Relative Risk Of Mortality Research Articles

Low-Dose Computed Tomography (LDCT) Lung Cancer Screening in Asian Female Never-Smokers Is as Efficacious in Detecting Lung Cancer as in Asian Male Ever-Smokers: A Systematic Review and Meta-Analysis

IntroductionLung cancer in never-smokers is the major cancer cause of death globally. We compared the efficacy of low-dose computed tomography (LDCT) lung cancer screening among never-smokers versus ever-smokers using systematic review and meta-analysis. MethodsLDCT lung cancer screening studies that simultaneously included both ever-smoker and never-smoker participants published by April 30, 2021, were searched through PubMed and Scopus. Primary outcome measure was relative risk (RR) of lung cancer diagnosed among never-smokers versus ever-smokers. ResultsA total of 14 studies (13 from Asia) were included (141,396 ever-smokers, 109,251 never-smokers, 1961 lung cancer cases diagnosed). RR of lung cancer diagnosed between ever-smokers versus never-smokers overall was 1.21 (95% confidence interval [CI]: 0.89–1.65), 1.37 (95% CI: 1.08–1.75) among males, and 0.88 (95% CI: 0.59–1.31) among females. RR was 1.78 (95% CI: 1.41–2.24) and 1.22 (95% CI: 0.89–1.68) for Asian female never-smokers versus male never-smokers and versus male ever-smokers, respectively, and 0.99 (95% CI: 0.65–1.50) versus high-risk ever-smokers (≥30 pack-years). Proportional meta-analysis revealed significantly more lung cancers diagnosed at first scan (95.4% [95% CI: 84.9–100.0] versus 70.9% [95% CI: 54.6–84.9], p = 0.010) and at stage 1 (88.5% [95% CI: 79.3–95.4] versus 79.7% [95% CI: 71.1–87.4], p = 0.071) among never-smokers versus ever-smokers, respectively. RR of lung cancer death and 5-year all-cause mortality in never-smokers versus ever-smokers was 0.27 (95% CI: 0.1–0.55, p < 0.001) and 0.13 (95% CI: 0.05–0.33, p < 0.001), respectively. ConclusionsThe RR of lung cancer detected by LDCT screening among female never-smokers and male ever-smokers in Asia was statistically similar. Overall and lung cancer specific mortality from the lung cancer diagnosed from LDCT screening was significantly reduced among never-smokers compared to ever-smokers.

Mortality among acute myocardial infarction patients admitted to hospitals on weekends as compared with weekdays in Taiwan

Weekend effect has been considered to be associated with poorer quality of care and patient’s survival. For acute myocardial infarction (AMI) patients, the question of whether patients admitted during off-hours have worse outcomes as compared with patients admitted during on-hours is still inconclusive. We conducted this study to explore the weekend effect in AMI patients, using a nationwide insurance database in Taiwan. Using Taiwan National Health Insurance (NHI) claims database, we designed a retrospective cohort study, and extracted 184,769 incident cases of AMI through the NHI claims database between January 2006 and December 2014. We divided the patients into weekend admission group and weekday admission group. Patients were stratified as ST elevation/non-ST elevation AMI and receiving/not receiving percutaneous coronary intervention (PCI). We used a logistic regression model to examine the relative risk of in-hospital mortality and 1-year mortality which were obtained from the Taiwan National Death Registry between study groups. We found no difference between weekend group and weekday group for risk of in-hospital mortality (15.8% vs 16.2%, standardized difference 0.0118) and risk of 1-year mortality (30.2% vs 30.9%, standardized difference 0.0164). There was no statistically significant difference among all the comparisons through the multivariate logistic regression analysis adjusting for all the covariates and stratifying by the subtypes of AMI and whether or not executing PCI during hospitalization. As for AMI patients in Taiwan, admission on weekends or weekdays did not have a significant impact on either in-hospital mortality or 1-year cumulative mortality.

