Predictor Of Long-term Mortality Research Articles

Performance of D-dimer, cardiac troponin T, C-reactive protein and NT-proBNP in prediction of long-term mortality in patients with suspected pulmonary embolism

Abstract Background Pulmonary embolism (PE) is a common and potentially life-threatening condition requiring emergent diagnostic work-up. Despite wide use of biomarkers, little is known how they predict long-term prognosis of patients evaluated for suspected PE. Methods We sought to assess the predictive performance of NT-proBNP, C-reactive protein (CRP), D-dimer (FIDD) and cardiac troponin T (cTnT) in patients who underwent computed tomography pulmonary angiography (CTPA) for clinical suspicion of PE. The analysis involved 1001 patients, with 222 (22.2%) receiving a PE diagnosis at index imaging. Mean age of patients with and without PE were 65.0 ± 17.1 and 64.5 ± 17.7 years, respectively. Median follow-up time was 3.9 years [IQR 2.9-4.9]. Results Mortality was relatively high both among patients with and without documented PE (24.8% vs. 31.7%, p=0.047). In patients with PE, only elevated NT-proBNP>1000 ng/L and CRP>50 mg/L levels at hospital admission were associated with higher mortality in an adjusted Cox regression model, but ROC analysis showed no improved prediction compared to clinical variables. Among patients without PE, elevated NT-proBNP>1000 ng/L, CRP>10 mg/L, cTnT>50 ng/L and FIDD>1.0 mg/L all predicted mortality. In an ROC analysis among patients without PE, models including NT-proBNP, cTnT or CRP provided improved predictive performance. Conclusions Patients evaluated for clinical suspicion of PE have high long-term mortality. Commonly used biomarkers provide long-term prognostic value in patients without PE. Given the relatively young age, it is vital to identify these high-risk patients, and perform differential diagnosis work-up for alternative life-threatening conditions, and manage them as appropriate.

Galectin-3 Predicts Long-Term Risk of Cerebral Disability and Mortality in Out-of-Hospital Cardiac Arrest Survivors

Background: Out-of-hospital cardiac arrest (OHCA) is associated with high mortality and cerebral disability in survivors. Current models of risk prediction and survival are mainly based on resuscitation duration. We examined the prognostic value of circulating biomarkers in predicting mortality and severe cerebral disability for OHCA survivors, alongside traditional clinical risk indicators. Methods: Biomarkers including BNP, troponin I, and galectin-3 were measured at hospital admission in resuscitated OHCA patients. Prognostic significance for mortality and cerebral disability involving circulating biomarkers, resuscitation duration, demographics, and laboratory and clinical characteristics was examined via univariate and multivariate Cox proportional hazards regression models. The incremental prognostic value of the index covariates was examined through model diagnostics, focusing on the Akaike information criterion (AIC) and Harrell’s concordance statistic (c-statistic). Results: In a combinatorial analysis of 144 OHCA survivors (median follow-up 5.7 years (IQR 2.9–6.6)), BNP, galectin-3, arterial pH, and resuscitation time were significant predictors of all-cause death and severe cerebral disability, whereas troponin I levels were not. Multivariate regression, adjusting for BNP, arterial pH, and resuscitation time, identified galectin-3 as an independent predictor of long-term mortality. Multiple linear regression models also confirmed galectin-3 as the strongest predictor of cerebral disability. The incorporation of galectin-3 into models for predicting mortality and cerebral disability enhanced fit and discrimination, demonstrating the incremental value of galectin-3 beyond traditional risk predictors. Conclusions: Galectin-3 is a significant, independent long-term risk predictor of cerebral disability and mortality in OHCA survivors. Incorporating galectin-3 into current risk stratification models may enhance early prognostication and guide targeted clinical interventions.

The Freiburg Index of Post-TIPS Survival accurately predicts mortality in patients with acute decompensation of cirrhosis.

