In-hospital Mortality Research Articles

Epigenomic biomarkers insights in PBMCs for prognostic assessment of ECMO-treated cardiogenic shock patients

ObjectiveAs the global use of extracorporeal membrane oxygenation (ECMO) treatment increases, survival rates have not correspondingly improved, emphasizing the need for refined patient selection to optimize resource allocation. Currently, prognostic markers at the molecular level are limited.MethodsThirty-four cardiogenic shock (CS) patients were prospectively enrolled, and peripheral blood mononuclear cells (PBMCs) were collected at the initiation of ECMO (t0), two-hour post-installation (t2), and upon removal of ECMO (tr). The PBMCs were analyzed by comprehensive epigenomic assays. Using the Wilcoxon signed-rank test and least absolute shrinkage and selection operator (LASSO) regression, 485,577 DNA methylation features were analyzed and selected from the t0 and tr datasets. A random forest classifier was developed using the t0 dataset and evaluated on the t2 dataset. Two models based on DNA methylation features were constructed and assessed using receiver operating characteristic (ROC) curves and Kaplan–Meier survival analyses.ResultsThe ten-feature and four-feature models for predicting in-hospital mortality attained area under the curve (AUC) values of 0.78 and 0.72, respectively, with LASSO alpha values of 0.2 and 0.25. In contrast, clinical evaluation systems, including ICU scoring systems and the survival after venoarterial ECMO (SAVE) score, did not achieve statistical significance. Moreover, our models showed significant associations with in-hospital survival (p < 0.05, log-rank test).ConclusionsThis study identifies DNA methylation features in PBMCs as potent prognostic markers for ECMO-treated CS patients. Demonstrating significant predictive accuracy for in-hospital mortality, these markers offer a substantial advancement in patient stratification and might improve treatment outcomes.

Influence of Stroke-Onset Location on the Efficacy of Endovascular Thrombectomy: Comparison of Outcomes between In-Hospital versus Community-Onset Strokes.

Previous studies have suggested that patients experiencing an in-hospital stroke may face delays in treatment and worse outcomes compared with patients with community-onset strokes. However, most studies occurred when IV thrombolysis was the primary treatment. This study aimed to examine the outcomes of patients experiencing an in-hospital stroke in the endovascular thrombectomy era. This was a single-center retrospective cohort study of patients older than 18 years of age with acute ischemic stroke treated with endovascular thrombectomy within 12 hours of stroke onset from January 1, 2015, to April 30, 2021. Patients were classified into 2 groups: in-hospital strokes and community-onset strokes. We compared the time metrics of stroke care delivery, the rate of successful reperfusion, and functional outcome as scored using the mRS score at 90 days (favorable outcome was defined as mRS 0-2). Differences in proportions were assessed using the Fisher exact and χ2 tests as appropriate. For continuous variables, differences in medians between groups were evaluated using Mann-Whitney U tests. A total of 676 consecutive patients were included, with 69 (10%) comprising the in-hospital stroke group. Patients experiencing in-hospital stroke were more likely to have diabetes (36% versus 18%, P = .02) and less likely to receive thrombolysis (25% versus 68%, P < .001) than those in the community-onset stroke group, but they were otherwise similar. Patients with in-hospital stroke had significantly faster overall time metrics, most notably from stroke recognition to imaging (median, 70 [interquartile range, 38-141] minutes versus 121 [74-228] minutes, P < .001). Successful recanalization was achieved in >75% in both groups (P = .39), with a median NIHSS score at discharge of <4 (P = .18). The 90-day mRS was similar in both groups, with a trend toward higher in-hospital mortality in the in-hospital stroke group (P = .06). Patients with in-hospital stroke had shorter workflow delays to initiation of endovascular thrombectomy compared with their community counterparts but with a similar rate of successful recanalization and clinical outcomes. Most important, 90-day mortality and mRS scores were equivalent between in-hospital stroke and community-onset stroke groups.

Advanced lung cancer inflammation index is associated with mortality in critically ill patients with heart failure.

