Mortality Profile Research Articles

Predictive Mortality Factors after Decompressive Craniectomy in Ischemic Stroke

Abstract Background Decompressive craniectomy is a consolidated method for the treatment of malignant ischemic stroke (iS) in the territory of the middle cerebral artery. Thus, factors contributing to mortality constitute an important area of investigation. Objective To evaluate the epidemiological clinical profile and predictors of mortality in a single-center population of patients undergoing decompressive craniectomy for the treatment of malignant iS. Methods A single-center retrospective study was performed in 87 patients with malignant iS subjected to emergency decompressive craniectomy from January 2014 to December 2017. Age, gender, laterality, aphasia, time interval between disease onset and treatment, and clinical and neurological outcomes using the Glasgow coma scale were assessed. The patients were stratified by age: a group of participants 60 years old or younger, and a group of participants older than 60 years old for assessment of survival and mortality by the Kaplan-Meier test and log-rank comparison. The intensity of the association between demographic and clinical variables was evaluated by multivariate Cox regression. Results Ischemic stroke was prevalent in patients with hypertension (63.29%). Seventy-seven (84%) patients had some type of postoperative complication, mostly pneumonia (42.8%). The risk of death was 2.71 (p = 0.0041) and 1.93 (p = 0.0411) times higher in patients older than 60 and with less than 8 points on the Glasgow coma scale, respectively. Conclusion Malignant iS has a significant mortality rate. Age above 60 years and Glasgow coma scale values below 8 were statistically correlated with unfavorable prognosis.

Hospitalizations and in-hospital mortality for inflammatory bowel disease in Brazil.

BACKGROUNDInflammatory bowel disease (IBD) is associated with complications, frequent hospitalizations, surgery and death. The introduction of biologic drugs into the therapeutic arsenal in the last two decades, combined with an expansion of immunosuppressant therapy, has changed IBD management and may have altered the profile of hospitalizations and in-hospital mortality (IHM) due to IBD.AIMTo describe hospitalizations from 2008 to 2018 and to analyze IHM from 1998 to 2017 for IBD in Brazil.METHODSThis observational, retrospective, ecological study used secondary data on hospitalizations for IBD in Brazil for 2008-2018 to describe hospitalizations and for 1998-2017 to analyze IHM. Hospitalization data were obtained from the Hospital Information System of the Brazilian Unified Health System and population data from demographic censuses. The following variables were analyzed: Number of deaths and hospitalizations, length of hospital stay, financial costs of hospitalization, sex, age, ethnicity and type of hospital admission.RESULTSThere was a reduction in the number of IBD hospitalizations, from 6975 admissions in 1998 to 4113 in 2017 (trend: y = -0.1682x + 342.8; R2 = 0.8197; P < 0.0001). The hospitalization rate also decreased, from 3.60/100000 in 2000 to 2.17 in 2010. IHM rates varied during the 20-year period, between 2.06 in 2017 and 3.64 in 2007, and did not follow a linear trend (y = -0.0005049x + 2.617; R2 = 0,00006; P = 0.9741). IHM rates also varied between regions, increasing in all but the southeast, which showed a decreasing trend (y = -0.1122x + 4.427; R2 = 0,728; P < 0.0001). The Southeast region accounted for 44.29% of all hospitalizations. The Northeast region had the highest IHM rate (2.86 deaths/100 admissions), with an increasing trend (y = 0.1105x + 1.110; R2 = 0.6265; P < 0.0001), but the lowest hospitalization rate (1.15). The Midwest and South regions had the highest hospitalization rates (3.27 and 3.17, respectively). A higher IHM rate was observed for nonelective admissions (2.88), which accounted for 81% of IBD hospitalizations. The total cost of IBD hospitalizations in 2017 exhibited an increase of 37.5% compared to 2008.CONCLUSIONThere has been a notable reduction in the number of hospitalizations for IBD in Brazil over 20 years. IHM rates varied and did not follow a linear trend.

Clinical Profile, Outcomes and Predictors of Mortality in Neonates Operated for Gastrointestinal Anomalies in a Tertiary Neonatal Care Unit- An Observational Study.