The recently developed Freiburg Index of Post-TIPS Survival (FIPS) allows improved risk classification of patients with decompensated cirrhosis allocated to transjugular intrahepatic portosystemic shunt (TIPS) implantation. This study investigated the prognostic value of the FIPS in patients hospitalized with acute decompensation of cirrhosis (AD), outside the setting of TIPS implantation. A total of 1133 patients with AD were included in a retrospective, multi-centre study. Ninety-day, 180-day and 1-year mortality were recorded and the FIPS' performance in predicting mortality at these time points was analysed using ROC analyses. Ninety-day, 180-day and 1-year mortality were 17.7%, 24.4% and 30.8%. Uni- and multivariable Cox regression models showed that the FIPS independently predicted 1-year mortality in the study cohort (HR 1.806, 95% CI 1.632-1.998, p < .0001). In ROC analyses, the FIPS offered consistently high performance in the prediction of mortality within 1 year after AD (area under the receiver operator characteristic [AUROC]: 1-year mortality .712 [.679-.746], 180-day mortality .740 [.705-.775] and 90-day mortality .761 [.721-.801]). In fact, in the subgroup of patients presenting with variceal bleeding, the FIPS even showed significantly improved discriminatory performance in the prediction of long-term mortality (AUROC 1-year mortality: .782 [.724-.839]) in comparison with established prognostic scores, such as the CLIF-C AD score (.724 [.660-.788], p = .0071) or MELD 3.0 (.726 [.662-.790], p = .0042). The FIPS accurately predicts mortality in patients with AD and seems to offer superior prognostication of long-term mortality in patients with variceal bleeding.

Outcomes of 576 patients with extracorporeal life support for the treatment of perioperative cardiogenic shock.

This study aims to analyse the short- and long-term outcomes in patients who received extracorporeal life support for the treatment of perioperative low-output syndrome and identify risk factors for mortality. All consecutive patients who received extracorporeal life-support system during or after cardiac surgery at a high-volume German cardiac centre between 2008 and 2017 were identified retrospectively and followed up to December 2023. This cohort was characterized, and long-term survival (>10 years) was analysed. Univariate and multivariable regression analyses were performed to identify risk factors for mortality. Five-hundred and seventy-six patients were included; 21.7% underwent isolated coronary bypass, 16.5% single valve surgery, 34.3% combined cardiac surgery and 13.2% heart transplantation. The system was implanted peripherally in 60.8% of patients. In-hospital and 1-year mortality for all patients was 66.0% and 77.7%, respectively. In the multivariable Cox adjustment, severe aortic valve stenosis, previous cardiac surgery and intra-aortic balloon pump were independent risk factors for in-hospital mortality (P < 0.05). Older age, severe mitral regurgitation and patients on insulin were predictors for long-term mortality (P < 0.05). However, peripheral cannulation significantly reduced mortality. There was no time-dependent interaction of perioperative stroke with mortality. For patients who were discharged alive, the estimated 10-year survival was 32.4%. Treatment of perioperative low-output syndrome with extracorporeal life-support systems is associated with poor outcome and only 34% of patients could be discharged successfully. Peripheral cannulation is prognostically favourable. Special attention should be paid to these patients because age, insulin therapy and severe mitral regurgitation are strong predictors for mortality after 10 years.

Clinical profile, microbiology and outcomes in infective endocarditis treated with aortic valve replacement: a multicenter case-control study

BackgroundAortic valve infective endocarditis (IE) is associated with significant morbidity and mortality. We aimed to describe the clinical profile, risk factors and predictors of short- and long-term mortality in patients with aortic valve IE treated with aortic valve replacement (AVR) compared with a control group undergoing AVR for non-infectious valvular heart disease.MethodsBetween January 2008 and December 2013, a total of 170 cases with IE treated with AVR (exposed cohort) and 677 randomly selected non-infectious AVR-treated patients with degenerative aortic valve disease (controls) were recruited from three tertiary hospitals with cardiothoracic facilities across Scandinavia. Crude and adjusted hazard ratios (HR) were estimated using Cox regression models.ResultsThe mean age of the IE cohort was 58.5 ± 15.1 years (80.0% men). During a mean follow-up of 7.8 years (IQR 5.1-10.8 years), 373 (44.0%) deaths occurred: 81 (47.6%) in the IE group and 292 (43.1%) among controls. Independent risk factors associated with IE were male gender, previous heart surgery, underweight, positive hepatitis C serology, renal failure, previous wound infection and dental treatment (all p < 0.05). IE was associated with an increased risk of both short-term (≤ 30 days) (HR 2.86, [1.36–5.98], p = 0.005) and long-term mortality (HR 2.03, [1.43–2.88], p < 0.001). In patients with IE, chronic obstructive pulmonary disease (HR 2.13), underweight (HR 4.47), renal failure (HR 2.05), concomitant mitral valve involvement (HR 2.37) and mediastinitis (HR 3.98) were independent predictors of long-term mortality. Staphylococcus aureus was the most prevalent microbe (21.8%) and associated with a 5.2-fold increased risk of early mortality, while enterococci were associated with the risk of long-term mortality (HR 1.78).ConclusionsIn this multicenter case-control study, IE was associated with an increased risk of both short- and long-term mortality compared to controls. Efforts should be made to identify, and timely treat modifiable risk factors associated with contracting IE, and mitigate the predictors of poor survival in IE.

