Non-surviving Patients Research Articles

Complications during Veno-Venous Extracorporeal Membrane Oxygenation in COVID-19 and Non-COVID-19 Patients with Acute Respiratory Distress Syndrome.

Background: Acute respiratory distress syndrome (ARDS) presents a significant challenge in critical care settings, characterized by compromised gas exchange, necessitating in the most severe cases interventions such as veno-venous extracorporeal membrane oxygenation (vv-ECMO) when conventional therapies fail. Critically ill ARDS patients on vv-ECMO may experience several complications. Limited data exist comparing complication rates between COVID-19 and non-COVID-19 ARDS patients undergoing vv-ECMO. This retrospective observational study aimed to assess and compare complications in these patient cohorts. Methods: We retrospectively analyzed the medical records of all patients receiving vv-ECMO for ARDS between March 2020 and March 2022. We recorded the baseline characteristics, the disease course and complication (barotrauma, bleeding, thrombosis) before and after ECMO cannulation, and clinical outcomes (mechanical ventilation and ECMO duration, intensive care unit, and hospital lengths of stay and mortalities). Data were compared between COVID-19 and non-COVID-19 patients. In addition, we compared survived and deceased patients. Results: Sixty-four patients were included. COVID-19 patients (n = 25) showed higher rates of pneumothorax (28% vs. 8%, p = 0.039) with subcutaneous emphysema (24% vs. 5%, p = 0.048) and longer non-invasive ventilation duration before vv-ECMO cannulation (2 [1; 4] vs. 0 [0; 1] days, p = <0.001), compared to non-COVID-19 patients (n = 39). However, complication rates and clinical outcomes post-vv-ECMO were similar between groups. Survival analysis revealed no significant differences in pre-vv-ECMO complications, but non-surviving patients had a trend toward higher complication rates and more pleural effusions post-vv-ECMO. Conclusions: COVID-19 patients on vv-ECMO exhibit higher pneumothorax rates with subcutaneous emphysema pre-cannulation; post-cannulation complications are comparable to non-COVID-19 patients.

Systematic analysis of approaches used in cardiac arrest trials to inform relatives about trial enrolment of non-surviving patients

BackgroundThe recruitment of patients to emergency research studies without the requirement for prior informed consent has furthered the conduct of randomised studies in cardiac arrest. Frameworks enabling this vary around...

Heparin binding protein as a reliable prognostic biomarker for severity of sepsis in the intensive care unit

ABSTRACT Background It is still challenging to identify people who are at risk for developing sepsis quickly and early. Heparin-binding protein (HBP) has been demonstrated a promising data that can be used as predictive qualities in identifying organ failure. Methods This prospective observational investigation of 55 adult patients who have been proven to have sepsis, and were hospitalized into the intensive care unit. By carrying out HBP, procalcitonin (PROCAL), C-reactive protein (CRP), serum lactate, SOFA score on admission and after 72 hours and detecting 28-day mortality. Results Despite PROCAL and HBP were higher in survival than non-survival patients at day 0 (1010.32 ± 341.72 vs 770.21 ± 327.97, p = 0.0112) (16.73 ± 7.19 vs 13.19 ± 7.26, p = 0.077) respectively, It was significantly lower in survival than non-survival at day 3 (542.09 ± 191.98 vs 995.00 ± 333.74, p =<0.0001) (9.03 ± 2.92 vs 16.67 ± 7.55,p =<0.0001) respectively. Our main marker HBP decreased significantly from day 0 to day 3 for survival patients with paired difference −7.69 ± 6.78 with p value < 0.0001, while it is increased with non-significant value for non-survival patients with paired difference 3.48 ± 9.45 with p value 0.084. ROC analysis for mortality showed for HBP that AUC at day 0 was 0.323 (p=0.025). At cut-off value of>15.5ng/ml, sensitivity was 29.2%, specificity was 64.5%, while at day 3 was 0.831 (p=0.000). At cut-off value of>9.5ng/ml, sensitivity was 83.33%, specificity was 77.42%. Conclusion HPB showed a strong prognostic marker of mortality in ICU septic patients at day 3 more than day 0 with important value and trend.

Microbiological Profile of Patients with Aspiration Pneumonia Identified by Combined Detection Methods.

