Potential Risk Factors For Mortality Research Articles

Taking ACTION: A Prognostic Tool for Pediatric Ventricular Assist Device Mortality.

We sought to develop a contemporary risk assessment tool for use in pediatric ventricular assist device (VAD) candidates to estimate risk for mortality on the device using readily available preimplantation clinical data. Training and testing datasets were created from Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry data on patients supported with a VAD from 2012 to 2021. Potential risk factors for mortality were assessed and incorporated into a simplified risk prediction model utilizing an open-source, gradient-boosted decision tree machine learning library, known as random forest. Predictive performance was assessed by the area under the receiver operating characteristic curve in the testing dataset. Nine significant risk factors were included in the final predictive model which demonstrated excellent discrimination with an area under the curve of 0.95. In addition to providing a framework for establishing pediatric-specific risk profiles, our model can help inform team expectations, guide optimal patient selection, and ultimately improve patient outcomes.

Preliminary study on the predictive value of the vasoactive-inotropic score for the prognosis of neonatal congenital diaphragmatic hernia

BackgroundNo study has reported on the relationship between the vasoactive-inotropic score (VIS) and the prognosis of neonates with a severe congenital diaphragmatic hernia (CDH). This study aimed to identify potential risk factors for mortality in patients with CDH. We calculated the VIS based on the vasoactive drugs used during the perioperative period to investigate the relationship between VIS and infant prognosis.MethodsWe retrospectively analyzed the clinical data of 75 neonates with CDH who were treated at our center between January 2016 and October 2021. We calculated the maximum and mean VIS during the first 24 h of hospitalization (hosVIS [24max] and hosVIS [24mean], respectively) and after surgery (postVIS [24max] and postVIS [24mean], respectively). The relationship between the VIS and the prognosis of neonates with CDH was analyzed using a receiver operating characteristic (ROC) curve, t-test, chi-square test, rank-sum test, and logistic regression analysis.ResultsIn total, 75 participants with CDH were included in the study. The chance of survival was 80%. Our results showed that hosVIS (24max) was an accurate predictor of prognosis (area under the ROC curve = 0.925, p = 0.007). The calculated optimal critical value of hosVIS (24max) for predicting a poor prognosis was 17 (J = 0.75). Multivariate analysis revealed that hosVIS (24max) was an independent risk factor for death in neonates with CDH.ConclusionIn neonates with CDH, a higher VIS, especially hosVIS (24max), suggests worsened cardiac function, a more severe condition, and a higher risk of death. The rising VIS score in infants prompts physicians to implement more aggressive treatment to improve cardiovascular function.

Intradural Extramedullary Pyogenic Abscess: Incidence, Management, and Clinical Outcomes in 45 Patients With a Mean Follow Up of 2 Years.

Retrospective review. Spinal intradural extramedullary abscess (SIEA) is a rare disease with an unknown incidence. In this study, we systematically described the clinical course of SIEA in a large cohort with acute onset of neurological illness, assessed the morbidity and mortality rates, and determined the potential risk factors for mortality. Electronic medical records of patients diagnosed with SIEA at a single institution for the period between September 2005 and December 2020 were retrieved. Over a period of 15years, 881 patients with spinal infections were treated either conservatively or surgically at our center, of whom 45 patients (45/881, 5.1%) had SIEA. The overall mean age was 69.6 ± 5.6years of patients diagnosed with SIEA and all of them underwent posterior decompression via laminectomy. The mean Charlson Comorbidity Index (CCI) was 6.9 ± 2.5, indicating a poor baseline reserve. Progressive neurological decline was observed in all patients (mean motor score, 88.6 ± 9.7). The in-hospital rate and 90-day mortality were 4.4% and 10%, respectively. Mortality was not surgery related. Most importantly, the patients' motor deficits and blood infection parameters significantly improved after surgery. Risk factors for mortality were increased age, comorbidities as measured by CCI, and preoperative motor weakness (MS). Immediate surgical decompression via laminectomy, with antiseptic irrigation and drainage of the subdural space, followed by antibiotic therapy, appears to be the key to ensuring beneficial clinical outcomes to treatment of rare diseases such as SIEA.

