Non-survivor Cases Research Articles

393 Why do patients develop in-hospital cardiac arrest? A prospective, single-center observational study of in-hospital cardiac arrest aetiologies (WHY-IHCA) - preliminary results in non-survivor cases

393 Why do patients develop in-hospital cardiac arrest? A prospective, single-center observational study of in-hospital cardiac arrest aetiologies (WHY-IHCA) - preliminary results in non-survivor cases

Oxidative stress and early mortality in acute ischemic stroke: A prospective cohort study

ABSTRACT Background Malondialdehyde (MDA) is an oxidative stress biomarker, which represents a unifying mechanism of brain injury that occurs throughout the ischemic stroke cascade. The current study aimed to examine whether or not acute ischemic stroke (AIS) patients who had elevated serum MDA levels at admission had an increased risk of mortality and a worse functional outcome three months later. Methods An observational, prospective cohort study that enrolled 90 patients with AIS. The patients were examined in the first 24 hours and then followed up for three months to assess mortality, short-term neurological functional outcome, and neurological disability by the Modified Rankin Scale (MRS). Results The mean of serum MDA level among AIS patients was 6.3 ± 3.7 nmol/ml. Non-survivor cases were associated with statistically significantly higher serum MDA levels compared to survivors (9.7 ± 4.3 vs. 5.3 ± 2.8, p < 0.001), respectively. Patients with severe stroke, according to NIHSS score, were associated with significantly (p < 0.05) higher MDA levels compared to moderate and mild cases (7.4 ± 4.3 vs. 5.4 ± 2.6 vs. 3.3 ± .6). At a cutoff point of ≥ 6.7 nmol/ml, the area under the curve (AUC) for serum MDA levels as a predictor of mortality was 0.8 (0.69–0.91; p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value were 77%, 80%, 89.5%, and 48.5%, respectively. Multivariate regression demonstrated that MDA level was a significant independent predictor of mortality among patients with AIS (OR = 1.29, 95% CI: 1.01 to 1.65; p = 0.041). Conclusion MDA serum level was significantly higher in non-survivors than in survivors patients, so MDA could be used as a predictor for early mortality and short-term outcome of cases with AIS.

A Survey on the First 100 COVID-19 Patients Admitted to a Referral Center in Northern Iran in Early 2020

Background: Lymphopenia is an important but nonspecific laboratory indicator of COVID-19.&#x0D; Objectives: To describe epidemiologic and clinical characteristics of the first cases of the COVID-19 referred to a center dedicated to COVID-19 patients in Iran.&#x0D; Methods: This research is a retrospective cross-sectional study on 100 confirmed cases with COVID-19, hospitalized from February 25 to March 10, 2020, in Qaemshahr Razi Hospital in Mazandaran Province, Iran. The main demographic data, clinical features, including outcomes, laboratory findings, and therapeutic protocols, were collected in a structured form and analyzed.&#x0D; Results: The Mean±SD age of the patients was 56.7±15.6 years. Fifty-nine percent (n=59) of the patients were male. Nineteen percent (n=19) were admitted to the ICU. The median (IQR) time from disease onset to hospital admission was 5 (3-7) days. The most common symptoms were fever (73%), dyspnea (67%), dry cough (61%), and myalgia (61%). The severity of the disease was moderate in most patients (n=54). The average hospital stay for patients was 7 days. The non-survivor cases in comparison to survived ones were from a higher age group (65 vs 52 years; P=0.001), had a higher frequency of underlying diseases (68.4% vs 39.5%; P=0.039), had a lower peripheral capillary O2 saturation at the time of admission (79% vs 94%; P&lt;0.001), and were more likely to have lymphopenia (63.2% vs 37%; P=0.034).&#x0D; Conclusion: Lymphopenia, increased neutrophil to lymphocyte ratio and decreased peripheral capillary O2 saturation are commonly seen in COVID-19 patients, especially among severe cases, and can be used in developing clinical prediction rules.&#x0D;

Ischemia-modified albumin as a novel marker for diagnosis of necrotizing enterocolitis in newborn infants

