Mortality-related Risk Factors Research Articles

Analysis of Risk Factors for Death in the Coronavirus Disease 2019 (COVID-19) Population: Data Analysis from a Large General Hospital in Anhui, China.

During the coronavirus disease 2019 (COVID-19) pandemic, clinical prevention, early diagnosis, and hematological monitoring were challenging areas.This study aims to comparerisk factors and hematological and biochemical data in non-survivor group patientswith COVID-19 versus survivor group patients.A total of 204 patients with COVID-19 were selected as research subjects from December 2022 to January 2023. We analyzed the age, sex, time from onset to admission, and laboratory test indicators upon admission. The differences between surviving and deceased patients and mortality-related risk factors were examined. Among the 204 patients, 168 survived, whereas 36 died during hospitalization. Significant differences were observed between the two groups with COVID-19 across various factors, including age (p < 0.0001), WBC count (p < 0.0001), RBC count (p < 0.05), neutrophils (p < 0.0001), lymphocytes (p < 0.05), mean corpuscular hemoglobin concentration (MCHC) (p < 0.0001), RBC distribution width-standard deviation (RDW-SD) (p < 0.0001), RBC distribution width coefficient of variation (RDW-CV) (p < 0.0001), aspartate aminotransferase (AST) (p < 0.05), albumin (ALB) (p < 0.0001), creatinine (CR) (p < 0.0001), uric acid (UA) (p < 0.0001), blood urea nitrogen (BUN) (p < 0.0001), plasma thrombin time (TT) (p < 0.05), prothrombin time (PT) (p < 0.0001), and D-dimer (p < 0.0001). Multivariate logistic analysis revealed that older age, CR, UA, and ALB were independent factors associated with death (p < 0.05).Elderly patients with underlying diseases, abnormal routine blood test indices, and abnormal renal function and coagulation indices are at an increased worse prognosisand should be identified early. Age, UA, CR, and ALB can be used as predictors to assess the worse prognosisin the hospital.

Risk factors for invasive pulmonary aspergillosis in patients with severe fever with thrombocytopenia syndrome: A multicenter retrospective study.

Invasive pulmonary aspergillosis (IPA) is a life-threatening complication in patients with severe fever with thrombocytopenia syndrome (SFTS), yet SFTS-associated IPA (SAPA)'s risk factors remain undefined. A multicenter retrospective cohort study across Hubei and Anhui provinces (May 2013-September 2022) utilized least absolute shrinkage and selection operator (LASSO) regression for variable selection. Multivariable logistic regression identified independent predictors of SAPA, Cox regression highlighted mortality-related risk factors. Of the 1775 screened SFTS patients, 1650 were included, with 169 developing IPA, leading to a 42-day mortality rate of 26.6% among SAPA patients. Multivariable logistic regression revealed SAPA risk factors including advanced age, petechia, hemoptysis, tremor, low albumin levels, elongated activated partial thromboplastin time (APTT), intensive care unit (ICU) admission, glucocorticoid usage, intravenous immunoglobulin (IVIG) and prolonged hospital stays. Cox regression identified predictors of 42-day mortality, including ecchymosis at venipuncture sites, absence of ICU admission, elongated prothrombin time (PT), vasopressor and glucocorticoid use, non-antifungals. Nomograms constructed on these predictors registered concordance indexes of 0.855 (95% CI: 0.826-0.884) and 0.778 (95% CI: 0.702-0.854) for SAPA onset and 42-day mortality, respectively. Lower survival rates for SAPA patients treated with glucocorticoids (p < 0.001) and improved 14-day survival with antifungal therapy (p = 0.036). Improving IPA management in SFTS-endemic areas is crucial, with effective predictive tool.

