Mortality Odds Ratio Research Articles

Effects of lumbar cerebrospinal fluid drainage on infection, rebleeding, clinical vasospasm, cerebral infarction, hydrocephalus and mortality among patients with aneurismal subarachnoid hemorrhage

Lumbar drainage (LD) has been proposed as a treatment to remove blood from the subarachnoid space in subarachnoid hemorrhage (SAH), but its effects on outcomes in aneurysmal SAH (aSAH) remain debated. This study analyzes the impact of continuous lumbar cerebrospinal fluid (CSF) drainage on infection, rebleeding, clinical vasospasm, cerebral infarction, hydrocephalus, and mortality in aSAH patients. A systematic search across PubMed, Web of Science, Embase, Elsevier Science Direct, and Springer Link identified 11 studies with 2059 patients for meta-analysis. The study evaluates the association between lumbar CSF drainage and clinical outcomes, considering how changes in intracranial pressure (ICP) and CSF dynamics may influence pathophysiology in aSAH. The pooled odds ratio (OR) for infection, rebleeding, clinical vasospasm, cerebral infarction, hydrocephalus, and mortality in the lumbar drainage group was 1.17 (95% CI: 0.81–1.70; P = 0.39), 0.75 (95% CI: 0.37–1.54; P = 0.44), 0.60 (95% CI: 0.48–0.75; P < 0.00001), 0.48 (95% CI: 0.35–0.64; P < 0.00001), 0.53 (95% CI: 0.22–1.24; P = 0.14), and 0.55 (95% CI: 0.36–0.84; P = 0.005), respectively, compared with the no-lumbar drainage group. Results indicate that lumbar CSF drainage does not significantly affect the occurrence of infection, rebleeding, or hydrocephalus. However, it reduces clinical vasospasm, cerebral infarction, and mortality, likely due to improved ICP management and enhanced cerebral perfusion. These findings suggest that continuous lumbar CSF drainage may benefit aSAH patients by mitigating ischemic injury, but further studies are needed to confirm its broader applicability and long-term effects on outcomes.

Enhancing emergency care for older persons: the role and impact of the electronic Frailty Index.

As the elderly population expands, enhancing emergency department (ED) care by assessing frailty becomes increasingly vital. To address this, we developed a novel electronic Frailty Index (eFI) from ED health records, specifically designed to assess frailty and predict hospitalization, in-hospital mortality, ICU admissions, and 30-day ED readmissions. This retrospective, single-center study included patients 65years old or older who presented to the ED of IRCCS Humanitas Research Hospital in Milan, Italy, between January 2015 and December 2019. Frailty was assessed using a novel electronic Frailty Index (eFI), based on the cumulative deficit model, incorporating 45 health deficits to quantify frailty. Patients were divided into four quartiles based on eFI scores to explore the association between frailty levels and adverse outcomes, including hospitalization, in-hospital mortality, ICU admission, and 30-day ED readmission. The study included 21,537 patients (mean age 77.4, 50.7% males). The median eFI score was 0.16. Hospitalization rates rose significantly with frailty, from 20% in the least frail quartile to 43% in the most frail. Similarly, in-hospital mortality and ICU admissions increased markedly with higher eFI scores, with mortality rates climbing from 0.44 to 5.0% across quartiles. The 30-day ED readmission rates significantly rose from 9.9 to 19.8%. For every 0.01 increase in eFI score, the odds of hospitalization, in-hospital mortality, ICU admission, and 30-day ED readmission significantly increased (P < 0.0001). Specifically, the adjusted odds ratios (OR) for hospitalization, in-hospital mortality, ICU admission, and ED readmission rose to 3.55, 14.15, 4.70, and 2.22, respectively (P < 0.0001), in the most frail compared to the least frail quartile. The integration of the eFI into ED settings can enable more precise risk stratification and resource allocation, significantly improving patient management and healthcare delivery for older persons in these urgent care contexts.

