Predictive Factors Of Mortality Research Articles

Incidence and predictive factors of mortality of infective endocarditis in adults with congenital heart disease: A systematic review and meta-analysis

IntroductionCongenital heart diseases (CHD) with abnormal turbulent blood flow are associated with the highest risk of infective endocarditis (IE). Despite advancement in diagnostics and treatment, the mortality rate of IE remains high due the life-threatening complications. Our study aims to assess the incidence and mortality rates of IE and predictive factors for mortality among adults CHD (ACHD). MethodsA systematic literature search was conducted on PubMed, SCOPUS, and Ovid SP to retrieve relevant studies. The pooled estimates and predictors of mortality were calculated using the random-effects generic inverse variance method using R programming. Results12 studies involving 3738 ACHD patients were included in this meta-analysis. The overall incidence of IE in ACHD was 1.26 per 1000 patient-years (95% CI 0.55–1.96). 60% (95% CI 46–72%) of patients had surgical management for IE. The mortality rate of IE was 9% (95% CI 7–12%). The predictors of mortality were conservative management (OR: 5.07, 95% CI: 4.63–5.57), renal dysfunction (OR: 4.15, 95% CI: 2.92–5.88), cerebral complications (OR: 3.59, 95% CI: 1.78–7.23), abscesses/valve complications (OR: 2.67, 95% CI: 1.71–4.16), Staphylococcus aureus infection (OR: 2.32, 95% CI: 1.33–4.06), emboli (OR: 2.03, 95% CI: 1.47–2.79), body mass index (OR: 1.10, 95% CI: 1.01–1.21), age (OR: 1.02, 95% CI: 1.00–1.04), and previous IE (OR: 1.02, 95% CI: 1.00–1.04). ConclusionThe mortality rate of IE in ACHD is low. However, conservative management is associated with the highest risk of mortality.

#2973 COVID-19 increased hemodialysis patients’ mortality, relation with inflammation and telomere attrition

Abstract Background and Aims An increased risk of mortality and hospitalization has been consistently demonstrated in patients with CKD who are additionally affected by corona virus disease 19 (COVID-19). In this study, we tried to identify predictive factors of mortality and hospitalizations, especially the ratio of neutrophils to lymphocytes (NLR), lactate dehydrogenase (LDH), c-reactive protein (CRP), disease status of COVID-19, telomere length in peripheral blood cells (TL) and 2-year risk score. Method A total of 130 chronic hemodialysis patients, were enrolled in the present study and followed up for 18 months. Routine laboratory parameters including LDH, were determined by standard automated methods, redox status parameters SOD and O2. - Using spectrophotometric methods.TL was determined using the modified Cawthon method and was calculated as the T/S ratio. Kaplan-Meier analysis was used to test survival predictors. Results Patients in deceased group (30%) were significantly older (p <0.001), with higher body mass index (BMI), (p < 0.01) than survived patients. Also, patients in the deceased group had higher levels of LDH, NLR index, CRP compared to survivors. Lower lymphocytes and shortened TL were characteristic of these patient groups, but the deceased group had the lowest lymphocytes (p < 0.005) and telomeres (p<0.002), and had the highest NLR (0.004). The difference in 2-years risk score also was significant (p < 0.001), with higher scores in the deceased group. Kaplan-Meier survival analysis showed six parameters were significant predictors in the following order of significance: COVID-19 status, 2-years risk score, NLR, TL, CRP, LDH. Using binary logistic regression analysis Summary risk score, a combination of these six parameters revealed as the best predictor of patients’ survival in this group of parameters (Log rank=25.4, P < 0.001). Conclusion Independent predictors of mortality in chronic haemodialysis patients are higher NLR, CRP, LDH, Lower lymphocytes and shortened TL, and COVID -19 made the situation even worse by significantly arising these patients’ mortality rate.

Typical Atrial Flutter in acute coronary syndrome with ST segment elevation: incidence, predictive factors and related mortality.