Comparison of Clinical Manifestation and Mortality-Related Risk Factors Between Elderly and Middle-Aged COVID-19 Patients

Given that the risk factors associated with mortality and morbidity of Coronavirus Disease (COVID-19) vary among age groups, this study aimed to describe the differences in clinical characteristics and mortality-related risk factors between elderly and middle-aged COVID-19 patients. A total of 1061 patients were included in this retrospective cohort study. Patients’ radiology reports and laboratory data were extracted from the available data on the Hospital Information System (HIS), and clinical findings were added in special forms. We followed up cases until death or discharge to evaluate patients’ outcomes. Chronic obstructive pulmonary disease (COPD) (95% CI, HR 2.73 (0.97-6.62)), need for antibiotics (95% CI, HR 2.26 (1.20-4.26)), and diabetes (95% CI, HR 1.77 (0.97-3.24)) were associated with a higher risk of mortality among middle-aged COVID-19 patients; while, age (95% CI, HR 1.04 (1.01-1.06)) was associated with increased mortality rate in elderly patients. We found that the need for antibiotics was associated with a worse outcome of COVID-19. Additionally, we described the differences between elderly and middle-aged COVID-19 patients regarding their comorbidities, laboratory findings, and clinical manifestation.

Optimal Management of Patients with Phlegmonous Esophagitis: A Systematic Review and Meta-Analysis.

To assess the characteristics and prognosis-influencing factors of phlegmonous esophagitis, a rare condition marked by suppurative inflammation of the esophageal submucosa and muscular layers. Effective management strategies for phlegmonous esophagitis are lacking. This study aims to systematically review cases to better understand the disease's features and prognostic determinants. A systematic search was performed using PubMed/MEDLINE and Google Scholar from inception to 20 April 2023. Phlegmonous esophagitis case reports and studies with patient information were included; clinical manifestations, laboratory results, imaging findings, other diagnostic findings, and outcomes were analyzed. A pooled analysis was performed to investigate mortality-related risk factors. A total of 35 cases of phlegmonous esophagitis were selected from 31 case reports and 2 case series (median age, 57.0 years; male, 54.3%). The patients presented various clinical symptoms, with neck-to-epigastric pain and dysphagia being the most common. Comorbid diabetes mellitus was a major predisposing factor; one-third of the patients had no previous medical history. Computed tomography (CT) and endoscopic examinations were predominantly used for phlegmonous esophagitis diagnosis. Radiological findings showed that the upper and middle esophagus were most frequently involved. Treatments included administration of broad-spectrum antibiotics and drainage via endoscopy or surgery. There were three cases of mortality, and non-survivors tended to have shorter hospital stays, indicating rapid disease progression. In logistic regression, thoracic surgery was a significant mortality-related risk factor (odds ratio, 19.30; 95% confidence interval, 1.33-282.00, p = 0.03). Advancements in CT and endoscopy have led to less-invasive diagnostic and treatment methods for phlegmonous esophagitis. Endoscopic localized abscess treatment is associated with positive outcomes.

The outcome of high-frequency oscillatory ventilation in pediatric patients with acute respiratory distress syndrome in an intensive care unit.

In adults with acute respiratory distress syndrome (ARDS), high-frequency oscillatory ventilation (HFOV) has been associated with higher mortality rates. Therefore, its use in children with ARDS is still controversial. Evaluate the overall mortality of HFOV in children with ARDS and explore mortality-related risk factors; compare the outcome of using HFOV post-endotracheal intubation early (≤24 hours) versus late (≤24 hours). Retrospective (medical record review) SETTING: Pediatric intensive care unit in a tertiary care center in Saudi Arabia. Data were collected from medical records of all pediatric patients with ARDS aged one week to 14 years, who were admitted to the pediatric intensive care unit (PICU) from January 2016-June 2019 and who required HFOV. PICU mortality. 135 ARDS patients including 74 females (54.8%), and 61 males (45.2%), with a median age (interquar-tile range) of 35 (72) months. The overall mortality rate was 60.0% (81/135), and most died in the first 28 days in the PICU (91.3%, 74/8). Of non-survivors, 75.3% (61/81) were immunocompromised, and 24.7% (20/81) were immuno-competent patients, 52 (64.2%) received inotropic support, 40 (49.4%) had a bone-marrow transplant (BMT) before HFOV initiation. Although the prone position was used in 20.7% (28/135) to improve the survival rate post-HFOV ventilation, only 28.6% (8/28) survived. In addition, altered code status or chemotherapy reported a significant association with mortality (P<.05). Interestingly, early HFOV initiation (≤24 hours) did not seem to have a high impact on survival compared to late initiation (>24 hours); (57.4% vs. 42.6%, P=.721). Immunocompromised and oncology patients, including post-BMT, reported poorer outcomes, and neither the prone position nor early use of HFOV improved outcomes. However, it is recommended to replicate the study in a larger cohort to generalize the results. Retrospective single-center study.

