Prognostic Factor For Morbidity Research Articles

Right Ventricular Dysfunction before and after Cardiac Surgery: Prognostic Implications.

Right ventricular dysfunction is a prognostic factor for morbidity and mortality across a broad spectrum of cardiovascular diseases. While the role of the right ventricle in surgical patients has emerged, the prognostic impact of right ventricular dysfunction remains unclear in a large cardiac surgery population. We reviewed the existing literature about the role of right ventricular dysfunction in adults undergoing different kinds of cardiac surgery either present before or developed after surgery itself. Pre- and post-operative right ventricular dysfunction has demonstrated substantial prognostic implications. However, there remains a lack of consensus regarding its definition and diagnostic criteria. The available literature is limited to small-sized studies, underscoring the need for studies with larger populations.

Prognostic Factors for Morbidity and Mortality in Redux Valve Surgery

Objectives: Redux valve surgery is increasingly common in Algeria, and the aim of this study was to identify the risk factors for hospital morbidity and mortality in this type of surgery. Method :49 patients with a mean age of 51 years (20-67 years) and a sex ratio of 0.88 underwent redux valve surgery between January 2015 and december 2019. 79%), and in almost half of the cases (46%) the first operation was performed in our department; the most frequent reasons for repeat operations were mitral plasty dysfunction, expression of new valve damage and removal of mechanical prostheses due to infective endocarditis. The Euroscore was used to predict operative risk. Results: 80% of our patients were classified in the moderate risk group (score 3-5) with an expected mortality of between 2.90 and 2.94%. Our results show a mortality rate of 2.56% for these patients. The study of post-operative results revealed a number of cardiac complications (28.5% low output and 37% rhythm disorders), infectious complications (8% mediastinitis) and neurological complications (6%). The risk factors for operative mortality were multiple valve procedures (p=0.03), persistent atrial fibrillation or fibrillation that appeared postoperatively (p=0.05) and age over 70 (p=0.04). Conclusion: Valvular redux surgery with a single-valve procedure has an operative morbi-mortality, actuarial survival and post-operative functional benefit that are entirely comparable to those of a primary intervention; whereas in redux surgery with a multi-valvular procedure, the operative morbi-mortality is significantly higher, but the actuarial survival and functional benefit are comparable to those of a primary intervention

MINOCA: A Working Diagnosis.

Cases of patients presenting with myocardial infarction (MI) without angiographic obstructive CAD are not trivial and have significant prevalence. "The Fourth Universal Definition of MI" (4UDMI) published in 2018 introduced MI with non-obstructive coronary arteries (MINOCA).The new section was of great importance as it validated the diagnosis by defining its criteria and recognizing its presence in the community and the need for further investigation. Given the nature of the diagnosis of MINOCA, coronary angiography provides limited information about prognosis and risk stratification for future major adverse cardiovascular events (MACE). Thus, additional imaging to understand the underlying etiology of MINOCA in conjunction with a better understanding of prognostic factors is necessary to expand on the current guidelines and aid in screening for possible complications, risk of MACE, and all-cause mortality. Discerning the etiology of the presentation is crucial, and physiologic studies, as well as additional imaging, are an important part of this evaluation. These modalities includeintravascular studies such as optical coherence tomography (OCT), intravascular ultrasound (IVUS), fractional flow reserve (FFR), and imaging in the form of cardiac CT (CCT) and cardiac MRI (CMR). This step is essential to target treatment regimens more efficiently. The purpose of promoting multiple imaging modalities beyond traditional angiography is to address the working MINOCA diagnosis, with the finality of identifying the specific ischemic pathophysiology. MINOCA has multiple causative mechanisms, making it a heterogeneous collection of etiologies, resulting in acute MI: atherosclerotic, and non-atherosclerotic. This literature revision demonstrates that MINOCA prevalence and mortality are not trivial, and the diagnosis affects quality of life. MINOCA presents a definitive risk of MACE without proper stratification and targeted medical therapy. Several prognostic factors of morbidity and mortality in MI-CAD patients have been identified to correlate with MINOCA patients, especially inflammatory markers. MINOCA is not an exclusion diagnosis but a working diagnosis for which further imaging studies should be performed.