Explainable AI associates ECG aging effects with increased cardiovascular risk in a longitudinal population study

Aging affects the 12-lead electrocardiogram (ECG) and correlates with cardiovascular disease (CVD). AI-ECG models estimate aging effects as a novel biomarker but have only been evaluated on single ECGs—without utilizing longitudinal data. We validated an AI-ECG model, originally trained on Brazilian data, using a German cohort with over 20 years of follow-up, demonstrating similar performance (r2 = 0.70) to the original study (0.71). Incorporating longitudinal ECGs revealed a stronger association with cardiovascular risk, increasing the hazard ratio for mortality from 1.43 to 1.65. Moreover, aging effects were associated with higher odds ratios for atrial fibrillation, heart failure, and mortality. Using explainable AI methods revealed that the model aligns with clinical knowledge by focusing on ECG features known to reflect aging. Our study suggests that aging effects in longitudinal ECGs can be applied on population level as a novel biomarker to identify patients at risk early.

Impact of American College of surgeons trauma verification on statewide collaborative outcomes.

American College of Surgeons (ACS) trauma center verification has demonstrated improved outcomes at individual centers, but its impact on statewide Trauma Quality Improvement Program (TQIP) Collaboratives is unknown. A statewide TQIP Collaborative, founded in 2011, noted underperformance in six of eight patient cohorts identified in the TQIP Collaborative report. We hypothesized that requiring ACS verification for level I and II trauma centers would result in improved outcomes for the state collaborative. The ACS verification requirement was tied to ongoing Trauma Commission funding. Trauma centers were required to apply for an ACS consultative visit by 2017 and were given until 2023 to achieve ACS verification. The effect of this intervention was measured in the number of centers achieving verification and in the performance of the TQIP Collaborative semiannual reports. In 2015, only 1 of 15 (7%) trauma centers were ACS verified, and 4 had undergone consultative visits. By 2023, 11 of 12 (92%) trauma centers achieved ACS verification. Following this intervention, the observed-to-expected odds ratio for all-patient morbidity and mortality improved from 1.60 to 1.17, and variation among patient-specific cohorts narrowed from 0.97-1.82 to 0.96-1.48 (Figure 2). Performance in all six underperforming patient-specific cohorts improved over the study period. ACS verification for level I and II trauma centers improves TQIP Collaborative performance. Statewide Collaboratives should consider ACS verification as a requirement for participation. Economic and Value-Based Evaluations, Level III.

Influence of Patient Gender on In-Hospital Mortality: A Population-Based Cross-Sectional Study.

To analyse the association between gender and in-hospital mortality odds ratios among patients in the Basque Country. Cross-sectional study. Admission data pertaining to the period between 1 January 2016 and 31 December 2018 were gathered for all registered acute care hospitals (both public and private) in the Basque Country. Odds ratios were calculated through binomial logistic regressions to determine the association between gender and mortality in each diagnostic category of the ICD-10. Women had a higher in-hospital mortality odds ratio for diseases of the circulatory system (OR 1.07 [1.01-1.14], p < 0.05). In contrast, men were at greater risk of in-hospital death from neoplasms (OR 0.86 [0.83-0.94], p < 0.05), diseases of the nervous system (OR 0.83 [0.70-0.97], p < 0.05), diseases of the genitourinary system (OR 0.83 [0.71-0.96], p < 0.05), endocrine diseases (OR 0.67 [0.54-0.84], p < 0.05), injury, poisoning and other consequences of external causes (OR 0.60 [0.54-0.67], p < 0.05) and diseases of the musculoskeletal system and connective tissue (OR 0.69 [0.50-0.93], p < 0.05). No patient or public contributions.

Investigating the Effects of Nosocomial Clostridioides difficile Infection Among Acute Leukemia Patients: Insights From the 2020 National Inpatient Sample.

Rising nosocomial Clostridioides difficile infections pose high risks, especially for immunocompromised leukemia patients, necessitating targeted research to enhance patient care and outcomes.The objective of this study was to investigate the impact of nosocomial Clostridioides difficile infections (CDI) on patients hospitalized with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Our study was a retrospective analysis of adult patients hospitalized with a primary diagnosis of ALL or AML, using the Nationwide Inpatient Sample (NIS) database for 2020. Primary outcomes included the incidence of nosocomial CDI and all-cause inpatient mortality. Secondary outcomes included hospital length of stay, resource utilization, and morbidity. Statistical analyses were conducted with STATA (address). Fisher's exact test was utilized to compare proportions, while the Student's t test was employed for continuous variables. Multivariate logistic and linear regression analyses were used to adjust for confounding variables. We found in 21 135 ALL and 58 560 AML adult patients that the CDI incidences were 2.77% and 3.0%, respectively. ALL and AML patients with CDI had adjusted mortality odds ratios of 3.02 (P = .003) and 1.51 (P = .02). Hospital length of stay was extended by mean differences of 10.16 days (ALL) and 8.33 days (AML) for those with CDI compared to those without it. In addition, patients with CDI displayed a significantly higher incidence of acute kidney injury, sepsis, vasopressor use, and intensive care unit admissions. This study highlights the significant impact of CDI infections on health outcomes for leukemia patients, emphasizing the need for robust infection control measures, early detection, and aggressive management of CDI to improve patient outcomes and minimize healthcare costs.

