Marker Of Mortality In Patients Research Articles

Portal venous contrast enhancement ratio of the adrenal glands and spleen as prognostic marker of mortality in patients with acute mesenteric ischemia.

Contrast enhancement of the adrenal gland defined by computed tomography (CT) was previously analyzed as a prognostic factor for critically ill patients in various diseases. However, no study investigated this quantitative parameter in patients with acute mesenteric ischemia. Therefore, the aim of this study was to evaluate the prognostic value of the contrast enhancement of the adrenal glands in patients with clinically suspected AMI. All patients with clinically suspected AMI were retrospectively assessed between 2016 and 2020. All patients underwent surgical exploration after CT imaging. Overall, 134 patients (52 female patients, 38.8%) with a mean age of 69.2 ± 12.4years were included into the present analysis. For all patients, the preoperative CT was used to calculate the contrast media enhancement of the adrenal glands and the spleen. A total of 27 patients (18.5%) died within the first 24h and over the following 30-day 94 patients (68.6%) died. There were statistically significant differences regarding the mean values for adrenal-to-spleen ratio for 24-h mortality (p = 0.001) and 30-day mortality (p = 0.004), whereas the radiodensity of the inferior vena cava and the radiodensity of the spleen was statistically significant between survivors and non-survivors after 30 days (p = 0.037 and p = 0.028, respectively). In Cox regression analysis, mean adrenal radiodensity was associated with 24-h mortality (HR 1.09, 95% CI 1.02-1.16, p = 0.01) but not with 30-day mortality (HR 1.03, 95% CI 0.99-1.07, p = 0.13). The contrast media enhancement of the adrenal gland is associated with the 24-h and 30-day mortality in patients with AMI. However, the prognostic relevance for translation into clinical routine needs to be validated in other cohorts.

Features of Inflammatory Syndrome in Patients with COVID-19-Associated Pneumonia and Concomitant Chronic Coronary Syndrome

Introduction. The COVID-19 coronavirus disease caused by the SARS-CoV-2 virus has become an unprecedented challenge for the healthcare system and has taken a leading position among infectious diseases due to its rapid spread and development of complications in various body systems. COVID-19 has been shown to increase the long-term risk of both ischemic and nonischemic cardiovascular diseases. This underscores the need for primary prevention through measures such as vaccination and a deeper understanding of the pathophysiology linking COVID-19 to endothelial dysfunction and systemic inflammation. Patients hospitalized for coronavirus disease often have concomitant cardiometabolic disease. Cardiovascular complications are common in these patients, emphasizing the need for ongoing research to better understand these effects. The role of integral inflammatory indices in patients with coronavirus disease in the setting of chronic coronary syndromes (CCS) is unexplored.
 Aim. To identify the features of the course of chronic coronary syndromes in patients with pneumonia caused by coronavirus infection COVID-19, as well as to assess the relationship between the level of inflammatory indices and the severity of the disease.
 Materials and methods. 124 patients with COVID-19 were enrolled upon admission to the cardiology department of the Central City Clinical Hospital in Ivano-Frankivsk, the therapeutic department of the Kolomyia Central District Hospital and the therapeutic department of the Verkhovyna Hospital, 124 patients with COVID-19-associated pneumonia were selected, including 92 patients with a history of chronic coronary syndromes (CCS), including 49 patients with a history of acute myocardial infarction, 43 patients with stable angina pectoris and 32 patients without a history of CCS.
 Results of the study. The mean age of the examined patients was (66,2±7,8) years in the CCS group and (59,9±8,9) years in the non-CCS group.Among the patients with severe course, there were 36 patients (39,1%) in the CCS group and 10 patients (31,2%) in the non-CCS group. In the CCS group, 4 patients (4,3%) died, and in the non-CCS group, 2 patients (6,2%) died. The BMI in patients with CCS was (28,3 [26,2; 30,9]) kg/m2, in the group without CCS (26,66±3,59) kg/m2 and was higher in the CCS group (p=0,03). The mean number of days from the onset of symptoms to hospitalization in the CCS group was (7 [5;7] days, in the non-CCS group (7 [5;7] days). There was significant difference in the levels of inflammatory indices in the study groups after treatment, lower levels of SIRI 1,12 [0,58; 1,98] vs. 1,71 [0,74; 3,98] (p=0,04), NLR 4,22 [2,79; 5,40] vs. 5,3 [3,8; 9,56] (p=0,03), SII 936,75 [571,30; 1263,16] vs. 1198,75 [784,0; 2627,78] (p=0,008), PLR 154,75 [115,27; 208,09] vs. [124,23; 307,83] (p=0,04), AISI 253,61 [96,18; 437,47] vs.345,28 [229,48; 1040,13] (p=0,01). In the CCS group, a significant increase in the level of the LMR index (p=0,01) and a decrease in the level of CRP/L (p<0,0001) were observed after treatment. According to the results of the ROC analysis, there is a significant prognostic value of the CRP/L marker for mortality in patients with COVID-19 pneumonia and concomitant CVD (AUC = 0,901; 95% CI 0,820 – 0,953; p<0,0001) during hospitalization. The markers NMR, SIRI, NLR, SII, PLR, AISI, dNLR, CRP/L had a significant prognostic value for mortality when observed in the dynamics.
 Conclusions. Increased levels of inflammatory indices showed a significant value in predicting hospital mortality from COVID-19 with concomitant CCS in the dynamics but had no prognostic value during hospitalization. Patients who were discharged with recovery or improvement had lower levels of inflammatory indices in the presence of concomitant CCS in the anamnesis.