Individual components of metabolic syndrome as a prognostic factor for morbidity and mortality in COVID-19

Background: COVID-19 has emerged as a rapidly spreading pandemic with millions of deaths. We aimed to investigate whether metabolic syndrome can be used as a prognostic factor for the outcome of patients infected with this viral disease, regarding the ICU stay, the requirement of mechanical ventilation (MV) and mortality. Methodology: This retrospective study included 90 patients admitted to intensive care unit (ICU) of Ain Shams University for pneumonic COVID-19 with a confirmed positive RT-PCR for COVID-19 and positive changes on chest computed tomography, over a period of 10 months from July 2021 to April 2022. They were divided into two groups according to the presence or absence of metabolic syndrome. The primary outcome measured was the length of ICU stay. Secondary outcome was the percentage of patients requiring mechanical ventilation (MV) and the mortality rate in the two groups. Results: Patients with metabolic syndrome had higher liver transaminases, random blood glucose, triglycerides, ferritin, and P/F ratio compared to those without metabolic syndrome (P < 0.05). Components of metabolic syndrome such as hypertension, type 2 diabetes mellitus, and obesity significantly increased the risk of hospitalization and mortality in COVID-19 patients (P < 0.05). Conclusion: Metabolic syndrome is a better prognostic indicator for severe disease outcomes in patients with COVID-19 than its individual components. Although patients with metabolic syndrome didn’t have a higher need for mechanical ventilation, they had longer duration of ICU stay and a higher mortality rate. Abbreviations: ACE-2: angiotensin-converting enzyme-2, hs-CRP: High sensitivity C-reactive protein,ICU: Intensive care unit, MV: Mechanical ventilation, MS: Metabolic syndrome, ROC: Receiver operating characteristic Key words: Metabolic Syndrome; COVID-19; ICU; Mechanical ventilation; Mortality Citation: Refaat SA, Elshaer AN, Hamza AH, Abdou AMH, SakrHAM. Individual components of metabolic syndrome as a prognostic factor for morbidity and mortality in COVID-19. Anaesth. pain intensive care 2023;27(3):343−350. DOI: 10.35975/apic.v27i3.2225 Received: February 14, 2023; Reviewed: March 08, 2023; Accepted: March 16, 2023

Intraoperative metabolic changes associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

BackgroundCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) causes considerable hemodynamic, respiratory, and metabolic changes during the perioperative period.ObjectivesTo evaluate metabolic changes associated with this procedure. Understanding perioperative factors and their association with morbidity may improve the perioperative management of patients undergoing this treatment.MethodsA retrospective review of a prospectively maintained database was performed. All consecutive unselected patients who underwent CRS plus HIPEC between January 2018 and December 2020 (n = 219) were included.ResultsThe mean age was 58 ± 11.7 years and 167 (76.3%) were female. The most frequent histology diagnosis was serous ovarian carcinoma 49.3% (n = 108) and colon carcinoma 36.1% (n = 79). Mean peritoneal cancer index was 14.07 ± 10.47. There were significant variations in pH, lactic acid, sodium, potassium, glycemia, bicarbonate, excess bases, and temperature (p < 0.05) between the pre-HIPEC and post-HIPEC periods. The closed HIPEC technique resulted in higher levels of temperature than the open technique (p < 0.05). Age, potassium level post-HIPEC potassium level, and pre-HIPEC glycemia were identified as prognostic factors for morbidity in multivariate analysis.ConclusionThe administration of HIPEC after CRS causes significant changes in internal homeostasis. Although the closed technique causes a greater increase in temperature, it is not related to higher morbidity rates. The patient’s age, post-HIPEC potassium level, and pre-HIPEC glycemia are predictive factors for morbidity.

