Death In Patients Research Articles

Unseen threat: how subclinical atherosclerosis increases mortality risk in patients with type 1 diabetes

BackgroundCardiovascular disease (CVD), particularly ischemic heart disease, remains the leading cause of death and morbidity in patients with type 1 diabetes. Detecting subclinical atherosclerosis could enhance cardiovascular risk stratification and enable individualised therapies. The aim of this study is to investigate the prevalence and predictors of subclinical atherosclerosis in patients with type 1 diabetes without overt cardiovascular disease (CVD) and to assess its impact on patient survival over a follow-up period of at least 5 years.MethodsThis observational study included 507 patients treated at the Diabetes Unit of the Hospital of Girona Doctor Josep Trueta between 2015 and 2023. The inclusion criteria for patients were as follows: those aged 18 and older with diabetes for a minimum of 10 years or those aged 40 and older with a diabetes for at least 5 years. Subclinical atherosclerosis was identified via ultrasound imaging of the carotid and femoral arteries. Clinical and biochemical evaluations were also conducted. Major cardiovascular events (MACE) and deaths from other causes were monitored, and survival analysis was performed using Kaplan‒Meier methods.ResultsSubclinical atherosclerosis was detected in 218 patients (43%). Multivariate analysis revealed that the male sex, diabetic nephropathy, tobacco exposure, higher HbA1c levels, older age, and longer diabetes duration were significant predictors. During a mean follow-up of 70.64 ± 27.08 months, 19 patients experienced MACE, and 13 died from any cause. The probability of MACE or death was greater in patients with subclinical atherosclerosis, with a hazard ratio (HR) of 25.1 (95% CI 5.81–108, p < 0.001) for MACE and an odds ratio (OR) of 7.57 (95% CI 1.97–53.9, p = 0.004) for death.ConclusionSubclinical atherosclerosis is independently associated with increased overall mortality and MACE in patients with type 1 diabetes. Identifying clinical predictors can improve risk stratification and personalised therapeutic strategies to prevent MACEs in this high-risk population.Graphical

Prognostic value of the neutrophil to lymphocyte ratio in the development of systemic inflammatory response syndrome and death in patients with liver cirrhosis

Introduction. The search for markers reflecting immune disorders and their contribution to the progression of liver cirrhosis (LC) is very relevant.Aim. To study the possibility of using the “neutrophil to lymphocyte ratio” indicator as a predictor of the development of systemic inflammatory response syndrome and death.Materials and methods. For a retrospective clinical study, 225 case histories of patients with cirrhosis were selected from 2008 to 2018. Three groups were formed from them: group 1: patients with cirrhosis class A according to Child – Pugh (n = 24); group 2: patients with cirrhosis class B and C according to Child – Pugh (n = 201) and group 3: healthy individuals (n = 50). The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) indicator in the development of systemic inflammatory response syndrome (SIRS) and death in patients with cirrhosis was analyzed.Results. Patients with LC had statistically significantly higher values of NLR compared to healthy individuals (p &lt; 0.001). The NLR indicator is an independent risk factor and a statistically significant predictor of the development of SIRS in patients with LC. A NLR value &gt; 3.59 had a sensitivity of 0.38 [95% CI: 0.28; 0.48] and specificity 0.93 [95% CI: 0.87; 0.97]. NLR served as a statistically significant predictor of death (p &lt; 0.001). A NLR value &gt; 4.5 had a sensitivity of 0.24 [95% CI: 0.15; 0.36] and specificity 0.97 [95% CI: 0.92; 0.99].Conclusion. An NLR value of more than 3.59 increases the risk of developing SIRS in patients with cirrhosis, and an NLR value of more than 4.5 increases the risk of death.

