Mortality Index Research Articles

A Simple and Interpretable Mortality-Based Value Metric for Condition- or Procedure-Specific Hospital Performance Reporting

ObjectiveTo develop a simple, interpretable value metric (VM) to assess the value of care of hospitals for specific procedures or conditions by operationalizing the value equation: Value = Quality/Cost. Patients and MethodsThe present study was conducted on a retrospective cohort from 2015 to 2018 drawn from the 100% US sample of Medicare inpatient claims. The final cohort comprised 637,341 consecutive inpatient encounters with a cancer-related Medicare Severity-Diagnosis Related Grouping and 13,307 consecutive inpatient encounters with the International Classification of Diseases, Ninth Revision or International Classification of Diseases, Tenth Revision procedure code for partial or total gastrectomy. Claims-based demographic and clinical variables were used for risk adjustment, including age, sex, year, dual eligibility, reason for Medicare entitlement, and binary indicators for each of the Elixhauser comorbidities used in the Elixhauser mortality index. Risk-adjusted 30-day mortality and risk-adjusted encounter-specific costs were combined to form the VM, which was calculated as follows: number needed to treat = 1/(Mortalitynational − Mortalityhospital), and VM = number needed to treat × risk-adjusted cost per encounter. ResultsAmong hospitals with better-than-average 30-day cancer mortality rates, the cost to prevent 1 excess 30-day mortality for an inpatient cancer encounter ranged from $71,000 (best value) to $1.4 billion (worst value), with a median value of $543,000. Among hospitals with better-than-average 30-day gastrectomy mortality rates, the cost to prevent 1 excess 30-day mortality for an inpatient gastrectomy encounter ranged from $710,000 (best value) to $95 million (worst value), with a median value of $1.8 million. ConclusionThis simple VM may have utility for interpretable reporting of hospitals’ value of care for specific conditions or procedures. We found substantial inter- and intrahospital variation in value when defined as the costs of preventing 1 excess cancer or gastrectomy mortality compared with the national average, implying that hospitals with similar quality of care may differ widely in the value of that care.

Pengaruh Toksisitas minyak Azadirachta indica, Ricinus communis, dan campurannya: Pengaruhnya terhadap indeks nutrisi larva dan oviposisi imago Spodoptera frugiperda (J. E. Smith) pada tanaman jagung

Spodoptera frugiperda (J. E. Smith) merupakan hama invasif yang menyebabkan dampak ekonomi yang besar pada tanaman jagung. Alternatif pengendalian yang relatif aman bagi serangga non-target perlu dikembangkan dan dapat dipadukan dengan pengendalian lainnya, yaitu pengendalian menggunakan insektisida nabati. Penelitian ini bertujuan untuk mengevaluasi toksisitas minyak Azadirachta indica (Meliaceae), Ricinus communis (Euphorbiaceae), dan campurannya (1:1) serta pengaruhnya terhadap indeks nutrisi dan oviposisi S. frugiperda. Pengujian toksisitas ekstrak dan campurannya serta pengaruhnya terhadap indeks nutrisi dilakukan dengan menggunakan metode celup pakan, sedangkan pengujian oviposisi dengan penyemprotan ekstrak pada tanaman. Data hubungan konsentrasi minyak nabati dengan kematian serangga uji dianalisis menggunakan analisis probit, sedangkan peubah lainnya dianalisis dengan sidik ragam. Hasil penelitian menunjukkan minyak A. indica, R. communis, dan campurannya bersifat toksik dengan nilai LC50 terhadap larva (II–VI) berturut-turut 0,039 (0,017–0,100)%, 0,144 (0,094–0,221)%, serta 0,034 (0,021–0,061)%, dan pada LC95 berturut-turut 0,391 (0,134–16,671)%, 4,379 (1,986–15,516)%, serta 0,219 (0,104–1,251)%. Toksisitas campuran tersebut meningkat 4,2 kali hingga 20,0 kali masing-masing pada LC50 dan LC95. Perlakuan minyak mengakibatkan penurunan laju konsumsi relatif, laju pertumbuhan relatif, efisiensi pemanfaatan makanan, dan peningkatan perkiraan jumlah makanan yang dicerna larva S. frugiperda. Selain bersifat insektisida, minyak nabati dapat berperan sebagai antioviposisi S. frugiperda. Namun, minyak A. indica, R. communis, dan campurannya terindikasi fitotoksik pada tanaman jagung. Oleh karena itu, potensi campuran minyak A. indica dan R. communis untuk digunakan sebagai insektisida perlu dievaluasi atau dapat digunakan pada tanaman lain yang lebih toleran.

