Risk Factor For Mortality Research Articles

Psoas muscle index in sarcopenia following transjugular intrahepatic portosystemic shunt: A multicenter, retrospective study

AbstractAimsAlthough the skeletal muscle index at the third lumbar vertebra (L3‐SMI) is commonly utilized for the diagnosis of sarcopenia, the psoas muscle index at L3 (L3‐PMI) may serve as a reliable alternative indicator. This study aims to investigate the application of the PMI in patients who have undergone transjugular intrahepatic portosystemic shunt (TIPS).MethodsThis study included a cohort of 406 patients with cirrhosis who underwent TIPS between February 2016 and July 2022 across three medical centers in China. Clinical and imaging data, specifically L3‐SMI and L3‐PMI, were collected for these patients. The prognosis of the patients was assessed through re‐examinations and telephone follow‐ups, which extended up to 5 years. The diagnostic thresholds for sarcopenia, as defined by L3‐PMI and L3‐SMI, were established at 6.36 or 42.00 cm²/m² for males and 3.92 or 38.00 cm²/m² for females, respectively. Cox proportional hazards and Kaplan–Meier (K‐M) analyses were employed to evaluate patient survival.ResultsThe findings indicated that both L3‐PMI and L3‐SMI before TIPS were independent risk factors for mortality. The results of the paired t‐test demonstrated a significant increase in L3‐PMI 1 month post‐TIPS (5.11 ± 1.81 vs. 5.71 ± 1.90 cm²/m², p < 0.001), whereas L3‐SMI did not exhibit a significant increase until 6 months post‐TIPS (45.45 ± 9.41 vs. 48.59 ± 10.38 cm²/m², p < 0.001). Among these patients, 191 (47.0%) and 159 (39.2%) were diagnosed with sarcopenia according to the L3‐PMI and L3‐SMI models, respectively. Patients identified as sarcopenic by both indicators demonstrated a significantly lower survival rate (L3‐SMI model: hazard ratio [HR], 1.913; 95% confidence interval [CI], 1.094–3.410; log‐rank p = 0.020; L3‐PMI model: HR, 1.867; 95% CI, 1.059–3.290; log‐rank p = 0.030). In sarcopenic patients, the reversal of sarcopenia associated with improved survival occurred 1 month after TIPS in the L3‐PMI model (HR, 2.675; 95% CI, 1.245–5.735; log‐rank p = 0.012), while a similar effect was not observed until 6 months post‐TIPS in the L3‐SMI model (HR, 3.342; 95% CI, 1.477–7.560; log‐rank p = 0.004).ConclusionsL3‐PMI and L3‐SMI demonstrate comparable efficacy in diagnosing cirrhosis‐related sarcopenia. Furthermore, L3‐PMI has the capacity to identify improvements in sarcopenia as early as 1 month following TIPS, thereby providing earlier insights into patient survival outcomes.

Abstract 4119072: When is the Broken Heart Most Dangerous? Assessing Risk Factors to Predicting Mortality in Takotsubo Cardiomyopathy: Analysis of The National Inpatient Sample 2021

Introduction: Takotsubo Cardiomyopathy often presents very similarly to acute coronary syndromes (ACS). Although the gravity of the condition is being increasingly recognized, prognostic factors have been hardly established. We applied known near-term ACS mortality risk factors to determine their prognostic value in takotsubo cardiomyopathy. Methods: We analyzed the National Inpatient Sample database for 2021. Inclusion criteria were Principal Diagnosis of Takotsubo Syndrome (ICD 10 code "I5181") and age 18 years or more. Different comorbidities, age, and gender were analyzed in these patients, and the primary outcome was inpatient mortality. Univariate logistic regression was used to test the association of each factor with mortality, and multivariate logistic regression was then used to test for independent predictive value. Analyses were performed using STATA/BE 18.0. Significance was set at 0.05. Results: 9109 admissions for takotsubo syndrome were identified (10.3% males and 89.7% females) with a mean age of 67 years and an inpatient mortality rate of 2.31%. On univariate regression, age (OR 1.04; p=0.013), heart failure (OR 3.2; p<0.001), atrial fibrillation (OR 3.12; p<0.001) and chronic kidney disease (OR 3.54; p<0.001) were significant predictors of mortality while gender(0.389), diabetes(0.132), hypertension (0.052), smoking (0.617), nicotine dependence (0.075), hypercholesterolemia (0.686), obesity (0.728), history of stroke (0.068) and history of myocardial infarction (0.613) were not significantly associated with mortality. On multivariate regression, only heart failure (OR 2.8; p=0.007) and chronic kidney disease (OR 2.34; p=0.032) were independently associated with inpatient mortality. Conclusion: Our findings are mostly congruent with the existing literature regarding this condition. Pre-existing heart failure and a history of chronic kidney disease are poor prognostic factors in patients presenting with Takotsubo cardiomyopathy. Further large-scale studies are required to validate our findings.