ECMO Support in Refractory Cardiogenic Shock: Risk Factors for Mortality.

Veno-arterial extracorporeal membrane oxygenation (va-ECMO) is a specialized temporary support for patients with refractory cardiogenic shock. The true value of this potentially lifesaving modality is still a subject of debate. Therefore, we aimed to investigate the overall in-hospital mortality and identify potential risk factors for mortality. We retrospectively analyzed the data of 453 patients supported with va-ECMO over a period of 14 years who were admitted to intensive care units of a tertiary university center in Austria. We observed in-hospital mortality of 40% for patients with refractory cardiogenic shock. Hemorrhage, ECMO initiation on weekends, higher SAPS III score, and sepsis were identified as significant risk factors for mortality. Hemorrhage was the most common adverse event (46%), with major bleeding events dominating in deceased patients. Thromboembolic events occurred in 25% of patients, followed by sepsis (18%). Although the rates of complications are substantial, a well-selected proportion of patients with refractory cardiogenic shock can be rescued from probable death. The reported risk factors could be used to increase the awareness of clinicians towards the development of new therapeutic concepts that may reduce their incidence.

Abstract 9882: Mortality Risk Factors Among Takotsubo Syndrome Patients In The United States; Insight From The National Inpatient Sample

Introduction: Takotsubo cardiomyopathy, also known as Takotsubo syndrome and Broken heart syndrome, is a temporary cardiovascular abnormality affecting the apical region primarily. While most cases are believed to affect post-menopausal women, we sought to address the potential risk factors for mortality in the United States. Method: Our retrospective study included patients with a principal diagnosis of Takotsubo Syndrome (ICD-10 code “I51. 81”) from the 2019 National Inpatient Sample (NIS). We searched and compared various variables and risk factors for in-hospital death via their appropriate ICD-10 codes. The Multivariable analysis allowed us to identify and adjust possible risk factors for mortality. Finally, the mean age, mean length of stay(LOS), and mean charges were also calculated. Results: In 2019, there were 8920 cases of Takotsubo syndrome requiring hospitalization.140 patients died (1.57%). Females (aOR 0.499, 95% CI: 0.320-0.779, p<0.01) were less likely to die compared to males, while those with diabetes (aoR: 3.087, 95% CI: 2.140-4.454, p<0.01), hypertension (aOR: 1.716, 95% CI: 1.118-4.454, p=0.013), and chronic pulmonary disease (aOR: 1.545, 95% CI: 1.063-2.246, p=0.023) were risk factors for in-hospital mortality. Moreover, patients dying were older (mean age 75.54 vs. 67.11), had a prolonged (LOS 6.11 days vs. 3.56 days), and costlier (mean charge $132,421.97vs. $54,792.96) stay. Conclusions: While Takotsubo affected more females than males, males showed a higher mortality risk. Additional risk factors included diabetes, hypertension, and chronic pulmonary disease.

Abstract 9885: Possible Risk Factors of In-Hospital Death Among Acute Ischemic Stroke Patients With Atrial Septal Defect; A Study From the 2019 National Inpatient Sample