An approach to COVID‑19 and oncology: From impact, staging and management to vaccine outcomes in cancer patients: A systematic review and meta‑analysis.

The COVID-19 pandemic has had a global impact, with >771 million confirmed cases and 6 million deaths reported by October 2023. Cancer patients, due to their immunosuppressed status, face an increased infection risk and higher COVID-19 complications. The present study aimed to assess clinical outcomes in COVID-19-infected cancer patients, focusing on mortality rates and other aspects, providing valuable insight for better protection and outcomes. This systematic review was conducted by searching the PubMed, Cochrane and Embase databases from August 2023 following the PRISMA guidelines. Studies from 2020 to 2023 pertaining to the impact of COVID-19 on patients previously diagnosed with malignancies were considered. Inclusion criteria entailed a pre-existing malignancy diagnosis, confirmed COVID-19 infection and an impact of COVID-19 on any aspect of the patient's cancer management. Studies written in English were exclusively reviewed. Post-COVID-19 malignancy diagnoses, case reports, review articles and data-insufficient studies were excluded. Screening and consensus on eligibility were carried out by a team of four authors, with disputes resolved by a non-screening author. Data extraction was performed by a five-author team, detailing study and population characteristics, as well as cancer patient outcomes related to COVID-19. Cross-checking was conducted by the same team, with conflicts resolved by a third author. The review of 27 studies explored COVID-19's impact on oncology, revealing diverse sample sizes (1,807,559 to 177 participants). Studies spanned various cancer types, including gastric adenocarcinoma, breast, lung, gynecologic, colorectal and non-melanoma skin cancer. Mortality rates were higher among cancer patients with COVID-19 compared to those without. Gastric adenocarcinoma exhibited a 5.9% mortality rate. Thoracic cancer patients faced elevated mortality and gastrectomies decreased. A meta-analysis (10 studies, 5,151 patients) showed a 19.1% mortality rate for COVID-19-infected cancer patients, contrasting with 1% for non-COVID-19 cancer patients (5 studies, 54,528 patients). The odds ratio for mortality in non-COVID-19 vs. COVID-19 cancer patients was 0.1036 (3 studies, 3,496 patients). Cancer patients consistently faced elevated mortality during the pandemic, with specific cancers showing unique impacts. Gastric adenocarcinoma exhibited a significant COVID-19 mortality rate. Patients with thoracic cancer faced increased risks, influencing surgical trends. Meta-analysis revealed an overall elevated mortality rate among COVID-19-infected cancer patients compared to non-COVID-19 counterparts.

Bloodstream Infections in a Nepalese Tertiary Hospital-Aetiology, Drug Resistance and Clinical Outcome

Background: Bloodstream infections (BSIs) are a leading cause of sepsis-related morbidity and mortality globally. We present the pathogenic agents of bloodstream infections, their antimicrobial susceptibilities, and associated outcomes, with a focus on drug-resistant cases.Methods: We included all adult patients admitted to B.P. Koirala Institute of Health Sciences with blood culture-positive sepsis from July 2019 to June 2020. Blood cultures and antimicrobial susceptibility tests followed standard methods. Demographic, clinical, and microbiological data, including clinical outcomes, were documented. Patients were categorized into non-multidrug resistant (non-MDR), multidrug resistant (MDR), and extensively drug resistant (XDR) groups for analysis of clinical outcomes. Results: Of 5372 adult patients with suspected bloodstream infections, 475 (9%) had culture-positive infections with 536 organisms cultured. The median age of the patients was 42 (25-60) years, and 47% of the patients were women. There were 146 (31%) non-MDR, 220 (46%) MDR and 109 (23%) XDR cases. Common pathogens were Staphylococcus aureus (27%), Acinetobacter spp (20%), and Klebsiella spp (15%). The overall in-hospital mortality rate was 8% (38/475). Mortality was highest among XDR patients (53%), compared to MDR (29%) and non-MDR patients (18%) (p &lt; 0.001). Patients in XDR group had longer hospital stays compared to MDR-BSI and non-MDR BSI patients (p=&lt;0.001). After adjusting for risk factors, the odds ratio for in-hospital mortality in XDR patients was 2.52 (CI 1.11–5.72, p = 0.02). Conclusions: Drug-resistant pathogens are prevalent in our setting, causing bloodstream infection. Extensively drug-resistant bacteria in the blood are independently and significantly linked to increased mortality. Keywords: Bloodstream infections; clinical outcome; drug resistance.