Background: Necrotizing enterocolitis (NEC) is the most common neonatal gastrointestinal emergency. Ischemia-modified albumin (IMA) is a marker of oxidative stress and ischemia. Its role in early diagnosis of NEC has been little investigated so far. Aim: The objective of our research was to study the role of serum IMA in diagnosis of NEC in newborn infants. Material and methods: The study was carried out on 80 neonates; 40 with NEC and 40 controls, subjected to serum IMA dosage with ELISA. Results: There was a highly statistically significant increase in IMA in both preterm (60.59 ± 34.97 U/ml) and full-term infants with NEC (60.50 ± 29.88 U/ml) compared to their controls (11.28 ± 3.09 U/ml; 5.34 ± 1.88 U/ml). The positive predictive value of IMA in preterm and full-term with NEC was 100% and 94.74%, while the negative predictive value was 80% and 90.48%, respectively. There was a statistically significant increase in serum level of IMA in stage II NEC compared to stage I NEC as well as in non-survivor cases. Significant positive correlation between serum IMA level and duration of recovery from NEC was detected. Conclusions: IMA is a sensitive marker for diagnosis of NEC in full-term and preterm infants and can predict severity of NEC and death.

Diagnostic performance of initial blood urea nitrogen combined with D-dimer levels for predicting in-hospital mortality in COVID-19 patients

The crude mortality rate in critical pneumonia cases with coronavirus disease 2019 (COVID-19) reaches 49%. This study aimed to test whether levels of blood urea nitrogen (BUN) in combination with D-dimer were predictors of in-hospital mortality in COVID-19 patients. The clinical characteristics of 305 COVID-19 patients were analysed and were compared between the survivor and non-survivor groups. Of the 305 patients, 85 (27.9%) died and 220 (72.1%) were discharged from hospital. Compared with discharged cases, non-survivor cases were older and their BUN and D-dimer levels were significantly higher (P < 0.0001). Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regression analyses identified BUN and D-dimer levels as independent risk factors for poor prognosis. Kaplan-Meier analysis showed that elevated levels of BUN and D-dimer were associated with increased mortality (log-rank, P < 0.0001). The area under the curve for BUN combined with D-dimer was 0.94 (95% CI 0.90-0.97), with a sensitivity of 85% and specificity of 91%. Based on BUN and D-dimer levels on admission, a nomogram model was developed that showed good discrimination, with a concordance index of 0.94. Together, initial BUN and D-dimer levels were associated with mortality in COVID-19 patients. The combination of BUN ≥ 4.6 mmol/L and D-dimer ≥ 0.845 μg/mL appears to identify patients at high risk of in-hospital mortality, therefore it may prove to be a powerful risk assessment tool for severe COVID-19 patients.

C-reactive protein: A promising biomarker for poor prognosis in COVID-19 infection

BackgroundThe novel coronavirus disease 2019 (COVID-19) first broke out in Wuhan, China, spread over 227 countries and caused approximately 0.3 million death worldwide. Several biomolecules have been explored for possible biomarkers for prognosis outcome. Although increased C reactive protein (CRP) is associated with death due to COVID-19 infections, results from different populations remain inconsistent. For a conclusive result, the present meta-analysis was performed. MethodsWe conducted a literature search in PubMed and Scopus database for the association of CRP concentration with COVID-19 disease outcomes. A total of 16 eligible studies were enrolled in the present analysis comprising of 1896 survivors and 849 non-survivors cases. Concentrations of CRP were compared and analyzed by a meta-analysis. ResultsEgger’s regression analysis (intercept = 0.04, P = 0.98, 95%CI = −5.48 to 5.58) and funnel plot revealed an absence of publication bias in the included studies. Due to the presence of significant heterogeneity across the studies (Q = 252.03, Pheterogeneity = 0.000, I2 = 93.65) random model was used for the analysis of the present study. The results of the meta-analysis demonstrated a significant role of CRP in COVID-19 infection outcome (Standard difference in means = 1.371, P = 0.000). ConclusionsConcentrations of CRP remained high in patients who died of COVID-19 infection and could be a promising biomarker for assessing disease lethality.

Clinical and Imaging Findings of 427 Hospitalized Patients with COVID-19 in Northeast of Iran