ABSTRACTBackground:Gastrointestinal (GI) malformations have varied short-term and long-term outcomes reported across various neonatal units in India.Methods:This descriptive study was done to study the clinical profile, outcomes and predictors of mortality in neonates operated for congenital GI malformations in a tertiary neonatal care unit in South India between years 2011 and 2020. Details were collected by retrospective review of the case sheets.Results:Total of 68 neonates were included with esophageal atresia (EA) in 10, infantile hypertrophic pyloric stenosis (IHPS) in 9, duodenal atresia (DA) in 10, ileal atresia in 8, jejunal atresia in 5, anorectal malformations (ARM) in 11, meconium ileus/peritonitis in 9, malrotation in 2, and Hirschsprung's disease (HD) in 4. Antenatal diagnosis was highest in DA (80%). Associated anomalies were maximum in EA (50%), the most common being vertebral, anal atresia, cardiac defects, tracheoesophageal fistula, renal and radial abnormalities, and limb abnormalities association (VACTERL). Overall mortality was 15%. IHPS, DA, Malrotation, HD and ARM had 100 % survival while ileal atresia had the least survival (38%). Gestational age <32 weeks (odds ratio [OR] 12.77 [1.96, 82.89]) and outborn babies (OR 5.55 [1.01, 30.33]) were significant predictors of mortality in babies operated for small intestinal anomalies. None of the surviving infants were moderately or severely underweight at follow-up.Conclusion:Overall survival of surgically correctable GI anomalies is good. Among the predictors for mortality, modifiable factors such as in-utero referral of antenatally diagnosed congenital anomalies need attention. One-fifth had associated anomalies highlighting the need to actively look for the same. Although these neonates are vulnerable for growth failure, they had optimal growth on follow-up possibly due to standardized total parenteral nutritional policy during neonatal intensive care unit stay.

Analysis of trend in mortality due to HIV/AIDS-defining and non-HIV/AIDS defining illnesses according to sociodemographic characteristics, by Federative Unit and Brazil, 2000-2018.

To analyze the temporal trend of mortality rate due to HIV/AIDS defining and non-HIV/AIDS defining illnesses in Brazil between 2000 and 2018. This was an ecological time series study, using data from the Mortality Information System, in Brazil and the Federative Units. Trend analysis was performed by means of Prais-Winsten regression model, according to overall mortality rate, sex, age group, marital status and race/skin color. A total of 237,435 deaths were recorded in the period. In the country, defining illnesses showed higher rates (7.4 to 4.4 deaths/100,000 inhabitants in the period) than those observed among non-defining diseases (0.4 to 0.8 death/100,000 inhabitants in the period). It could be seen a decrease in overall mortality due to defining diseases (-6.3%; 95%CI -8.8;-3.8); while it increased due to non-defining diseases (11.0%; 95%CI 6.5;15.7). There was a change in HIV/AIDS mortality profile over the years, with a decrease in deaths due to HIV/AIDS-defining diseases.

Epidemiological and Clinical Profile of COVID-19 Patients Admitted in a Tertiary Care Hospital in Western India.

Introduction:Ahmedabad city reported the highest number of cases and deaths. In order to guide various interventions and monitor future trends, evidence is required. Hence, we conducted the present study to explore the epidemiological determinants, clinical profile, risk factors, and predictors of mortality of COVID-19.Methods:This was a retrospective record-based descriptive study of 2268 confirmed COVID-19 patients admitted in a designated COVID hospital of Ahmedabad city from March to July 2020.Results:The median age of patients was 54 years, and 60.9% of them were males. Majority (83.27%) had comorbidities; the most common comorbidity was hypertension (62.59%) followed by diabetes (44.76%). The most common symptoms reported were fever (69.76%), breathlessness (55.47%), and cough (53.18%). Majority (61.12%) of the patients showed lymphocytopenia, and in one-third (34.85%), D-dimer levels were elevated (>1 μg/ml). Odds of inhospital deaths were higher in patients having breathlessness and gastrointestinal symptoms and comorbidities. More of the deceased had leukocytosis and lymphocytopenia, high D-dimer levels, C-reactive protein, and altered liver function tests as compared to the survivors.Conclusion:While making decisions such as prevention of exposure of high-risk population to the infection, control of the existing comorbid condition, and prioritization of this population for vaccination, criteria of case definition for surveillance keeping in mind the typical and atypical manifestations of the disease, require robust evidence which the current study could provide insight to.