Prognostic values of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in the early prediction of aluminum phosphide-poisoned patients’ outcomes

Background In Egypt, aluminum phosphide (ALP) is one of the most serious health problems that threaten the health system, with a very high mortality rate that ranges from 30%–100% of cases, according to medical facilities. ALP records suicidal deaths related to the toxin ingestion in Egypt, which accounts for 70% of the deaths. Patients usually deteriorate early; death is expected in the first 48 h. The aim of this study is to investigate the early recorded neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in anticipation of the ALP-intoxicated patients’ outcome. Patients and methods Thirty-three subjects diagnosed with ALP poisoning were divided into two groups according to their need for mechanical ventilation and whether they could survive or not. A complete blood count (CBC) was done immediately after admission, and NLR and PLR were calculated. Patients’ conditions were evaluated by arterial blood gases (ABG), random blood sugar (RBS), sodium (Na+), potassium (K+), and an electrocardiogram (ECG). Results There were significant differences in the need for ICU and mechanical ventilation between the different NLR groups. There was also a highly significant difference in the patient’s fate. Increased NLR was associated with a high incidence of mechanical ventilation and death in ALP-poisoned patients. Conclusion The early assessment of NLR can be valuable in predicting death and the need for ICU admission. NLR ≥ 3.35 can predict death in ALP-poisoned patients. Early CBC and calculation of NLR are promising tools that are easy and more accurate than the presence of leukocytosis or leucopenia.

Soluble Urokinase Plasminogen Activator Receptor as a Predictor of All-Cause Death in Patients Undergoing Coronary Angiography at 10-Year Follow-Up.

Background: We aimed to explore the predictive role of soluble urokinase plasminogen activator receptor (suPAR) in patients undergoing coronary angiography by systematically evaluating its association with adverse cardiovascular events at 10 years follow-up. Methods: The KORONEF study was a single-center, observational, prospective study with 492 subjects included. In the multivariable Cox regression model, we checked the impact of suPAR, neutrophil elastase, myeloperoxidase, and DNase 1 on long-term outcomes. Results: The mean study population age was 64.4 ± 9.9 years, and there were 37.2% women. We divided the population into tertiles of suPAR levels (T1 0.793-2.135 ng/mL; T2 2.136-2.868 ng/mL; and T3 2.872-8.677 ng/mL). Patients with higher suPAR concentrations were more often females (tertile 1 vs. tertile 3: 27.4% vs. 50.6%, p < 0.001) and older age (60.8 ± 8.7 years vs. 68.8 ± 9.5 years, p < 0.001). They also characterized higher incidence of diabetes (17.7% vs. 38.0%, p < 0.001), previous myocardial infarction (22% vs. 44.8%, p < 0.001), and chronic kidney disease (3% vs. 18.4%, p < 0.001), but lower incidence of dyslipidemia (54.3% vs. 35.6%). The 10-year all-cause death rates were 14.6% vs. 34.1%, HR 2.68, 95% CI 1.66-4.33, p < 0.001 for tertile 2, and 14.6% vs. 39.9%, HR 3.24, 95% CI 2.03-5.17, p < 0.001 for tertile 3. The optimal cut-off suPAR value of 2.39 ng/mL provided a sensitivity of 66.9% and a specificity of 54.6% in predicting all-cause death. Conclusions: The association of elevated suPAR with increased mortality risk suggests its potential relevance in predicting long-term outcomes and may help inform more individualized management strategies for high-risk patients.

EP.01A.02 Risk Factors and Nomogram Construction of Early Death in Patients with Stage IV Lung Squamous Cell Carcinoma: A SEER-Based Study

EP.01A.02 Risk Factors and Nomogram Construction of Early Death in Patients with Stage IV Lung Squamous Cell Carcinoma: A SEER-Based Study

Process Groups for Supporting Resident Wellbeing: Factors Influencing Resident Wellness amid the COVID-19 Pandemic.

Background: Burnout is a well-recognized problem among resident physicians. The COVID-19 pandemic impacted the dynamics of the patient/resident relationship and introduced new stressors for medical trainees, such as new restrictions in the hospital, increased patient death, and uncertainty around safety. There is limited research on the implementation of group therapy for residents to address issues of wellbeing and burnout during the pandemic. Method: In response to perceived burnout amongst internal medicine residents, a university-based internal medicine residency program in the Northeast United States implemented process groups, a form of group therapy, in the curriculum. These sessions were held hourly once every five weeks for each cohort of twelve residents during the academic year. We sought to measure resident burnout and identify themes that impacted wellbeing to facilitate the intervention of process groups during the pandemic. In 2021 and 2022, internal medicine residents were invited to complete the Maslach Burnout Inventory (MBI) and answer two open-ended questions about the factors that most negatively and positively influenced their wellness. Results: Of the 134 participants, 82% had high emotional exhaustion or depersonalization. The most prevalent themes hindering wellness were negative personal interactions at work, most notably rude behavior by patients, unsupportive attendings, residency program expectations, and work intensity. Findings unique to the pandemic include social isolation from family, distress from poor outcomes, and fear of contracting or spreading the virus. The most prevalent themes for supporting wellness were personal life, camaraderie, professional satisfaction, and program structured support. Conclusions: Our findings suggest that programs can tailor structured support to improve wellness, despite the presence of significant stressors.

