Predictors Of Fatal Outcome Research Articles

Predictors of Death in Comorbid Patients with Thrombotic Complications: a Single-Center Retrospective Cross- Sectional Study

INTRODUCTION. Despite the improvements and success in the management of thrombosis, the prognosis of thrombotic complications in comorbid patients remains extremely unfavorable. Understanding this problem suggests that it is rational to pay more attention to the prevention of thrombosis in order to avoid thrombotic complications in the first place, and there is an urgent need to improve the ability to predict the development of complications and, most importantly, death. Therefore, some inexpensive, but effective methods of risk assessment need to be developed and integrated in clinical practice. AIM OF STUDY. To assess which laboratory markers can be associated with higher probability of fatal outcome in patients with thrombotic complications. MATERIAL AND METHODS. The retrospective cross-sectional study included 283 patients who were admitted to the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2021. Minimum age was 21 years, maximum age was 96 years, median age – 68 (59,0; 76,5) years. 161 (56,9 %) patients were males, 122 (43,1 %) – females. Group I included 226 patients with thrombotic complications; Group II included 57 (20,1 %) patients who died during hospitalization. The patients were diagnosed with the following thrombotic complications: pulmonary embolism (PE) was diagnosed in 28 (9.9 %), acute coronary syndrome with ST segment elevation in 38 (13.4 %), arterial thrombosis in 84 (29.7 %), venous thrombosis in 54 (19.1 %), thrombophlebitis in 22 (7.8 %), and systemic thromboembolism in 7 (2.5 %) patients. RESULTS. It was established that the decrease in the estimated glomerular filtration to the levels of stage 3 (and lower) chronic kidney disease (AUC — 0,881, sensitivity — 86.92 %, specificity — 85.71 %), hemoglobin level — to less than 120 g/L (AUC — 0,690, sensitivity — 77,21 %, specificity — 55,1 %), as well as hypoalbuminemia (AUC — 0,905, sensitivity — 78,89 %, specificity — 91,18 %) statistically significantly increased the likelihood of death by 19 (OR 19.276, 95 % CI [7,792–47.687], p < 0.001), 4 (OR 4.158, 95 % CI [2.177–7.939], p < 0.001), and 30 (OR 30,000, 95 % CI [9.93–90,610], p < 0.001) times, respectively. The statistical analysis using the univariate logistic regression model revealed that such diseases as coronary artery disease (OR 8,6, 95 % CI [2,6–28,466], p < 0.001), chronic heart failure (CHF) (OR 13,714, 95 % CI [4,784–39,313], p < 0.001), atrial fibrillation (OR 3,455, 95 % CI [1,830–6,525], p < 0.001), type 2 diabetes (OR 2.5, 95 % CI [1,286–4,858[, p = 0.007), postinfarction cardiosclerosis (OR 3,734, 95 % CI [1,953–7,142], p < 0.001), and previous stroke (OR 3,319, 95 % CI [1,519–6,490], p = 0.002) made an independent contribution to death prediction. During the study, we calculated the patients’ serum albumin-to-creatinine ratio (sACR). ROC analysis revealed a cut-off point for sACR to be 0.33 g/mmol as having the best predictive ability of death (AUC — 0.920, 84.3 % sensitivity, 85.29 % specificity). It was established that sACR less than 0.33 g/mmol increased the probability of death by 26 times (OR 26.3806, 95 % CI [9.4573.57], p < 0.001). CONCLUSION. Serum albumin-to-creatinine content ratio can be used as a predictor of fatal outcome in comorbid patients with thrombotic complications.

Delayed deaths in near-hanging cases: An autopsy study of causes and associated factors

BACKGROUND: Near-hanging refers to individuals who survive a hanging injury for various durations. However, hospitalized patients succumb to complications resulting in delayed deaths.
 AIM: to evaluate various factors associated with causes of delayed death in near-hanging events and provide insight into the improvement of emergency services.
 MATERIALS AND METHODS: A prospective autopsy-based study was conducted at the Department of Forensic Medicine, M.S. Ramaiah Medical College, between 2012 and 2021. All near-hanging cases of hospitalized patients who later succumbed to complications and were subsequently subjected to medicolegal autopsy were included in the study.
 RESULTS: Victims were commonly women aged 19–30 years. More than half of them could reach the hospital within 30 min to 1 hour, and 47.8% of them were suspended for between 1–3 min. Moreover, 65% survived for more than a day. Partial hanging with a faint ligature mark was more common, and 95.7% of them had taken off from a platform with a falling height of 1 metre. Cerebral edema and consolidation were the common postmortem findings in the brain and lungs. Death was attributed to hypoxic encephalopathy in the majority of the cases.
 CONCLUSION: Longer the duration of suspension, higher fall height, noncontact with the ground while being suspended, cerebral edema, hypoxia, pulmonary edema, hypotension, and need for resuscitation are predictors of fatal outcomes in near-hanging events.