Background: Typical Atrial Flutter in acute coronary syndrome with ST segment elevation is very rare and never reported as a separate electrocardiographic entity, but associated with atrial fibrillation. Its incidence isn’t reported in the literature, and no data about its predictive factors or related mortality, also its epidemiological data is lacking in Algeria. Aims: The main objective of our study is the determination of the frequency of typical atrial flutter in acute coronary syndrome with ST segment elevation, the secondary objective was the analysis of its predictive factors, and related mortality. Methods and materials: In this prospective study, conducted in the cardiology department of Hussein Dey hospital (Algiers-Algeria), 467 patients with acute coronary syndrome with elevated ST segment (87 women and 380 men) were enrolled between 28 February 2014 and 16 July 2015. The average age is 60 ± 13 years; at admission, a Holter recorder was attached for continuous ECG monitoring during 48 hours Kruskal’s ANNOVA or H tests were used for comparison of quantitative variables, χ2 test or Fisher’s exact test, were used for qualitative variables, all tests were performed with 1st species risk of 5%. Results: The frequency of typical atrial flutter is 0.4 % (2 patients), CI 95%: [0%-1%], multivariate analysis identified right heart failure as the only predictive factor. The risk of mortality expressed by Hazard Ration (HR) is 27 (CI95%: [3.5-207], p = 0.001); right heart failure is the only predictive factor of mortality identified in our study. Conclusion: typical atrial flutter is very rare in acute coronary syndrome with elevated ST segment, its predictive factor according to our study is right heart failure, and its occurrence increases the risk of hospital mortality.

Hemorrhagic Strokes: Predictive Factors of Mortality

Hemorrhagic Strokes: Predictive Factors of Mortality

Long-term outcomes in patients with bicuspid valve stenosis and aortic dilation undergoing transcatheter valve implantation

BackgroundTo date, whether ascending aorta dilation (AAD) should be considered a contraindication for transcatheter aortic valve replacement (TAVR) remains a topic of debate.. ObjectiveThe study investigated the clinical outcome of TAVR in patients with bicuspid aortic valve stenosis (BAV-AS) complicated by AAD. MethodsWe included patients with BAV-AS who underwent TAVR between 2012 and 2019. We collected patient perioperative clinical data., tracked clinical outcomes for over four years post-TAVR, and obtained echocardiography images one year postoperatively. The Kaplan-Meier method was employed for analyzing both unadjusted and adjusted survival data, which was compared using the log-rank test. COX regression and nomograms were used to assess the impact of AAD on post-TAVR clinical outcomes in patients with aortic stenosis (AS), with all-cause mortality as the primary clinical endpoint. ResultsA total of 111 BAV patients were included in this study. Long-term follow-up showed an increased mortality risk in patients with BAV-AAD (adjusted Kaplan–Meier analysis: P = .02/0.001). Cox correlation analysis indicated that age (OR = 1.137; P = .034), AAD (OR = 3.51; P = .038), and postoperative left ventricular pressure (LVSP) (OR: 0.959; P = .044) were predictive factors for mortality more than four years after TAVR in patients with BAV. The area under the curve of the Nomogram predicting long-term survival for the training set of patients based on the above metrics was 0.845 (95% CI: 0.696–0.994). Short-term cardiac ultrasound follow-up showed a more rapid rate of AA expansion (0.29 [0–0.34] vs. -1 [−3.3–1] mm/month, P = .001) and a smaller proportion of AA diameter reduction (7.1% vs. 53.7%, P = .001) in patients who died. ConclusionsPatients with BAV-AAD-AS treated with TAVR have an increased risk of long-term mortality, and clinical prediction models, including AAD age and postoperative LVSP, may predict long-term patient survival. Condensed abstractThe study investigated the clinical outcome of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (BAV-AS) complicated by ascending aorta dilation (AAD). Patients with BAV-AAD-AS treated with TAVR have an increased risk of long-term mortality. AAD, age and postoperative LVSP, may predict long-term patient survival. Short-term cardiac ultrasound follow-up showed a more rapid rate of AA expansion and a smaller proportion of AA diameter reduction in patients who died. A high postoperative AAD expansion rate may indicate an adverse clinical outcome. Surgery regimens for tolerable BAV-AADs and can be considered as a treatment option.

Evaluation of the factors affecting mortality after cardiac arrest - do lactate and procalcitonin concentrations have any implications?