The assessment of serum uric acid-to-HDL cholesterol ratio as a new predictor of mortality in ST-elevation myocardial infarction: a cross-sectional study

Aims: The objective of this study was to evaluate the predictive efficacy of the Uric Acid-to-High Density Lipoprotein Cholesterol Ratio (UHR) as a novel inflammatory and metabolic marker for mortality in patients with ST-segment Elevation Myocardial Infarction (STEMI).
 Methods: This retrospective, single-center, cross-sectional, observational study enrolled 1361 patients diagnosed with STEMI undergoing primary percutaneous coronary intervention (PPCI) from March 2021, to January 2022. The participants were categorized into two groups: those experiencing in-hospital mortality (n=100) and those without in-hospital mortality (n=1265).
 Results: In-hospital mortality occurred in 100 patients (7.3%). UHR was notably higher in the mortality group compared to the non-mortality group (23.6±14.9% vs. 15.3±6.9%, p

Spot urinary sodium as a prognostic marker for mortality in patients with acute decompensated heart failure

Introduction. Urinary sodium has been proposed as a prognostic marker and indicator of the diuretic response in patients with heart failure. However, study results are heterogeneous. Objective. To evaluate the spot urinary sodium level as a risk factor for mortality in patients with decompensated heart failure. Materials and methods. We conducted a case-control study nested in a prospective cohort of patients with decompensated heart failure. The primary outcome was mortality at 180 days. The risk factors associated with mortality were evaluated through a bivariate analysis. Differences in clinical variables between groups with urinary sodium greater than or lesser than 70 mEq/L were analyzed. Results. The study included 79 patients; 15 died at 180 days. Their mean age was 68.9 years (SD=± 13.8); 30 were women (38%), and 15 (18.9%) had urinary sodium <70 mEq/L. In the bivariate analysis, a significant association was found between mortality and past medical history of hospitalizations, SBP<90 mm Hg, the use of inotropes, and urinary sodium <70 mEq/L. Regarding clinical characteristics, patients with low urinary sodium level in the last year were hospitalized more frequently with hyponatremia and hypotension at admission. Conclusion. Patients with urinary sodium <70 mEq/L had more severe signs. In a bivariate analysis, urinary sodium was associated with mortality at 180 days.