Aspirin With or Without Statin in Individuals Without Atherosclerotic Cardiovascular Disease Across Risk Categories

BackgroundThe effects of aspirin in adults without atherosclerotic cardiovascular disease (ASCVD), stratified by statin use across different ASCVD risks, remain uncertain. ObjectivesThe purpose of this study was to examine the effects of aspirin in adults without ASCVD, stratified by statin use across different ASCVD risks. MethodsWe searched databases through March 2022 and selected randomized controlled trials of aspirin without ASCVD and follow-up of ≥1 year. We used random-effects models and estimated relative and absolute risks for cardiovascular outcomes, major bleeding, and mortality over 5 years. We calculated absolute risk differences assuming constant relative risks (RRs) across statin use and ASCVD risks. The Cholesterol Treatment Trialists Collaboration, and the ASCEND (A Study of Cardiovascular Events in Diabetes) trial were used to estimate baseline risks. ResultsIn 16 trials [171,215 individuals; median age, 64 (Q1-Q3: 60-65) years], aspirin vs control reduced myocardial infarction (MI) [RR: 0.85 (95% CI: 0.77-0.95)] but increased major bleeding [RR: 1.48 (95% CI: 1.32-1.66)]. Aspirin did not reduce mortality. Statin vs no statin was associated with lower bleeding and MI risk; the bleeding and MI risk were proportional to ASCVD risk. For every 10,000 adults, aspirin reduced MI (very low risk: 3 events as monotherapy or 1 event with statin; very high risk: 49 events as monotherapy or 37 events with statin) and increased major bleeding (very low risk: 21 events as monotherapy or 20 events with statin; very high risk: 98 events as monotherapy or 94 events with statin) proportional to baseline ASCVD risk. ConclusionsIn adults without ASCVD, concomitant statin appeared to significantly reduce absolute risk reduction for MI associated with aspirin without influencing bleeding risk. The anticipated absolute risk of major bleeding with aspirin exceeds absolute MI benefits for every level of ASCVD risk.

Understanding COVID-19 Vaccine Effectiveness against Death Using a Novel Measure: COVID Excess Mortality Percentage.

COVID-19 vaccines have saved millions of lives; however, understanding the long-term effectiveness of these vaccines is imperative to developing recommendations for booster doses and other precautions. Comparisons of mortality rates between more and less vaccinated groups may be misleading due to selection bias, as these groups may differ in underlying health status. We studied all adult deaths during the period of 1 April 2021-30 June 2022 in Milwaukee County, Wisconsin, linked to vaccination records, and we used mortality from other natural causes to proxy for underlying health. We report relative COVID-19 mortality risk (RMR) for those vaccinated with two and three doses versus the unvaccinated, using a novel outcome measure that controls for selection effects. This measure, COVID Excess Mortality Percentage (CEMP), uses the non-COVID natural mortality rate (Non-COVID-NMR) as a measure of population risk of COVID mortality without vaccination. We validate this measure during the pre-vaccine period (Pearson correlation coefficient = 0.97) and demonstrate that selection effects are large, with non-COVID-NMRs for two-dose vaccinees often less than half those for the unvaccinated, and non-COVID NMRs often still lower for three-dose (booster) recipients. Progressive waning of two-dose effectiveness is observed, with an RMR of 10.6% for two-dose vaccinees aged 60+ versus the unvaccinated during April-June 2021, rising steadily to 36.2% during the Omicron period (January-June, 2022). A booster dose reduced RMR to 9.5% and 10.8% for ages 60+ during the two periods when boosters were available (October-December, 2021; January-June, 2022). Boosters thus provide important additional protection against mortality.

Dose rate effect on mortality from ischemic heart disease in the cohort of Russian Mayak Production Association workers

For improvement of the radiation protection system it is crucial to know the factors that modify the radiation dose–response relationship. One of such key factors is the ionizing radiation dose rate. There are, however, very few studies that examine the impact of the dose rate on radiogenic risks observed in human cohorts exposed to radiation at various dose rates. Here we investigated the impact of the dose rate (in terms of the recorded annual dose) on ischemic heart disease (IHD) mortality among Russian nuclear workers chronically exposed to radiation. We observed significantly increased excess relative risks (ERR) of IHD mortality per unit of external gamma-ray absorbed dose accumulated at higher dose rates (0.005–0.050 Gy/year). The present findings provide evidence for the association between radiation dose rate and ERRs of IHD mortality in occupationally chronically exposed workers per unit total dose. IHD mortality risk estimates considerably increased with increasing duration of uninterrupted radiation exposure at high rates. The present findings are consistent with other studies and can contribute to the scientific basis for recommendations on the radiation protection system.

