Potential Risk Factors For Death Research Articles

Influence of age factor and age-associated predictors on remote results of coronary artery bypass grafting

This study was undertaken to analyse long-term survival and its predictors, depending on age of patients who underwent isolated coronary aortic bypass grafting. Our study included a total of 177 consecutive patients operated on during 2014. For the purpose of statistical analysis, the patients were divided into two groups according to their age at the time of surgery: <60 years (n=96) and >60 years (n=81). The mean age in the groups <60 years and >60 years amounted to 54.5±2.9 years and 63.5±2.5 years, respectively. All data were obtained from the patients' medical histories, outpatient follow-up records, and operative reports. The average duration of follow-up in the overall cohort amounted to 5.1±1.7 years. Chronic obstructive pulmonary disease, peripheral artery disease, and acute impairment of cerebral circulation were of significantly less common occurrence in the younger patient cohort. However, the frequency of a body mass index of ≥30 kg/m2, unstable angina, previously endured myocardial infarction and left ventricular systolic dysfunction in the preoperative period appeared to be significantly higher in this population. At 5 years after surgery, freedom from survival amounted to 94.8% in patients younger than 60 years (5 patients) and to 90.1% (8 patients) in those aged 60 years and older (p<0.001). Based on the findings of a multivariate analysis, independent predictors of mortality turned out to be a history of myocardial infarction, chronic kidney disease, diabetes mellitus, chronic obstructive pulmonary disease, lesions of peripheral arteries and the trunk of the left coronary artery. The area under the receiver operating characteristic curve was 0.834 (p<0.001, 95% CI: 0.724-0.902). Despite the fact that coronary artery bypass grafting is an effective method of treatment of ischaemic heart disease for both groups, special attention should be paid to the development and improvement of preventive strategies aimed at decreasing the impact of specific risk factors for cardiovascular diseases such as diet, lifestyle, weight control, and more aggressive medical therapy in younger patients. It is necessary to elaborate a reasonable strategy and optimization of the choice of an optimal approach to myocardial revascularization for elderly patients with multivessel and truncal lesions of coronary arteries, which are potential risk factors of death in the postoperative period.

Geographical disparities in the impacts of heat on diabetes mortality and the protective role of greenness in Thailand: A nationwide case-crossover analysis

Diabetes is a major public health problem globally, and heat exposure may be a potential risk factor for death among diabetes. This study examines the association between heat and diabetes mortality in different regions of Thailand and investigates whether heat effects are modified by regional greenness. Daily temperature and daily diabetes deaths data were obtained for 60 provinces of Thailand during 2000–2008. A case-crossover analysis was conducted to quantify the odds of heat-related death among diabetes. Meta-regression was then used to examine potential modification effects of regional greenness (as represented by the Normalized Difference Vegetation Index) on heat-related mortality. A strong association between heat and diabetes mortality was found in Thailand, with important regional variations. Nationally, the pooled odds ratio of diabetes mortality was 1.10 (95% confidence interval (CI): 1.06–1.14) for heat (90th percentile of temperature) and 1.20 (95% CI: 1.10–1.30) for extreme heat (99th percentile of temperature) compared with the minimum mortality temperature, across lag 0–1 days. Central and northeast Thailand were the most vulnerable regions. Regional greenness modified the effects of heat, with lower mortality impacts in areas of higher levels of greenness. In conclusion, heat exposure increases mortality risk in diabetes, with large geographical variations in risk suggesting the need for region-specific public health strategies. Increasing greenness levels may help to reduce the burden of heat on diabetes in Thailand against the backdrop of a warming climate.

Evaluation of short-term outcomes and potential risk factors for death and intestinal dehiscence following full-thickness large intestinal incisions in dogs.