Outcome and prognostic factors of morbidity and mortality in suprasellar meningioma

Outcome and prognostic factors of morbidity and mortality in suprasellar meningioma

170: SHORT AND LONG TERM OUTCOMES IN ELDERLY PATIENTS WITH ESOPHAGEAL CANCER: UPFRONT ESOPHAGECTOMY COMPARED TO SURGERY AFTER NEOADJUVANT TREATMENTS

Abstract Background and aim The current standard of care in treating locally-advanced esophageal cancer has been established after the publication of the landmark CROSS trial and several others, which demonstrated an overall survival benefit from preoperative chemoradiation prior to esophagectomy in this setting. However, elderly patients have been generally excluded from randomized study protocols, so literature regarding the choice of the best treatment approach for resectable esophageal cancer in patients older than 75 years old is limited. The aim of this study was to characterize outcomes associated with neoadjuvant chemoradiation prior to esophagectomy, compared to esophagectomy alone, in older patients with esophageal cancer. Methods We conducted a retrospective study in patients ≥75 years with locally-advanced esophageal cancer (both adenocarcinoma -EAC and squamous cell carcinoma -SCC) undergoing esophagectomy ± neoadjuvant chemoradiation at our Center between 2000 and 2020. Results A total of 141 patients were included in the study. Patients were subcategorized into two groups: patients undergoing upfront surgery (SURG, n = 97) and patients undergoing neoadjuvant therapy before surgery (NAT, n = 44). Patients in the NAT group experienced a significantly higher postoperative morbidity when compared to the SURG group. Overall survival (21 months and 25 months, p = 0.8883) and cancer-related survival (20 and 25 months, p 0.8052) were not statistically different between the SURG and the NAT group. When looking to the histology, OS for EAC and for SCC did not significantly differ between the 2 groups. We subcategorized patients according to their final pathological stage into patients with pTNM stage I and II, and patients with stage III and IV. Among patients with EACs stage III-IV, the NAT group experienced a significant benefit in OS when compared to the SURG group. Univariate analysis for risk factors for postoperative morbidity showed a significant association between NAT and postoperative complications (p 0,0336). Multivariate analysis confirmed neoadjuvant therapy as an independent prognostic factor for morbidity (P 0,0226). Conclusion In our study, patients undergoing NAT before surgery experienced a higher postoperative morbidity when compared to patients undergoing upfront esophagectomy. Further studies are needed to identify which older patients are most suitable for neoadjuvant therapy before esophagectomy.

Nutritional status and its impact on patients hospitalized for Covid-19

Rationale: During COVID-19 infection, undernutrition appears to be a prognostic factor for morbidity and mortality. The objectives were to study the nutritional status of patients admitted with COVID-19 on admission and its evolution until discharge, ii) to compare patients who lost more or less than 5% of their body weight, iii) to study the factors associated with weight loss over 5% during hospitalization and length of stay.

Team Strategy Optimization in Combined Resections for Synchronous Colorectal Liver Metastases. A Comparative Study with Bootstrapping Analysis.

The aim of the study was to evaluate perioperative outcomes and to evaluate factors influencing rative morbidity and adoption of minimally invasive technique in 1-team (1-T) versus two teams (2-T) management of synchronous colorectal liver metastases. Within four referral centers, a group of 234 patients treated in 1-T centers was identified and compared with a group of 253 patients treated in 2-T. A nonparametric bootstrap process was applied to the original cohorts of 1-T group and 2-T group as a resampling method to obtain bootstrapped cohorts (155 patients per group). 33.5% of patients in 1-T boot group and 38.1% in the 2-T boot group were operated by laparoscopic approach. Multivariate analysis revealed that approach to primary tumor (laparoscopic or open) and intraoperative blood loss were independent prognostic factors for morbidity. Team approach did not show any significant correlation with incidence of postoperative complications nor with choice for laparoscopic approach. The optimization of team strategy for patients with SCRLM is not solely based on the adoption of a 1-T or 2-T approach, but should instead be based on the implementation of a standard protocol for management of these patients.

J Point and ST Elevation Resembling Brugada: A Marker of Mortality in Methanol Toxicity.