Association between the triglycerides and glucose index and critically ill stroke in non-obese population: An observational study on eICU database.

Both the triglyceride glucose (TyG) index and stroke are associated with insulin resistance (IR). Studies have shown that TyG is associated with stroke. However, the relationship between TyG index and stroke in non-obese population remains unclear. This study investigated the association between TyG and the prognosis of severe stroke in non-obese individuals. This was a retrospective observational study. TyG was determined at baseline and stroke mortality was assessed at follow-up. All data were extracted from the eICU Collaborative Research Database. Hospital and intensive care unit (ICU) mortality rates were determined as endpoints. Smoothing curves were performed to estimate the relationship between TyG and stroke mortality. Multivariate logistic regression analysis and restricted cubic spline regression were used to evaluate the independent effect of TyG on stroke mortality. A total of 1946 eligible subjects were included. The hospital and ICU mortality rates were 10.6% and 5.3%, respectively. In univariate analysis, for per unit increase in TyG, the odds ratio (OR) for in-hospital mortality and ICU mortality of stroke were 1.85 (95%CI 1.50-2.28) and 2.08 (95%CI 1.58-2.75), respectively. After fully adjusting for confounding factors, the OR for in-hospital mortality and ICU mortality of stroke were 8.64 (95%CI 4.25-17.55) and 9.30 (95%CI 3.73-23.20), respectively. The restricted cubic spline regression model indicated a linear increase in hospital and ICU mortality with rising TyG index. Subgroup analysis showed consistent effect sizes and directions across different subgroups, demonstrating the stability of the findings. In the non-obese population, an increase in TyG was related to higher stroke mortality. TyG may have clinical significance in identifying poor prognosis of stroke patients.

Risk factors and outcomes of renal insufficiency after colectomy for diverticulitis.

Diverticulitis has significantly increased in prevalence in recent decades, requiring higher rates of colon resections. While current literature focuses on postoperative complications such as abscesses, wound infections, and anastomotic leaks, many are limited in showing details regarding the significant risk associated with developing renal insufficiency among diverticulitis patients undergoing colectomy. We selected patients from the 2022 National Surgical Quality Improvement Program (NSQIP) Colectomy database who underwent colon resection for diverticulitis using International Classification of Disease (ICD10) code K57.92. To analyze postoperative renal function, we removed all patients with preoperative renal failure. From there, a total of 6985 patients with no postoperative renal insufficiency (Control group) and 492 with postoperative renal insufficiency (Post-op. RI group) were identified. Of individuals undergoing colectomy for diverticulitis, 6.58% experienced postoperative renal insufficiency. In all diverticulitis colectomies, comorbidities such as diabetes (21.95% versus 10.95%; p = 0.018), congestive heart failure (11.59% versus 2.95% p < 0.001), hypertension (61.79% versus 42.83%; p < 0.001), and chronic obstructive pulmonary disease (9.96% versus 3.66%; p < 0.001) were associated with higher risk of kidney injury. Multivariate regression analysis indicated that postoperative renal insufficiency is independently associated with increased risk of mortality (odds ratio = 3.8001; p < 0.001). As the prevalence of diverticulitis has increased in the USA, it is paramount to recognize the risks associated with the required operation as well as the factors that affect patient outcomes and risks for developing renal insufficiency.

Delta shock index predicts injury severity, interventions, and outcomes in trauma patients: A 10-year retrospective observational study.

