Injury Mortality Research Articles

The impact of the introduction of industrial robots on workplace injury risk and mortality

In the 19th century, the Luddites protested against the introduction of new technology into the wool and cotton industries, concerned that this would mean a reduction in the quality of their work, less need for their skill and a lower pay. Nowadays, luddite is used to refer to someone who dislikes technology. In modern society, there are similar concerns regarding artificial intelligence (AI) and what its introduction and evolution means for the human workforce. Despite these fears of past and present society, there is no doubt that there are significant benefits associated with the introduction of new technologies. For example, industrial robots play an important role in reducing workplace injury and mortality risk. Associate Professor Masahiro Yoshida, Department of Political Science and Economics, Waseda University, Japan has a background in economics and is interested in the socio-economic drivers and impacts of injuries in the workplace. While the nationwide injury rate improved before the Great Recession, it subsequently began to stagnate. Given accelerated investment in industrial robots, Yoshida found this puzzling and, through his work in this area, found that most industrial robots are utilised in innately safe sectors rather than in more risky sectors, suggesting a profit-seeking reasoning behind investment in robots rather than the prioritisation of workplace safety. He also found that these sectors tend to have a higher dependency on immigrants. This led Yoshida to explore the relationship between the dependency on immigration and the progress of robot adoption across industries.

Trauma Outcomes Based on Remoteness of Injury in Australia: A Systemic Review.

Research suggests a significant disparity between rural and urban trauma patient outcomes, causing substantial social, economic and emotional costs, impacting health-related quality of life and functionality, and straining our healthcare system. There has not been a systematic examination of contributing factors in Australia. This study aims to systematically describe the nature of research on trauma outcomes by geographical location and (where possible) describe factors found to increase or decrease the likelihood and severity of injury in rural Australia. Five databases (EMBASE, PubMed/MEDLINE, Web of Science, Scopus, CINAHL) and reference lists were searched. Eligible studies compared injury outcomes by geographic location in Australia, using a quantitative study design. No restrictions were placed on publication year or outcomes explored. The results were synthesised narratively. We found 14 papers. Mortality, the most studied outcome (n = 11), was overall positively related to traumatic incidents in more rural locations. Other data outcomes included hospital admissions and length of stay, admission to ICU, 28-day hospital readmission, rehabilitation, and patient-reported quality of life. Study findings show different mechanisms of injury (e.g., falls) and limited accounts of pre-hospital experiences. Geographical location of trauma may impact the likelihood of injury mortality but is potentially confounded by the different mechanisms and severity of injury. There is insufficient evidence to make conclusions on other non-mortality and longer-term outcomes, and a greater understanding of prehospital outcomes is also needed. This relationship is considered weak due to the limited geographic representation across Australia and the general paucity of recent literature.

Trends and Patterns of Road Traffic Accidents in Maharashtra: A Comparative Examination of NCRB and MEMS Databases

Abstract Background: The emergence of high incidence of Road Traffic Accidents (RTA) has contributed to the burden of Non-Communicable Disease (NCD) both in terms of mortality and morbidity. It is very important to have a structured and accurate database for strategizing road safety and associated public health benefits. There are multiple sources of data available for the research of road traffic accidents and road safety. It is utmost necessary to identify the most appropriate data source for RTA research. Materials and Methods: The current study is based on five years’ time series data (2017 to 2021) from two data sources namely National Crime Record Bureau (NCRB) and Maharashtra Emergency Medical Services (MEMS). Injury rate and death rate was used along with the trend analysis to define the trend of RTA. Corelation coefficient was used for establishing the patterns of reporting of RTA in the state of Maharashtra. The data is analysed by using MS Excel and SPSS16.0. Results: Both the databases exhibit a declining trend in the reporting of RTA in the state of Maharashtra with a CAGR of -1.99% in NCRB and -13.77% in MEMS. Although the number of incidents reported in NCRB is around 40% less than MEMS, both the sources have almost the same number of victims per accident (r= 84%). Injury rate reported in NCRB is around 40% less than the MEMS data and the variation in injury rate in cities is high as per NCRB data than in MEMS data. MEMS data provides a number of information including the severity of injury which may be useful for the analysis and insight generation. Conclusion: Both the databases are important in providing crucial information for generating insight and strategies for road safety. A central database in combining both the database would be ideal for the researchers in the areas of injury and road safety. MEMS was the better source in terms of amount of information for epidemiological research in road safety.