Association between prognostic nutritional index and peritoneal dialysis discontinuation: a retrospective cohort study

BackgroundMalnutrition is associated with discontinuing peritoneal dialysis (PD). The prognostic nutritional index (PNI), composed of serum albumin level and total lymphocyte count, has been suggested as a prognostic marker for mortality in patients undergoing PD. However, the relationship between PNI and PD discontinuation has not yet been well addressed. We evaluated the relationship between PNI and PD discontinuation in patients with end-stage kidney disease who initiated PD treatment.MethodsThis retrospective cohort study included patients who underwent PD at a single academic hospital between 2007 and 2022. We examined the association between PNI (< 40 vs. ≥ 40) and PD discontinuation using Cox proportional hazards regression models. We used restricted cubic spline analysis to examine the continuous associations between the PNI and outcomes.ResultsThe mean age (and standard deviation) of the 91 patients was 57.1 ± 13.4 years; 72 (79.1%) discontinued PD during the median follow-up period of 25.0 months. Lower PNI was associated with an increased risk of PD discontinuation. The hazard ratios (95% confidence intervals) with three levels of adjustments were 1.74 (1.08, 2.79), 2.21 (1.32, 3.66), and 1.81 (1.01, 3.24) (reference: PNI ≥ 40). Restricted cubic spline analysis showed that a PNI < 40 was continuously associated with a higher risk of PD discontinuation.ConclusionA lower PNI (< 40) was associated with a higher risk of PD discontinuation. Our findings suggest that evaluating the PNI may help identify patients at high risk of PD discontinuation and lead to appropriate nutritional management for dialysis maintenance.

Correlation between admission red cell distribution width and GRACE risk score as an early mortality marker in patients with acute myocardial infarction

Background: Red blood cell distribution width (RDW) is a measurement of the size variation of red blood cells in circulation. The Global Registry of Acute Coronary Events (GRACE) score is the most commonly used risk-stratification scoring system to predict mortality in acute coronary syndrome for both ST- elevated myocardial infarction (STEMI), non-ST elevated myocardial infarction (NSTEMI). The aim of this study was to assess the easily determinable red blood cell distribution width (RDW) as an early mortality marker of acute myocardial infarction (MI) mortality and the correlation of RDW-CV on admission with GRACE risk score in patients with acute myocardial infarction. Methods: This hospital-based, prospective observational study included 211 patients (mean age 58.15 +/- 12.45 years, male 176) admitted with acute MI (STEMI/NSTEMI) from January 2022 to June 2022. The study population was divided into two groups basing on the 50th percentile of the admission RDW-CV value -13.7. The GRACE score was calculated on admission to predict the GRACE in hospital mortality score within 24 hours of admission. Results: The study found that the higher RDW-CV values were associated with adverse prognostic factors in acute myocardial infarction like increased age, lower systolic blood pressure, heart failure, cardiac arrest, higher cardiac biomarker levels and higher in-hospital mortality (p = 0.049, level of significance p&lt; 0.05) and this correlated with a higher GRACE score (Pearson’s correlation coefficient R= 0.47, P&lt;0.05). Conclusion: Thus, RDW can be used as a useful parameter for predicting in-hospital mortality in acute MI patients.

#5319 ACCURACY OF PLATELET INDICES AS PREDICTOR OF IN-HOSPITAL MORTALITY IN PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING RENAL REPLACEMENT THERAPY

Abstract Background and Aims Acute kidney injury (AKI) is a major medical complication associated with a markedly increased risk of death, particularly in patients admitted to the ICU where in-hospital mortality exceeds 50%1. This study aimed to determine the accuracy of MPV, platelet count, and PDW as predictors of adverse outcomes in patients with AKI who received initiation renal replacement therapy (RRT). Method A retrospective cohort single-center study was done in a local private tertiary hospital in Cebu. Four hundred ninety-one patients with AKI who underwent RRT between January 2018 and December 2021 were enrolled. A retrieval of data on demographic and clinical parameters during the initiation of RRT was done. The impact of mortality-related factors were identified using univariate and multivariate logistic regression analysis. Determination of optimal cut-off values of platelet indices for in-hospital mortality was done. Results This study showed that the in-hospital mortality of patients was 58.45%, with a mean age of 68.6 ± 16.28 years among non-survivors. Among the platelet indices, platelet count and PDW were good predictors of in-hospital mortality in patients who received initiation renal replacement therapy. The optimal cut-off value of platelet count was 173 × 103/uL (sensitivity 56.45%, specificity 62.25%, PPV 67.78%, NPV 50.40%, AUC 0.604). The optimal cut-off value of PDW was 16.45% (sensitivity 50.87%, specificity 71.57%, PPV 71.57%, NPV 50.87%, AUC 0.611). Conclusion Platelet indices are feasible parameters that can be used as prognostic markers for mortality in patients with AKI requiring RRT. The in-hospital mortality of patients with AKI requiring initiation RRT is high (58.45%). Low platelet counts, high MPV values, and high PDW values are associated with poorer outcomes and higher mortality risk as compared to patients with normal indices.

