Predictor Of Death In Patients Research Articles

Predictors for mortality in patients with antineutrophil cytoplasmic autoantibody-associated vasculitis: a study of 398 Chinese patients.

Patients with antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) have high mortality despite the introduction of immunosuppressive therapy. We investigated factors associated with mortality of patients with AAV in a single Chinese cohort. A total of 398 consecutive patients with AAV diagnosed in our center were recruited. Clinical and laboratory data were collected retrospectively. The predictive values of variables associated with mortality were analyzed. During followup of a median duration 25.5 months (range 1-196 mo), 135 out of 398 patients (33.9%) died, with 83 deaths within the first 12 months after diagnosis. Independent predictors of all-cause mortality were age (p < 0.001), secondary infection (p < 0.001), pulmonary involvement of AAV (p = 0.012), and initial renal function (p = 0.001). Secondary infection was the leading cause of death (53/153, 39.3%) during the first year after diagnosis, while cardiovascular event was the leading cause of death (15/53, 28.8%) after 12 months from diagnosis. Independent predictors of secondary infection were age (p = 0.002), initial renal function (p = 0.041), lymphocyte counts in the peripheral blood (p = 0.03), and underlying pulmonary involvement of AAV (p = 0.001). Secondary infection is the overall leading cause and independent predictor of death in patients diagnosed with AAV. Cardiovascular event is a major cause of death during the late followup. Prudent monitoring should be given to patients of advancing age with renal dysfunction to reduce adverse events, especially infectious complications.

The combination of HTATIP2 expression and microvessel density predicts converse survival of hepatocellular carcinoma with or without sorafenib.

Our previous studies have demonstrated that sorafenib can promote the dissemination of hepatocellular carcinoma (HCC) through downregulation of HTATIP2, a suppressor of tumor growth and metastasis that is associated with inhibition of angiogenesis. Here, we investigated the predictive values of the HTATIP2 level and microvessel density (MVD) with or without sorafenib administration for HCC. Three independent cohorts were included. Using tissue microarray, we assessed the relationship between HTATIP2 expression/MVD and overall survival. The results showed that high HTATIP2 expression and a low MVD value were independent protective prognostic factors after curative HCC resection (297 cases/cohort 1); however, both parameters were converted to independent negative prognostic indicators for patients with postsurgical sorafenib treatment (69/143 cases/cohort 2; P<0.05 for all). This same relationship was observed in patients that received sorafenib treatment for advanced HCC (83 cases/cohort 3; efficacy measures and survival analyses, P<0.05 for all). Moreover, the combination of HTATIP2 and MVD had better power to predict patient death and disease recurrence (P<0.001 for both). We conclude that the combination of HTATIP2 and MVD predicts the converse survival of HCC with or without sorafenib intervention. Our findings can assist in the selection of candidates for personalized treatment with sorafenib.

RNA-Seq reveals strain-specific immune gene expression by epithelial cells infected with Mycobacterium tuberculosis strains of varying pathogenicity

Background: Sepsis isone of the major predictor of death in patients with visceral leishmaniasis(VL).However, there are currently no reliable data available on bacterial sepsis in VL patients in Ethiopia. This study aimed to assess the prevalence of bacterial sepsis, causative agents and their antimicrobial susceptibility patterns and focus of infection in patients with VL. Methods & Materials: A prospective cross sectional study was conducted among parasitologically confirmed VL patients suspected of sepsis admitted to University of Gondar Hospital, Northwest Ethiopia from February 2012 to May 2012.Sociodemographic characteristics and clinical manifestations were documented after patient interview and physical examination. Samples (blood, urine and others as indicated) were collected and culturedusing standard methods.Isolates were tested for antimicrobial susceptibility using the disc diffusionmethod.Data were entered and analyzed using SPSS version 20. Results: Most of the patients 81 (97.6%), 67 (80.7%), 75 (90.4%), 80 (96.4%) were febrile, tachycardic, tachypnic, and leukopenic, respectively. The prevalence of culture confirmed bacterial sepsis was 19.3% (16/83). The most frequently isolated organism was Staphylococcus aureus, accounting for 11/16 (68.8%) of cases. There was a concordance rate of 11/12 (91.6%) between bacterial isolates and their susceptibility pattern between focal infections and blood stream infections. The overall multiple resistance was 13/16 (81.3%). The highest rate of resistance was for ampicillin 11/11 (100%), and two were MRSA. Vancomycin, gentamicin and ceftriaxone were found to be effective against most isolates. Focal bacterial infection was showed significant association with bacterial sepsis (P =0.00; Odds ratio =11.65; 95% confidence interval 4.29-31.60). Factors such as sex, age, HIV status, 72 hour hospital staywere not associatedwith bacterial sepsis. Conclusion: The prevalence of culture confirmed bacterial sepsis was high, multiple drug resistant Staphylococcus aureus being the frequent isolate. Focal bacterial infections are potential sources for bacterial sepsis among VL patients. Therefore, clinicians should give emphasis to treat VL patients with focal bacterial infection before developing to sepsis. Rational use of antibiotics should be practiced in order tominimize the spread of drug resistant bacteria.

