Predictor Of Higher Mortality Research Articles

The risk of child and adolescent mortality among vulnerable populations in Rio de Janeiro, Brazil.

This study investigated the importance of socioeconomic factors such as education, income, religion, family structure and residence in explaining the increased risk of mortality among vulnerable populations aged less than 20 years in Rio de Janeiro, Brazil. Data used were from the 1991 Brazilian Demographic Census and comprised 121,060 women aged 15-49 residing in Rio de Janeiro. Two alternative statistical methods were used to calculate the risk of death: the widely used Brass method (an indirect estimate which assesses population risks) and a case-control study (which assesses individual risks). The study also focused on the importance of indicators of human and social capital, the lack of which may explain the higher risk of death among children and adolescents. Lack of education was found to be a major determinant of mortality at young ages. Residence in a favela (shantytown), families in which mothers were the head of the family, and a lower median level of income were found to be significant determinants of mortality among vulnerable populations in Brazil. However, religion was not found to be as important a predictor of high mortality.

Influence of associated valvular lesions on long-term prognosis of mitral stenosis A 20-year follow-up of 202 patients

Other valvular lesions associated with pure MS were studied in 202 consecutive patients whose mean age was 43.4 +/- 12.7 years; 76.7% were females. MS was isolated in 63.4%, associated with aortic regurgitation (AR) in 27.7%, aortic stenosis in 1.0%, tricuspid stenosis (+aortic valve lesion) in 1.0%. In isolated MS, 42.4% were NYHA class III or IV, compared with 49.0% in MS + aortic valve lesion. One hundred and sixty-nine (85.4%) patients were operated on; 23.1% had mitral valve replacement, 76.9% had closed (31.4%) or open (45.6%) mitral commissurotomy; 7.1% had associated aortic valve replacement. There were perioperative complications in 20.4%, and the perioperative death rate was 4.1%. Two patients were reoperated in the postoperative course, and 28 patients after this period. The follow-up was 13.3 +/- 4.5 years. The survival rate was 77.7 +/- 4.6% (SE) for isolated MS, and 71.1 +/- 6.3% for MS associated with an aortic valve lesion (NS). The prognosis of MS is very good: the survival rate at 20 years follow-up is 75%. The association of aortic stenosis or tricuspid stenosis does not appear to alter this survival, but numbers are small. Important aortic regurgitation is a significant predictor of higher mortality in patients with MS.

Hypermagnesemia and hypocalcemia as predictors of high mortality in critically ill pediatric patients

Ca and Mg are biologically important minerals that are involved in maintaining the stability of membranes, muscle contractions, and enzyme activity in nearly all cells. Derangements of Ca and Mg homeostasis can precipitate serious and life-threatening problems in the critically ill patients. We examined serum ionized Ca and Mg levels in pediatric patients consecutively admitted to a pediatric ICU. Abnormal Mg and ionized Ca levels on admission were found in 43.3% and 17% of the patients, respectively. Hypocalcemia and hyper-magnesemia were both associated with poor outcome as measured by either survival or length of ICU stay. In addition, ionized Ca levels could not be predicted from total Ca measurement either alone or in combination with serum albumin and pH.

Hypothyroxinemia in Critically III Patients as a Predictor of High Mortality

Thyroid function was measured in 86 patients hospitalized in an intensive care unit. Two patients were found to have primary hypothyroidism and were excluded from the study. Hypothyroxinemia with normal thyroid-stimulating hormone (TSH) levels was found in 22% of the patients and was associated with a high mortality (thyroxine [T4] levels less than 3.0 micrograms/dL, 84% mortality; T4 levels of 30 to 5.0 micrograms/dL, 50% mortality; and T4 levels greater than 5.0 micrograms/dL, 15% mortality). There was a high correlation between low T4 levels and mortality.

Hypothyroxinemia in critically ill patients as a predictor of high mortality

Thyroid function was measured in 86 patients hospitalized in an intensive care unit. Two patients were found to have primary hypothyroidism and were excluded from the study. Hypothyroxinemia with normal thyroidstimulating hormone (TSH) levels was found in 22% of the patients and was associated with a high mortality (thyroxine [T₄] levels less than 3.0 μg/DL, 84% mortality; T₄levels of 3.0 to 5.0 γg/DL, 50% mortality; and T₄levels greater than 5.0 γg/DL, 15% mortality). There was a high correlation between low T₄levels and mortality. (<i>JAMA</i>1981;245:43-45)