Predictors of Fatal Outcome in Hospitalised Adult Patients with Acute Kidney Injury at Two Tertiary Hospitals in Sub-Saharan Africa

Predictors of Fatal Outcome in Hospitalised Adult Patients with Acute Kidney Injury at Two Tertiary Hospitals in Sub-Saharan Africa

Biomarkers — predictors of mortality in patients with ischemic stroke

BACKGROUND: Stroke is a global health problem and the second leading cause of death worldwide, with ischemic stroke accounting for the majority of acute cerebrovascular accidents. Predicting outcomes in patients with ischemic stroke is challenging due to the limited prognostic performance of existing models. The lack of reliable and predictive biomarkers of ischemic stroke used in clinical practice provides a rationale for studies to address this issue.
 AIM: The aim of this study was to identify clinical, demographic, neuroimaging and molecular biomarkers of ischemic stroke associated with the fatal outcome of the disease.
 MATERIALS AND METHODS: We retrospectively analyzed cases of ischemic stroke confirmed by computed tomography of the brain with a duration of 3 months or less. As factors potentially related to the outcome of ischemic stroke, we considered (1) clinical and demographic characteristics, including sex, age, history of acute cerebrovascular accident, time from stroke to hospitalization, phase and type of stroke, neurological status on admission (level of consciousness, FOUR coma scale), comorbidities (diabetes mellitus, infectious complications, oncological diseases); (2) molecular biomarkers including blood glucose and neuron-specific enolase (NSE) levels at different phases of stroke; (3) neuroimaging biomarkers such as number and location of stroke lesion, total infarct volume, signs of edema, hemorrhagic component according to computed tomography.
 RESULTS: 38 patients with ischemic stroke were included in the study. Lesion volume was larger in non-survivors: 123 [44.6–206.2] versus 42.7 [8.2–88.7] ml3 (p=0.032), and cerebral edema was detected significantly more often on admission CT scan than in survivors: 7 (77.8%) versus 10 (34.5%), p=0.022. Stroke lesion volume was a predictor of mortality (AUC 0.739; 95% CI 0.542–0.937; p=0.032). The optimal cut-off for stroke lesion volume was found to be 90 ml3.
 CONCLUSION: Signs of edema/brain stem dislocation and cerebral lesion volume 90 ml3 documented at hospital admission are predictors of fatal outcome. Therefore, neuroimaging biomarkers can be used for risk stratification of fatal outcome in ischemic stroke patients.

Pulmonary vasculitis in Behçet's disease: reference atlas computed tomography pulmonary angiography (CTPA) findings and risk assessment-management proposal.

Pulmonary artery aneurysms (PAAs) are the most well-defined type of pulmonary vascular complication in Behçet's disease (BD).The aim of this study is to analyze which CT pulmonary angiography (CTPA) signs are associated with serious morbidity and mortality. The study included 42 BD patients with pulmonary vascular complications. All patients' medical records were reviewed retrospectively in terms of demographics, disease characteristics, laboratory investigations, pulmonary manifestations, arterial and/or venous thrombosis and CTPA vascular and parenchymal findings. Deep venous thrombosis was observed in 31(73.8%) patients, arterial thrombosis in 13(31%), peripheral arterial aneurysms in 12(286%), haemoptysis in 38 (90.5%), and fatal haemoptysis in 8(19 %) patients. CTPA revealed: in situ thrombosis in 14(33.3%) patients, true stable PAAs in 13(31), true unstable PAAs in 11(26.2%), stable pulmonary artery pseudoaneurysms (PAPs) in 7(16.7%), unstable PAPs in 17(40.5%), the latter were associated with perianeurysmal leaking in 26(61.9%) and bronchial indentation in 19(45.2%).In regression analysis, fatal outcomes were associated with age in years (p=0.035), arterial thrombosis (p=0.025), peripheral arterial aneurysms (p=0.010), intracardiac thrombosis (p=0.026) and positively associated with haemoptysis severity (p<0.001). Peripheral arterial thrombosis and/or aneurysms, intracardiac thrombosis and haemoptysis severity are predictor of fatal outcomes in BD pulmonary vasculitis. PAPs with perianeurysmal alveolar haemorrhage and/or bronchial indentation are serious CTPA signs that require prompt identification and aggressive treatment. PAPs are a more serious aneurysmal pattern than true PAAs because they are a contained rupture of a PA branch in the context of pulmonary vasculitis.