Mortality and morbidity rates are very high in patients admitted to the Intensive Care Unit (ICU) after cardiac arrest. In this study, we aimed to determine the mortality rates, risk factors, and predictive factors for mortality in post-cardiac arrest patients admitted to the ICU. Following approval from the Ethics Committee, we conducted a retrospective review of patient files for individuals over the age of 18 who received treatment for cardiac arrest in the ICU from January 2017 to June 2020. Demographic data of the patients, comorbidities, arrest location, etiology of arrest, duration of hospitalization, CPR duration, APACHE 2 scores, pH and HCO3 measurements in initial blood gases, lactate levels (1st, 6th, 12th, 24th hour), change in lactate levels (24-1), rate of lactate change, procalcitonin (PRC) levels (1st and 24th hour), change in PRC levels (24-1), rate of PRC change, and blood glucose levels were recorded. The patients were divided into two groups (survivors and non-survivors groups). 151 patients were included in the study. pH and HCO3 levels were lower in the non-survivors group than in the survivors group. Initial PRC levels were similar in both groups, but the 24th-hour PRC levels were higher, and the changes in PRC levels in the first 24 hours were greater in the non-survivors group. The lactate changes in the first 24 hours were higher in the non-survivors group. The receiver operating characteristic (ROC) curve showed that the HCO3 levels, 1st-, 6th-, 12th-, and 24th-hour lactate levels, and changes in lactate levels had predictability for mortality. In logistic regression analysis, we found that high 24th-hour lactate levels and changes in lactate levels were independent risk factors for mortality. Considering PRC and lactate levels, along with clinical examination and laboratory findings, may improve the accuracy of determining the prognosis of patients experiencing cardiac arrest.

Predictive Factors of Mortality in Pediatric Pleuropulmonary Blastoma: A Surveillance Epidemiology and End Results Database Analysis.

Pleuropulmonary blastoma (PPB) is a rare malignancy associated with mutations in the DICER1 gene. Early-stage disease (PPB type I) mimics cystic lung malformations and develops in infants <1 year of age, and PPB type II and III arises in older children. The objective of this study was to analyze predictive factors of mortality in pediatric patients aged 0-19 years diagnosed with PPB between 2000 and 2019 in the USA. A retrospective analysis of pediatric patients (0-19 years) in the Surveillance Epidemiology and End Results database was conducted from 2000 to 2019 with a diagnosis of PPB using International Classification of Disease for Oncology, third edition code 8973/3 and rare tumor code 45. Demographics, incidence, staging, treatment, and mortality were extracted. A mortality risk predictive equation was developed using logistic regression. Statistical analysis was conducted through Microsoft Excel Analysis ToolPak and Solver. There were a total of 71 new cases of PPB during the study period, with 16 (22%) deaths. The demographic analysis demonstrated that 40/71 (56.3%) patients were female, 57/71 (80.3%) were White, and 64/71 (90.1%) resided in metropolitan areas. Regression analysis demonstrated a statistically significant correlation between mortality and stage (P = 0.029), need for chemotherapy (P = 0.047), and female sex (P = 0.019). There was no significant correlation between mortality and need for radiation, race, or age at diagnosis. Multiple logistic regression analysis generated a predictive equation of mortality dependent on the stage of PPB, need for chemotherapy, and sex. This equation has an 82% accuracy, 81% sensitivity, and an 18% false positive rate. PPB is a rare disease. Distinguishing PPB from benign cystic lung malformations in infancy is important to avoid progression to Type II and III PPB. Advanced stages of PPB have a greater need for systemic chemotherapy and radiation with a poor prognosis.