To determine complication rates for dogs in which full-thickness large intestinal incisions were performed, assess potential risk factors for death during hospitalization and for intestinal dehiscence following these surgeries, and report short-term mortality rates for these patients. 90 dogs. Medical records of 4 veterinary referral hospitals were reviewed to identify dogs that underwent large intestinal surgery requiring full-thickness incisions. Signalment, history, clinicopathologic data, medical treatments, surgical procedures, complications, and outcomes were recorded. Descriptive statistics were calculated; data were analyzed for association with survival to discharge (with logistic regression analysis) and postoperative intestinal dehiscence (with Fisher exact or Wilcoxon rank sum tests). Overall 7-day postoperative intestinal dehiscence and mortality rates were 9 of 90 (10%) and 15 of 90 (17%). Dogs with preoperative anorexia, hypoglycemia, or neutrophils with toxic changes and those that received preoperative antimicrobial treatment had greater odds of death than did dogs without these findings. Preexisting colon trauma or dehiscence, preexisting peritonitis, administration of blood products, administration of > 2 classes of antimicrobials, positive microbial culture results for a surgical sample, and open abdominal management of peritonitis after surgery were associated with development of intestinal dehiscence. Five of 9 dogs with intestinal dehiscence died or were euthanized. Factors associated with failure to survive to discharge were considered suggestive of sepsis. Results suggested the dehiscence rate for full-thickness large intestinal incisions may not be as high as previously reported, but several factors may influence this outcome and larger, longer-term studies are needed to confirm these findings.

Clinical Risk Factors for Death Caused by Extended-Spectrum Beta-Lactamase: Producing Bacteria

Objectives: Extended-spectrum beta-lactamase (ESBL)-producing bacteria often causes bacteremia, leading serious outcomes. In this study, we conducted a retrospective analysis to identify the risk factors associated with death by bacteremia of ESBL-producing bacteria. Methods: Patients with bacteremia by ESBL-producing bacteria were retrospectively collected in Kobe University Hospital, Japan, between January 2011 and December 2015. Potential risk factors for death caused by ESBL-bacteremia were analyzed for patients’ outcome (recovery or death) by univariate and multivariate analysis. Results: A total of 101 patients (64 male and 37 female) were recruited. The most frequently detected ESBL-producing bacteria were Escherichia coli (91 cases; 90.1%), followed by Klebsiella pneumoniae (8 cases; 7.9%). Most frequently used antibiotics after the detection of bacteremia was meropenem (66.3%; 67/101) followed by cefmetazole (51.5%; 52/101). Univariate analysis showed a significantly positive correlation with mortality in ICU admission (p < 0.001), circulatory diseases (p = 0.022), shock (p = 0.044), and respirator requirement (p = 0.002). Multivariate analysis showed ICU admission remained significant risk factor for mortality (p = 0.0192). Conclusions: We showed ICU admission was significantly correlated with death from bacteremia by ESBL-producing bacteria. These factors should be monitored to estimate severity of ESBL causing-bacteremia for better patients’ outcomes.

Prospective Immunophenotyping of CD8+ T-cells and Associated Clinical Outcomes of Patients with Oligometastatic Prostate Cancer Treated with Metastasis-Directed Stereotactic Body Radiation Therapy