Introduction: Atrial septal defect (ASD) is one of the most common congenital cardiac defects. It can also allow paradoxical emboli to move into the cerebral vasculature leading to Acute Ischemic Stroke (AIS). As there is a lack of adequate information on the additional risk factors for mortality in ASD patients following AIS, we queried the largest inpatient database in the United States for answers. Methods: Patients with ASD were identified among patients of ages 25 and more admitted with a principal diagnosis of AIS ICD-10 code (I63.x) in 2019 from the National Inpatient Sample(NIS). Various patient characteristics and procedures were also studied. A Multivariate regression model adjusting for several factors allowed our study to further evaluate potential risk factors for mortality among ASD patients. Results: Our study found 551,385 cases of AIS, amongst which 19,670 (3.6%) also had a diagnosis of ASD. ASD patients had a higher risk of requiring mechanical thrombectomy (aOR 1.239, 95% CI 1.167- 1.316, p<0.01) and intravenous tissue plasminogen activator (IV tPA) (aOR 1.177, 95% CI 1.125-1.230, p<0.01). Unfortunately, 1.5% (295 cases) of patients with ASD died. A higher risk of mortality among ASD patients was seen if they had also undergone mechanical thrombectomy (aOR 2.839, 95% CI 2.033-3.936), while a lower risk of mortality was seen among those ages 25-60 (aOR 0.695, 95% CI 0.540-0.894, p<0.01) compared to those above 60, among those who underwent tPA (aOR 0.485, 95% CI 0.306-0.769, p<0.01), smokers (aOR 0.550, 95% CI 0.423-0.715), and those with hyperlipidemia (aOR 0.374, 95% CI 0.290-0.482, p<0.01). A lower overall mortality risk among ASD patients following AIS (1.5% vs 3.8%) was also seen (aOR 0.393, 95% CI 0.349-0.441, p<0.01). Conclusions: While several studies have shown that ASD predisposes to a higher risk of developing AIS, our study found that the risk of mortality among ASD patients following admission for AIS was lower than non-ASD patients. However, mechanical thrombectomy was associated with a higher risk of death among these patients. Further studies to understand the associated reasons, pathways, and methods to improve their outcomes should thus be encouraged.

Nomogram Analysis of Clinical Characteristics and Mortality Risk Factor of Non-Fermentative Gram-Negative Bacteria-Induced Post-Neurosurgical Meningitis.

To explore the clinical characteristics of post-neurosurgical meningitis (PNM) patients infected with nonfermenting Gram-negative bacilli (NFGNB) and to evaluate the related mortality risk factors. A cohort analysis of PNM patients infected with NFGNB in Beijing Tiantan Hospital and Capital Medical University from 2012.1 to 2020.12. The microbial distribution, antimicrobial sensitivity and genotypes were tested, and potential mortality risk factors were evaluated using Mann-Whitney U or chi-squared tests. Independent risk factors for mortality were established by constructing a logistic model. A total of 2940 PNM patients were enrolled in this study, of whom 207 (17.1%) were infected with NFGNB. Among these patients, 29 died of NFGNB meningitis, with an overall mortality rate of 14.0%. The top three NFGNBs were Acinetobacter baumannii (105 cases, 50.7%), Pseudomonas aeruginosa (29 cases, 14.0%) and Acinetobacter lwoffii (20 cases, 9.7%). Nomogram analysis revealed that hypertension (OR 4.551, 95% CI: 1.464-14.154, P = 0.009), external ventricular drainage (EVD) (OR 3.944, 95% CI: 1.286-12.095, P = 0.016), and assisted mechanical ventilator (AMV) (OR 6.192, 95% CI: 1.737-22.081, P = 0.005) were independent risk factors for mortality. In addition, antibiotic prophylaxis was shown to play a vital role in NFGNB-induced PNM therapy. PNM patients infected with NFGNB have a high mortality rate. Hypertension, EVD and AMV were independent mortality risk factors, and clinical attention should be paid to their prevention and treatment.

Patients with heat-related illness admitted to an intensive care unit in Hong Kong: A single-centre retrospective study (2009–2020)

Introduction: In Hong Kong, heat-related illness (HRI) represents an important cause of morbidity and mortality among healthy adults engaging in outdoor activities during summer. It can result in intensive care unit (ICU) admission. This retrospective study aimed to profile critically ill patients with HRI and identify potential risk factors for mortality. Methods: This retrospective case series included adults with HRI from 1 January 2009 to 30 June 2020 admitted to the ICU of Pamela Youde Nethersole Eastern Hospital (PYNEH). Demographics, admission severity, co-morbidities, and laboratory investigations were analysed. Outcome data studied included mortality, ICU length of stay (LOS), ventilator days, and hospital LOS. Results: Among the 38 individuals included, 97% were hikers. About 92.1% of patients survived, while 7.9% expired. The median age of the patients was 48 years, and 78.9% were men. Hypertension was the most frequent concurrent disorder. Most cases were presented during the hot summer months of May (29%), July (24%) and August (18%). The localities’ median peak temperature and humidity were 33.2°C and 88%, respectively. Ninety-two percent of patients were airlifted to the hospital by helicopters. The median peak body temperature was 40.3°C. Central nervous system derangement (Glasgow Coma Scale (GCS) score ⩽ 8) was the top presenting feature (65.7%). About 57.9% of patients required vasopressor support, followed by mechanical ventilation (50%) and renal replacement therapy (31.6%). Conclusions: Most critically ill patients suffering from HRI were hikers and middle-aged adults. Mortality was 7.9% despite advanced life support in ICU. Raising public awareness of the associated risk with hiking in hot summer is essential for the prevention of HRI.