Predictors of Fatal Outcome after Incident of Stroke among Patients from Three Hospitals in Kinshasa, Democratic Republic of the Congo

Predictors of Fatal Outcome after Incident of Stroke among Patients from Three Hospitals in Kinshasa, Democratic Republic of the Congo

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.

Clinical characteristics and outcomes of COVID-19 in kidney transplant recipients

Introduction. The pandemic caused by the SARS-CoV-2 coronavirus is characterized by significant morbidity and mortality. Kidney transplant recipients are at high risk of a more severe course of coronavirus infection due to ongoing immunosuppression, a high comorbidity index, and elder age.Aim. To investigate the features of the clinical course, the treatment applied and also the outcomes of the new coronavirus infection in patients after kidney transplantation.Material and methods. The retrospective study included 69 adult kidney transplant recipients continuously followed-up by our transplant nephrology service and who fell ill with COVID-19 from April 2020 till February 2021. The comparison study of the clinical pattern, laboratory and instrumental test results, treatment features and outcomes was made.Results. The most common clinical symptoms were hyperthermia (85.5%, n= 59), weakness (65.2%, n=45) and cough (52.2%, n=36), other symptoms were significantly less common. In 89.5% of cases (n=60), the virus ribonucleic acid was detected at least once by polymerase chain reaction; in 10.5% of cases (n=7), the polymerase chain reaction results were negative. According to CT, the extent of lung tissue lesion was identified as CT1 stage in 28 patients (46.7%), CT2 stage in 24 (40%); and only in 8 (13%) patients the lesion was assessed as CT3. Later on the number of patients with more than 50% lung damage increased to 16 (26.7%) and in 1 case the severity of lung tissue damage was consistent with CT4. Typical features for all patients were anemia and lymphopenia of varying severity, hypoproteinemia, increased serum creatinine and urea, C-reactive protein, ferritin, procalcitonin and D-dimer in the laboratory test results. The treatment included antiviral, antibacterial, anticoagulant therapy, corticosteroids, biological anti-cytokine drugs. In 95% of cases (n=66), the maintenance immunosuppressive therapy was changed up to complete withdrawal of the certain components. The patient survival rate with a functioning graft was 76.8% (n=53), the graft loss was observed in 4.3% of cases (n=3), and the lethal outcome was reported in 18.8% (n=13). The cause of death was a severe respiratory distress syndrome with multiple organ dysfunction complicated by sepsis and septic shock in 8 patients (61.5%). Invasive ventilation and hemodialysis were associated with 17.2 (p&lt;0.00001) and 21.5 (p&lt;0.0006) times higher risk of death, respectively.Conclusions. Severe lymphopenia is associated with a clinical worsening of the COVID-19 course. Predictors of fatal outcome were identified as follows: bacterial sepsis, invasive ventilation, the need for renal replacement therapy (p&lt;0.00001). Immunosuppression adjustment should be personalized considering the severity of infection, age, comorbidities, post-transplant timeframe, and the risk of rejection.&gt;&lt;0.00001). Immunosuppression adjustment should be personalized considering the severity of infection, age, comorbidities, post-transplant timeframe, and the risk of rejection.

In-hospital Outcomes of Infective Endocarditis from 1978 to 2015: Analysis Through Machine-Learning Techniques