Silent witnesses: unveiling the epidemic of femicides in North-west Tshwane, South Africa – a decade of analysis

BackgroundFemicides, defined as the gender-based killing of women, are a pressing public health issue worldwide, with South Africa experiencing some of the highest rates globally. This study focuses on the North-west region of Tshwane, particularly the Garankuwa area, aiming to address gaps in understanding the epidemiology, demographics, circumstances, and pathology associated with femicides. The Garankuwa mortuary serves as the primary site for this investigation, providing a detailed analysis over a ten-year period, shedding light on contributing risk factors in the context of systemic gender inequality.ObjectivesThe study had four main objectives: to analyse the demographics and incidence rates of femicides in the North-west Tshwane area, to examine the circumstances surrounding femicides (including the time, location, and demographic risk factors), to identify the causes and pathological characteristics of femicides; and to observe trends in femicide rates over the ten-year study period.MethodsThis study was a retrospective cross-sectional descriptive analysis, focusing on all deceased females admitted to the Garankuwa mortuary from 2009 to 2018. The inclusion criteria comprised female cases at autopsy, with a suspected homicidal manner of death. Excluded were cases classified as suicides, accidents, or natural deaths after further examination. Data was collected through the National Injury Mortality Surveillance System (NIMSS) and cross-verified with post-mortem reports, police data and death registers.ResultsOver the ten-year period, the Garankuwa mortuary admitted an annual average of 1131 bodies, with approximately 23.5% (266) being female. Of these, 17.5% were identified as femicides. The average incidence rate of femicides was 11.2 per 100,000 female population, showing a general decline over the study period, except for notable increases in 2013 and 2016. The study found that the most common months for femicides were September and December, with most incidents occurring at home, followed by residential areas and medical facilities. The geographic analysis identified Temba, Rietgat, and Akasia as the areas with the highest number of femicide cases. Demographically, the majority of femicide victims were black, with the most affected age group being 18–39 years. The leading causes of death were gunshot wounds, sharp force injuries and blunt force trauma, with significant incidences of strangulation and asphyxial deaths, primarily affecting the neck and head regions.ConclusionThis study highlights the high incidence and distinct characteristics of femicides in the North-west Tshwane area, underscoring the role of socio-economic disparities and racial demographics. The findings emphasize the necessity for targeted prevention programs, stricter firearm control measures, and community-based violence prevention strategies. The demographic data indicate that young black women are particularly vulnerable, necessitating protective and educational initiatives tailored to this group.

Characteristics of injury deaths among homeless and non-homeless US veterans (2017–2021)

ObjectiveThe objective of this study is to assess whether experiencing homelessness may be associated with future risk of injury death and characterise these injury deaths by homelessness status among veterans...

Thoracic Endovascular Aortic Repair for Penetrating Aortic Trauma.

Thoracic Endovascular Aortic Repair (TEVAR) reduced mortality for blunt aortic injury (BAI) from 30-50% to < 10%; however, penetrating traumatic aortic injury (PAI) remains highly lethal (>40% mortality). This study's goal is to determine outcomes of TEVAR for PAI. Patients undergoing TEVAR for traumatic aortic injuries were identified from the Vascular Quality Initiative database from 2011-2022. Patients with blunt and penetrating injuries were compared based on pre-operative characteristics, injury severity, and post operative outcomes. TEVAR was performed for 1,867 patients with traumatic aortic injuries of which 1808 (96.9%) patients had BAI, and 59 (3.1%) had PAI. The majority of injuries being treated were either grade 3 (pseudoaneurysm) (55.3%) or grade 4 (transection) (16.4%). PAI patients had a higher proportion of grade 4 injuries compared to BAI (36.4% vs. 16.5%, p=0.001). The majority of PAI were in zones 4-5 (61.1% vs. 14.2%, p<0.001), whereas the majority of BAI were in zone 3 (66.5% vs. 16.7%, p<0.001). Overall, the mortality rate was 8.2% (N=154). In hospital mortality was 8.5% in the PAI group and 8.2% in the BAI group (p=0.813). There was no significant difference in major complication rates between PAI and BAI patients. PAI occurs more commonly in zones 4-5 of the thoracic aorta and often presents with higher grade aortic injury when compared to BAI. TEVAR for PAI provides excellent in-hospital survival, especially compared to historical mortality rates around 40%. An endovascular first approach may lead to improved survival for PAI.