The role of MPV/albumin ratio in determining disease severity in acute cholangitis in the emergency medicine

Background: We aimed to examine the relationship of mean platelet volume (MPV) / albumin ratio (MAR) with disease and disease severity in patients with acute cholangitis. Material and Method: Cases older than 18 years of age, who applied to the emergency department and were diagnosed with acute cholangitis after detailed evaluation were included in the study.Tokyo 2018 criteria are used to determine the severity of acute cholangitis. Result: There was a positive correlation between MAR levels and Tokyo severity,and increased MAR levels were determined as an independent predictor for each risk group.The cut-off value of the MAR level in predicting moderate risk compared to the mild risk group was found to be >20.9% with 73.3% sensitivity and 70.6% specificity (AUC±SE=0.785±0.03; +PV= 51.3%, -PV= 86.2%; p< 0.001). The cut-off value of the MAR level in predicting severe risk compared to the moderate risk group was found to be >23.2% with 77.2% sensitivity and 59.1% specificity (AUC±SE=0.744±0.03; +PV= 64.5%, -PV= 72.9%; p<0.001).Mean MAR levels were found to be higher in patients admitted to the ICU compared to those who were not admitted (25.2±6.0 vs 21.3±4.6; p<0.001) and increased MAR levels were a potential risk factor for mortality (HR= 1.09; p<0.001). Conclusion: We found that the MAR level is a very good marker in determining the severity of acute cholangitis.

Risk factors for the prognosis of patients with sepsis in intensive care units.

To date, sepsis remains the main cause of mortality in intensive care units (ICU). This study aimed analyze the risk factors of the prognosis in sepsis patients. In this case-control study, patients with sepsis admitted to the intensive care unit of a Chinese hospital between January and November 2020 were analyzed. Ultrasound and clinical data were analyzed and compared between non-survivors and survivors. The ROC curve analysis was also performed to determine the best indicator for predicting mortality. A total of 72 patients with sepsis in ICU were included for analysis. The basic characteristics between the survivals and non-survivals were similar, except for acute physiology and chronic health evaluation (APACHE) Ⅱ score, sepsis-related organ failure assessment (SOFA) score, lactate level, ultrasound parameters from superior mesenteric artery (SMA) such as peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI). Univariate analysis revealed that the APACHE Ⅱ score, SOFA score, lactate, low PSV, EDV, and RI were potential risk factors for mortality in sepsis, while multivariate analysis suggested that low PSV was an independent risk factor for mortality, and the adjusted odds ratio was 0.295 (95% CI: 0.094-0.925). The ROC analysis showed that the PSV (AUC = 0.99; sensitivity and specificity were 0.99 and 0.96, respectively) had good predictive value for mortality in sepsis. Low PSV as found to be an independent risk factor and good predictor for mortality in patients with sepsis. This study shows the promise of ultrasound in predicting mortality in patients with sepsis; however, further studies are needed to validate these results.