Physician’s Knowledge and Skill to Complete the Certificate of Cause of Death According to who Guidelines A Survey Among the Doctors of A Tertiary Care Hospital at Lahore\

Background: The medical document certifying the cause of death provides vital data to develop health policies. In spite of very comprehensive guidelines issued by the WHO for thecompletion of death certificates; very few certificate arefound errorfree which might be due to lack of knowledge and practice on the part of physicians issuing that certificate.Purpose of this study is to assess the knowledge and competencies of a doctor in completing a death certificate. Methods: This study was cross-sectional. The population of this study was physicians of a tertiary care hospital of Lahore. A structured questionnaire along with a case scenario was given to 137 physicians having variable working experiences, performing in different clinical departments of a tertiary care hospital of Lahore.The participants were asked to complete the component of cause of death of the certificateonly. The percentage of omissions done by the doctors during the completion of said section was analyzed using the chi square test to establish the association between participant’s characteristics and their relevant responses. Results: Among 137participants working in different clinical departments of a Tertiary Care Hospital at Lahore, 89% were having less than 5 years’ experience and 11% having more than 5 years’ experience. 53% were qualified from public sector, 24% from private sector and 23% from foreign institutes. 77% doctors identified immediate cause of death incorrectly, 83 % did not identify and interpret underlying cause of death correctly; 90 % did notidentify contributory cause of death correctly. In46 % cases mechanism/mode of death was confused with the cause of death. Practical Implication: The correct completion of death certificates would provide an accurate and genuine mortality index essential for framing a national health policy. Conclusion: Physician’s knowledge and skill of completing the death certificates is very deficient and alarming which necessitate periodical and regular training of the physicians on completing the death certificates as per guidelines of the WHO to get an appropriate and valid health statistics effective for future public national health policies and strategies. Keywords (MeSH): Death certificate completion, Medical certification of cause of death, Physician’s knowledge, skill to complete death certificate, Mortality index

Cardiac contractility modulation in heart failure with reduced ejection fraction treatment

Heart failure with reduced left ventricular ejection fraction (LV EF) (HFrEF) is a significant issue of health care due to increasing indexes of morbidity and mortality. The emergence of a number of drugs and implantable devices for the treatment of HFrEF has allowed improvement of patients' well-being and prognosis. However, high mortality and recurrent decompensated heart failure remain a substantial issue and stimulate the search for new methods of CHF treatment. Cardiac contractility modulation (CCM) is a method of managing patients with HFrEF. Available data from randomized clinical trials (RCT) indicate the efficacy of CCM in improvement of patients' well-being and quality of life. The question remains open: what effect does CCM have on LV reverse remodeling? Experimental data and results of observational studies suggest a possibility of reverse remodeling by CCM; however, this has not been confirmed in RCT. Also, it remains unclear how CCM influences the frequency of hospitalizations for decompensated heart failure and the death rate of patients with HFrEF. Results of both RCTs and observational studies have shown a moderate improvement of quality of life associated with CCM. Furthermore, RCTs have not found any increase in LV EF due to the therapy, nor has a meta-analysis of RCTs revealed any improvement of the prognosis associated with CCM. Further RCTs are needed to evaluate the effect of CCM on reverse remodeling, survival rate, and to determine the place of CCM in the treatment of patients with CHF.

Comprehensive assessment of age-specific mortality rate and its incremental changes using a composite measure: A sub-national analysis of rural Indian women.