Alcohol and cause-specific mortality in Russia: the Know Your Heart Study 2015-23.

Alcohol-related mortality in Russia exceeds the world average and presents a critical public health concern. This study assesses the impact of alcohol consumption levels on mortality and investigates mortality predictors among Russians, including people treated for alcohol-related diagnoses (narcology patients). We examined 2629 men and women aged 35-69 years who participated in the Know Your Heart study (2015-17), Arkhangelsk, Russia. The participants were categorized into five drinking levels (non-drinking, low-risk, hazardous, harmful, narcology patients) and followed up using a regional mortality database. We used Cox proportional hazards regressions to analyze sociodemographic and cardiovascular biomarkers as mortality predictors among narcology patients and general population and to compare mortality risks across the five drinking levels. During a median follow-up of 6.3 years, 223 (8.5%) participants died. Age- and sex-standardized all-cause mortality rates per 100,000 person-years were 1229 (95% CI: 691-1767) in non-drinking participants, 890 (95%CI: 684-1096) and 877 (95%CI: 428-1325) in low-risk and hazardous drinking participants, 2170 (95%CI: 276-4064) in those with harmful drinking, and 4757 (95%CI: 3384-6131) in narcology patients. The largest proportions of deaths were caused by cardiovascular diseases (37.2%), neoplasms (20.2%), and external causes (13.9%). Compared with low-risk drinkers, narcology patients had higher risks of death with hazard ratios of 3.23 (95%CI: 2.02-5.16) for all-cause mortality, 3.25 (95%CI: 1.52-6.92) for cardiovascular diseases, 9.36 (95%CI: 2.63-33.3) for external causes, and 7.79 (95%CI: 3.34-18.1) for other causes. Neoplasm-related mortality did not differ between groups. All-cause mortality in the general population had positive associations with smoking, waist-to-hip ratio, resting heart rate, systolic blood pressure, high-sensitivity C-reactive protein, and negative associations with left ventricular ejection fraction (LVEF) and higher education. These associations were substantially weaker and non-significant in narcology patients. Cardiovascular mortality in narcology patients was increased with higher education, while male sex, LVEF and N-terminal prohormone of brain natriuretic peptide had less impact compared to the general population sample. Narcology patients face markedly higher mortality risks-threefold from all causes and cardiovascular diseases, ninefold from external causes, and sevenfold from other causes. Compared with the general population, conventional mortality risk factors were less predictive of deaths in narcology patients.

Clinical Characteristics and Factors Associated with 30-Day Mortality in Patients with Methicillin-resistant Staphylococcal Pneumonia

Objective: We aimed to identify the risk factors associated with 30-day mortality in patients with methicillin-resistant Staphylococcus spp. (MRS) pneumonia.Material and Methods: From March 2021 to March 2023, we conducted a prospective, observational study at Cho Ray Hospital, Viet Nam, in hospitalized patients aged ≥18 years with pneumonia due to MRS. To assess the risk factors for 30-day mortality, we performed univariable and multivariable logistic regression analyses.Results: The 30-day mortality was 39.1% (36 out of 92 patients with MRS pneumonia). The risk factors for death within 30 days in cases with MRS pneumonia were severe pneumonia, being overweight, respiratory failure, shock, or having a medical device (a tracheostomy or endotracheal tube, a central venous catheter, a urinary catheter, or a nasogastric tube). The 30-day mortality increased proportionally with the number of risk factors.Conclusion: Pre-existing factors were associated with the 30-day mortality risk of MRS pneumonia. Therefore, comprehensive therapy, including initial anti-MRS treatment, might be important for improving outcomes in patients with the studied risk factors.

Updated risk prediction model for pancreaticoduodenectomy using data from the National Clinical Database in Japan

