Mortality Factors Research Articles

Preoperative D-dimer and outcomes in obstructive hypertrophic cardiomyopathy after myectomy

BackgroundThe prognostic significance of D-dimer in patients with hypertrophic cardiomyopathy undergoing septal myectomy has not been well established. MethodsWe retrospectively analyzed D-dimer levels in 728 patients who underwent septal myectomy at our hospital between 2009 and 2018. Baseline D-dimer levels were categorized into tertiles (<0.21, 0.21–0.3, ≥0.3 mg/L) The primary and secondary endpoints were all-cause mortality and cardiovascular mortality, respectively. Cox regression and competing risk models were used to evaluate risk factors for all-cause and cardiovascular mortality, respectively. ResultsHigher D-dimer levels were associated with older age, female sex, more severe mitral regurgitation, and elevated N-terminal pro B-type natriuretic peptide levels (P < 0.05). Over a median follow-up of 4.2 years, 31 (4.3 %) patients reached the primary endpoint; 23 deaths were attributed to cardiovascular causes. The optimal cutoff D-dimer level for predicting 5-year mortality was 0.29 mg/L. After adjusting for covariates, D-dimer levels of >0.29 mg/L were significantly associated with an increased risk of all-cause mortality (hazard ratio [HR], 3.12; 95 % confidence interval [CI], 1.42–6.86; p = 0.005) and cardiovascular mortality (HR, 3.29; 95 % CI, 1.12–9.62; p = 0.030). Body mass index and left atrial diameter were also independent predictors of both all-cause mortality (HR, 1.12; p = 0.026, and HR, 1.08; p = 0.006, respectively) and cardiovascular mortality (HR, 1.12; p = 0.043, and HR, 1.11; p = 0.004, respectively). The inclusion of D-dimer levels of >0.29 mg/L improved the net reclassification index for all-cause mortality (p = 0.016). ConclusionD-dimer is a robust predictor of mid-to-long-term all-cause and cardiovascular mortality in patients undergoing septal myectomy.

The relationship between comorbidity factors and in-hospital mortality in patients with carbapenem-resistant Klebsiella pneumoniae pneumonia

This study aimed to explore the relationship between comorbidity factors and in-hospital mortality related to factors in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) pneumonia. This study collected clinical data from 218 patients with CRKP pneumonia in Beijing hospital from November 2011 to December 2023, analyzed the number of comorbidities carried by CRKP pneumonia patients, comorbidity patterns, Charlson Comorbidity Index (CCI) scores, and comorbidity of underlying diseases, and explored the relationship between various indicators and comorbidity factors and in-hospital mortality in CRKP pneumonia patients. The Ward.D cluster analysis was performed on the comorbidities of patients and used to draw heatmaps. Using a multiple logistic regression model, a nomogram model was constructed to predict in-hospital mortality in patients with CRKP pneumonia. This study included 218 patients with CRKP pneumonia. The results showed that there were significant differences in the age (P=0.003), comorbidities such as heart failure (P<0.001), arrhythmia (P=0.002), chronic liver disease (P=0.003), chronic kidney disease (P=0.002), CCI score (P=0.007), total number of comorbidities (P<0.001), and comorbidity patterns (respiratory/immune/psychiatric disease patterns and cardiovascular/tumor/metabolic disease patterns, P=0.003) between the survival and death groups of CRKP pneumonia patients. The multiple logistic regression showed that cardiovascular/tumor/metabolic disease patterns (P=0.030), CCI score (P=0.040), concomitant heart failure (P=0.011), and concomitant arrhythmia (P=0.025) were independent risk factors for in-hospital mortality in patients with CRKP pneumonia. The nomogram model for predicting the risk of in-hospital mortality in patients with CRKP pneumonia, constructed based on the identified risk factors, had an area under the ROC curve of 0.758. Both the ROC curve and validation curve indicated that the nomogram model had stable performance in predicting in-hospital mortality in patients with CRKP pneumonia. In summary, comorbidity factors are risk factors for predicting in-hospital mortality in patients with CRKP pneumonia, and the role of comorbidity factors in in-hospital mortality in patients with CRKP pneumonia should be taken seriously.

Predictive Mortality of the Prognostic Nutritional Index Combined with APACHE II Score for Critically Ill Tuberculosis Patients.