To prospectively observe CD8+ T-cell immunophenotypic changes in prostate cancer (PCa) patients treated with metastasis-directed stereotactic body radiation therapy (mdSBRT) and correlate these phenotypic changes with clinical outcomes. We prospectively analyzed peripheral blood mononuclear cells (PBMCs) that were isolated – before and at multiple time points after mdSBRT – from 37 patients enrolled between January 2013 and October 2014 with recurrent oligometastatic PCa (≤3 extracranial sites). Immunophenotyping was performed on isolated PBMCs using flow cytometry to identify subpopulations of circulating CD8+ T-cells including Tumor-Reactive (TTR; PD-1+CD11ahigh), Effector Memory (TEM; CCR7-CD45RA-), Central Memory (TCM; CCR7+CD45RA-), Effector (TEF; CCR7-CD45RA+), and Naïve (TN; CCR7+CD45RA+) T-cells. Univariate Cox proportional hazards regression was used to assess whether changes in these T-cell subpopulations were potential risk factors for death and progression. Kaplan-Meier method was used for survival. Cumulative incidence for progression and new distant metastasis (NDM) was estimated considering death as a competing risk. Median follow-up was 39 months (IQR 34-43). Overall survival at 3 years was 78.2%. Cumulative incidence for local progression at 3 years was 16.5% and for NDM at 3 years was 67.6%. Androgen deprivation therapy (ADT) was given concurrently with mdSBRT vs. delayed until additional progression for 19 (51%) and 18 (49%) patients, respectively. Concurrent ADT was protective against the risk of NDM (HR 0.44; 95% CI 0.20-0.96; p=0.039). Median time to NDM was 28 (IQR 5-41) vs. 8 (IQR 4-12) months for concurrent vs. delayed ADT, respectively. Seven out of 7 (100%) patients that continue to remain progression-free received concurrent ADT with mdSBRT. An increase in the TCM cell subpopulation between baseline and day 14 after mdSBRT was associated with the risk of death (HR 1.22; 95% CI 1.02-1.47; p=0.033). An increase in the TTR cell subpopulation between baseline and day 14 was protective against the risk of local progression (HR 0.80; 95% CI 0.65-0.98; p=0.032). Relative increases ≥1% in the TTR cell subpopulation between baseline and day 14 were associated with a non-significant protective effect against the risk of any progression, distant or local (HR 0.42; 0.17-1.01; p=0.052). Prospective CD8+ T-cell immunophenotyping before and after mdSBRT in patients with oligometastatic PCa provided insight into clinical outcomes. An increase in the TCM cell subpopulation was associated with the risk of death. An increase in the TTR cell subpopulation was protective against the risk of local progression. Concurrent ADT with mdSBRT was protective against the risk of NDM. This is the first report to show that an increase in the TTR cell subpopulation after mdSBRT is associated with PCa disease control, and has implications for combining mdSBRT and adoptive cell transfer therapies. Supported by NCI R01 CA200551.

Prospective Immunophenotyping of CD8+ T Cells and Associated Clinical Outcomes of Patients With Oligometastatic Prostate Cancer Treated With Metastasis-Directed SBRT

This study examined the effects of metastasis-directed stereotactic body radiation therapy (mdSBRT) on CD8+ T-cell subpopulations and correlated post-mdSBRT immunophenotypic responses with clinical outcomes in patients with oligometastatic prostate cancer (OPCa). Peripheral blood mononuclear cells were prospectively isolated from 37 patients with OPCa (≤3 metastases) who were treated with mdSBRT. Immunophenotyping identified circulating CD8+ T-cell subpopulations, including tumor-reactive (TTR), effector memory, central memory (TCM), effector, and naïve Tcells from samples collected before and after mdSBRT. Univariate Cox proportional hazards regression was used to assess whether changes in these T-cell subpopulations were potential risk factors for death and/or progression. The Kaplan-Meier method was used for survival. Cumulative incidence for progression and new distant metastasis weas estimated, considering death as a competing risk. Median follow-up was 39months (interquartile range, 34-43). Overall survival at 3years was 78.2%. Cumulative incidence for local progression and new distant metastasis at 3years was 16.5% and 67.6%, respectively. Between baseline and day 14 after mdSBRT, an increase in the TCM cell subpopulation was associated with the risk of death (hazard ratio, 1.22 [95% confidence interval, 1.02-1.47]; P=.033), and an increase in the TTR cell subpopulation was protective against the risk of local progression (hazard ratio, 0.80 [95% confidence interval, 0.65-0.98]; P=.032). An increase in the TTR cell subpopulation was protective against the risk of disease progression, and an increase in the TCM cell subpopulation was associated with the risk of death in patients with OPCa treated with mdSBRT. Disease control may be further improved by better understanding the CD8+ T-cell subpopulations and by enhancing their antitumor effect.