Impact of ventricular arrhythmias on survival in patients after myocardial infarction

Introduction: Despite the continuous development of new methods of pharmacological and invasive treatment for patients with acute myocardial infarction (MI) the prognosis of long-term survival is still uncertain. Therefore, there is still need to look for new noninvasive predictors of death in patients after MI. Aim: To analyze the prognostic value of ventricular arrhythmias in predicting mortality following MI in long-term follow-up. Methods: We analyzed 390 consecutive patients (114 females and 276 males, aged 63.9 ± 11.15 years, mean EF: 43.8 ± 7.9%) with MI treated invasively. On the 5th day after MI 24-hour digital Holter recording was performed to assess the number of premature ventricular beats (VPB) and their sustained forms such as: salvos and nonsustained ventricular tachycardia (nsVT &lt; 30 s). The large numbers of ventricular extrasystoles: ≥ 10 VPB / hour were considered as abnormal. In echocardiography the size of heart cavities and cardiac contractile function were evaluated. Within 30.1 ± 15.1 months of follow-up 38 patients died. Results: In the group of patients with MI the mean value of ventricular ectopy during the day was: 318.8 ± 1447.6. Large numbers of ventricular extrasystoles were observed in 75% patients, while nsVT in 6% patients. Significant differences in the incidence of death after MI were observed in patients with nsVT and ventricular salvos. In the group of patients who died in comparison to the group of patients who survived in long-term follow-up, a significantly less ventricular ectopic incidence was noted (9.83% vs 90.17%, p &lt; 0.01). In patients who died after MI more premature ventricular beats (≥ 10 VPB / h) and a greater nsVT incidence were observed; however not significant. Moreover, in patients with MI the systolic and diastolic LV dimension, decreased values of hemoglobin, salvos and nsVT incidence are the independent risk factors of death. The strongest independent risk factor of death after MI is salvos (HR: 1.32, P &lt; 0.01). Conclusions: In long term follow-up the largest differences in death were observed in patients with ventricular salvos and nsVT. Furthermore, ventricular salvos are the strongest independent risk factor of death in patients with AMI.

Heart rate variability, t wave alteration and prolonged qt interval as markers of arrhythmogenesis in patients with sleep apnea syndrome and arterial hypertension

Introduction Many researches have provided evidence supporting the associations between obstructive sleep apnea (OSA) with cardiovascular morbidity and mortality. But underlying mechanisms explaining these associations are not entirely delineated. Materials and methods Cross-sectional study of 58 patients, aged 45–65 years old, 29 males and 15 females with arterial hypertension, who underwent Holter ECG with rheopneumogram. Demographics, cardiovascular risk factors, heart rate variability, QT intervals, microvolt T wave alteration were examined. Patients were divided in three groups according to sleep apnea hypopnea index (AHI): group 1 (AHI n = 15), group 2 (AHI = 5–29, n = 12), group 3 (AHI > 30, n = 11). Control group – 20 patients without breath disturbances. Results Positive test on microvolt T wave alteration was found in 36.3 % patients with severe and 41.6 % moderate OSA and in 1 patients of control group. Decreased heart rate variability, predominating of sympathetic activity, rigid rhythm, transient prolonged QT interval especially at night were common for patients with severe and moderate OSA. Significant positive correlation was found between AHI and QT interval ( p = 0.03, r = 0.3), QTc interval ( p = 0.04, r = 0.5), negative correlation between AHI and SDNN ( p = 0.04, r = −0.3). Conclusion Decreased heart rate variability, predominating of sympathetic activity, prolonged QT interval and T wave alteration are important background for fatal arrhythmias and predictors of sudden cardiac death in patients with OSA. Acknowledgement Thank You for a possibility to deal with my modest research.