Most trauma occurs among young male subjects in Qatar. We examined the predictive values of the delta shock index (DSI), defined as the change in the shock index (SI) value from the scene to the initial reading in the emergency unit (i.e., subtracting the calculated SI at admission from SI at the scene), at a Level 1 trauma center. To explore whether high DSI is associated with severe injuries, more interventions, and worse outcomes [i.e., blood transfusion, exploratory laparotomy, ventilator-associated pneumonia, hospital length of stay (HLOS), and in-hospital mortality] in trauma patients. A retrospective analysis was conducted after data were extracted from the National Trauma Registry between 2011 and 2021. Patients were grouped based on DSI as low (≤ 0.1) or high (> 0.1). Data were analyzed and compared using χ 2 and Student's t-tests. Correlations between DSI and injury severity score (ISS), revised trauma score (RTS), abbreviated injury scale (AIS), Glasgow coma scale (GCS), trauma score-ISS (TRISS), HLOS, and number of transfused blood units (NTBU), were assessed using correlation coefficient analysis. The diagnostic testing accuracy for predicting mortality was determined using the validity measures of the DSI. Logistic regression analysis was performed to identify predictors of mortality. This analysis included 13212 patients with a mean age of 33 ± 14 years, and 24% had a high DSI. Males accounted for 91% of the study population. The trauma activation level was higher in patients with a high DSI (38% vs 15%, P = 0.001). DSI correlated with RTS (r = -0.30), TRISS (r = -0.30), NTBU (r = 0.20), GCS (r = -0.24), ISS (r = 0.22), and HLOS (r = 0.14) (P = 0.001 for all). High DSI was associated with significantly higher rates of intubation, laparotomy, ventilator-associated pneumonia, massive transfusion activation, and mortality than low DSI. For mortality prediction, a high DSI had better specificity, negative predictive value, and negative likelihood ratio (77%, 99%, and 0.49%, respectively). After adjusting for age, emergency medical services time, GCS score, and ISS, multivariable regression analysis showed that DSI was an independent predictor of mortality (odds ratio = 1.9; 95% confidence interval: 1.35-2.76). In addition to sex-biased observations, almost one-quarter of the study cohort had a higher DSI and were mostly young. High DSI correlated significantly with the other injury severity scores, which require more time and imaging to be ready to use. Therefore, DSI is a practical, simple bedside tool for triaging and prognosis in young patients with trauma.

The effectiveness of HALP score in predicting mortality in non-ST-elevation myocardial infarction patients.

The HALP score, measured based on hemoglobin, albumin, lymphocyte, and platelet levels, is regarded as a novel scoring system that indicates the status of systemic inflammation and nutritional health. Our study aimed to evaluate the relationship between HALP score and prognosis in non-ST-elevation myocardial infarction (NSTEMI) patients. Between 1 January 2020 and 1 January 2022, 568 consecutive patients diagnosed with NSTEMI from a single center were included in the study retrospectively. The patients were divided into two equal groups according to the median HALP cutoff value of 44.05. Patients were followed for at least 1 year from the date of admission. The average age of the patients was 62.3 ± 10.6 years and 43.7% were female. In-hospital and 1-year mortality were found to be significantly higher in the group with low HALP scores (6.0 vs. 2.1%, P = 0.019 and 22.5 vs. 9.9%, P < 0.001, respectively). In receiver operating characteristic curve analysis, a cutoff level of 34.6 of the HALP score predicted 1-year mortality with 71% sensitivity and 65% specificity (area under the curve: 0.707, 95% confidence interval: 0.651-0.762, P < 0.001). In Kaplan-Meier analysis, higher mortality rates were observed over time in the group with lower HALP scores (log-rank test=16.767, P < 0.001). In Cox regression analysis, the HALP score was found to be an independent predictor of 1-year mortality (odds ratio: 0.969, 95% confidence interval: 0.958-0.981, P < 0.001). We found that a low HALP score could predict in-hospital and 1-year mortality in patients admitted to the hospital with a diagnosis of NSTEMI.

Predictors of Mortality for Upper Extremity Penetrating Vascular Injuries (UEPVI).