Comparison of efficacy and safety between rabbit anti-thymocyte globulin and anti-T lymphocyte globulin in kidney only transplantation: A retrospective observational study

Introduction: The two formulations of antihuman thymocyte immunoglobulin that are used as T-cell depleting induction agents in renal transplantation are anti-thymocyte globulins (ATG) thymoglobulin and (antiT-lymphocyte globulin [ATLG]-Grafalon-formerly ATG-Fresenius). Very few trials have compared these two formulations. In this retrospective study, we compared the incidence of infections, rejections, graft survival, mortality, and lymphocyte profile of ATG and ATLG. Materials and Methods: This was a single-center retrospective study of 127 consecutive kidney-alone transplant recipients from January 2014 to June 2019. Patients received 3 mg/kg of ATG or 4 mg/kg single dose of ATLG. CD 3 counts were done on day 3 of the transplant. Most of the recipients received standard triple immunosuppression of tacrolimus, mycophenolate mofetil, and prednisolone. Results: Fifty-eight patients received ATG and 69 patients received ATLG. Baseline demographics were similar between the two groups. Death-censored graft survival (99%) (P = 0.258) and biopsy-proven acute rejection (BPAR) (32% vs. 29%, P = 0.128) were similar in both groups. Graft survival was better in ATLG group (92.7% vs. 87.5% P = 0.020). Bacterial infections (41.1% vs. 27.6%, P = 0.03) and sepsis-related mortality (11.54% vs. 4.34% P = 0.02) were significantly higher in the ATG group. Conclusion: ATLG, when used as an induction agent, was associated with a lesser rate of bacterial infections and sepsis-related mortality, but better graft survival as compared to ATG but has comparable BPAR, death-censored graft survival, and viral/fungal infections.

Factors associated with mortality from external causes in an Intensive Care Unit

The demographic and epidemiological profile of mortality in Brazil is marked by an increasing number of external causes, which generates a financial impact for the Unified Health System due to the increase in hospital admissions, especially in Intensive Care Units. This study aimed to analyze the factors associated with mortality from external causes in an intensive care unit. This is a cross-sectional survey, based on secondary data, carried out in an Intensive Care Unit in 2019. The data were analyzed using descriptive statistics, to verify the factors associated with hospital mortality, the Qui-squared and Pearson's tests were used. There were 267 (26.72%) admissions to the Intensive Care Unit, of which 49 (18.4%) died. There was an association of death with the variables: sex (p=0.003), age group (p&lt;0.001), city of residence (p=0.041), nature of the injury (p=0.005), affected body region (p=0.023 ), length of stay in the ICU (p=0.024), time to ICU admission (p&lt;0.001), Glasgow Coma Scale (GCS) (p&lt;0.001), Richmond Agitation Sedation Scale (p=0.021), invasive mechanical ventilation (p&lt;0.001), duration of invasive mechanical ventilation (p&lt;0.001), vasoactive drugs (p&lt;0.001), acute kidney failure (p = 0.002), indwelling urinary catheter (p&lt;0.001), gastric tube (p&lt;0.001), central venous catheter (p&lt;0.001), and invasive blood pressure (p&lt;0.001). It was identified that the factors associated with mortality from external causes in the ICU are related to the sociodemographic profile, and the characteristics referring to the event and the care provided.

Fatores associados a mortalidade por causas externas em Unidade de Terapia Intensiva