AbstractAimRisk prediction models for mortality, severe postoperative complications, and postoperative pancreatic fistula in patients undergoing pancreaticoduodenectomy were established using data from the National Clinical Database more than a decade ago, and the surgical outcomes of pancreaticoduodenectomy have improved over the years. The aim of this study is to update the risk prediction model for pancreaticoduodenectomy using National Clinical Database data.MethodsBetween 2019 and 2021, the data of 35 365 patients who underwent pancreaticoduodenectomy and who were registered in the National Clinical Database were retrospectively analyzed. According to the registration year, the patients were divided into two cohorts: the development cohort (2019–2020; n = 23 654) and the validation cohort (2021; n = 11 711). Logistic regression analyses were performed to create risk models for surgical mortality, severe postoperative complications, and grade C postoperative pancreatic fistula.ResultsOverall, the rates of surgical mortality, severe postoperative complications, and grade C postoperative pancreatic fistula were 1.8%, 2.2%, and 1.3%, respectively. Logistic regression analyses revealed 28, 28, and 14 risk factors for surgical mortality, severe postoperative complications, and grade C postoperative pancreatic fistula, respectively. The area under the receiver operating characteristic curve of the risk model in the development cohort was 0.759 for surgical mortality, 0.712 for severe complications, and 0.699 for postoperative pancreatic fistula, comparable to the validation cohort. The calibration plots were favorable in both cohorts.ConclusionThe updated risk model for pancreaticoduodenectomy will be useful to predict surgical mortality, severe postoperative complications, and grade C postoperative pancreatic fistula.

NCOG-44. EXPLORING THE IMPACT OF PRE-OPERATIVE MAJOR DEPRESSIVE DISORDER ON POSTOPERATIVE OUTCOMES IN PATIENTS UNDERGOING SURGICAL EXCISION OF MENINGIOMAS

Abstract INTRODUCTION Meningiomas are prevalent brain tumors that can cause significant morbidity for patients. Major depressive disorder (MDD), especially in the setting of other medical conditions, is associated with poor prognoses and increased mortality. This study aims to investigate whether pre-operative MDD is a risk factor for postoperative mortality and cognitive impairment in patients with meningiomas undergoing surgical excision. METHODS A retrospective cohort study was conducted using the TriNetX database including adults undergoing craniotomy for meningioma excision, one group comprising patients with pre-operative MDD and the other without. Propensity-score matching was performed to control for age, sex, race, ethnicity, history of cognitive impairment, neurodegenerative diseases, other psychiatric disorders, and socioeconomic barriers to care. Primary outcomes were postoperative mortality, depressive episodes, and cognitive impairment measured within 5 years postoperatively. RESULTS After matching, the study included 289 patients per cohort. Postoperative mortality rates for patients with pre-operative MDD compared to those without were similar (11.42% vs 9.69%, RR: 1.179, 95% CI: 0.732-1.898). Patients with MDD had a significantly higher prevalence of postoperative depressive episodes compared to those without MDD (64.71% vs 38.06%, RR: 1.7, 95% CI: 1.434-2.015). There were no statistically significant differences between the two groups in the prevalence of attention and concentration deficits (5.88% vs 4.15%, RR: 1.417, 95% CI: 0.689-2.913), cognitive communication deficits (8.99% vs 6.57%, RR: 1.368, 95% CI: 0.775-2.416), or executive function deficits (3.46% vs 3.46%, RR: 1, 95% CI: 0.423-2.366). CONCLUSION This study suggests no significant relationship between pre-operative MDD and post-operative mortality and cognitive deficits in patients undergoing meningioma resection. However, the risk of experiencing a depressive episode within 5 years post-operation is very high, especially in those with pre-operative MDD. Therefore, preoperative psychiatric evaluation and postoperative monitoring in patients with meningiomas and MDD are crucial. Further research is warranted to elucidate underlying mechanisms and relationships.

Exploring mortality risk factors and specific causes of death within 30 days after hip fracture hospitalization.

This study examined the sex-specific mortality risk and causes of death soon after hip fracture in Taiwan. The objective of this study was to evaluate the 30-day mortality risk and cause of death in patients with hip fracture and identify its associated risk factors. We conducted a retrospective cohort study using data from the National Health Insurance Research Database in Taiwan from 2000 to 2015. This study included patients aged 50 years or older who were admitted to a hospital with a hip fracture diagnosis for the first time. Of 285,891 patients hospitalized for their first hip fracture, 8,505 (2.98%) died within 30 days. The mortality risk of hip fracture declined from 3.76% in 2000 to 2.92% in 2015. Circulatory system diseases like ischemic heart disease and cerebrovascular disease were the most common cause of death and accounted for 22% of deaths within 30 days after fracture. Accidents and unintentional injuries caused 18% of deaths, followed by malignant neoplasms in 10% of deaths. Multivariate Cox regression identified older age, male sex, higher Charlson Comorbidity Index (CCI), suburban or rural residence, and lower income as risk factors for hip fracture mortality. The 30-day mortality risk of hip fractures has decreased but remains correlated with male sex, older age, and comorbidities. Circulatory diseases were the main cause of death. Early identification and treatment by experienced clinicians may optimize outcomes, minimize complications, and reduce mortality risk in the 30 days following hip fracture.

