTrials.gov NCT05726786. Registered on March 9, 2023.

Body Weight's Role in Infective Endocarditis Surgery.

Objective: to investigate how body mass index (BMI) affects the outcome in patients treated surgically for infective endocarditis (IE). Methods: This is a single-center observational analysis of consecutive patients treated surgically for IE. We divided the cohort into six groups, according to the WHO classification of BMI, and performed subsequent outcome analysis. Results: The patient population consisted of 17 (2.6%) underweight, 249 (38.3%) normal weight, 252 (38.8%) overweight, 83 (12.8%) class I obese, 28 (4.3%) class II obese, and 21 (3.8%) class III, or morbidly obese, patients. The median age of the entire cohort was 64.5 [52.5-73.6] years. While only 168 (25.9%) patients were female, women significantly more often exhibited extremes in regards to BMI, including underweight (47.1%) and morbid obesity (52.4%), p = 0.026. Class II and III obese patients displayed more postoperative acute kidney injury (47.9%), p = 0.003, more sternal wound infection (12.9%), p < 0.001, worse 30-day survival (20.4%), p = 0.031, and worse long-term survival, p = 0.026, compared to the results for the other groups. However, the multivariable analysis did not identify obesity as an independent risk factor for 30-day mortality, with an odds ratio of 1.257 [0.613-2.579], p = 0.533. Rather, age > 60, reduced LVEF < 30%, staphylococcal infection, and prosthetic valve endocarditis correlated with mortality. While BMI showed poor discrimination in predicting 30-day mortality on the ROC curve (AUC = 0.609), it showed a fair degree of discrimination in predicting sternal wound infection (AUC = 0.723). Conclusions: Obesity was associated with increased comorbidities, complications, and higher postoperative mortality in IE patients, but it is not an independent mortality risk factor. While BMI is a poor predictor of death, it is a good predictor of sternal wound infections.