Mortality-related risk factors of inpatients with diabetes and COVID-19: A multicenter retrospective study in Belgium

Background and aimsWe describe mortality-related risk factors of inpatients with diabetes and coronavirus disease 2019 (COVID-19) in Belgium. MethodsWe conducted a multicenter retrospective study from March to May, 2020, in 8 Belgian centers. Data on admission of patients with diabetes and COVID-19 were collected. Survivors were compared to non-survivors to identify prognostic risk factors for in-hospital death using multivariate analysis in both the total population and in the subgroup of patients admitted in the intensive care unit (ICU). ResultsThe study included 375 patients. The mortality rate was 26.4% (99/375) in the total population and 40% (27/67) in the ICU. Multivariate analysis identified older age (HR 1.05 [CI 1.03–1.07], P<0.0001) and male gender (HR 2.01 [1.31–3.07], P=0.0013) as main independent risk factors for in-hospital death in the total population. Metformin (HR 0.51 [0.34–0.78], P=0.0018) and renin-angiotensin-aldosterone system blockers (HR 0.56 [0.36–0.86], P=0.0088) use before admission were independent protective factors. In the ICU, chronic kidney disease (CKD) was identified as an independent risk factor for death (HR 4.96 [2.14–11.5], P<0.001). ConclusionIn-hospital mortality due to the first wave of COVID-19 pandemic in Belgium was high in patients with diabetes. We found that advanced age and male gender were independent risk factors for in-hospital death. We also showed that metformin use before admission was associated with a significant reduction of COVID-19-related in-hospital mortality. Finally, we showed that CKD is a COVID-19-related mortality risk factor in patients with diabetes admitted in the ICU.

Development and validation of models for risk of death in patients with systemic lupus erythematosus admitted to the intensive care unit: a retrospective study.

For patients with systemic lupus erythematosus (SLE) in the intensive care unit (ICU), early detection of the mortality risk is a significant factor in improving outcomes. In this study, we developed and validated predictive models for the mortality risk. Using MIMIC-III v1.4 and MIMIC-IV v0.4, we collected data of patients with SLE who were admitted to the ICU. The patients were divided into two groups based on death or survival within 30 days. Two prediction models were built for each group: a traditional logistic regression model and a linear discriminant analysis (LDA) model constructed by the random subspace method (RSM) (RSM-LDA model). The performance of the two models was analyzed using the area under the receiver operating characteristic curve (AUC). MIMIC-III and MIMIC-IV were used to establish and validate the models. This study involved 383 patients with SLE, 65 of whom died. They were divided into two groups according to whether they died within 30 days. The predictive factors were the type of admission to the ICU, SLE-associated interstitial pneumonia, lupus nephritis, immunoglobulin G level, and cardiolipin antibody level. A logistic regression model and an RSM-LDA model were established. The AUCs of the two models were 0.87 (95% confidence interval, 0.86-0.90) and 0.91 (95% confidence interval, 0.88-0.93), respectively. The RSM-LDA model can predict the risk of death in patients with SLE admitted to the ICU at an early stage. Key Points • Compared with traditional prediction models, RSM-LDA model has a better ability to predict the risk of death inpatients with systemic lupus erythematosus. • Compared with traditional prediction models, the more input variables (mortality related risk factors), the better the prediction results of RSM-LDA model.

Assessment of mortality-related risk factors and effective antimicrobial regimens for treatment of bloodstream infections caused by carbapenem-resistant Pseudomonas aeruginosa in patients with hematological diseases.