Prognostic value of N–terminal pro B–type natriuretic peptide and troponin I in children with dengue shock syndrome

Objective: To investigate the contribution of N-terminal pro B-type natriuretic peptide (NT-pro BNP) and troponin I to mortality in children with dengue shock syndrome. Methods: A longitudinal study was conducted on children with dengue shock syndrome in a hospital in southern Vietnam. Detailed clinical histories, physical examinations, and laboratory parameters, including NT-pro BNP and troponin I, were recorded. A comparison between survival and non-survival was carried out to identify factors influencing mortality. Results: A total of 107 patients with a median age of 9 years were included in the study. Among them, 63.6% (68/107) presented with compensated shock, 36.4% (39/107) had hypotensive shock, 23.4% (25/107) required mechanical ventilation, and 12.1% (13/107) died. The NT-pro BNP levels were 3.9 pmol/L (IQR: 1.9, 10.3) and 15.2 pmol/L (5.8, 46.3), while the median high sensitivity troponin I levels were 20 pg/L (6, 95) and 62 pg/L (12, 325) at the first and second measurements, respectively. The mortality group exhibited higher rates of hypotensive shock, prolonged shock, lactate levels, liver damage, NT-pro BNP, and troponin I levels. Hypotensive shock (OR 12.96, 95% Cl 2.70-62.30, P=0.004), prolonged shock (OR 39.40, 95% CI 6.68-232.70, P&lt;0.001), AST &gt; 1 000 IU/L (OR 9.50, 95% CI 2.63-34.34, P=0.041), and NT-pro BNP &gt; 7 pmol/L (OR 44.40, 95% CI 5.44-362.20, P=0.001) were identified as predictive factors for mortality in dengue shock syndrome. Conclusions: The NT-pro BNP level could serve as a potential biomarker for predicting mortality in children with dengue shock syndrome.

Characteristics of myocardial injury and predictive factors of mortality in patients with severe anaphylaxis

Characteristics of myocardial injury and predictive factors of mortality in patients with severe anaphylaxis

Lifetime and 10-year risks of cardiovascular mortality in relation to risk factors in middle and old age: 50-year follow-up of the Whitehall study of London Civil Servants

BackgroundCardiovascular disease (CVD)-related mortality has declined substantially in the United Kingdom (UK) in recent decades, but the continued relevance of conventional risk factors for prediction of CVD mortality throughout the life-course is uncertain. We compared the 10-year risks and lifetime risks of CVD mortality associated with conventional risk factors recorded in middle and old age. MethodsThe Whitehall study was a prospective study of 19,019 male London civil servants (mean age 52 years) when enrolled in 1967–1970 and followed-up for 50 years for cause-specific mortality. In 1997, 7044 (83%) survivors (mean age 77 years) were re-surveyed. The 10-year and lifetime risks of CVD mortality were estimated by levels of CVD risk factors recorded in middle-age and old-age, respectively. ResultsBy July 2020, 97% had died (22%, 51% and 80% before age 70, 80 and 90 years, respectively) and 7944 of 17,673 deaths (45%) were from CVD. The 10-year and lifetime risks of CVD death increased linearly with higher levels of CVD risk factors recorded in middle-age and in old-age. Individuals in the top versus bottom 5% of CVD risk scores in middle age had a 10.3% (95% CI:7.2–13.4) vs 0.6% (0.1–1.2) 10-year risk of CVD mortality, a 61.4% (59.4–65.3) vs 31.3% (24.1–34.5) lifetime risk of CVD mortality and a 12-year difference in life expectancy from age 50 years. The corresponding differences using a CVD risk score in old-age were 11.0% (4.4–17.5) vs 0.8% (0.0–2.2) for 10-year risk and 42.1% (28.2–50.0) vs 30.3% (6.0–38.0) for lifetime risk of CVD mortality and a 6-year difference in life expectancy from age 70 years. ConclusionsConventional risk factors remained highly predictive of CVD mortality and life expectancy through the life-course. The findings highlight the relevance of estimation of both lifetime risks of CVD and 10-year risks of CVD for primary prevention of CVD.

