Prognostic Marker For In-hospital Mortality Research Articles

Prognostic Value of Dynamic Segmented Neutrophil to Monocyte (SeMo) Ratio Changes in Patients with Moderate to Severe Traumatic Brain Injury.

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in trauma patients, necessitating reliable prognostic tools. The segmented neutrophil-to-monocyte (SeMo) ratio, indicative of the inflammatory response, has emerged as a valuable biomarker. This study evaluates the prognostic value of dynamic changes in the SeMo ratio in predicting outcomes for patients with moderate to severe TBI. A retrospective analysis was conducted on data from 1118 TBI patients admitted to the surgical intensive care unit at a level I trauma center between January 2009 and December 2020. Patients were selected based on an Abbreviated Injury Scale (AIS) score ≥ 3 in the head region. Initial and follow-up SeMo ratios were calculated upon admission and 48-72 h later, respectively. The dynamic SeMo ratio was defined as the difference between the second and initial SeMo ratios. Statistical analyses included receiver operating characteristic (ROC) curve analysis to determine the optimal threshold for mortality prediction, and comparative analysis of clinical outcomes. The study cohort included 121 deceased and 997 surviving patients. Deceased patients had significantly higher second SeMo ratios (20.9 ± 16.1 vs. 15.8 ± 17.2, p = 0.001) and dynamic SeMo ratios (2.4 ± 19.8 vs. -2.1 ± 19.5, p = 0.019) than those survival patients. In the multivariate analysis, the dynamic SeMo is a significant independent risk factor for in-hospital mortality (OR 1.01, 95%CI: 1.01-1.03, p = 0.031). The optimal cut-off for the dynamic SeMo ratio was 5.96, above which patients exhibited higher mortality (21.4% vs. 8.5%, p < 0.001), higher adjusted mortality (adjusted odds ratio: 2.98; 95% confidence interval: 1.95-4.56; p = 0.005), and longer hospital stays (23.6 days vs. 19.7 days, p = 0.005). Dynamic SeMo ratio changes serve as a prognostic marker for in-hospital mortality and hospital stay duration in moderate to severe TBI patients. A higher dynamic SeMo ratio indicates increased risk, highlighting the importance of early monitoring and intervention. Future prospective studies should validate these findings and explore integration with other biomarkers for enhanced prognostication.

Central Oxygen Venous Saturation and Mortality in Patients Undergoing Coronary Artery Bypass Grafting.

Central venous oxygen saturation (ScvO2) has been reported as a prognostic marker of in-hospital mortality when it is below 60% in certain situations. Nevertheless, it has not been widely reported in patients undergoing coronary artery bypass graft (CABG). The study determined the association between ScvO2 and in-hospital mortality in patients undergoing CABG in a high-complexity health institution in Santiago de Cali, Colombia. A retrospective cohort study was conducted with patients undergoing isolated CABG. The subject sample included 515 subjects aged 18 years or older. Exposure was defined as ScvO2 <60% upon admission to the intensive care unit (ICU) following surgery. The major outcome was mortality rates after 30 days. Furthermore, exposure variables were measured at preoperative, intra-operative, and postoperative time points. A total of 103 exposed and 412 unexposed subjects were included. The final model revealed a higher mortality risk in individuals with ScvO2 <60% upon ICU admission compared with those with higher saturation levels (relative risk 4.2, 95% confidence interval: 2.4-7.2; p = 0.001). Values were adjusted using variables such as age (>75 years), low socioeconomic stratum, chronic kidney failure before surgery, unstable angina before surgery, ischemia time (>60 min), and intra-operative inotrope use. The primary cause of death was cardiogenic shock (54.7%), followed by sepsis (25.0%) and postoperative bleeding (17.2%). The study identified an association between ScvO2 <60% and in-hospital mortality in patients undergoing CABG.

