Predictors Of Lethal Outcome Research Articles

Evaluation of systemic immune inflammation index as a predictor of lethal outcome in patients with thoracic empyema

Evaluation of systemic immune inflammation index as a predictor of lethal outcome in patients with thoracic empyema

Clinical Features and Predictors of Lethal Outcome in Tick-Borne Encephalitis: A Retrospective Study from Lithuania

Background. In Lithuania, the incidence rate of tick-borne encephalitis (TBE) increases and remains the highest in the whole Europe. Diverse clinical manifestations cause difficulties in diagnosing and treating this infectious disease. The aim of the study was to analyze clinical manifestations of the TBE and to indicate predictive variables for unfavorable outcome.
 Methods. A retrospective study of case histories of patients diagnosed with TBE and treated at the Vilnius University Hospital Santaros Klinikos in the years 2019-2021. Demographic variables, symptoms and clinical form of the disease, laboratory values, and aspects of treatment were recorded.
 Results. Six hundred and seven case histories were analyzed. Of these, 588 case histories were included in the final analysis. Men made up 56.97% of the population studied. The median age of the patients was 54 years (18-86). The median length of hospitalization was 9 days (1-50). Seventeen (2.89%) patients were immunized against TBE, the others were not immunized (401, 68.20%) or their immunization status was unknown (170, 28.91%). The most common symptoms were headache (509, 86.56%) followed by febrile fever (403, 68.54%), fatigue (400, 68.03%), and dizziness (394, 67.01%). The most prevalent clinical form of TBE cases was meningoencephalitis (387, 76.18%) followed by meningitis (88, 17.32%), meningoencephalomyelitis (29, 5.71%), and encephalitis (4, 0.79%). Patients with the meningoencephalomyelitic form of TBE less often had headache on admission, more often had diabetes, and had fewer lymphocytes in the CSF (all p<0.05). Six patients (1.02%) died. The latter patients were significantly older (71 vs. 53 years, p=0.003), had higher protein concentration and cytosis in the CSF (1.04 vs. 0.70 g/L, p=0.006 and 422 vs. 84 cells per milliliter, p=0.003, respectively), whereas the percentage of lymphocytes in the CSF was lower (62% vs. 81%, p<0.001). Univariate analysis showed that older age, absence of headache and fatigue, higher cytosis and percentage of neutrophils in the CSF may be prognostic variables for the lethal outcome of the disease. Multivariate analysis showed that the absence of fatigue and higher pleocytosis were significant predictors of unfavorable outcome.
 Conclusions. Clinical forms of TBE differ based on symptoms and laboratory values. Symptoms and laboratory results may prognose the outcome of the disease.

Machine learning prediction of in-hospital recurrent infarction and cardiac death in patients with myocardial infarction

Background and aimThe aim of the study is to identify statistical patterns in patients with myocardial infarction (MI) during hospitalization that allow predicting the development of acute conditions (recurrent myocardial infarction, cardiac death). MethodsWe identified 3471 episodes of patients treated with a diagnosis acute MI in Almazov National Medical Research Centre. For modelling we selected episodes with acute MI with cardiac surgery operations. Classical machine learning models were chosen as forecasting models: decision trees and ensembles based on them, logistic regression and support vector machine. ResultsThe important signs for predicting recurrent MI were the minimum values of hemoglobin, the echocardiography parameters end systolic volume and pulmonary regurgitation, and the minimum value of leukocyte level. Predictors of lethal outcome during hospitalization were advanced age, high values of leukocytes, low values of hemoglobin, high values of alanine aminotransferase. ConclusionThe obtained results make it possible to predict the development of a lethal outcome and re-infarction based on simple parameters that are easily available in clinical practice.