#5304 ACCURACY OF PLATELET INDICES AS PREDICTOR OF IN-HOSPITAL MORTALITY IN PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING RENAL REPLACEMENT THERAPY

Abstract Background and Aims Acute kidney injury (AKI) is a major medical complication associated with a markedly increased risk of death, particularly in patients admitted to the ICU where in-hospital mortality exceeds 50%1. This study aimed to determine the accuracy of MPV, platelet count, and PDW as predictors of adverse outcomes in patients with AKI who received initiation renal replacement therapy (RRT). Method A retrospective cohort single-center study was done in a local private tertiary hospital in Cebu. Four hundred ninety-one patients with AKI who underwent RRT between January 2018 and December 2021 were enrolled. A retrieval of data on demographic and clinical parameters during the initiation of RRT was done. The impact of mortality-related factors were identified using univariate and multivariate logistic regression analysis. Determination of optimal cut-off values of platelet indices for in-hospital mortality was done. Results This study showed that the in-hospital mortality of patients was 58.45%, with a mean age of 68.6 ± 16.28 years among non-survivors. Among the platelet indices, platelet count and PDW were good predictors of in-hospital mortality in patients who received initiation renal replacement therapy. The optimal cut-off value of platelet count was 173 x 103/uL (sensitivity 56.45%, specificity 62.25%, PPV 67.78%, NPV 50.40%, AUC 0.604). The optimal cut-off value of PDW was 16.45% (sensitivity 50.87%, specificity 71.57%, PPV 71.57%, NPV 50.87%, AUC 0.611). Conclusion Platelet indices are feasible parameters that can be used as prognostic markers for mortality in patients with AKI requiring RRT. The in-hospital mortality of patients with AKI requiring initiation RRT is high (58.45%). Low platelet counts, high MPV values, and high PDW values are associated with poorer outcomes and higher mortality risk as compared to patients with normal indices.

#4589 HYPOCHLOREMIA AS A MARKER OF ALL-CAUSE MORTALITY AND UNPLANNED DIALYSIS STARTS IN A COHORT OF ACUTE KIDNEY INJURY: A 4-YEAR FOLLOW-UP STUDY

Abstract Background and Aims Serum chloride is an emerging marker of mortality in patients with hypertension, heart failure, sepsis, and chronic kidney disease. The relationship between hyperchloremia and acute kidney injury is well known, especially in critically ill patients. However, the role of baseline hypochloremia in the prognosis of hospitalized patients with acute kidney injury (AKI) remains poorly understood. Method Retrospective cohort type study. We included n=243 patients with AKI stage 3 from consultations received by the nephrology department of our hospital between January 1, 2017, to December 31, 2017. The sample was divided into two groups considering baseline serum chloride (Cl−) levels. Hypochloremia was considered if Cl−&amp;lt; 98 mEq/L. The primary endpoint was a composite variable for unplanned dialysis starts and all-cause mortality. Results The mean age was 68 years. Females accounted for 39.5%. The mean baseline sodium was 137±7.2 mEq/l, and the mean baseline chloride was 98.9±7.05 mEq/l (Table 1). The mean follow-up of the patients was 21±19.61 months. The incidence of the primary endpoint was n=166 (68.3%). 148 (60.9%) died, of whom 78 (32%) died during their hospital stay. The causes of death were: 30.6% cardiovascular, 12.9% tumor, 44.7% infectious, and 11.8% other. Kaplan-Meier estimates showed lower survival rates in patients with chloride levels below 98 mEq/l (p=0.006, log-rank test) (Figure 1). Conclusion Patients with AKI stage 3 with lower baseline chloride levels (&amp;lt;98 mEq/L) were more likely to have higher overall mortality and unplanned dialysis starts.