Mitral valve replacement versus repair for severe mitral regurgitation in patients with reduced left ventricular ejection fraction

ObjectiveThis study compares early and long-term outcomes following mitral valve (MV) repair and replacement in patients with mitral regurgitation (MR) and reduced left ventricular ejection fraction (LVEF). MethodsPatients with primary or secondary MR and LVEF <50% who underwent MV replacement or repair (with/without atrial septal defect closure and/or atrial fibrillation ablation) between 2005 and 2017 at our center were retrospectively analyzed using unadjusted and propensity score matching techniques (42 pairs). ResultsA total of 356 patients with either primary (n = 162 [45.5%]) or secondary MR (n = 194 [54.5%]) and LVEF <50% underwent MV repair (n = 293 [82.3%]) or replacement (n = 63 [17.7%]) during the study period. In-hospital mortality was 0.3% (repair) and 1.6% (replacement) in the unmatched cohort (P = .32); there were no in-hospital deaths after matching. Estimated survival was 72.8% (repair) versus 50.1% (replacement) at 8 years in the unmatched (P < .001), and 64.3% (repair) versus 50.7% (replacement) in the matched groups (P = .028). Eight-year cumulative incidence of reoperation was 7.0% and 11.6% in unmatched (P = .28), and 9.9% and 12.7% in matched (P = .69) repair and replacement groups, respectively. Markedly reduced LVEF (<40%) was among the independent predictors of long-term mortality (hazard ratio, 1.7; 95% CI, 1.2-2.4; P = .002). In secondary MR, MV repair showed an 8-year survival benefit over replacement (65.1% vs 44.6%; P = .002), with no difference in reoperation rate (11.6% [repair] vs 17.0% [replacement]; P = .11). ConclusionsMV repair performed in primary or secondary MR and reduced LVEF provides superior long-term results compared with replacement. Severe LV dysfunction is a significant predictor of reduced survival following MV surgery.

Causes of Death After Bariatric Surgery: Long-Term Study of 10 Years.

There is a lack of up-to-date research addressing the causes of death and predictors of long-term mortality after bariatric surgery. This was a single-centre retrospective study. Trust records were used to identify deceased patients and their medical history. The demographic data, comorbidities, cause of death, and time since surgery were retrieved and tabulated. Data was recoded to allow for use in IBM SPSS. There were 39 deaths amongst 891 patients who underwent bariatric surgery between 15th June 2010 to 18th September 2022. The main cause of death was pneumonia and respiratory causes with 15.4% of the cohort. A history of asthma/COPD had an association with the cause of death (p = 0.021). A history of hypertension, ischaemic heart disease (IHD), and smoking were all associated with a higher age at death, whilst a history of IHD was associated with a higher number of days from operation to death. Age at operation and number of comorbidities both correlated with age at death, and multiple linear regression of age at death with age at operation and number of comorbidities as predictors was significant (p < 0.001). A Cox regression found age at operation to have a significant effect on survival, with a hazard ratio of 1.063 (95% CI:1.027 to 1.100, p < 0.001). Pneumonia and respiratory causes are the largest causes of long-term mortality after bariatric surgery. The only factor found to have a detrimental effect on all-cause mortality was age at operation which reduced survival. Hypertension, IHD, and smoking are indirect factors that are associated with mortality.