The demographic and epidemiological profile of mortality in Brazil is marked by an increasing number of external causes, which generates a financial impact for the Unified Health System due to the increase in hospital admissions, especially in Intensive Care Units. This study aimed to analyze the factors associated with mortality from external causes in an intensive care unit. This is a cross-sectional survey, based on secondary data, carried out in an Intensive Care Unit in 2019. The data were analyzed using descriptive statistics, to verify the factors associated with hospital mortality, the Qui-squared and Pearson's tests were used. There were 267 (26.72%) admissions to the Intensive Care Unit, of which 49 (18.4%) died. There was an association of death with the variables: sex (p=0.003), age group (p&lt;0.001), city of residence (p=0.041), nature of the injury (p=0.005), affected body region (p=0.023 ), length of stay in the ICU (p=0.024), time to ICU admission (p&lt;0.001), Glasgow Coma Scale (GCS) (p&lt;0.001), Richmond Agitation Sedation Scale (p=0.021), invasive mechanical ventilation (p&lt;0.001), duration of invasive mechanical ventilation (p&lt;0.001), vasoactive drugs (p&lt;0.001), acute kidney failure (p = 0.002), indwelling urinary catheter (p&lt;0.001), gastric tube (p&lt;0.001), central venous catheter (p&lt;0.001), and invasive blood pressure (p&lt;0.001). It was identified that the factors associated with mortality from external causes in the ICU are related to the sociodemographic profile, and the characteristics referring to the event and the care provided.

Evolution of the pandemic: Analysis of demographic characteristics of COVID-19-infected patients during its two waves in Gwalior district of central India.

Background:Studies of pandemics in past centuries have suggested that the second wave was always more lethal and devastating as compared to the first wave. Regarding coronavirus disease (COVID) pandemic also, various speculations were made that during the second wave virus changes its nature either for age structure, gender or rural–urban differential. Present study was aimed to compare the demographic and mortality profile of COVID-19 patients during the two waves.Materials and Methods:A total of 51,425 individuals with 16,538 cases from first wave and 34,887 cases from the second wave were included in the study. Frequency, percentage, case fatality rate (CFR) and OR (95% CI) were calculated. Level of significance was considered at 5%.Results:Maximum cases were observed in the age group 21–30 years (23.7%). During the first wave, 29.5% females were infected while during the second wave 38.5% females were infected. Infection in rural areas increased to 5.7% as compared to 4.8% in the first wave. Among the females, CFR increased to 37% in second wave which was 25.2% in the first wave. Disease load was at its peak in the month of April 2021.Conclusion:During the second wave, infection rate and mortality were higher in females and patients residing in rural areas showing extension of community spread. Patients with age above 50 years succumbed more. Occurrence of more than two-fifth of the cases in a single month (April 2021) shows a need for better planning for the supposed third wave to tackle any unwanted situation.

Clinical Profile and Predictors of Mortality in Patients admitted with COVID-19 in a Tertiary Care Hospital

Hospitalization and survival rate in patients with coronavirus disease 2019 (COVID-19) is affected by pre-existing chronic medical conditions and the disease severity. The objectives of the study were to describe the baseline clinical profile, co-morbidities, disease severity and to assess the predictors of mortality in hospitalized adult patients with COVID-19 in a tertiary care hospital in Nepal. A cross-sectional study was conducted for two months on 168 adult COVID-19 patients admitted to Nobel Medical College Teaching Hospital Biratnagar. Demographics, comorbidities, disease severity, oxygen requirement, and treatment outcomes were studied. The mean age of the patients was 57.1 years and 56.5% were male. Out of 168, 16.7% and 10.1% of the participants had currently or in the past used alcohol or tobacco products respectively. Hypertension (28.6%) and chronic lung disease (16.1%) were the most common co-morbidities. The overall case-fatality rate was 17.9%, with 32.1% and 56.3% in the severe and critical COVID-19 subgroup respectively. The mortality rate for patients without co-morbidities was 2.4% which increased to 63.6% for those with three or more co-morbidities. Age, disease severity, and the number of co-morbidities were found to be associated with increased mortality (P&lt;0.05), whereas gender was not. The pre-existing chronic diseases and increased severity of the disease were associated with increased mortality in hospitalized COVID-19 adult patients.