Phase angle, nutritional status, and mortality in systemic sclerosis: An exploratory pilot study

ObjectivesSystemic sclerosis (SSc) is a rare autoimmune disease characterized by microvascular damage and fibrosis of the skin and internal organs. Among SSc complications, changes in nutritional status have a negative effect on quality of life and predispose patients to malnutrition. The aim of this exploratory pilot study was to examine whether bioelectrical impedance analysis-derived phase angle (PhA) is a parameter of nutritional status and a marker of mortality in patients with SSc. MethodsConsecutive adult patients with SSc were included in the study. Biochemical analyses, anthropometric data, and bioelectrical impedance analysis assessments were recorded at the time of enrollment. The Malnutrition Universal Screening Tool (MUST) and Global Leadership Initiative on Malnutrition (GLIM) were applied to assess nutritional status. ResultsA total of 104 patients with SSc (88 women; median age: 55 y [interquartile range (IQR), 45.5– 66 y]) were enrolled. In patients with SSc and high malnutrition risk according to MUST, mean values of PhA were significantly lower than those of patients with SSc and low malnutrition risk (4° [IQR, 3.7°–4.4°] vs 4.6° [IQR, 4.2°–5.1°]; P = 0.004). Patients with SSc and malnutrition according to the GLIM criteria showed significantly lower PhA than patients with SSc but without malnutrition (3.8° [IQR, 3.5°–4.3°] vs 4.6° [IQR, 4.2°–5.1°]; P < 0.0001). Kaplan–Meier curves demonstrated that overall survival was significantly shorter (34.57 mo [±13.35] vs 48 mo [±0]; P = 0.001) in patients with SSc and PhA <3.75°. In the multivariate analysis, only PhA was a predictive factor for death (hazard ratio: 0.283; 95% confidence interval, 0.083–0.965; P = 0.044). ConclusionsThe data obtained suggest that lower PhA values in patients with SSc are associated with an increased malnutrition risk with MUST, malnutrition with GLIM, and increased mortality. Additional studies are necessary to confirm these preliminary results.

Every Time Prealbumin May Not be an Indicator for Prognosis in Critically Ill Patients

Objective: Prealbumin renamed transthyretin is a protein that is made in the liver and released in the blood and has been used as a beneficial nutritional indicator for long years. It aimed to investigate whether serum prealbumin level is a marker of mortality in patients hospitalized in the intensive care unit. Methods: This retrospective and single-center study was carried out at level 3 intensive care unit. Data were collected from hospital electronic records and patient file archives. Patient age, gender, acute physiologic and chronic health evaluation score, nutritional risk screening 2002, nutric score, neutr ophil -lymp hocyt e ratio, need for mechanical ventilation and duration, intensive care unit length of stay, comorbid conditions, the situation of nutrition support, causes of enteral feeding intolerance, the situation of protein and energy intake (7 days), laboratory parameters (included prealbumin (0 and 7 days)) at the time of admission to intensive care unit, and mortality status were recorded. Patients were divided into 2 groups as survivors and non-survivors, and the differences between the 2 groups were analyzed for all parameters. Results: Sixty-three (60%) were female of 105 patients who participated in this study. The mean age was 59 ± 23 years. The mortality rate was 48.6%. The length of stay in the intensive care unit was 30 ± 34 days. The median level of serum albumin (g/dL) on day 1 was 2.7 (2.3-3.2) and on day 7, it was 2.5 (2.1-2.8). The mean level of serum prealbumin (mg/dL) on day 1 was 13.8 ± 6.6 and on day 7, it was 12.5 ± 6.5. Prealbumin (on days 0 and 7) values were not different between survivors and non-survivors (for all P &lt; .05). In the binary logistic regression analysis, age and albumin value (on day 7) were found to be independent risk factors for mortality (odds ratio: 1.038 (1.002-1.075), P = .036, odds ratio: 1.148 (1.021-1.290), P = .021), respectively. Conclusions: Prealbumin levels did not differ for critically ill patients with and without mortality.