COVID-19 Infection in Hemodialysis Patients, Incidence, Risk Factors and Mortality. Single Centre Study

Background: Hemodialysis patients are not only prone to acquire COVID-19 infection but also more likely to suffer a higher rate of morbidity and mortality. This study aims to report the incidence and mortality rate of COVID-19 infection in our hemodialysis patients and to determine risk factors. Methods: This is an observational, retrospective study conducted in the dialysis unit of Dubai Hospital. Our target population was hemodialysis patients who tested positive for COVID infection (PCR assay of the nasopharyngeal swab) from 1st April 2020 to 31st August 2021. Our primary outcome was to study the mortality rate associated with COVID-19 infection in dialysis patients in Dubai hospital. Our secondary objectives were to study the incidence and determine risk factors for the severity of infection. Patient demographics and clinical features were collected from medical record software, i.e., EPIC. Univariate Cox regression analysis was performed to evaluate potential risk factors for mortality in our cohort. Results: 72 out of 250 (28.8%) hemodialysis patients acquired COVID infection during the study period, the median age was 54.32 (15-93) years, and 56.94% (n=41) were male. The most common comorbid was hypertension (59.72%), while the main symptom at presentation was shortness of breath (25%). One-third of patients required a different form of oxygen therapy, and 11.11% of patients were mechanically ventilated. The mortality rate was 16.6%. High median age, ischemic heart disease, low absolute lymphocyte count, and high levels of ferritin, LDH, and procalcitonin, as well as mechanical ventilation, were statistically significant risk factors associated with mortality. Conclusion: The overall outcome of COVID infection in our hemodialysis patients was better compared to the hemodialysis population from other parts of the world.

Identification of risk factors for 1-year mortality among critically ill older adults with hip fractures surgery: A single medical center retrospective study.

AimThe purpose of this study was to analyze the potential risk factors for mortality 1 year after hip fracture surgery in critically ill older adults.MethodsWe reviewed 591 critically ill older adults who underwent hip surgery at our institution from January 2018 to April 2021. We collected baseline demographics, clinical information, and 1-year survival status of the sample patients by means of medical record systems and follow-up phone calls. Patients were divided into survival and mortality groups based on survival within 1 year after surgery.ResultsBased on the results of the 1-year postoperative follow-up of patients, we obtained 117 cases in the death group and 474 cases in the survival group, and this led to a 1-year mortality rate of 19.8% (117/591) after hip fracture in critically ill older adults at our hospital. The risk factors that influenced the 1-year postoperative mortality were identified as advanced age (HR:1.04, 95%, 1.01–1.06), preoperative arrhythmia (HR: 1.95, 95%, 1.26–2.70), high level of NLR (HR:1.03, 95%, 1.01–1.06), respiratory failure (HR: 2.63, 95%, 1.32–5.23), and acute cardiovascular failure. 5.23) and acute cardiovascular events (HR: 1.65, 95%, 1.05–2.59).ConclusionAdvanced age, preoperative arrhythmias, high levels of NLR, postoperative respiratory failure, and acute cardiovascular events were independent risk factors for survival of critically ill older adults with hip fracture at 1 year after surgery. Therefore, laboratory tests such as high levels of preoperative NLR can be an important indicator of patient prognosis.

Development and validation of a nomogram for predicting overall survival in cirrhotic patients with acute kidney injury.

BACKGROUNDAcute kidney injury (AKI) is a common and severe complication in patients with cirrhosis, and is associated with poor prognosis. Therefore, identifying cirrhotic patients with AKI who are at high risk of mortality is very important and may be helpful for providing timely medical interventions to improve the prognosis of these patients. However, studies focused on investigating the risk factors for the mortality of cirrhotic patients with AKI were scarce.AIMTo identify risk factors for mortality and establish a nomogram for predicting the prognosis of these patients.METHODSTwo hundred fifty consecutive patients with cirrhosis and AKI were recruited and randomly divided into training cohort (n = 173) and validation cohort (n = 77). In the training cohort, potential risk factors for death were identified by performing a Cox regression analysis, and a nomogram was established. The predictive performance of the nomogram was internally and externally validated by calculating the area under the receiver operating characteristic curve (AUROC), constructing a calibration curve and performing decision curve analysis.RESULTSThe serum sodium level, international normalized ratio, peak serum creatinine level > 1.5 mg/dL, the presence of hepatic encephalopathy and diabetes were potential risk factors for mortality of cirrhotic patients with AKI in the training dataset. A prognostic nomogram incorporating these variables was established for predicting the overall survival of these patients. Compared with Child-Turcotte-Pugh, the model for end-stage liver disease (MELD) and the MELD-Na scores, the nomogram in predicting 90- and 180-d mortality exhibited better discriminatory power with AUROCs of 0.792 and 0.801 for the training dataset and 0.817 and 0.862 for the validation dataset, respectively. With a nomogram score of 98, patients were divided into low- and high-risk groups, and high-risk patients had a higher mortality rate.CONCLUSIONA prognostic nomogram displayed good performance for predicting the overall survival of cirrhotic patients with AKI, and will assist clinicians in evaluating the prognosis of these patients.