Nutrition and inflammation status play a vital role in the prognosis of patients with heart failure (HF). This study aimed to investigate the association between the advanced lung cancer inflammation index (ALI), a novel composite indicator of inflammation and nutrition, and short-term mortality among critically ill patients with HF. This retrospective study included 548 critically ill patients with HF from the MIMIC-IV database. ALI was computed using body mass index, serum albumin and neutrophil-lymphocyte ratio. The primary endpoint was all-cause in-hospital mortality, and the secondary endpoint was 90day mortality. Kaplan-Meier survival curve analysis with long-rank test and Cox proportional hazards regression models were employed to assess the relationship between baseline ALI and short-term mortality risk. The incremental predictive ability of ALI was evaluated by C-statistic, continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI). The average age of 548 patients was 72.2 (61.9, 82.1) years, with 60% being male. Sixty-three patients (11.5%) died in the hospital, and 114 patients (20.8%)died within 90days of intensive care unit admission. The Kaplan-Meier analysis revealed that the cumulative incidences of both in-hospital and 90day mortality were significantly higher in patients with lower ALI (log-rank test, in-hospital mortality: P<0.001; 90day mortality: P<0.001). The adjusted Cox proportional hazard model revealed that ALI was inversely associated with both in-hospital and 90day mortality after adjusting for confounders [hazard ratio (HR) (95% confidence interval) (CI): 0.97 (0.94, 0.99), P=0.035; HR (95% CI): 0.62 (0.39, 0.99), P=0.046]. A linear relationship was observed between ALI and in-hospital mortality (P for non-linearity=0.211). The addition of ALI significantly improved the prognostic ability of GWTG-HF score in the in-hospital mortality [C-statistic improved from 0.62 to 0.68, P=0.001; continuous NRI (95% CI): 0.44 (0.20, 0.67), P<0.001; IDI (95% CI): 0.03 (0.01, 0.04), P<0.001] and 90day mortality [C-statistic improved from 0.63 to 0.70, P<0.001; continuous NRI (95% CI): 0.31 (0.11, 0.50), P=0.002; IDI (95% CI): 0.01 (0.00, 0.02), P=0.034]. Subgroup analysis revealed stronger correlations between ALI and in-hospital mortality in males and patients aged over 65years (interaction P=0.031 and 0.010, respectively). The C-statistic of in-hospital mortality in patients over 65years was 0.66 (95% CI: 0.58, 0.74). ALI at baseline can independently predict the risk of short-term mortality in critically ill patients with HF, with lower ALI significantly associated with higher mortality. Further large prospective research with extended follow-up periods is necessary to validate the findings of this study.

Incidence, In-Hospital and Long-Term Mortality, and Sequelae of Epidermal Necrolysis in Adults

The incidence of epidermal necrolysis (EN), including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), varies across studies. While in-hospital mortality rates range from 15% to 20%, contributors to long-term mortality have been rarely evaluated and remain unknown. To assess the incidence of and compare factors associated with in-hospital mortality and postdischarge mortality and sequelae among patients with EN. This cohort study used French Health System data from January 1, 2013, to December 31, 2022, and included all adult patients (aged ≥18 years) with EN identified using International Statistical Classification of Diseases, Tenth Revision codes combined with a validated algorithm. Epidermal necrolysis. Incidence, in-hospital mortality, postdischarge mortality, and sequelae were assessed as main outcomes. Factors associated with mortality were assessed using a multivariable Cox proportional hazards model. A total of 1221 adult patients with EN (median [IQR] age, 66 [49-79] years; 688 females [56.3%]) were included. Incidence was 2.6 (95% CI, 2.5-2.7) cases per million person-years. The in-hospital mortality rate was 19% (95% CI, 17%-21%) and postdischarge mortality rate, 15% (95% CI, 13%-17%) for an overall mortality of 34% (95% CI, 31%-36%). In multivariable analysis, factors associated with in-hospital mortality were age (adjusted hazard ratio [AHR], 1.03 per year of age; 95% CI, 1.02-1.04 per year of age), history of cancer (AHR, 2.04; 95% CI, 1.53-2.72), dementia (AHR, 1.85; 95% CI, 1.12-3.07), liver disease (AHR, 1.81; 95% CI, 1.24-2.64), and EN severity (TEN vs SJS: AHR, 2.14; 95% CI, 1.49-3.07). Cancer, liver disease, and dementia remained associated with postdischarge mortality (AHR, 3.26 [95% CI, 2.35-4.53], 1.86 [95% CI, 1.11-3.13], and 1.95 [95% CI, 1.11-3.43], respectively). Conversely, EN initial severity was not associated with mortality after hospital discharge (TEN vs SJS: AHR, 0.95; 95% CI, 0.60-1.47), but acute complications remained associated (AHR, 2.14 [95% CI, 1.26-3.63] and 2.44 [95% CI, 1.42-4.18] for acute kidney injury and sepsis, respectively). The main sequelae were ophthalmologic and mood disorders. The findings of this cohort study suggest that although EN is a rare condition, it is associated with high rates of in-hospital and postdischarge mortality among patients who are older and have comorbid conditions. However, in contrast with in-hospital mortality, postdischarge mortality is not associated with EN initial severity but with acute in-hospital complications (eg, acute kidney injury and sepsis). Future studies are needed to construct models to estimate long-term outcomes and sequelae in patients with EN.