Modelling of the time to death of breast cancer patients at Hiwot Fana Specialized University Hospital

Breast cancer is the most common cause of cancer death and is a frequently diagnosed cancer among women worldwide. It is becoming a challenging health condition in Ethiopia with a high rate of morbidity and mortality. The main aim of this study was to model the time to death in breast cancer patients at Hiwot Fana Specialized University Hospital. A retrospective cohort study was carried out from April 1st, 2020, to April 1st, 2023, and 296 women were included in the study. We used nonparametric methods and Bayesian accelerated failure time models (with Laplace approximation) to identify risk factors and choose a model fitting breast cancer patient data. Model comparison was performed using the marginal likelihood, deviance information criterion and Watanabe Akaike information criterion. From the total of 296 patients in the study, 56 (18.9%) died. The estimated median survival time was 33 months. The log-rank test showed that age group, stage, alcohol consumption, smoking habit, and comorbidity were potential risk factors associated with the time to death in breast cancer patients at the 5% level of significance. The Bayesian Weibull accelerated failure time model was found to be the best fitted model for predicting the survival time of patients with minimum DIC (520.39) and WAIC (521.59) values. The final Bayesian Weibull AFT model with the integrated nested Laplace approximation estimation technique revealed that age group, stage, alcohol consumption, smoking habit, and comorbidity were significantly associated with the time to death in breast cancer patients. Individuals older than 65 years, with stage IV disease, drinking alcohol, smoking cigarettes and having comorbidities had shortened survival times in patients with breast cancer. Hence, Hiwot Fana Specialized University Hospital and related bodies should work on awareness creation to reduce smoking habits and alcohol use as well as give due attention to elderly and stage IV breast cancer patients during intervention.

The impact of COVID-19 infection on idiopathic pulmonary fibrosis mortality: a systematic review and meta-analysis.

COVID-19 has a negative impact on the survival of respiratory patients, especially those with interstitial lung disease. This review aims to better understand the effect of COVID-19 on patients with idiopathic pulmonary fibrosis (IPF). A systematic search of MEDLINE, PubMed, Embase, and Scopus performed from December 2019 up to July 2024 identified relevant studies. Eligibility criteria included English language, sample size ≥10 patients, COVID-19 infection and outcome measures. Two independent reviewers assessed studies using the Newcastle-Ottawa Scale for bias and extracted data. Meta-analysis employed a random-effects model, and the Grading of Recommendations Assessment, Development and Evaluation assessed evidence quality. Outcomes considered were hospitalization, intensive care unit admission, and mortality. Of the 1541 initially identified articles, 6 high-quality studies were included. Meta-analysis revealed a 34% mortality rate [95% confidence interval (CI): 21-48%], 36% hospitalization rate (95% CI: 10-75%), and 31% ICU admission rate (95% CI: 7-71%) among IPF patients with COVID-19. The certainty of evidence was low or very low due to publication bias and heterogeneity. This study underscores the elevated risk of hospitalization and death in IPF patients with COVID-19, emphasizing the vulnerability of this population. Prompt and tailored care is crucial to mitigate the impact of COVID-19 on IPF patients, necessitating proactive measures, vaccination, and comprehensive management.

Sudden Cardiac Death Reporting in US Dialysis Patients: Comparison of USRDS and National Death Index Data.