Epicardial adipose tissue and muscle distribution affect outcomes in very old patients after transcatheter aortic valve replacement

Abstract Aims To analyse the relevance of body composition and blood markers for long-term outcomes in very old patients after transcatheter aortic valve replacement (TAVR). Methods and results A total of 403 very old patients were characterized with regard to subcutaneous, visceral, and epicardial fat, psoas muscle area, plasma growth differentiation factor 15 (GDF-15), and leptin. Cohorts grouped by body mass index (BMI) were analysed for long-term outcomes. Patients underwent transapical and transfemoral TAVR (similar 30-day/1-year survival). Body mass index &amp;gt;35 kg/m2 showed increased 2- and 3-year mortality compared with BMI 25–34.9 kg/m2 but not compared with BMI &amp;lt;25 kg/m2. Fat areas correlated positively to BMI (epicardial: R2 = 0.05, P &amp;lt; 0.01; visceral: R2 = 0.20, P &amp;lt; 0.001; subcutaneous: R2 = 0.13, P &amp;lt; 0.001). Increased epicardial or visceral but not subcutaneous fat area resulted in higher long-term mortality. Patients with high BMI (1781.3 mm2 ± 75.8, P &amp;lt; 0.05) and lean patients (1729.4 ± 52.8, P &amp;lt; 0.01) showed lower psoas muscle area compared with those with mildly elevated BMI (2055.2 ± 91.7). Reduced psoas muscle area and increased visceral fat and epicardial fat areas were independent predictors of long-term mortality. The levels of serum GDF-15 were the highest in BMI &amp;gt;40 kg/m2 (2793.5 pg/mL ± 123.2) vs. BMI &amp;lt;25 kg/m2 (2017.6 pg/mL ±130.8), BMI 25–30 kg/m2 (1881.8 pg/mL ±127.4), or BMI 30–35 kg/m2 (2054.2 pg/mL ±124.1, all P &amp;lt; 0.05). Increased GDF-15 level predicted mortality (2587 pg/mL, area under the receiver operating characteristic curve 0.94). Serum leptin level increased with BMI without predictive value for long-term mortality. Conclusion Morbidly visceral and epicardial fat accumulation, reduction in muscle area, and GDF-15 increase are strong predictors of adverse outcomes in very old patients post-TAVR.

Deep learning to predict long-term mortality from plain chest X-ray in patients referred for suspected coronary artery disease.

The hypothesis that a deep learning (DL) model can produce long-term prognostic information from chest X-ray (CXR) has already been confirmed within cancer screening programs. We summarize our experience with DL prediction of long-term mortality, from plain CXR, in patients referred for angina and coronary angiography. Data of patients referred to an Italian academic hospital were analyzed retrospectively. We designed a deep convolutional neural network (DCNN) that, from CXR, could predict long-term mortality. External validation was performed on patients referred to a Dutch academic hospital. A total of 6,031 were used for model training (71%; n=4,259) and fine-tuning/validation (10%; n=602). Internal validation was performed with the remaining patients (19%; n=1,170). Patients' stratification followed the DL-CXR risk score quartiles division. Median follow-up was 6.1 years [interquartile range (IQR), 3.3-8.7 years]. We observed an increment in estimated mortality with the increase of DL-CXR risk score (low-risk 5%, moderate 17%, high 29%, very high 46%; P<0.001). The DL-CXR risk score predicted median follow-up outcome with an area under the curve (AUC) of 0.793 [95% confidence interval (CI): 0.759-0.827, sensitivity 78%, specificity 68%]. Prediction was better than that achieved using coronary angiography findings (AUC: 0.569, 95% CI: 0.52-0.61, P<0.001) and age (AUC: 0.735, 95% CI: 0.69-0.77, P<0.004). At Cox regression, the DL-CXR risk score predicted follow-up mortality (P<0.005, hazard ratio: 3.30, 95% CI: 2.35-4.64). External validation confirmed the DL-CXR risk score performance (AUC: 0.71, 95% CI: 0.49-0.92; sensitivity 0.838; specificity 0.338). In patients referred for coronary angiogram because of angina, the DL-CXR risk score could be used to stratify mortality risk and predict long-term outcome better than age and coronary artery disease status.

Evaluation of the Atherogenic Index of Plasma to Predict All-Cause Mortality in Elderly With Acute Coronary Syndrome: A Long-Term Follow-Up.