High mortality rates are commonly found in critically ill patients with tuberculosis (TB), which is due partially to limitations in the existing prognostic evaluation methods. Therefore, we aimed to find more effective prognostic evaluation tools to reduce the mortality rate. Data from critically ill patients with TB admitted to the intensive care unit of The Second Hospital of Nanjing, Nanjing, China, between January 2020 and December 2022 were analyzed retrospectively. A total of 115 patients were enrolled and divided into a survival group (n = 62) and a death group (n = 53) according to 30-day survival. Univariate and least absolute shrinkage and selection operator (LASSO) regression analyses were used to investigate the risk factors for 30-day death in critically ill patients with TB. A prediction model for risk of 30-day mortality was developed for critically ill patients with TB in the intensive care unit. The LASSO regression model showed that the prognostic nutritional index (PNI) and Acute Physiology and Chronic Health Status (APACHE II) scores on the third day after admission to the intensive care unit were independent risk factors for 30-day mortality in critically ill patients with TB (P <0.05). The area under the curve value and that PA3 represents the combination of the PNI and APACHE II score on the third day, which was 0.952 (95% CI: 0.913-0.991, P <0.001), was significantly higher than that of the PNI or the APACHE II score on the third day. The new model is as follows: PA3 = APACHE II score (on the third day) × 0.421 - PNI × 0.204. The PNI combined with the APACHE II score on the third day could well predict the 30-day mortality risk of critically ill patients with TB.

Patient-specific multifactorial mortality risk assessment using classification and regression tree analysis in the context of ambulatory blood pressure monitoring.

Ambulatory blood pressure monitoring is essential for understanding blood pressure patterns beyond clinical visits, aiding in risk assessment, treatment evaluation, and managing hypertension. This retrospective cohort study aimed to identify risk factors for all-cause mortality and major cardiovascular events in patients who underwent ambulatory blood pressure monitoring. Eligible participants aged 18 or older, with an estimated glomerular filtration rate (eGFR) > 60ml/min/1.73m2, who underwent ambulatory blood pressure monitoring for various reasons, were included in the study. Data were gathered through telephone interviews, electronic health records, and the national health record system. Descriptive analysis and classification and regression tree modeling were used to uncover significant risk factors related to all-cause mortality and cardiovascular events, and to assess the model's performance compared to traditional Cox survival analysis. The study included 1291 patients, primarily male (51.8%) with a mean age of 61.1 ± 15.2years. During a mean follow-up of 46.9months, 76 (5.9%) patients died of any cause, and 195 (15.1%) had a cardiovascular event. The highest survival rates were observed in patients with a diastolic blood pressure (BP) dipping percentage between -2% and 29%, nighttime systolic BP variability below 32mmHg, and age below 72. Conversely, smokers with a diastolic BP dipping percentage below -10% showed the lowest survival rates. The best cardiovascular outcomes were observed in patients with diastolic BP dipping above -11%, nighttime mean systolic BP < 144mmHg, no statin use, normotensive status, and daytime mean heart rate ≥ 60bpm. Conversely, the worst outcomes were seen in patients with diastolic BP dipping below -11% and a morning surge ≥ 14mmHg. In all-cause mortality and cardiovascular event analysis, the combined model demonstrated excellent calibration and predictive power, like the classification and regression tree model and traditional analysis. These findings highlight the potential of a combined model for assessing mortality and cardiovascular event risk in patients who have undergone ambulatory blood pressure monitoring.

Epidemiology of Emergency Department Visits for Children With Clinically Significant Cardiovascular Disease.

The aim of the study is to determine the epidemiology, cost, and factors associated with hospital admission, deterioration if hospitalized, and mortality for children with a history of clinically significant cardiovascular disease (CVD) presenting to pediatric emergency departments (EDs). Using the Pediatric Health Information System, we performed a retrospective analysis of ED encounters of children ≤17 years old with clinically significant CVD between 2016 and 2021. Patients were included if they had a cardiovascular complex chronic condition, defined by ICD diagnosis, and procedure codes. We assessed the primary diagnosis, admission rate, ICU transfer rate (as a marker of disease progression), mortality, resource utilization, and costs. We conducted multivariable analyses to identify risk factors for admission, ICU transfer, and mortality. There were 201,551 ED visits (mean 33,592 ± 3354 per year) among 129,938 children with clinically significant CVD. Most ED encounters had a primary diagnosis of a circulatory (21.1%) or respiratory (19.7%) illness. Seventy-six percent of visits had at least one blood test or imaging study conducted. The overall admission rate was 59.7%, with 28.7% admitted to the ICU, and 6.2% transferred to the ICU after the first 24 hours. The median costs for encounters resulting in admission were $13,605 in US 2023 dollars. In multivariable analyses, younger age, a greater number of noncardiac complex chronic conditions, and CVD type were associated with increased odds of admission, ICU transfer after 24 hours, and mortality (all P < 0.05). ED visits for children with clinically significant CVD lead to substantial resource utilization, including frequent hospitalization, ICU level of care, and costs. This baseline data aids in the development of prospective studies to inform the appropriate ED management for children with clinically significant CVD.