Features of the course of coronavirus infection in patients after thoracic and cardiac surgery

Objective: To study the features of the coronavirus infection course in cardiosurgical and thoracic patients to determine the factors potentially affecting the possibility of lethal outcome. To identify the predictors of fatal outcome based on the analyses of the features of the coronavirus infection course in this category of patients.Material and methods: During the analyzed period 80 patients from the departments of thoracic surgery and cardiac surgery were transferred to the infectious diseases department: 20 patients from the cardiac surgery department (CSD) – group 1; 60 patients from the thoracic surgery departments (TSD) – group 2. A control group number 3 consisting of 59 non-thoracic and non-cardiosurgical patients was also formed. According to the disease outcome the patients were divided into two groups: group 1 – fatal outcome, group 2 – recovery.Results: Out of 80 patients, lethal outcome was recorded in 25 cases: 22 patients of the thoracic profile (36% of the total number of transferred from this department) and 3 patients of the cardiosurgical profile (15% of the total number of those transferred from the cardiac surgery department). 20 out of 20 cardiac patients had been operated on the day before, 49 out of 60 thoracic patients also underwent surgery. 3 people from the group of non-operated patients transferred from departments of thoracic surgery died. Moreover, after pneumonectomy, fatal outcome was recorded in 7 out of 8 cases (87.5%).Conclusion: During the analyses of indicators it was revealed that the number of fatal outcomes in patients of the thoracic profile with COVID-19 infection is higher than of the cardiosurgical profile and in the infectious diseases department. Presumably, this is due to the fact that coronavirus infection affects the lungs to a greater extent, and in patients with a thoracic profile (in particular, those who have undergone resection interventions), the volume of the lung parenchyma is initially reduced. This is confirmed particularly by the highest percentage of fatal outcomes after pneumonectomy. Cardiosurgical patients after surgical interventions do not have a reduction in the functioning lung parenchyma, which creates an additional “reserve” for recovery. Moreover, men predominate among patients of the thoracic profile, with the survival rate lower in all groups compared to women. Patients transferred from thoracic departments showed higher rates of systemic inflammation, which indicates a more severe course of the viral infection and the possible development of complications.When analyzing the predictors of lethal outcome, the following factors were identified: male gender and, in general, a more severe course of a viral infection (low saturation, a high percentage of lung lesions on CT, more pronounced changes in laboratory screening). The studied factors are associated with a large number of fatal outcomes in thoracic and cardiac surgery patients. Among the factors that do not affect the prognosis are diabetes mellitus, stroke and myocardial infarction in history.Thus, patients diagnosed with coronavirus infection that developed after thoracic surgery had the most unfavorable prognosis. The revealed patterns are of interest for optimizing the routing of this category of patients in order to prevent coronavirus infection.

Cardiac Function Index as a Possible Target Parameter Hemodynamic Correction in Abdominal Sepsis (Pilot Study)

Aim of the study: to determine the predictive value of central hemodynamic parameters in relation to mortality and evaluate their potential acceptability for goal-directed therapy during days 1-4 of treatment in patients with sepsis.Material and methods. The results of investigation and treatment of 62 patients aged 50.9±2.13 years with abdominal sepsis were analyzed. The patient severity on admission to the intensive care unit was 13 [10-15] on the APACHE II scale, 8 [6.75-9.25] on the SOFA scale. Lethal outcome 15.6±1.4 days after admission occurred in 19 (31%) patients. Central hemodynamic parameters were studied by transpulmonary thermodilution according to the standard technique. Infusions and administration of sympathomimetic drugs were performed according to Sepsis-3 guidelines. Statistical analysis was performed using logistic regression and ROC analysis.Results. The median values of the main circulatory parameters during days 1-4 of sepsis treatment were within normal ranges. Cardiac index, afterload-related cardiac performance, global cardiac ejection fraction and cardiac function index were predictors of mortality at all stages of treatment. However, the first three parameters did not provide either sufficient model quality at the study stages or a stable cutoff value with acceptable sensitivity and specificity. The cardiac function index maintained good model quality (area under the ROC curve 0.708-0.753) and a stable cutoff value (≤5.75 to ≤5.81 min-1) with acceptable and balanced sensitivity and specificity of about 70% at all study stages.Conclusion. The cardiac index, afterload cardiac performance, global cardiac ejection fraction and cardiac function index during days 1-4 of intensive care of sepsis are predictors of lethal outcome. At the same time, only the cardiac function index maintains good model quality and consistent cut-off point value with acceptable sensitivity and specificity at all stages of the study. The feasibility of using the cardiac function index as one of the parameters of goal-directed therapy aimed at cardiovascular function improvement in sepsis needs further investigation.