Cause-specific mortality data from the United States Renal Data System (USRDS) form the basis for identifying cardiovascular disease (CVD), specifically sudden cardiac death (SCD), as the leading cause of death for patients on dialysis. Death certificate data from the National Death Index (NDI) is the epidemiological standard for assessing causes of death for the United States population. The cause of death has not been compared between the USRDS and the NDI. Among 39,507 adults starting dialysis in the US, we identified 6436 patients who died between 2003-2009. We classified the cause of death as SCD, non-SCD CVD, cancer, infection, and others; and compared the USRDS to the NDI. Median age at the time of death was 70 years, 44% were female, and 30% were non-Hispanic Black individuals. The median time from dialysis initiation to death was 1.2 years. Most deaths occurred in-hospital (N=4681, 73%). The overall concordance in cause of death between the two national registries was 42% (κ=0.23, 95% confidence interval 0.22 to 0.24). CVD, including SCD and non-SCD CVD, accounted for 67% of deaths per the USRDS but only 52% per the NDI; this difference was mainly driven by the larger proportion of SCD in the USRDS (42%) versus the NDI (22%). Of the 2962 deaths reported as SCD by the USRDS, only 35% were also classified as SCD by the NDI. Out-of-hospital deaths were more likely to be classified as SCD in the USRDS (60%) versus the NDI (29%), compared to in-hospital deaths (41% in the USRDS; 25% in the NDI). Significant discordance exists in the causes of death for patients on dialysis reported by the USRDS and the NDI. Our findings underscore the urgent need to integrate NDI data into the USRDS registry and enhance the accuracy of cause-of-death reporting.

Subcutaneous adipose tissue measured by computed tomography could be an independent predictor for early outcomes of patients with severe COVID-19.

Patients with severe Coronavirus Disease 2019 (COVID-19) can experience protein loss due to the inflammatory response and energy consumption, impairing immune function. The presence of excessive visceral and heart fat leads to chronic long-term inflammation that can adversely affect immune function and, thus, outcomes for these patients. We aimed to explore the roles of prognostic nutrition index (PNI) and quantitative fat assessment based on computed tomography (CT) scans in predicting the outcomes of patients with severe COVID-19. A total of 130 patients with severe COVID-19 who were treated between December 1, 2022, and February 28, 2023, were retrospectively enrolled. The patients were divided into survival and death groups. Data on chest CT examinations following admission were collected to measure cardiac adipose tissue (CAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) and to analyze the CT score of pulmonary lesions. Clinical information and laboratory examination data were collected. Univariate and multivariate logistic regression analyses were used to explore the risk factors associated with death, and several multivariate logistic regression models were established. Of the 130 patients included in the study (median age, 80.5 years; males, 32%), 68 patients died and 62 patients survived. PNI showed a strong association with the outcome of severe COVID-19 (p < 0.001). Among each part of the fat volume obtained based on a CT scan, SAT showed a significant association with the mortality of severe COVID-19 patients (p = 0.007). However, VAT and CAT were not significantly correlated with the death of patients. In the multivariate models, SAT had a higher predictive value than PNI; the area under the curve (AUC) of SAT was 0.844, which was higher than that of PNI (AUC = 0.833), but in the model of the combination of the two indexes, the prediction did not improve (AUC = 0.830), and SAT lost its significance (p = 0.069). Subcutaneous adipose tissue measured by computed tomography and PNI were found to be independent predictors of death in patients with severe COVID-19.

Deep learning of echocardiography distinguishes between presence and absence of late gadolinium enhancement on cardiac magnetic resonance in patients with hypertrophic cardiomyopathy

