Prognostic Marker Of Mortality Research Articles

Time-to-positivity in bloodstream infection for Candida species as a prognostic marker for mortality.

Time-to-positivity (TTP) may assist in predicting outcome of candidaemia. We analysed a candidaemia dataset collected prospectively in Australia over 1 year (2014-2015). Time to positivity was defined as the period from blood culture sampling to the blood culture flagging positive. Of 415 candidaemia episodes, overall 30-day mortality was 29% (120/415); mortality with Candida albicans was 35% (59/169), C. glabrata complex, 37% (43/115), C. tropicalis, 43% (10/23), Pichia kudriavzevii 25% (3/12) and C. parapsilosis complex 7% (5/71). Each day of increased TTP multiplied the odds ratio (OR) of survival at 30 days by a factor of 1.32 (95%CI 1.06-1.69). Shorter TTP was associated with increased mortality, with 1 day TTP associated with 30-day mortality 37% (41/112) (95%CI: 28%-46%) and 5-day TTP 11% (2/18) (95%CI: 2%-36%).

Prognostic utility of pulse pressure in patients with heart failure with preserved ejection fraction: The RICA Registry

Background and aimsThe prognostic role of pulse pressure (PP) in heart failure (HF) patients with preserved left ventricular ejection fraction (LVEF) is not well understood. Our aim was to evaluate it in acute and stable HF. Material and methodsThis work is a retrospective observational study of patients included in the RICA registry between 2008 and 2021. Blood pressure was collected on admission (decompensation) and 3 months later on an outpatient basis (stability). Patients were categorized according to whether the PP was greater or less than 50mmHg. All-cause mortality was assessed at 1year after admission. ResultsA total of 2291 patients were included, with mean age 80.1±7.7 years. 62.9% were women and 16.7% had a history of coronary heart disease. In the acute phase, there was no difference in mortality according to PP values, but in the stable phase PP<50mmHg was independently associated with all-cause mortality at 1-year follow-up (HR 1.57, 95% CI 1.21−2.05, p=0.001), after adjusting for age, sex, New York Heart Association functional class, previous HF, chronic kidney disease, valvular heart disease, cerebrovascular disease, score on the Barthel and Pfeiffer scales, hemoglobin and sodium levels. ConclusionsLow stable-phase PP was associated with increased all-cause mortality in HF patients with preserved LVEF. However, PP was not useful as a prognostic marker of mortality in acute HF. Further studies are needed to assess the relationship of this variable with mortality in HF patients.

Neutrophil-to-Lymphocyte Ratio (NLR) as a Prognostic Marker for Burn Patients

BACKGROUND Complications like sepsis due to infection and death can occur in the treatment of major burn trauma patients because of inflammation process. The Neutrophil-to-Lymphocyte Ratio (NLR) is believed as a prognostic marker for the incidence of mortality and sepsis in burns patient care. Various studies have stated that NLR is quite easy, inexpensive and efficient tool for clinical application. AIMS to analyze the role of NLR as prognostic marker for mortality and sepsis in burn patients. METHODS A cross-sectional retrospective single-center study was conducted between 2019 – 2021 using 222 medical records from 245 burn patients at our Burns Unit. Demographics and laboratory data results were recorded, including NLR levels on 1st and 3rd day of treatment. Correlation analysis of NLR levels was carried out on the incidence of mortality and sepsis using Logistic Regression and Chi Square tests. RESULTS The subjects of this study were dominated by patients with median age of 33 years old (SD ±20), male (68.5%) and average burns area of 30.22% (SD ±23.3%). This study noted that the NLR on 1st day (cutoff of 7.97) and 3rd day (cutoff of 6.2) of treatment had a correlation with the incidence of mortality and sepsis (p<0.05). CONCLUSION Neutrophil-to-Lymphocyte Ratio (NLR) can be used as a prognostic marker of mortality and sepsis in burn patients.