Diverse socio-economic and cultural issues contribute to adverse health outcomes and increased mortality rates among rural Indian women across different age categories. The present study aims to comprehensively assess age-specific mortality rates (ASMR) and their temporal trends using a composite measure at the sub-national level for rural Indian females to capture cross-state differences. A total of 19 states were included in the study to construct a composite age-specific mortality index for 2011 (base year) and 2018 (reference year) and examine the incremental changes in the index values across these years at the sub-national level in India. Sub-index values were calculated for each component age group and were subsequently used to compute the composite ASMR index using the geometric mean method. Based on the incremental changes, the performance of states was categorized into four different typologies. Improvement in mortality index scores in the 0-4 years age group was documented for all states. The mortality rates for the 60+ age group were recorded to be high for all states. Kerala emerged as the overall top performer in terms of mortality index scores, while Bihar and Jharkhand were at the bottom of the mortality index table. The overall mortality composite score has shown minor improvement from base year to reference year at all India level. An overall reduction in the mortality rates of rural Indian women has been observed over the years in India. However, in states like Bihar and Jharkhand, mortality is high and has considerable scope for improvement. The success of public health interventions to reduce the under-five mortality rate is evident as the female rural mortality rates have reduced sizably for all states. Nevertheless, there is still sizable scope for reducing mortality rates for other component age groups. Additionally, there is a need to divert attention toward the female geriatric (60+ years) population as the mortality rates are still high.

Modifications in Electrocardiographic and Vectordardiographic Morphological Parameters in Elderly Males as Result of Cardiovascular Diseases and Diabetes Mellitus.

Morphological electrocardiographic and vectorcardiographic features have been used in the detection of cardiovascular diseases and prediction of the risk of cardiac death for a long time. The objective of the current study was to investigate the morphological electrocardiographic modifications in the presence of cardiovascular diseases and diabetes mellitus in an elderly male population, most of them with multiple comorbidities. A database of ECG recordings from the Italian Longitudinal Study on Aging (ILSA-CNR), created to evaluate physiological and pathological modifications related to aging, was considered. The study examined a group of 1109 males with full clinical documentation aged 65-84 years. A healthy control group (219 individuals) was compared to the groups of diabetes mellitus (130), angina pectoris (99), hypertension (607), myocardial infarction (160), arrhythmia (386), congestive heart failure (73), and peripheral artery disease (95). Twenty-one electrocardiographic features were explored, and the effects of cardiovascular diseases and diabetes on these parameters were analyzed. The three-years mortality index was derived and analyzed. Myocardial infarction and arrhythmia were the diagnostic groups that showed a significant deviation of 11 electrocardiographic parameters compared to the healthy group, followed by hypertension and congestive heart failure (10), angina pectoris (9), and diabetes mellitus and peripheral artery disease (8). In particular, a set of three parameters (QRS and T roundness and principal component analysis of T wave) increased significantly, whereas four parameters (T amplitude, T maximal vector, T vector ratio, and T wave area dispersion) decreased significantly in all cardiovascular diseases and diabetes mellitus with respect to healthy group. The QRS parameters show a more specific discrimination with a single disease or a group of diseases, whereas the T-wave features seems to be influenced by all the pathological conditions. The present investigation of disease-related electrocardiographic parameters changes can be used in assessing the risk analysis of cardiac death, and gender medicine.

Shock index, modified shock index, age shock index score, and reverse shock index multiplied by Glasgow Coma Scale predicting clinical outcomes in traumatic brain injury: Evidence from a 10-year analysis in a single center.