Whole Blood Massive Transfusion Score is the Most Sensitive Predictor of Mortality among Patients Requiring Emergent Trauma Laparotomy and Massive Resuscitation

Introduction: The whole blood massive transfusion score (WB MT = 3*RBC+WB) was developed to account for the use of whole blood (WB) in trauma resuscitations. A positive WB MT (WB MT ≥7) has shown to better predict mortality among patients requiring activation of massive transfusion (MTP). We sought to evaluate the ability of WB MT to predict mortality in patients with activation of MTP requiring emergent trauma laparotomy (ETL). Methods: A retrospective cohort study of all trauma patients with both ETL and activation of MTP from 11/2019-12/2021. ETL was defined as laparotomy from the trauma bay within 90 minutes of arrival. WB MT was compared with other markers of resuscitation volume [classic massive transfusion (cMT), critical administration threshold (CAT), and resuscitation intensity (RI)] on the basis of diagnostic ability to identify 24-hour and hospital mortality. Results: There were 227 patients included with 24-hour and hospital mortality rates of 18% (n = 40) and 22% (n = 51), respectively. Those with 24-hour mortality were significantly more likely to receive WB MT (100 vs 60%, p < 0.001), cMT (68 vs 13%, p < 0.001), and CAT (90 vs 42%, p < 0.001) compared with survivors. WB MT was the most sensitive predictor of 24-hour and hospital mortality compared with all other markers of massive resuscitation. Conclusion: WB MT was the most sensitive marker of mortality in patients with ETL requiring activation of MTP. Patients with 24-hour survival were significantly more likely to receive WB only MTP while those that died were significantly more likely to received mixed blood products.

The usefulness of D-dimer as a predictive marker for mortality in patients with COVID-19 hospitalized during the first wave in Italy.

The coronavirus disease 2019 (COVID-19) presents an urgent threat to global health. Identification of predictors of poor outcomes will assist medical staff in treatment and allocating limited healthcare resources. The primary aim was to study the value of D-dimer as a predictive marker for in-hospital mortality. This was a cohort study. The study population consisted of hospitalized patients (age >18 years), who were diagnosed with COVID-19 based on real-time PCR at 9 hospitals during the first COVID-19 wave in Lombardy, Italy (Feb-May 2020). The primary endpoint was in-hospital mortality. Information was obtained from patient records. Statistical analyses were performed using a Fine-Gray competing risk survival model. Model discrimination was assessed using Harrell's C-index and model calibration was assessed using a calibration plot. Out of 1049 patients, 507 patients (46%) had evaluable data. Of these 507 patients, 96 died within 30 days. The cumulative incidence of in-hospital mortality within 30 days was 19% (95CI: 16%-23%), and the majority of deaths occurred within the first 10 days. A prediction model containing D-dimer as the only predictor had a C-index of 0.66 (95%CI: 0.61-0.71). Overall calibration of the model was very poor. The addition of D-dimer to a model containing age, sex and co-morbidities as predictors did not lead to any meaningful improvement in either the C-index or the calibration plot. The predictive value of D-dimer alone was moderate, and the addition of D-dimer to a simple model containing basic clinical characteristics did not lead to any improvement in model performance.

POS-549 ADDING UREA THERAPY FROM THE 1890'S TO 21ST CENTURY STANDARD OF CARE

Congestive heart failure (CHF) is present in approximately 2 to 3% of patients older than age 65 years and is 5 to 10% in patients beyond age 75 years. Hyponatremia is a marker of mortality in patients with CHF. Standard therapy includes loop diuretics, but this is sometimes limited by extensive salt losses and diuretic resistance. Vasopressin antagonists like tolvaptan (PO) and conivaptan (IV) are another option in these difficult to treat patients, but use is limited due to availability, price, and side effects that include liver failure, overcorrection, and increased thirst.

Prognostic markers of mortality in patients with methanol poisoning

Prognostic markers of mortality in patients with methanol poisoning

Usefulness of Immature Granulocytes as A Prognostic Factor in ST-Elevation Myocardial Infarction.