Neutrophil-to-Lymphocyte ratio as a prognostic marker of mortality and disease severity in septic Acute kidney injury Patients: A retrospective study

BackgroundAcute kidney injury (AKI) is a frequent complication of sepsis associated with increased mortality and morbidity. The neutrophil-to-lymphocyte ratio (NLR) has been shown as a risk factor for septic AKI. In this study, we aimed to further evaluate NLR’s prediction value on the prognosis of septic AKI patients. MethodsSeptic AKI patients at a tertiary university-affiliated medical center were retrospectively enrolled from August 2015 to August 2021. The primary outcomes were 30-day and 90-day mortality, and secondary outcomes were disease severity, length of stay, and rehospitalization in survivors. Kaplan–Meier curves, Cox proportional hazards, cubic spline and logistics regression analyses were performed for adverse outcomes basing on NLR. The predictive value of NLR on morality was also estimated by the area under the receiver operating characteristic curve (AUROC). ResultsA total of 309 septic AKI patients were included with a mean age of 57.8 ± 18.1 years and 92 (29.8 %) being female. The 30-day mortality was 43.4 % and 90-day morality was 61.8 %. When divided by the median of NLR at hospital admission, patients in the high NLR group were associated with an increased 30-day/90-day mortality. After adjusting for multiple covariates, the predictive value of NLR remained significant for 30-day mortality (HR: 2.96, 95 % CI: 1.48–5.92, p = 0.002) and 90-day mortality (HR: 1.88, 95 % CI: 1.11–3.16, p = 0.018).NLR at admission had the highest AUROC (0.618) for 30-day mortality compared with other parameters such as white blood cell (0.573), neutrophil (0.579), lymphocyte (0.567), platelet (0.546), BUN (0.580), albumin (0.545), C-reactive protein (0.571) and procalcitonin (0.534). A similar predictive value on mortality was also observed for NLR measured at septic AKI diagnosis. For secondary outcomes, high NLR was associated with increased risk of transfer to ICU, mechanical ventilation, stage-3 AKI and renal replacement therapy, but not with length of hospital/ICU stay or long-term rehospitalization. ConclusionHigh NLR is independently associated with 30-day/90-day mortality and disease severity in septic AKI patients. NLR may serve as an economic and widely available biomarker of septic AKI prognosis.

Radiologic Assessment of Lung Edema Score as a Predictor of Clinical Outcome in Children with Acute Respiratory Distress Syndrome.

The radiographic assessment of lung edema (RALE) score enables objective quantification of lung edema and is a valuable prognostic marker of adult acute respiratory distress syndrome (ARDS). We aimed to evaluate the validity of RALE score in children with ARDS. The RALE score was measured for its reliability and correlation to other ARDS severity indices. ARDS-specific mortality was defined as death from severe pulmonary dysfunction or the need for extracorporeal membrane oxygenation therapy. The C-index of the RALE score and other ARDS severity indices were compared via survival analyses. Among 296 children with ARDS, 88 did not survive, and there were 70 ARDS-specific non-survivors. The RALE score showed good reliability with an intraclass correlation coefficient of 0.809 [95% confidence interval (CI), 0.760-0.848]. In univariable analysis, the RALE score had a hazard ratio (HR) of 1.19 (95% CI, 1.18-3.11), and the significance was maintained in multivariable analysis adjusting with age, ARDS etiology, and comorbidity, with an HR of 1.77 (95% CI, 1.05-2.91). The RALE score was a good predictor of ARDS-specific mortality, with a C-index of 0.607 (95% CI, 0.519-0.695). The RALE score is a reliable measure for ARDS severity and a useful prognostic marker of mortality in children, especially for ARDS-specific mortality. This score provides information that clinicians can use to decide the proper time of aggressive therapy targeting severe lung injury and to appropriately manage the fluid balance of children with ARDS.

Role of serum lactate as prognostic marker of mortality among emergency department patients with multiple conditions: A systematic review.

In the Emergency Department, the physician's purpose is to rapidly and accurately diagnose the severity of a patient's condition so that proper treatment can be administered. Therefore, this study pays close attention to the association and prognostic value of blood lactate on different disease outcomes by systematically reviewing recently published studies. The search strategy was developed based on searches in the year 2022 for potential publications including original articles, case reports, and reviews using the following web databases google scholar, PubMed, and Science Direct. A total of 25 studies were identified and reviewed extensively to evaluate the link between mortality and serum lactate levels. This literature review presents the strong association of elevated serum lactate levels with the in-hospital mortality rate among emergency department patients. These findings suggest that even a moderately raised lactate level in serum can predict the severe outcome in emergency department patients suffering from different conditions. Therefore, early (at the time of administration of hospital) and periodic serum lactate value determination through different techniques and scores is of need and should become part of routine analyses in emergency department to predict and choose therapies that could benefit critically ill patients.