Creatinine clearance/eGFR ratio: a simple index for muscle mass related to mortality in ICU patients

IntroductionIn patients admitted to the intensive care unit (ICU), muscle mass is inversely associated with mortality. Although muscle mass can be estimated with 24-h urinary creatinine excretion (UCE), its use for risk prediction in individual patients is limited because age-, sex-, weight- and length-specific reference values for UCE are lacking. The ratio between measured creatinine clearance (mCC) and estimated glomerular filtration rate (eGFR) might circumvent this constraint. The main goal was to assess the association of the mCC/eGFR ratio in ICU patients with all-cause hospital and long-term mortality.MethodsThe mCC/eGFR ratio was determined in patients admitted to our ICU between 2005 and 2021 with KDIGO acute kidney injury (AKI) stage 0–2 and an ICU stay ≥ 24 h. mCC was calculated from UCE and plasma creatinine and indexed to 1.73 m2. mCC/eGFR was analyzed by categorizing patients in mCC/eGFR quartiles and as continuous variable.ResultsSeven thousand five hundred nine patients (mean age 61 ± 15 years; 38% female) were included. In-hospital mortality was 27% in the lowest mCC/eGFR quartile compared to 11% in the highest quartile (P < 0.001). Five-year post-hospital discharge actuarial mortality was 37% in the lowest mCC/eGFR quartile compared to 19% in the highest quartile (P < 0.001). mCC/eGFR ratio as continuous variable was independently associated with in-hospital mortality in multivariable logistic regression (odds ratio: 0.578 (95% CI: 0.465—0.719); P < 0.001). mCC/eGFR ratio as continuous variable was also significantly associated with 5-year post-hospital discharge mortality in Cox regression (hazard ratio: 0.27 (95% CI: 0.22—0.32); P < 0.001).ConclusionsThe mCC/eGFR ratio is associated with both in-hospital and long-term mortality and may be an easily available index of muscle mass in ICU patients.

Factors related to cardiac rupture after acute myocardial infarction.

Cardiac rupture (CR) after acute myocardial infarction (AMI) is a fatal mechanical complication. The early identification of factors related to CR in high-risk cases may reduce mortality. The purpose of our study was to discover relevant risk factors for CR after AMI and in-hospital mortality from CR. In this study, we enrolled 1,699 AMI cases from October 2013 to May 2020. A total of 51 cases were diagnosed with CR. Clinical diagnostic information was recorded and analyzed retrospectively. We randomly matched these cases with AMI patients without CR in a 1:4 ratio. Univariate and multivariate logistic regression and stratifying analysis were used to identify risk factors for CR. Univariate and multivariate Cox regression hazard analysis and stratifying analysis were used to assess predictors of in-hospital mortality from CR. The incidence of CR after AMI was 3.0% and in-hospital mortality was approximately 57%. Multivariate logistic regression analysis identified that white blood cell count, neutrophil percentage, anterior myocardial infarction, a Killip class of >II, and albumin level were independently associated with CR (p < 0.05). Stratifying analysis showed that age, systolic blood pressure, and bicarbonate were independent risk factors for female CR (p < 0.05) but not male CR. Triglyceride and cardiac troponin I were independent risk factors for male CR (p < 0.05) but not female CR. Anterior myocardial infarction, a Killip class of >II, and neutrophil percentage were independent risk factors for male and female CR (p < 0.05). Multivariate Cox regression analysis showed that the time from symptom to CR and the site of CR were independent predictors for in-hospital mortality from CR (p < 0.05). Stratification analysis indicated that risk factors did not differ based on gender, but platelet counts were predictors for in-hospital mortality in female and male CR. Low albumin, a high white blood cell count, neutrophil percentage, anterior myocardial infarction, and a Killip class of >II were independent and significant predictors for CR. However, risk factors are different in male and female CR. The time from symptom to CR, the site of CR, and platelet counts were independent predictors for in-hospital mortality from CR. These may be helpful in the early and accurate identification of high-risk patients with CR and the assessment of prognosis. In addition, gender differences should be considered.

Evolving Role of Coronary Collaterals in STEMI Outcomes: A Comparative Analysis of Pandemic and Post-Pandemic Phases.