Early Adequate Nutrition in ICU is Associated with Survival Gain : Retrospective Cohort Study in Patient with Traumatic Brain Injury.

Patients with traumatic brain injury (TBI) commonly exhibit a poor mental health status and can easily develop aspiration pneumonia. Thus, early proper nutrition through oral or tube feeding is difficult to achieve, leading to malnutrition. However, evidence regarding early nutritional support in the intensive care unit (ICU) is lacking. We aimed to assess the effect of early nutrition in patients with TBI admitted to the ICU. Data of adult patients with TBI admitted to the trauma ICU of a regional trauma center in Korea between 2022 and 2023 were retrospectively analyzed. Those with ICU stay <7 days, younger than 18 years, and with underlying diseases that could alter baseline metabolism, were excluded. Nutritional support on day 4 of ICU admission was measured. The patients were classified into mortality and survival groups, and risk factors for mortality were evaluated. Subgroup analyses were performed based on TBI severity. Overall, 864 patients were diagnosed with acute TBI, of whom 227 were included in this study. The mortality rate in the study population was 15% (n=34). Those in the survival group were younger, had longer hospital stays, had a higher initial Glasglow Coma Scale (GCS) score, and had a higher intake of calorie supplements than those in the mortality group. In a subgroup analysis of patients with non-severe TBI (GCS>8), total calorie intake (751.4 vs 434.2 kcal, p=0.029), total protein intake (37.5 vs. 22.1 g, p=0.045), and ratio of supplied to target calories (0.49 vs 0.30, p=0.047) were higher in the survival group than in the mortality group. Logistic regression analysis revealed that calorie intake (B=-0.002, p=0.040) and initial hemoglobin level (B=-0.394, p=0.005) were risk factors for mortality in patients with non-severe TBI. More calories were supplied to the survival group than the mortality group among patients with TBI. Additionally, logistic regression analysis showed that increased calorie supply was associated with reduced mortality in patients with non-severe TBI. The mortality group had low protein intake; however, this did not emerge as a risk factor for mortality. Early sufficient nutritional support improves the prognosis of patients with TBI.

Effects of Continuous Positive Airway Pressure Treatment on Vascular Function in a Real-Life Cohort of Elderly Patients with Obstructive Sleep Apnoea Syndrome

Background: Obstructive sleep apnoea syndrome (OSAS) is an independent risk factor for cardiovascular morbidity and mortality and has a detrimental effect on vascular function, in particular on arterial stiffness and endothelial function. Continuous positive airway pressure (CPAP) is the gold-standard therapy for OSAS and its effects on arterial stiffness and endothelial function have been demonstrated in non-elderly patients. Objectives: The objective of this study was to evaluate the effect of one year of CPAP treatment on arterial stiffness, through assessment of carotid–femoral pulse wave velocity (cf-PWV), and on endothelial function, through the reactive hyperaemia index (RHi), in a real-life cohort of elderly patients with moderate-to-severe OSAS and several comorbidities. Methods: In this nonrandomised prospective study, we enrolled 469 consecutive elderly patients affected by moderate-to-severe OSAS distributed in two groups: CPAP-treated (n = 225) and untreated patients (n = 244). Results: At one-year follow-up, in the treated group emerged an important improvement in poligraphics (AHI, ODI, TC90, mean SpO2%), laboratory (HOMA index, eGFR, hs-CRP) and vascular function parameters: cf-PWV. The stepwise multivariate linear regression demonstrated a significant correlation between the delta of the polygraph parameters and the delta of PWV and RHi. Conclusions: Our study confirmed the favourable effects of CPAP therapy in a cohort of elderly patients affected by OSAS and several comorbidities on sleep respiratory parameters and vascular function; early diagnosis and treatment with CPAP might be beneficial to delay or prevent the occurrence of cardiovascular events in these groups of patients.

Epidemiological and molecular characteristics of carbapenem-resistant Klebsiella pneumoniae from pediatric patients in Henan, China

PurposeCarbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging global threat, whereas its epidemiological characteristics in children are rarely reported. This study aims to analyze clinical and epidemiological characteristics of CRKP from children in Henan, China.MethodsCRKP strains were isolated from pediatric patients, and the antimicrobial susceptibility of CRKP was determined using broth microdilution methods. The epidemiological characteristics of CRKP, including specimen sources, clinical data, carbapenemase types, virulence factors, MLST and PBRT typing were analyzed.ResultsIn total, 108 CRKP isolates were isolated from specimens including sputum, blood and urine, mainly from preterm pediatric department and internal medical intensive care unit (ICU). Newborns and staying in the ICU were risk factors for crude mortality. 107 isolates exhibited a multi-drug resistant (MDR) phenotype, and one isolate was extensively drug-resistant (XDR). Bacterial susceptibility to colistin, tigecycline and trimethoprim/sulfamethoxazole was 98.10%, 78.50% and 91.43%, respectively. Carbapenemase blaKPC (86.11%) was predominant, followed by blaNDM (5.56%) and blaIMP (2.78%). Two strains co-harbored blaKPC-blaNDM, one had blaKPC-blaIMP, whereas three isolates did not carry any of the analyzed carbapenemase genes. All strains possessed fimH, and 98% of the isolates possessed mrkD. Hypervirulent factors rmpA2 and iucA showed high positive rates (71.30% and 49.07%), with 48.15% of strains containing both genes. MLST analysis identified nine distinct sequence types (STs), with ST11 (82.41%) being the most common, followed by ST2154 (4.63%) and ST307 (3.70%). PBRT analysis revealed IncFII (85.19%) as the most prevalent plasmid.ConclusionIn summary, this study reported the epidemiological features of CRKP in pediatric patients in Henan, China, highlighting the high prevalence of multi-drug-resistant and hypervirulent strains, and underscoring the significance of continuous surveillance.

The role of obesity in mortality from digestive diseases in UK Biobank

Most current studies use body mass index (BMI) or waist circumference (WC) to define obesity, and BMI, which reflects subcutaneous fat independent of visceral fat, is the most commonly used indicator of obesity. WC reflects subcutaneous and visceral fat. This research aims to investigate the effect of obesity on mortality in people with digestive diseases. According to BMI and WC, we divided patients with obesity into the following four groups: general obesity, abdominal obesity, combined obesity, and non-obese. The effects of different obesity types on mortality in a population with digestive diseases were analysed via Cox regression and inverse probability-weighted Cox regression. Our research employed multivariate imputation via the chained equations method to interpolate missing values. A total of 254,445 participants, with a mean age of 57.8 ± 7.8 years, were included in the analysis. Of these participants, 227,111 (89.3%) participants were censored, and 27,334 (10.7%) participants died. Abdominal obesity and combined obesity were independent predictors of mortality in patients with digestive diseases. The combination of BMI and WC was valuable and significant for considering the type of obesity. In addition, our study revealed that sex, socioeconomic status, lifestyle habits, and physical activity were also associated with death in people with digestive disorders. Combined obesity, which is determined by both BMI and WC, is an important factor that influences mortality in a population with digestive diseases, and it plays a stronger role than abdominal obesity alone. These modifiable risk factors for mortality can provide guidance to populations with digestive diseases to avoid poor lifestyles and prolong survival time.

Endo-Aortic Clamp for Minimally Invasive Redo Mitral Valve Surgery: Early Outcome

Objective: Redo mitral valve surgery still represents a challenging and high-risk procedure in cardiac surgery. The incidence of cardiac structural injuries during re-sternotomy remains consistent and is reported to be an independent risk factor for hospital mortality. Minimally invasive cardiac surgery with retrograde femoral arterial perfusion and endo-aortic clamping avoids re-entry injuries and reduces the requirement for dissection of adhesions and the risk of damage to cardiac structures. The aim of this study is to analyze redo patients undergoing mitral valve surgery with retrograde arterial perfusion and endo-aortic clamping setting. Methods: A retrospective analysis was performed on patients undergoing surgery from 2006 to 2022. Exclusion criteria were more than mild aortic regurgitation, moderate-to-severe peripheral vascular disease, dilated ascending aorta, and a lack of preoperative vascular screening. The primary outcome was perioperative mortality. Results: Two hundred eighty-five patients were analyzed. Mean age was 63.8 ± 13.3 years, mean EuroSCORE was 16.5 ± 14.5%, and one quarter of the patients had undergone two or more previous procedures via sternotomy. Perioperative mortality was 3.9% (11/285). Stroke was reported in six (2.1%) patients. Median intensive care unit and hospital length of stay were 1 and 8 days, respectively. Conclusions: Endo-aortic clamping setting in redo MV surgery avoids re-entry injuries and allows the surgeon to clamp the aorta and deliver the cardioplegia with minimal dissection of adhesions. In high-volume and experienced centers, this approach can be applied safely and effectively and may in the near future become the standard of care for redo mitral valve surgery.