Changing Pattern of Bacteriological Profile, Antimicrobial Resistance and Mortality in Neonatal Sepsis in a Developing Country: A Retrospective Study

Introduction: Neonatal sepsis is one of the major contributors of mortality and morbidity among neonates. Irrational and overuse of antibiotics have led to an increase in antimicrobial resistance. This study was undertaken to investigate the bacteriological profile, antimicrobial resistance and predictors of mortality among blood culture-positive cases of neonatal sepsis. Methods: Demographic and bacteriological data were collected from electronic and manual case records. Automated BACTEC 9050 system using Peds Plus Vial was used for blood culture. Multidrug resistance was defined as a resistance to any three of five antibiotic classes like aminoglycoside, carbapenem, extended spectrum cephalosporins, fluoroquinolones and piperacillin. Results: Among 7180 admitted neonates, 433 (6.03%) were blood culture positive with early onset sepsis (EOS) in 50.1% of cases. Gram negative bacteria was the causative organism in 371 (85.7%) babies with klebsiella being the commonest pathogen (43.6%). The pathogen mix of early onset and late onset sepsis was similar and 90% of gram negative isolates were resistant to penicillin group. Multi drug resistance (MDR) was found in 51.2% of the gram negative organisms. EOS (Odds ratio 1.99; 95% confidence interval, 1.29-3.05) and MDR (Odds ratio 2.07; 95% confidence interval, 1.77-4.12) were independently associated with neonatal death due to sepsis. Conclusions: Gram-negative pathogens, specifically klebsiella accounted for a huge burden of neonatal sepsis. EOS and MDR were found to be independent predictors of death due to such sepsis. This study calls for multicentric studies on early onset neonatal infection and its relationship with pathogenic maternal flora.

Effects of Intermittent Kangaroo Mother Care on Low-Birth-Weight Neonates: A Retrospective Before-and-After Study

Objective. To compare outcomes of low-birth-weight neonates delivered before and after implementation of intermittent kangaroo mother care (KMC) in terms of duration of hospital stay, mortality rate, and clinical outcome.&#x0D; Methods. This is a retrospective analytical study that included all neonates delivered in a tertiary government hospital with birth weight of less than 2000 grams before and after intermittent KMC implementation from January 2015 to December 2016. Chart review was done for demographics, mortality profile, and length of hospital stay. Chi-square test and Student’s t-test were used to compare mortality rate and length of hospital stay, and odds ratio was used for mortality outcome.&#x0D; Results. A total of 677 low birth weight newborns were reviewed and of these, 276 (79.8%) neonates in group 1 (Pre-intermittent KMC implementation), and 263 (79.4%) neonates in group 2 (Post-intermittent KMC implementation) fulfilled the inclusion criteria. The duration of hospital stay of neonates enrolled in KMC was significantly shorter (p ≤ 0.05). In Groups 1 and 2, 93–94% of neonates were discharged improved with a 5–6% mortality of almost equal distribution. There was no significant difference in mortality between groups 1 and 2 (OR 1.19, 95% CI 0.59, 2.42).&#x0D; Conclusion. There was no significant difference in mortality rate and cause of death pre- and post-intermittent KMC implementation. However, the length of hospital stay among the LBW neonates discharged improved was significantly shortened.

A Scoping Review of Men's Health Situation in Primary Health Care

Introduction: There has been an increasing number of studies that have evidenced the profile of male morbidity and mortality, their causes and related consequences, and their association with the low demand and men's permanence in the services offered in Primary Health Care (PHC). Objective: The objective of the study was to map the literature on men's health situation in Primary Health Care. Methods: A scoping review, according to the Joanna Briggs Institute protocol, with the PCC acronym (P – men, C – health situation, C – in primary care), was conducted in the Medline/Pubmed, COCHRANE, Web of Science, SCOPUS, Science Direct, LILACS, BDENF, MEDCARIBE, and SciELO databases, using the descriptors “Men”, “Men's Health”, “Health Services Needs and Demand”, “Primary Health Care” in three information sources (EBSCO, PubMed and SciELO). Results: Men's health situation in Primary Health Care is defined by the influence of the social construction of the masculinities and cultural aspects in the adoption of health care behaviors and practices, in the way in which men present their health complaints, demands, and needs, and establish bonds with the health professionals and the services. Conclusion: There is a number of sociocultural factors inherent to masculinities, institutional factors of the services' organization, and relational factors of men with the health professional that intervene together with the health situation.

Predictors of Mortality in Neonatal Shock: A Retrospective Cohort Study.