Risk factors for mortality among hospitalized COVID-19 patients in Northern Ethiopia: A retrospective analysis.

BackgroundCOVID-19 is a deadly pandemic caused by an RNA virus that belongs to the family of CORONA virus. To counter the COVID-19 pandemic in resource limited settings, it is essential to identify the risk factors of COVID-19 mortality. This study was conducted to identify the social and clinical determinants of mortality in COVID-19 patients hospitalized in four treatment centers of Tigray, Northern Ethiopia.MethodsWe reviewed data from 6,637 COVID-19 positive cases that were reported from May 7, 2020 to October 28, 2020. Among these, 925 were admitted to the treatment centers because of their severity and retrospectively analyzed. The data were entered into STATA 16 version for analysis. The descriptive analysis such as median, interquartile range, frequency distribution and percentage were used. Binary logistic regression model was fitted to identify the potential risk factors of mortality of COVID-19 patients. The adjusted odds ratio (AOR) with 95% confidence interval was used to determine the magnitude of the association between the outcome and predictor variables.ResultsThe median age of the patients was 30 years (IQR, 25–44) and about 70% were male patients. The patients in the non-survivor group were much older than those in the survivor group (median 57.5 years versus 30 years, p-value < 0.001). The overall case fatality rate was 6.1% (95% CI: 4.5% - 7.6%) and was increased to 40.3% (95% CI: 32.2% - 48.4%) among patients with critical and severe illness. The proportions of severe and critical illness in the non-survivor group were significantly higher than those in the survivor group (19.6% versus 5.1% for severe illness and 80.4% versus 4.5% for critical illness, all p-value < 0.001). One or more pre-existing comorbidities were present in 12.5% of the patients: cardiovascular diseases (42.2%), diabetes mellitus (25.0%) and respiratory diseases (16.4%) being the most common comorbidities. The comorbidity rate in the non-survivor group (44.6%) was higher than in the survivor group (10.5%). The results from the multivariable binary regression showed that the odds of mortality was higher for patients who had cardiovascular diseases (AOR = 2.49, 95% CI: 1.03–6.03), shortness of breath (AOR = 9.71, 95% CI: 4.73–19.93) and body weakness (AOR = 3.04, 95% CI: 1.50–6.18). Moreover, the estimated odds of mortality significantly increased with patient’s age.ConclusionsAge, cardiovascular diseases, shortness of breath and body weakness were the predictors for mortality of COVID-19 patients. Knowledge of these could lead to better identification of high risk COVID-19 patients and thus allow prioritization to prevent mortality.

Bacterial etiology and mortality rate in community-acquired pneumonia, healthcare-associated pneumonia and hospital-acquired pneumonia in Thai university hospital

Pneumonia is caused by infection at the pulmonary parenchyma which constitutes a crucial risk factor for morbidity and mortality. We aimed to determine the mortality rate and its risk factors as well as etiology among inpatients with community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and healthcare-associated pneumonia (HCAP). A hospital-based retrospective cohort study was conducted in a university hospital located in Bangkok, Thailand. A total of 250 inpatients with pneumonia was included in the present study. The inhospital mortality rate was 1.25 (95% CI 0.99–1.56) per 100 person-days. The present study reported that overall pneumonia caused by gram-negative pathogens accounted for 60.5%. P. aeruginosa was a frequent gram-negative pathogen among these participants, especially among patients with HCAP and HAP. Adjusted hazard ratio (AHR) of inhospital mortality among patients with HAP was 1.75 (95% CI 1.01–3.03) times that of those among patients with CAP, while AHR for 28-day mortality among patients with HAP compared with those with CAP was 2.81 (95% CI 1.38–5.75). Individual risks factors including cardiomyopathy, active-smoker and insulin use were potential risk factors for mortality. Initial qSOFA and acid-based disturbance should be assessed to improve proper management and outcomes.