Impact of Respiratory Syncytial Virus (RSV) in Adults 60 Years and Older in Spain.

Background/Objectives: Respiratory illnesses frequently lead to hospitalization in adults aged 60 and older, especially due to respiratory viral infectious (RVI). This study investigates hospitalization patterns and characteristics of RVI at HM Hospitals from October 2023 to March 2024; Methods: We retrospectively explored hospitalizations of patients aged 60 years and older with RVIs, gathering data on demographics, clinical profiles, comorbidities, and treatments. Outcomes included hospitalization, ICU admissions, and mortality, and independent factors associated with outcomes were identified using a multi-state model; Results: From October 2023 to March 2024, from a total of 3258 hospitalizations, 1933 (59.3%) were identified as positive for RVIs. Overall, SARS-CoV-2 was the most prevalent (52.6%), followed by influenza (32.7%), and RSV (11.8%). Most RVI involved single infections (88.2%). Hospitalization rates increased with age for SARS-CoV-2 (333.4 [95% CI: 295.0-375.2] to 651.6 [95% CI: 532.1-788.4]), influenza (169.8 [95% CI: 142.6-200.7] to 518.6 [95% CI: 412.1-643.1]), and RSV (69.2 [95% CI: 52.2-90.0] to 246.0 [95% CI: 173.8-337.5]), with SARS-CoV-2 showing the highest rate, followed by influenza and RSV. In the multi-state model, RSV infection significantly increased ICU admission risk (HR: 2.1, 95%, p = 0.037). Age on admission (HR: 1.1, 95%, p < 0.001) and Charlson score (HR: 1.4, 95%, p = 0.001) were associated with transitioning from admission to death. ICU to death risks included age at admission (HR: 1.7, 95%, p < 0.001); Conclusions: RVI in adults 60 years and older are associated with high hospitalization and mortality rates, primarily driven by influenza and SARS-CoV-2, followed by RSV. Age and comorbidities significantly impact disease severity, emphasizing the need for targeted prevention and management strategies for RSV in this vulnerable population.

Distinct Impacts of Clinicopathological and Mutational Profiles on Long-Term Survival and Recurrence in Medullary Thyroid Carcinoma.

Medullary thyroid carcinoma (MTC) has a poorer prognosis than differentiated thyroid cancers; however, comprehensive data on the long-term outcomes of MTC remain scarce. This study investigated the extended clinical outcomes of MTC and aimed to identify prognostic factors. Patients diagnosed with MTC between 1980 and 2020 were retrospectively reviewed. Their clinical characteristics, longterm clinical outcomes, and prognostic factors for recurrence and mortality were analyzed. The study included 226 patients (144 women, 82 men). The disease-specific survival (DSS) rates for all MTC patients at 5-, 10-, 20-, and 30-year intervals were 92.7%, 89.4%, 74.3%, and 68.1%, respectively. The recurrence-free survival (RFS) rates were 71.1%, 56.1%, 40.2%, and 32.1% at these intervals. DSS was comparable between the groups from 1980-2009 and 2010-2020 (P=0.995); however, the 1980-2009 group had significantly lower RFS rates (P=0.031). The 2010-2020 group exhibited greater extents of surgical and lymph node dissection (P=0.003) and smaller tumors (P=0.003). Multivariate analysis identified extrathyroidal extension as the strongest prognostic factor for both RFS and DSS. Age >55 years and tumor size of ≥2 cm were also significant prognostic factors for DSS, while hereditary disease and lymph node metastasis were significant for RFS. Survival analysis after propensity-score matching of rearranged during transfection (RET)-negative and non-screened RET-positive groups showed comparable DSS but longer RFS in the RET-negative group. Extrathyroidal extension was identified as the strongest prognostic factor for RFS and DSS. Older age and larger tumor size were associated with decreased DSS, while RET mutation and lymph node metastasis significantly impacted RFS.

Association between the serum albumin-creatinine ratio and 28-day intensive care unit mortality among patients with sepsis: a multicenter retrospective cohort study.