Acute ST-elevation myocardial infarction (STEMI) is a critical condition where coronary collaterals can mitigate myocardial damage. The Coronavirus Disease 2019 (COVID-19) pandemic introduced unique challenges in STEMI management, potentially affecting outcomes. This study evaluates the efficacy of coronary collaterals during the pandemic compared to the post-pandemic period. A review of 1465 STEMI patients treated at a high-volume tertiary care center from April 2020 to December 2022 was conducted. Collaterals were assessed using the Rentrop classification. In-hospital mortality and 1-year major adverse cardiac events (MACE) were analyzed based on collateral status and timeframes. During the pandemic, there was a higher incidence of robust collaterals (28.2% vs 23.2%, P = .04), but they were less protective, with similar in-hospital mortality (14.4% vs 8.1%, P = .07) and 1-year MACE rates (21.9% vs 30.4%, P = .09) across groups. Post-pandemic, robust collaterals showed significant protective effects with reduced in-hospital mortality (3.6% vs 7.4%, P = .04) and 1-year MACE rates (17.1% vs 24.9%, P = .03). These findings highlight a dynamic role of collaterals in STEMI management, with the pandemic impairing their functionality. This underscores the need for adaptive STEMI care strategies, especially during global health crises.

Ability of the SMART-COP score to predict the need for intensive care unit admission and mortality in older patients with non-ventilator-associated hospital-acquired pneumonia: A retrospective observational study.

To evaluate the ability of SMART-COP (systolic blood pressure, multilobar infiltrates, albumin, respiratory rate, tachycardia, confusion, oxygen and pH) score to predict the need for intensive care unit (ICU) admission and mortality among patients with non-ventilator-associated hospital-acquired pneumonia (NV-HAP) and to compare ICU-hospitalized patients with those followed-up in the clinic, as well as the patients who survived with those who died in the ICU, in terms of clinical and laboratory parameters. A total of 203 patients (aged > 65 years) who were diagnosed with NV-HAP while staying in the geriatric clinic were enrolled in this retrospective observational study. Patient information was retrieved from hospital files. In a total of 203 patients with NV-HAP, the rate of ICU admission was 77.3% and the rate of mortality was 40.9%. The SMART-COP score was significantly higher in those admitted to the ICU and those died in the ICU (ICU nonsurvivors). The rate of ICU mortality was 52.9%. The SMART-COP score had significantly poor to moderate ability to predict the need for ICU admission (area under the curve [AUC] = 0.583) and both in-hospital mortality (AUC = 0.633) and ICU mortality (AUC = 0.617) with low sensitivity. The regression analysis revealed that a one-unit increase in SMART-COP score resulted in a 1.2-fold increase in both the hospital and ICU mortality (P < 0.05 for both) and 1.1-fold increase in ICU admission (P = 0.154). The SMART-COP score has poor to moderate ability to predict the need for ICU admission, in-hospital mortality and ICU mortality, and a one-unit increase in the SMART-COP score significantly increases the risk of both hospital and ICU mortality. Geriatr Gerontol Int 2024; ••: ••-••.

Perioperative Risk Factors for Postoperative Delirium in Non-Dementia Older Patients after Non-Cardiac Surgery and Anesthesia: A Prospective Study.

To investigate the incidence and perioperative risk factors for postoperative delirium (POD) in non-dementia older patients who underwent anesthesia for non-cardiac surgery. This prospective cohort study was conducted on 195 non-dementia older patients, aged 60 years or older, who were hospitalized after non-cardiac surgery and anesthesia. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used to evaluate the occurrence of POD. Incidence of POD was reported. We conducted univariate and multivariate logistic regression to identify the risk factors associated with POD. 195 patients were enrolled; 172 completed the study. POD occurred in seven patients within three days after anesthesia, which is a 4.1% incidence of POD. Multivariate logistic analysis showed arrhythmia, coagulopathy, urinary comorbidity, minimum intraoperative heart rate, and minimum post-anesthesia care unit (PACU) pain score as independent risk factors for POD. A minimum PACU pain score > 1 is the optimum cutoff pain score for developing POD, with a sensitivity of 85.7% and a specificity of 69.1%. The postoperative complication rate and in-hospital mortality were significantly higher for patients with POD compared to those without POD. The incidence of POD in the study population is 4.1%. Arrhythmia, coagulopathy, urinary comorbidity, minimum intraoperative heart rate, and minimum PACU pain score were independent risk factors for POD. The minimum PACU pain score is the strongest independent risk factor of POD. POD is associated with increased postoperative complications and in-hospital mortality rates in non-dementia older patients.

Video laryngoscopy may improve the intubation outcomes in critically ill patients: a systematic review and meta-analysis of randomised controlled trials

BackgroundThe role of video laryngoscopy in critically ill patients requiring emergency tracheal intubation remains controversial. This systematic review and meta-analysis aimed to evaluate whether video laryngoscopy could improve the clinical...