Red Cell Distribution Width on First Day Intensive Care Unit Admission in Paediatrics.

Red distribution width (RDW) has recently been acclaimed as prognostic marker for mortality in critically-ill patients. However, this claim is still unclear and reports are still inadequate for the association between RDW and mortality in critically-ill paediatric patients. This research assessed the correlation between RDW within 24 hours of PICU (paediatric intensive care unit) admission and PELOD-2 score. A cross-sectional study was carried out involving 59 pediatric patients admitted to the PICU Haji Adam Malik Hospital, Medan, Indonesia, from May to July 2019. The association between RDW and PELOD-2 score was assessed by using Spearman correlation test. The RDW level of paediatric patients in the PICU on the first 24 hours was elevated (median 14.7%, range 11.4-31.2%). The median of PELOD-2 score assessment was 8 (range 2-21). There was no significant correlation between RDW and PELOD-2 in this research (r=0.187, p=0.156).

Calprotectin Levels and Neutrophil Count Are Prognostic Markers of Mortality in COVID-19 Patients.

Inflammation plays a crucial role in worsening coronavirus disease (COVID-19). Calprotectin is a pro-inflammatory molecule produced by monocytes and neutrophilic granulocytes. The aim of the study was to evaluate both the prognostic role of circulating calprotectin levels and neutrophil count toward fatal outcome in COVID-19 patients. We retrospectively collected and analyzed data on 195 COVID-19 adult patients, 156 hospitalized in the infectious disease unit and 39 in the intensive care unit (ICU). Calprotectin levels and neutrophil counts measured at the first hospitalization day were higher in the patients with a fatal outcome than in surviving ones. The association of high calprotectin levels and neutrophil count to patient death remain significant by logistic regression, independent of patient age. ROC curves analysis for calprotectin levels and neutrophil count revealed a good discriminatory power toward survival (area under the curve of 0.759 and 0.843, respectively) and identified the best cut-off (1.66 mg/L and 16.39 × 103/µL, respectively). Kaplan–Meier analysis confirmed the prognostic role of high calprotectin levels and neutrophil count in death prediction. In conclusion, this study highlights that calprotectin levels together with neutrophil count should be considered as biomarkers of mortality in COVID-19 patients.

Limited value of neutrophil-to-lymphocyte ratio and serum creatinine as point-of-care biomarkers of disease severity and infection mortality in patients hospitalized with COVID-19.

In hospitalized COVID-19, neutrophil-to-lymphocyte ratio (NLR) and serum creatinine is sometimes measured under assumption they predict disease severity and mortality. We determined the potential value of NLR and serum creatinine as predictors of disease severity and mortality in COVID-19. Prospective cohort study of COVID-19 patients admitted to premier COVID-19 treatment hospitals in Ethiopia. Predictive capability of biomarkers in progression and prognosis of COVID-19 was analyzed using receiver operating characteristics. Survival of COVID-19 patients with different biomarker levels was computed. Logistic regression assessed associations between disease severity and mortality on NLR and serum creatinine adjusted for odds ratio (AOR). The study enrolled 126 adults with severe (n = 68) or mild/moderate (n = 58) COVID-19, with median age 50 [interquartile range (IQR 20-86)]; 57.1% males. The NLR value was significantly higher in severe cases [6.68 (IQR 3.03-12.21)] compared to the mild/moderate [3.23 (IQR 2.09-5.39)], with the NLR value markedly associated with disease severity (p<0.001). Mortality was higher in severe cases [13 (19.1%)] compared to mild/moderate cases [2 (3.4%)] (p = 0.007). The NLR value was significantly higher in non-survivors [15.17 (IQR 5.13-22.5)] compared to survivors [4.26 (IQR 2.40-7.90)] (p = 0.002). Serum creatinine was significantly elevated in severe cases [34 (50%)] compared with mild/moderate [11 (19%)] (p<0.001). Disease severity [AOR 6.58, 95%CI (1.29-33.56), p = 0.023] and NLR [AOR 1.07, 95%CI (1.02-1.12), p = 0.004)] might be associated with death. NLR had a sensitivity and specificity of 69.1% and 60.3% as predictor of disease severity (cut-off >4.08), and 86.7% and 55.9% as prognostic marker of mortality (cut-off >4.63). In COVID-19, NLR is a biomarker with only modest accuracy for predicting disease severity and mortality. Still, patients with NLR >4.63 are more likely to die. Monitoring of this biomarker at the earliest stage of the disease may predict outcome. Additionally, high creatinine seems related to disease severity and mortality.