Defining the burden, scope, and future of vascular acute care surgery

ObjectiveThe paradigm of acute care surgery has revolutionized nonelective general surgery. Similarly, nonelective vascular surgery may benefit from specific management and resource capabilities. To establish the burden and scope of vascular acute care surgery, we analyzed the characteristics and outcomes of patients hospitalized for vascular surgical procedures in Maryland. MethodsA retrospective analysis of a statewide inpatient database was performed to identify patients undergoing noncardiac vascular procedures in Maryland from 2009 to 2013. Patients were stratified by admission acuity as elective, urgent, or emergent, with the last two groups defined as acute. The primary outcome was inpatient mortality, and secondary outcomes were critical care and hospital resource requirements. Groups were compared by univariate analyses, with multivariable analysis of mortality based on acuity level and other potential risk factors for death. ResultsOf 3,157,499 adult hospital admissions, 154,004 (5%) patients underwent a vascular procedure; most were acute (54% emergent, 13% urgent), whereas 33% were elective. Acute patients had higher rates of critical care morbidity and required more hospital resource utilization. Admission for acute vascular surgery was independently associated with mortality (urgent odds ratio, 2.1; emergent odds ratio, 3.0). ConclusionsThe majority of inpatient vascular care in Maryland is for acute vascular surgery, which is an independent risk factor for mortality. Acute vascular surgical care entails greater critical care and hospital resource utilization and—similar to emergency general surgery—may benefit from dedicated training and practice models.

Can oesophagectomy be performed for patients with oesophageal carcinoma and concomitant liver cirrhosis? A retrospective study based on a propensity-matched cohort.

For patients with oesophageal carcinoma and concomitant liver cirrhosis, the safety profile and postoperative prognosis of oesophagectomy are not clearly established due to the lack of relevant studies with large sample sizes. Our objective was to explore the surgical indications and postoperative prognosis in patients with oesophageal carcinoma and liver cirrhosis. A total of 2226 patients with oesophageal carcinoma underwent curative oesophagectomy (37 with liver cirrhosis and 2189 without) in our department from April 2008 to September 2013. Overall, 37 patients with liver cirrhosis (30 Child-Pugh Grade A and 7 Child-Pugh Grade B) and a propensity-matched cohort of 74 patients without cirrhosis were analysed. We compared the rates of postoperative complications and 5-year survival in these 2 groups. In addition, we performed an analysis of any potential risk factors for death, including patient demographic information and of operation performed. A higher operative mortality rate was observed in patients with oesophageal carcinoma and liver cirrhosis compared to patients with oesophageal carcinoma but without cirrhosis (11 vs 1%, P = 0.042). Patients with cirrhosis included those with Child-Pugh Grade B (43%), preoperative moderate ascites (100%), a prothrombin time of ≥ 4 s (75%) and greater weight loss. Although the rates of surgical death and postoperative hydrothorax were significantly higher in patients with liver cirrhosis, the rates of other major complications and 5-year overall survival were not significantly different compared to patients without cirrhosis. Curative oesophagectomy is a feasible, beneficial treatment option for patients with oesophageal carcinoma and liver cirrhosis, with a higher perioperative risk but reasonable longer term survival compared to patients without cirrhosis.

Pirfenidone for acute exacerbation of idiopathic pulmonary fibrosis: A retrospective study

BackgroundAcute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is a rapid and ultimately fatal condition, and no effective treatment has been established. Pirfenidone has antifibrotic effects in IPF; however, its efficacy for AE-IPF is unclear. ObjectivesTo evaluate the efficacy of pirfenidone for AE-IPF. MethodsWe retrospectively reviewed the medical records of 135 IPF patients treated during the period from April 2008 to April 2015 and identified and extracted 47 AE-IPF patients (42 men, 5 women; mean age, 73.5 years). The clinical features and outcomes of the 20 patients treated with pirfenidone were compared with those of the 27 patients treated without pirfenidone. We then excluded the 25 patients who did not receive recombinant human soluble thrombomodulin (rhTM) and analyzed data from the remaining 22 patients (20 men, 2 women; mean age, 73.7 years). Clinical features and outcomes were compared between the 10 patients treated with pirfenidone and the 12 patients who did not receive pirfenidone. ResultsThere were no significant differences between the two groups in baseline characteristics, except for pirfenidone use before onset. Three-month survival was significantly better in patients treated with pirfenidone than in the control group (55% vs 34%, p = 0.042). In univariate analysis, nonuse of pirfenidone was a potential risk factor for death at 3 months (hazard ratio, 6.993; p = 0.043) in patients treated with rhTM. ConclusionA regimen of pirfenidone combined with corticosteroids and rhTM may improve survival in patients with AE-IPF.