BackgroundHypertrophic cardiomyopathy (HCM) can cause myocardial fibrosis, which can be a substrate for fatal ventricular arrhythmias and subsequent sudden cardiac death. Although late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) represents myocardial fibrosis and is associated with sudden cardiac death in patients with HCM, CMR is resource-intensive, can carry an economic burden, and is sometimes contraindicated. In this study for patients with HCM, we aimed to distinguish between patients with positive and negative LGE on CMR using deep learning of echocardiographic images.MethodsIn the cross-sectional study of patients with HCM, we enrolled patients who underwent both echocardiography and CMR. The outcome was positive LGE on CMR. Among the 323 samples, we randomly selected 273 samples (training set) and employed deep convolutional neural network (DCNN) of echocardiographic 5-chamber view to discriminate positive LGE on CMR. We also developed a reference model using clinical parameters with significant differences between patients with positive and negative LGE. In the remaining 50 samples (test set), we compared the area under the receiver-operating-characteristic curve (AUC) between a combined model using the reference model plus the DCNN-derived probability and the reference model.ResultsAmong the 323 CMR studies, positive LGE was detected in 160 (50%). The reference model was constructed using the following 7 clinical parameters: family history of HCM, maximum left ventricular (LV) wall thickness, LV end-diastolic diameter, LV end-systolic volume, LV ejection fraction < 50%, left atrial diameter, and LV outflow tract pressure gradient at rest. The discriminant model combining the reference model with DCNN-derived probability significantly outperformed the reference model in the test set (AUC 0.86 [95% confidence interval 0.76–0.96] vs. 0.72 [0.57–0.86], P = 0.04). The sensitivity, specificity, positive predictive value, and negative predictive value of the combined model were 0.84, 0.76, 0.78, and 0.83, respectively.ConclusionCompared to the reference model solely based on clinical parameters, our new model integrating the reference model and deep learning-based analysis of echocardiographic images demonstrated superiority in distinguishing LGE on CMR in patients with HCM. The novel deep learning-based method can be used as an assistive technology to facilitate the decision-making process of performing CMR with gadolinium enhancement.

Bereavement coping strategies among healthcare professionals: A qualitative systematic review and meta-synthesis.

Coping with a patient's death is one of the most challenging events faced by healthcare professionals in clinical practice. A broad understanding of the coping strategies used by healthcare professionals is fundamental to the development of effective interventions and the provision of good bereavement care. This review aims to systematically synthesize the coping experience of healthcare professionals in the course of their work when they are confronted with patient deaths. PubMed, Embase, ScienceDirect, CINAHL, PsycINFO, Web of Science, Cochrane Library, Scopus, and Wiley online library were searched in April 2023 with no restriction on publication date. A 3-stage thematic synthesis method was applied for data integration and analysis. Thirty studies involving 545 participants met the inclusion criteria and scored a high level on quality assessment ranging from 9.0 to 10.0. Six themes were identified: emotional coping, cognitive coping, behavioral coping, relational coping, spiritual coping, and occupational coping. Overall, the coping strategies used by healthcare professionals in response to bereavement were found to be unique and multidimensional. Understanding how healthcare practitioners use emotional, cognitive, behavioral, relational, spiritual, and professional strategies to cope with bereavement will prove extremely beneficial in helping them to manage their grief, and can furthermore promote their professional growth and ensure the provision of excellent bereavement care for patients.

LMNA-Cardiomyopathy in Emery-Dreifuss Muscular Dystrophy

Emery-Dreifuss muscular dystrophy is a rare disease resulting from a genetic defect in nuclear envelope proteins, most commonly in emerin and lamin A/C. The disease is characterized by slowly progressing weakness of the scapular-brachial and pelvic-peroneal muscle groups, myodystrophy, primary joint contracture and cardiomyopathy with rhythm disorders and conduction abnormalities. Cardiovascular complications and life-threatening arrhythmias are the main cause of death in such patients at a young age. Depending on the leading symptoms and family history, patients are under the care of different specialists. Unfortunately, neurologists, cardiologists, cardio surgeons and orthopedics are not well informed about this rare condition and thus the disease tends to be not diagnosed in time. This article examines the data of epidemiology, pathophysiology, features of the course, diagnosis, approaches to the management of cardiovascular pathology in progressive Emery-Dreyfus muscular dystrophy with the development of LMNA cardiomyopathy. A clinical case of this disease is also given.