Epidemiological Characteristics of Hospitalized Burn Patients-A 10-Year Retrospective Study in a Major Burn Center in Serbia.

Many European countries' epidemiological data on burns were analyzed. This research aimed to analyze the key epidemiological characteristics of hospitalized burn patients in Serbia's major burn unit over 10 years, as well as to create the very first national epidemiological dataset with the basic requirements for future epidemiological studies. A retrospective cross-sectional study was conducted, and demographic, clinical, and burn characteristics, as well as predictors of mortality, were analyzed. A total of 996 patients were included. The mean age of the population was 54.65 ± 27.15 years. Regarding etiology, flame was the most common (49.0%). Patient comorbidities were noted on admission in 50.1% of cases. The mean % of total burn surface area (TBSA) was 16.89 ± 18.72%. Inhalation injury was confirmed in 7.5% of patients, and a total of 10.3% of patients required mechanical ventilation during hospitalization. The requirement for mechanical ventilation support was the strongest independent predictor of mortality, while other independent predictors of mortality were male gender, higher %TBSA, deep burns, mechanism of injury, an extended total length of stay (LOS), the occurrence of complications during hospitalization, and conservative treatment modalities. Burn injury mortality remains high, and %TBSA, burn depth, mechanical ventilation requirement, inhalation injury, and the presence of comorbidities on admission unfavorably influence mortality rates.

High-grade liver injury: outcomes with a trauma surgery–liver surgery collaborative approach

BackgroundOperative mortality for high-grade liver injury (HGLI) remains 42% to 66%, with near-universal mortality after retrohepatic caval injury. The objective of this study was to evaluate mortality and complications of...

Is access to crisis teams associated with changes in behavioral health mortality?

Behavioral health-related mortality-deaths from suicide, drug overdose, and acute alcohol injury-are leading causes of death among US adults. Crisis teams, trained behavioral health professionals who serve as first responders to assess and stabilize clients in crisis, as well as refer to treatment as necessary, have been shown to reduce psychiatric hospitalizations, but whether crisis teams reduce behavioral health mortality has not been studied. We assessed the association between changes in access to crisis team programs and changes in county-level suicide, drug overdose, and acute alcohol injury mortality from 2014 through 2019. We found that 250 (9%) of counties experienced crisis team program entry and another 237 (9%) experienced crisis team program closure. Access to crisis team programs was associated with significant changes in county-level drug overdose deaths, but not suicide or acute alcohol injury. Compared with counties with no change in access, crisis team program entry was associated with a 7% reduction in county-level drug overdose death rates, and crisis team program closure was associated with a 13% increase in drug overdose death rates. These findings may support the use of crisis teams as 1 intervention to address substance use disorder treatment gaps in the United States.

Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture-recapture analysis.

Accurate mortality estimates help quantify and memorialise the impact of war. We used multiple data sources to estimate deaths due to traumatic injury in the Gaza Strip between Oct 7, 2023, and June 30, 2024. We used a three-list capture-recapture analysis using data from Palestinian Ministry of Health (MoH) hospital lists, an MoH online survey, and social media obituaries. After imputing missing values, we fitted alternative generalised linear models to the three lists' overlap structure, with each model representing different possible dependencies among lists and including covariates predictive of the probability of being listed; we averaged the models to estimate the true number of deaths in the analysis period (Oct 7, 2023, to June 30, 2024). Resulting annualised age-specific and sex-specific mortality rates were compared with mortality in 2022. We estimated 64 260 deaths (95% CI 55 298-78 525) due to traumatic injury during the study period, suggesting the Palestinian MoH under-reported mortality by 41%. The annualised crude death rate was 39·3 per 1000 people (95% CI 35·7-49·4), representing a rate ratio of 14·0 (95% CI 12·8-17·6) compared with all-cause mortality in 2022, even when ignoring non-injury excess mortality. Women, children (aged <18 years), and older people (aged ≥65 years) accounted for 16 699 (59·1%) of the 28 257 deaths for which age and sex data were available. Our findings show an exceptionally high mortality rate in the Gaza Strip during the period studied. These results underscore the urgent need for interventions to prevent further loss of life and illuminate important patterns in the conduct of the war. None.