Infections caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) are related to higher mortality. The objective of this study was to explore clinical outcomes of CRPA bacteremia, identify risk factors and also, compare the efficacy of traditional and novel antibiotic regimens. This retrospective study was conducted at a blood diseases hospital in China. The study included hematological patients who were diagnosed with CRPA bacteremia between January 2014 and August 2022. The primary endpoint was all-cause mortality at day 30. Secondary endpoints included 7-day and 30-day clinical cure. Multivariable Cox regression analysis was employed to identify mortality-related risk factors. 100 patients infected with CRPA bacteremia were included and 29 patients accepted allogenic-hematopoietic stem cell transplantation. 24 received ceftazidime-avibactam (CAZ-AVI)-based therapy and 76 received other traditional antibiotics. 30-day mortality was 21.0%. Multivariable cox regression analysis showed neutropenia >7 days after bloodstream infections (BSI) (P=0.030, HR: 4.068, 95%CI: 1.146~14.434), higher Pitt bacteremia score (P<0.001, HR:1.824, 95%CI: 1.322~2.517), higher Charlson comorbidity index (P=0.01, HR: 1.613, 95%CI: 1.124~2.315) and bacteremia due to multidrug-resistant Pseudomonas aeruginosa (MDR-PA) (P=0.024, HR:3.086, 95%CI: 1.163~8.197) were identified as independent risk factors of 30-day mortality. After controlling for confounders, an additional multivariable cox regression analysis revealed definitive regimens containing CAZ-AVI were associated with lower mortality in CRPA bacteremia (P=0.016, HR: 0.150, 95%CI: 0.032~0.702), as well as in MDR-PA bacteremia (P=0.019, HR: 0.119, 95%CI: 0.020~0.709). For patients with hematological diseases and CRPA bacteremia, 30-day mortality rate was 21.0% (21/100). Neutropenia >7 days after BSI, higher Pitt bacteremia score, higher Charlson comorbidity index and bacteremia due to MDR-PA increased 30-day mortality. CAZ-AVI-based regimens were effective alternatives for bacteremia due to CRPA or MDR-PA.

Assessment of Effective Antimicrobial Regimens and Mortality-Related Risk Factors for Bloodstream Infections Caused by Carbapenem-Resistant Acinetobacter baumannii.

This study aimed to determine the clinical features, risk factors, and effective antimicrobial therapy for Carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection (BSI). This was a retrospective analysis of data from patients with CRAB bacteremia in a Chinese tertiary hospital between January 2012 and October 2021. Risk factors, predictors of 30-day mortality, and effective antimicrobial therapy for CRAB BSI were identified using logistic and cox regression analyses. Data from 276 patients with Acinetobacter baumannii (AB) BSI were included, of whom 157 (56.9%) had CRAB BSI. The risk factors that were significantly associated with CRAB BSI included previous intensive care unit (ICU) stay (P < 0.001), immunocompromised status (P < 0.001), cephalosporin use (P = 0.014), and fluoroquinolone use (P = 0.007). The 30-day mortality of the CRAB BSI group was 49.7% (78/157). ICU stay after BSI (P = 0.047), sequential organ failure assessment (SOFA) score ≥10 (P < 0.001), and multiple organ failure (MOF) (P = 0.037) were independent predictors of 30-day mortality. Among antibiotic strategies for the treatment of patients with CRAB BSI, we found that definitive regimens containing cefoperazone/sulbactam were superior to those without cefoperazone/sulbactam in reducing the 30-day mortality rate (25.4% vs 53.4%, P = 0.005). After propensity score matching, we observed a significant increase in the 30-day mortality (77.8%vs 33.3%, P = 0.036) in patients receiving tigecycline monotherapy compared to those receiving cefoperazone/sulbactam monotherapy. The mortality rate of patients receiving tigecycline with cefoperazone/sulbactam was also higher than that of patients receiving cefoperazone-sulbactam monotherapy; however, the difference was not significant (28.6%vs 19.0%, P = 0.375). The severity of patient conditions was significantly associated with mortality in patients with CRAB BSI. Those Patients treated with cefoperazone/sulbactam had better clinical prognoses, and tigecycline should be used with caution.