Clinical characteristics and prognosis of Klebsiella pneumoniae meningitis in adults

BackgroundKlebsiella pneumoniae is a causative agent of bacterial meningitis in adults. However, there is little information regarding this infection. Therefore, this study comprehensively analyzed the clinical characteristics and prognosis of Klebsiella pneumoniae meningitis (KPM) patients. MethodsThe clinical data of adult hospitalized patients with KPM were retrospectively collected from January 2015 to December 2022. The clinical characteristics and antibiotic resistance of KPM were evaluated. Meanwhile, a set of logistic regression models was constructed to identify prognostic factors for death. These prognostic factors were subsequently combined to develop a nomogram for predicting the risk of in-hospital mortality in individual patients. Finally, the receiver operating characteristic curve and calibrate plot were utilized to verify the performance of the nomogram. ResultsThis study included 80 adult patients with KPM, 58 (72.5%) of whom were males. The mortality rate was 45%. Among them, 74 (92.5%) were diagnosed with healthcare-associated meningitis. Thirty-seven carbapenem-resistant Klebsiella pneumoniae (CRKP) strains were susceptible to tigecycline, polymyxin, and ceftazidime/avibactam. CRKP (OR = 9.825, 95%CI = 2.757–35.011, P < 0.001), length of stay (OR = 0.953, 95%CI = 0.921–0.986, P = 0.005), and C-reactive protein-to-prealbumin ratio (CRP/PA, OR = 3.053, 95%CI = 1.329–7.016, P = 0.009) were identified as predictive factors for mortality using multivariate logistic regression. Finally, a nomogram for death prediction was established. The area under the curve of this nomogram was 0.900 (95% CI = 0.828–0.971). ConclusionsKPM is a fatal disease associated with high incidence of healthcare-associated infections and carbapenem resistance. Moreover, CRKP, length of stay, and CRP/PA were found to be independent predictors of mortality.

Mortality of the Danish Nationwide AQP4 Antibody-Seropositive Neuromyelitis Optica Spectrum Disorder Patient Cohort.

We aimed to evaluate the mortality of patients with AQP4 antibody-seropositive (AQP4-Ab+) neuromyelitis optica spectrum disorder (NMOSD) in Denmark compared with that in the general population. We identified patients with AQP4-Ab+ NMOSD fulfilling the 2015 International Panel for Neuromyelitis Optica Diagnosis (IPND) criteria from multiple sources (laboratories and the Danish Multiple Sclerosis Registry). We obtained detailed information about patients from hospital records and about the general population matched on age, sex, and calendar year from Statistics Denmark. We calculated standardized mortality ratio (SMR), excess number of deaths per 1,000 person-years (EDR), and life expectancies compared with those of the matched general population. We examined predictive factors of mortality and the cause of death. Of 66 patients with AQP4-Ab+ NMOSD between 2008 and 2020, 15 died. Overall, the SMR was 2.54 (95% CI 1.47-4.09), and the EDR was 16.8 (95% CI 4.6-34.3). The median life expectancy for patients with AQP4-Ab+ NMOSD was 64.08 years (95% CI 53.02-83.9), compared with 83.07 years for the general population. Risk of death over time was increased in the patient population with a hazard ratio (HR) of 2.22 (1.34-3.68; p = 0.002). The cause of death was directly related to NMOSD in 93% of the cases. The age at disease onset was an independent predictor of death (HR 1.042; 95% CI 1.006-1.079; p = 0.02). AQP4-Ab+ NMOSD is associated with increased mortality and shorter life expectancy compared with that in the general population, underlining the need for highly effective treatment approaches.

Lactate and Lactate Clearance Are Predictive Factors for Mortality in Patients with Extracorporeal Membrane Oxygenation.

Findings of inadequate tissue perfusion might be used to predict the risk of mortality. In this study, we evaluated the effects of lactate and lactate clearance on mortality of patients who had undergone extracorporeal membrane oxygenation (ECMO). Patients younger than 18 years old and who needed venoarterial ECMO support after surgery for congenital heart defects, from July 2010 to January 2019, were retrospectively analyzed. Patients successfully weaned from ECMO constituted Group 1, and patients who could not be weaned from ECMO were in Group 2. Postoperative clinics and follow-ups of the groups including mortality and discharge rates were evaluated. There were 1,844 congenital heart surgeries during the study period, and 55 patients that required ECMO support were included in the study. There was no statistically significant difference between the groups regarding demographics and operative variables. The sixth-, 12th-, and 24th-hour lactate levels in Group 1 were statistically significantly lower than those in Group 2 (P=0.046, P=0.024, and P<0.001, respectively). There were statistically significant differences regarding lactate clearance between the groups at the 24th hour (P=0.009). The cutoff point for lactate level was found as ≥ 2.9, with 74.07% sensitivity and 78.57% specificity (P<0.001). The cutoff point for lactate clearance was determined as 69.44%, with 59.26% sensitivity and 78.57% specificity (P=0.003). Prognostic predictive factors are important to initiate advanced treatment modalities in patients with ECMO support. In this condition, lactate and lactate clearance might be used as a predictive marker.