Clinical progression and predictors of death in patients with severe fever with thrombocytopenia syndrome in China

BackgroundSevere fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease of which the clinical progression and factors related to death are still unclear. ObjectiveTo identify the clinical progression of SFTS and explore predictors of fatal outcome throughout the disease progress. Study designA prospective study was performed in a general hospital located in Xinyang city during 2011–2013. Confirmed SFTS patients were recruited and laboratory parameters that were commonly evaluated in clinical practice were collected. The clinical progression was determined based on analysis of dynamic profiles and Friedman's test. At each clinical stage, the laboratory features that could be used to predict fatal outcome of SFTS patients were identified by stepwise discriminant analysis. ResultsTotally 257 survivors and 54 deceased SFTS patients were recruited and the data of 11 clinical and laboratory parameters along their entire disease course were consecutively collected. Three clinical stages (day 1–5 post onset, day 6–11 post onset and day 12 to hospital discharge) were determined based on distinct clinical parameters evaluations. Multivariate discriminant analysis at each clinical stage disclosed the indicators of the fatal outcome as decreased platelet counts at early stage, older age and increased AST level at middle stage, and decreased lymphocyte percentage and increased LDH level at late stage. ConclusionsThe significant indicators at three clinical stages could be used to assist identifying the patients with high risk of death. This knowledge might help to perform supportive treatment and avoid fatality.

Using Simple Imaging Markers to Predict Prognosis in Patients With Aortic Valve Stenosis and Unacceptable High Risk for Operation

Aortic valve stenosis (AS) in patients >75years of age is a challenge for diagnosis and management of every day clinical routine. Therefore, this clinical follow-up study aims to investigate predictors of death in patients with advanced stages of AS. In a single-center study, all patients (n= 157) with primary conservatively treated severe AS (mean age 78 ± 6years) were included. All patients had initially refused aortic valve replacement (AVR). During a median follow-up of 2.6 years (quartiles 1.7, 3.8), 62 patients with severe AS switched to AVR and 95 remained conservatively treated (no AVR). Routine clinical data were assessed together with conventional echocardiography including the measurement of longitudinal wall function and deformation (mitral ring displacement and longitudinal strain and strain rate imaging). The end points were all-cause and cardiac death. During follow-up, cardiac death occurred in 49% in no-AVR group. In a Cox regression analysis, New York Heart Association functional class, valvuloarterial impedance, stroke volume, longitudinal strain and strain rate, and mitral annular displacement identified an increased risk of all-cause death (hazard ratio [HR] for mitral annular displacement 15.9, 95% confidence interval [CI] 6.24 to 40.86, p <0.001, positive predictive value 91%). In contrast, ejection fraction or EuroSCORE was not predictive (ejection fraction: HR 1.3, 95% CI 0.82 to 2.33, p= 0.25; EuroSCORE: HR 1.1, 95% CI 0.64 to 2.02, p= 0.64). Furthermore, in multivariate regression analysis, only longitudinal mitral annular displacement and longitudinal strain rate was a significant predictor of all-cause and cardiac death risk. These data show that prognosis in elderly patients with AS is determined by symptoms, hemodynamics, and particularly by cardiac long-axis function. Thus, for risk stratification, a comprehensive assessment of cardiac function including the measurement of longitudinal mitral annular displacement should be considered.