Analysis of mortality and related factors in 2195 adult myasthenia gravis patients in a 10-year follow-up study

To analyze the mortality and potential risk factors for death in myasthenia gravis (MG) patients. A total of 2195 adult patients with MG (aged older than 18 years) diagnosed during the period between 2003 and 2013 were followed-up and retrospectively reviewed. During the 10-year follow-up, 129 patients died and the total mortality rate was 5.88%. The risk factors associated with MG-related deaths were duration of the disease, occurrence of myasthenic crisis, severity of disease that included the Myasthenia Gravis Foundation of America (MGFA) grade III and IV at onset, elevation of acetylcholine receptor antibody (AchR-abs) titers, presence of thymic pathology, and failure of administrating immunosuppressants (P < 0.05). In addition, the non-MG related factors, including the history of preceding strokes, and the presence of chronic obstructive pulmonary disease (COPD), diabetes mellitus, atrial fibrillation, hyperlipidemia, myocardial infarction, and malignant tumors, were closely linked with death in the MG population (the hazard ratios [HRs] were 3.251, 4.173, 3.738, 3.886, 1.945, 2.177, and 14.7, respectively; P< 0.05). The severity of disease at entry, presence of AchRabs, thymic pathology, and duration of the disease predict a higher risk for death. Systemic illnesses including stroke, COPD, diabetes mellitus, atrial fibrillation, hyperlipidemia, myocardial infarction, and malignant tumor, which may also increase the risk of death, should be carefully monitored and managed.

Low Neonatal Mortality and High Incidence of Infectious Diseases in a Vietnamese Province Hospital.

Background. Neonatal deaths constitute the majority of child mortality in Vietnam, but studies are scarce and focus on community settings. Methods. During a 12-month period, all sick neonates admitted to a pediatric department in a province hospital were studied. Potential risk factors of death covering sociodemographic factors, pregnancy history, previous neonatal period, and status on admission were registered. The neonates were followed up until discharge or death or until 28 completed days of age if still hospitalized or until withdrawal of life support. The main outcome was neonatal death. Results. The neonatal mortality was 4.6% (50/1094). In a multivariate analysis, four associated risk factors of death were extremely low birth weight (OR = 22.9 (2.3–233.4)), no cry at birth (OR = 3.5 (1.3–9.4)), and cyanosis (OR = 3.3 (1.2–8.7)) and shock (OR = 12.3 (2.5–61.5)) on admission. The major discharge diagnoses were infection, prematurity, congenital malformations, and asphyxia in 88.5% (936/1058), 21.3% (225/1058), 5.0% (53/1058), and 4.6% (49/1058), respectively. In 36, a discharge diagnosis was not registered. Conclusion. Infection was the main cause of neonatal morbidity. Asphyxia and congenital malformations were diagnosed less frequently. The neonatal mortality was 4.6%. No sociodemographic factors were associated with death. Extreme low birth weight, no cry at birth, and cyanosis or shock at admission were associated with death.

Predictive factors of death in patients with tuberculosis: a nested case-control study.

Tuberculosis is one of the main causes of death worldwide. This study aimed to determine predictive factors for death in patients with tuberculosis to set priorities for public heath interventions to reduce mortality in these patients. This nested case-control study was carried out in Mazandaran province of Islamic Republic of Iran among tuberculosis patients who were treated during 2002-2009. Each deceased patient was individually matched with a control patient according to sex, age, area of involvement and time of follow-up. Potential risk factors for death were evaluated using multivariate conditional logistic regression models. From 2206 patients 376 cases and 376 matched controls were selected. Only positive serology for HIV (OR = 19.1), history of kidney disease (OR = 6.81) and use of immunosuppressant drugs (OR = 3.96) significantly increased the risk of death in tuberculosis patients. These potentially modifiable risk factors could be taken into account in preventive interventions for tuberculosis patients in our country.

Mortality among MDR-TB cases: comparison with drug-susceptible tuberculosis and associated factors.