Prognostic marker for mortality of COVID-19 patients in the intensive care unit: the delta neutrophil index

Aim: The Delta Neutrophil Index (DNI) shows the ratio of immature granulocytes in the circulation and increases in conditions of infection and inflammation. The aim of this study was to investigate the suitability of using DNI as a prognostic marker of mortality in COVID-19 patients in the Intensive Care Unit (ICU). Material and Method: This retrospective study included 316 patients followed up in the ICU with a diagnosis of COVID-19. A record was made for each patient of demographic data, laboratory values, clinical results and mortality status. All the data of the patients were evaluated and compared between the two groups of surviving and non-surviving patients. Results: Mortality developed in 181 (57.27%) patients. The Glasgow Coma Scale score was lower and the APACHE II and SOFA scores were higher in the mortality group than in the surviving group (p&lt;0.001 for all). The creatinine, procalcitonin, white blood cell, neutrophil count, neutrophil-lymphocyte ratio, lactate, interleukin -6 and C-reactive protein values were statistically significantly higher in the mortality group. In the comparison of DNI between the groups, a statistically significant difference was only determined on day 3 (p=0.026). For the DNI examined on day 3, the AUC value was 0.574 and the cutoff value was 1.35% for the prediction of mortality. Conclusion: DNI, which is low cost and simple to use, can be considered safe for use in the prediction of mortality of ICU patients diagnosed with COVID-19. The monitoring of increasing or decreasing trends by keeping regular records can be considered important for the clinical course.

QRS fragmentation versus QRS prolongation in predicting right ventricular enlargement and dysfunction in children and adults with repaired Tetralogy of Fallot

Patients with repaired Tetralogy of Fallot (rTOF) have risks of late life-threatening sequelae, including right ventricular (RV) dilation and failure, arrhythmias, and sudden death. QRS prolongation is a well-known ECG predictor of these outcomes but has poor sensitivity for mortality. Growing evidence demonstrates QRS fragmentation (fQRS) as a better prognostic marker for mortality in adults with rTOF, though the two markers have not been directly compared as correlates for CMR abnormalities. Additionally, fQRS has never been studied in pediatric TOF. This single institution retrospectively reviewed 138 CMRs in rTOF patients (median age 21.7 years) who had a corresponding 12-lead ECG within 1 year. fQRS was defined as ≥3 R-waves/notches in the R/S complex (>2 in right bundle branch block) in ≥2 contiguous leads. QRS prolongation was defined as QRS ≥160 ms. Nearly half (46%) the sample had fQRS (42.1% of pediatric subgroup), and 26% had QRS prolongation. Both markers were significantly associated with reduced RV ejection fraction (EF%) (p < 0.01) and larger RV end-diastolic volumes (p < 0.01). QRS prolongation alone predicted lower LV EF% (p = 0.02). Regression analyses showed both QRS prolongation (p < 0.01) and fQRS (p < 0.01) independently associated with reduced RV EF%; QRS prolongation alone predicted RV dilation (p < 0.01). We concluded that both QRS prolongation and fQRS are equivalent as significant markers of RV dysfunction in rTOF patients. QRS prolongation may be a better surrogate for RV dilation specifically. fQRS was frequently seen in children with rTOF and was significantly associated with similar late structural sequelae.

Right ventricular systolic pressure – Non-invasive bedside predictor of mortality and readmission in heart failure with reduced and preserved ejection fraction hospitalization

ObjectiveTo study the prognostic role of right ventricular systolic pressure (RVSP) in patients with heart failure (HF). BackgroundAlthough RVSP is a readily available echocardiographic parameter, it is often underused. Its prognostic role in patients with heart failure is not well established compared with pulmonary artery pressure measured by right heart catheterization. MethodsThis single-center retrospective cohort study included patients with acute heart failure hospitalization admitted to the hospital from January 2005 to December 2018. The primary predictor was right ventricular systolic pressure (RVSP) obtained from bedside transthoracic echocardiography at admission. We divided RVSP into two groups, RVSP <40 mm Hg (reference group) and RVSP ≥40 mm Hg. Primary outcome was all-cause mortality. Secondary outcomes were all-cause readmission and cardiac readmission. We conducted propensity-score matching and applied cox-proportional hazard model to compute hazard ratio (HR) with 95% confidence interval (CI). ResultsOut of 972 HF patients, 534 patients had RVSP <40 mm Hg and 438 patients had RVSP ≥40 mm Hg. Patients with RVSP ≥40 mm Hg compared with RVSP <40 mm Hg were associated with higher rates of death [HR: 1.60, 95% CI: 1.22–2.09, P-value = 0.001], all-cause readmissions [HR: 1.37, 95% CI: 1.09–1.73, P-value = 0.008] and cardiac readmissions [HR: 1.41, 95% CI: 1.07–1.85, P-value = 0.014]. ConclusionHigher RVSP (≥40 mm Hg) in HF patients was associated with higher rates of death, all-cause readmissions, and cardiac readmissions. RVSP can be considered as a prognostic marker for mortality and readmission.