Intratumoral α-SMA Enhances the Prognostic Potency of CD34 Associated with Maintenance of Microvessel Integrity in Hepatocellular Carcinoma and Pancreatic Cancer

Microvessel density (MVD) as an angiogenesis predictor is inefficient per se in cancer prognosis. We evaluated prognostic values of combining intratumoral alpha-smooth muscle actin (α-SMA)-positive stromal cell density and MVD after curative resection in hypervascular hepatocellular carcinoma (HCC) and hypovascular pancreatic cancer (PC). Tissue microarrays were constructed from tumors of 305 HCC and 57 PC patients who underwent curative resection and analyzed for α-SMA and CD34 expression by immunostaining. Prognostic values of these two proteins and other clinicopathological features were examined. Both low α-SMA density and high MVD-CD34 were associated in HCC with the presence of intrahepatic metastasis and microvascular invasion, and they were related to lymph node involvement and microvascular invasion in PC (p<0.05). Although CD34 alone, but not α-SMA, was an independent prognostic factor for overall survival and recurrence-free survival, the combination of low α-SMA and high CD34 was a predictor of worst prognosis for both types of tumors and had a better power to predict patient death and early recurrence (p<0.01). Furthermore, the results show that distribution of most of the α-SMA-positive cells and vascular endothelial cells overlap, showing major colocalization on vascular walls. Poor microvessel integrity, as indicated by high MVD, together with low perivascular α-SMA-positive cell coverage is associated with early recurrence, unfavorable metastasis, and short survival after tumor resection. This finding highlights the significance of vascular quality in tumor progression, which provides an optimized complement to vascular quantity in prognosis of postoperative patients.

Free triiodothyronine plasma levels: a strong predictor of death in patients with ST-elevation myocardial infarction?

Introduction: It is well known that mild thyroid hormone (TH) abnormalities are associated with a poor prognosis in patients with heart failure. Aim of the this study is to define the role of free triiodothyronine (fT3) levels as a predictor of mortality in patients with ST-elevation myocardial infarction. Methods: 846 patients (mean age: 65.4±12.5 years; males: 631, 74.7%) admitted for STEMI and undergoing early revascularization were enrolled. According fT3 plasma levels measured at arrival, our population was divided in two groups: Group A (n=425, 50.2%), characterized by fT3 levels 2.06 ng/L. Follow-up (mean: 25.6±18.3 months) started at hospital admission and was interrupted in the case of cardiac and non cardiac death. Results: Group A patients were older (67.4±12.1 vs 63.1±12.7years, P<0.0001), with higher BNP (2.2±0.6 vs 2.0±0.5 ng/L, P<0.0001) and TnI (48.2±77.3 vs 35.9±56.3 ng/mL) levels and lower ejection fraction (43.6±10.2 vs 45.6±8.9%, P<0.001). Cumulative survival was significantly reduced in group A patients (log-Rank test, P<0.001). At multivariate regression analysis fT3 levels <2.06 ng/L resulted the strongest predictor of all cause death (HR 2.74, P<0.01). Conclusions: fT3 dosage is a simple blood test that is often performed at hospital admission. As a predictor of mortality, it allows the identification of high risk STEMI patients, that might benefit from a strict surveillance and more aggressive medical therapy.

Scintigraphic perfusion abnormality and fragmented qrs predicts cardiac death in patients with non-ischemic left ventricular dysfunction