Background: Since December 2019, the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged the world. In this descriptive study, we aim to share the clinical information of 427 Iranian COVID-19 patients. Methods: The different information on COVID-19 patients who were hospitalized from 24 February 2020 to 1 April 2020 was analyzed using R software. The patients were categorized into two groups as non-severe or severe and survivor or non-survivor cases. Outcomes of the cases were followed up until one month after the time of admission. Findings: Overall, the median age of the patients was 53 with a difference of ten years between two categories in each group. Among patients, 50·8% were males who had worse outcomes than female patients. Cough (72·8%), fever (69·3%), and dyspnea (64·0%) were the most common symptoms. There were more underlying comorbidities in the group of severe (73·5%) and non-survivor (77·5%) cases compared to the non-severe (53·6%) and survivor (44·1%) groups. Changes in the pattern of the parameters of complete blood counts including lymphopenia (227/333; 68·2%) were the most prominent findings. Factors associated with the liver and kidney damage were significantly increased in patients, especially in non-survivor cases. Around 90% of the COVID-19 patients had at least one abnormality in the chest CT scans including simultaneously both crazy paving and consolidation patterns (27·1%), followed by the ground-glass opacity (24·7%). Interpretation: According to the results, the patients' age, underlying comorbidities, percentage of SpO2, and blood laboratory findings at the time of admission may indicate the progression of the disease in the coming days. Funding Statement: The Golestan University of Medical of Sciences, Iran. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The ethics committee of Golestan University of Medical Sciences approved the study (IR.GOUMS.REC.1398.383).

The early mortality rate of people infected with coronavirus (COVID-2019) in Wuhan, China: Review of three retrospective studies.

ABSTRACTBackground:The infection with coronavirus and non-survivor cases have been escalated since the first inception between January and March 2020. Therefore, reviewing the collated clinical characteristics of non-survivors might assist in current preventive efforts, triaging, and management of survivors. The aim of this review was to summarize the clinical characteristics of non-survivor cases due to the infection caused by a novel coronavirus and to identify the relevant data that might put the new cases at increased mortality.Materials and Methods:We have identified three published articles on novel coronavirus reported during December 01, 2020, to March 15, 2020, which have described the mortality rate in Wuhan, Hubei, China.Results:The mean duration of studies (i.e., the three retrospective studies with 278 cases) was 24.7 days, and the duration of onset to dyspnea was variable between 8 and 5 days. The main reported complications were acute respiratory distress, pneumonia, acute kidney injury, and acute cardiac disease. The overall major comorbidity reported was cardiovascular diseases at 23.7% (66 of 278). The reported overall mortality rate was 8.3% (23 of 278), with the highest mortality rate of 15.0% (6 of 41) reported in Jin Yintan Hospital at Wuhan city.Conclusions:The clinical characteristics of the non-survivors from the novel coronavirus included adult males, aged older than 50 years, having comorbidities of cardiovascular disease, respiratory distress syndrome, acute kidney injury, and diabetes with higher admission to the intensive care unit. The mortality rate was high in two of the reported studies (15.0% and 11.0%), which was decreased in the later-dated study to 3.4%.

A New Formula as a Predictive Score of Post–Liver Transplantation Outcome: Postoperative MELD-Lactate

IntroductionLiver transplantation (OLT) involves a 5% to 10% 30-day mortality rate. Multiple scores have been used as predictors of early postoperative mortality, such as the original Model for End-stage Liver Disease (MELD) and MELD sodium. Investigations have been conducted over the last 5 years to find new predictors of early post-OLT mortality. ObjectiveThe aim of this study was to develop a new mathematical model to predict the individual chance of 30-day mortality after OLT. MethodsThe study was conducted on 58 patients submitted to OLT at the University Hospital, between October 2008 and March 2012. The 29 latest survivor and 29 latest nonsurvivor cases were selected. Arterial blood sodium, lactate, international normalized ratio, total bilirubin, and creatinine values were determined 1 hour after the end of surgery. The MELD original equation, MELD sodium, and new MELD lactate were also elaborated. The results were analyzed by the Mann-Whitney and Wilcoxon tests. The level of significance was set at .05. ResultsThe new formula elaborated was as follows: MELD lactate = 5.68 × loge (lactate) + 0.64 × (Original MELD) + 2.68. The MELD lactate values were significantly higher than the MELD sodium and original MELD values (P < .05). The area under the receiver operating characteristic curve of MELD lactate in predicting the outcome of patients submitted to OLT was 0.80, as opposed to 0.71 for the original MELD and 0.72 for MELD sodium (P < .05). ConclusionThe postoperative MELD lactate score proved to be more specific and sensitive than the original MELD and MELD sodium as a predictive model of the outcome of patients submitted to OLT.

Ultrasonographic severity scoring of non-immune hydrops: a predictor of perinatal mortality.