Prognostic value of red cell distribution width-to-platelet ratio in mortality of major burn in Sanglah Hospital Bali

Introduction: The mortality rate in Sanglah Hospital due to major burns is quite high. The ratio of red cell distribution width (RDW) and platelet (PLT) (RPR) as a prognostic marker of mortality in major burns has never been studied in Indonesia. Calculations of RPR are easy, widely available and cost-efficient.Method: This study was retrospective observational case-control, with 60 patients with major burns consisting of 30 cases and 30 controls. Samples were taken from the Sanglah Hospital Medical Record Unit from April 2019 to April 2021. Cases were samples with mortality after day seven, while controls were samples that survived. RDW and PLT value on day seven are associated with the incidence of mortality.Results: The mean of RPR in the case group was higher than in the control group. RPR mean of the control group was 0.0559, and the case group was 0.0947 (p&lt;0.001). The increase of RPR in the case group was 40.97%. Statistical analysis showed that high RPR was a significant mortality risk factor in patients with major burns (OR = 21.36; p &lt; 0.001).Conclusion: High RPR is a prognostic marker of mortality in major burns at Sanglah Hospital.

Exercise capacity assessed with the one-minute sit-to-stand test (1-min STST) is associated with echocardiographic findings in patients with heart failure with preserved ejection fraction (HFpEF)

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure with preserved ejection fraction (HFpEF) is a major cause of cardiovascular morbidity and mortality (1). Non-invasive imaging, particularly echocardiography, plays a central role in the evaluation of HFpEF patients. Numerous prognostic markers for mortality have been identified in patients with HFpEF, including right ventricular tricuspid annular plane systolic excursion (TAPSE) and estimated systolic pulmonary artery pressure (ePASP) [(2) (3) (4)]. ePASP is calculated with Doppler measurement of peak tricuspid regurgitation velocity (TRV). Despite those markers, precise risk stratification remains challenging. Recently the one-minute sit-to-stand-test (1-min STST), a quick and objective test of functional capacity that can be potentially used for risk stratification, has attracted the interest of researchers. In this test, participants are encouraged to stand up and sit down from a chair as quickly and as many times as possible within one minute. The 1-min STST provides valuable information on the ability to perform daily life activities in HFpEF patients and adds to our options of diagnostic tests in HFpEF. Purpose The aim of this investigation was to prospectively examine whether 1-min STST results correlate with transthoracic echocardiographic parameters in a group of HFpEF patients. Patient and methods 32 HFpEF patients [59% New York Heart Association (NYHA) Class III, 63% female, age (mean ± standard deviation) 70 ± 11 years and 66% atrial fibrillation] were prospectively studied. Functional performance was examined with the 1-min STST. Echocardiographic estimations of pulmonary artery pressure and additional parameters (TRV and systolic function measured by echocardiography) as well as clinical characteristics were obtained. Results Mean 1-min STST repetitions were 16.41 ± 6.7. Twelve (38%) of the 32 HFpEF patients had moderate to severe mitral regurgitation and 29 (91%) had moderate or more tricuspid regurgitation. Mean left ventricular ejection fraction (LVEF) was 52.57 ± 1.74 % and mean ePASP was 65.81 ± 23.17 mmHg. 10 (32%) patients were in NYHA class I or II, 22 (69%) in NYHA class III or IV. There was a significant inverse association between higher NYHA class and the 1-min STST (t = 2.6, p = 0.012). The following additional parameters correlated significantly with the 1-min STST: ePASP (r = -0.545, p = 0.001), TRV (r = -0.598, p &amp;lt; 0.001) and the ratio of TAPSE/ePASP (r = 0.767, p = 0.001) (see table 1). Interestingly, the decline in oxygen saturation during the 1-min STST showed significant correlation with ePASP (r = -0.559, p &amp;lt; 0.001) and TRV (r = 0.540, p = 0.002). Conclusion Our investigation shows a direct linear correlation between ePASP, TRV and TAPSE/ePASP measured by echocardiography and measurements of functional capacity derived by the 1-min STST. Thus, the current results emphasize the role of the 1-min STST as an additional diagnostic tool in patients with HFpEF. Abstract Figure.