COVID-19 vaccination and lethality reduction: a prospective observational study in Venezuela during the last two waves

BackgroundIn Venezuela, the predominant vaccines administered are BBIBP-CorV and Gam-COVID-Vac. Despite robust evidence from randomized clinical trials validating the effectiveness of COVID-19 vaccines in mitigating hospitalization and mortality, there is still a lack of post-authorization safety studies conducted within this demographic population.MethodsA prospective observational study from October 5, 2021 to March 31, 2022 encompassed COVID-19 vaccinated and unvaccinated patients from four sentinel hospitals in Venezuela. Patient lethality was predicted using Charlson Comorbidity index. Clinical outcomes were assessed through WHO’s COVID-19 Clinical Progression Scale.ResultsOut of the 175 patients assessed, 85 (48.6%) were vaccinated. The median Charlson Comorbidity index was 3 points, with no statistically significant differences observed between the groups (p = 0.2). A total of 50 (28.6%) patients died during the study period, with higher proportion of deaths in unvaccinated patients (35.6% vs. 21.2%, p = 0.035). Advanced age (OR = 1.043, 95% CI = 1.015–1.071, p = 0.002) was associated with increased death risk, whereas vaccination against COVID-19 (OR = 0.428, 95% CI = 0.185–0.99, p = 0.047), high oxygen saturation (OR = 0.964, 95% CI = 0.934–0.995, p = 0.024), and enoxaparin administration (OR = 0.292, 95% CI = 0.093–0.917, p = 0.035) were associated with decreased death risk.ConclusionDuring the third and fourth waves of the pandemic, COVID-19 vaccination was associated with a 57% reduction in lethality among patients in four public hospitals in Venezuela.

Risk factors of thromboembolic events in patients with scrub typhus.

Thromboembolic events are a well-recognized cause of in-hospital deaths of patients with infectious diseases. However, thromboembolic events in patients with scrub typhus, caused by Orientia tsutsugamushi have rarely been reported. This study aimed to assess risk factors associated with thromboembolic events in patients with scrub typhus. All 93 scrub typhus patients' diagnoses were confirmed serologically or by positive nested polymerase chain reaction (PCR). The clinical and laboratory findings from 12 scrub typhus patients with thromboembolic events and 81 scrub typhus patients with nonthromboembolic events were retrospectively studied. To determine the factors implicated in thromboembolic events, we performed multivariate logistic regression analysis using the six independent factors identified by the univariate analysis. The mean age of the patients in the thromboembolic group was 76.4 years (median, 76 years), and in nonthromboembolic group it was 64.6 years (median, 65 years) (P<0·001). Thromboembolic events were observed in 12 patients. These events included acute coronary syndrome (n = 5), acute limb ischemia (n = 4), ischemic stroke (n = 1), deep vein thrombosis combined with pulmonary thromboembolism (n = 1), and left common iliac artery aneurysm with a thrombus (n = 1). According to multivariate analysis, the following four factors were significantly associated with the thromboembolic events: 1) treatment with rifampin (OR = 57.6; CI 1.2-2700.3), 2) Taguchi genotype (OR = 41.5, P = 0.028; CI 1.5-1154.6), 3) atrial fibrillation (OR = 9.4, P = 0.034; CI 1.2-74.0), and 4) age (OR = 1.1, P = 0.046; CI 1.0-1.3). Our study suggests that clinicians should be cautious when managing patients with scrub typhus to avoid the development of thromboembolic events, especially in patients with risk factors such as treatment with rifampin, Taguchi genotype, atrial fibrillation, and advanced age.

Prediction of Fetal Death in Preterm Preeclampsia Using Fetal Sex, Placental Growth Factor and Gestational Age.

Preeclampsia (PE) is a systemic disease that affects 4.6% of pregnancies. Despite the existence of a first-trimester screening for the prediction of preterm PE, no consensus exists regarding neither the right moment to end the pregnancy nor the appropriate variables to estimate the prognosis. The objective of this study was to obtain a prediction model for perinatal death in patients with preterm PE, useful for clinical practice. Singleton pregnant women with PE and preterm delivery were included in an observational retrospective study. Multiple maternal and fetal variables were collected, and several multivariable logistic regression analyses were applied to construct models to predict perinatal death, selecting the most accurate and reproducible according to the highest area under the curve (AUC) and the lowest Akaike Information Criteria (AIC). A group of 148 pregnant women were included, and 18 perinatal deaths were registered. Univariable logistic regression selected as statistically significant variables the following: gestational age (GA) at admission, fetal sex, poor response to antihypertensive drugs, PlGF, umbilical artery (UA) pulsatility index (PI), cerebroplacental ratio (CPR), and absent/reversed ductus venosus (DV). The multivariable model, including all these parameters, presented an AUC of 0.95 and an AIC of 76.5. However, a model including only GA and fetal sex presented a similar accuracy with the highest simplicity (AUC 0.93, AIC 67.6). Finally, in fetuses with a similar GA, fetal death became dependent on PlGF and fetal sex, underlying the role of fetal sex in all circumstances. Female fetal sex and low PlGF are notorious predictors of perinatal death in preterm PE, only surpassed by early GA at birth.