Aspiration pneumonia (AP) challenges public health globally. The primary aim of this study was to ascertain the microbiological profile characteristics of patients with AP evaluated by combined detection methods, including conventional microbiological tests (CMTs), chips for complicated infection detection (CCID), and metagenomic next-generation sequencing (mNGS). From June 2021 to March 2022, a total of thirty-nine patients with AP or community-acquired pneumonia with aspiration risk factors (AspRF-CAP) from 3 hospitals were included. Respiratory specimens, including bronchoalveolar lavage fluid (BALF), sputum, and tracheal aspirate, were collected for microorganism detection. Patients with AP were more inclined to be older, to have a shorter duration from illness onset to admission, to have a higher prevalence of different underlying diseases, particularly diabetes mellitus, chronic heart disease, and cerebrovascular disease, and to have a higher CURB-65 score (all P < 0.05). A total of 213 and 31 strains of microorganisms were detected in patients with AP and AspRF-CAP, respectively. The most common pathogens in AP were Corynebacterium striatum (17/213, 7.98%), Pseudomonas aeruginosa (15/213, 7.04%), Klebsiella pneumoniae (15/213, 7.04%), and Candida albicans (14/213, 6.57%). Besides, the most common pathogens in AspRF-CAP were Candida albicans (5/31, 16.13%), Pseudomonas aeruginosa (3/31, 9.68%) and Klebsiella pneumoniae (3/31, 9.68%). Moreover, Klebsiella pneumoniae (7/67, 10.45%) and Candida glabrata (5/67, 7.46%) were the most common pathogens among the 9 non-survived patients with AP. The prevalent pathogens detected in cases of AP were Corynebacterium striatum, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Candida albicans. Early combined detection methods for patients with AP enhance the positive detection rate of pathogens and potentially expedites the initiation of appropriate antibiotic therapeutic strategies.

Predictors for negative clinical outcome in acute mesenteric ischemia after on-pump cardiac surgery: a retrospective observational trial

INTRODUCTION: Acute mesenteric ischemia (AMI) is one of the most dangerous complications of cardiac surgery using cardiopulmonary bypass (CPB). Several factors may contribute to the development of AMI, such as: age over 70 years, prolonged CBP, postoperative heart failure, cardiogenic shock, mechanical circulatory support and others. The mortality rate in AMI reaches 85 %. OBJECTIVE: To identify predictors of a negative clinical outcome in the development of acute mesenteric ischemia in patients after on-pump cardiac surgery. MATERIALS AND METHODS: A single-center retrospective observational cohort study included 53 patients in the intensive care unit who developed AMI after cardiac surgery performed using CPB. All patients with AMI included in the study were divided into two groups — survivors (n = 31) and non- survivors (n = 22) to identify predictors of negative clinical outcome. RESULTS: At the preoperative stage, the left ventricular ejection fraction (LVEF) was impaired in both groups, but in non-survived patients was significantly lower: 34.6 (25.4–52.4) in survivors and 28.7 (25.2–42.7) in non-survivors (p = 0.05). 12 hours after the surgery, the cardiac index (CI) (p = 0.01) and the index of left ventricular work (ILVW) were significantly (p = 0.03) lower in non-survivors. The average duration of CPB was 124 minutes (95–142) in survivors and 164 minutes in non-survivors (145–176) (p = 0.02). Also, 72.7 % of n0n-survivers received high doses of adrenomimetics in the postoperative period, in survivors — 41.9 % (p = 0.03). The rate of long-term mechanical respiratory support usage in non-survivors reached 86.3 %, in survivors — 35.4 % (p = 0.003). CONCLUSIONS: The key predictors of a negative outcome of OMI in cardiac surgery patients are: prolonged use of CBP, low CI, LVWI before and after surgery, high doses of adrenomimetics, prolonged mechanical respiratory support, as well as high concentrations of blood lactate 12 hours after the end of the surgery.

Awake venovenous extracorporeal membrane oxygenation and survival.