BackgroundAn increase in multidrug-resistant tuberculosis (MDR-TB) cases is evident worldwide. Its management implies a complex treatment, high costs, more toxic anti-tuberculosis drug use, longer treatment time and increased treatment failure and mortality. The aims of this study were to compare mortality between MDR and drug-susceptible cases of tuberculosis, and to determine risk factors associated with mortality among MDR-TB cases.Methods and ResultsA retrospective cohort study was performed using data from clinical records of the National Strategy for Prevention and Control of Tuberculosis in Lima, Peru. In the first objective, MDR-TB, compared to drug-susceptible cases, was the main exposure variable and time to death, censored at 180 days, the outcome of interest. For the second objective, different variables obtained from clinical records were assessed as potential risk factors for death among MDR-TB cases. Cox regression analysis was used to determine hazard ratios (HR) and 95% confidence intervals (95%CI). A total of 1,232 patients were analyzed: mean age 30.9 ±14.0 years, 60.0% were males. 61 patients (5.0%) died during treatment, whereas the MDR-TB prevalence was 19.2%. MDR-TB increased the risk of death during treatment (HR = 7.5; IC95%: 4.1–13.4) when compared to presumed drug-susceptible cases after controlling for potential confounders. Education level (p = 0.01), previous TB episodes (p<0.001), diabetes history (p<0.001) and HIV infection (p = 0.04) were factors associated with mortality among MDR-TB cases.ConclusionsMDR-TB is associated with an increased risk of death during treatment. Lower education, greater number of previous TB episodes, diabetes history, and HIV infection were independently associated with mortality among MDR-TB cases. New strategies for appropriate MDR-TB detection and management should be implemented, including drug sensitivity tests, diabetes and HIV screening, as well as guarantee for a complete adherence to therapy.

Potential Risk Factors of Death in Multiple Trauma Patients.

rauma has been recognized as one of the leading causes of death in many countries for decades. Reduction in mortality and morbidity rate of trauma cases is one of the most important attitudes in this field. Evaluation of different risk factors have been considered as the main goal of some studies. The purpose of this study was determining potential risk factors of death in trauma patients. In a retrograde study, data of 740 patients admitted during three years (2009-2011) were studied. Demographic data (sex and age), clinical factors (blood pressure, pulse rate, respiratory rate, Glasgow coma scale (GCS)), trauma characteristics (location, type of injury, etc.), as well as outcome of patients were evaluated. Data analyses was done using SPSS 18.0. Stepwise multivariate regression analysis was used for recognition of independent predictive factors of death in multiple trauma patients. Of those admitted, majority of patients were male (81.4%), 68% between 18 to 60 years, and 11.2% of them died during the course of treatment. Age; type of trauma; abnormal respiration rate, pulse rate, blood pressure; total GCS ≤8; abnormal pupil size; and head and neck; vertebral, and extremities fractures were obtained as significant predictive factor of death. GCS≤8, head and neck fracture, and abnormal pulse rate were independent death predictors. We identified GCS≤8, head and neck fracture, and abnormal pulse rate as predictive factors of mortality after trauma, which remained independent in the presence of all other factors and potentially treatable.

Mortality rate and causes of death in women with self-reported musculoskeletal pain: Results from a 17-year follow-up study