Mortality-Related Risk Factors in Geriatric Patients with Hip Fracture.

Mortality rates after hip fractures increase by up to 30% with age. This study investigated the contribution of various parameters to prognosis and mortality. Our study prospectively examined patients with hip fracture aged 65 years and over who applied to the Atatürk University Medical Faculty Hospital Orthopedics Service in 2020-2021. The 120 patients included in the study had a mean age of 79.71±7.27 years, and 51.7% were female. Twenty patients (16.7%) died within the first 30 days after a hip fracture. They had a significantly lower median Lawton-Brody instrumental activities of daily living (IADL) scale score (p=0.045) and a higher rate of malnutrition according to the Mini Nutritional Assessment (MNA) score (p=0.016). Additionally, these patients with 30-day mortality had a significantly lower rate of surgical treatment (p=0.027) and a longer time from injury to surgery (p=0.014). The time to surgery was a significant independent risk factor for 30-day mortality, with each 1-hour delay increasing the odds of mortality by 1.066 (odds ratio [OR]=1.066; 95% confidence interval [CI], 1.001-1.013; p=0.013). In addition, the presence of malnutrition was another independent risk factor that increased the odds of mortality by 4.166 times (OR=4.166; 95% CI, 1.285-13.427; p=0.017). We recommend placing more importance on supportive treatment in patients presenting with hip fractures, especially in those with malnutrition; performing surgical intervention as early as possible; and more closely following up with patients with the aforementioned risk factors.

Mortality-related risk factors of inpatients with diabetes and COVID-19: a Multicentric Retrospective Study in Belgium

Mortality-related risk factors of inpatients with diabetes and COVID-19: a Multicentric Retrospective Study in Belgium

Risk Factors for Mortality and Antimicrobial Regimens in Pediatric Intensive Care Unit Patients with Carbapenem-Resistant Enterobacteriaceae Infections: A Six-Year Retrospective Study.

Limited data are available on the characteristics, risk factors, and antimicrobial treatment of critically ill pediatric patients with carbapenem-resistant Enterobacteriaceae (CRE) infections. This study was to identify the risk factors for 30-day mortality in pediatric intensive care unit (PICU) patients with CRE infections and compare the clinical outcomes of different antimicrobial regimens. A retrospective, observational cohort study was performed on patients admitted to the PICU with positive CRE cultures between January 2016 and December 2021. For the 56 patients, the overall 30-day mortality was 50% (n=28). Multivariable logistic regression analysis revealed that pediatric critical illness score (PCIS; HR = 0.879; 95% CI, 0.827-0.935; P < 0.001) and serum albumin levels (HR = 0.921; 95% CI, 0.860-0.987; P = 0.019) were independently associated with 30-day mortality. At the same time, there was no significant difference in 30-day mortality (42.9% versus 45.5%, P = 0.854) or clinical efficiency rate (53.4% versus 40.9%, P = 0.374) between with and without polymyxin B therapy. The study revealed PCIS and serum albumin levels were the independent mortality-related risk factors of CRE infections in critically ill pediatric patients. Treatment with polymyxin B could not reduce 30-day mortality. Future prospective cohort studies are needed to investigate the optimal antimicrobial regimens for CRE infection in PICU patients.

Mortality-Related Risk Factors and Novel Antimicrobial Regimens for Carbapenem-Resistant Enterobacteriaceae Infections: A Systematic Review.