Our objective was to determine risk factors and operative outcomes for patients with upper extremity penetrating vascular injuries(UEPVI). A retrospective review was performed of all adult UEPVI patients presenting to a level I trauma center between 1986 and 2019. Statistical analyses were performed to determine the independent predictors of mortality and hospital length of stay(LOS) among patients who underwent operative repair. Among 481 UEPVI patients, the majority were male(87%),Caucasian(52%), uninsured/underinsured(52%). Over half of injuries were caused by violent means and required surgery. Female patients had a higher injury severity score(ISS)(mean 9.55 vs 6.77,p=0.02),were more likely to proceed urgently to the operating room (OR)(40.6% vs 24.2%,p=0.02),but had a lower mortality(1.6% vs 4.8%,p=0.009)compared to male patients. 43 (0.9%) of patients suffered amputation and 213 (44%) of patients ultimately underwent operative repair; odds ratio of mortality with an operation amongst all patients was 0.20 (p=0.011, 95% CI: 0.058-0.687). Among operative patients, only ISS was significant predictor of longer LOS (standardized coefficient=0.47, 95% CI: 0.76-1.36, p<0.001). This retrospective analysis demonstrates that the majority of UEPVI are incurred by men and associated with violence. Operative intervention was protective with regards to mortality. Amongst operative patients, increased age and ISS were predictive of longer LOS.

Socioeconomic Disparities in the Clinical Outcomes of Pediatric Traumatic Brain Injury: A Nationwide Analysis of the Past Decade

Socioeconomic status has historically influenced traumatic brain injury (TBI) outcomes, yet pediatric TBI disparities remain understudied. We aimed to analyze the National Inpatient Sample (NIS) database for socioeconomic disparities in the outcomes of pediatric TBI patients. The NIS from 2011 to 2020 was retrospectively analyzed for pediatric TBI patients. Socioeconomic variables included age, sex, race, household income, geographic location, and primary expected payer. Outcomes included length of stay (LOS), in-hospital mortality, mortality risk, and illness severity. A total 45,109 pediatric TBI patients (63.9% male) were identified. Mean age was 7.76 years, mean LOS was 4.57 days, and overall mortality rate was 3.2%. African-American or Native American patients had significantly longer LOS (1.6 and 3.4 days, respectively; p<0.01) than White patients. African-American patients had an odds ratio of mortality of 1.57 compared to White patients. Female patients had significantly higher mortality risk and LOS (0.5 days) than male patients (p<0.001). Patients in the bottom 50% of income and those in rural counties had higher odds of mortality (2.20 and 1.27, respectively) compared to higher-income and urban patients. Regional mortality rate differences were significant (p<0.001), with the East South Central region having the highest rate. Medicaid and self-pay patients had higher LOS (p<0.001) and odds ratios of mortality (1.19 and 2.36, respectively) compared to private insurance patients. This study highlights significant differences based on race, sex, income, insurance type, and geographic location in pediatric TBI outcomes. Future research should focus on identifying factors contributing to inequalities and developing strategies to mitigate them.

Mechanical Power Is Associated With Mortality in Pressure-Controlled Ventilated Patients: A Dutch, Single-Center Cohort Study.

Mechanical power (MP) could serve as a valuable parameter in clinical practice to estimate the likelihood of adverse outcomes. However, the safety thresholds for MP in mechanical ventilation remain underexplored and contentious. This study aims to investigate the association between MP and hospital mortality across varying degrees of lung disease severity, classified by Pao2/Fio2 ratios. This is a retrospective cohort study using automatically extracted data. Patients admitted to the ICU of a tertiary referral hospital in The Netherlands between 2018 and 2024 and ventilated in pressure-controlled mode were included. Logistic regression, adjusted for age, sex, Acute Physiology and Chronic Health Evaluation-IV score, and Pao2/Fio2 ratio, was used to calculate the odds ratio (OR) for all-cause in-hospital mortality. A total of 2184 patients were analyzed, with a mean age of 62.5 ± 13.8 years, of whom 1508 (70.2%) were male. The mean MP was highest in patients with the lowest Pao2/Fio2 ratios (21.5 ± 6.5 J/min) compared with those with the highest ratios (12.0 ± 3.8 J/min; p < 0.001). Adjusted analyses revealed that increased MP was associated with higher mortality (OR, 1.06; 95% CI, 1.03-1.09 per J/min increase). Similarly, MP normalized for body weight showed a stronger association with mortality (OR, 1.004; 95% CI, 1.002-1.006 per J/min/kg increase). An increase in mortality was seen when MP exceeded 16-18 J/min. Our findings demonstrate a significant association between MP and hospital mortality, even after adjusting for key confounders. Mortality increases notably when MP exceeds 16-18 J/min. Normalized MP presents an even stronger association with mortality. These results underscore the need for further research into ventilation strategies that consider MP adjustments.