High-sensitivity troponin in the prognosis of patients hospitalized in intensive care for COVID-19: a Latin American longitudinal cohort study

Objective:The current study assessed the prevalence of troponin elevation and its capacity to predict 60day mortality in COVID-19 patients in intensive care.Methods:A longitudinal prospective single-center study was performed on a cohort of patients in intensive care due to a COVID-19 diagnosis confirmed using real-time test polymerase chain reaction from May to December 2020. A Receiver Operating Characteristic curve was constructed to predict death according to troponin level by calculating the area under the curve and its confidence intervals. A Cox proportional hazards model was generated to report the hazard ratios with confidence intervals of 95% and the p value for its association with 60day mortality.Results:A total of 296 patients were included with a 51% 60-day mortality rate. Troponin was positive in 39.9% (29.6% versus 49.7% in survivors and non-survivors, respectively). An area under the curve of 0.65 was found (95%CI: 0.59 - 0.71) to predict mortality. The Cox univariate model demonstrated a hazard ratio of 1.94 (95%CI: 1.41 - 2.67) and p < 0.001, but this relationship did not remain in the multivariate model, in which the hazard ratio was 1.387 (95%CI: 0.21 - 1.56) and the p value was 0.12.Conclusion:Troponin elevation is frequently found in patients in intensive care for COVID-19. Although its levels are higher in patients who die, no relationship was found in a multivariate model, which indicates that troponin should not be used as an only prognostic marker for mortality in this population.

Prognostic markers of mortality in patients with methanol poisoning

Prognostic markers of mortality in patients with methanol poisoning

Red cell distribution width is associated with cardiovascular risk in adults.

Red cell distribution width (RDW) is a measure of erythrocyte size variability. Recent studies have shown that RDW is a predictive, and prognostic marker of mortality and cardiovascular (CVD) events in the general population and in CVD patients. This study aimed to investigate the association between RDW and CVD risk in a large sample of adults. A subsample of CVD free participants of the ELSA-Brasil cohort were included (n=4,481). In the cross-sectional approach, multiple regression analysis was used to investigate the association between RDW and the Framingham Risk Score (FRS). Linear mixed effect model evaluated whether baseline RDW predicted changes in CVD risk after about four-year follow up. Cross-sectional analysis showed that RDW was independently associated with FRS, participants in the fourth-quartile of RDW distribution had a 29% higher FRS than those in the first-quartile RDW (p<0.001). A longitudinal analysis revealed that RDW remained associated with increased FRS. In this large cohort of adult Brazilians, RDW was independently associated with increased CVD risk, as measured by the FRS, both at baseline and after four-year follow-up. However, RDW did not predict change in CVD risk in this short-term follow up.

Troponina de alta sensibilidade no prognóstico de pacientes internados em terapia intensiva por COVID-19: um estudo de coorte longitudinal latino-americano

The current study assessed the prevalence of troponin elevation and its capacity to predict 60day mortality in COVID-19 patients in intensive care. A longitudinal prospective single-center study was performed on a cohort of patients in intensive care due to a COVID-19 diagnosis confirmed using real-time test polymerase chain reaction from May to December 2020. A Receiver Operating Characteristic curve was constructed to predict death according to troponin level by calculating the area under the curve and its confidence intervals. A Cox proportional hazards model was generated to report the hazard ratios with confidence intervals of 95% and the p value for its association with 60day mortality. A total of 296 patients were included with a 51% 60-day mortality rate. Troponin was positive in 39.9% (29.6% versus 49.7% in survivors and non-survivors, respectively). An area under the curve of 0.65 was found (95%CI: 0.59 - 0.71) to predict mortality. The Cox univariate model demonstrated a hazard ratio of 1.94 (95%CI: 1.41 - 2.67) and p < 0.001, but this relationship did not remain in the multivariate model, in which the hazard ratio was 1.387 (95%CI: 0.21 - 1.56) and the p value was 0.12. Troponin elevation is frequently found in patients in intensive care for COVID-19. Although its levels are higher in patients who die, no relationship was found in a multivariate model, which indicates that troponin should not be used as an only prognostic marker for mortality in this population.