D-DIMER AS A SURROGATE MARKER OF DISEASE SEVERITY IN AFRICAN AMERICAN POPULATION WITH COVID-19 PNEUMONIA: A COMMUNITY HOSPITAL RETROSPECTIVE STUDY

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: In December 2019 Coronavirus disease 2019 (COVID-19) emerged from China and has since spread all over the world, with over 140 million confirmed cases and about 570, 000 deaths in the United States as of April 21, 2021. The aim of this study is to explore disease severity in African American population with COVID-19 pneumonia using D-dimer as a surrogate marker. METHODS: This is a retrospective observational single-center study of consecutive African-American patients admitted to a Community Hospital in New York City with a positive polymerase chain reaction test for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) between March 19th and April 25th of 2020. The data were extracted from EPIC electronic medical record system using slicer dicer extraction tool. Elevated D-dimer was defined by the laboratory-specific upper limit of normal (>243 ng/mL). Categorical variables were presented as n (%) while continuous variables were reported as means ± SD or median (interquartile range, IQR) as appropriate. The differences between patients who died and those who survived were compared using chi-square or Fisher’s exact for categorical data and Wilcoxon rank-sum test for continuous data. Patients were also compared in severe and non-severe categories using ICU admission as the severity factor. D-dimer levels were divided as mild 3,000 ng/mL. RESULTS: Total of 137 COVID -19 positive Non-Hispanic black patients were admitted during study period with median length of stay of 8 days and about 5.9% of patients died on admission with total of 33.33% of them dying over observational period. Patients that died had a higher mean age compared to survivors but the difference wasn’t statistically significant (68.77 ± 15.33 years vs 63.87 ± 12.93 years, P = 0.07). Significantly, higher proportions of patients who died were admitted to Intensive Care Unit (ICU) (54.72% vs 19.51%, p<0.001) and/or intubated (49.05% vs 12.20%, p <0.001). There’s no statistically significant difference in odds of dying among patients with severe D-dimer levels compared to mild D-dimer levels (OR =0.53, 95% CI: 0.25-1.10) but D-dimer levels are significantly higher among patients who died compared to patients who survived (16912 vs 12892, p=0.004). CONCLUSIONS: Elevated D-dimer level has been well documented to be associated with higher mortality among patients admitted with COVID-19 pneumonia. This study further emphasize D-dimer as a reliable prognostic marker for in-hospital mortality among African-Americans admitted for COVID-19 and significantly higher D-dimer is associated with mortality. This study also showed that patients admitted to ICU and/or intubated are more likely to die compared to patients managed on the General Medical Floor/Telemetry unit. CLINICAL IMPLICATIONS: D-dimer is closely related to mortality among COVID-19 patients, it should therefore be closely monitored among in-hospital patients. DISCLOSURES: No relevant relationships by Raji Ayinla, source=Web Response No relevant relationships by Idayat Brimah, source=Web Response No relevant relationships by Ibrahim Omore, source=Web Response No relevant relationships by Jinal Shah, source=Web Response

Abstract 17073: In Hospital Outcomes in Patients With Infective Endocarditis With and Without Liver Cirrhosis - Insight From National Inpatient Sample

Introduction: Chronic liver disease is known to be an important prognostic factor in determining morbidity and mortality in preoperative risk assessment and mortality in general. Data are limited on outcomes in patients with infective endocarditis (IE) and comorbid concurrent liver cirrhosis. Objective of our study is to evaluate the clinical outcomes of patient with IE with and without underlying liver cirrhosis and determining in-hospital mortality and outcomes of interest i.e. renal failure, cardiogenic shock, hematologic (coagulopathy/thrombocytopenia) and hepatic complications (hepatic encephalopathy/hepatitis). Hypothesis: Liver Cirrhosis worsen clinical outcomes in patients with IE. Methods: Patients with principle diagnosis of IE with and without liver cirrhosis were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically, National Inpatient Sample for year 2013 and 2014 based on ICD9 codes. Results: During 2013 and 2014, a total of 17, 952 patients were admitted with diagnosis of IE, out of whom 780 had concurrent liver cirrhosis. There was an increased in-hospital mortality [15.6% vs 10.2%, aOR 1.57(1.27-1.93)], acute kidney injury [41.4% vs 32.6%, aOR 1.45(1.24-1.69)], coagulopathy/thrombocytopenia [32.1 vs 14.7%, aOR 2.87(2.44-3.37)] in patients with IE with liver cirrhosis when compared to patients with IE without liver cirrhosis. IE without liver cirrhosis underwent increased number of interventions i.e. aortic (7.2 vs 3.7%, 0.51(0.34-0.76)] and mitral (4.9% vs 3.4%, aOR 0.39(0.23-0.69)] valvular replacements as compared to without liver cirrhosis. Conclusions: Liver cirrhosis is an important prognostic marker of in-hospital mortality in patients with concurrent IE. High risk surgical state with coagulopathy, bleeding complications, worsening hepatic complications and renal dysfunction lead to higher mortality.