Early identification of traumatic brain injury (TBI) patients at a high risk of mortality is very important. This study aimed to compare the predictive accuracy of four scoring systems in TBI, including shock index (SI), modified shock index (MSI), age-adjusted shock index (ASI), and reverse shock index multiplied by the Glasgow Coma Scale (rSIG). This is a retrospective analysis of a registry from the Taipei Tzu Chi trauma database. Totally, 1,791 patients with TBI were included. We investigated the accuracy of four major shock indices for TBI mortality. In the subgroup analysis, we also analyzed the effects of age, injury mechanism, underlying diseases, TBI severity, and injury severity. The predictive accuracy of rSIG was significantly higher than those of SI, MSI, and ASI in all the patients [area under the receiver operating characteristic curve (AUROC), 0.710 vs. 0.495 vs. 0.527 vs. 0.598], especially in the moderate/severe TBI (AUROC, 0.625 vs. 0.450 vs. 0.476 vs. 0.529) and isolated head injury populations (AUROC 0.689 vs. 0.472 vs. 0.504 vs. 0.587). In the subgroup analysis, the prediction accuracy of mortality of rSIG was better in TBI with major trauma [Injury Severity Score (ISS) ≥ 16], motor vehicle collisions, fall injury, and healthy and cardiovascular disease population. rSIG also had a better prediction effect, as compared to SI, MSI, and ASI, both in the non-geriatric (age < 65 years) and geriatric (age ≥ 65 years). rSIG had a better prediction accuracy for mortality in the overall TBI population than SI, MSI, and ASI. Although rSIG have better accuracy than other indices (ROC values indicate poor to moderate accuracy), the further clinical studies are necessary to validate our results.

Predictive value of the hemoglobin-albumin-lymphocyte-platelet (HALP) index for ICU mortality in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

The combined index of hemoglobin, albumin, lymphocyte, and platelet (HALP) is a novel indicator reflecting systemic inflammation and nutritional status. To explore the relationship between HALP score and ICU mortality risk in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). A total of 1533 AECOPD patients from the eICU Collaborative Research Database (eICU-CRD) between 2014 and 2015 were included in this retrospective cohort study. Univariate and multivariate Cox proportional hazards models were utilized to investigate the association of HALP score, platelet-to-lymphocyte ratio (PLR) score, and lymphocyte-to-monocyte ratio (LMR) score with the ICU mortality risk in patients with AECOPD. Stratified analyses were performed based on patients' ICU admission type, body mass index (BMI), and Acute Physiology, Age and Chronic Health Evaluation IV (APACHE IV) score. Of these 1533 AECOPD patients, 123 (8.00%) patients died in the ICU. Low HALP score [hazard ratio (HR) = 1.69; 95% confidence interval (CI) 1.14-2.53] and low LMR score (HR = 1.60; 95% CI 1.07-2.39) were associated with an increased ICU mortality risk in patients with AECOPD after adjusting for all confounders. Stratified analyses indicated that low HALP score were still associated with a higher ICU mortality risk in patients admitted to ICU by emergency (HR = 1.81; 95% CI 1.11-2.96), obese patients (HR = 2.81; 95% CI 1.29-6.10), and patients with low APACHE scores (HR = 2.87; 95% CI 1.75-4.69). Low HALP score was associated with an increased risk of ICU mortality in patients with AECOPD, suggesting that the HALP score may be a novel prognostic predictor in patients with AECOPD.

Biruni Index as a Novel Diagnostic Tool for the Early Prediction of Mortality in Critical Patients With COVID-19: A Cohort Study.

The aim of this study was to find out the potential risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19) patients hospitalized due to viral bronchopneumonia, and to establish a novel COVID-19 mortality index for daily use. The study included 431 quantitative real-time polymerase chain reaction (qRT-PCR)-confirmed COVID-19-positive patients admitted to the intensive care unit in a tertiary care hospital. Patients were divided into training and validation cohorts at random (n= 285 and n= 130, respectively). Biruni Indexwas developed by multivariate logistic regression analysis for predicting COVID-19-related mortality. In univariate logistic regression analysis, age, systolic and diastolic blood pressures,respiratory and pulse rates per minute, D-dimer, pH, urea, ferritin, and lactate dehydrogenaselevels at first admission were statistically significant factors for the prediction of mortality in the training cohort. By using multivariate logistic regression analysis, all of these statistically significant parameters were used to produceBiruni Index. Statistically significant differences in Biruni Index were observed between ex and non-ex groups in both training and validation cohorts (P< 0.001 for both comparisons). Areas under receiver operating characteristic (ROC) curve for Biruni Index were 0.901 (95CI%: 0.864-0.938, P< 0.001) and 0.860 (95CI%: 0.795-0.926, P< 0.001) in training and validation cohorts, respectively. As a pioneering clinical study, Biruni Index may be a useful diagnostic tool for clinicians to predict the mortalityin critically ill patients with COVID-19 hospitalized due to severe viral bronchopneumonia. However, Biruni Index should be validated with larger series of multicenter prospective clinical studies.