Neutrophil-Lymphocyte Ratio as a Prognostic Factor for 15-Day Mortality of Patients infected in ICU

Abstract Introduction The determination of the groups at risk of death at admission in patients with bacterial infection in the ICU is important. Several prognostic factors have already been identified, however the neutrophil/lymphocyte ratio (NLR) has the advantage of being common and inexpensive. Objective To determine the threshold value of NLR to determine the group at risk of 15-day mortality and the overall survival of patients according to this threshold. Methods This was a retrospective cohort conducted in the intensive care unit of the Ibn Rochd University Hospital in Casablanca over a period of 2 years (January 2019 - January 2021), among hospitalized patients with bacterial infection, acquired or nosocomial. The sample size was calculated a priori and multivariate statistical analyses (multiple logistic regression, Youden index and Kaplan Meier survival estimation and Log Rank) were performed using Rstudio software. The significance level was less than 5%. Results A total of 200 patients were included in the study, 136 patients were alive at 15 days, there were no differences in age between the two groups. Factors associated with patient mortality at 15 days were: gender, use of vasoactive drugs, use of mechanical ventilation, type of sepsis, site of infection, SOFA score (p &amp;lt; 0.000), Apache score (p = 0.009) and NLR at admission (p = 0.001). The cut-off value for NLR was 15.07 with a mean discriminant value of 64.1%. The difference in median overall survival of patients in the two groups according to the threshold value was statistically significant 22 +/- 1.9 days and 11 +/-1.12 days (p = 0.042). Conclusions The NLR appears to be a prognostic factor for 15-day mortality. The knowledge of prognostic factors and threshold values of these indicators allow the prediction of at-risk groups in order to best adapt their management. Key messages The use of common and inexpensive biological prognostic markers are a reliable alternative to identify at-risk patients to optimize their management in developing countries. The RNL is a good biological prognostic markers of mortality of patients infected in ICU.

The Prognostic Role of Right Ventricular Stroke Work Index during Liver Transplantation.

Right heart-associated hemodynamic parameters including intraoperative pulmonary vascular resistance (PVR) were reported to be associated with patient survival after liver transplantation. We investigated whether intraoperative stroke work indexes of both ventricles could have a better prognostic value than PVR. We reviewed 683 cases at a tertiary care academic medical center. We collected intraoperative variables of baseline central venous pressure, baseline right ventricle end-diastolic volume, mixed venous oxygen saturation, intraoperative PVR and right and left ventricular stroke work indexes. Time-weighted means or area under the curve of intraoperative right and left ventricular stroke work indexes were calculated as exposure variables. One-year all-cause mortality or graft failure was our primary outcome. Cox proportional hazard regression analysis was performed to evaluate the association between exposure variables and one-year all-cause mortality or graft failure. Kaplan–Meier survival curve analysis of our primary outcome was performed for different time-weighted mean ventricular stroke work index groups. Cubic spline curve analysis was performed to evaluate the linear relationship between our exposure variables and primary outcome. Time-weighted mean right ventricular stroke work index was significantly associated with one-year all-cause mortality or graft failure (hazard ratio 1.21, 95% confidence interval (CI) 1.12–1.36, p < 0.001). However, there was no significant association between time-weighted mean left ventricular stroke work index, time-weighted mean PVR, PVR at the end of surgery and one-year mortality. Area under the curve of right ventricular stroke work index was also significantly associated with one-year mortality or graft failure (hazard ratio 1.24, 95% CI 1.15–1.37, p < 0.001). Kaplan–Meier survival curve analysis showed a significant difference in the survival between different mean right ventricular stroke work index groups (Log-rank test: p = 0.002). Cubic spline function curve showed the gradual increase in the risk of mortality with a positive slope with time-weighted mean right ventricular stroke work index. In conclusion, intraoperative elevated right ventricular stroke work index was significantly associated with poor patient or graft survival after liver transplantation. Intraoperative right ventricular stroke work index could be an intraoperative hemodynamic goal and prognostic marker for mortality after liver transplantation.