The Atherogenic Index of Plasma (AIP) is associated with coronary artery disease (CAD) and acute coronary syndrome (ACS), but the relationship between AIP and ACS in elderly patients remains unclear. We investigated the prognostic capability of AIP for in-hospital and long-term mortality in elderly patients with ACS undergoing coronary angiography (CA). We analyzed 627 patients with ACS over 75years of age who were admitted to our clinic between April 2015 and December 2022 and underwent CA. The primary clinical endpoints were in-hospital, 30-day, 1-year, and long-term mortality. The median follow-up time was 27months. AIP was defined as log (triglyceride/high-density lipoprotein cholesterol). In-hospital mortality rates for patients with AIP ≤.1 and AIP >.1 were 4.7% and 17.6% (P < .001), 30-day mortality rates were 8.7% and 32.2% (P = .01), 1-year mortality rates were 12.1% and 45.1% (P < .001), and long-term mortality rates were 47.3% and 67.5% (P < .001), respectively. Multivariate Cox regression analysis revealed AIP, age, left ventricle ejection fraction (LVEF), admission creatinine, and Killip ≥2 as independent predictors for long-term mortality. AIP can predict in-hospital and long-time all-cause mortality in elderly patients with ACS undergoing CA. Age, LVEF, admission creatinine, and Killip ≥2 are additional factors that predict long-term all-cause mortality.

The additive effect of the triglyceride-glucose index and estimated glucose disposal rate on long-term mortality among individuals with and without diabetes: a population-based study

BackgroundThe triglyceride-glucose (TyG) index and estimated glucose disposal rate (eGDR), which are calculated using different parameters, are widely used as markers of insulin resistance and are associated with cardiovascular diseases and prognosis. However, whether they have an additive effect on the risk of mortality remains unclear. This study aimed to explore whether the combined assessment of the TyG index and eGDR improved the prediction of long-term mortality in individuals with and without diabetes.MethodsIn this cross-sectional and cohort study, data were derived from the National Health and Nutrition Examination Survey (NHANES) 2001–2018, and death record information was obtained from the National Death Index. The associations of the TyG index and eGDR with all-cause and cardiovascular mortality were determined by multivariate Cox regression analysis and restricted cubic splines.ResultsAmong the 17,787 individuals included in the analysis, there were 1946 (10.9%) all-cause deaths and 649 (3.6%) cardiovascular deaths during a median follow-up of 8.92 years. In individuals with diabetes, the restricted cubic spline curves for the associations of the TyG index and eGDR with mortality followed a J-shape and an L-shape, respectively. The risk of mortality significantly increased after the TyG index was > 9.04 (all-cause mortality) or > 9.30 (cardiovascular mortality), and after eGDR was < 4 mg/kg/min (both all-cause and cardiovascular mortality). In individuals without diabetes, the association between eGDR and mortality followed a negative linear relationship. However, there was no association between the TyG index and mortality. Compared with individuals in the low TyG and high eGDR group, those in the high TyG and low eGDR group (TyG > 9.04 and eGDR < 4) showed the highest risk for all-cause mortality (hazard ratio [HR] = 1.592, 95% confidence interval [CI] 1.284–1.975) and cardiovascular mortality (HR = 1.683, 95% CI 1.179-2.400) in the overall population. Similar results were observed in individuals with and without diabetes.ConclusionsThere was a potential additive effect of the TyG index and eGDR on the risk of long-term mortality in individuals with and without diabetes, which provided additional information for prognostic prediction and contributed to improving risk stratification.

Shock Index and Modified Shock Index Are Predictors of Long-Term Mortality in STEMI and NSTEMI Patients

Background: Acute coronary syndromes (ACS), including STEMI and NSTEMI, are leading causes of mortality worldwide. The Shock Index (SI) and Modified Shock Index (MSI) are non-invasive markers traditionally used to assess hemodynamic status but their role in predicting long-term mortality in ACS patients is less understood. Objective: To evaluate the prognostic value of SI and MSI in predicting long-term mortality among patients with STEMI and NSTEMI. Methods: A prospective cohort study was conducted on 275 consecutive patients diagnosed with STEMI and NSTEMI at the Department of Cardiology, PIMS, Islamabad, between March 1, 2024, and July 31, 2024. Patients were divided into two groups: Group 1 (n=138) assessed using SI and Group 2 (n=137) using MSI. Follow-up for three years was conducted to record all-cause mortality. Data were analyzed using SPSS version 25.0, with Cox proportional hazards regression and Kaplan-Meier survival analysis employed to assess mortality risk. Results: During the three-year follow-up, mortality rates were 24.6% in the SI group and 26.3% in the MSI group. Higher SI and MSI values were significantly associated with increased mortality (SI HR=1.85, 95% CI: 1.35-2.54, p&lt;0.001; MSI HR=2.10, 95% CI: 1.50-2.93, p&lt;0.001). Conclusion: SI and MSI are significant predictors of long-term mortality in STEMI and NSTEMI patients and should be integrated into routine clinical assessments for better risk stratification.