BackgroundEarly identification of patients with infective endocarditis (IE) at higher risk for in-hospital mortality is essential to guide management and improve prognosis. MethodsA retrospective analysis was conducted of a cohort of patients followed up from 1978 to 2015, classified according to the modified Duke criteria. Clinical parameters, echocardiographic data, and blood cultures were assessed. Techniques of machine learning, such as the classification tree, were used to explain the association between clinical characteristics and in-hospital mortality. Additionally, the log-linear model and graphical random forests (GRaFo) representation were used to assess the degree of dependence among in-hospital outcomes of IE. ResultsThis study analyzed 653 patients: 449 (69.0%) with definite IE; 204 (31.0%) with possible IE; mean age, 41.3 ± 19.2 years; 420 (64%) men. Mode of IE acquisition: community-acquired (67.6%), nosocomial (17.0%), undetermined (15.4%). Complications occurred in 547 patients (83.7%), the most frequent being heart failure (47.0%), neurologic complications (30.7%), and dialysis-dependent renal failure (6.5%). In-hospital mortality was 36.0%. The classification tree analysis identified subgroups with higher in-hospital mortality: patients with community-acquired IE and peripheral stigmata on admission; and patients with nosocomial IE. The log-linear model showed that surgical treatment was related to higher in-hospital mortality in patients with neurologic complications. ConclusionsThe use of a machine-learning model allowed identification of subgroups of patients at higher risk for in-hospital mortality. Peripheral stigmata, nosocomial IE, absence of vegetation, and surgery in the presence of neurologic complications are predictors of fatal outcomes in machine learning–based analysis.

B-Type Natriuretic Peptides and High-Sensitive Troponin I as COVID-19 Survival Factors: Which One Is the Best Performer?

Increased concentrations of B-type natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin I (HsTnI) in COVID-19 patients have already been reported. The aim of this study is to evaluate which of these common markers of cardiac disease is the most useful predictor of fatal outcome in COVID-19 patients. One hundred and seventy-four patients affected with COVID-19 were recruited, and markers of cardiac disease and the clinical history of the patients were collected at admission in the infectious disease unit or intensive care unit. NT-proBNP, BNP and HsTnI values were higher in in-hospital non-surviving patients. Receiver operating characteristic (ROC) curve analysis of NT-proBNP, BNP and HsTnI was performed, with NT-proBNP (AUC = 0.951) and HsTnI (AUC = 0.947) being better performers (p = 0.01) than BNP (AUC = 0.777). Logistic regression was performed assessing the relation of HsTnI and NT-proBNP to fatal outcome adjusting for age and gender, with only NT-proBNP being significant. The population was then divided into two groups, one with higher NT-proBNP values at admission than the cut-off resulted from the ROC curve (511 ng/L) and a second one with lower values. The Kaplan–Meier analysis showed an absence of fatal outcome in the group of patients with NT-proBNP values lower than the cut-off (p < 0.001). NT-proBNP proved to be the best prognostic tool for fatal outcome among markers of cardiac disease in COVID-19 patients.

Does the insurance status influence in-hospital outcome? A retrospective assessment in 30,175 surgical trauma patients in Switzerland

IntroductionThere has been growing evidence in trauma literature that differences in insurance status lead to inequality in treatment and outcome. Most studies comparing uninsured to insured patients were done in the USA. We sought to gain further insights into differences in the outcomes of trauma patients in a healthcare system with mandatory public health coverage by comparing publicly versus privately insured patients.MethodsWe used a prospective national quality assessment database from the Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie (AQC). More than 80 surgical departments in Switzerland are part of this quality program. We included all patients in the AQC database with any S- or T-code diagnosis according to the International Classification of Diseases ICD-10 (any injuries) who were treated during the 11-year period of 2004–2014. Missing insurance status information was an exclusion criterion. In total, 30,175 patients were included for analysis. The primary outcome was in-hospital mortality. Secondary outcomes included overall and intra- and postoperative complications. Bi- and multivariate analyses were performed, adjusted for insurance status, age, sex, American Society of Anesthesiologists (ASA) physical status category, type of injury, and surgeon’s level of experience.ResultsIn total, 76.8% (n = 23,196) of the patients were publicly insured. Patients with public insurance were significantly younger (p < 0.001), more often male (p < 0.001), and in better general health according to the ASA physical status category (p < 0.001). Length of pre- and postoperative stay and the number of operations per case were similar in the two groups. Patients with public insurance had a lower mortality rate (1.3% vs. 1.9%, p < 0.001), but after adjusting for confounders, insurance status was not a predictor of mortality. Overall complication rates were significantly higher for publicly insured patients (8.4% vs. 6.2%, p < 0.001), and after adjusting for confounders, insurance status was identified as an independent risk factor for overall complications (p < 0.001).ConclusionDifferences exist with respect to patient and procedural characteristics: publicly insured patients were younger, more often male, and scored better on ASA physical status. Insurance status seems not to be a predictor for fatal outcome after trauma, although it is associated with complications.