Association of short-term exposure to ambient air pollution and temperature with bronchiectasis mortality: a nationwide time-stratified case-crossover study

Ambient pollution and non-optimal temperature are major risk factors for respiratory health. However, the relationships between short-term exposure to these factors and bronchiectasis mortality remain unknown. A nationwide, time-stratified case-crossover study across Mainland China was conducted from 2013 to 2019. Records of bronchiectasis deaths were extracted from the National Death Registration Reporting Information System. Daily concentrations of fine particulate matter (PM2.5), coarse particulate matter (PM2.5-10), nitrogen dioxide (NO2), ozone (O3), and daily temperature were obtained from high-resolution prediction models. We utilized conditional logistic regression model and distributed lag nonlinear model to explore the associations of these exposures with bronchiectasis mortality. We included a total of 19,320 bronchiectasis deaths. Air pollutant was associated with bronchiectasis mortality within the first 3 days after exposure and the exposure-response relationships were almost linear. An interquartile range increase in PM2.5, PM2.5-10, and O3 was associated with increments of 3.18%, 4.14%, and 4.36% in bronchiectasis mortality at lag 02 d, respectively. Additionally, lower temperature was associated with higher odds of bronchiectasis mortality. Compared to referent temperature (23.6°C), the odds ratio for bronchiectasis mortality associated with extremely low temperature (P1:-13.4°C) was 1.54 (95% CI: 1.05, 2.25). This national study provides compelling evidence, and highlights the necessity and importance of reducing air pollution exposures and keeping warm for susceptible populations. National Natural Science Foundation of China (81925001; 82330070); Innovation Program of Shanghai Municipal Education Commission (202101070007-E00097); Program of Shanghai Municipal Science and Technology Commission (21DZ2201800); Program of Shanghai Shenkang Development Center (SHDC12023110); and Major Project of National Health Commission of China.

Transcatheter vs Surgical Aortic Valve Replacement in Bicuspid Aortic Valves.

Recent approval of transcatheter aortic valve replacement (TAVR) in patients at lower risk profiles has resulted in a real-world expansion in patients with bicuspid aortic valves (BAV), otherwise excluded from trials comparing TAVR with surgical aortic valve replacement (SAVR). This study compared perioperative and longitudinal outcomes between BAV patients undergoing TAVR vs SAVR. Using the United States Centers for Medicare and Medicaid Services inpatient claims database, we evaluated all beneficiaries with BAV undergoing isolated SAVR or TAVR (2018-2022). Comorbidities and frailty were accounted for using validated metrics with doubly robust risk adjustment using inverse probability weighting, multilevel regression models, and competing-risk time to event analysis. Subgroup analysis evaluated patients <75 years with low surgical risk (<4%). The study included 11,289 BAV patients (8123 SAVR and 3166 TAVR). Accounting for age, comorbidities, and frailty, TAVR was associated with lower procedural mortality (odds ratio, 0.40; P < .001) but higher pacemaker (12.4% vs 2.3%; odds ratio, 5.4; P < .001), longitudinal stroke (2.4% vs 1.5%; hazard ratio [HR], 1.35; P < .001), and all-cause mortality (8.8% vs 5.7%; HR, 1.49; P < .001) compared with SAVR. The young low-risk subgroup (5393 SAVR and 1731 TAVR) highlighted similar findings, with TAVR associated with higher longitudinal stroke (2.1% vs 1.7%; HR, 1.22; P= .017) and composite stroke, valve reintervention, or death (8.1% vs 5.9%; HR, 1.37; P < .001) compared with SAVR. Among Medicare beneficiaries with BAV, TAVR was associated with lower index in-hospital mortality but also lower 5-year risk-adjusted freedom from longitudinal stroke compared with SAVR, even in the youngest low-risk patients.

Evaluating the Impact of Phosphatidylethanol Testing on Hospital Outcomes.