Racial Inequities in Receiving Neoadjuvant Treatment in Patients With Pancreatic Cancer Are Associated With Worse Outcomes in Louisiana.

Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related deaths. In recent years, the approach to managing this malignancy has evolved toward embracing neoadjuvant treatment (NAT), backed by studies reporting its survival benefit. This study aimed to identify factors that contribute to disparities in NAT utilization and their impact on outcomes in patients with PDAC who underwent resection in Louisiana. Data on diagnosed PDAC cases were obtained from the Louisiana Tumor Registry between 2000 and 2020. We conducted multivariable logistic regression to adjust for potential confounding factors in assessing the covariate relationships with NAT use. Multivariate Cox regression analysis was performed to determine which factors were associated with survival. Chained multiple imputation was performed on covariates with missing data in multivariable regressions. The study encompassed 2121 patients who underwent resection for PDAC. Upon controlling for potential confounding variables, Black patients were on average 5.7% less likely to receive NAT than their White counterparts (ATE = 5.7, aOR= 0.56, 95% CI = 0.40-0.80, p = 0.001). After adjustment for confounding factors, there was a significant decrease in the risk of overall death for patients who received NAT (aHR = 0.82, 95% CI = 0.71-0.94, p = 0.006). There was no significant interaction between race and NAT for the risk of death. Black patients with PDAC were less likely to receive NAT before resection in Louisiana. Overall survival improved in patients who underwent NAT. These differences were independent of insurance status and poverty zip codes, and future investigations should identify modifiable barriers to access and receipt of NAT in patients with PDAC.

Usefulness of the CHA2DS2-VASc Score in Predicting the Outcome in Subjects Hospitalized with COVID-19—A Subanalysis of the COLOS Study

Background: The aim of this study was to see if the CHA2DS2-VASc score (Cardiac failure or dysfunction, Hypertension, Age ≥ 75 [Doubled], Diabetes, Stroke [Doubled]—Vascular disease, Age 65–74 and Sex category [Female] score) could have potential clinical relevance in predicting the outcome of hospitalization time, need for ICU hospitalization, survival time, in-hospital mortality, and mortality at 3 and 6 months after discharge home. Materials: A retrospective analysis of 2183 patients with COVID-19 hospitalized at the COVID-19 Centre of the University Hospital in Wrocław, Poland, between February 2020 and June 2021, was performed. All medical records were collected as part of the COronavirus in LOwer Silesia—the COLOS registry project. The CHA2DS2-VASc score was applied for all subjects, and the patients were observed from admission to hospital until the day of discharge or death. Further information on patient deaths was prospectively collected following the 90 and 180 days after admission. The new risk stratification derived from differences in survival curves and long-term follow-up of our patients was obtained. Primary outcomes measured included in-hospital mortality and 3-month and 6-month all-cause mortality, whereas secondary outcomes included termination of hospitalization from causes other than death (home discharges/transfer to another facility or deterioration/referral to rehabilitation) and non-fatal adverse events during hospitalization. Results: It was shown that gender had no effect on mortality. Significantly shorter hospitalization time was observed in the group of patients with low CHA2DS2-VASc scores. Among secondary outcomes, CHA2DS2-VASc score revealed predictive value in both genders for cardiogenic (5.79% vs. 0.69%; p &lt; 0.0001), stroke/TIA (0.48% vs. 9.92%; p &lt; 0.0001), acute heart failure (0.97% vs. 18.18%; p &lt; 0.0001), pneumonia (43% vs. 63.64%; p &lt; 0.0001), and acute renal failure (7.04% vs. 23.97%; p &lt; 0.0001). This study points at the usefulness of the CHA2DS2-VASc score in predicting the severity of the course of COVID-19. Conclusions: Routine use of this scale in clinical practice may suggest the legitimacy of extending its application to the assessment of not only the risk of thromboembolic events in the COVID-19 cohort.