Background and aim: Recently, importance of fragmented QRS (fQRS) is recognized in patients with various cardiovascular diseases. Several reports showed that fQRS reflects myocardial scar and predicts outcome in patients with non-ischemic cardiomyopathy. Furthermore, some reports showed that Impaired myocardial perfusion on myocardial perfusion imaging (MPI) reflects myocardial fibrosis and is an important variable in predicting outcomes in patients with dilated cardiomyopathy. The aim of this study is to evaluate relationship between myocardial perfusion imaging (MPI) and fQRS and whether combination of MPI, and fQRS predicting outcome among patients with non-ischemic left ventricular dysfunction (LVD). Methods: We performed 201Tl myocardial scintigraphy and evaluated clinical parameters in 104 patients (61.5±14 years, 78 men) with LVEF<50% on echocardiography. fQRS included ≥ 1 notches in the R or S wave in at least 2 contiguous leads corresponding to a major coronary artery territory in case of QRS duration <120 msec or ≥ 2 notches in case of QRS duration≥120msec on standard 12-leads electrocardiogram. We calculated total defect score (201Tl-TDS) based on 17 segments model of SPECT images on a 5-point scale (0: normal to 4: defect) and assessed TDS (0 to 85). Thereafter patients were observationally followed-up. Cardiac death was reviewed retrospectively. Results: During 2.5±2.1 years of follow-up, cardiac death occurred in 11 patients. LVEF was significantly lower (p=0.033), Tl-TDS was significantly higher (p=0.022) in patients with f-QRS (n=55) than those in without f-QRS (n=49). Furthermore, Tl-TDS was significantly higher in patients with fQRS in ≥ 2 major coronary artery territories (n=28) than those in with fQRS in 1 territory (n=27, p<0.0001). Tl-TDS was one of the few clinical parameters related to presence of fQRS. Patients with fQRS showed significantly lower survival than those without fQRS by Kaplan-Meier analysis (Log-rank test p=0.017). 201Tl-TDS cut-off value was 18 for cardiac death (AUC 0.78, p< 0.0001). In patients with fQRS, patients with Tl-TDS≥18 showed significantly lower survival than those with TDS<18 by Kaplan-Meier analysis (Log-rank test p<0.0001). In multivariate analysis, presence of both fQRS and Tl-TDS≥18 was strongest predictor for cardiac death in patients with LVD (OR: 23.44, 95% CI: 4.34-203.9, p<0.0001) Conclusion: This study indicated that presence of fQRS related to severity of impaired myocardial perfusion on MPI and presence of both fQRS and impaired myocardial perfusion predicts poor prognosis in patients with non-ischemic LVD.

Trend of decreased incidence and mortality of right ventricular infarction in association with increased use of reperfusion therapy; results from over 30-year database of acute myocardial infarction

Purpose: Inferior myocardial infarction complicated by right ventricular infarction (RVI) is associated with a greater risk of in-hospital mortality and morbidity. However, it remains unclear whether the incidence of RVI and the mortality rate have been changed by evolving therapeutic strategies of early reperfusion therapy. We also evaluated the potential determinant for in-hospital death in those particular patients, who were characterized as low cardiac output syndrome, by using over 30-year database of 5894 acute myocardial infarction (AMI). Methods: Present study included a total of 1874 consecutive inferior AMI patients (M/F; 1464/410, age 66±12 [SD] years) who admitted to our institution between 1979 and 2011. We divided them into 3 groups in chronological order; 1st interval (n=490; 1979 to 1989), 2nd interval (n=600; 1990 to 2000) and 3rd interval (n=784; 2001 to 2011). Results: Over 30 years, the incidence of RVI decreased progressively (1st; 24.9%, 2nd; 16.7%, 3rd; 15.1%, P<0.001) in parallel with a progressive use of reperfusion therapy (1st; 3%, 2nd; 55%, 3rd; 79%, P<0.001) (Figure A). Among 340 patients with RVI, there was a progressive reduction in the mortality rate (1st; 12.4% to 3rd; 5.1%, P=0.04) with an increased use of reperfusion therapy (1st; 4% to 3rd; 97%, P<0.001) (Figure B). In multivariate analysis, no reperfusion (OR 1.6-12.0, P=0.002), previous infarction (OR 1.1-8.1, P=0.04), age ≥70years (OR 1.1-7.5, P=0.02) and Killip class ≥2 (OR 1.9-10.9, P<0.001) were the independent predictor for in-hospital death in patients with RVI. ![Figure][1] Figure 1. A. Incidence of RVI in inf-AMI. B. Mortality of RVI patients. Conclusion: These findings indicate that the incidence of RVI and its mortality rate decreased from 1979 to 2011 with greater use of reperfusion therapy. Patients complicating Killip class ≥2 left heart failure is one of the high-risk subsets of RVI. [1]: pending:yes

Hypertrophic cardiomyopathy: prognostic factors and survival analysis in 128 Egyptian patients