The relationship between comorbidity factors and in-hospital mortality in patients with carbapenem-resistant Klebsiella pneumoniae pneumonia

This study aimed to explore the relationship between comorbidity factors and in-hospital mortality related to factors in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) pneumonia. This study collected clinical data from 218 patients with CRKP pneumonia in Beijing hospital from November 2011 to December 2023, analyzed the number of comorbidities carried by CRKP pneumonia patients, comorbidity patterns, Charlson Comorbidity Index (CCI) scores, and comorbidity of underlying diseases, and explored the relationship between various indicators and comorbidity factors and in-hospital mortality in CRKP pneumonia patients. The Ward.D cluster analysis was performed on the comorbidities of patients and used to draw heatmaps. Using a multiple logistic regression model, a nomogram model was constructed to predict in-hospital mortality in patients with CRKP pneumonia. This study included 218 patients with CRKP pneumonia. The results showed that there were significant differences in the age (P=0.003), comorbidities such as heart failure (P<0.001), arrhythmia (P=0.002), chronic liver disease (P=0.003), chronic kidney disease (P=0.002), CCI score (P=0.007), total number of comorbidities (P<0.001), and comorbidity patterns (respiratory/immune/psychiatric disease patterns and cardiovascular/tumor/metabolic disease patterns, P=0.003) between the survival and death groups of CRKP pneumonia patients. The multiple logistic regression showed that cardiovascular/tumor/metabolic disease patterns (P=0.030), CCI score (P=0.040), concomitant heart failure (P=0.011), and concomitant arrhythmia (P=0.025) were independent risk factors for in-hospital mortality in patients with CRKP pneumonia. The nomogram model for predicting the risk of in-hospital mortality in patients with CRKP pneumonia, constructed based on the identified risk factors, had an area under the ROC curve of 0.758. Both the ROC curve and validation curve indicated that the nomogram model had stable performance in predicting in-hospital mortality in patients with CRKP pneumonia. In summary, comorbidity factors are risk factors for predicting in-hospital mortality in patients with CRKP pneumonia, and the role of comorbidity factors in in-hospital mortality in patients with CRKP pneumonia should be taken seriously.

Patient-specific multifactorial mortality risk assessment using classification and regression tree analysis in the context of ambulatory blood pressure monitoring.

Ambulatory blood pressure monitoring is essential for understanding blood pressure patterns beyond clinical visits, aiding in risk assessment, treatment evaluation, and managing hypertension. This retrospective cohort study aimed to identify risk factors for all-cause mortality and major cardiovascular events in patients who underwent ambulatory blood pressure monitoring. Eligible participants aged 18 or older, with an estimated glomerular filtration rate (eGFR) > 60ml/min/1.73m2, who underwent ambulatory blood pressure monitoring for various reasons, were included in the study. Data were gathered through telephone interviews, electronic health records, and the national health record system. Descriptive analysis and classification and regression tree modeling were used to uncover significant risk factors related to all-cause mortality and cardiovascular events, and to assess the model's performance compared to traditional Cox survival analysis. The study included 1291 patients, primarily male (51.8%) with a mean age of 61.1 ± 15.2years. During a mean follow-up of 46.9months, 76 (5.9%) patients died of any cause, and 195 (15.1%) had a cardiovascular event. The highest survival rates were observed in patients with a diastolic blood pressure (BP) dipping percentage between -2% and 29%, nighttime systolic BP variability below 32mmHg, and age below 72. Conversely, smokers with a diastolic BP dipping percentage below -10% showed the lowest survival rates. The best cardiovascular outcomes were observed in patients with diastolic BP dipping above -11%, nighttime mean systolic BP < 144mmHg, no statin use, normotensive status, and daytime mean heart rate ≥ 60bpm. Conversely, the worst outcomes were seen in patients with diastolic BP dipping below -11% and a morning surge ≥ 14mmHg. In all-cause mortality and cardiovascular event analysis, the combined model demonstrated excellent calibration and predictive power, like the classification and regression tree model and traditional analysis. These findings highlight the potential of a combined model for assessing mortality and cardiovascular event risk in patients who have undergone ambulatory blood pressure monitoring.

Epidemiology of Emergency Department Visits for Children With Clinically Significant Cardiovascular Disease.