Surgical resection for hepatocellular carcinoma: a single-centre's one decade of experience.

Liver cancer is the third leading cause of global cancer deaths, and hepatocellular carcinoma is its most common type. Liver resection is one of the treatment options for hepatocellular carcinoma (HCC). This study aims to explore our hospital's more than a decade of experience in liver resection for HCC patients. This is a retrospective cohort study on HCC patients undergoing resection from 2010 to 2021 in a tertiary-level hospital in Jakarta, Indonesia. Mortality rates were explored as the primary outcome of this study. Statistical analysis was done on possible predictive factors using Pearson's χ2. Survival analysis was done using the Log-Rank test and Cox Regression. Ninety-one patients were included in this study. The authors found that the postoperative mortality rates were 8.8% (in hospital), 11.5% (30 days), and 24.1% (90 days). Excluding postoperative mortalities, the long-term mortality rates were 44.4% (first year), 58.7% (3 years), and 69.7% (5 years). Cumulatively, the mortality rates were 46.4% (1 year), 68.9% (3 years), 77.8% (5 years), and 67.0% (all time). Significant predictive factors for cumulative 1-year mortality include large tumour diameter [odds ratio (OR) 14.06; 95% CI: 2.59-76.35; comparing <3cm and >10cm tumours; P<0.01], positive resection margin (OR 2.86; 1.17-77.0; P=0.02), and tumour differentiation (P=0.01). Multivariate analysis found hazard ratios of 6.35 (2.13-18.93; P<0.01) and 1.81 (1.04-3.14; P=0.04) for tumour diameter and resection margin, respectively. The mortality rate of HCC patients undergoing resection is still very high. Significant predictive factors for mortality found in this study benefit from earlier diagnosis and treatment; thus, highlighting the importance of HCC surveillance programs.

Endocardite infectieuse : facteurs prédictifs de mortalité intrahospitalière

IntroductionInfective endocarditis (IE) remains a serious disease with significant morbidity and mortality despite therapeutic advancements. The aim of our study was to determine the predictive factors of in-hospital mortality. Patients and methodsA prospective comparative study over a period of 54 months was conducted, including all patients admitted for definite infective endocarditis, diagnosed according to the modified Duke criteria published in 2015 by the European Society of Cardiology. ResultsThirty-four patients were included. Drug addiction was the main risk factor for infective endocarditis (56%). Tricuspid valve involvement was predominant (50%). Staphylococcus aureus was the most commonly isolated pathogen (65%). In-hospital mortality rate was 47%. In multivariate analysis, predictive factors for mortality were acute heart failure (OR=7.4; p=0.026; 95% CI [1.2–44]) and cerebral embolic localization (OR=11.1; p=0.024; 95% CI [13–90]). ConclusionsCardiac and cerebral complications influence the prognosis of IE. Thus, close collaboration among multidisciplinary teams is necessary for improved diagnostic and therapeutic management.

Wound, Ischemia, Foot Infection (Wifi) Classification System And Its Predictive Ability Concerning Amputation-Free Survival, Mortality And Major Limb Amputation In A Portuguese Population: A Single Center Experience.