Predictors of lethal outcome in patients with tuberculosis, resistance to rifampicin, and HIV infection

The objective : to identify and rank the predictors of lethal outcome in patients with tuberculosis resistance to at least rifampicin and concurrent HIV infection ( T B -R / HIV ). Subjects and methods. 130 cases T B -R / HIV notified in Rostov Region in 201 7-2 018 were included in an observational retrospective cohort study. Two cohorts were formed: cohort A consisted of 31 patients with a documented fatal outcome within 12 months after registration for treatment, cohort B included 99 patients didn't die at least during the first year after registration for treatment. At the first stage of the study, the statistical significance of differences of certain signs in patients of cohorts A and B was determined. The signs with confirmed statistical significance of differences were included in the second stage of the study, during which their sensitivity as predictors of lethal outcome was determined. For this, automated artificial neural networks were used. Results. The following can be used as predictors of lethal outcome for T B -R / HIV patients (in decreasing order of significance): homelessness (people who have no place of residence), addiction to alcohol or drugs, interruption of ant i- T B chemotherapy in the past, low body mass index, low hemoglobin level, including anemia (but not severe), low level of CD 4 T-l ymphocytes (the prognosis is especially unfavorable with less than 100 cell s/ μ l). The level of total protein may also be a potential predictor, however, the selection criteria for this indicator require further clarification.

Predictors of Progressive Course of Multifocal Atherosclerosis in Patients With Myocardial Infarction

Determination of clinical and instrumental predictors of progressive course of multifocal atherosclerosis (MFA) in patients one year after myocardial infarction (MI), initially having hemodynamically insignificant stenoses of carotid arteries. From database of patients with acute coronary syndrome treated in the Kemerovo Regional Clinical Cardiac Dispensary in 2009-2010 we selected for this study 141 patients with verified diagnosis of MI and hemodynamically insignificant lesions in the internal carotid artery (ICA) (stenosis up ≤ 55 %). All patients had coronary atherosclerosis verified on coronary angiography at admission because of MI. A multivariate analysis of possible predictors of the progressive course of multifocal atherosclerosis was made based on assessment of the development of cardiovascular complications (CVC) (death, MI, stroke and transient cerebral circulatory attacks [TIA]), as well as revascularizations and negative dynamics of parameters of color duplex scanning (CDS) of ICA during one year after MI. One year after MI the overall incidence of CVC was 16.3 % (n=23). Structure of registered events was as follows: death from MI 7.1 % (n=10), deaths from stroke 2.1 % (n=3) and other causes 2.1 % (n=3), non-fatal MI 5.0 % (n=7), non-fatal stroke / TIA 2.1 % (n=3), carotid revascularization 2.8 % (n=4), coronary revascularization 14.9 % (n=21). CDC of ICAs was repeated in 125 patients. There were 17 (13.6 %) cases of progression of carotid atherosclerosis in the form of de novo bilateral stenoses in 14 (11.2 %) patients, stenoses in the left and right ICA 1 patient and 2 patients, respectively. The following predictors of progression of atherosclerosis of cerebral arteries were identified: family history of cardiovascular diseases (CVD),ICA stenosis ≥45 %, baseline circular atherosclerotic plaque (ASP). Predictors of high risk of stroke were family history of CVD, history of stroke,ICA stenosis ≥45 %, heterogeneous hypoechoic ASP. As predictors of lethal outcome, we identified history of MI, high functional class of angina preceding the index MI, severe coronary vascular bed involvement (SYNTAX score >23), presence of any bilateral atherosclerotic lesion in ICAs, and heterogeneous hypoechoic ASP. Assessment of the contribution of adherence to therapy in the prognosis 1 year after hospital discharge was fulfilled in 125 alive patients. It allowed to conclude that patients with progression of atherosclerosis and nonfatal CVC were characterized by insufficient adherence to standard therapy. Predictors of the progressive course of multifocal atherosclerosis during one year after MI were identified in this study. It is necessary to strengthen therapeutic and preventive measures aimed at minimization of the impact of these factors in this category of patients.