D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study

BackgroundOver 5,488,000 cases of coronavirus disease-19 (COVID-19) have been reported since December 2019. We aim to explore risk factors associated with mortality in COVID-19 patients and assess the use of D-dimer as a biomarker for disease severity and clinical outcome.MethodsWe retrospectively analyzed the clinical, laboratory, and radiological characteristics of 248 consecutive cases of COVID-19 in Renmin Hospital of Wuhan University, Wuhan, China from January 28 to March 08, 2020. Univariable and multivariable logistic regression methods were used to explore risk factors associated with in-hospital mortality. Correlations of D-dimer upon admission with disease severity and in-hospital mortality were analyzed. Receiver operating characteristic curve was used to determine the optimal cutoff level for D-dimer that discriminated those survivors versus non-survivors during hospitalization.ResultsMultivariable regression that showed D-dimer > 2.0 mg/L at admission was the only variable associated with increased odds of mortality [OR 10.17 (95% CI 1.10–94.38), P = 0.041]. D-dimer elevation (≥ 0.50 mg/L) was seen in 74.6% (185/248) of the patients. Pulmonary embolism and deep vein thrombosis were ruled out in patients with high probability of thrombosis. D-dimer levels significantly increased with increasing severity of COVID-19 as determined by clinical staging (Kendall’s tau-b = 0.374, P = 0.000) and chest CT staging (Kendall’s tau-b = 0.378, P = 0.000). In-hospital mortality rate was 6.9%. Median D-dimer level in non-survivors (n = 17) was significantly higher than in survivors (n = 231) [6.21 (3.79–16.01) mg/L versus 1.02 (0.47–2.66) mg/L, P = 0.000]. D-dimer level of > 2.14 mg/L predicted in-hospital mortality with a sensitivity of 88.2% and specificity of 71.3% (AUC 0.85; 95% CI = 0.77–0.92).ConclusionsD-dimer is commonly elevated in patients with COVID-19. D-dimer levels correlate with disease severity and are a reliable prognostic marker for in-hospital mortality in patients admitted for COVID-19.

Is neutrophil/eosinophil ratio at admission a prognostic marker for in-hospital mortality of acute ischemic stroke?

ObjectivesThere has been a recent focus on hematological parameters affecting the prognosis of acute ischemic stroke (AIS). However, there are no studies investigating the neutrophil/eosinophil ratio (NER). This study aimed to investigate whether NER at admission is a prognostic marker for in-hospital mortality in patients with AIS. Methods204 AIS patients with similar vascular occlusion were included in the study, including 135 patients who survived and 69 patients who died in the hospital. Multivariate logistic regression analysis was performed to investigate the prognostic factors of AIS. The receiver operating characteristics (ROC) curve analysis was used to evaluate the predictive value of the variables and calculate the cut-off values. Results69 patients died in the hospital [24 men and 45 women, median age: 78 (49-99)], and 135 patients survived [58 men and 77 women, median age: 74 (22–99)]. The mean age of patients with mortality was higher compared to the patients who survived (p value=0.007). Multivariate logistic regression model revealed that only NER and red blood cell distribution width (RDW-SD) were prognostic factors (p = 0.036 and p = 0.032, respectively). Areas under the ROC curve were 0.675 for NER (95% CI, 0.59–0.75), 0.636 for neutrophil (95% CI, 0.55–0.71), 0.602 for RDW-SD (95% CI, 0.51-0.69) and 0.656 for eosinophil (95% CI, 0.57-0.74). ConclusionOur results showed that there is a correlation between the in-hospital mortality of AIS and high NER at admission. NER at admission can be used as a poor prognostic marker for AIS.