Carbapenem-resistant Enterobacteriaceae (CRE) has become a significant public health problem in the last decade. We aimed to explore the risk factors of mortality in patients with CRE infections and to focus on the current evidence on antimicrobial regimens for CRE infections, particularly from the perspective of mortality. A systematic literature review was performed by searching the databases of EMBASE, PubMed, and the Cochrane Library to identify studies that evaluated mortality-related risk factors and antimicrobial regimens for CRE infections published from 2012 to 2022. In total, 33 and 28 studies were included to analyze risk factors and antibiotic treatment, respectively. The risk factors most frequently reported as significantly associated with CRE mortality were antibiotic use (92.9%; 26/28 studies), comorbidities (88.7%; 23/26 studies), and hospital-related factors (82.8%; 24/29 studies). In 10 studies that did not contain ceftazidime/avibactam (CAZ-AVI) therapy, seven demonstrated significantly lower mortality in combination therapy than in monotherapy. However, 5 of 6 studies identified no substantial difference between CAZ-AVI monotherapy and CAZ-AVI combination therapy. Six studies reported substantially lower mortality in CAZ-AVI regimens than in other regimens. Several risk factors, particularly antibiotic use and patients' comorbidities, are strong risk factors for CRE mortality. The optimal regimen for CRE infections remains controversial. Combination therapy should be considered when carbapenems, colistin, tigecycline, or aminoglycosides are administered. CAZ-AVI appears to be a promising antibiotic for CRE infections. Most importantly, treatment should be individualized according to the source and severity of the disease or other highly related risk factors.

The mortality predictors in non-vaccinated COVID-19 patients

Aim: The novel coronavirus (SARS-CoV-2) causes COVID-19 disease. From December 31, 2019, to the present (July 2022), 545 million new cases have been detected, while the number of deaths due to the disease has reached 6.3 million. This study aims to reveal mortality-related risk factors, including comorbid conditions, clinical course, imaging, and laboratory parameters in COVID-19 patients hospitalized in a tertiary hospital. &#x0D; Material and Method: An observational, retrospective study was conducted among hospitalized COVID-19 patients at the tertiary health center in Turkey between November 2020 and April 2021. A total of 601 patients were treated in this period and vaccinated 85 patients were excluded. The remaining 516 patients’ demographical data, clinical severity, laboratory parameters, thorax computed tomography (CT) involvement, and mortalities were recorded. &#x0D; Results: In evaluating the factors affecting COVID-19 mortality, it was observed that male gender and advanced age were significantly associated with mortality, and the mortality rate was higher in patients with involvement in thorax CT and patients with a clinically severe course. In the evaluation of the patients in terms of comorbidities, DM, HT, and CAD were significantly higher in the patients who died. It was determined that patients who died during hospitalization needed respiratory support at a higher rate. &#x0D; Conclusion: Identifying predicting factors is essential for the early recognition the vulnerable patients for hospitalization decisions and early aggressive treatment. In this study, male gender, advanced age, comorbidities (DM, HT, CAD), pulmonary involvement, and severe clinical presentation were identified as significantly related factors associated with mortality.

Mortality and Related Risk Factors of Fragile Hip Fracture.

ObjectiveTo explore the mortality of patients with fragile hip fractures and assess the death‐associated risk factors.MethodsA total of 690 patients with osteoporotic hip fractures (age, 50–103 years) that were treated from January 2010 to December 2015 were enrolled and followed‐up in this study and the clinical data were retrospectively collected. Three months, 1 year, and the total mortality were measured. Mortality‐related risk factors were assessed including age, gender, surgery, the duration from injury to operation, pulmonary infection, and the number and type of complications. The mortality of each group was compared by chi‐square test or corrected chi‐square test for univariate analysis, and the factors with statistically significant mortality difference confirmed by univariate analysis were analyzed by binary logistic multivariate analysis.ResultsThe 3‐month mortality was 7.69%, the 1‐year mortality was 15.60%, and the total mortality of the follow‐up time was 24.06%. The 1‐year and total mortality during the follow‐up of the patients were higher in the >75‐year‐old group than those in the ≤75‐year‐old group (p = 0.000, respectively); were higher in the male patients than that in the female patients (p = 0.042; p = 0.017, respectively); were significantly lower in the operation group than that in the non‐operation group (p = 0.000, respectively); were significantly lower in the patients that underwent the operation in ≤5 days than the patients that underwent the operation within >5 days (p = 0.008; p = 0.000, respectively); were significantly lower in patients with >2 kinds of combined medical diseases than those with ≥2 kinds of chronic diseases (p = 0.000, respectively); were significantly lower in patients receiving anti‐osteoporosis treatment than in patients not receiving anti‐osteoporosis treatment (p = 0.000, p = 0.002, respectively). Binary logistic regression analysis showed that the independent risk factors affecting mortality included advanced age >75‐years‐old (OR = 5.653, p = 0.000), male (OR = 1.998, p = 0.001), non‐surgical treatment (OR = 9.909, p = 0.000), the number of combined medical diseases ≥2 (OR = 1.522, p = 0.042), and non‐anti‐osteoporosis treatment (OR = 1.796, p = 0.002).ConclusionAge, whether or not surgical treatment was performed, the number of medical diseases, and whether or not anti‐osteoporosis treatment was performed were independent risk factors for 3‐month and 1‐year mortality in patients with fragile hip fractures.