Predictors of fatal outcomes among hospitalized COVID-19 patients with pre-existing hypertension in China.

BackgroundCoronavirus disease 2019 (COVID‐19) is an emerging, rapidly evolving pandemic, hypertension is one of the most common co‐existing chronic conditions and a risk factor for mortality. Nearly one‐third of the adult population is hypertensive worldwide, it is urgent to identify the factors that determine the clinical course and outcomes of COVID‐19 patients with hypertension.Methods and results148 COVID‐19 patients with pre‐existing hypertension with clarified outcomes (discharge or deceased) from a national cohort in China were included in this study, of whom 103 were discharged and 45 died in hospital. Multivariate regression showed higher odds of in‐hospital death associated with high‐sensitivity cardiac troponin (hs‐cTn) > 28 pg/ml (hazard ratio [HR]: 3.27, 95% confidence interval [CI]: 1.55–6.91) and interleukin‐6 (IL‐6) > 7 pg/ml (HR: 3.63, 95% CI:1.54–8.55) at admission. Patients with uncontrolled blood pressure (BP) (n = 52) which were defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg for more than once (≥2 times) during hospitalization, were more likely to have ICU admission (p = 0.037), invasive mechanical ventilation (p = 0.028), and renal injury (p = 0.005). A stricter BP control with the threshold of 130/80 mm Hg was associated with lower mortality. Treatment with renin‐angiotensin‐aldosterone system (RAAS) suppressors, including angiotensin‐converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and spironolactone, was associated with a lower rate of ICU admission compared to other types of anti‐hypertensive medications (8 (22.9%) vs. 25 (43.1%), p = 0.048).ConclusionAmong COVID‐19 patients with pre‐existing hypertension, elevated hs‐cTn and IL‐6 could help clinicians to identify patients with fatal outcomes at an early stage, blood pressure control is associated with better clinical outcomes, and RAAS suppressors do not increase mortality and may decrease the need for ICU admission.

Використання екстракорпоральної мембранної оксигенації при реваскуляризації міокарда у пацієнтів з ішемічною хворобою серця на фоні кардіогенного шоку

Актуальність. Використання екстракорпоральної мембранної оксигенації (ЕКМО) стало ефективною методикою в лікуванні дорослих і дітей із тяжкою серцевою і легеневою дисфункцією, резистентною до традиційної терапії. Метою даної роботи було узагальнення досвіду використання ЕКМО при кардіальній дисфункції, що розвивається у пацієнтів з ішемічною хворобою серця при проведенні рентген-ендоваскулярної реваскуляризації міокарда. Матеріали та методи. У дослідженні проведено ретроспективний одноцентровий аналіз 23 пацієнтів з ішемічною хворобою серця (19 чоловіків і 4 жінки, середній вік — 65,7 ± 12,3 року), яким в ДУ «Інститут серця МОЗ України» в період з березня 2014 по червень 2018 р. при проведенні черезшкірної транслюмінальної коронарної ангіопластики (ЧТКА) використовувалася методика ЕКМО. Результати. 13 (56,52 %) пацієнтів, яким проводили ЕКМО при ЧТКА, померли безпосередньо в стаціонарі або через 30 днів після виписки, серед них переважали особи чоловічої статі (92,30 %). Незалежними предикторами фатальних наслідків виступали цукровий діабет (ВШ = 17,58; 95% ДI = 6,47–47,48; р = 0,00125), хронічна ниркова недостатність (ВШ = 20,81; 95% ДI = 5,95–72,21; р = 0,00014), ішемія міокарда в басейні правої коронарної артерії (ВШ = 25,51; 95% ДI = 8,27–79,12; р = 0,00013). Процедура тромбоекстракції та феномен «no reflow» на 18,5 і на 13,1 % частіше реєструвались у пацієнтів, які померли. Перераховані вище обставини зумовили і менший процедуральний успіх у пацієнтів, що померли (TIMI потік після ЧТКА становив 1,50 ± 0,48), тоді як у тих, що вижили, TIMI становив 2,40 ± 0,37 (р = 0,00138). Підключення ЕКМО до виникнення кардіологічних подій достовірно частіше виявлялося в групі пацієнтів, які вижили (90 % випадків), порівняно з померлими (0 %) (р = 0,0000001). Висновки. Цукровий діабет, ниркова недостатність, ураження правої коронарної артерії є незалежними предикторами летальності при проведенні рентгенендоваскулярної реканалізації у пацієнтів з ішемічною хворобою серця. Планове використання ЕКМО у пацієнтів групи високого ризику при черезшкірній реваскуляризації міокарда є позитивним прогностичним фактором виживання пацієнтів.