Objective J point and coved ST elevation in right precordial leads (not produced by coronary artery disease) are still a matter of challenge, especially when resembling Brugada patients. This clinical entity, among asymptomatic individuals with no family history of sudden cardiac death, would be reported in some severely ill patients before ventricular fibrillation. This study investigated the relationship between the electrocardiograms with demographic and laboratory data and also analyzed their association with mortality rate among patients with methanol poisoning. Methods The sample consisted of 356 patients who were hospitalized with a diagnosis of methanol poisoning in Faghihi and Namazi Hospitals in Shiraz, Southern Iran, in March and April 2020. In this period, a major outbreak of methanol poisoning had occurred in this area. Furthermore, the study used the data on any recorded complications or mortality during hospital course. Results The ECG (BrP) was observed in a total of 20 (5.6%) patients. Its presence was associated with increased mortality, Glasgow coma scale score <3, and blood sugar levels and was inversely associated with PH, O2 saturation, and calcium levels (P < 0.05). Conclusions This study found that certain ECG patterns and laboratory data can be used as prognostic factors of morbidity and mortality in patients with methanol intoxication. Electrocardiography machines are widely available tools, which can be easily used for risk stratification based on the presence of Brugada approximating electrocardiograms among patients with methanol intoxication.

To Evaluate The Clinical Aspects, And The Prognostic Factors Of Morbidity And Mortality Of Eclampsia

Introduction: Pre-eclampsia is a leading cause of maternal morbidity and mortality. Substandard care is often present and many deaths are preventable. Eclampsia, a major neurological complication of pre-eclampsia, is defined by a convulsive manifestation and/or conscious-ness disorder occurring in a preeclampsia context and cannot be at-tributed to a pre-existing neurological problem. Objective: To Evaluate the Clinical Aspects, And the Prognostic Factors Of Morbidity and Mortality Of Eclampsia. Materials and Methods: This is a retrospective, descriptive and analytical study of all patients admitted for eclampsia from April 2020 to March 2021 in the multipurpose intensive care unit of the anesthesiology Dept. Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh. The diagnosis of eclampsia was based on the occurrence of peripartum seizures in a woman whose history and examination revealed no other cause for the convulsion. We studied the clinical, therapeutic, evolutionary and prognostic factors of morbidity and mortality. Results: We collected 45 cases of eclampsia for 2502 deliveries in the study (incidence of 1.8%). The average age of the patients was 22.23 years. Primiparity was found in 25 patients (55.5%). Antenatal consultations were effective in 4 patients (8.8%). Conscious-ness was clear at admission in 38 patients (84.4%) and for one patient a Glasgow score <8 was reported (1.96%). Severe hypertension was observed in 27.4% of cases. A ventilation intubation of 03 days was required in one patient in 1.9% of cases. Caesarean was the mode of delivery in 56.8% of cases and vaginal delivery was performed in 43%of cases. General anesthesia was doing in 18 patients (72%) and spinal anesthesia was performed in 7 patients (28%). Maternal complications were represented by: Postpartum acute renal failure (13.3%), Hellp syndrome (11.1%), and coagulopathy (16.6%). Prematurity was found in 12 neonates (13.3%), perinatal mortality was 9.1% and the maternal mortality rate was 4.4%. Conclusion: Eclampsia is still responsible for high maternal and infant mortality. The association of two or even more serious factors is very important in this mortality.

Taquicardia como factor pronóstico de morbimortalidad en pacientes sin enfermedad previa con fiebre en urgencias pediátricas

Taquicardia como factor pronóstico de morbimortalidad en pacientes sin enfermedad previa con fiebre en urgencias pediátricas

Anesthesia-Resuscitation and Prognostic Factors of Morbidity and Mortality of Eclampsia: A Study in Cumilla Medical College, Cumilla, Bangladesh

Anesthesia-Resuscitation and Prognostic Factors of Morbidity and Mortality of Eclampsia: A Study in Cumilla Medical College, Cumilla, Bangladesh

18F-NaF PET/CT and Extraordinary Involvement: Non-calcific Brain Involvement in a Prostate Cancer Case