ObjectivesDeep sedation on the ICU is linked to poor outcome. This study investigated the link between Richmond Agitation-Sedation Scale (RASS) and outcome in venovenous extracorporeal membrane oxygenation (V-V ECMO).MethodsWe performed a secondary analysis of a single-center V-V ECMO cohort. RASS was used as a surrogate measure of sedation depth, patients with a score ≥ −1 were considered awake. V-V ECMO durations below 24 h were excluded. Primary endpoint was 30-day survival. Secondary endpoints were hospital survival and weaning from both ventilator and ECMO therapy.ResultsA total of 343 patients were reanalyzed. The median age was 55 years and 52.2% (179/343) survived for 30 days after ECMO cannulation. Median duration of ECMO was 7.9 (4.7–15.0) days and the median duration of mechanical ventilation after ECMO cannulation was 11.8 (6.7–23.8) days.In the whole cohort, median RASS on day one and seven after ECMO were − 4 (−4 to −1) and − 3 (−4 to 0), respectively. ECMO survivors consistently had significantly higher RASS scores during the first 7 days of ECMO compared to non-surviving patients (p &amp;lt; 0.01). On day two after ECMO, survival of awake patients (i.e., RASS ≥-1) was significantly better compared to sedated [i.e., RASS −4 to −2; OR 2.20 (1.28–3.71), p &amp;lt; 0.01] or unresponsive patients [i.e., RASS -5; OR 2.27 (1.15–4.64), p = 0.02]. The survival benefit of awake ECMO was consistent from day two to seven. Patients awake at least once during ECMO showed higher 30-day survival rates [64.4% vs. 39.6%, OR 2.75 (1.77–4.24), p &amp;lt; 0.01].ConclusionIn this retrospective study, awake patients on V-V ECMO showed higher 30-day survival rates compared to sedated or unresponsive patients. These data should encourage further research on awake V-V ECMO.

The Association of Serum Profile of Transferrin Isoforms with COVID-19 Disease Severity.

Background/Objective: Bearing in mind the relationship of transferrin (TRF) microheterogeneity with the biological activity of its isoforms, we propose, in this study, to determine the association of the profile of TRF isoforms with COVID-19 disease severity and to compare this profile to the profiles of other diseases. Methods: The disease group consisted of 96 patients from whom blood was collected twice, upon admission to the ward and after treatment (on average on the ninth day). TRF isoforms were separated by capillary electrophoresis. The analysis included disease severity, cytokine storm, comorbidities, patient survival, oxygen therapy, and modified early warning scores (MEWSs). Results: The concentration of 5-sialoTRF was higher in patients compared to controls at the beginning and during COVID-19 treatment. The concentration of this isoform varies with the severity of disease and was higher in critical patients than those with a moderate condition. Additionally, the level of 5-sialoTRF was lower and the level of 4-sialoTRF was higher in patients with comorbidities than that in patients without them. The concentration of 5-sialoTRF was lower and the concentration of 4-sialoTRF was higher in surviving patients than in non-surviving patients. There were no statistical changes in TRF isoforms according to presence of cytokine storm, MEWS, and oxygen therapy. Conclusions: We conclude that the profile of TRF isoforms in COVID-19 patients differs from that in other diseases. An increase in the concentration of a sialic acid-rich isoform, 5-sialoTRF, may be a compensatory mechanism, the goal of which is to increase oxygen delivery to tissues and is dependent on the severity of the disease. Additionally, the concentration of 5-sialoTRF may be a prognostic marker of the survival of COVID-19 patients.

Comparison of clinical characteristics and outcomes between COVID-19 survivors and non-survivors: a retrospective observational study