ST-segment elevation myocardial infarction (STEMI) is a serious, life-threatening disease. Inflammatory markers have recently become the focus of attention in the assessment of severity in the early stages of STEMI. This study aimed to evaluate the importance of immature granulocytes (IG) as a prognostic marker in STEMI. Patients admitted to the coronary care unit with a diagnosis of STEMI and who underwent primary percutaneous coronary intervention (pPCI) within the period from January 1, 2019 to January 1, 2020, were retrospectively scanned. A total of 146 patients were analised; of these, 112 (76.7%) were male and 34 (33.3) were female, with a mean age of 62.65±14.06 years. Patients' age, gender, haemogram, biochemistry, and mortality results were recorded. The patients were divided into two groups as low (<0.6) and high (≥0.6) IG levels and compared. The mean IG levels were significantly higher in the non-survivor group compared to the survivor group (1.12±0.22 vs. 0.50±0.28, P<0.001). Mortality rates were significantly higher in the high IG group compared to the low IG group (26.9% vs. 9.6%, P=0.006). IG was shown to predict mortality with a sensitivity of 72.2% and a specificity of 77.8% at a cut-off value of 0.65 (area under the curve: 0.740, 95% CI: 0.635-0.846, P<0.001). High IG values in the blood collected at the time of admission to the emergency department are a marker of mortality in patients with STEMI.

Effect of acute kidney injury on hospital-based outcomes in patients admitted for variceal hemorrhage. Analysis of national inpatient sample database.

Acute kidney injury (AKI) is known to be a marker of mortality in patients with cirrhosis and variceal hemorrhage. To study the effect of AKI on hospital-based outcomes in patients with variceal hemorrhage. We obtained data from the National Inpatient Sample for the years 2016-2018. Study inclusion criteria comprised adult variceal hemorrhage patients who also had AKI. The primary outcome of interest was in-hospital mortality. Secondary outcomes were length of stay, hospital charge, shock, blood transfusion, and ICU admission. We also determined the independent predictors of mortality in variceal hemorrhage patients using multivariate regression analysis. We used 2 different methods: multivariate logistic regression and propensity matching to adjust for confounders. The number of people included in this study was 124,430, of whom 32,315 (26%) had AKI. Mortality in variceal hemorrhage patients with AKI was 30.4% in comparison to 4.8% without AKI. The presence of AKI was associated with increased odds of mortality (AOR = 8.28, 95% CI: 7.45-9.20, p < 0.01), ICU admissions (AOR = 4.76, 95% CI: 4.42-5.13, p < 0.01), blood transfusion (AOR = 1.24, 95% CI: 1.15-1.32, p < 0.01), and shock (AOR = 3.41, 95% CI 3.07-3.79, p < 0.01). The patients with AKI also had increased length of stay and hospital charges. Higher Charlson co-morbidity index, African American race, and being admitted to large sized hospital were independently associated with increased mortality. After analyzing the combined NIS dataset of 2016-2018, we concluded that patients admitted with variceal hemorrhage who has AKI are prone to adverse hospital outcomes.

Lesion Length as a Prognosis Marker of Mortality in Patients with Fournier's Gangrene: Proposal of a New Scoring System.

To assess the prognostic value of mortality of a new system for quantifying the lesion length circumscribed to the genitals and adjacent anatomical areas in patients with Fournier's gangrene. An observational, analytical and prospective study in the Urology service of the Arnaldo Milián Castro University Hospital, between January 2007 and December 2019. The sample consisted of 60 patients diagnosed with Fournier's gangrene. To determine the lesion length, a new quantification system was designed by the authors. Its predictive capacity was determined by binary logistic regression analysis and its discriminatory capacity by the area under the ROC curve. In the studied sample, Fournier's gangrene mortality was 26.7%. The logistic regression analysis demonstrated the prognostic value of mortality of the quantification system evaluated, for each point that the extension of the lesion increased, the risk of death increased by approximately five times, thus being superior to the methods previously used to quantify the injury. Results of the calibration of the quantification system by the Hosmer-Lemeshhow test showed that the data were adjusted to the regression equation (p = 0.278). An area under the curve of 0.957 was observed, which reflects a good discriminatory capacity, showing a sensitivity of 93.75% and a specificity of 93.18%. The system for quantifying the lesion length in patients with Fournier's gangrene proposed in the present study showed an excellent prognostic value for mortality. The integration of this new method into others prognostic scores could substantially increase sensibility and specificity on diagnostic, by means of offering a more precise approach of the lesion dimensions.

Fragmented QRS is a marker of mortality in patients with severe COVID-19: A retrospective observational study.