Alcohol dependence remains a significant global health issue, exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. Phosphatidylethanol (PEth), a direct biomarker of recent alcohol consumption, offers improved specificity, sensitivity, and a longer detection window of 2 - 4 weeks compared to traditional biomarkers. This study evaluates the association between PEth testing and hospital outcomes in hospitalized patients by comparing outcomes among patients with positive PEth and negative PEth test results. This retrospective cohort study used data from the TriNetX database, comprising de- identified medical records from 66 US healthcare organizations from 2015 to 2024. The study population included patients with documented PEth test results. Patients were divided into two groups: positive PEth test results (≥ 20 ng/mL) and negative PEth test results (≤ 19 ng/mL). Propensity score matching was performed to minimize bias, balancing for age, sex, race, ethnicity, and comorbidities such as cirrhosis, diabetes mellitus, hypertension, coronary artery disease, and chronic obstructive pulmonary disease (COPD). Key hospital outcomes assessed included mortality, delirium tremens, endoscopy/colonoscopy, liver transplant status, liver transplant rejection, liver transplant complications, hepatorenal syndrome, intensive care unit (ICU) admission, hepatic encephalopathy, and sarcopenia. These outcomes were chosen based on their prevalence in patients with alcohol use. Patients with positive PEth results demonstrated significantly worse outcomes compared to patients in the negative PEth group. Positive PEth results were associated with higher mortality (odds ratio, 10.037; P < 0.001), ICU admissions, and rates of complications such as hepatorenal syndrome, hepatic encephalopathy, and sarcopenia. Postoperative liver transplant complications and rejection were also more frequent in the positive cohort. This study highlights the association between recent alcohol use, as identified by PEth testing, and severe hospital outcomes. While PEth testing provides an objective measure of recent alcohol consumption, further research is needed to explore its role in improving clinical outcomes and guiding interventions for patients with alcohol use.

The impact of aging on outcomes in acute respiratory distress syndrome: a multicenter cohort study

Advanced age significantly influences outcomes in acute respiratory distress syndrome, with implications for intensive care unit-free days, ventilator-free days, and mortality. Understanding these relationships is essential for optimizing care in elderly populations. This retrospective multicenter cohort study included 1992 patients with acute respiratory distress syndrome from the Acute Respiratory Distress Syndrome Network trials, specifically the ALTA (Albuterol for the Treatment of Acute Lung Injury), EDEN (Early vs. Delayed Enteral Nutrition), Omega (Omega-3 Fatty Acid, Gamma-Linolenic Acid, and Anti-Oxidant Supplementation), and SAILS (Statins for Acutely Injured Lungs from Sepsis) studies, categorized into four age groups: &lt; 40 years (n = 450, 22.6%), 40–60 years (n = 915, 45.9%), 60–80 years (n = 536, 26.9%), and &gt; 80 years (n = 91, 4.6%). Key demographic characteristics, including gender, race, and ethnicity, were analyzed. Regression models adjusted for driving pressure and PaO₂/FiO₂ ratio examined associations between age and intensive care unit-free days, ventilator-free days, and mortality at 60 and 90 days. The results showed that older age was correlated with significantly fewer intensive care unit-free days and ventilator-free days and higher mortality. Patients &gt; 80 years experienced 8.47 fewer intensive care unit-free days (95% CI: –11.24 to –5.69) and 9.26 fewer ventilator-free days (95% CI: –12.22 to –6.31) compared to those &lt; 40 years. Mortality increased with age; 60-day mortality odds ratios were 1.44 (95% CI: 1.02–1.88) for 60–80 years and 2.32 (95% CI: 1.66–3.00) for &gt; 80 years. Results persisted at 90 days. Subgroup analysis revealed demographic disparities: non-Hispanic White patients comprised 77.3%, Black patients 15.4%, and Hispanic ethnicity 11.6%. Men accounted for 50.9% of the cohort. The findings suggest that aging significantly worsens acute respiratory distress syndrome outcomes, with reductions in intensive care unit-free days, ventilator-free days, and survival. Older patients warrant targeted management strategies, emphasizing ventilatory optimization, particularly driving pressure and oxygenation indices, to improve outcomes. These findings underscore the need for personalized approaches to acute respiratory distress syndrome management in elderly populations.

Impact of COVID-19 pandemic on traumatic brain injury emergency department visits, interfacility transfer and mortality in the United States, 2016–2020: a cross-sectional study

ObjectiveThe aim of this study was to determine how the COVID-19 pandemic affected patient demographics, injury mechanisms, interhospital transfers and mortality of patients with traumatic brain injuries (TBIs) treated in...