New predictors of fatal outcome in patients with COVID-19 viral infection

<h3></h3> В статье приводится сравнительный анализ лабораторных данных умерших и выживших пациентов с установленным диагнозом COVID-19 для оценки их ассоциации с исходами заболевания. Выявлено, что наряду с такими известными показателями, как тропонин, креатинфосфокиназа MB, креатинин, С-реактивный белок, прокальцитонин, лактатдегидрогеназа и D-димер, прогностическое значение имеют лабораторные показатели: альбумин, нейтрофильно-альбуминовое и нейтрофильно-лимфоцитарное отношение.

In-hospital care in acute heart failure during the COVID-19 pandemic: insights from the German-wide Helios hospital network.

The coronavirus disease 2019 (COVID-19) pandemic has led to changes in health care utilization for different acute cardiovascular diseases. Whether hospitalization rates and in-hospital mortality were affected by the pandemic in patients with acute symptomatic heart failure (HF) was investigated in this study. Administrative data provided by 67 German Helios hospitals were examined for patients with a main discharge diagnosis of HF using ICD codes. Urgent hospital admissions per day were compared for a study period (13 March-21 May 2020) with control intervals in 2020 (1 January-12 March) and 2019 (13 March-21 May), resulting in a total of 13 484 patients excluding all patients with laboratory-proven COVID-19 infection. Incidence rate ratios (IRR) were calculated using Poisson regression. Generalized linear mixed models were used for univariable and multivariable analysis to identify predictors of in-hospital mortality. The number of admissions per day was lower in the study period compared to the same year [IRR 0.69, 95% confidence interval (CI) 0.67-0.73, P < 0.01] and the previous year control group (IRR 0.73, 95% CI 0.70-0.76, P < 0.01). Age was similar throughout the intervals, but case severity increased in terms of distribution within New York Heart Association (NYHA) classes and comorbidities. Within the study period, 30-day rates for urgent hospital readmissions were higher compared to the same year but not the previous year control group. In-hospital mortality was 7.3% in the study period, 6.1% in the same year (P=0.03) and 6.0% in the previous year control group (P=0.02). In multivariable analysis, age, NYHA class and other predictors of fatal outcome were identified but hospitalization during the study period was not independently associated with mortality. Our data showed a significant reduction of urgent hospital admissions for HF with increased case severity and concomitant in-hospital mortality during the COVID-19 pandemic in Germany. Identifying causes of reduced inpatient treatment rates is essential for the understanding and valuation with regard to future optimal management of patients with HF.

Extracorporeal Membrane Oxygenation during Percutaneous Coronary Intervention in Patients with Coronary Heart Disease.

Extracorporeal membrane oxygenation (ECMO) has become an effective method in the treatment of adults and children with severe cardiac and pulmonary dysfunction that is resistant to conventional therapy. The aim of this article was to summarize an experience of ECMO usage for cardiac dysfunction, which develops in patients with coronary heart disease (CHD) during percutaneous transluminal coronary angioplasty. The study comprised a retrospective, single-center analysis of 23 patients with CHD (19 men and four women, average age 65.7 ± 12.3 years), who undertook the ECMO technique during percutaneous transluminal coronary angioplasty. A total of 13 (56.52%) patients died directly in the hospital, or 30 days after a discharge. Independent predictors of fatal outcomes were diabetes mellitus (odds ratio [OR] = 17.58; 95% confidence interval [CI] = 6.47-47.48; p = .00125), chronic renal failure (CRF) (OR = 20.81; 95% CI = 5.95-72.21; p = .00014), and damage to the right coronary artery (RCA) (OR = 25.51; 95% CI = 8.27-79.12; p = .00013). For deceased patients, the "no reflow" phenomenon was indicated in a larger percentage of cases (23.1% in the group of deceased, vs. 10% in the group of survivors). A routine connection to ECMO before the occurrence of cardiac events was significantly more often used in the group of survived patients (90% of cases) than in the deceased (p = .0000001). Diabetes mellitus, CRF, and damage to the RCA were independent predictors of mortality during percutaneous transluminal coronary angioplasty in patients with CHD. The routine use of ECMO in high-risk patients with percutaneous transluminal coronary angioplasty was a positive prognostic factor of patient survival.