In this study, we aimed to investigate the association of fragmented QRS (f-QRS) with in-hospital death in patients with severe novel coronavirus disease 2019 (COVID-19). This was a retrospective and observational study. A total of 201 consecutive patients with severe COVID-19 were enrolled. Demographic data, laboratory parameters, medications, electrocardiographic (ECG) findings, and clinical outcomes were recorded. Patients with and without f-QRS were compared, and predictors of all-cause in-hospital mortality were analyzed. A total of 135 patients without f-QRS (mean age of 64 years, 43% women) and 66 patients with f-QRS (mean age of 66 years, 39% women) were included. C-reactive protein (CRP), D-dimer, troponin I, ferritin levels, and CRP to albumin ratio were significantly higher in patients with f-QRS. The need for invasive mechanical ventilation (63.6% vs. 41.5%, p=0.003) and all-cause in-hospital mortality [54.5% vs. 28.9%, log rank p=0.001, relative risk 1.88, 95% confidence interval (CI) 1.16-4.78] were significantly higher in patients with f-QRS. A number value of f-QRS leads ≥2 yields sensitivity and specificity (85.3% and 86.7%, respectively) for predicting in-hospital all-cause mortality. Multivariable analysis showed that f-QRS (odds ratio: 1.041, 95% Cl: 1.021-1.192, p=0.040) were independently associated with in-hospital death. This study revealed that the presence of f-QRS in ECG is associated with higher in-hospital all-cause mortality in patients with severe COVID-19. f-QRS is an easily applicable simple indicator to predict the risk of death in these patients.

High sensitivity troponin as a 60-day mortality marker in patients with COVID-19 in intensive care at a Latin American hospital

Abstract Introduction Coronavirus disease (COVID) - 19 presents with periodic outbreaks with a large number of critical cases that overwhelm the health system. One of the objectives of screening and management is to have markers that can efficiently stratify the individual risk of experiencing adverse results. High-sensitivity troponin has been proposed as one of the possible prognostic markers. Purpose To evaluate the prevalence of troponin elevation and its performance for predicting 60-days mortality in patients in ICU due to COVID - 19 in a Latin American population. Methodology A single-center retrospective cohort study was carried out in which patients in ICU for COVID-19 confirmed by RT-PC between May and December 2020 were included. Patients with previous conditions that determined a limitation of therapeutic effort and pregnant women were excluded. The outcome was 60-days mortality. Kaplan Meier survival curves were constructed, a ROC curve was generated for the prediction of death according to troponin levels by calculating the area under the curve. Finally, a Cox proportional hazards model was generated. Results 296 patients were included, 110 (37.2%) female, the mean age was 60 (SD 14) years and the duration of symptoms before admission to the ICU was 8.4 (SD 4.2) days. 81.4% of the patients had at least one comorbidity, 117 (39.5%) had hypertension, 65 (21.9%) had diabetes, and 63 (21.3%) had chronic lung disease. Mortality occurred in 151 cases (51%), 225 (76%) presented shock, 242 (81.8%) severe ARDS (PaO2 / FiO2 &amp;lt;100 mmHg), 232 (78.4%) required invasive ventilatory support, and 153 (5.7%) developed acute kidney injury. The APACHE II average was 13.1 and SOFA 4.8. Troponin was positive in 118 (39.9%) patients, 29.6% of the survivors and 49.7% in non survivors. The AUC was 0.65 (95% CI 0.59–0.71) for predicting mortality (Figure 1). The Kaplan Meier curves are shown in Figure 2 with a p less than 0.001 by achieving the test. In the bivariate analysis, troponin obtained a HR of 1.94 and p&amp;lt;0.001, but in the multivariate model it was 1.39 (95% CI of 0.21–1.56) and p of 0.12. Conclusions High sensitivity troponin was found to be elevated in patients hospitalized for COVID-19 in the intensive care unit who died, with regular discrimination (AUC: 0.65), even though the univariate analysis by the Cox and Kaplan Meier methods showed association with 60-days mortality, this was not maintained in the multivariate model. Funding Acknowledgement Type of funding sources: None. Figure 1. ROC curveFigure 2. Kaplan Meier survival curves