Mortality-Related Risk Factors for Coronavirus Disease (COVID-19)-Associated Mucormycosis: a systematic review and meta-analysis.

Purpose of ReviewSevere Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) can increase the susceptibility of individuals to contracting mucormycosis through several mechanisms. Nowadays, coronavirus disease (COVID-19)-associated mucormycosis (CAM) is a serious public health concern, particularly in developing countries. This meta-analysis aims to identify the risk factors that affect the mortality rate of patients with CAM.Recent FindingsWe systematically searched PubMed, Google Scholar, Scopus, Cochrane library, and preprint databases using pertinent keywords and the reference lists of the included relevant articles from inception till October 27, 2021. In order to reduce the effects of small-scale studies, we only selected cross-sectional, case–control, and cohort studies and case series with at least four patients. We identified 26 articles that included 821 patients with CAM. The effect size (ES) of mortality rate was 28% (95% confidence interval (CI) 20%–38%; I2 =82.28%; p for Cochran Q<0.001). The CAM patients with a history of comorbidities other than diabetes (malignancies, transplant, or renal failure), mechanical ventilation due to COVID-19, pulmonary and cerebral mucormycosis, and those who only received medical treatment for mucormycosis had the highest mortality rate.SummaryCoronavirus disease (COVID-19)-associated mucormycosis (CAM) is a major public health problem, particularly in developing countries. Severe COVID-19 infection, history of mechanical ventilation, early CAM, comorbidities other than diabetes (malignancies, transplant, or renal failure), pulmonary and rhino-orbito-cerebral mucormycosis, and delivering only medical treatment for mucormycosis were the worst prognostic factors in CAM patients. Identifying the mortality-related risk factors in CAM patients may help reduce the mortality rate by implementing optimized treatment approaches.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12281-022-00440-2.

Ex utero intrapartum therapy in infants with congenital diaphragmatic hernia: a propensity score matching analysis

ObjectivePrevious studies have shown that ex utero intrapartum therapy (EXIT) is safe and feasible for newborns with congenital diaphragmatic hernia (CDH). This study reports our experience with EXIT in fetuses...

MDR Pathogens Organisms as Risk Factor of Mortality in Secondary Pulmonary Bacterial Infections Among COVID-19 Patients: Observational Studies in Two Referral Hospitals in West Java, Indonesia.