Association between Inflammation-Based Prognostic Markers and Mortality in Patients Admitted to Intensive Care Units.

We compared the prognostic value of the C-reactive protein (CRP)-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and modified Glasgow prognostic score (mGPS) with the Sequential Organ Failure Assessment (SOFA) score in an intensive care unit (ICUs). This study used the data of 53,877 adult patients admitted to an ICU between June 2013 and May 2022. Using the CAR, NLR, and mGPS values, as well as the SOFA score from the ICU, we conducted multivariable logistic regression analysis and used the receiver operating characteristic (ROC) curve to compare the predictive value for 28-day and 1-year mortality. A total of 2419 patients (4.5%) died within 28 days, and 6209 (11.5%) patients died within 1 year. After an adjustment, all predictors were found to be independent risk factors for 28-day mortality (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.29-1.33, p < 0.001 for the SOFA score; OR 1.05, 95% CI 1.03-1.07, p < 0.001 for CAR; OR 1.01, 95% CI 1.00-1.02, p < 0.001 for the NLR; and OR 1.19, 95% CI 1.08-1.30, p < 0.001 for the mGPS). This trend persisted for the 1-year mortality. In ROC curve analysis, the CAR showed better predictability than the NLR and mGPS. Furthermore, the predictive power of the CAR was significantly higher than that of the SOFA score for 1-year mortality. The CAR, NLR, and mGPS values at ICU admission were independent risk factors of mortality after ICU admission. The predictive value of CAR was higher than that of the SOFA score for 1-year mortality. CAR assessment at ICU admission may be a feasible predictor of long-term mortality.

Predictors of spontaneous intracerebral hemorrhage mortality: a community-based study in Brno, Czech Republic.

Intracerebral hemorrhage (ICH) is a serious medical condition with high mortality. However, factors leading to long-term mortality after ICH are largely unclear. The aim of this community-based study is to assess predictors of long-term mortality after spontaneous ICH. We identified all patients admitted with spontaneous ICH to hospitals with a certified stroke unit in Brno, the second largest city in the Czech Republic (CR), in 2011, the year of the Czech Population and Housing Census. We reviewed their medical records for risk factors, radiographic parameters, and measures of post-stroke neurological deficit [National Institutes of Health Stroke Scale (NIHSS)]. Using the dates of death from the Czech National Mortality Register, we calculated mortality at 30days, six months, one year, and three years after the ICH. Multivariate analysis with forward stepwise logistic regression was performed to determine independent predictors of mortality (p < 0.05). In 2011, 1086 patients with stroke were admitted to the four stroke-certified hospitals in Brno, CR. Of these, 134 had spontaneous ICH, with complete data available in 93 of them entering the final analysis. The mortality at 30days, 6months, 1year, and 3years post-ICH was 34%, 47%, 51%, and 63%, respectively. The mortality was highest in the first few days post-event, with 50% of patients dying in 255days and average survival being 884 ± 90days. Both NIHSS and modified ICH (MICH) score showed to be strong and reliable predictors of short- as well as long-term mortality; the risk of death post-ICH increased with older age and size of ICH. Other risk factors contributing to higher, primarily shorter-term mortality included history of cardiac failure, myocardial infarction, or atrial fibrillation. In our community-based study, we found that severity of neurological deficit at admission (NIHSS), combined with age and size of ICH, well predicted short- as well as long-term mortality after spontaneous ICH. A history of cardiac failure, myocardial infarction, or atrial fibrillation at presentation were also predictors of mortality, underscoring the need for optimal cardiac management in patients with ICH.

Prehospital point-of-care medication burden as a predictor of poor related outcomes in unselected acute diseases.