Commonly used chronic limb-threatening ischemia (CLTI) classifications lack granularity and detail to precisely stratify patients according to risk of limb loss, expected revascularization benefit and mortality. The aim of this study is to evaluate in a Portuguese population the prognostic value of an updated CLTI classification based on Wound, Ischemia, and foot Infection (WIfI) proposed by the Society for Vascular Surgery. Single-center retrospective evaluation of prospectively collected data of consecutive patients with CLTI submitted to lower limb revascularization from January to December of 2017. All consecutive patients with chronic peripheral artery disease with ischemic rest pain or tissue loss were included. The exclusion criteria were patients with intermittent claudication, vascular trauma, acute ischemia, non-atherosclerotic arterial disease and isolated iliac intervention. The primary end-point was major limb amputation, mortality and amputation-free survival (AFS) at 30 days, 1 year and 2 year follow-up. Secondary end-points were minor amputation, wound healing time (WHT) and rate (WHR). A total of 111 patients with CLTI were submitted to infra-inguinal revascularization: 91 endovascular and 20 open surgery. After categorizing them according to the WIfI: 20 had stage 1 (18.52%), 29 stage 2 (26.85%), 38 stage 3 (35.19%) and 21 stage 4 (19.44%). Overall mortality rate was 1.8%, 17% and 22.3% at 30 days, 1 year and 2 years follow-up. Major amputation rate was 0.9%, 2.7% and 2.7% at 30 days, 1 year and 2 years follow-up. AFS rate was 97.3%, 82.1%, and 76.8% at 30 days, 1 year, 2 years follow-up. In multi-variable analysis, higher WIfI score was the only predictive factor for mortality and AFS. WIfI 3 and 4 were also associated with increased risk of non-healing ulcer. This study proved the prognostic value of the WIfI classification in a Portuguese population by showing an association between higher scores and increased mortality, lower AFS and non-healing ulcer.

Unveiling mortality risk factors in paediatric sickle cell disease patients during acute crises in the Democratic Republic of the Congo

Sickle cell disease (SCD) is a significant health burden in the Democratic Republic of the Congo (DRC). This study aims to identify predictive factors of mortality in SCD children admitted to emergency care in Lubumbashi, DRC. We performed a non-interventional cohort follow-up on SCD patients aged 0 to 16 admitted for a “true emergency”. Demographic, clinical, and biological data were collected. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors associated with mortality. Among the 121 patients included, 24 died during the follow-up period. Univariate regression revealed age, Mikobi score, referral origin, stroke, and severe infection as significant risk factors. Multivariate analyses identified Hb, WBC, SR, and LDH as predictive factors of mortality. Notably, patients aged 12 to 16 years faced a higher risk, shifting the age of mortality from early to late childhood and adolescence. This study provides valuable insights into mortality risk factors for paediatric SCD patients during acute crises. Early diagnosis, regular follow-up, and therapeutic education are essential to improve patient outcomes and survival rates. These findings contribute to better disease management and targeted interventions, aiming to reduce mortality associated with SCD.

COVID-19 pneumonia in older patients: clinical features and outcomes of a 400 case series

Background Since late 2019, COVID-19 has been a major health issue worldwide. Older patients seemed more susceptible to severe forms and complications with higher mortality rates. This study aimed to identify the clinical features and outcomes of SARS-Cov-2 pneumonia in elderly patients. Methods Retrospective monocentric study in the internal medicine Covid-19 unit of the Ben Arous regional hospital, enrolling admitted patients with confirmed SARS-CoV-2 pneumonia, aged 65 years and above from September 2020 to September 2021. Results The study group counted 222 women (55.5%). The mean age was 74 years. At least one chronic disease was found in 84.75% of patients. The most common comorbidities were high blood pressure (55.75%), and diabetes mellitus (50%). The most frequent symptoms were dyspnoea (69.8%), fatigue (66.8%) and dry cough (65.8%). Corrected Qt interval was prolonged in 24.2% of cases. Chest computed tomography were performed in 277 cases (69.3%). Ground glass opacities (93.86%), consolidations (73.3%) and crazy paving (36%) were the main findings. Assessment of pulmonary extent found important involvement (41.87%), sever lesions (23.82%), moderate involvement (21.29%) and critical involvement (1.8%). C-reactive protein (CRP) was elevated in 94.25% of patients. Elevated D-dimer levels were common (68.8%). Antinuclear antibodies were positive in 22.85% cases, and lupus anticoagulant in 35.41%. Acute kidney failure was noted in 25% of patients. The incidence of pulmonary embolism in the current study was 12.99%. The death rate was 8%. According to multivariate logistic regression: older age (odds ratio:1.11, 95% CI: 1.058-1.167; P P&lt; .005), elevated C-reactive protein levels (odds ratio: 1.008, 95% CI: 1.003-1.013; P&lt; .005) and duration of hospital stay (odds ratio: 1.131, 95% CI: 1.062-1.204; P&lt; .005) were predictive factors of mortality. Conclusions Clinical presentation of covid-19 pneumonia in elderly patients is particular due to pre-existing comorbidities and frailty. Mortality risk factors are age, elevated CRP and length of hospitalization.