TLR4 Inhibition Attenuated LPS-Induced Proinflammatory Signaling and Cytokine Release in Mouse Hearts and Cardiomyocytes.

Sepsis is associated with myocardial injury and early mortality. The innate immune receptor Toll-like receptor 4 (TLR4) can recognize pathogen-associated-molecular-patterns (PAMPs) and damage-associated molecular patterns (DAMPs); the latter are released during tissue injury. We hypothesized that TLR4 inhibition reduces proinflammatory signaling and cytokine release in: (1) LPS or Escherichia coli-treated isolated mouse heart; (2) LPS-treated mouse primary adult cardiomyocytes; and (3) the isolated heart during ischemia-reperfusion. Isolated C57BL/6N male mouse hearts were perfused for 120 min, with either LPS, E. coli, with and without CLI-095 (TLR4 inhibitor). Primary adult mouse cardiomyocytes were treated with LPS or LPS + CLI-095. Isolated hearts, exposed to 35 min of global ischemia, were treated with either vehicle or CLI-095 during reperfusion. Infarct size was quantified by triphenyltetrazolium staining. Cytokine expression was analyzed with ELISA, western blot analysis, and qPCR. In isolated hearts, E. coli increased the expression of proinflammatory cytokines (IL-6 and CXCL2), which was not attenuated with TLR4 inhibition. TLR4 inhibition reduced expression (p = 0.004) and release of IL-6 (p < 0.0001) in LPS-exposed isolated hearts. LPS activated the nuclear-factor κ-light-chain-enhancer of activated B cells signaling pathway (NF-κB) in primary adult cardiomyocytes. Moreover, TLR4 inhibition reduced LPS-induced mRNA expression and release of IL-6 in primary adult cardiomyocytes. Isolated hearts treated with CLI-095 during reperfusion after ischemia (induced DAMPs release) showed reduced infarct size (39 ± 17% to 26 ± 8%, p = 0.034) and decreased IL-6 release (p = 0.006). Inhibition of TLR4 reduced proinflammatory signaling and cytokine release in LPS-treated and ischemia-reperfused isolated mouse hearts and in primary adult murine cardiomyocytes.

Causes of death among older children and adolescents (5–19 years) in the Magu Health and Demographic Surveillance Study, Tanzania, 1995–2022

ABSTRACT Background Population data on mortality and causes of death among 5–19-year-olds are limited. Objectives To assess levels, trends, and risk factors of cause-specific mortality and place at death among 5–19-year-olds in Tanzania (1995–2022). Methods Using longitudinal data from the Magu Health and Demographic Surveillance System in northwest Tanzania, we identified leading causes of death among 5–19-year-olds from verbal autopsy interviews, using physician review and a Bayesian probabilistic model (InSilicoVA). We analyzed trends in cause and place of death using three periods: 1995–2004, 2005–2014 and 2015–2022, and assessed risk factors in a Cox-proportional hazards model. We compared the results with children aged 1–4 years and global estimates for Tanzania. Results Between 1995 and 2022, communicable disease mortality decreased by 73%, similar to the 76% decline among 1–4-year-olds. This decline in communicable disease mortality drove all-cause mortality declines of 43% and 48% among 5–14- and 15–19-year-olds, respectively. Non-communicable diseases and injuries gained importance, with their relative share of all deaths increasing from 15% in 1995–2004 to 58% in 2015–2022. Mortality risks were significantly higher among boys (particularly for injuries), those residing in rural areas (for non-communicable diseases), and those from the poorest households (for communicable diseases). By 2015–2022, 48% of 5–14 and 42% of 15–19-year-olds died in health facilities, up from 25% in 1995–2002. Conclusions Since 1995, the decline in communicable disease mortality drove a major all-cause mortality reduction among 5–19-year-olds. Further progress will depend on continued reduction in communicable disease mortality, particularly among the poorest, and effectively addressing non-communicable and injury mortality.

Effects of Therapeutic Hypothermia and Minimal Enteral Nutrition on Short-Term Outcomes in Neonates with Hypoxic-Ischemic Encephalopathy: A 10-Year Experience from Oman.