To develop an ultrasonographic severity scoring of non-immune hydrops in order to predict perinatal outcomes in women with non-immune hydrops. The study population consisted of pregnant women who were admitted and delivered with the diagnosis of fetal non-immune hydrops and singleton gestation. Cases were divided into "perinatal survivor" and "perinatal non-survivor" groups. Perinatal non-survivor cases were defined as those with stillbirth or neonatal death ≤28 completed days after birth. The presence of an abnormal fluid collection in each body compartment, such as subcutaneous edema, pleural effusion, pericardial effusion, or ascites was assigned a score of 1 point per each body compartment, and the absence of abnormal fluid collection was scored as 0 point. The total number of abnormal fluid collections was converted to a numeric score, which was called the ultrasonographic severity scoring of non-immune hydrops (USNIH). Perinatal death occurred in 46.5% (20/43) of the cases of non-immune hydrops. USNIH in patients of the non-survivor group was significantly higher than that in those of the survivor group [non-survivor group 3 (2-4) vs. survivor 2 (2-3); median (range); P<0.05]. Perinatal mortality rates were higher in patients with USNIH ≥3 points than in those with USNIH of 2 points (67% vs. 13%, P<0.005). This difference remained significant after adjustment for confounding variables. When confining analysis to those with idiopathic non-immune hydrops, women in the perinatal non-survivor group had significantly higher USNIH score than those in the perinatal survivor group, and this difference remained significant after adjustment. Our USNIH system may be a reliable predictive marker for perinatal outcomes in cases of non-immune hydrops, especially in idiopathic hydrops during the antenatal period.

Tu1027 A New Formula As a Predictive Score of Post-Liver Transplantation Outcome: Postoperative MELD Lactate

Introduction. Liver transplantation (OLT) involves a 5% to 10% 30-day mortality rate. Multiple scores have been used as predictors of early postoperative mortality, such as the original Model for End-stage Liver Disease (MELD) and MELD sodium. Investigations have been conducted over the last 5 years to find new predictors of early post-OLT mortality. Objective. The aim of this study was to develop a new mathematical model to predict the individual chance of 30-day mortality after OLT. Methods. The study was conducted on 58 patients submitted to OLT at the University Hospital, between October 2008 and March 2012. The 29 latest survivor and 29 latest nonsurvivor cases were selected. Arterial blood sodium, lactate, international normalized ratio, total bilirubin, and creatinine values were determined 1 hour after the end of surgery. The MELD original equation, MELD sodium, and new MELD lactate were also elaborated. The results were analyzed by the Mann-Whitney and Wilcoxon tests. The level of significance was set at .05. Results. The new formula elaborated was as follows: MELD lactate ¼ 5.68 � loge (lactate) þ 0.64 � (Original MELD) þ 2.68. The MELD lactate values were significantly higher than the MELD sodium and original MELD values (P < .05). The area under the receiver operating characteristic curve of MELD lactate in predicting the outcome of patients submitted to OLT was 0.80, as opposed to 0.71 for the original MELD and 0.72 for MELD sodium (P < .05). Conclusion. The postoperative MELD lactate score proved to be more specific and sensitive than the original MELD and MELD sodium as a predictive model of the outcome of patients submitted to OLT.

The relationship between blood lactate levels and mortality in pediatric intensive care patients

Objective: To determine relationship between blood lactate level and mortality rate in children admitted to the intensive care unit. Methods: 298 critically ill patients aged between 28 days and 16 years admitted to Dicle University Hospital, the third step Pediatric Intensive Care Unit in between January 2007 and December 2007 were included. Age, sex, diagnosis, Glasgow coma score points, the first measured blood lactate levels (lactate 1) and the arithmetic average of all measured blood lactate levels during treatment (lactate 2) of cases were evaluated. Patients were divided into group A (lactate < 20 mg/dl) and B (lactate ≥ 20 mg/dl). According to the results, patients were classified as survivors and non-survivors. Both lactate 1 and lactate 2 were compared with mortality rates. Results: In this study, a total of 298 patients were evaluated, 158 of them were nonsurvivors and 140 were survivors. A significant correlation was found between lactate levels and mortality rates. Lactate levels were higher in non-survivor cases (p<0.001). In group B, lactate 1 had 68% (106/156) sensitivity and 75% (106/142) specificity for determining the risk of mortality. Also in group B, lactate 2 had 85% (134/158) sensitivity and 79% (134/169) specificity for determining the risk of mortality. Conclusion: There is a strong association between high blood lactate levels and mortality rates in the critically ill patients in pediatric intensive care unit. In these patients blood lactate levels can be used for follow-up and evaluation of the effectiveness of treatment and determining mortality.