How prehospital medication predicts patient outcomes is unclear. The aim of this work was to unveil the association between medication burden administration in prehospital care and short, mid, and long-term mortality (2, 30, and 365day) in unselected acute diseases and to assess the potential of the number of medications administered for short, mid, and long-term mortality prediction. A prospective, multicenter, ambulance-based, cohort study was carried out in adults with unselected acute diseases managed by emergency medical services (EMS). The study was carried out in Spain with 44 ambulances and four hospitals. The principal outcome was cumulative mortality at 2, 30, and 365days. Epidemiological variables, vital signs, and prehospital medications were collected. Patients were classified into four categories: no medication dispensed in prehospital care, one to two medications, three to four medications, and five or more medications. A total of 6401 patients were selected. The 2-day mortality associated with each group was 0.5%, 1.8%, 6.5%, and 18.8%. The 30-day mortality associated with each group was 3.8%, 6.2%, 13.5%, and 31.9%. The 365-day mortality associated with each group was 11%, 15.3%, 25.2%, and 45.7%. The predictive validity of the number of drugs administered, measured by the area under the curve, was 0.808, 0.720, and 0.660 for 2-, 30-, and 365-day mortality, respectively. Our results showed that prehospital drugs could provide relevant information regarding the mortality prediction of patients. The incorporation of this score could improve the management of high-risk patients by the EMS.

Longitudinal Follow-up of Medicare Patients After Esophageal Cancer Resection in the STS Database

BackgroundUnderstanding characteristics associated with survival after esophagectomy for cancer is critical to preoperative risk stratification. This study sought to define predictors for long-term survival after esophagectomy for cancer in Medicare patients. MethodsThe Society of Thoracic Surgeons General Thoracic Surgery Database was queried for patients aged ≥65 years who underwent esophagectomy for cancer between 2012 and 2020 and linked to Centers for Medicare and Medicaid Services (CMS) data using a deterministic matching algorithm. Patient, hospital, and treatment variables were assessed using a multivariable Cox proportional hazards model to evaluate characteristics associated with long-term mortality and readmission. Kaplan-Meier and cumulative incidence curves were generated and differences evaluated using the log-rank test and Gray’s test, respectively. ResultsAfter CMS linkage, 4798 patients were included. Thirty-day and 90-day mortality in the study group was 3.84% and 7.45%, respectively. In the multivariable model, American Society of Anesthesiologists score >3, body mass index >35, and diabetes were associated with increased mortality <90 days post-surgery, while pN/pT upstaging was associated with increased mortality >90 days post-surgery. Patients upstaged to pN(+) had a 147% increased mortality risk (adjusted hazard ratio [aHR], 2.47; 95% CI, 2.02-3.02) and those that remained pN(+) a 75% increased mortality risk (aHR, 1.75; 95% CI, 1.57-1.95) compared with downstaged patients. Patients who were pT upstaged had a 109% (aHR, 2.09; 95% CI, 1.73-2.53) increased mortality risk compared with pT downstaged patients. Risk for readmission was independent of procedure type or approach and was higher in c stage ≥2, American Society of Anesthesiologists score ≥4, and pN+. ConclusionsMedicare patients undergoing esophagectomy for cancer have identifiable patient-specific predictors for short-term mortality and tumor-specific predictors for long-term mortality and readmission. In the absence of pathologic T and N downstaging, risk for long-term mortality and readmission are increased.

Prognostic value of electrical bioimpedance measured with a portable and wireless device in acute heart failure

Introduction and objectivesThe current evaluation of acute heart failure (HF) does not allow an adequate prediction of its evolution. The electrical bioimpedance (BI) allows knowing the state of blood volume, until now only with fixed equipment. We have developed and validated a portable and wireless device to measure BI at the ankle (IVOL). The objective of the study is to know the long-term prognostic value of the point measurement of BI with IVOL in patients with acute HF. MethodsA prospective cohort study of unselected patients admitted for acute HF in a tertiary hospital. The association between BI and different clinical, analytical and echocardiographic variables on admission and clinical evolution were analyzed. Results76 patients were included (mean age 66.1 years, 71.1% men, 68.4% hypertensive, 34.2% diabetic, mean NT-ProBNP: 7,103 pg/ml). Of these, 52.6% with non-preserved left ventricular ejection fraction (LVEF) (<50%) and 56.6% with right ventricular (RV) dysfunction. 26.3% died during a mean follow-up of 35.8 months. Survival in patients with BI ≤ 21,8 Ω was lower, globally and in the subgroups of patients without preserved LVEF and with RV dysfunction, p < 0.008). In the multivariate analysis, a BI ≥ 21.8 Ω was an independent survival factor (HR 0.242, 95% CI:0.86−0.681, p = 0.007). ConclusionsBI values ​​measured with IVOL may be an independent predictor of long-term mortality in patients hospitalized for acute HF. This prognostic value is maintained in patients without preserved LVEF function and with RV dysfunction.