To study the incidence, clinical profile, and predictors of mortality in neonatal shock. We enrolled consecutive inborn neonates, who developed shock during hospital stay (between January 1, 2018 to December 31, 2019) at a tertiary-care, research center of northern India. We retrieved the clinical data from our electronic database, case record files, nursing charts, and laboratory investigations from the hospital's Health Information System. Non-survivors were compared with survivors to identify independent predictors of mortality. We had 3,271 neonatal admissions during the study period. We recorded 415 episodes of neonatal shock in 392 neonates [incidence 12.0% (95% confidence interval: 10.9%-13.2%)]. Of 415 episodes, 237 (57%) episodes were identified as septic shock, 67 (16%) episodes as cardiogenic shock, and six (1.4%) episodes as obstructive shock. Remaining 105 (25%) episodes were contributed by more than one etiology of shock. There were 242 non-survivors among 392 neonates with shock (case fatality rate: 62%). On univariate analysis, gestational age, birth weight, incidence of hyaline membrane disease, early-onset sepsis, Acinetobacter sepsis, and cardiogenic shock were significantly different between survivors and non-survivors. Female gender and small for gestational age (SGA) neonates showed a trend of significance. On multivariable regression analysis, we found gestational age, SGA neonates, female gender, and Acinetobacter sepsis to have an independent association with mortality. Septic shock was the commonest cause of neonatal shock at our center. Neonatal shock had very high case fatality rate. Gestational age, SGA, female gender, and Acinetobacter sepsis independently predicted mortality in neonatal shock.

Clinical profile and predictors of mortality in patients admitted with COVID-19 in a tertiary care hospital

Background: Hospitalization in patients with coronavirus disease 2019 (COVID-19) is affected by pre-existing chronic medical conditions and the disease severity. Co-morbidities and the disease severity also affect the survival rate of these patients. Objectives of the study was to describe the baseline clinical profile, co-morbidities and disease severity and to assess the predictors of the mortality in hospitalized adult patients with COVID-19 in a tertiary care hospital in Nepal.Methods: A cross-sectional study was conducted in 168 adult patients admitted with COVID-19 in Nobel Medical College Teaching Hospital, Biratnagar for two months. Demographics, comorbidities, disease severity, oxygen requirement, and treatment outcome were studied.Results: The mean age of the patients was 57.1 years with 56.5% male. Out of 168, 16.7% and 10.1% of the participants had currently or in the past used alcohol or tobacco products respectively. Hypertension (28.6%) and chronic lung disease (16.1%) were the most common co-morbidities. The overall case-fatality rate was 17.9% with 32.1% and 56.3% in the severe and critical COVID-19 subgroup respectively. The mortality rate for patients without co-morbidities was 2.4% which increased to 63.6% for those with three or more co-morbidities. Age, disease severity, and the number of co-morbidities were found to be associated with increased mortality (p&lt;0.05) whereas gender was not.Conclusions: The presence of pre-existing chronic diseases and increased severity of the disease were associated with increased mortality in hospitalized COVID-19 patients.

Non-communicable diseases in Southern Tunisia: morbidity, mortality profile and chronological trends

Abstract Introduction Non-communicable diseases (NCDs) represent a major public health problem worldwide. Giving their impact on the morbidity and mortality burden, understanding their chronological trends over time is a priority for epidemiological surveillance. We aimed to determine the epidemiological specificities of NCDs and to study their chronological trends over the period 2010-2015. Methods We retrospectively collected data of hospitalized patients from the regional registry of morbidity and mortality in the Southern University Hospital of Tunisia during the period 2010-2015. Results We included 18081 patients with NCDs aged ≥ 25 years, with an annual number of 3013 cases/year. The median age of patients was 60 years(Interquartile range IQR = [43-80 years)]). There were 10288 males(57%), with a sex ratio (male/female)of 1.3. The distribution of NCDs was characterized by the predominance of cardiovascular disease(CVD)(10346 cases, 57.2%), then cancers(3034 cases; 16.8%),diabetes(2489 cases; 13.8%) and chronic respiratory tract diseases(2212 cases; 12.2%). Chronological trends analysis of NCDs showed that they remained globally stable between 2010 and 2015. The same result was applied to the group of cancers, chronic respiratory diseases and diabetes mellitus. However, there was a sharp rise for CVD between 2010 and 2015(ρ = 0.84; p = 0.036). The proportion of CVD increased significantly among men(ρ = 0.87; p = 0.019) and elderly(ρ = 0.88; p = 0.019). During the study period, 234 deaths were due to NCDs, with hospital mortality and lethality rates of 5.2/1000 hospitalizations and 1.29%, respectively. CVD were the main cause of deaths(60%). The hospital mortality rate of NCDs increased significantly from 2010 to 2015(ρ = 0.85; p = 0.031), notably for CVDs(ρ = 0.94; p = 0.005). Conclusions Chronological trends analysis revealed a significant rise in the morbidity and mortality burden ofCVDs during the period 2010-2015. It is imperative, therefore, to strengthen health care for these patients. Key messages Non-communicable diseases. Morbidity and mortality.