Evaluating systemic immune-inflammation index for in-hospital and long-term mortality in elderly non-ST elevation myocardial infarction patients

Abstract Introduction This investigation aimed to evaluate the predictive value of systemic immune-inflammation index (SII) for in-hospital and long-term mortality in elderly patients with non-ST elevation myocardial infarction (NSTEMI). Methods In this retrospective investigation, 314 consecutive elderly patients who were diagnosed with NSTEMI in a tertiary center were included. The SII was computed as neutrophils x platelets/lymphocytes. Based on the increased SII values, we classified the research sample into three tertile groups as T1, T2, and T3. The in-hospital and long-term mortality were defined as the primary outcomes. Results Patients in the T3 group had lower chances to survive both in the in-hospital and long-term periods as compared to those in the T2 and T1 groups. The SII was independently related with in-hospital (HR: 1.001, 95% CI: 1.000–1.1003, p=0.038) and long-term mortality (HR: 1.004, 95% CI: 1.002–1.006, p&amp;lt;0.001) according to the multivariable Cox regression models. To predict long-term mortality, the optimal value of the SII was &amp;gt;2174 with 80% sensitivity and 85.4% specificity. When the AUC values of the SII, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) were assessed to predict long-term mortality, the SII had the greatest value (AUC: 0.862), followed by the NLR (AUC: 0.731) and the PLR (AUC: 0.698). Additionally, combining SII with the traditional risk factors and the Charlson Comorbidity Index revealed a significant improvement in C-statistics. Conclusion This might be the first investigation to demonstrate that the SII was independently linked with in-hospital and long-term mortality in elderly NSTEMI patients. Funding Acknowledgement Type of funding sources: None.

Late Breaking Abstracts

Late Breaking Abstracts

Predictive analytics methods for investigating inpatient volume in rural hospitals

Rural hospitals continue to face significant challenges, including declining inpatient admissions, which may have a deteriorating impact on rural hospitals’ financial viability and the health care of rural residents. We use descriptive and predictive analytics to analyze trends in the average daily census (ADC), a measure of inpatient volume, and identify factors that may be associated with the ADC in Pennsylvania’s rural hospitals. We use retrospective longitudinal data on Pennsylvania’s rural acute care hospitals from 2000 to 2019. Overall, Pennsylvania’s rural hospitals experienced a decline in ADC. Readmission index, registered nurse (RN) staffing, population over 65 years of age, and population per square mile were statistically significant and positively associated with ADC. The mortality index was statistically significant and negatively associated with ADC, and the payer mix did not seem to impact ADC. In addition, critical access hospitals (CAHs) had a statistically significant and negative association with ADC. The continuing decline in ADC may deteriorate rural hospitals’ financial stability and overall health in rural communities. Hospital administrators should consider increasing nurse staffing to improve the quality of care and patient communication to build trust. Policymakers should encourage more hospitals, especially the CAHs and smaller hospitals, to participate in the Pennsylvania Rural Health Model to ensure their financial stability.