With the increase in the diagnosis of the cancer, the frequency of using imaging methods for diagnosis and for staging is also increased. Because of the complex structure of cancer and tumor behavior, the assessment methods have been updated and metabolic imaging has gained weight. The most popular of these techniques is hybrid positron emission tomography/computed tomography (PET/CT) systems. Prostate cancer is the second most common cancer in the world, is the fifth common type in cancer-related male deaths. Estimation of prognosis and treatment planning of the patients are based on the TNM classification. Bone metastasis is a prognostic factor of morbidity and mortality in prostate cancer. Sodium fluoride (NaF) PET/CT is a promising imaging modality in evaluation of skeletal system. This article will review the involvement of 18F-NaF in extra-osseous tissues in the prostate cancer and reveal the fundamental differences between 18F-NaF imaging and 18F-FDG imaging in these areas.

"Anesthesia-Resuscitation and prognostic Factors of Morbidity and Mortality of Eclampsia: A Study in Cumilla Medical College, Cumilla, Bangladesh"

"Anesthesia-Resuscitation and prognostic Factors of Morbidity and Mortality of Eclampsia: A Study in Cumilla Medical College, Cumilla, Bangladesh"

Etiology of Fournier gangrene as a prognostic factor in mortality: Analysis of 121 cases

ObjectiveEvaluate the origin of Fournier gangrene (FG) as a prognostic factor of morbidity and mortality. Material and methodsPatients who came to our clinic with a diagnosis of FG from 2010 to 2017 were included retrospectively. Patients were categorized depending on the origin of the infection. Three severity factors were determined in each group: days of hospital stay, the FG severity index, and mortality. Logistic regression test was performed to analyze the data. ResultsOf the 130 patients evaluated, the origin was established in 121 based on the clinical history and radiological and surgical findings. Thirty-five patients had an intestinal origin with a mortality of 20.68%, 46 patients had a testicular origin with a mortality of 2.22%, 12 patients had a urinary origin with a mortality of 0%, and 28 patients with a cutaneous origin with a mortality of 16.6%. The testicular origin was the most frequent (38%) in addition to presenting a lower hospital stay, a lower FG severity index, and a lower mortality than those with an intestinal origin (p=0.022). ConclusionsThe origin of the infection has a significant prognostic value in the mortality of the patient.

Etiología de la gangrena de Fournier como factor pronóstico de mortalidad: análisis de 121 casos

ObjectiveEvaluate the origin of Fournier gangrene (FG) as a prognostic factor of morbidity and mortality. Material and methodsPatients who came to our clinic with a diagnosis of FG from 2010 to 2017 were included retrospectively. Patients were categorized depending on the origin of the infection. Three severity factors were determined in each group: days of hospital stay, the FG severity index, and mortality. Logistic regression test was performed to analyze the data. ResultsOf the 130 patients evaluated, the origin was established in 121 based on the clinical history and radiological and surgical findings. Thirty-five patients had an intestinal origin with a mortality of 20.68%, 46 patients had a testicular origin with a mortality of 2.22%, 12 patients had a urinary origin with a mortality of 0%, and 28 patients with a cutaneous origin with a mortality of 16.6%. The testicular origin was the most frequent (38%) in addition to presenting a lower hospital stay, a lower FG severity index, and a lower mortality than those with an intestinal origin (P=.022). ConclusionsThe origin of the infection has a significant prognostic value in the mortality of the patient.

Surgery or Radiotherapy of the Primary Tumor in T1-2 Head and Neck Squamous Cell Carcinoma with Resectable N3 Nodes: A Multicenter GETTEC Study.