The aim of the study is to determine the epidemiology, cost, and factors associated with hospital admission, deterioration if hospitalized, and mortality for children with a history of clinically significant cardiovascular disease (CVD) presenting to pediatric emergency departments (EDs). Using the Pediatric Health Information System, we performed a retrospective analysis of ED encounters of children ≤17 years old with clinically significant CVD between 2016 and 2021. Patients were included if they had a cardiovascular complex chronic condition, defined by ICD diagnosis, and procedure codes. We assessed the primary diagnosis, admission rate, ICU transfer rate (as a marker of disease progression), mortality, resource utilization, and costs. We conducted multivariable analyses to identify risk factors for admission, ICU transfer, and mortality. There were 201,551 ED visits (mean 33,592 ± 3354 per year) among 129,938 children with clinically significant CVD. Most ED encounters had a primary diagnosis of a circulatory (21.1%) or respiratory (19.7%) illness. Seventy-six percent of visits had at least one blood test or imaging study conducted. The overall admission rate was 59.7%, with 28.7% admitted to the ICU, and 6.2% transferred to the ICU after the first 24 hours. The median costs for encounters resulting in admission were $13,605 in US 2023 dollars. In multivariable analyses, younger age, a greater number of noncardiac complex chronic conditions, and CVD type were associated with increased odds of admission, ICU transfer after 24 hours, and mortality (all P < 0.05). ED visits for children with clinically significant CVD lead to substantial resource utilization, including frequent hospitalization, ICU level of care, and costs. This baseline data aids in the development of prospective studies to inform the appropriate ED management for children with clinically significant CVD.

Epidemiology, clinical and biological characteristics, and prognosis of critically ill COVID 19 patients: a single-center experience through 4 successive waves

ObjectiveThe aim of this study was to describe the characteristics of patients admitted to the intensive care unit with severe pneumonia due to SARS-CoV-2, comparing them according to successive waves, and to identify prognostic factors for morbidity and mortality.Materials and methodsThis single-center retrospective observational descriptive study was conducted from March 10, 2020, to October 17, 2021. All adult patients admitted with SARS-CoV-2 pneumonia presenting acute respiratory failure were included. COVID 19 diagnosis was confirmed by RT-PCR testing of respiratory specimens. The primary endpoint was ICU mortality. Secondary endpoints were the occurrence of ventilator-associated pneumonia (VAP) or bronchopulmonary aspergillosis.ResultsOver the study period, 437 patients were included of whom 282 (65%) patients were ventilated for 9 [5;20] days. Among the studied population, 38% were treated for one or more episodes of VAP, and 22 (5%) for bronchopulmonary aspergillosis. ICU mortality was 26% in the first wave, then fell and stabilized at around 10% in subsequent waves (p = 0.02). Increased age, Charlson index, SOFA score and lactatemia on admission were predictive of mortality. Survival at 90 days was 85% (95% CI 82–88) and was unaffected by the presence of VAP. However, the occurrence of bronchopulmonary aspergillosis increased mortality to 36%.ConclusionIn this study, we observed mortality in the lower range of those previously reported. Risk factors for mortality mainly included age and previous comorbidities. The prognosis of these critically ill Covid 19 patients improved over the four waves, underlining the likely beneficial effect of vaccination and dexamethasone.

Association between the serum albumin–creatinine ratio and 28-day intensive care unit mortality among patients with sepsis: a multicenter retrospective cohort study

IntroductionSepsis is a substantial global health challenge with a considerable disease burden. Despite advancements in sepsis research, the mortality rates associated with this condition remain high. The relationship between the serum albumin-to-creatinine ratio (sACR) and mortality in patients with sepsis remains unclear. Therefore, this study aimed to investigate the association between the sACR and 28-day mortality in intensive care unit (ICU) patients with sepsis.MethodsIn this retrospective cohort study, we used data sourced from the eICU Collaborative Research Database. The primary exposure variable was sACR, and the primary outcome measure was mortality within 28 days after ICU admission. Statistical analyses included univariate and multivariate logistic regression models, generalized additive models, and two-piecewise linear regression models, which were employed to explore non-linear relationships and threshold effects between sACR and mortality.ResultsThe study cohort comprised 9,690 ICU patients with sepsis, with a 28-day mortality rate of 9.99%. The results of the multivariate logistic regression model indicated that elevated sACR levels were significantly associated with a reduced risk of mortality (odds ratio = 0.78, 95% confidence interval: 0.71–0.87, p &amp;lt; 0.001), even after adjusting for potential confounding variables. Curve fitting revealed a non-linear relationship between sACR and 28-day mortality, with an inflection point of 4.79.DiscussionThis study demonstrated that sACR is an independent risk factor for 28-day mortality in ICU patients with sepsis, exhibiting a non-linear negative dose–response relationship and a threshold effect. These findings may serve as early warning indicators in high-risk populations.