Implementing Bundle Care in Major Abdominal Emergency Surgery: Long-Term Mortality and Comprehensive Complication Index

BackgroundMajor abdominal emergency surgery (MAES) has a high risk of postoperative mortality and a high complication rate. The aim of this study was to evaluate whether the implementation of a perioperative care bundle reduced long-term mortality and the Comprehensive Complication Index (CCI) after MAES.MethodsThis study was a single-centre retrospective cohort study. Data in the intervention group were collected prospectively and compared with a historical cohort from the same centre. It includes adult patients undergoing MAES. We implemented a care bundle under the name Abdominal Surgery Acute Protocol (ASAP). We initiated fast-track initiatives and standardised optimised care in before, during and after surgery. Data were analysed using survival analysis and multiple regression.ResultsWe included 120 patients in the intervention cohort and 258 in the historical cohort. The one-year mortality rate was 21.7% in the intervention cohort compared to 28.3% in the standard care cohort. Adjusted odds ratio of one-year mortality 0.81 (CI95% 0.41–1.56). The 30-day mortality was lowered from 19.0 to 6.7% (p = 0.003). The CCI in the intervention cohort was 8.7 (IQR 0–34) compared to 21 (IQR 0–36) in the control cohort (p = 0.932) The length of stay increased by two days (p = 0.021). Most cases had 71–80% protocol compliance.ConclusionImplementing bundle care in major abdominal emergency surgery lowered the 30-day postoperative mortality. The difference in mortality was preserved over time although not significant after one year. The changes in the Comprehensive Complication Index were not statistically significant.

Mortality in Recreational Mountain-Biking in the Austrian Alps: A Retrospective Study over 16 Years.

Despite recreational mountain-biking’s growing popularity worldwide, the literature on mortality in this leisure sporting activity is scarce. Therefore, the aim of the present study was to investigate the characteristics of fatal accidents as well as resulting dead victims during recreational mountain-biking in the Austrian Alps over the past 16 years. For this purpose, a retrospective study based on Austrian institutional documentation from 2006 to 2021 was conducted. In total, 97 fatalities (1 woman) with a mean age of 55.6 ± 13.9 years were recorded by the Austrian Alpine Police. Of those, 54.6% died due to a non-traumatic (mostly cardio-vascular) and 41.2% due to a traumatic event. Mountain-bikers fatally accidented for non-traumatic reasons frequently belonged to older age classes (p = 0.05) and mostly (73.6%) died during the ascent, whereas traumatic events mainly (70.0%) happened during the descent (p < 0.001). Throughout the examined period, the absolute number of fatalities slightly increased, whereas the mortality index (proportion of deaths/accidented victims) did not (mean value: 1.34 ± 0.56%). Factors such as male sex in general, above average age and uphill riding for non-traumatic accidents, as well as downhill riding for traumatic events, seem to be associated with fatalities during recreational mountain-biking in the Austrian Alps. These results should be considered for future preventive strategies in recreational mountain-biking.

PSXIII-11 Avemix XG 10 Improves Piglet Performance When Dietary net Energy Content is Decreased

Abstract Plant-based dietary ingredients contain non-starch polysaccharides (NSP) fibers. Both soluble and insoluble NSP fibers are anti-nutritional factors for monogastrics that limit intestinal absorption and digestion of dietary nutrients. Increased digesta viscosity also occurs, which results in satiety and potential health issues. AveMix XG 10, containing high endo-1,4-β-xylanase and endo-1,3(4)-β-glucanase activity, hydrolyzes NSP fibers resulting in increased nutrient availability and digestibility. Therefore, it was hypothesized that AveMix XG 10 enables gain of some extra net energy (NE) content from piglet diets, optimizing the cost of live-weight growth. A 47-day trial was conducted with 3-week old weaned piglets (6.0 kg) allocated to three groups: control (CON), low energy (-56 kcal/kg feed; LE), and low energy + enzyme (LE+E). All groups had 13 pens of 28 pigs (n=364) and received wheat and corn mix based diets that had a similar NSP fiber content (11.4 %). Overall, CON diets had greater NE (2,456 kcal/kg feed) relative to the LE and LE+E groups (2,400 kcal/kg feed). The diet of the LE+E group was supplemented with AveMix XG 10 (Palital Feed Additives B.V.) at 100 g/T. For each pen the daily feed intake, weekly weight, diarrhea index and mortality were recorded. Compared with both CON and LE, LE+E significantly increased average daily gain (ADG) and average daily feed intake (ADFI) during weeks 4-7 and overall, and also significantly increased final weight (Table 1). During weeks 1-3, ADG and ADFI did not differ between CON and LE+E groups, and the LE+E group was significantly greater than LE. Overall, LE detrimentally increased the feed conversion ratio (FCR) compared with CON; however, during weeks 4-7 the LE+E had similar FCR compared with CON. No significant effects were observed on mortality or diarrhea index. In conclusion, AveMix XG 10 improved piglet performance when dietary NE content is decreased.