Microbiology of infective endocarditis in Hong Kong from 2000 to 2019: a 20-year analysis

Abstract Background Infective endocarditis (IE) is associated with high mortality and complex microbiological profile. The antibiotic prophylaxis guidelines underwent a major revision in 2009 to reduce unnecessary antibiotic exposure. Substantial geographic variations in microbiological profiles exist, of which the understanding in an Asian population is lacking. Purpose We aim to describe the trends in the microbiology of IE in Hong Kong in the past 2 decades. Methods All patients aged 20 or above diagnosed with incident IE with blood culture results from 2000–2019 were included from a well-validated territory-wide database in Hong Kong, and were classified as 7 groups of causative organisms as shown in Figure 1. To evaluate the association between microbiology and 1-year all-cause death, a multivariable Cox proportional-hazards model was used, adjusted with demographics and comorbidities. Temporal trends in the proportion of each organism were characterised using Poisson regression. Interrupted time series analysis was used to evaluate the change in the organism-specific incidence after the revision of guidelines. Results In a total of 5,657 patients (age 59.9±18.3 years, 37.2% females), there were 2,185 (38.6%) patients with culture-negative endocarditis. Staphylococcus aureus (22.4%) and Streptococci (20.5%) were the most common organisms identified. Over time, there was a significant reduction in the proportion of culture-negative endocarditis (annual percentage change [APC] −2.3% [−2.8 to −1.7], P&amp;lt;0.001), and a significant increase in the proportion of endocarditis due to Staphylococcus aureus (APC 1.6% [0.7 to 2.4], P&amp;lt;0.001) and Streptococci (APC 2.3% [1.4 to 3.3], P&amp;lt;0.001) (Figure 1). After guidelines revision in 2009, there was no significant change in organism-specific incidence (all P-values for relative change&amp;gt;0.05). Compared to patients with culture-negative endocarditis, those infected with Staphylococcus aureus (hazard ratio [HR] 2.19 [1.94–2.47], P&amp;lt;0.001), other Staphylococci (HR 1.56 [1.20–2.01], P&amp;lt;0.001), Enterococci (HR 1.60 [1.25–2.05], P&amp;lt;0.001), other microorganisms (HR 1.30 [1.05–1.60], P=0.015), and mixed microorganisms (HR 2.40 [2.02–2.84], P&amp;lt;0.001) had a higher risk of 1-year all-cause death (Figure 2). There was a significant increase in the proportion of methicillin-resistant Staphylococcus aureus (MRSA) endocarditis (APC 4.1% [1.9 to 6.3], P&amp;lt;0.001), with no significant interval change after 2009. Patients infected with MRSA had a higher all-cause death (HR 2.00 [1.70–2.36], P&amp;lt;0.001). Conclusions Different causative organisms carry variable mortality signals in infective endocarditis. Over time, there were fewer cases of culture-negative endocarditis, and the revision of antibiotic prophylaxis guidelines did not result in a significant change in the microbiological profile. There was an increasing trend for MRSA endocarditis, which was associated with a higher risk of death. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The Shenzhen Key Medical DisciplineThe Sanming Project of HKU-SZH Cardiology

Long-term outcomes among Nigerian stroke survivors; data from the CogFAST-Nigeria study

Africa faces a rising burden of stroke with rising incidence and prevalence but little is known about the profile and trajectory of long-term outcomes and mortality after stroke. The aim of this study is to explore the trajectory and determinants of long-term outcomes up to four years among a cohort of stroke survivors recruited into the CogFAST-Nigeria study.