IntroductionChronic musculoskeletal pain represents a significant health problem among adults in Norway. The prevalence of chronic pain is reported to be 35–53% in cross sectional studies of both genders. For many years, it has been a common opinion among medical doctors that chronic pain may indeed reduce a person's quality of life, but not affect life expectancy. However, over the previous two decades, reports about mortality and cause of death in individuals with chronic pain have been published. So far, several studies conclude that there is an increased mortality in patients with chronic pain, but it is not clear what causes this. Increased occurrences of cardio-vascular death or cancer death have been reported in some studies, but not verified in other studies. Aims of the studyThe aims of this study were to estimate the mortality rate in females with different extent of pain, to identify potential risk factors for death and to investigate if the causes of death differ according to prior reported pain. MethodsThis is a prospective population-based study of all women between 20 and 50 years registered in Arendal, Norway, in 1989 (N=2498 individuals). At follow-up in 2007, 2261 living females were retraced, 89 had died.All subjects received a questionnaire containing questions about chronic pain (pain≥3 months duration in muscles, joints, back or the whole body) as well as 13 sub-questions about pain-modulating factors, non-specific health complaints and sleep problems, by mail in 1990, 1995 and 2007. Only subjects who answered the questionnaire in 1990 were included in the analyses. Of the deceased, 71 had answered the questionnaire in 1990.A multivariate model for cox regression analysis was used in order to clarify if chronic pain, sleep problems, feeling anxious, frightened or nervous and number of unspecific health were risk factors for death.The causes of death of 87 of the deceased individuals were obtained by linking the ID-number with the Norwegian Cause of Death Registry. ResultsThe ratio of deceased responders was 2% (14/870) among those with no pain versus 5% (57/1168) among those with chronic pain at baseline. When separating into chronic regional pain and chronic widespread pain, the mortality rate was respectively 4% and 8% in the different groups. Age adjusted hazard ratio for mortality rate in individuals with initially chronic pain was [HR 2.5 (CI 1.4–4.5)] compared to pain free individuals. In the multivariate analysis, having chronic pain [HR 2.1 (1.1–4.2)] and feeling anxious, frightened or nervous [HR 3.2 (1.8–5.6)] were associated with increased risk of death. There was no difference in death from cardiovascular disease or malignancies between the groups of pain free individuals vs. the group of individuals with chronic pain. ConclusionThe mortality rate was significantly higher for individuals with chronic pain compared to pain free individuals, adjusted for age. In addition, feeling anxious, frightened or nervous were risk factors for death. There was an increase in all-cause mortality.

South African measles outbreak 2009 - 2010 as experienced by a paediatric hospital

Between 2009 and 2010, South Africa experienced a major measles outbreak, with more than 18 000 confirmed cases reported to the National Institute of Communicable Diseases. We studied measles admissions during the outbreak to Red Cross War Memorial Children's Hospital, Cape Town, between 1 November 2009 and 31 July 2010. Factors associated with mortality were retrospectively identified from notification records and hospital admissions data. Multivariate logistic regression was used to investigate potential risk factors for death. In total, 1 861 children were diagnosed with measles; 552 (30%) were admitted to hospital. The most common reason for admission was pneumonia (379 (68%)) and/or diarrhoea (262 (48%)). The median age at admission was 7.36 months (interquartile range (IQR) 5.0 - 10.7). The median duration of admission was 4 days (IQR 2 - 6); total hospital admission time was 3 746 days (10.3 child-years). HIV status was known in 404 (73%) children: 39/400 (14%) were HIV-infected. Eighteen children died (3% of all admissions); 15 (83%) of them were less than 1 year old. In the regression model, HIV-infection (adjusted odds ratio (aOR) 7.55, 95% confidence interval (CI) 2.27 - 25.12) and female sex (aOR 3.86, 95% CI 1.26 - 11.84) were associated with higher odds of death. There was a large paediatric admission burden during the 2009 - 2010 measles outbreak in Cape Town; young children were predominantly affected. HIV-infected children had a significantly higher case fatality.

Factors associated with death in intensive care unit patients with ventilator-associated pneumonia

Background: The incidence of ventilator-associated pneumonia (VAP) among patients on mechanical ventilation ranges from 15% to 25%, and mortality ranges from 33% to 38%. Aim: The aim of our study was to analyse the importance of previously uninvestigated potential risk factors for death in intensive care unit (ICU) patients with VAP. Methods: A case-control design was chosen for this study. The study population consisted of all patients who developed ventilator-associated pneumonia in the central ICU of a tertiary care hospital (n = 65 ) during a period of 6 months. Cases (n=45) included patients who died during their treatments in the ICU, if their primary cause of death was ventilator-VAP. Controls (n=20) included patients with VAP who survived their treatments in the ICU and who subsequently were subsequently transferred to other hospital wards. Results: Significant associations were found between death and age over 65 (ORadjusted = 10.66; CI: 1.22, 93.12; p = 0.032), death and infection upon admission to the ICU (ORadjusted = 434.39; CI: 3.07, 61449.65; p = 0.016), and death and administration of ceftriaxone prior to VAP (ORadjusted = 69.32; CI: 1.74, 2768.92; p = 0.024). A synergistic effect on death was found only for age over 65 and infection upon admission to the ICU. Conclusions: ICU patients with VAP experience have increased risk of mortality if they receive ceftriaxone prophylactically, if they have an infection upon admission to the ICU and if their age is advanced.