Background To compare the clinical characteristics of COVID-19 survivors and non-survivors who were transferred from general wards to the critical care units in four tertiary hospitals of Nepal. Methods This study utilized electronic data from the National Intensive Care Unit (ICU) registry managed by the Nepal Intensive Care Research Foundation (NICRF). A retrospective observational study was conducted among 78 eligible COVID-19 patients admitted to the intensive care units of four different hospitals between 2020 and 2022. The Mann-Whitney U test was used to compare each continuous variable between the survivors and non survivors, while Pearson's chi-squared test was used to examine the association between each categorical variable and outcome. Results Among 78 cases of COVID-19 studied, 29 (37.1%) had died, and 49 (62.8%) had recovered. The median age of the patient was 57.5 years, with a higher percentage of males (66.6%). Hypertension (41%) and diabetes (26.9%) were common comorbidities, whereas pneumonia (41%) and acute respiratory distress syndrome (19.2%) were common complications. Most patients required oxygen therapy (96.2%). Corticosteroids (76.9%) and anticoagulants (83.3%) were commonly administered medications. Median of mean arterial pressure was 85 mm Hg [ IQR- 79.2 - 99.5] in non-survivors and 93.3 mm Hg [IQR- 86.6 - 102.6 ] in survivors which was significantly different between the two groups (p=0.04). Nine of the patients had cardiac dysfunction on ICU admission, of which none survived (p=0.001). Out of ten patients requiring inotropes or vasopressors, only two survived (p=0.001). Conclusions Non-survivor COVID patients had lower mean arterial pressure on admission to intensive care units. A higher proportion of patients with cardiac dysfunction and requiring inotropes or vasopressors could not survive.

Prognosis prediction of procalcitonin within 24 h for acute diquat poisoning

BackgroundTo explore the predictive value of procalcitonin (PCT) within 24 h after poisoning for prognosis of acute diquat poisoning.MethodsThis retrospective study included acute diquat poisoning patients in the Nanyang City Hospital between May 2017 and July 2021.ResultsAmong the 45 patients included, 27 survived. The maximum PCT value within 24 h after poisoning was significantly higher in the non-survival patients [9.65 (2.63, 22.77) vs. 0.15 (0.10, 0.50) µg/mL, P < 0.001] compared to the survival patients. The area under the ROC curve (AUC) indicated that the maximum PCT value within 24 h had a good predictive value (AUC = 0.905, 95% CI: 0.808-1.000) compared to ingested quantity (AUC = 0.879, 95% CI: 0.776–0.981), serum creatinine (AUC = 0.776, 95% CI: 0.640–0.912), or APACHE II score (AUC = 0.778, 95% CI: 0.631–0.925). The predictive value of maximum PCT value within 24 h was comparable with blood lactate (AUC = 0.904, 95%CI: 0.807-1.000).ConclusionsThe maximum PCT value within 24 h after poisoning might be a good predictor for the prognosis of patients with acute diquat poisoning.

Risk Factors for Death in Patients with Severe Acute Pancreatitis in Guizhou Province, China.

To compare the clinical characteristics of survival and nonsurvival patients with severe acute pancreatitis (SAP) and explore the risk of mortality in SAP patients. This was a single-center retrospective study performed in a severe acute pancreatitis diagnosis and treatment center. According to the outcome, SAP patients were divided into survival group and nonsurvival group. One-way ANOVA or independent t-test was used to compare the clinical characteristics of two groups of patients. Multivariate retrospective analysis was used to identify risk factors for mortality in SAP patients. A total of 486 SAP patients were included in the study, and the 90-day mortality for SAP patients was 13.58%. The common etiologies of SAP are biliary tract diseases (69.75%) and hyperlipidemia (17.28%). The most common complications caused by SAP were organ failure (55.14%), ARDS (50.62%), AKI (30.45%), sepsis (27.16%), and abdominal fluid collection (27.57%). There were differences in age, complications, and medical intervention between the nonsurvival group and the survival group. The main causes of death were infection (46.97%), abdominal bleeding (28.79%), and organ failure (9.09%). The binary logistic regression analysis showed that there were significant differences in age, AKI, sepsis, abdominal hemorrhage, organ failure, laparotomy, creatinine, and APTT between the nonsurvival group and the survival group. Age, AKI, sepsis, abdominal hemorrhage, and organ failure are risk factors for mortality in SAP patients. SAP patients with high creatinine and prolonged APTT upon admission require doctors to be vigilant. The main cause of death in SAP patients is pancreatitis-related organ failure and secondary infection.

Investigation on the relationship between serum periostin, MMP-7, TGF-β, and IL-18 levels and the clinical course and prognosis of COVID-19.