Sepsis is a substantial global health challenge with a considerable disease burden. Despite advancements in sepsis research, the mortality rates associated with this condition remain high. The relationship between the serum albumin-to-creatinine ratio (sACR) and mortality in patients with sepsis remains unclear. Therefore, this study aimed to investigate the association between the sACR and 28-day mortality in intensive care unit (ICU) patients with sepsis. In this retrospective cohort study, we used data sourced from the eICU Collaborative Research Database. The primary exposure variable was sACR, and the primary outcome measure was mortality within 28 days after ICU admission. Statistical analyses included univariate and multivariate logistic regression models, generalized additive models, and two-piecewise linear regression models, which were employed to explore non-linear relationships and threshold effects between sACR and mortality. The study cohort comprised 9,690 ICU patients with sepsis, with a 28-day mortality rate of 9.99%. The results of the multivariate logistic regression model indicated that elevated sACR levels were significantly associated with a reduced risk of mortality (odds ratio = 0.78, 95% confidence interval: 0.71-0.87, p < 0.001), even after adjusting for potential confounding variables. Curve fitting revealed a non-linear relationship between sACR and 28-day mortality, with an inflection point of 4.79. This study demonstrated that sACR is an independent risk factor for 28-day mortality in ICU patients with sepsis, exhibiting a non-linear negative dose-response relationship and a threshold effect. These findings may serve as early warning indicators in high-risk populations.

Clinical Impact of Baseline Frailty Status and Residual Mitral Regurgitation After Transcatheter Edge-to-Edge Repair: Insights From the OCEAN-Mitral Registry.

The Clinical Frailty Scale (CFS) is a useful frailty marker for predicting clinical outcomes in patients undergoing invasive therapy. However, the clinical impact of CFS after transcatheter edge-to-edge repair in patients with mitral regurgitation (MR) remains unclear. This study aimed to elucidate the association between the baseline frail status defined by the CFS and clinical outcomes with or without postprocedural MR ≥2+ (post-MR ≥2+) after transcatheter edge-to-edge repair. Based on a Japanese multicenter registry (OCEAN [Optimized Catheter Valvular Intervention]-Mitral), data from 2078 patients with MR who underwent transcatheter edge-to-edge repair were analyzed. The patients were classified into 5 groups: CFS 1 to 3, 4, 5, 6, and ≥7. The procedural and clinical outcomes and post-MR ≥2+ were compared among the groups. All-cause mortality for up to 2 years was explored using Cox proportional hazards regression analysis. Although the rates of acute procedural success and post-MR ≥2+ were similar, all-cause mortality at 2 years was significantly increased across the 5 CFS categories (15.5%, 23.8%, 27.7%, 34.6%, and 48.8%, respectively, P<0.001). The incremental CFS categories and post-MR ≥2+ were independent predictive risk factors of all-cause mortality (all P<0.05). Among the patients with 5 CFS categories, the incidence of all-cause mortality was higher in those with post-MR ≥2+ than in those without (all P<0.05). Although prognosis was poor in patients with higher CFS grade after transcatheter edge-to-edge repair, minimizing modifiable factors of residual MR is warranted to improve the clinical outcomes. URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000027188; Unique identifier: UMIN000023653.

E-dengue System Insights: Exploring the Factors Influencing Dengue-related Deaths in an Urbanized State in a Low-Middle Income Country (LMIC)

BackgroundDengue has emerged as a rapidly escalating health issue in low- and middle-income countries, with its burden and geographic spread increasing over the years. Malaysia, in particular, has witnessed a significant rise in dengue cases, accompanied by a spike in mortality rates. Several studies have identified various factors, primarily focusing on the 27 clinical aspects of severe dengue infection and the development of dengue-related fatalities. Expanding on this focus, this study aims to identify the demographic, clinical, and environmental factors contributing to dengue mortality, providing a more comprehensive understanding of the variables influencing dengue-related fatalities.MethodsThis study utilized a 1:2 case-control design, analyzing data from the E-dengue system database and medical records from January 2015 to December 2022, involving 219 participants (73 dengue fatalities as cases and 146 recovered patients as controls). Dengue deaths were confirmed by the Penang State Mortality Review Committee, and controls were randomly selected from laboratory-confirmed dengue cases. Statistical analyses were performed using SPSS software, including descriptive statistics, chi-square tests, and multivariable logistic regression to identify predictors of dengue mortality, with variables included in the multivariable model if p < 0.05.ResultsSeveral significant predictors of dengue-related mortality, including clinical and environmental factors were identified. Key predictors were a platelet count below 50,000/µL (OR 15.70; 95% CI: 5.65–43.53), presence of one comorbid condition (OR 2.90; 95% CI: 1.22–6.90), more than two comorbid conditions (OR 10.15; 95% CI: 3.53–29.23), bronchial asthma (OR 12.00; 95% CI: 1.08-132.13), and outbreak locality status (OR 2.3; 95% CI: 1.11–4.79). An interaction was also found between locality status and platelet levels.ConclusionThe study emphasizes the need for developing risk profiles for dengue patients by integrating factors such as platelet levels, comorbidities, and locality status to improve clinical care. Nuanced protocols are needed to address the specific challenges of single-case and outbreak areas. In single-case localities, patients with low platelet counts (below 100,000/µL) should be prioritized for rapid intervention to mitigate severe outcomes. In outbreak areas, healthcare systems should bolster resources and apply comprehensive triage approaches considering platelet levels and other risk factors. Implementing predictive models that account for geographical factors can enhance resource allocation and preparedness for dengue outbreaks. These recommendations aim to empower public health personnel, healthcare providers, and communities to collectively reduce dengue-related mortality rates.