Current, effectiveness of therapy and outcomes of new coronavirus infection: preliminary analysis

Relevance. Verification of a new coronavirus infection (COVID-19) requires clear algorithms for the diagnosis and treatment of patients, depending on clinical, laboratory and instrumental dates. Timely and informed decisions on optimizing management tactics and prescribing proactive anti-inflammatory therapy before development of a complete symptom complex life threatening conditions are needed in some cases.&#x0D; Aim of the study. To analyze the course and outcomes of a new coronavirus infection, depending on the initial characteristics of the patients and treatment options.&#x0D; Materials and methods. A preliminary analysis of the case histories of 129 people hospitalized in the center for treating patients with a new coronavirus infection at North-Western State Medical University n.a. I.I. Mechnikov was made by random sampling. Among the hospitalized patients there were 67 men (51.9%), the average age was 57.9 16.4 years, 62 women (48.1%), and the average age was 60.2 13.6 years. During hospitalization, all patients underwent standard clinical laboratory and instrumental examination, as well as determination of saturation (SpO2), markers of the cytokine storm (CRP, ferritin, AST, D-dimer, fibrinogen, lymphocytes), compute tomography (CT) of the lungs. The effectiveness and safety of therapy was evaluated by the outcome (recovery, death), as well as by the presence of adverse events in the background of the therapy. Statistical processing of the research results was carried out using the Statistica 12 for Windows application software package, the significance of differences between the two relative values was evaluated using the Student t-test (t 2, p 0.05).&#x0D; Results. Fatal outcomes were significantly more frequently recorded among patients of older age groups and males. The presence of concomitant diseases such as obesity, diabetes mellitus, pathology of the cardiovascular system was accompanied by more frequent fatal outcomes. That allows considering comorbidity as a risk factor for severe course and poor prognosis of COVID-19. However, in general, in the presence of the indicated forms of concomitant diseases, it was not possible to establish significant differences with the outcomes of COVID-19, which may be due to an insufficient amount of patients. Predictors of fatal outcome was low values of saturation, the presence of respiratory failure, a significant amount of lung tissue damage (CT-3-4), as well as high values of CRP, ferritin, AST, D-dimer, neutrophilia, lymphopenia, thrombocytopenia. The use of anticytokine drugs (ACD) in complex therapy can be considered a favorable predictor of outcome, which indicates the advisability of wider use. The materials of the study allow not only a preliminary assessment of the course and effectiveness of complex therapy using anticytokine drugs with COVID-19 in patients with comorbid diseases, but also to develop therapeutic and diagnostic algorithms in patients of this category.

Predictors of fatal outcome after severe necrotizing fasciitis: Retrospective analysis in a tertiary hospital for 20 years

BackgroundPrognostic factors for fatal outcomes of patients with necrotizing fasciitis remain unclear. MethodsWe retrospectively analyzed data of patients with necrotizing fasciitis from January 1998 to July 2019 using our hospital's medical database. Clinical characteristics of patients who died during hospitalization or had been discharged were evaluated. Sex, age, body mass index, smoking history, alcohol use, comorbidities (diabetes mellitus, arteriosclerosis obliterans, heart disease, obstructive arteriosclerosis, dialysis, cancer, skin disease, steroid use history), shock vital, physical findings, Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, sepsis, disseminated intravascular coagulation, fascial administration, tracheal intubation, and surgical treatment (dismemberment and/or debridement) were compared between the survivor (group S) and nonsurvivor (group N) groups. ResultsFifty-five patients with necrotizing fasciitis were included (40 patients in group S and 15 patients in group N). Serum creatine was a significant prognostic factor (odds ratio [OR], 3.03; 95% confidence interval [CI], 0.15–0.75; P = 0.0078), with a cutoff value of 1.56 mg/dL. Moreover, the estimated glomerular filtration rate was a significant prognostic factor (OR, 1.06; 95% CI, 1.02–1.10, P = 0.000548), with a cutoff value of 20.6 mL/min. ConclusionRenal dysfunction is a significant prognostic factor for fatal outcomes of patients with necrotizing fasciitis. Level of EvidenceLevel IV, Case series.