Differences on In-hospital Outcomes in Patients with Cardiogenic Shock due to STEMI vs NSTEMI Using A Nationwide Database

ABSTRACT Background Our study aims to compare in-hospital management and outcomes in patients with cardiogenic shock due to ST-segment elevation myocardial infarction (STEMI) vs. non-ST-segment elevation myocardial infarction (NSTEMI). Methods We conducted a retrospective cohort study using the National Inpatient Sample database between 2016-2019, including patients with STEMI/NSTEMI complicated by cardiogenic shock. An inverse probability treatment weighting (IPTW) analysis was performed to compare in-hospital management and outcomes between patients with STEMI and NSTEMI. Adjusted relative risks (aRR) with their 95% confidence intervals (CI) were estimated. Results A total of 150,395 patients with cardiogenic shock due to acute myocardial infarction were included, of whom 52.8% had STEMI. The median age was 68 years (60 - 77) and 35% were female. Percutaneous coronary intervention (PCI), intra-aortic balloon counterpulsation, percutaneous ventricular assist device, extracorporeal membrane oxygenation and mechanical ventilation use were significantly higher in the STEMI group compared to NSTEMI. Coronary artery bypass grafting (CABG), renal replacement therapy, length of hospital stay, and total costs were lower in the STEMI group. Pulmonary arterial catheterization and cardiac transplantation were similar between both groups. IPTW analysis showed that in-hospital mortality was significantly higher in the STEMI group compared to NSTEMI (34.2% vs. 28.8%, aRR 1.19, 95% CI 1.14 - 1.23) and also major bleeding. Conclusion In conclusion, patients with cardiogenic shock due to STEMI had worse prognosis, higher use of PCI/mechanical circulatory support and major bleeding than the NSTEMI group. In contrast, patients with NSTEMI had greater use of CABG and hospital resources.

Surgical treatment of chronic pancreatitis with an inflammatory pancreatic head mass: a retrospective study

BackgroundConservative treatment of chronic pancreatitis has only a limited effect in most patients. Surgery offers very good long-term results, even in the early stages of the disease. Unfortunately, only a minority of patients undergo surgical treatment. The aim of this work was to summarise the current treatment options for patients with an inflammatory mass of the pancreatic head. Data from patients in our study demonstrates that the surgery is a safe method, and here we compare the perioperative and early postoperative outcomes of patients who underwent a pancreatoduodenectomy and duodenum-preserving pancreatic head resection for chronic pancreatitis.MethodsAll patients who underwent a pancreaticoduodenectomy or a duodenum-preserving pancreatic head resection in our department between 2014 and 2022 were included in this study. Perioperative and early postoperative results were statistically analysed and compared.ResultsThirty-eight pancreaticoduodenectomies and 23 duodenum-preserving pancreatic head resections were performed. The overall mortality was 3%, whereas the in-hospital mortality after pancreaticoduodenectomy was 5%. The mortality after duodenum-preserving pancreatic head resection was 0%. No statistically significant differences in the hospital stay, blood loss, and serious morbidity were found in either surgery. Operative time was significantly shorter in the duodenum-preserving pancreatic head resection group.ConclusionsBoth pancreatoduodenectomy and duodenum-preserving pancreatic head resection are safe treatment options. Duodenum-preserving pancreatic head resection showed a statistically significant superiority in the operative time compared to pancreaticoduodenectomy. Although other monitored parameters did not show a statistically significant difference, the high risk of complications after pancreaticoduodenectomy with a mortality of 5%; maintenance of the duodenum and upper loop of jejunum, and lower risk of metabolic dysfunctions after duodenum-preserving pancreatic head resection may favour duodenum-preserving pancreatic head resection in recommended diagnoses. Attending physicians should be more encouraged to use a multidisciplinary approach to assess the suitability of surgical treatment in patients with chronic pancreatitis.

Early Analysis of Endothelial Markers to predict Sepsis in the Emergency Department.

Acute infections and sepsis are a leading cause of death. These patients are primarily encountered at the emergency department (ED), where early assessment for sepsis is necessary to improve outcome. In sepsis, the inflammatory response causes several characteristic pathophysiological changes, including a dysregulated and generalized activation of the endothelium. This study aimed to analyse endothelial markers released to the blood as diagnostic biomarkers for acute infection and sepsis in the ED, as smaller studies have previously shown promising results in other settings. Serum samples from n = 312 adult patients with suspected acute infections at presentation to the ED were utilized. Patients' courses of disease and outcomes were assessed by clinical adjudication. E-Selectin, P-Selectin, ICAM-1, and VCAM-1 were measured by ELISAs. The accuracy of each marker for predicting bacterial infection, sepsis, and in-hospital mortality, was evaluated. For sepsis, E-Selectin and ICAM-1 both showed an AUROC of 0.62, lower than procalcitonin with 0.77 (both p < 0.01) and lactate with 0.73 (p = 0.030 and 0.046, respectively), but similar to CRP with 0.60 (p = 0.758 and 0.876, respectively). For 28-day in-hospital mortality among patients with infection, ICAM-1 performed best with an AUROC of 0.75. Despite promising results in small studies and specific cohorts, particularly in intensive care units, this large-scale evaluation of four endothelial biomarkers highlights their limited diagnostic utility in a broader inclusion set-up design at the earliest possible time-point of evaluation.