Cytokines are involved in the inflammatory/anti-inflammatory balance and have been shown to play an important role in the course of COVID-19. This study aimed to evaluate the relationship of periostin, transforming growth factor-beta (TGF-β), interleukin-18 (IL-18), and matrix metalloproteinase 7 (MMP-7) levels with clinical course and mortality in patients with early COVID-19 pneumonia. A total of 150 hospitalized patients were diagnosed with COVID-19 between June and October 2021, and a control group of 30 healthy individuals were included in our study. The COVID-19 patients were divided into those who developed macrophage activation syndrome (MAS) in Group 1 and those who did not in Group 2. Serum periostin, MMP-7, TGF-β, and IL-18 levels were measured from blood samples obtained at admission using enzyme-linked immunosorbent assay (ELISA). Periostin, MMP-7, and IL-18 levels were significantly higher in COVID-19 patients compared to the control group (p<0.001 for all). Periostin and MMP-7 levels were also significantly higher in Group 1 than in Group 2 (p<0.001 for both). Periostin, MMP-7, IL-18, and TGF-β levels were significantly higher in non-surviving patients compared to survivors (p=0.04, p<0.001, p<0.001, and p<0.001, respectively). In the receiver operating characteristic (ROC) curve analysis, MMP-7 was found to have high sensitivity (90%) at a predictive value of 2.66 ng/mL. It is still not possible to predict which patients with early COVID-19 pneumonia will go on to develop MAS despite receiving standard treatment. The results of our study suggest that elevation of periostin and MMP-7 levels in the early period may predict the development of macrophage activation syndrome.

Lactate/Albumin Ratio as a Predictor of Mortality in Patients with Crimean-Congo Hemorrhagic Fever

Objective:This study aimed to determine the relationship of lactate/albumin (L/A) ratio with prognosis and fatality in CCHF patients. Materials and Methods: A total of 260 patients diagnosed with CCHF between January 2019 and December 2022, 36 of whom were deceased and 224 of whom were alive, were retrospectively included in the study. The findings of survivor and non-survivor patients were compared. Results: There was no significant difference between the groups in terms of age and gender. While albumin, glucose and platelet levels were quite low in the patient group who died due to CCHF (p

Meta-analysis of evaluating neuron specific enolase as a serum biomarker for sepsis-associated encephalopathy

IntroductionBrain dysfunction in sepsis is known as Sepsis-associated encephalopathy (SAE), which often results in severe cognitive and neurological sequelae and increases the risk of death. Neuron specific enolase (NSE) may serve as an important neurocritical biomarker for detection and longitudinal monitoring in SAE patients. Our Meta-analysis aimed to explore the diagnostic and prognostic value of serum NSE in SAE patients. Currently, no systematic Review and Meta-analysis have been assessed that NSE as a biomarker of SAE. MethodsThe study protocol was registered in the PROSPERO database (CRD42023398736) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We conducted a systematic review and Meta-analysis to evaluate the serum NSE’s diagnostic accuracy for SAE and prognostic strength for probability of death of septic patients. We systematic searched electronic bibliographic databases from PubMed, MEDLINE, Web of Science, Embase, Cochrane databases, CNKI, CQVIP, and WFSD. QUADAS-2 assessment tool was used to evaluate quality and risk of bias of the selected studies. Subgroup analyses, funnel plots, sensitivity analyses were also carried out. Review Manager version 5.4 and Stata16.0. was used for statistical analysis. ResultsThis Meta-analysis included 22 studies with 1361 serum samples from SAE patients and 1580 serum samples from no-encephalopathy septic (NE) patients. The Meta-analysis showed that individuals with SAE had higher serum NSE level than NE controls (SMD 1.93 (95 % CI 1.51–2.35), P < 0.00001). In addition, there are 948 serum samples from survival septic patients and 446 serum samples from non-survival septic patients, septic patients with survival outcomes had lower serum NSE levels than those with death outcomes (SMD −1.87 (95 % CI −2.43 to −1.32), P < 0.00001). ConclusionOur Meta-analysis reveals a significant association between elevated NSE concentrations and the increased likelihood of concomitant SAE and mortality during septic patients. This comprehensive analysis will equip ICU physicians with up-to-date insights to accurately identify patients at risk of SAE and implement appropriate intervention strategies to mitigate morbidity and improve neurological outcomes. However, it is important to note that the presence of substantial heterogeneity among studies poses challenges in determining the most effective discrimination cutoff values and optimal sampling collection time.