Clinical profile, outcomes and predictors of mortality in elderly patients admitted to the emergency medicine intensive care unit of a teaching hospital - A single-center registry.

Aim:Emergency intensive care of the elderly is often complicated and multifaceted. Understanding the clinical profile of elderly patients admitted in an emergency department-intensive care unit (ED-ICU) is crucial in planning health policies in geriatric emergency medicine. Thus, the aim of the study was to create a local registry of elderly people utilizing the ED-ICU services and to understand the rate and predictors of mortality.Methods:A retrospective chart analysis was performed including all patients aged ≥60 years who had an ED-ICU admission during a 6-month period (August 2018–January 2019). A structured case record form was used to capture information such as basic demography, clinical profile, and outcomes.Results:Total number of records considered for final analysis were 503. Mortality was seen in 21.07% (n = 106/503). The most common presenting complaint and cause of death was breathing difficulty (n = 48/503; 29.42%) and pneumonia (n = 41/106; 38.67%), repectively. The significant predictors of mortality [adjusted odds ratio; 95% confidence intervals; P value] were hypertension (2.195; 1.255, 3.840; 0.006), chronic liver disease (CLD) (4.324; 1.170, 15.979; 0.028), malignancy (2.854; 1.045, 7.796; 0.041), requiring noninvasive ventilation (NIV) (2.618; 1.449, 4.730; 0.001), requiring intubation (6.638; 3.705, 11.894; <0.001), and requiring vasopressors (3.583; 1.985, 6.465; <0.001).Conlusion:Approximately one in every five elderly patients getting admitted in ED-ICU died, and respiratory illness was the common diagnosis leading to death. Those with comorbidities such as hypertension, CLD, or malignancy and those requiring NIV, intubation, or vasopressors had higher mortality.

Clinical Profile and Predictors of Mortality in Neonates Born With Non-Immune Hydrops Fetalis: Experience From a Lower-Middle-Income Country.

IntroductionHydrops fetalis (HF) is a life-threatening condition in which a fetus has an abnormal collection of fluid in the tissue around the lungs, heart, abdomen, or under the skin. Based on its pathophysiology, it is classified into immune and non-immune types. With the widespread use of anti-D immunoglobulin, non-immune HF has become more common, with an incidence of one in 1,700-3,000 live births. A multitude of fetal diseases with various causes can lead to non-immune HF. Due to the recent advances in prenatal diagnostic and therapeutic interventions together with improved neonatal intensive care, the diagnosis and subsequent management of HF have been refined. However, HF is still associated with a high mortality rate. A recent assessment of the literature found that there is a lack of data on prognostic variables in neonates with HF from low- and middle-income countries. In light of this, we sought to establish the etiologic causes, predictors of mortality, and eventual fate of newborns born non-immune HF at the Aga Khan University Hospital, Karachi during the 10-year period spanning January 2009-December 2019 in this retrospective analysis.MethodologyFor this study, we collected data from the computerized database and patient record files at the hospital on all infants with non-immune HF. Demographic data, postnatal interventions, clinical and laboratory findings, outcomes, and the results of comparison between HF patients who died and those who survived were analyzed.ResultsThe incidence of non-immune HF at our hospital was 0.62/1,000 live births during the period under study, with 33 newborn babies diagnosed with non-immune HF from a total of 53,033 live-born deliveries. An etiologic factor was discovered in 17 (51.5%) neonates with non-immune HF while 16 (48.4%) were classified as those with unidentified etiology. The most common causes were cardiovascular and genetic syndromes, which resulted in 100% mortality. The overall mortality rate was 67%. The need for mechanical ventilation, surfactant therapy, and prolonged hospitalization were identified as independent risk factors of mortality.ConclusionOur study proves that the need for mechanical ventilation [moderate to severe hypoxic respiratory failure (HRF)] and prolonged hospitalization are strong predictors of poor outcomes in neonates with non-immune HF. Therefore, severe hydrops causing significant mortality can be anticipated based on the patients' respiratory status and the need for escalated oxygen support.