Therapeutic hypothermia (TH) is the standard treatment for moderate to severe hypoxic-ischemic encephalopathy (HIE) in developed countries, but data on its safety and efficacy in low-middle-income countries are limited and often conflicting. The impact of enteral feeding during TH remains inadequately explored. We aimed to examine TH's effects on mortality and brain injury and evaluate the safety and effectiveness of minimal enteral feeding during TH. Here, we report our single-center experience with TH over a 10-year period". A total of 187 neonates with moderate to severe HIE who underwent cooling were included in this retrospective study. Post-rewarming MRI scans were scored using a validated MRI scoring system. The primary outcomes were mortality and composite outcomes of mortality and brain injury. The mortality rate was 3% in moderate and 25% in severe cases (p < 0.001). Overall, 85% (160/187) of neonates received minimal enteral nutrition. Multivariate regression analysis revealed that the severity of HIE at admission (OR 3.4 (1.03-11.6); p < 0.04) and gestational age (OR: 0.624 (0.442-0.882); p < 0.008) were independent predictors of composite outcomes of death and brain injuries. MRI score was a strong predictor of mortality (AUC: 0.89; p < 0.001) and of ability to orally feed at discharge (AUC: 0.73; p < 0.001). Mortality rates associated with TH in infants with moderate-severe HIE align with those in high-income countries, and minimal enteral feeding during TH is safe. The severity of HIE, MRI scores, and feeding status are important predictors of outcomes.

Exercise preconditioning and resveratrol reduce the susceptibility of rats with obstructive jaundice to endotoxin and alleviate lung injury.

Endotoxemia is a common issue for patients with biliary obstruction. The lung is the most affected organ by endotoxins. Exercise training can alleviate lipopolysaccharide (LPS)-induced lung inflammation and resveratrol has biological effects similar to exercise. In this study, we evaluated the protective effects of exercise preconditioning, resveratrol, and theircombination on LPS-induced lung injury and mortality in rats with obstructive jaundice. Endotoxemia was simulated in rats by common bile duct ligation (CBDL) and intraperitoneal injection of low-dose LPS. The treatment groups were pretreated with exercise and/or resveratrol to assess their effects on lung injury and mortality. Immunohistochemistry, immunofluorescence, and ELISA were subsequently used to evaluate the impact of exercise and/or resveratrol on inflammation in lung tissue and bronchoalveolar lavage fluid. We found that even in the early stages, compared to sham-LPS rats, low-dose LPS induced excessive systemic inflammatory responses in CBDL rats, as evidenced by a significant increase in TNF-α and IL-6, severe lung inflammation, lung injury, and higher mortality rates, indicating that cholestasis increased rats' susceptibility to endotoxins. Exercise training reduced neutrophil infiltration in the lungs of model rats and IL-6 levels in bronchoalveolar lavage fluid. Both exercise training and resveratrol exhibited synergistic effects in reducing macrophage accumulation in lung tissues, lowering TNF-α and IL-6 levels in the lungs, and decreasing TNF-α concentration in bronchoalveolar lavage fluid. Additionally, exercise and combined interventions both significantly increased the expression of IL-10. The interventions induced a marked improvement in lung tissue pathological damage and lung edema in model rats and prolonged the survival time of rats with obstructive jaundice. This study demonstrates that exercise preconditioning and/or resveratrol can significantly reduce rats' susceptibility to endotoxins after CBDL and alleviate lung injuries through their anti-inflammatory effects, thereby decreasing the mortality risk.

Examining the Interactive Associations of Cannabis and Alcohol Outlets With Self-harm Injuries in California: A Spatiotemporal Analysis.

Cannabis use and alcohol use are associated with self-harm injuries, but little research has assessed links between recreational cannabis outlet openings on rates of self-harm within communities or the interactions of cannabis outlets with the density of alcohol outlets. We estimated the associations of recreational cannabis outlets, alcohol outlets, and their interaction on rates of fatal and nonfatal self-harm injuries in California, 2017-2019. Using California statewide data on recreational cannabis outlets, alcohol outlets, and hospital discharges and deaths due to self-harm injuries, we conducted Bayesian spatiotemporal analyses of quarterly ZIP code-level data over 3 years, accounting for confounders and spatial autocorrelation. Using the model posteriors, we estimated parameters corresponding to hypothetical shifts in outlet densities. If recreational cannabis outlets had never opened, we estimated that nonfatal self-harm injuries would have been -0.35 per 100,000 lower (95% credible interval [CI]: -1.25, 0.51), while fatal self-harm injuries would have been -0.004 per 100,000 lower (95% CI: -0.26, 0.25). These associations did not depend on alcohol outlet density, but a hypothetical 20% reduction in alcohol outlet densities was associated with fewer self-harm injuries (risk difference per 100,000, nonfatal: -1.59; 95% CI: -2.60, -0.59; fatal: -0.10; 95% CI: -0.37, 0.16). Associations for nonfatal incidents were strongest for people aged 15-34 years, and White and Hispanic people. We did not find evidence that the introduction of recreational cannabis outlets was associated with self-harm injuries or that cannabis and alcohol outlet densities interact, but alcohol outlet density had a strong association with nonfatal self-harm injuries.