Persistent high sepsis-induced coagulopathy and sequential organ failure assessment scores can predict the 28-day mortality of patients with sepsis: A prospective study

BackgroundThe performance of the sepsis-induced coagulopathy (SIC) and sequential organ failure assessment (SOFA) scores in predicting the prognoses of patients with sepsis has been validated. This study aimed to investigate the time course of SIC and SOFA scores and their association with outcomes in patients with sepsis.MethodsThis prospective study enrolled 209 patients with sepsis admitted to the emergency department. The SIC and SOFA scores of the patients were assessed on days 1, 2, and 4. Patients were categorized into survivor or non-survivor groups based on their 28-day survival. We conducted a generalized estimating equation analysis to evaluate the time course of SIC and SOFA scores and the corresponding differences between the two groups. The predictive value of SIC and SOFA scores at different time points for sepsis prognosis was evaluated.ResultsIn the non-survivor group, SIC and SOFA scores gradually increased during the first 4 days (P < 0.05). In the survivor group, the SIC and SOFA scores on day 2 were significantly higher than those on day 1 (P < 0.05); however, they decreased on day 4, dropping below the levels observed on day 1 (P < 0.05). The non-survivors showed higher SIC scores on days 2 (P < 0.05) and 4 (P < 0.001) than the survivors, whereas no significant differences were found between the two groups on day 1 (P > 0.05). The performance of SIC scores on day 4 for predicting mortality was more accurate than that on day 2, with areas under the curve of 0.749 (95% confidence interval [CI]: 0.674–0.823), and 0.601 (95% CI: 0.524–0.679), respectively. The SIC scores demonstrated comparable predictive accuracy for 28-day mortality to the SOFA scores on days 2 and 4. Cox proportional hazards models indicated that SIC on day 4 (hazard ratio [HR] = 3.736; 95% CI: 2.025–6.891) was an independent risk factor for 28-day mortality.ConclusionsThe time course of SIC and SOFA scores differed between surviving and non-surviving patients with sepsis, and persistent high SIC and SOFA scores can predict 28-day mortality.

Adenosine Deaminase as a Potential Diagnostic and Prognostic Biomarker for Severe Fever with Thrombocytopenia Syndrome.

Severe fever with thrombocytopenia syndrome (SFTS) is a serious infectious disease caused by the Dabie bandavirus, with a high mortality rate. Currently, there are no effective vaccines or specific treatments for SFTS. Early diagnosis and accurate severity assessment are crucial. This study included 171 cases of SFTS, COVID-19, and hepatitis B virus (HBV) patients and healthy controls. We compared the serum adenosine deaminase (ADA) activity across these groups. The diagnostic and prognostic efficiency of serum ADA for SFTS was evaluated by using receiver operating characteristic (ROC) curve analysis. We also examined the correlation between serum ADA in SFTS patients and clinical lab parameters as well as serum cytokines. SFTS patients had significantly higher serum ADA activity than those of COVID-19, HBV patients, and healthy controls. Nonsurvivor SFTS patients had notably higher ADA than survivors. ROC analysis indicated ADA as an effective SFTS diagnostic and prognostic biomarker. ADA correlated with prognosis, viral load, APTT, PT, AST, ferritin, negatively with HDL-c and LDL-c, and positively with cytokines like IL-6, TNF-α, and IL-1β. Multiorgan failure patients showed significant ADA increase. Elevated serum ADA activity in SFTS patients is linked with disease severity and prognosis, showing potential as a diagnostic and prognostic biomarker for SFTS.

Prognostic value of right ventricular free wall strain in patients with sepsis.