Hypertrophic cardiomyopathy is an important cause of disability and death in patients of all ages. Egyptian children may differ from Western and Asian patients in the pattern of hypertrophy distribution, clinical manifestations, and risk factors. The aim of our study was to report the clinical characteristics and outcomes of Egyptian children with hypertrophic cardiomyopathy studied over a 7-year duration and to determine whether the reported adult risk factors for sudden cardiac death are predictive of the outcome in these affected children. This retrospective study included 128 hypertrophic cardiomyopathy children. The data included personal history, family history, physical examination, baseline laboratory measurements, electrocardiogram, and Holter and echocardiographic results. Logistic regression analysis was used for the detection of risk factors of death. Fifty-one out of 128 patients died during the period of the study. Of the 51 deaths, 36 (70.5%) occurred in patients presenting before 1 year of age. Only eight patients had surgical intervention. Extreme left ventricular hypertrophy, that is, interventricular septal wall thickness or posterior wall thickness Z-score >6, sinus tachycardia, and supraventricular tachycardia were found to be independent risk factors for prediction of death in patients with hypertrophic cardiomyopathy. At our Egyptian tertiary care centre, hypertrophic cardiomyopathy has a relatively worse prognosis when compared with reports from Western and Asian series. Infants have a worse outcome than children presenting after the age of 1 year. A poorer prognosis in childhood hypertrophic cardiomyopathy is predicted by an extreme left ventricular hypertrophy, the presence of sinus tachycardia, and supraventricular tachycardia.

Predictors of outcome in acute encephalitis

To investigate predictors of outcome in patients with all-cause encephalitis receiving care in the intensive care unit. A retrospective analysis of encephalitis cases at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center was performed. Using multivariate logistic regression analysis, we examined mortality and predictors of good outcome (defined as modified Rankin Scale scores of 1-3) and poor outcome (scores 4 and 5) in those surviving to hospital discharge. In our cohort of 103 patients, the median age was 52 years (interquartile range 26), 52 patients (50.49%) were male, 28 patients (27.18%) had viral encephalitis, 19 (18.45%) developed status epilepticus (SE), 15 (14.56%) had cerebral edema, and 19 (18.45%) died. In our multivariate logistic regression analysis, death was associated with cerebral edema (odds ratio [OR] 18.06, 95% confidence interval [CI] 3.14-103.92), SE (OR 8.16, 95% CI 1.55-43.10), and thrombocytopenia (OR 6.28, 95% CI 1.41-28.03). Endotracheal intubation requirement with ventilator support was highly correlated with death (95%). In addition, in those patients who survived, viral, nonviral, and unknown causes of encephalitis were less likely to have a poor outcome at hospital discharge compared with an autoimmune etiology (viral encephalitis: OR 0.09, 95% CI 0.01-0.57; nonviral encephalitis: OR 0.02, 95% CI 0.01-0.31; unknown etiology: OR 0.18, 95% CI 0.04-0.91). Our study suggests that predictors of death in patients with encephalitis comprise potentially reversible conditions including cerebral edema, SE, and thrombocytopenia. Further prospective studies are needed to determine whether aggressive management of these complications in patients with encephalitis improves outcome.

An Integrated Clinico-Metabolomic Model Improves Prediction of Death in Sepsis

Sepsis is a common cause of death, but outcomes in individual patients are difficult to predict. Elucidating the molecular processes that differ between sepsis patients who survive and those who die may permit more appropriate treatments to be deployed. We examined the clinical features and the plasma metabolome and proteome of patients with and without community-acquired sepsis, upon their arrival at hospital emergency departments and 24 hours later. The metabolomes and proteomes of patients at hospital admittance who would ultimately die differed markedly from those of patients who would survive. The different profiles of proteins and metabolites clustered into the following groups: fatty acid transport and β-oxidation, gluconeogenesis, and the citric acid cycle. They differed consistently among several sets of patients, and diverged more as death approached. In contrast, the metabolomes and proteomes of surviving patients with mild sepsis did not differ from survivors with severe sepsis or septic shock. An algorithm derived from clinical features together with measurements of five metabolites predicted patient survival. This algorithm may help to guide the treatment of individual patients with sepsis.