Biochemical indicators of euthyroid sick syndrome in critically ill children.

This study aimed to determine the prevalence and predictors of euthyroid sick syndrome (ESS) in pediatric intensive care, and to establish a link between thyroid function tests and mortality. Between January 2015 and March 2020, children admitted to our pediatric intensive care unit (PICU) and tested for free triiodothyronine (fT3), free thyroxine (fT4), and thyrotropin (TSH) levels were included. Patients with decreased fT3, with normal or decreased fT4, and normal or decreased TSH levels were assigned to the ESS group. The association between biochemical indicators and ESS, as well as the relationship between fT3 and mortality, were examined. A total of 141 (36%) of 386 children included to study were classified in the ESS group. The ESS group had a higher rate of 28-day mortality (12 [8.5%] vs. 9 [3.7%]). Blood urea nitrogen (BUN), albumin, platelet, lactate, and pediatric index of mortality 3 [PIM3 (%)] were significantly associated with ESS (odds ratios in order: 1.024, 0.422, 0.729, 1.208, 1.013). Multivariate regression analysis showed that BUN, albumin, platelet, and lactate were independently associated with ESS progression. The area under curve (AUC [95%CI]) for fT3 was 0.644 (0.555-0.789) to detect mortality. Children with a fT3 level lower than 2.31pg/mL had significantly higher 28-day mortality (log rank test, p=0.001). Our study identified BUN, albumin, lactate, and platelet count as independent risk factors for ESS progression in children. Furthermore, our findings indicated a correlation between fT3 and mortality, which makes fT3 anideal candidate to be included in mortality indices.

Development and Validation of the Summary Elixhauser Comorbidity Score for Use With ICD-10-CM-Coded Data Among Older Adults.

Older adults have many comorbidities contributing to mortality. To develop a summary Elixhauser (S-Elixhauser) comorbidity score to predict 30-day, in-hospital, and 1-year mortality in older adults using the 38 comorbidities operationalized by the Agency for Healthcare Research and Quality (AHRQ). Retrospective cohort study. Medicare beneficiaries from 2017 to 2019. Persons hospitalized in 2018 (n= 899844) and 3 disease-specific hospitalized cohorts. Weights were derived for 38 comorbidities to predict 30-day, in-hospital, and 1-year mortality. The S-Elixhauser score was internally validated and calibrated. Individual Elixhauser comorbidity indicators (38 comorbidities), the modified application of the AHRQ-derived Elixhauser summary score, the Charlson comorbidity indicators (17 comorbidities), and the Charlson summary score were externally validated. The c-statistic was used to evaluate discrimination of a comorbidity score model. The S-Elixhauser score was well calibrated and internally validated, with a c-statistic of 0.705 (95% CI, 0.703 to 0.707) in predicting 30-day mortality, 0.654 (CI, 0.651 to 0.657) for in-hospital mortality, and 0.743 (CI, 0.741 to 0.744) for 1-year mortality. In external validation of other comorbidity indices for 30-day mortality, the c-statistic was 0.711 (CI, 0.709 to 0.713) for the individual Elixhauser comorbidity indicators, 0.688 (CI, 0.686 to 0.690) for the AHRQ Elixhauser score, 0.696 (CI, 0.694 to 0.698) for the Charlson comorbidity indicators, and 0.690 (CI, 0.688 to 0.693) for the Charlson summary score. In 3 disease-specific populations, the discrimination of the S-Elixhauser score in predicting 30-day mortality ranged from 0.657 to 0.732. Validation of the S-Elixhauser comorbidity score and head-to-head comparison with other comorbidity scores in an external population are needed to evaluate comparative performance. The S-Elixhauser comorbidity score is well calibrated and internally validated but its advantage over the AHRQ Elixhauser and Charlson summary scores is unclear. National Institute on Aging.