Management of myocardial infarction with non-obstructive coronary arteries (MINOCA) in Germany: a single-center study on hospital resources and healthcare economics.

Patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) present as a main feature ≤50% stenosis upon angiography despite clinical symptoms and biomarker elevation related to acute coronary syndrome. Due to broad availability of high sensitivity troponin testing as well as invasive and non-invasive imaging, this clinical entity receives increasing clinical awareness. We aimed to investigate the in-hospital work flow and economic impact of MINOCA vs. MICAD (myocardial infarction with obstructive coronary artery disease) patients and related clinical outcomes in a single-center patient collective of a large university heart center in Germany. We retrospectively screened and analyzed all patients who were admitted to our hospital under the suspicion of an acute coronary syndrome within a 12-month period (2017-2018) for further diagnostics and treatment. All included patients showed a pathological troponin elevation and received invasive coronary angiography for acute coronary syndrome. Associated in-hospital costs, procedural and various clinical parameters as well as timelines and parameters of work-flow were obtained. After screening of 3,021 patients, we included 660 patients with acute coronary syndrome. Of those, 118 patients were attributed to the MINOCA-group. 542 patients presented with a "classical" myocardial infarction (MICAD group). MINOCA patients were less frail, more likely female, but showed no relevant difference in age or other selected comorbidities except for fewer cases of diabetes. In-hospital mortality (11% vs. 0%; p < 0.001) and 30-day mortality (17.3% vs. 4.2%; p < 0.001) after the index event were significantly higher in the "classical" myocardial infarction group (MICAD)- Despite a shorter overall length of hospital stay (9.5 ± 8.7 days vs. 12.3 ± 10.5 days, p < 0.01) with a significantly shorter duration of high care monitoring (intensive/intermediate care or chest pain units) (2.4 ± 2.1 days vs. 4.7 ± 3.3 days, p < 0.01) MINOCA patients consumed a relevant contingent of hospital resources. Thus, in a 12-months period a total sum of almost 300 days was attributed to high care monitoring for MINOCA patients with a mean difference of approximately 50% compared to patients with classical myocardial infarction. With average and median costs of 50% less per index, MINOCA treatment costs were lower compared to the MICAD group in the hospital reimbursement system of Germany. Consequently, MINOCA treatment was not associated with a relevant profit for these expanses and a relevant share of nearly 40% of the total costs was generated due to high care monitoring. In light of lower mortality than MICAD and growing scarcity of staff, financial and capacity resources the clinical symptom complex of MINOCA should be put under particular consideration for refining care concepts and resource allocation.

Critical care therapy and in-hospital mortality after radical nephroureterectomy for nonmetastatic upper urinary tract carcinoma

BackgroundUse of critical care therapies (CCT), that include invasive mechanical ventilation (IMV), total parenteral nutrition (TPN) and other modalities are unknown after radical nephroureterectomy (RNU) for upper urinary tract carcinoma (UUTC). Their relationship with in-hospital mortality is also unknown. MethodsWithin the National Inpatient Sample (2008–2019), we identified non-metastatic UUTC patients treated with RNU. Multivariable logistic regression models were used. ResultsOf 8,995 patients, 375 (4.2%) received CCT and 82 (0.9%) experienced in-hospital mortality. Of CCT modalities, 215 (2.4%) received IMV and 139 (1.5%) TPN. Temporal CCT, IMV, and TPN trends very closely followed in-hospital mortality trends. Relative to historical UUTC patients (2008–2013), contemporary (2014–2019) patients exhibited lower CCT (Δ = 2.2%, P value < 0.0001), lower IMV (Δ = 1.4%, P < 0.0001), lower TPN (Δ = 2.2%, P < 0.0001), and lower in-hospital mortality (Δ = 0.4%, P = 0.03) rates. Of in-hospital mortalities, 52 out of 82 received CCT but 30 of 82 did not. Median age (> 72 years; odds ratio [OR] 1.4; P = 0.002) and Charlson comorbidity index ≥ 3 (OR 4.1; P < 0.001) and ≥ 1-2 (OR 1.7; P = 0.001) independently predicted overall higher CCT, IMV, TPN, and in-hospital mortality. ConclusionAfter RNU, CCT rates parallels in-hospital mortality rates. CCT represents a 5 to 6-fold multiple of in-hospital mortality rate. In RNU patients, CCT rates are higher in older and sicker individuals. Lower CCT rates that are paralleled by lower in-hospital mortality may be interpreted as an indicator of improved quality of care. Ideally all in-hospital mortalities should be predated by CCT exposure.