Epidemiology, clinical and biological characteristics, and prognosis of critically ill COVID 19 patients: a single-center experience through 4 successive waves

ObjectiveThe aim of this study was to describe the characteristics of patients admitted to the intensive care unit with severe pneumonia due to SARS-CoV-2, comparing them according to successive waves, and to identify prognostic factors for morbidity and mortality.Materials and methodsThis single-center retrospective observational descriptive study was conducted from March 10, 2020, to October 17, 2021. All adult patients admitted with SARS-CoV-2 pneumonia presenting acute respiratory failure were included. COVID 19 diagnosis was confirmed by RT-PCR testing of respiratory specimens. The primary endpoint was ICU mortality. Secondary endpoints were the occurrence of ventilator-associated pneumonia (VAP) or bronchopulmonary aspergillosis.ResultsOver the study period, 437 patients were included of whom 282 (65%) patients were ventilated for 9 [5;20] days. Among the studied population, 38% were treated for one or more episodes of VAP, and 22 (5%) for bronchopulmonary aspergillosis. ICU mortality was 26% in the first wave, then fell and stabilized at around 10% in subsequent waves (p = 0.02). Increased age, Charlson index, SOFA score and lactatemia on admission were predictive of mortality. Survival at 90 days was 85% (95% CI 82–88) and was unaffected by the presence of VAP. However, the occurrence of bronchopulmonary aspergillosis increased mortality to 36%.ConclusionIn this study, we observed mortality in the lower range of those previously reported. Risk factors for mortality mainly included age and previous comorbidities. The prognosis of these critically ill Covid 19 patients improved over the four waves, underlining the likely beneficial effect of vaccination and dexamethasone.

The neutrophil–lymphocyte ratio is associated with all-cause and cardiovascular mortality in cardiovascular patients

This study investigates the relationship of neutrophil–lymphocyte ratio (NLR) with the risk of all-cause and cardiovascular mortality in patients with cardiovascular disease. The data for this analysis came from 2239 participants with cardiovascular disease of the National Health and Nutrition Examination Survey conducted between 1999–2018. The optimal cutoff point for NLR was determined using maximally selected rank statistics. Survival analysis was performed using Cox regression models to assess the impact of NLR on the risk of all-cause mortality and cardiovascular mortality. Restricted cubic spline was used to visualize the association of NLR with mortality risk. Subgroup analysis was performed to examine the relationship between NLR and mortality within subgroups based on age, sex, diabetes and hypertension. During a median follow-up period of 6.7 (IQR, 3.3–10.9) years, 992 all-cause deaths occurred, including 381 cardiovascular deaths. Our study revealed that NLR is a risk factor for all-cause mortality (HR: 1.15 95%Cl: 1.11 ~ 1.19) and cardiovascular mortality (HR: 1.14 95%Cl: 1.08 ~ 1.2) among patients with cardiovascular disease. The restricted cubic spline regression analysis showed a non-linear association between NLR and all-cause mortality (p < 0.05 for nonlinearity) in cardiovascular patients. This association remained robust in subgroup analyses stratified by age, sex, diabetes, and hypertension. Conclusion NLR stands as a significant risk factor for both all-cause and cardiovascular mortality among patients with cardiovascular disease.

Lipopolysaccharide-Induced Delirium-Like Behavior and Microglial Activation in Mice Correlate With Bispectral Electroencephalography.

Delirium is a multifactorial medical condition characterized by impairment across various mental functions and is one of the greatest risk factors for prolonged hospitalization, morbidity, and mortality. Research focused on delirium has proven to be challenging due to a lack of objective measures for diagnosing patients, and few laboratory models have been validated. Our recent studies report the efficacy of bispectral electroencephalography (BSEEG) in diagnosing delirium in patients and predicting patient outcomes. We applied BSEEG to validate a lipopolysaccharide-induced mouse model of delirium. Moreover, we investigated the relationship between BSEEG score, delirium-like behaviors, and microglia activation in hippocampal dentate gyrus and cortex regions in young and aged mice. There was a significant correlation between BSEEG score and impairment of attention in young mice. Additionally, there was a significant correlation between BSEEG score and microglial activation in hippocampal dentate gyrus and cortex regions in young and aged mice. We have successfully validated the BSEEG method by showing its associations with a level of behavioral change and microglial activation in an lipopolysaccharide-induced mouse model of delirium. In addition, the BSEEG method was able to sensitively capture an lipopolysaccharide-induced delirium-like condition that behavioral tests could not capture because of a hypoactive state.