Necrotizing Fasciitis: A Vicious Soft Tissue Infection: Review Article

Background: Necrotizing fasciitis is rapidly progressive, lethaldestructive inflammation with polymicrobialinfection and secondary necrosis. Though it is a disease described from the Hippocratic era, there is an increase inthe incidence of necrotizing fasciitis. The most important factors determining the outcome of the disease are earlydiagnosis and aggressive debridement.Materials and Methods: Cross-sectional descriptive study was conducted in a tertiary care teaching hospital’ssurgical ward. A total of 50 patients, diagnosed with necrotizing fasciitis based on the criteria set were includedin the study. After detailed clinical and laboratory evaluation, appropriate and adequate surgical and medicalinterventions were administered and were followed to note the outcome.Results: The majority of patients were over 40 years old and 74% of them were male. 72% of them had fever, 88% ofthem had tenderness. 68% of the patients had involvement of the lower extremities. Trauma was the predominanttriggering factor and diabetes, the most commonly associated predisposing disease present in 72% of patients.84% of the infections were polymicrobial and E. coli was isolated from 74% of them. 4 patients succumbed to thedisease and 6 patients needed amputations as a life-saving measure. Acidosis and hypoalbuminemia were themost common independent predictive factors for mortality. Once sepsis is overcome and the granulation tissue isformed, the wound is covered with an SSG or flap cover.Conclusion: The aggressive and destructive course of necrotizing fasciitis could lead to morbidity and mortality.Early recognition, aggressive debridement are the essential steps for recovery. Though broad-spectrum antibioticsstarted as empirical therapy to avoid the catastrophe of septic shock, appropriate antibiotics should be started asthe disease is often polymicrobial. Acidosis, truncallocation, leucocytosis and decreased albumin were found to befactors strongly associated with mortality.

Factors and a model to predict three-month mortality in patients with acute fatty liver of pregnancy from two medical centers

BackgroundAcute fatty liver of pregnancy (AFLP) is an uncommon but potentially life-threatening complication. Lacking of prognostic factors and models renders prediction of outcomes difficult. This study aims to explore factors and develop a prognostic model to predict three-month mortality of AFLP.MethodsThis retrospective study included 78 consecutive patients fulfilling both clinical and laboratory criteria and Swansea criteria for diagnosis of AFLP. Univariate and multivariate cox regression analyses were used to identify predictive factors of mortality. Predictive efficacy of prognostic index for AFLP (PI-AFLP) was compared with the other four liver disease models using receiver operating characteristic (ROC) curve.ResultsAFLP-related three-month mortality of two medical centers was 14.10% (11/78). International normalised ratio (INR, hazard ratio [HR] = 3.446; 95% confidence interval [CI], 1.324–8.970), total bilirubin (TBIL, HR = 1.005; 95% CI, 1.000-1.010), creatine (Scr, HR = 1.007; 95% CI, 1.001–1.013), low platelet (PLT, HR = 0.964; 95% CI, 0.931–0.997) at 72 h postpartum were confirmed as significant predictors of mortality. Artificial liver support (ALS, HR = 0.123; 95% CI, 0.012–1.254) was confirmed as an effective measure to improve severe patients’ prognosis. Predictive accuracy of PI-AFLP was 0.874. Area under the receiver operating characteristic curves (AUCs) of liver disease models for end-stage liver disease (MELD), MELD-Na, integrated MELD (iMELD) and pregnancy-specific liver disease (PSLD) were 0.781, 0.774, 0.744 and 0.643, respectively.ConclusionTBIL, INR, Scr and PLT at 72 h postpartum are significant predictors of three-month mortality in AFLP patients. ALS is an effective measure to improve severe patients’ prognosis. PI-AFLP calculated by TBIL, INR, Scr, PLT and ALS was a sensitive and specific model to predict mortality of AFLP.