MO326: Factors Influencing Death Rate in COVID-19-Associated Acute Kidney Injury

BACKGROUND AND AIMSDuring a 2-year pandemic, COVID-19 proved to be a condition with a high potential to affect various organs other than the lungs. Acute kidney injury (AKI) in hospitalized COVID-19 patients is associated with a poor prognosis. The aim of this study was to identify factors influencing in-hospital mortality.METHODIn a retrospective analysis, we included 268 adult patients with RT-PCR-confirmed SARS-CoV-2 infection and AKI admitted to two Emergency University Hospitals during a 6-month period, between 1 November 2020 and 30 April 2021. Data were retrieved from the electronic databases of the two hospitals. We analysed kidney and patient outcomes at discharge and the potential risk factors for mortality in AKI patients. We defined and staged AKI according to KDIGO 2012 creatinine criteria.RESULTSIn our cohort the mean age was 72.28 years, 169 (63%) patients were men, and 111 (41.4%) had previously known chronic kidney disease. 81 patients were classified as having stage 1 AKI, 79 patients had stage 2 AKI and 108 had stage 3 AKI. A total of 135 (50.37%) patients died during hospitalization.Statistic analysis using the Mann–Whitney U-test revealed significant differences (P < .01) between survivors and non-survivors regarding peak values of serum urea (137.9 versus 190.9 mg/dL), creatinine (2.88 versus 3.94 mg/dL), procalcitonin (3.56 versus 15.86 ng/mL), C-reactive protein (92.32 versus 176.09 mg/L), interleukin-6 (243 versus 9552 pg/mL), ferritin (1331 versus 5189 ng/ml) and d-dimers (3.68 versus 6.88 mcg/ml). No significant differences were found between survivors and non-survivors regarding peak values of erythrocyte sedimentation rate (69 versus 71 mm/1 h; P = .35) and fibrinogen (629 versus 645 mg/dL; P = .24) and also regarding the lowest lymphocyte count during hospitalization (519 versus 649/mmc; P = .80).The analysis using Fisher’s exact test showed that deceased patients were significantly more associated with AKI KDIGO stage 2 or 3 (51.9%/63% versus 32.1%), with higher need for renal replacement theraphy (RRT) (68.8% versus 47.9%), with ICU (intensive care unit) admission (90.1% versus 22.3%) (Table 1). Moreover, death was associated more frequently with partial or absent renal function recovery (20%/50% versus 6.4%) (P < .05) (Table 1).In a logistic regression model (using KDIGO stages, serum urea and need for RRT), it was proved that only serum urea had a significant prediction power (P = .001): every increase of serum urea with 1 unit increases the risk of death by 1.007 times (95% confidence interval 1.003–1.011).CONCLUSIONMortality of COVID-19 patients associating AKI is proportionally augmented by both markers of severity of SarS-CoV-2 and also by severity of AKI. In our study, the peak value of serum urea during hospitalization was the best predictor for death in COVID-19.

Risk Factors of Mortality from Foreign Bodies in the Respiratory Tract: The Japan Collaborative Cohort Study.

Objective This study assessed the risk factors of mortality from foreign bodies in the respiratory tract using the Japan Collaborative Cohort Study for the Evaluation of Cancer Risk data. Methods Data of 110,585 participants 40-79 years old living in 45 areas in Japan were collected between 1988 and 2009. Mortality from foreign bodies in the respiratory tract was assessed in a multivariable-adjusted analysis using a Cox proportional hazard regression model. Results Among all participants, 202 deaths occurred from foreign bodies in the respiratory tract. In the multivariable-adjusted model, older age [50-59 (hazard ratio, 4.93; 95% confidence interval, 1.91-12.74), 60-69 (hazard ratio, 14.96, 6.01-37.25) and 70-79 (hazard ratio, 53.81; 95% confidence interval, 21.44-135.02) years old compared to 40-49 years old], male sex (hazard ratio, 2.34; 95% confidence interval, 1.54-3.54), a history of apoplexy (hazard ratio, 7.04; 95% confidence interval, 4.24-11.67) and the absence of a spouse (hazard ratio, 1.56; 95% confidence interval, 1.05-2.32) were associated with an increased risk of mortality from foreign bodies in the respiratory tract. Conclusions Older age, male sex, medical history of apoplexy and the absence of a spouse were potential risk factors of mortality from foreign bodies in the respiratory tract. Especially in elderly men, social connections, such as cohabitation or relationships, may be important for ensuring the early detection of asphyxia and preventing death due to foreign bodies in the respiratory tract.