Left ventricular diastolic dysfunction worsens prognosis in patients with heart failure due to dilated cardiomyopathy.

The prognostic significance of left ventricular (LV) diastolic dysfunction (LVDD) severity in patients with dilated cardiomyopathy (DCM) remains uncertain. This study aimed to evaluate the association of LVDD severity and elevated left atrial pressure (eLAP) with patient outcomes in stable, non-acutely decompensated patients with DCM. This single-centre, retrospective, observational study involved 740 DCM patients (either inpatients or outpatients) managed at our tertiary cardiac centre between 2010 and 2021. Due to incomplete data, 96 patients were excluded. LVDD and eLAP were assessed using echocardiography according to the 2016 guidelines of the European Association of Cardiovascular Imaging (EACVI). The primary outcomes were all-cause mortality and heart failure (HF)-related mortality. The final cohort comprised of 644 DCM patients [mean age: 52±12years, LV ejection fraction (LVEF): 26±10%]. Over a median follow-up period of 41 (18.5-66.7) months, 105 (16.3%) patients died: 8 (5.3%) patients in the normal left atrial pressure (nLAP) group and 97 (19.6%) patients in the eLAP group. eLAP was identified as an independent prognostic factor for both all-cause mortality [hazard ratio (HR) 2.0; 95% confidence interval (CI) 1.1-3.7; P=0.01] and HF-related mortality (HR 2.5; 95% CI 1.01-6.5; P=0.04), even after adjusting for LVEF and atrial fibrillation (AF) presence. Additionally, HF-related mortality rates were significantly higher in patients with moderate to severe LVDD compared with those with mild LVDD [5 (3.3%) vs. 67 (13.6%), P<0.05]. This study's findings highlight the importance of assessing the severity of LVDD in patients with DCM, which provides incremental prognostic information over LVEF.

Correlation of factor XIII subunit A with factor XIII activity in a population of parturient women.

The role of factor XIII in acute bleeding situations is gaining more and more importance. It has previously been shown that prepartum factor XIII activity has a significant impact on postpartum blood loss. Whether factor XIII antigen behaves in a similar manner is unknown. As postpartum hemorrhage is one of the leading causes of maternal morbidity and mortality worldwide and factor XIII antigen determination might be available more readily in some centers as compared to factor XIII activity, this is an important question to answer, especially in the emergency situation of a postpartum hemorrhage. To assess the correlation of prepartum factor XIII antigen with prepartum factor XIII activity and to evaluate the correlation between prepartum factor XIII antigen on measured postpartum blood loss. This is a secondary analysis of a prospective cohort study which analyzed the impact of prepartum blood coagulation factor XIII activity on postpartum blood loss in 1300 women at the University Hospital Zurich, Switzerland between October 2015 and November 2016 ("PPH-1300 study"). Blood loss was quantified using a previously validated technique. The association of factor XIII activity and factor XIII antigen was assessed by means of a Spearman rank correlation and differences were displayed using Bland-Altman plot and Passing-Bablok regression. The effect of the prepartum factor XIII antigen on blood loss was estimated by continuous outcome logistic regression. Prepartum factor XIII activity significantly correlated with prepartum factor XIII antigen (Spearman rank correlation coefficient for prepartum values 0.89, p < 0.001 and postpartum values 0.902, p < 0.001). Elevated values of prepartum factor XIII antigen showed a trend toward lower measured postpartum blood loss. The correlation of factor XIII activity with factor XIII antigen (subunit A) in a large real-world sample as well as an association of prepartum factor XIII antigen and postpartum blood loss is observed. Factor XIII antigen determination, a highly automatable test, could be useful in emergency situations such as a PPH (as well as other bleeding situations) if the determination of factor XIII activity is not possible. To evaluate whether FXIII replenishment reduces blood loss is the focus of ongoing studies.

Glycemic control and risk factors of mortality in patients with diabetes mellitus and COVID-19: A single center experience from Pakistan.