Poor performance status is a strong predictor for death in patients with smear-positive pulmonary TB admitted to two Japanese hospitals

Estimation of performance status (PS) has been assessed as a tool to determine which patients with newly diagnosed pulmonary TB (PTB) are most at risk of dying. This simple prediction rule has not been validated in patients with PTB with different background characteristics and from different geographic areas. A retrospective cohort study was conducted in two Japanese hospitals in different regions and included 432 inpatients with newly diagnosed smear-positive non-multidrug-resistant lung TB without HIV infection. The patients had a mean ± SD age of 64.9 ± 19.7 years and 135 were female (31.3%). Detailed nursing charts were reviewed to estimate PS, which was graded 0 (best condition), 1, 2, 3 or 4 (worst condition), for each patient. Single variable and multivariable Cox regression analyses models revealed that a one-point increase in PS was associated with a 2.8-fold (95% CI 2.2-3.6) and 2.3-fold (95% CI 1.8-3.0), adjusted for age, gender, comorbidities and treatment regimen, increase in the HR for death (p < 0.001 for both models). Kaplan-Meier curves also showed a significant difference in mortality among different PS groups (p < 0.001). PS was strongly associated with mortality from PTB in the study cohort. Estimation of PS at the start of treatment for newly diagnosed PTB patients could be a useful tool in case management in resource-limited countries.

Mean platelet volume and its prognostic value in acute coronary syndrome complicated by cardiogenic shock

Elevated mean platelet volume (MPV) has been recently discussed as a predictor of death in patients with acute coronary syndrome (ACS), but the cut-off point of MPV in relation to poor prognosis has not been estimated so far. The aim of this study was to evaluate MPV and its prognostic value in ACS complicated by cardiogenic shock (CS). Such an analysis in patients with the most serious and fatal complication of ACS has not been performed inpreviously published research. Fifty three patients with ACS complicated by CS (age 68.9 ± 11.4, 49% women, 92% STEMI, 55% fatal CS) and 53 age- and gender-matched patients with uncomplicated ACS as a control group (age 69.1 ± 10.6, 49% women, 92% STEMI, 0% fatal) were included in our prospective study from 2010 to 2012. All the patients underwent successful primary percutaneous coronary intervention. MPV was determined on admission (MPV1) and in consecutive two days of hospitalization (MPV2, MPV3). The blood sample was analyzed immediately after collection in EDTA tubes using an automatic blood counter. MPV1 was similar in both groups (8.91 ± 1.11 fl vs. 8.57 ± 0.74 fl, NS). Furthermore, there were no statistically significant differences in MPV value in fatal and nonfatal CS(8.90 ± 1.18 fl vs. 8.93 ± 1.05 fl, NS). The above results suggest that MPV cannot be considered a predictor of poor in-hospital outcome in patients with ACS complicated by cardiogenic shock.

Comparison of CURB-65 and CRB-65 as predictors of death in community-acquired pneumonia in adults admitted to an ICU

Community-acquired pneumonia is one of the most common causes of sepsis and ICU admissions. Patients with CAP who demand critical care had mortality rates of 25 to 50%. Thereby, the assessment of the severity is essential to guide the treatment. There are several severity scores for CAP and some of the most acknowledged are CURB-65 and CRB-65. The objective of this study was to evaluate the accuracy of CURB-65 and CRB-65 as predictors of death in patients with community-acquired pneumonia.

Prehospital ECG signs of acute coronary occlusion are associated with reduced one-year mortality