The Role of a Community Surgeon in the Care of Hepatopancreatobiliary Patients: Short-Term Outcomes and Learning Curve.

Background Owing to the well-established volume-outcome relationship, hepatopancreatobiliary (HPB) surgery is commonly regionalized to academic, teaching hospitals. However, regionalization is associated with decreased access for some populations in need, as well as geographic and financial barriers for patients. If high surgeon and institutional volumes can be achieved, the community, non-teaching HPB surgical practice could help alleviate some issues associated with regionalization. The HPB experience of a community surgeon immediately after surgical oncology training was reviewed, hypothesizing that high volumes with acceptable short-term outcomes could be achieved, although a learning curve may be observed. Materials and methods Electronic medical records from 2013 to 2023 were reviewed. Data included patient demographics, perioperative details, pathology, complications, and deaths over 90 postoperative days. Perioperative quality metrics were assessed for trends over time in pancreaticoduodenectomy (PD) and liver resection subgroups. Results A total of 295 patients underwent 176 (59.7%) pancreatic and 119 (40.3%) hepatobiliary operations. The most common operations were PD (n=87; 49.4%) and partial hepatic lobectomy (n=56; 41.1%). In the pancreas group, morbidity was 25% (n=44), and mortality was 4.5% (n=8). In the hepatobiliary group, morbidity and mortality were 19.3% (n=23) and 5.0% (n=6), respectively. Within the PD and liver resection subgroups, operative time, estimated blood loss, and hospital length of stay (LOS) trended downward over time, with LOS decreasing significantly. Conclusion High HPB volumes with acceptable short-term outcomes can be achieved by a solo practitioner in the community, non-teaching setting. For PDs and liver resections, perioperative metrics trended downward over time, illustrating the learning curve encountered after training.

Spatial multiomics atlas reveals smooth muscle phenotypic transformation and metabolic reprogramming in diabetic macroangiopathy

BackgroundDiabetic macroangiopathy has been the main cause of death and disability in diabetic patients. The mechanisms underlying smooth muscle cell transformation and metabolic reprogramming other than abnormal glucose and lipid metabolism remain to be further explored.MethodSingle-cell transcriptome, spatial transcriptome and spatial metabolome sequencing were performed on anterior tibial artery from 11 diabetic patients with amputation. Multi-omics integration, cell communication analysis, time series analysis, network analysis, enrichment analysis, and gene expression analysis were performed to elucidate the potential molecular features.ResultWe constructed a spatial multiomics map of diabetic blood vessels based on multiomics integration, indicating single-cell and spatial landscape of transcriptome and spatial landscape of metabolome. At the same time, the characteristics of cell composition and biological function of calcified regions were obtained by integrating spatial omics and single cell omics. On this basis, our study provides favorable evidence for the cellular fate of smooth muscle cells, which can be transformed into pro-inflammatory chemotactic smooth muscle cells, macrophage-like smooth muscle cells/foam-like smooth muscle cells, and fibroblast/chondroblast smooth muscle cells in the anterior tibial artery of diabetic patients. The smooth muscle cell phenotypic transformation is driven by transcription factors net including KDM5B, DDIT3, etc. In addition, in order to focus on metabolic reprogramming apart from abnormal glucose and lipid metabolism, we constructed a metabolic network of diabetic vascular activation, and found that HNMT and CYP27A1 participate in diabetic vascular metabolic reprogramming by combining public data.ConclusionThis study constructs the spatial gene-metabolism map of the whole anterior tibial artery for the first time and reveals the characteristics of vascular calcification, the phenotypic transformation trend of SMCs, and the transcriptional driving network of SMCs phenotypic transformation of diabetic macrovascular disease. In the perspective of combining the transcriptome and metabolome, the study demonstrates the activated metabolic pathways in diabetic blood vessels and the key genes involved in diabetic metabolic reprogramming.Graphical abstract