Objective: To highlight the effect of COVID-19 and DM on each other by studying glycemic control and risk factors for mortality. Study Design: Retrospective Observational Review. Setting: Sindh Institute of Urology and Transplantation Karachi Pakistan. Period: March 2020 till March 2021. Methods: Covid-19 diagnosed patients admitted were enrolled. They were divided into DM and non-DM. Demographics, clinical variables and outcome were compared. Glycemic control during hospitalization was noted. Fasting glucose level &gt;120 mg/dl, and random &gt;200 mg/dl were considered as poor glycemic control. Survivors and non- survivors among DM patients were compared. Results: A total of 366 patients were included, 113(30.87%) DM and 253(69.12%) non-DM. Mean age was higher in DM group (58yrs vs 49.6yrs p &lt;0.001). Significantly more patients with hypertension (p &lt;0.001) and ischemic heart disease (p=0.001) developed Covid-19 in DM group. There was no difference in mortality (p = 0.295). In DM patients, the significant risk factors for mortality were age &gt;60years, hypertension and chronic kidney disease. The mean high fasting and pre-dinner blood glucose levels at admission and day 5 were significantly associated with mortality. Conclusion: Diabetic patients with advanced age, hypertension and chronic kidney disease were associated with increased risk of death. More attention should be focused on dynamic monitoring and strict glycemic control as uncontrolled diabetes is associated with severe infection and mortality.

Safety and efficacy of surgical revascularization with percutaneous ventricular assist device for acute myocardial infarction complicated by cardiogenic shock: Japanese national registry study.

This study aims to assess the safety of coronary artery bypass grafting (CABG) with percutaneous ventricular assist device (PVAD) in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). A retrospective analysis was conducted on 1198 patients with AMI-CS from the J-PVAD registry, who underwent PVAD support using Impella® (Abiomed Inc., Danvers, MA) and subsequent revascularization between February 2020 and December 2021. Patients were divided into two groups based on the method of coronary revascularization: percutaneous coronary intervention (PCI, n = 1084) and CABG (n = 114). The study assessed short-term all-cause and cardiac-related mortality. The CABG group exhibited significantly lower short-term all-cause mortality compared with the PCI group (30-day: 26.2% vs. 39.9%, 90-day: 45.5% vs. 58.4%, log-rank p = 0.004). Short-term cardiac-related mortality was similar toward low in the CABG group compared with the PCI group (30-day: 18.7% vs. 25.6%, 90-day: 29.4% vs. 35.5%, log-rank p = 0.084). Multivariable analysis using the Cox proportional hazard model did not identify revascularization strategy as a risk factor for both all-cause mortality (Hazard ratio (HR): 0.743, 95% confidence intervals (CI): 0.457-1.208, p = 0.231) and cardiac-related mortality (HR: 0.762, 95% CI: 0.390-1.490, p = 0.427). These results were not attenuated even in subgroup analyses separately comparing CABG alone and hybrid therapy with PCI after propensity score matching. Thus, CABG can be a treatment option with feasible short-term outcomes in patients with AMI-CS under PVAD support.

Risk factors for occurrence and death of sepsis-associated acute kidney injury in children with sepsis

IntroductionThe 28th Acute Disease Quality Initiative (ADQI) Workgroup proposed the first international consensus on definition of SA-AKI in June 2023. The incidence and mortality of ADQI-defined SA-AKI in septic children is unknown, and the risk factors for the occurrence and death of SA-AKI is unexplored. MethodsWe conducted a retrospective study of septic children between January 1, 2018 and December 31, 2022. Logistic regression analysis was used to identify risk factors for SA-AKI. COX proportional hazards regression analysis was utilized for analyzing the risk factors for 30-day mortality in SA-AKI and septic children. Results221 children were included, of which 81 (36.7 %) developed SA-AKI, with 25.9 % developed into acute kidney disease. Older age, lower baseline eGFR and mechanical ventilation were independently associated with SA-AKI (P < 0.001, P < 0.01 and P < 0.05 respectively). Among the 81 SA-AKI children, 32.1 % died within 30 days from sepsis diagnosis, with higher mortality in children with late SA-AKI than early SA-AKI (72.2 % versus 20.6 %, P < 0.001). Septic shock was independently associated with 30-day death in SA-AKI children (P < 0.05). The overall 30-day mortality of septic children was 19.0 %, with mechanical ventilation, SA-AKI, and septic shock identified as independently associated with 30-day death (P < 0.001, P < 0.05 and P < 0.001 respectively). ConclusionsSA-AKI is of high incidence and mortality in septic children. Older age, lower baseline eGFR and mechanical ventilation were independent risk factors for SA-AKI. SA-AKI was independently associated with 30-day mortality in septic children.