The role of TNF-α superfamily members in immunopathogenesis of sepsis

BackgroundMembers of TNFα superfamily, A proliferation inducing ligand (APRIL), B-cell activating factor (BAFF) and Transmembrane activator and calcium cyclophylin interactor (TACI) are main regulators of B-cell function. The aim of this study was to evaluate concentrations of APRIL, BAFF and soluble TACI (sTACI) receptor in septic patients compared to healthy controls and compare concentrations of these biomarkers depending on sepsis severity and outcome. Materials and methodsA total of 115 septic patients and 30 healthy volunteers were included and concentrations of APRIL, BAFF and sTACI were determined in all subjects at the admission (ELISA R&D Systems tests). Concentrations of these biomarkers in function of sepsis severity (sepsis n = 94 and septic shock n = 21) and outcome (lethal n = 40, recovery n = 75) were tested, as well as correlations with APACHE II and SOFA scores, immunoglobulins, complement, PCT and CRP concentrations. ResultsConcentrations of all three biomarkers were significantly increased in septic patients compared to controls (AUCAPRIL = 0.982, AUCBAFF = 0.873, AUCsTACI = 0.683). Higher concentrations of APRIL and sTACI (p = 0.033, p = 0.037), and lower concentrations of BAFF (p = 0.005) were observed in patients with septic shock compared to sepsis. BAFF concentrations correlated positively with IgM, C3 and C4 levels. sTACI and APRIL were shown to be predictors of lethal outcome (p = 0.003, p = 0.049). ConclusionsConcentrations of observedTNFα superfamily members are significantly increased in septic patients, confirming their role in sepsis pathogenesis.Higher concentrations of anti-inflammatory sTACI receptor correlated with severity of sepsis and poorer prognosis, thus potentially indicating domination of anti-inflammatory response in septic patients with worse outcome.

DYNAMICS OF SYSTEMIC INFLAMMATORY RESPONSE MARKERS IN PATIENTS WITH URGENT CONDITIONS DEPEND-ING ON THE DEVELOPMENT OF SEPSIS

Background There is still no information on the dynamics of pro- and anti-inflammatory cytokines and mark-ers of the septic process before the clinical manifestation of sepsis. The aim of the study was to analyze the dynamics of inflammation and sepsis markers concentration in early periods in patients with urgent pathology, depending on the subsequently developed sepsis. Materials and methods. The concentration of procalcitonin, C-reactive protein, LBP, IL-6, IL-10, IL-2R in 61 patients with a high risk of sepsis was investigated starting from the first day after admission to the hospital and then with intervals of 3–5 days. The Group 1 included 29 patients with verified sepsis. All patients of this group survived. The Group 2 included 8 patients who died. The Group 3 included 24 patients who had no clinical signs of sepsis. All the patients in this group recovered. Results. We revealed significant differences in concentrations of systemic inflammatory response markers and its dynamics in the period preceding clinical manifestations of sepsis. It was found that it was possible to predict the development of sepsis and its unfavorable outcome with a high statistical probability in the study of paired samples of blood serum of patients received on day 1–3 and 4–6 from the onset of the disease or severe trauma. The predictors were multidirectional changes of IL-6, IL-10, LBP concentrations and more than three-fold IL-2R increase on the background of high concentrations of procalcitonin and C-reactive protein. Conclusion. The highest concentrations of procalcitonin, C-reactive protein, IL-10 and IL-2R were revealed within the first three days in patients who died of sepsis. High concentrations of IL-6 and IL-10 within first three days and different directions of their concentrations during the next 4–6 days indicate the development of sepsis with an unfavorable outcome. Reduction of IL-2R and IL-6 and an increase in IL-10 within the first week after the onset of the disease or trau-ma are predictors of lethal outcome.