Predictive Value of the Ankle-Brachial Index for All-Cause and Cardio-Cerebrovascular Mortality.

The present study explored the relationship between the ankle-brachial index (ABI) (>.9) and all-cause or cardio-cerebrovascular mortality. Participant details were obtained from the National Health and Nutrition Examination Survey 1999-2004. The association between baseline ABI and the risk of mortality was evaluated by a priori defined quartile categories and on a continuous scale (per .1-unit change) with Cox regression models adjusted for demographic and traditional risk factors. A total of 7087 individuals (age: 59.6 ± 12.8years) were included; 3612 (51.0%) were male. After an average follow-up of 12.2 years, 1926 deaths occurred. Kaplan-Meier analysis showed that the lowest ABI quartile (<1.06) was associated with the highest risk of all-cause, cardio-cerebrovascular and cancer mortality (all P < .001). However, after adjusting for potential confounders, ABI ranging between 1.06 and 1.12 was associated with the lowest risk of all-cause mortality (hazard ratio .88, 95% confidence interval .78-1.00, P < .05) compared with the reference group (<1.06). Besides, splines showed the relationship was nonlinear (P < .05) and the inflection point was 1.11. In conclusion, the level of ABI associated with the lowest risk of all-cause mortality was 1.11, under which a lower ABI was independently associated with an increased risk of all-cause mortality.

Prognostic value of the TyG index for in-hospital mortality in nondiabetic COVID-19 patients with myocardial injury.

SUMMARYOBJECTIVE:The purpose of this study was to explore the efficacy of the triglyceride glucose (TyG) index on in-hospital mortality in nondiabetic coronavirus disease 2019 (COVID-19) patients with myocardial injury.METHODS:This was a retrospective study, which included 218 nondiabetic COVID-19 patients who had myocardial injury. The TyG index was derived using the following equation: log [serum triglycerides (mg/dL) ×fasting blood glucose (mg/dL)/2].RESULTS:Overall, 49 (22.4%) patients died during hospitalization. Patients who did not survive had a higher TyG index than survivors. In multivariate Cox regression analysis, it was found that the TyG index was independently associated with in-hospital death. A TyG index cutoff value greater than 4.97 was predicted in-hospital death in nondiabetic COVID-19 patients with myocardial damage, with 82% sensitivity and 66% specificity. A pairwise evaluation of receiver operating characteristic (ROC) curves demonstrated that the TyG index (AUC: 0.786) had higher discriminatory performance than both triglyceride (AUC: 0.738) and fasting blood glucose (AUC: 0.660) in predicting in-hospital mortality among these patients.CONCLUSIONS:The TyG index might be used to identify high-risk nondiabetic COVID-19 patients with myocardial damage.

Outcomes of radical cystectomy in pT4 bladder cancer frail patients: Α high-volume single center study.

Objectives:This study aims to evaluate the effect of frailty in patients undergoing radical cystectomy (RC) for locally advanced bladder cancer.Methods:In this retrospective, single center study we evaluated 51 patients with pT4 bladder cancer treated with radical cystectomy between 2016-2020. Patient frailty was assessed with the Clinical Frailty Scale (CFS). Furthermore, six separate parameters (early mortality index within 30 days after surgery, death after one year, length of stay, respiratory complications, readmission index, total hospital charges) were also evaluated. The patients were categorized on three groups (Group 1, 2, 3) based on the CFS.Results:A total of 51 pT4 RC patients were included in the study. Mean age was 75.6 years. Early mortality rate at 30 days after surgery was low all the groups. One year mortality rate was higher in Group 2 (22%) and 3 (69%). The length of stay and the number of patients with respiratory complications were also higher in the frailer groups. 30 days readmission rate was 22% in Group 2 and 38% in Group 3.Conclusions:Preoperative frailty is associated with worse postoperative results after RC. CFS is an objective tool for patient risk stratification and can predict postoperative complications and mortality.