The prognosis of advanced nodal (N3) squamous cell carcinoma of the head and neck (HNSCC) is poor. We investigated whether surgery or radiotherapy of early (T1-2) primary stage HSNCC is preferable to limit the overall morbidity after upfront neck dissection (uND) for N3 disease. This retrospective multicentric Groupe d'Étude des Tumeurs de la Tête Et du Cou study included patients undergoing uND and surgery or radiotherapy of their primary. Prognostic factors were evaluated using propensity score matching to account for biases in performing surgery depending on primary site and stage. Of 189 T1-2, N3 HNSCC patients, 70 (37.0%) underwent uND: 42 with surgery of their primary and 28 with radiotherapy only. Radiotherapy alone was more frequent in patients with hypopharyngeal primaries. All local (N = 3) and regional (N = 10) relapses (included 2 locoregional relapses) occurred within the first 2years. There were 16 distant metastatic failures. Five-year locoregional relapse and survival incidences were 15.7% and 66.5% and were similar regardless of the treatment of the primary. The overall morbidity rate was 65.2% and was similar after weighting by the inverse propensity score (p = 0.148). The only prognostic factor for morbidity was the radicality of the uND. Prolonged parenteral feeding was not more frequent in patients only irradiated to their primary (p = 0.118). Prolonged tracheostomy was more frequent after surgery of the primary. In patients with T1-2, N3 HNSCC undergoing uND, radiotherapy and surgery of the primary yield similar oncological outcomes. Morbidity was related to the extent of neck dissection.

Hypertensive Retinopathy: A Prognostic Factor for Morbidity and Mortality after Acute ST Elevation Myocardial Infarction.

To determine the association between hypertensive retinopathy (HR) and post ST elevation myocardial infarction (STEMI) complications among successfully thrombolysed patients. A cohort study. Cardiology Unit, Lady Reading Hospital, Peshawar, from June 2016 to December 2017. Patients with history of hypertension for at least 5 years who presented with STEMI and were successfully thrombolysed, were included. On the basis of fundoscopy, patients were grouped into no, mild, moderate, and severe hypertensive retinopathy. Primary and secondary endpoints included a composite of death, re-MI, stroke, re-hospitalisation secondary to left ventricular failure, cardiogenic shock, arrhythmia, heart block, and ventricular septal rupture at 30 days and 4 months, respectively. Association between hypertensive retinopathy and post STEMI complications was determined by Chi-square test. Regression model was used to calculate relative risk of complications with hypertensive retinopathy. P <0.05 was taken as significant. A total of 118 patients with a mean age of 54.83 ±8.6 years were included in the study. Of these, 49.2% (n=58) were males. Moreover, 38.1% (n=45) of patients were grouped under no HR, 22.8% (n=27) under mild HR, 21.1% (n=25) and 17.7% (n=21) under moderate and severe HR, respectively. Primary endpoints achieved were 0% in no HR group and 19% in severe HR group x² = 18.1, p <0.001). Secondary endpoints were achieved in 2.2% in no HR group and 40.7%, 56% and 100% in mild, moderate and severe HR group, respectively, ( x² = 81.1, p <0.001). HR also increased the relative risk of complications by 3.17 times (p <0.001) and death by 1.75 times (p <0.001). Hypertensive retinopathy is an independent risk factor for post-acute STEMI complications in successfully thrombolysed patients and increased the relative risk for complications by 3.17 times.

Prognostic factors for short-term and long-term outcomes of gastric cancer surgery for elderly patients: 10 years of experience at a single tertiary care center.

This retrospective study aimed to verify the short-term and long-term outcomes of elderly patients who underwent gastric resection for gastric cancer and to compare the results between younger and elderly patients. 222 Patients, who underwent gastrectomy between January 2005 and December 2014, were divided into 2 groups: ≤ 75years old (group A) and > 75years (group B). The groups were homogeneous except for more advanced pathological stage (p = 0.011) and higher number of comorbidities in group B (p < 0.001) and a higher rate of neoadjuvant or adjuvant complementary therapy in group A (p = 0.029 and p < 0.001). Perioperative morbidity rates were 38.7 and 65.5% (p = 0.001), and mortality rates were 2.5 and 7.9% (p = ns), respectively. The independent negative prognostic factors for morbidity were age older than 75years [odds ratio (OR) 2.7], multiple organ resection (OR 2.4), and male gender (OR 1.8). The 36-month survival rates were 76.1% and 42.1% (p = 0.002) and disease-free survival rates were 85% and 76.3% (p = 0.017), respectively. Surgical indications should not be limited by age.