CHA2DS2-VASc Score and In-Hospital Mortality in Critically Ill Patients With New-Onset Atrial Fibrillation

To examine the role of the CHA2DS2-VASc (Congestive heart failure; Hypertension; Age ≥75 years [doubled]; Diabetes; previous Stroke, transient ischemic attack, or thromboembolism [doubled]; Vascular disease; Age 65-75 years; and Sex category) score as a prognostic marker of in-hospital mortality in critically ill patients who develop new-onset atrial fibrillation (NOAF). Retrospective analyses. A single-center study in a tertiary care academic medical center. The study comprised all adult patients with NOAF admitted to noncardiac intensive care units (ICUs) at a tertiary care academic institution between January 2009 and March 2016. None. The authors retrospectively reviewed electronic medical records of all adult patients admitted to noncardiac ICUs at a tertiary care academic institution between January 2009 and March 2016. Patients with NOAF were identified and their CHA2DS2-VASc score was calculated. The authors evaluated the association of CHA2DS2-VASc score and its individual components with in-hospital mortality in these patients. A total of 640 (1.7% [38,708 patients]; 95% CI 1.5%-1.8%) patients developed NOAF during the study period. The in-hospital mortality rate in patients included in the analysis was 14.3%. There was no association between in-hospital mortality and CHA2DS2VASc score. However, the likelihood of in-hospital death was 1.56 times greater for patients having atrial fibrillation and concomitant vascular disease (95% CI 1.003-2.429; p = 0.049). New-onset atrial fibrillation is common in critically ill patients and is associated with high in-hospital mortality. The authors found that the CHA2DS2-VASc score itself is not a reliable prognostic marker of in-hospital mortality in these patients. However, the presence of vascular disease in patients with NOAF may increase the mortality associated with this disease.

Neutrophil to lymphocyte ratio (NLR) as a prognostic marker for in-hospital mortality of patients with sepsis: A secondary analysis based on a single-center, retrospective, cohort study.

Neutrophil-to-lymphocyte ratio (NLR) has been reported to serve as a prognostic marker in inflammatory diseases. The purpose of this study was to evaluate the association of NLR at admission with in-hospital mortality in patients with sepsis presenting to emergency department.This was a secondary analysis based on a single-center, retrospective, cohort study. Patients with sepsis admitted to an academic emergency department between January 2010 and January 2015 were enrolled. NLR of patients was analyzed from the hospital's electronic health record (EHR) system. A total of 174 adult patients, of which 80 (46.0%) died in hospital. The primary outcome was in-hospital mortality. Secondary outcome was 28-day mortality.Contrary to previous studies, a larger NLR was found to have less odds of in-hospital mortality, as well as the presence of bacteremia. Patients who has severe/shock or had a history of chronic heart failure (CHF) had larger odds of death during hospital. Multivariate logistic regression analysis indicated that low NLR was an independent predictor of in-hospital mortality (OR = –0.98; 95% CI –0.96 to –0.99; P = .022). However, no correlation was found between the NLR and 28-day hospital mortality in patients with sepsis (P = .988). As a predictor of in-hospital survival, the area under curve (AUC) of the NLR was 0.622 (95%CI 0.54–0.71; P = .006) and the cut-off value was 9.11 with 0.551 sensitivity and 0.707 specificity.NLR at admission was an independent predictor of in-hospital mortality of sepsis patients.

Validity of GRACE Risk Score as a Prognostic Marker of In-hospital Mortality after Acute Coronary Syndrome.

To determine validity of GRACE risk score as a determinant of immediate death during hospitalization for Acute Coronary Syndrome (ACS) and analyze the percentage of cardiac deaths among high, intermediate and low risk groups. Cross-sectional study. Coronary Care Unit of Mayo Hospital, Lahore, from April to July 2015. Patients with acute chest pain were selected according to inclusion and exclusion criteria. Online GRACE risk score calculator was used to determine the predicted risk of death following ACS according to the score. Data was analyzed on SPSS 20. Quantitative data was in the form of median (IQR). Discrimination of GRS was evaluated by using c-statistics, area under the ROC curve. Calibration of GRS was tested by Hosmer-Lameshow test. The correlation between GRACE risk score category and predicted risk of death was determined using Kendall's tau-b bivariate correlation test. Shapiro-Wilk test was applied to check normality of data. The various parameters of GRACE score were studied in patients using Mann-Whitney U-test. The statistically significant p-value was <0.05. There were 165 cases in the study. Overall median GRS was 139 (54). In-hospital deaths were 12.2%. Discrimination of GRS evaluated by area under the ROC curve was 0.913 (95% CI 0.843-0.982; p<0.0001). Application of Hosmer-Lameshow test revealed a p-value of 0.236. Kendall's tau-b bivariate correlation coefficient was 0.384 (p<0.001). GRS is an excellent tool to stratify patients of ACS into different risk categories according to various parameters noted at the time of presentation. The risk of predicted death according to the score was variable among different cases, especially those with higher scores. Even though GRS is an effective and valid tool, but it has some tendency of overestimating probability of death following ACS and may require a fine tuning in some cases.