Trends in In-Hospital Mortality in Patients Admitted With Cardiovascular Diseases in the United States With Demographics and Risk Factors of All Cardiovascular In-Hospital Mortality: Analysis of the 2021 National Inpatient Sample Database.

Introduction and background Cardiovascular diseases (CVDs) encompass a range of disorders involving coronary artery diseases, valvular heart diseases, myocardial diseases, pericardial diseases, hypertensive heart diseases, heart failure (HF), and pulmonary artery diseases. Given the high prevalence of CVDs, understanding both overall and in-hospital mortality rates from these diseases is crucial. Unsurprisingly, most research, procedures, and new pharmacological interventions aim to reduce these rates. No recent studies have comprehensively detailed in-hospital mortality rates, demographics, and risk factors for all CVDs combined. Yet, in-hospital mortality rates due to CVD significantly impact patients' families and healthcare teams and serve as a critical measure of healthcare system development and effectiveness. Therefore, analyzing in-hospital mortality rates is essential for filling the gap in the recent comprehensive analysis of in-hospital mortality rates, demographics, and risk factors of all CVDs. Method The study used data from the National Inpatient Sample and the Nationwide Inpatient Sample (NIS) Databases of 2021 and HCUP tools. The NIS database extrapolates national estimates based on a stratified sample of 20% of US hospital discharges. Results were expressed as probability and relative risk using the t-test, with a P-value <0.05 being statistically significant. Statistical analyses were done using Stata statistical software version 18 (StataCorp LLC, College Station, TX, US). Results This study included 6,666,752 hospital admissions in the United States. Of these, 2,337,589 patients were admitted with CVDs and related symptoms, with 70,552 deaths occurring during hospitalization, resulting in an in-hospital mortality rate of 3.01% due to CVDs. Our study showed all CVD-induced in-hospital mortality combined was found to have a higher association with diabetes but a lower association with hypertension, hyperlipidemia, alcohol, and smoking. Conclusion The highest rates of cardiovascular disease in-hospital mortality are cardiac arrest, rupture of the cardiac wall as a complication of acute myocardial infarction, cardiogenic shock, rupture of papillary muscle as a complication of acute myocardial infarction, and rupture of chorda tendinea as a complication of acute myocardial infarction. The most common causes of CVD in-hospital mortality are non-ST-elevation myocardial infarction (NSTEMI) (19.20%), ST-elevation myocardial infarction (STEMI) (17.80%), cardiac arrest (15.10%), hypertensive heart disease with heart failure (12.50%), ventricular fibrillation (4.70%), ventricular tachycardia (3.30%), and aortic stenosis (2.10%). The most common risk factors for CVD in-hospital mortality are age, male gender, and diabetes. Proper diabetes control and management might be the highest preventive measure for all CVD-induced in-hospital mortality.

Predicting the impact of stress-induced hyperglycemia on in-hospital mortality in patients with chronic kidney disease and acute coronary syndrome: A retrospective study

BackgroundStress hyperglycemia is prevalent in critical illnesses and has been associated with adverse short- and long-term outcomes in individuals with acute coronary syndrome (ACS). However, there is limited evidence for the predictive value of stress hyperglycemia and hospitalization mortality in patients with chronic kidney disease (CKD) and ACS. This study aimed to explore the association between hospitalized mortality, stress hyperglycemia ratio (SHR), and admission blood glucose (ABG) in patients with CKD and ACS. MethodsThis study included 655 hospitalized patients who were diagnosed with ACS and CKD. Patients with incomplete data were excluded, resulting in the analysis of 550 patients. The primary outcome measured was in-hospital mortality. ResultsThe median age of the cohort included in the analysis was 71 years, with a male proportion of 66.2 %, and a mean estimated glomerular filtration rate (eGFR) of 27.8 mL/min/1.73 m2. Patients classified as having stage 3, stage 4, and stage 5 chronic kidney disease (CKD) comprised 46.95 %, 17.1 %, and 36 % of the population, respectively. The overall in-hospital mortality rate was 10.7 % (n = 59). Both SHR (OR = 2.67; 95 % CI 1.51–4.74; p < 0.001) and ABG (OR = 1.09; 95 % CI 1.04–1.14; p < 0.001) were significantly associated with in-hospital mortality in CKD and ACS patients. SHR and ABG showed a linear relationship with in-hospital mortality, with SHR demonstrating superior reclassification ability over ABG. The inclusion of SHR or ABG, irrespective of diabetes mellitus status, substantially enhanced the predictive performance of the Global Registry of Acute Coronary Events (GRACE) score model. ConclusionsIn patients with ACS and CKD, a robust correlation was observed between SHR, ABG, and in-hospital mortality. Both SHR and ABG improved the predictive accuracy of the GRACE score in forecasting inpatient mortality in this population.