P2-381 Childhood mortality risk factors in rural areas of Shahroud, Iran: a community based nested case-control study

BackgroundThere is a complex causal framework for one-month to five-year-old child mortality. Hence, the improvement of this health indicator would also be quite gradual. This study was carried out to...

Primary liver transplantation for autoimmune hepatitis: A comparative analysis of the European Liver Transplant Registry

The principal aim of this study was to compare the probability of and potential risk factors for death and graft loss after primary adult and pediatric liver transplantation in patients undergoing transplantation for autoimmune hepatitis (AIH) to those in patients undergoing transplantation for primary biliary cirrhosis (PBC; used as the reference group) or alcoholic cirrhosis (used as an example of a nonautoimmune liver disease). The 5-year survival of patients undergoing transplantation for AIH (n = 827) was 0.73 [95% confidence interval (CI) = 0.67-0.77]. This was similar to that of patients undergoing transplantation for alcoholic cirrhosis (0.74, 95% CI = 0.72-0.76, n = 6424) but significantly worse than that of patients undergoing transplantation for PBC (0.83, 95% CI = 0.80-0.85, n = 1588). Fatal infectious complications occurred at an increased rate in patients with AIH (hazard ratio = 1.8, P = 0.002 with PBC as the reference). The outcome of pediatric AIH patients was similar to that of adult patients undergoing transplantation up to the age of 50 years. However, the survival of AIH patients undergoing transplantation beyond the age of 50 years (0.61 at 5 years, 95% CI = 0.51-0.70) was significantly reduced in comparison with the survival of young adult AIH patients (0.78 at 18-34 years, 95% CI = 0.70-0.86) and in comparison with the survival of patients of the same age group with PBC or alcoholic cirrhosis. In conclusion, age significantly affects patient survival after liver transplantation for AIH. The increased risk of dying of infectious complications in the early postoperative period, especially above the age of 50 years, should be acknowledged in the management of AIH patients with advanced-stage liver disease who are listed for liver transplantation. It should be noted that not all risk factors relevant to patient and graft survival could be analyzed with the European Liver Transplant Registry database.

Presence of electroencephalogram burst suppression in sedated, critically ill patients is associated with increased mortality.

This study investigates the possibility of a relationship between oversedation and mortality in mechanically ventilated patients. The presence of burst suppression, a pattern of severely decreased brain wave activity on the electroencephalogram, may be unintentionally induced by heavy doses of sedatives. Burst suppression has never been studied as a potential risk factor for death in patients without a known neurologic disorder or injury. Post hoc analysis of a prospectively observational cohort study. Medical intensive care units of a tertiary care, university-based medical center. A total of 125 mechanically ventilated, adult, critically ill patients. A validated arousal scale (Richmond Agitation-Sedation Scale) was used to measure sedation level, and the bispectral index monitor was used to capture electroencephalogram data. Burst suppression occurred in 49 of 125 patients (39%). For analysis, the patients were divided into those with burst suppression (49 of 125, 39%) and those without burst suppression (76 of 125, 61%). All baseline variables were similar between the two groups, with the overall cohort demonstrating a high severity of illness (Acute Physiology and Chronic Health Evaluation II scores of 27.4 +/- 8.2) and 98% receiving sedation. Of those with burst suppression, 29 of 49 (59%) died within 6 months compared with 25 of 76 (33%) who did not demonstrate burst suppression. Using time-dependent Cox regression to adjust for clinically important covariates (age, Charlson comorbidity score, baseline dementia, Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, coma, and delirium), patients who experienced burst suppression were found to have a statistically significant higher 6-month mortality [Hazard's ratio = 2.04, 95% confidence interval, 1.12-3.70, p = 0.02]. The presence of burst suppression, which was unexpectedly high in this medical intensive care unit population, was an independent predictor of increased risk of death at 6 months. This association should be studied prospectively on a larger scale in mechanically ventilated, critically ill patients.