Workplace Injury and Death: A National Overview of Changing Trends by Sex, United States 1998-2022.

Women represent a substantial portion of the US workforce. However, injury and fatality rates for female workers have, historically, remained lower than rates for male workers. Fatal occupational data from the Census of Fatal Occupational Injuries (CFOI) and nonfatal injury data from the National Electronic Injury Surveillance System-Occupational Supplement (NEISS-Work) for the years 1998-2022 were examined to produce rate ratios of male to female fatal and nonfatal occupational injury rates for all workers in the United States. Auto-regressive linear models were developed to analyze rate ratios by sex for fatal and nonfatal occupational injuries by age group, injury event, and select industries to determine if female occupational fatal and nonfatal injury rates were following trends comparable to male rates. Over the 25-year study period, male injury and fatality rates were consistently higher than females. Occupational fatality rates for males were more than nine times higher than female rates, and for nonfatal occupational injuries, male rates were 1.4 times higher than female rates. These analyses indicate that the differences in nonfatal injury rates by sex may be attenuating, however, the large gap by sex in workplace fatalities has remained unchanged. Occupational safety and health research with a more specific focus on these sex differences is needed to gain a clearer understanding of how sex differences affect hiring, job training, task assignment and completion, and injury risk, to identify areas where prevention efforts could be most successful.

Progress in reducing mortality from 10 major causes by county poverty level, from 1990-1994 to 2016-2020, in the US.

Overall death rates in the US have been declining in the past few decades. However, progress against mortality across counties with different socioeconomic profiles has not been well described. The objective of this study was to examine changes in death rates from leading causes of death by county poverty level in the contiguous US. Using county-level death (all causes, 10 leading causes in 2020, excluding COVID-19) and population data derived from the National Center for Health Statistics, we calculated absolute and relative changes in age-standardized death rates by county poverty level from 1990-1994 to 2016-2020. From 1990-1994 to 2016-2020, death rates from all causes, diseases of the heart, cancer, cerebrovascular disease, and pneumonia/influenza declined nationally, but rates increased for unintentional injury, chronic obstructive pulmonary disease, Alzheimer's disease, diabetes, suicide/self-inflicted injury, and kidney disease mortality. Counties with higher poverty levels (≥20%) had smaller declines or larger increases in death rates for each evaluated cause of death, exacerbating the disparities in mortality by county poverty level, except for unintentional injury and suicide/self-inflicted injury. Consequently, in 2016-2020, the death rates for leading causes of death were 12% (for Alzheimer's disease; suicide/self-inflicted injury) to 81% (for diabetes) higher in people residing in counties with the highest poverty level than in those residing in counties with the lowest poverty level. Disparities in mortality from most leading causes of death by county poverty level widened during the past three decades. There was no external funding for this study.

Mortality of Acute Kidney Injury in Cirrhosis: A Systematic Review and Meta-Analysis of Over 5 Million Patients Across Different Clinical Settings.