We wanted to evaluate predictors of direct admittance to a coronary care unit (CCU) and predictors of death in patients with suspected acute coronary syndromes (ACS). During 2004-2007, all consecutive prehospitally triaged patients with suspected ACS were prospectively included. Prehospital and emergency data were collected at point of care. Data from medical records, ECG-, echocardiography- and laboratory databases was collected retrospectively. In all, 2757 patients were included. Out of these 858 were directly admitted to the CCU or cath/lab. Predictors for direct admittance to the CCU were ST-segment elevation on the initial ECG; odds ratio (OR) 46.11, left bundle branch block; OR 3.30, ongoing symptoms; OR 2.90, current smoking; OR 2.18 and ST-segment depression; OR 2.05. Independent predictors for 1-year mortality were cardiogenic shock; OR 14.40, increasing age OR (per year) 1.08, diabetes; OR 2.09 and chronic heart failure; OR 1.67. ST-segment elevation was associated with a lower 1-year mortality rate; OR 0.52. Among patients with a suspected ACS, prehospital ECG-signs indicating an acute coronary occlusion were not only a predictor for direct admission to acute coronary care but also a predictor for increased survival. To improve future outcome in acute ischemic heart diseases we must find and treat not only the STEMI's but also the high-risk NSTEMIs that otherwise would have a poor prognosis.

Predicting short term mortality after investigation for venous thromboembolism

IntroductionDeaths following diagnosis of venous thromboembolism (VTE) often result from another concurrent illness. The specificity of mortality markers predicting death from pulmonary embolism is unknown. The aim of this analysis was to compare blood predictors of death in patients with confirmed VTE to patients with negative investigations for VTE. Materials and methodsConsecutive patients investigated for VTE were prospectively consented from a single hospital over 9months. VTE was diagnosed and excluded with a standard diagnostic algorithm. Blood was drawn for biomarker analysis and analyzed in batches for NT-proBNP, high sensitivity troponin T, C-reactive protein (CRP), fatty acid binding protein (FABP) and ischemia modified albumin (IMA). Participants were followed for 3months. The cohort was analyzed in two groups: those diagnosed with VTE and those who had thrombosis excluded. Regression analysis for 3-month mortality was performed for each group. Results16/153 patients diagnosed with VTE died within three months (10.5%) as did 23/606 patients who had negative investigations for VTE (3.8%). Predictors for death following VTE included cancer, NT-proBNP, troponin T, FABP, and Hb<95g/L. NT-proBNP>500pg/ml in acute cancer associated VTE predicted death with C-statistic of 0.89 (0.80-0.99). Cancer, NT-proBNP and troponin T also predicted death in patients with negative investigations for VTE. ConclusionSeveral blood markers are not specific for death from PE and may be surrogate markers of global declining health.

Comparison of the Seattle Heart Failure Model and Cardiopulmonary Exercise Capacity for Prediction of Death in Patients With Chronic Ischemic Heart Failure and Intracoronary Progenitor Cell Application

Despite many therapeutic advances, the prognosis of patients with chronic heart failure (CHF) remains poor. Therefore, reliable identification of high-risk patients with poor prognosis is of utmost importance. Cardiopulmonary exercise testing (CPET) provides important prognostic information by peak O2 uptake (peak VO2 ), maximal oxygen pulse (O2 Pmax), O2 uptake efficiency slope (OUES), and VE/VCO2 slope (VE/VCO2 ). A different approach for prognostic assessment is the Seattle Heart Failure Model (SHFM), which is based on clinical data and calculates the estimated annual mortality. Comparison of the prognostic value of the Seattle Heart Failure Score and cardiopulmonary excercis testing in patients with chronic heart failure. One hundred fifty-seven patients with ischemic heart failure and recent intracoronary progenitor cell application were analyzed for mortality during a follow-up of 4 years. CPET (peak VO2 , O2 Pmax, OUES, VE/VCO2 ) was performed in all patients at baseline. The SHFM score was calculated for every patient, with data obtained at the time of CPET. During follow-up, 24 patients died (15.2%). Nonsurvivors had significantly worse initial CPET results and a higher SHFM score compared to survivors. Receiver operating characteristics curve analysis of sensitivity and specificity revealed the largest area under the curve value for the SHFM score, followed by VE/VCO2 slope. Kaplan Meier analysis using cutoff points of SHFM and VE/VCO2 slope with highest sensitivity and specificity resulted in significant discrimination of survivors and nonsurvivors. By multivariate analysis, only the SHFM score persisted as independent predictor of mortality in these patients. These data indicate superior prognostic power of the SHFM score compared to CPET in patients with chronic ischemic heart failure.