PurposeThe coronavirus disease (COVID-19) outbreak has created a global health crisis. Secondary pulmonary bacterial infection is a COVID-19 complication, increasing morbidity and mortality. This study aimed to determine the pathogens, antibiotic susceptibility patterns, and risk factors for mortality in hospitalized COVID-19 patients.Patients and MethodsThis retrospective study used secondary data from patients’ electronic medical records at Hasan Sadikin General Hospital and Santo Borromeus Hospital between March 2020 and March 2021. Overall, 2230 hospitalized COVID-19 patients were screened, and 182 of them who were hospitalized ≥48 hours with a procalcitonin level of ≥0.25 ng/mL were enrolled. Culture examination was performed on sputum samples to determine pathogen and antibiotic susceptibilities. Univariate and multivariate analyses were used to determine mortality-related risk factors in hospitalized COVID-19 patients.ResultsThe prevalence of secondary pulmonary bacterial infections in COVID-19 patients was 8.2%, with 161/182 pathogen growth from sputum samples. Mainly gram-negative bacteria (64.8%) were present, including Acinetobacter baumannii (31.9%), Klebsiella pneumoniae (19.8%), and Pseudomonas aeruginosa (8.8%). High rate of multidrug-resistant (MDR) pathogens was found among isolate (45.9%), ie carbapenem-resistance A.baumannii (CR-Ab) was 84.2%, extended-spectrum β-lactamase (ESBL) among K. pneumoniae was 61.1%. Secondary infection of MDR pathogens was associated with a higher risk of mortality (AOR 5.63, p = 0.001). Other associated factors were age ≥60 years, ventilator use, and female gender.ConclusionGram-negative bacteria are the predominant pathogens causing secondary pulmonary bacterial infection in COVID-19 patients, implying nosocomial infection. High resistance to first-line antimicrobial drugs was observed in Gram-negative bacteria and Gram-positive bacteria. High rate of MDR pathogens was found among isolate and was associated with a significant risk of mortality.

Mortality-Related Risk Factors in Total Hip Arthroplasty for Femoral Neck Fractures in Elderly Patients

Mortality-Related Risk Factors in Total Hip Arthroplasty for Femoral Neck Fractures in Elderly Patients

Predicting Mortality Rate in ICU-Admitted COVID-19 Patients Implementing Visual Semi-Quantitative CT Severity Scoring System

Abstract: Objectives: The aim of this study was to identify the clinical and laboratory features and CT scan (CT intensity score and pleural effusion) associated with COVID-19 pneumonia to evaluate the relationship between CT scan findings and mortality by comparing deceased patients with normal patients. Methods: In this retrospective case-control study, 290 ICU admitted patients with RT-PCR confirmed COVID-19 pneumonia were investigated. Totally, 150 deceased patients (with confirmed COVID-19 related death) were extracted from the COVID-19 registry of the affiliated university hospital belonging to mentioned period of time (in-hospital mortality subgroup, case), and 150 patients who survived the admission course were randomly selected from the same data set (surviving subgroup, control). Available electronic records for each patient were enlisted, including laboratory and clinical information, and their on-admission computed tomography (CT) images were reviewed. Mortality-related risk factors were compared between case and control subgroups. Results: The mean age of deceased patients (68.20±16.07) was significantly higher than that of the surviving patients (54.72± 19.50) (p &lt;0.001). Diabetes, hypertension, and chronic kidney disease (CKD) were significantly related with higher mortality rates (62.2%, 58.7%, and 80.4% mortality in diabetic, hypertensive, and CKD patients versus 41.7%, 42.1%, and 35.9% in non-diabetics, normotensives, and patients without CKD). Additionally, the mean on-admission air-room SPO2 level in deceased patients (90%) was significantly lower than that of the survivors (93%) (p = 0.001). Lymphocyte count, neutrophil to lymphocyte ratio (NLR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lactate dehydrogenase (LDH), fasting blood sugar (BS), blood urea nitrogen (BUN), and Creatinine (Cr), mean CT severity score (CT-ss), and O2 supportive therapy requirement were significantly higher in the mortality subgroup (p &lt;0.05). Pleural effusion showed no significant correlation with short-term mortality. CT-ss of &gt;11, in isolation or in combination with above-mentioned prognosticators, was 64% or 81.4% sensitive, and 60% or of 78.6% specific, to predict mortality. Conclusions: Factors such as advanced age, underlying diseases such as diabetes, hypertension, and CKD, decreased air-room SPO2, and increased lymphocyte count, higher NLR, ESR, CRP, LDH, BS, BUN, and Cr level, as well as higher CT-ss and O2 supportive therapy, are all significantly correlated with higher mortality in ICU-admitted COVID-19 patients.