Acute kidney injury (AKI) represents a commonly seen condition in the natural course of cirrhosis associated with unfavourable outcomes. To evaluate and compare the pooled mortality rates of patients with cirrhosis, with versus without AKI, across different clinical settings and diagnostic criteria. A systematic search of several databases was performed up to Oct 2023. Meta-analysis was performed using a generalised linear mixed model with a random effects model for all calculations. A total of 59 studies comparing patients with cirrhosis, with and without AKI, were included in the meta-analysis, encompassing 1,153,193 individuals with AKI and 4,630,814 without AKI. AKI development predisposed to significantly higher short (in-hospital and 30-days)-, intermediate (90-days)- and long (1-year)-term mortality rates in both inpatients and outpatients. Remarkably, patients with AKI admitted to intensive care unit (ICU) or diagnosed with acute-on-chronic liver failure (ACLF) experienced the higher short-term mortality rates, reaching 76% [95% confidence interval (CI): 73%-79%] and 54% (95%CI: 33%-73%), respectively. AKI staging correlated with mortality risk, with higher stages indicating higher mortality rates, while the timing of AKI development, whether community-acquired or hospital-acquired, plays a crucial role in patient prognosis, with distinct mortality patterns observed in each group. The selection of diagnostic criteria for AKI may also impact its association with the short-term mortality risk. AKI substantially affects the prognosis of patients with cirrhosis, especially those in ICU and/or with ACLF. Prognosis is also greatly influenced by the AKI stage, timing of onset and diagnostic criteria.

Epidemiology and Outcomes of Antibiotic De-escalation in Patients with Suspected Sepsis in US Hospitals.

Little is known about the frequency, hospital-level variation, predictors, and clinical outcomes of antibiotic de-escalation in suspected sepsis. We retrospectively analyzed all adults admitted to 236 US hospitals between 2017-2021 with suspected sepsis (defined by a blood culture draw, lactate measurement, and intravenous antibiotic administration) who were initially treated with ≥2 days of anti-MRSA and anti-pseudomonal antibiotics but had no resistant organisms requiring these agents identified through hospital day 4. De-escalation was defined as stopping anti-MRSA and anti-pseudomonal antibiotics or switching to narrower antibiotics by day 4. We created a propensity score for de-escalation using 82 hospital, demographic, and clinical variables, matched de-escalated to non-de-escalated patients, and then assessed associations between de-escalation and outcomes. Among 124,577 eligible patients, antibiotics were de-escalated in 36,806 (29.5%) including narrowing in 27,177 (21.8%) and cessation in 9,629 (7.7%). De-escalation rates varied widely between hospitals (median 29.4%, IQR 21.3-38.0%). Predictors of de-escalation included less severe disease on day 3-4, positive cultures for non-resistant organisms, and negative/absent MRSA nasal swabs. De-escalation was more common in medium, large, or teaching hospitals in the Northeast or Midwest. De-escalation was associated with lower adjusted risks for acute kidney injury (OR 0.80, 95% CI: 0.76-0.84), ICU admission after day 4 (OR 0.59, 95% CI: 0.52-0.66), and in-hospital mortality (OR 0.92, 95% CI: 0.86-0.996). Antibiotic de-escalation in patients with suspected sepsis is infrequent, variable across hospitals, linked with clinical and microbiologic factors, and associated with lower risk for acute kidney injury, ICU admission, and in-hospital mortality.

Diverse NKT cells regulate early inflammation and neurological outcomes after cardiac arrest and resuscitation.

Neurological injury drives most deaths and morbidity among patients hospitalized for out-of-hospital cardiac arrest (OHCA). Despite its clinical importance, there are no effective pharmacological therapies targeting post-cardiac arrest (CA) neurological injury. Here, we analyzed circulating immune cells from a large cohort of patients with OHCA, finding that lymphopenia independently associated with poor neurological outcomes. Single-cell RNA sequencing of immune cells showed that T cells with features of both innate T cells and natural killer (NK) cells were increased in patients with favorable neurological outcomes. We more specifically identified an early increase in circulating diverse NKT (dNKT) cells in a separate cohort of patients with OHCA who had good neurological outcomes. These cells harbored a diverse T cell receptor repertoire but were consistently specific for sulfatide antigen. In mice, we found that sulfatide-specific dNKT cells trafficked to the brain after CA and resuscitation. In the brains of mice lacking NKT cells (Cd1d-/-), we observed increased inflammatory chemokine and cytokine expression and accumulation of macrophages when compared with wild-type mice. Cd1d-/- mice also had increased neuronal injury, neurological dysfunction, and worse mortality after CA. To therapeutically enhance dNKT cell activity, we treated mice with sulfatide lipid after CA, showing that it improved neurological function. Together, these data show that sulfatide-specific dNKT cells are associated with good neurological outcomes after clinical OHCA and are neuroprotective in mice after CA. Strategies to enhance the number or function of dNKT cells may thus represent a treatment approach for CA.