Lower Urinary Tract Symptoms and Mortality among Finnish Men: The Roles of Symptom Severity and Bother.

The utility of male lower urinary tract symptoms (LUTS) as mortality risk factors remains unclear. We explored LUTS-associated mortality among Finnish men, evaluating the association of symptom severity and bother with risk of death. A questionnaire including the Danish Prostatic Symptom Score was mailed to a population-based cohort of 3,143 men aged 50, 60 and 70 years in 1994, with repeat surveys in 1999, 2004, 2009 and 2015. The men were followed until the end of 2018. Mortality associated with LUTS was analyzed using time-dependent Cox regression adjusted for age and comorbidity, updating symptom data every 5 years, including interaction terms between symptoms and associated bother. Of the 1,167 men in the analysis, 591 (50.6%) died during the 24-year followup. In analyses of moderate and severe symptoms disregarding bother, overall voiding and storage LUTS, daytime frequency and urgency incontinence were associated with increased mortality: the multivariable-adjusted hazard ratios were 1.19 (95% CI 1.00-1.40), 1.35 (1.13-1.62), 1.31 (1.09-1.58) and 2.19 (1.42-3.37), respectively. In analyses disregarding symptom severity and bother, voiding LUTS were associated with decreased mortality, while daytime frequency and nocturia were associated with increased mortality: the HRs were 0.82 (95% CI 0.67-1.00), 1.31 (95% CI 1.09-1.58) and 1.52 (95% CI 1.21-1.91), respectively. Excess mortality associated with bothersome daytime frequency and nocturia tended to be slightly higher: the HRs were 1.86 (95% CI 1.41-2.47) and 1.88 (95% CI 1.38-2.58), respectively. No significant interactions were found between symptoms and associated bother, however. Moderate and severe LUTS are potential risk factors for mortality, independently of their bother.

Potential risk factors for mortality in patients with COVID-19: A retrospective study

Potential risk factors for mortality in patients with COVID-19: A retrospective study

Risk Factors for Mortality in Anti-NMDAR, Anti-LGI1, and Anti-GABABR Encephalitis.

ObjectiveWe aimed to investigate the mortality rate and identify the predictors of death in patients with anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis.MethodsPatients with anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis were recruited from the Neurology Department of the First Hospital of Jilin University from March 2015 to November 2021. The primary outcome variable was a binary variable of death vs. survival. The potential risk factors for mortality were evaluated. The mortality rates were determined, and the independent predictors of death were identified using multivariable logistic regression analysis.ResultsA total of 100 hospitalized patients with anti-NMDAR, anti-LGI1, or anti-GABABR encephalitis were included in the final analysis. Fifteen patients (15%) died during a median follow-up period of 18 months. The mortality rates were 10% for anti-NMDAR encephalitis, 2.8% for anti-LGI1 encephalitis, and 41.7% for anti-GABABR encephalitis. The multivariable analysis results showed that older age at onset [adjusted odds ratio (OR) = 1.017, 95% confidence interval (CI) = 1.009–1.136; p = 0.023] was independently associated with an increased risk of death. Antibody type was also associated with mortality. Patients with anti-GABABR encephalitis had 13.458-fold greater odds of dying than patients with anti-LGI1 encephalitis (adjusted OR = 13.458, 95% CI = 1.270–142.631; p = 0.031).ConclusionThe general mortality rate of anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis was 15%. Age at onset and type of autoimmune encephalitis antibody were independent predictors of death in these patients.