Clinical and epidemiological features and organ dysfunction in newborns with neonatal sepsis

Purpose. To evaluate clinical and epidemiological features of neonatal sepsis and assess the impact of organ dysfunction on its outcome.Characteristics of children and research methods. The authors carried out a retrospective analysis of 66 patients with neonatal sepsis hospitalized to the neonatal intensive care unit of the Kazan City Children’s Hospital No. 1 from 2013 to 2017. The diagnosis was based on the development of a systemic inflammatory response syndrome, an increase in C-reactive protein concentration in the blood more than 1 mg/dl, the presence of one or more foci of infection, the development of organ dysfunction and the isolation of the microorganism from venous blood. Bacteremia was a mandatory inclusion criterion.Results. In the most cases (54.5%) neonatal sepsis was caused by gram-negative bacteria. 41 and 4.5% of cases were caused by gram-positive bacteria and fungi, respectively. Among the gram-negative bacteria, the main causative agents of sepsis were Klebsiella pneumoniae (27 cases, 41%), among the gram-positive bacteria –staphylococci (24 cases, 36.5%). Fungal sepsis was caused by Candida kruzei (2 cases) and Candida albicans (1 case). In 11 (17%) cases there was a dysfunction of a single organ, in 31 (47%) cases – dysfunction of 2 organs and in 24 (36%) cases – dysfunction of more than 2 organs. The most common impairments were respiratory dysfunction (86%) and hemostatic disorders in the form of thrombocytopenia (58%). Neonatal sepsis was fatal in 11 (17%) cases. It was found that the multiple organ dysfunction was associated with a risk of death (odds ratio – OR = 29.3; 95% CI 3.4–249.7). Among the signs of organ dysfunction, coma (OR = 30.8; 95% CI 3.0–316.6), elevated blood lactate level of more than 5 mmol/l (OR = 22.1; 95% CI 3.5–139,6) and a low platelet count of less than 50 · 109/l (OR = 5; 95% CI 1.2–21.3) had the prognostic significance.Conclusion. Modern neonatal sepsis has a diverse etiology with gram-negative bacteria as causative agents in half of the cases. Despite modern treatment methods, neonatal sepsis remains a formidable infectious pathology. The risk of fatal outcome is associated with organ dysfunction. Coma, elevated blood lactate level and severe thrombocytopenia are the most significant predictors of fatal outcome in neonatal sepsis.

Predictors of fatal outcomes in pedestrian accidents in Tabriz Metropolis of Iran: Application of PLS-DA method

Objectives: Road traffic deaths in walking pedestrians are a global public health problem. Considering that in Iran pedestrians have a high proportion of deaths caused by traffic accidents, the objective of the present study was to investigate mortality rate and related factors of fatal injury in pedestrian crashes in Tabriz Metropolis of Iran as the largest and most populous city of the northwest of Iran.Methods: The design of this study is case-control based on police and Forensic Medicine Organization data. All registered fatal pedestrian crashes in Tabriz Metropolis from 2014 to 2015 (146 cases) were included in the study as the case group. Also, 292 pedestrians (the ratio of cases to controls was 1:2) with non-fatal crashes were considered as the control group. Due to high dimensional data and multicollinearity issue, Partial least squares discriminant analysis (PLS-DA) was used for data analysis. Importance of the variables was determined by the VIP (Variable Importance in the Projection) index. Performance of the model was assessed by using training and test set validation method. The area under the ROC curve (AUC) and classification error rates were calculated for the test set. R software version 3.5.1 (mixOmcs packages) was used for data analysis.Results: According to the results of PLS-DA, the most important variables related to fatal outcome in pedestrian crashes with VIP > 1 were: pedestrian age (positive effect), type of vehicle (light machinery with a negative effect), kind of vehicle plate (private plate with a negative effect), season of accident occurrence (winter season with a positive effect), type of driver’s licenses (Class A with a positive effect), pedestrian gender (male with a positive effect) and Fault of Pedestrian (At-fault with a positive effect). The overall accuracy for the fitted model and AUC were 0.77 and 0.79, respectively.Conclusions: The results show that predictors of a fatal outcome in pedestrian accidents in Tabriz can be attributed to the pedestrian characteristics (which notably account for differences in vulnerability in case of an accident), the car and driver features, and weather (which may all notably influence the amount of energy involved in the collision, through the car mass, speed, and conditions delaying the braking response or reducing the braking effectiveness). Regarding the statistical method, the PLS-DA is a powerful method which can be used to analyze high dimension data with multicollinearity issue.