Predictors of poor outcome in treatment of patients with pyoinflammatory otogenic and rinosinusogenic intracranial complications

OBJECTIVE. The authors would like to reveal preoperative and intraoperative predictors of lethal outcome in patients with otogenic and rhinosinusogenic pyoinflammatory intracranial complications. The study assessed an efficacy of specialized medical care of this category of patients. MATERIAL AND METHODS. Тhis research included 303 patients (199 (65,68 %) men and 104 (34,32 %) women) aged from 39,3 ± 17,4 years on average who underwent operation concerning intracranial pyoinflammatory oto- and rinosinusogenic complications in multidisciplinary hospitals of different subjects of the Russian Federation at the period from 2000 to 2014. RESULTS. Multiple logit regression analysis of predictors of lethal outcome showed the presence of higher number of factors and errors which influenced on treatment during preoperative period. These factors and errors caused an extension of preoperative period and increase of unfavorable outcome. CONCLUSIONS. While planning the management of primary and specialized care, doctors should take into account the identified predictors for patients of this category.

The level of free circulating mitochondrial DNA in blood as predictor of death in case of acute coronary syndrome

BackgroundThe efficacy of treating acute myocardial ischemic damages depends, to a large extent, on the development of technologies for predicting their course and outcome. The aim of this paper was to explore whether it would be possible to consider the content of free circulating mitochondrial DNA as a danger-associated molecular pattern for assessing the probability of death from myocardial infarction.MethodsWe have analyzed the clinical outcomes based on discharge summaries and autopsy reports obtained in the course of the PROTOCOL observational trial. This study was approved by the Irkutsk Scientific Center of Surgery and Traumatology ethics committee (protocol No. 3, 10.08.2015). To examine whether the assessment of the level of free circulating mtDNA in acute coronary syndrome can help predicting clinical outcomes, all patients were divided into two groups: group 1, involving those who survived during 30 days after hospitalization, and group 2, involving those who died during this time. A quantitative analysis of the free circulating mtDNA was conducted using the PCR method in situ.ResultsThe analysis showed that in patients who survived the level of freely circulating mtDNA (36.0 copies/ml) was 164 times lower than in those who died (5900 copies/ml, p = 0.049). It should be mentioned that according to the logistic regression analysis, the probability of death of patients with the increased level of blood plasma mtDNA (more than 4000 copies/ml) is 50%.ConclusionsThus, the PROTOCOL observational trial proved that the increase in the content of free circulating mtDNA in blood is a predictor of lethal outcome in patients with acute coronary syndrome.Trial registration The observational studies (those in which the assignment of the medical intervention is not at the discretion of the investigator) do not require registration.

Cardiac surgery in patients with chronic renal failure

Introduction/Objective. Patients with chronic renal failure (CRF) undergoing cardiac surgery are believed to have more postoperative complications and significantly higher mortality rate. The aim of the paper was to determine preoperative predictors of exacerbation of CRF and the outcome in patients with CRF submitted to cardiac surgery. Methods. A retrospective study included 169 patients hospitalized from 2012 to 2015 (age 67.71 ? 8.46 years, 72.3% male). The analysis included numerous perioperative characteristics. Results. Preoperative stage I CRF was present in 62 (37%), stage II in 77 (46%), and stage III?V in 30 (17%) patients. Exacerbation of CRF was registered in 37 (21.9%), and the lethal outcome in 16 (9.5%) patients. Stage II of CRF (odds ratio [OR] 4.76; 95% confidence interval [CI] 1.31?17.28; p = 0.018) and stage III?V of CRF (OR 11.39; 95% CI 2.87?45.14; p = 0.001) were designated as predictors for exacerbation of CRF following cardiac surgery. In patients with CRF stage I and II, multivariate analysis designated previous cerebrovascular insult (OR 3.36; 95% CI 1.04?10.93; p = 0.044) and ejection fraction ? 35% (OR 5.35; 95% CI 1.83?15.64; p = 0.02) as predictors for the exacerbation of CRF. The only predictor of postoperative dialysis requirement was higher stage of CRF (OR 5.81; 95% CI 1.22?27.81; p = 0.028). CRF stage III?V was a predictor of lethal outcome (OR 7.64; 95% CI 1.49?39.27; p = 0.015). Conclusion. Higher stage of CRF in patients submitted to cardiac surgery is a predictor of exacerbation of renal failure and the lethal outcome.

Severe Protein C Deficiency, Predictor of Lethal Outcome in Meningococcal Septicaemia

Severe Protein C Deficiency, Predictor of Lethal Outcome in Meningococcal Septicaemia