Age Prediction From 12-lead Electrocardiograms Using Deep Learning: A Comparison of Four Models on a Contemporary, Freely Available Dataset.

The 12-lead electrocardiogram (ECG) is routine in clinical use and deep learning approaches have been shown to have the identify features not immediately apparent to human interpreters including age and sex. Several models have been published but no direct comparisons exist. We implemented three previously published models and one unpublished model to predict age and sex from a 12-lead ECG and then compared their performance on an open-access data set. All models converged and were evaluated on the holdout set. The best preforming age prediction model had a hold-out set mean absolute error of 8.06 years. The best preforming sex prediction model had a hold-out set area under the receiver operating curve of 0.92. We compared performance of four models on an open-access dataset.

Outcomes of Transcatheter Aortic Valve Implantation in Patients with and without Diabetes Mellitus.

Diabetes mellitus (DM) in patients undergoing cardiac transcatheter or surgical interventions usually is correlated with poor outcomes. Transcatheter aortic valve implantation (TAVI) has been developed as a therapy choice for inoperable, high-, or intermediate-risk surgical patients with severe aortic stenosis (AS). To evaluate the impact of DM and hemoglobin A1c (HbA1c) on outcomes and survival after TAVI. Five hundred and fifty-two symptomatic severe AS patients who underwent TAVI, of whom 164 (29.7%) had DM, were included in this retrospective study. Follow-up was performed after 30 days, six months, and annually. The device success and risks of procedural-related complications were similar between patients with and without DM, except for acute kidney injury, which was more frequent in the DM group (2.4% vs. 0%, P=0.021). In-hospital and first-year mortality were similar between the groups (4.9% vs. 3.6%, P=0.490 and 15.0% vs. 11.2%, P=0.282, respectively). There was a statistical difference between HbA1c ≥ 6.5 and HbA1c ≤ 6.49 groups in total mortality (34.4% vs. 15.8%, P<0.001, respectively). The only independent predictors were Society of Thoracic Surgeons score (hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.09-1.51; P=0.003) and HbA1c level ≥ 6.5 (HR 10.78, 95% CI 2.58-21.50; P=0.003) in multivariable logistic regression analysis. In this study, we conclude that DM was not correlated with an increased mortality risk or complication rates after TAVI. Also, it was shown that mortality was higher in patients with HbA1c ≥ 6.5, and it was an independent predictor for long-term mortality.

Predictive value of the controlling nutritional status (CONUT) score to assess long-term mortality (10 Years) in patients with hypertension

Background and aimsMalnutrition is associated with poor outcomes in patients with chronic diseases. The aim of this study is to investigate the prevalence of malnutrition in patients with hypertension and relationship between malnutrition severity and long-term mortality in these patients. Methods and resultsThe study included 11,278 patients with hypertension from the National Health and Nutrition Examination Survey database. The degree of malnutrition was assessed using the Controlled Nutritional Status score, with patients divided into normal, mild, and moderate-to-severe groups. After 10 years of follow-up, the results showed that patients who died had higher CONUT scores, poorer nutritional status, and lower albumin, total cholesterol, and lymphocytes than those who survived (P < 0.05). The Kaplan–Meier analysis revealed that patients with poor nutritional status had a significantly higher risk of all-cause death. In the Non-Lipid Lowering Drugs group, the CONUT score (hazard ratio (HR): 1.225; 95% confidence interval (CI): 1.162–1.292; P < 0.0001), as well as mild (HR: 1.532; 95% CI 1.340–1.751; P < 0.0001) and moderate-to-severe malnutrition (HR: 2.797; 95% CI: 1.441–5.428; P = 0.0024), were independent predictors of long-term mortality. The competing risk regression models showed that cardiovascular and cerebrovascular mortality increased with increasing CONUT scores. The results were robust in both subgroup and sensitivity analyses. ConclusionsMalnutrition significantly impacts long-term mortality in hypertensive patients. The CONUT score may be a useful tool for assessing the nutritional status of patients with hypertension in the non-lipid-lowering population and for predicting their long-term mortality.