Right ventricular systolic dysfunction (RVSD) in patients with sepsis is an area of growing interest, but its prognostic significance remains unclear and additional tools are needed to improve our understanding. Right ventricular free wall strain (RV-FWS) is a relatively new parameter to assess RV function. This study aimed to investigate the potential correlation between impaired RV-FWS and prognostic outcomes in patients with sepsis. We prospectively assessed right ventricular function in patients with sepsis within the initial 24 h of their hospital admission. RV-FWS, right ventricular global strain (RV-GS), fractional area change (FAC), and tricuspid annular plane systolic excursion (TAPSE) were examined. RVSD was defined as impaired RV-FWS. Moreover, the association between RVSD and 30-day mortality rate was assessed. This study included 89 patients. Among them, 27 (30.3%) succumbed to their illness within 30 days. The nonsurviving patients demonstrated significantly lower absolute RV-FWS (-19.7% ± 2.4% vs. -21.1% ± 2.1%, P = 0.008) and RV-GS (-17.7% ± 1.2% vs. -18.4% ± 1.4%, P = 0.032) values than the surviving patients. However, TAPSE and FAC values were not significantly different between the two groups. The optimal cutoff values for RV-FWS, RV-GS, FAC, and TAPSE were -19.0%, -17.9%, 36.5%, and 1.55 cm, respectively. Kaplan-Meier survival curves revealed that patients with impaired RV-FWS and RV-GS demonstrated lower 30-day survival rates, and the predictive performance of RV-FWS (hazard ratio [HR]: 3.97, 95% confidence interval [CI]: 1.85-8.51, P < 0.001) was slightly higher than FAC and TAPSE. However, multivariable Cox regression analysis revealed no association between impaired RV-FWS and mortality outcomes (HR: 1.85, 95% CI: 0.56-6.14, P = 0.316). Impaired RV-FWS is not associated with short-term mortality outcomes, and RV strain imaging is of limited value in assessing the prognosis of sepsis.

The Impact of Chemotherapy on Cardiovascular Mortality across Breast Cancer Subtypes.

This retrospective study used the SEER database of chemotherapy-receiving breast cancer patients (diagnosed in 2013-2020). The study population was categorized by cancer subtype, stage, patient age, and cause of death (COD). The percentage of cardiovascular CODs, odds ratio (ORs), 5-year cumulative crude probability of death, and standardized mortality ratios (SMRs) of each group were analyzed. Among 23,263 nonsurviving breast cancer patients, 5.8% died from cardiovascular disease, whereas the HER2+/HR+ and HER2+/HR- subtypes exhibited the highest ORs of cardiovascular death and percentages of cardiovascular CODs, at 8.21% and 6.55%, respectively. The cardiovascular SMR increased with advancing stages and decreasing patient age. The HER2+/HR- subtype had the highest cardiovascular SMR, at 0.83 (p < 0.05), followed by TNBC, at 0.78 (p < 0.05). The 5-year cumulative probability of cardiovascular CODs also showed the highest risk in the HER2+/HR- subtype (1.02 ± 0.11%) and the TNBC subtype (0.95 ± 0.07%). Breast cancer patients on chemotherapy face an elevated cardiovascular mortality risk, especially with aggressive subtypes (HER2-enriched, TNBC), advanced age, or HER2+/HR+ cancer receiving long-term treatment.

Artificial intelligence-derived risk score for mortality in secondary mitral regurgitation treated by transcatheter edge-to-edge repair: the EuroSMR risk score.

Risk stratification for mitral valve transcatheter edge-to-edge repair (M-TEER) is paramount in the decision-making process to appropriately select patients with severe secondary mitral regurgitation (SMR). This study sought to develop and validate an artificial intelligence-derived risk score (EuroSMR score) to predict 1-year outcomes (survival or survival + clinical improvement) in patients with SMR undergoing M-TEER. An artificial intelligence-derived risk score was developed from the EuroSMR cohort (4172 and 428 patients treated with M-TEER in the derivation and validation cohorts, respectively). The EuroSMR score was validated and compared with established risk models. The EuroSMR risk score, which is based on 18 clinical, echocardiographic, laboratory, and medication parameters, allowed for an improved discrimination of surviving and non-surviving patients (hazard ratio 4.3, 95% confidence interval 3.7-5.0; P < .001), and outperformed established risk scores in the validation cohort. Prediction for 1-year mortality (area under the curve: 0.789, 95% confidence interval 0.737-0.842) ranged from <5% to >70%, including the identification of an extreme-risk population (2.6% of the entire cohort), which had a very high probability for not surviving beyond 1 year (hazard ratio 6.5, 95% confidence interval 3.0-14; P < .001). The top 5% of patients with the highest EuroSMR risk scores showed event rates of 72.7% for mortality and 83.2% for mortality or lack of clinical improvement at 1-year follow-up. The EuroSMR risk score may allow for improved prognostication in heart failure patients with severe SMR, who are considered for a M-TEER procedure. The score is expected to facilitate the shared decision-making process with heart team members and patients.