Association of Stress Hyperglycemia Ratio and in-Hospital Mortality in Patients with Sepsis: A Two Center Retrospective Cohort Study.

In critically ill patients, the stress hyperglycemia ratio (SHR) was significantly associated with mortality. However, the relationship between SHR and mortality in septic patients is still unclear.In this study, patients with sepsis from two Chinese academic centers were identified and divided into quartiles based on SHR levels. Multivariable regression analysis will be used to determine associations between SHR and clinical outcomes in sepsis patients.The Kaplan-Meier curve was used to predict mortality in various groups of septic patients. A total of 1835 septic patients were included in the study.The in-hospital, 30-day, and 60-day mortality rates for all septic patients were 22.8%, 18.7%, and 21.7%, respectively. Increased SHR was significantly associated with hospital mortality in multivariate regression analysis.These results were further confirmed in the adjusted analysis, where the hospital mortality and the 60-day mortality of the highest SHR quartile were significantly increased compared to the lowest SHR quartile. However, the highest SHR quartile was not associated with 30-day mortality.In addition, the risk of in-hospital mortality, 30-day mortality and 60-day mortality showed a consistent upward trend with increasing SHR quartile. The survival curve showed that the worst prognosis was in the fourth SHR quartile. In conclusion, SHR was significantly associated with hospital mortality in patients with sepsis. This finding indicates that the SHR may be useful in identifying septic patients at higher risk of hospital mortality.

Impact of diabetes on epicardial reperfusion and mortality in a contemporary STEMI population undergoing mechanical reperfusion: insights from the ISACS STEMI COVID 19 Registry

Background and AimDiabetes has been shown in last decades to be associated with a significantly higher mortality among patients with ST‐segment elevation myocardial infarction (STEMI) treated with primary PCI (PPCI). Therefore, the aim of current study was to evaluate the impact of diabetes on times delays, reperfusion and mortality in a contemporary STEMI population undergoing PPCI, including treatment during the COVID pandemic. Methods and ResultsThe ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving PPCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 1st of March until June 30, 2019 and 2020. Primary study endpoint of this analysis was in-hospital mortality. Secondary endpoints were postprocedural TIMI 0-2 flow and 30-day mortality. Our population is represented by 16083 STEMI patients. A total of 3812 (23,7%) patients suffered from diabetes. They were older, more often males as compared to non-diabetes. Diabetic patients were less often active smokers and had less often a positive family history of CAD, but they were more often affected by hypertension and hypercholesterolemia, with higher prevalence of previous STEMI and previous CABG. Diabetic patients had longer ischemia time, had more often anterior MI, cardiogenic shock, rescue PCI and multivessel disease. They had less often out-of-hospital cardiac arrest and in-stent thrombosis, received more often a mechanical support, received less often a coronary stent and DES. Diabetes was associated with a significantly impaired postprocedural TIMI flow (TIMI 0-2: 9.8% vs 7.2%, adjusted OR [95% CI] = 1.17 [1.02-1.38], p = 0.024) and higher mortality (in-hospital: 9.1% vs 4.8%, Adjusted OR [95% CI] =1.70 [1.43-2.02], p < 0.001); 30-day mortality (10.8% vs 6%, Adjusted HR [95% CI] =1.46 [1.26-1.68], p < 0.001) as compared to non-diabetes, particularly during the pandemic. ConclusionsOur study showed that in a contemporary STEMI population undergoing PPCI, diabetes is significantly associated with impaired epicardial reperfusion that translates into higher in-hospital and 30-day mortality, particularly during the pandemic.

Relationship between the albumin-corrected anion gap and short-term prognosis among patients with cardiogenic shock: a retrospective analysis of the MIMIC-IV and eICU databases

ObjectivesWe aimed to investigate the association between the albumin-corrected anion gap (ACAG) and the prognosis of cardiogenic shock (CS).DesignA multicentre retrospective cohort study.SettingData were collected from the Medical Information Mart...