A multicenter retrospective study on clinical features and pathogenic composition of septic shock in children

Objective: To investigate the clinical features, pathogen composition, and prognosis of septic shock in pediatric intensive care units (PICU) in China. Methods: A multicenter retrospective cohort study. A retrospective analysis was conducted on the clinical data of children with septic shock from 10 hospitals in China between January 2018 and December 2021. The clinical features, pathogen composition, and outcomes were collected. Patients were categorized into malignant tumor and non-malignant tumor groups, as well as survival and mortality groups. T test, Mann Whitney U test or Chi square test were used respectively for comparing clinical characteristics and prognosis between 2 groups. Multiple Logistic regression was used to identify risk factors for mortality. Results: A total of 1 247 children with septic shock were included, with 748 males (59.9%) and the age of 3.1 (0.9, 8.8) years. The in-patient mortality rate was 23.2% (289 cases). The overall pathogen positive rate was 68.2% (851 cases), with 1 229 pathogens identified. Bacterial accounted for 61.4% (754 strains) and virus for 24.8% (305 strains). Among all bacterium, Gram negative bacteria constituted 64.2% (484 strains), with Pseudomonas aeruginosa and Enterobacter being the most common; Gram positive bacteria comprised 35.8% (270 strains), primarily Streptococcus and Staphylococcus species. Influenza virus (86 strains (28.2%)), Epstein-Barr virus (53 strains (17.4%)), and respiratory syncytial virus (46 strains (17.1%)) were the top three viruses. Children with malignant tumors were older and had higher pediatric risk of mortality (PRISM) Ⅲ score, paediatric sequential organ failure assessment (pSOFA) score (7.9 (4.3, 11.8) vs. 2.3 (0.8, 7.5) years old, 22 (16, 26) vs. 16 (10, 24) points, 10 (5, 14) vs. 8 (4, 12) points, Z=11.32, 0.87, 4.00, all P<0.05), and higher pathogen positive rate, and in-hospital mortality (77.7% (240/309) vs. 65.1% (611/938), 29.7% (92/309) vs. 21.0% (197/938), χ2=16.84, 10.04, both P<0.05) compared to the non-tumor group. In the death group, the score of PRISM Ⅲ, pSOFA (16 (22, 29) vs. 14 (10, 20) points, 8 (12, 15) vs. 6 (3, 9) points, Z=4.92, 11.88, both P<0.05) were all higher, and presence of neoplastic disease, positive rate of pathogen and proportion of invasive mechanical ventilation in death group were also all higher than those in survival group (29.7% (87/289) vs. 23.2% (222/958), 77.8% (225/289) vs. 65.4% (626/958), 73.7% (213/289) vs. 50.6% (485/958), χ2=5.72, 16.03, 49.98, all P<0.05). Multiple Logistic regression showed that PRISM Ⅲ, pSOFA, and malignant tumor were the independent risk factors for mortality (OR=1.04, 1.09, 0.67, 95%CI 1.01-1.05, 1.04-1.12, 0.47-0.94, all P<0.05). Conclusions: Bacterial infection are predominant in pediatric septic shock, but viral infection are also significant. Children with malignancies are more severe and resource consumptive. The overall mortality rate for pediatric septic shock remains high, and mortality are associated with malignant tumor, PRISM Ⅲ and pSOFA scores.

MRG15 promotes cell apoptosis through inhibition of mitophagy in hyperlipidemic acute pancreatitis.

Hyperlipidemia is a common cause of acute pancreatitis (AP), often leading to more severe clinical symptoms. The mortality factor 4-like protein 1 (MORF4L1, also called MRG15) plays a crucial role in regulating lipid metabolism. Therefore, this study aimed to explore the mechanism of MRG15 in hyperlipidemic acute pancreatitis (HAP). Mendelian randomization, transcriptome analysis, and single-cell analysis were employed to explore the association between MRG15 and AP by utilizing publicly available databases. In vivo, hypertriglyceridemia mouse models were created by intraperitoneal injection of P407 or using APOE-deficient mice. Subsequently, the HAP model was induced by cerulean. In vitro, a cell model of HAP was established by initially exposing cells to palmitic acid to simulate a high-fat environment, followed by cerulein treatment. Subsequently, MRG15-related indicators were measured. Through Mendelian randomization, it was discovered that there is a positive correlation between genetic expression of MRG15 and the risk of AP. Transcriptome and single-cell analysis revealed that elevated MRG15 expression in AP contributes to lipid metabolism disorders and the activation of apoptosis pathways in pancreatic acinar cells. MRG15 is found to be significantly upregulated in cases of HAP. Knocking down MRG15 led to an increase in mitophagy and a decrease in apoptosis in pancreatic cells, and this effect was reversed when the mitochondrial Tu translation elongation factor (TUFM) was simultaneously knocked down. MRG15 inhibits mitophagy by degrading TUFM, ultimately promoting cell apoptosis and worsening the progression of HAP.