Novel Oxygenation and Saturation Indices for Mortality Prediction in COVID-19 ARDS Patients: The Impact of Driving Pressure and Mechanical Power.

Background: The oxygenation index (OI) and oxygen saturation index (OSI) are proven mortality predictors in pediatric and adult patients, traditionally using mean airway pressure (Pmean). We introduce novel indices, replacing Pmean with DP (ΔPinsp), MPdyn, and MPtot, assessing their potential for predicting COVID-19 acute respiratory distress syndrome (ARDS) mortality, comparing them to traditional indices. Methods: We studied 361 adult COVID-19 ARDS patients for 7 days, collecting ΔPinsp, MPdyn, and MPtot, OI-ΔPinsp, OI-MPdyn, OI-MPtot, OSI-ΔPinsp, OSI-MPdyn, and OSI-MPtot. We compared these in surviving and non-surviving patients over the first 7 intensive care unit (ICU) days using Mann-Whitney U test. Logistic regression receiver operating characteristic (ROC) analysis assessed AUC and CI values for ICU mortality on day three. We determined cut-off values using Youden's method and conducted multivariate Cox regression on parameter limits. Results: All indices showed significant differences between surviving and non-surviving patients on the third day of ICU care. The AUC values of OI-ΔPinsp were significantly higher than those of P/F and OI-Pmean (P values .0002 and <.0001, respectively). Similarly, AUC and CI values of OSI-ΔPinsp and OSI-MPdyn were significantly higher than those of SpO2/FiO2 and OSI-Pmean values (OSI-ΔPinsp: P < .0001, OSI-MPdyn: P values .047 and .028, respectively). OI-ΔPinsp, OSI-ΔPinsp, OI-MPdyn, OSI-MPdyn, OI-MPtot, and OSI-MPtot had AUC values of 0.72, 0.71, 0.69, 0.68, 0.66, and 0.64, respectively, with cut-off values associated with hazard ratios and P values of 7.06 (HR = 1.84, P = .002), 8.04 (HR = 2.00, P ≤ .0001), 7.12 (HR = 1.68, P = .001), 5.76 (HR = 1.70, P ≤ .0001), 10.43 (HR = 1.52, P = .006), and 10.68 (HR = 1.66, P = .001), respectively. Conclusions: Critical values of all indices were associated to higher ICU mortality rates and extended mechanical ventilation durations. The OI-ΔPinsp, OSI-ΔPinsp, and OSI-MPdyn indices displayed the strongest predictive capabilities for ICU mortality. These novel indices offer valuable insights for intensivists in the clinical management and decision-making process for ARDS patients.

A Thorough Study and Meta-Analysis of The Prognostic Relevance of the C-Reactive Protein-Albumin Ratio in Acute Pancreatitis

Background: Although most cases of acute pancreatitis (AP) are minor, severe cases are associated with a substantial risk of death. Acute pancreatitis (AP) is a common illness. Therefore, it is critical to assess AP severity as soon as possible. This review aimed to ascertain the predictive significance of the CRP to albumin ratio in individuals with AP. Methods: We searched PubMed, Science Direct, and Cochrane Library electronic databases Until January 2023. Studies that reported the CRP/alb ratio at admission and its relationship to the severity or death of patients with AP were included. Using a random-effects model, we computed the pooled mean difference (MD) and 95% confidence interval (CI). The quality of the included studies was evaluated using the Newcastle-Ottawa scale. Results: This meta-analysis combined data from six trials with a total of 2244 patients. Upon admission, the CRP/alb ratio was higher in patients with severe AP than in those with mild to moderate AP (pooled MD:3.59; 95% CI:2.51- 4.68; p&lt;0.00001). Additionally, non-survivor AP patients had a substantially higher CRP/alb ratio than survivor AP patients (pooled MD:2.12; 95% CI:0.43-3.8; p &lt; 0.01). In conclusion, individuals with AP may benefit from a high CRP/ALB ratio as a preliminary indicator of poor prognosis.