Could Anemia Impact the Severity of Infections? COVID-19 as an Example

Background The association between anemia and severity of infection as well as mortality rates among patients infected with COVID-19 has scarcely been studied. This is the first study from the UAE aimed to assess the influence of anemia on COVID-19 severity, ICU admission, and mortality rate. Methods A retrospective chart review of hospitalized COVID-19 patients was conducted in a large COVID-19 referral hospital in UAE. The study included adult patients with confirmed COVID-19. Clinical and laboratory data, severity of the disease, ICU admissions, and mortality rates were analyzed and correlated to the presence of anemia among the patients. Results A total of 3092 patients were included. 362 patients (11.7%) were anemic and most of the cases were between asymptomatic and mild COVID-19 (77.4%, n=2393). Among patients with anemia, 30.1% (n=109) had moderate to severe COVID-19. Statistically, anemia was associated significantly with a higher risk for severe COVID-19 outcome compared to nonanemic patients (AOR:1.59, 95% CI:1.24-2.04, p&lt;0.001). Intensive care unit (ICU) admission was almost 3 times higher among anemic patients compared to nonanemic (AOR:2.83,95% CI:1.89-4.25, p&lt;0.001). In addition, the overall mortality rate of 2.8% (n=87) was 2.5-fold higher in anemic than nonanemic patients (OR:2.56, CI: 1.49-4.06, p&lt;0.001). Moreover, older age (≥48-year-old) and male gender were independent predictors for severe illness (Age: OR=1.26, CI:1.07-1.51, p=0.006; Gender: OR:1.43,CI:1.15-1.78, p&lt;0.001)) and ICU admission (Age: OR:2.08, CI:1.47-2.94, p&lt;0.001; Gender: OR: 1.83, CI:1.12-3.00, p=0.008) whereas only age ≥48 years old contributed to higher mortality rate (OR:1.60, CI:1.04-2.46, p=0.034). Conclusion Anemia was a major risk factor for severe COVID-19, ICU admission and mortality among hospitalized COVID-19 patients. Thus, healthcare providers should be aware of monitoring the hematological parameters among hospitalized patients with COVID-19 and anemia to reduce the risk of disease complications and mortality. This association should also be considered in other infectious diseases.

The neutrophil–lymphocyte ratio is associated with all-cause and cardiovascular mortality in cardiovascular patients

This study investigates the relationship of neutrophil–lymphocyte ratio (NLR) with the risk of all-cause and cardiovascular mortality in patients with cardiovascular disease. The data for this analysis came from 2239 participants with cardiovascular disease of the National Health and Nutrition Examination Survey conducted between 1999–2018. The optimal cutoff point for NLR was determined using maximally selected rank statistics. Survival analysis was performed using Cox regression models to assess the impact of NLR on the risk of all-cause mortality and cardiovascular mortality. Restricted cubic spline was used to visualize the association of NLR with mortality risk. Subgroup analysis was performed to examine the relationship between NLR and mortality within subgroups based on age, sex, diabetes and hypertension. During a median follow-up period of 6.7 (IQR, 3.3–10.9) years, 992 all-cause deaths occurred, including 381 cardiovascular deaths. Our study revealed that NLR is a risk factor for all-cause mortality (HR: 1.15 95%Cl: 1.11 ~ 1.19) and cardiovascular mortality (HR: 1.14 95%Cl: 1.08 ~ 1.2) among patients with cardiovascular disease. The restricted cubic spline regression analysis showed a non-linear association between NLR and all-cause mortality (p < 0.05 for nonlinearity) in cardiovascular patients. This association remained robust in subgroup analyses stratified by age, sex, diabetes, and hypertension. Conclusion NLR stands as a significant risk factor for both all-cause and cardiovascular mortality among patients with cardiovascular disease.

LPS-induced delirium-like behavior and microglial activation in mice correlate with bispectral electroencephalography (BSEEG).

Delirium is a multifactorial medical condition characterized by impairment across various mental functions and is one of the greatest risk factors for prolonged hospitalization, morbidity, and mortality. Research focused on delirium has proven to be challenging due to a lack of objective measures for diagnosing patients, and few laboratory models have been validated. Our recent studies report the efficacy of bispectral electroencephalography (BSEEG) in diagnosing delirium in patients and predicting patient outcomes. We applied BSEEG to validate a lipopolysaccharide (LPS)-induced mouse model of delirium. Moreover, we investigated the relationship between BSEEG score, delirium-like behaviors, and microglia activation in hippocampal dentate gyrus and cortex regions in young and aged mice. There was a significant correlation between BSEEG score and impairment of attention in young mice. Additionally, there was a significant correlation between BSEEG score and microglial activation in hippocampal dentate gyrus and cortex regions in young and aged mice. We have successfully validated the BSEEG method by showing its associations with a level of behavioral change and microglial activation in an LPS-induced mouse model of delirium. In addition, the BSEEG method was able to sensitively capture an LPS-induced delirium-like condition that behavioral tests could not capture because of a hypoactive state.