Prognostic effect of cardiac troponin elevation in acute aortic dissection: A meta-analysis.

Acute aortic dissection (AAD) is a highly lethal medical emergency that requires immediate assessment and therapy. To date, no one biomarker plays a significant role in risk stratification of patients with AAD and whether cardiac troponin could be a prognostic marker of in-hospital mortality is still unknown. To assess the prognostic role of cardiac troponin elevation during AAD, we performed an updated systematic review and meta-analysis. Four studies were included in the final analysis. Elevated cardiac troponin was present in 26.8% of patients with AAD and ranged between 23% and 33%. We showed that elevated troponin levels were significantly associated with increased risk of short-term mortality (OR 2.57; 95% CI 1.66-3.96). The analysis of pooled studies showed a low heterogeneity (I(2) 34.3%), and no publication bias was detected (Egger bias 3.34, p=0.18). Cardiac troponin elevation at the time of admission for AAD is associated with an increased risk of in-hospital mortality.

Uric acid as a predictor of in-hospital mortality in acute myocardial infarction: a meta-analysis.

Uric acid (UA) is generalized as a byproduct the terminal steps of purine catabolism, which are catalyzed by xanthine oxidoreductase. Xanthine oxidase activity and uric acid synthesis are reported to be increased under tissue ischemia. Therefore, elevated uric acid may act as a prognostic marker of acute myocardial infarction (AMI). A few studies have showed that UA is associated with therapeutic outcomes in patients with acute myocardial infarction. The purpose of this meta-analysis is to evaluate the prognostic significance of the UA as a predictor of in-hospital mortality. We performed a systematic review and included studies that used both UA and in-hospital mortality from Embase and PubMed. Six studies have been included in this review with totally 5,686 patients. During the follow-up, high UA level was found to be associated with an increased risk of in-hospital mortality [risk ratios (RR) 2.10 (1.03-4.26), number needed to harm (NNH) 37], MACE [RR 3.44 (2.33-5.08), NNH 17]. High UA level has the potential to be an important prognostic marker for in-hospital mortality in individuals with AMI.

Incidence and prognostic significance of hypoglycemia in hospitalized non-diabetic elderly patients

To assess the incidence and prognostic value of hypoglycemia in hospitalized non-diabetic elderly patients. An observational retrospective study, with a 3-year follow-up, was performed in a series of 678 patients aged over 65 years, admitted between January 1 2001 and December 31 2001 to the Units of Gerontology and Geriatrics of the Careggi University Hospital, Florence, Italy. Patients with diabetes mellitus were excluded. To determine the cumulative incidence of hypoglycemia, all measurements of venous or capillary blood glucose during hospital stay were taken into account. In-hospital mortality was determined from hospital discharge records. Information on all-cause, three-year mortality after hospital admission was obtained from the City of Florence Registry Office. Hypoglycemia was observed in 8.6% of patients, and was asymptomatic in about 25% of cases. In-hospital mortality was significantly higher in patients with hypoglycemia (41.4% vs 14.3%; p<0.001), even after adjustment for potential confounders, including comorbidity, indices of malnutrition, and pharmacological treatment (adjusted OR 2.17[1.25;3.85]). 3-year mortality was significantly higher in patients with hypoglycemia during hospital stay, but the difference was not significant after adjustment for confounders. Hypoglycemia is a prognostic marker of in-hospital mortality in non-diabetic hospitalized patients, even after adjustment for comorbidity and indices of malnutrition. Instead, it does not seem to have any relevant independent prognostic value in the longer term.