Different Changing Patterns for Stroke Subtype Mortality Attributable to High Sodium Intake in China During 1990 to 2019.

It is unclear whether sodium intake had similar effects on mortality of stroke subtypes. The purpose of this study is to compare the long-term trends in mortality of stroke subtypes attributable to high sodium intake in China during 1990 to 2019. Data for China in the GBD (Global Burden of Disease) 2019 study were obtained mainly from the Chinese surveillance systems and the KaiLuan Study. The trends in stroke mortality due to high sodium intake (>5 g/d) were evaluated using join-point regression and age-period-cohort methods adjusting for age, period, and cohort. The age-standardized mortality rates of stroke attributable to high sodium intake showed downward trends during 1990 to 2019 in China, with an average annual percentage change of -0.6 (95% CI, -0.8 to -0.4) for ischemic stroke, -2.5 (95% CI, -2.8 to -2.2) for intracerebral hemorrhage, and -6.1 (95% CI, -6.6 to -5.7) for subarachnoid hemorrhage. The curves of local drifts, which reflected the average annual percentage change of stroke mortality due to high sodium intake across age groups, showed a slow upward trend with age for ischemic stroke, a slow downward trend for intracerebral hemorrhage, and a sharp downward trend for subarachnoid hemorrhage. The high sodium-related mortality increased dramatically with age for ischemic stroke and intracerebral hemorrhage, while it reached a peak at 50 to 70 years old for subarachnoid hemorrhage. The period and cohort rate ratios of stroke mortality due to high sodium intake decreased in the past 3 decades, with the greatest decline for subarachnoid hemorrhage and the weakest decrease for ischemic stroke. Notably, men had higher high sodium-related mortality and risk but slighter declines for all stroke subtypes than women. Our results provided powerful evidence that high sodium-related age-standardized mortality rates and risk of stroke in China decreased in the past 3 decades, with diverse changing patterns for different stroke subtypes, highlighting that salt reduction had distinct impact on stroke subtypes.

Socioeconomic inequalities in cancer mortality between and within countries in Europe: a population-based study.

Reducing socioeconomic inequalities in cancer is a priority for the public health agenda. A systematic assessment and benchmarking of socioeconomic inequalities in cancer across many countries and over time in Europe is not yet available. Census-linked, whole-of-population cancer-specific mortality data by socioeconomic position, as measured by education level, and sex were collected, harmonized, analysed, and compared across 18 countries during 1990-2015, in adults aged 40-79. We computed absolute and relative educational inequalities; temporal trends using estimated-annual-percentage-changes; the share of cancer mortality linked to educational inequalities. Everywhere in Europe, lower-educated individuals have higher mortality rates for nearly all cancer-types relative to their more highly-educated counterparts, particularly for tobacco/infection-related cancers [relative risk of lung cancer mortality for lower- versus higher-educated=2.4 (95% confidence intervals: 2.1-2.8) among men;=1.8 (95% confidence intervals: 1.5-2.1) among women]. However, the magnitude of inequalities varies greatly by country and over time, predominantly due to differences in cancer mortality among lower-educated groups, as for many cancer-types higher-educated have more similar (and lower) rates, irrespective of the country. Inequalities were generally greater in Baltic/Central/East-Europe and smaller in South-Europe, although among women large and rising inequalities were found in North-Europe (relative risk of all cancer mortality for lower- versus higher-educated ≥1.4 in Denmark, Norway, Sweden, Finland and the England/Wales). Among men, rate differences (per 100,000 person-years) in total-cancer mortality for lower-vs-higher-educated groups ranged from 110 (Sweden) to 559 (Czech Republic); among women from approximately null (Slovenia, Italy, Spain) to 176 (Denmark). Lung cancer was the largest contributor to inequalities in total-cancer mortality (between-country range: men, 29-61%; women, 10-56%). 32% of cancer deaths in men and 16% in women (but up to 46% and 24%, respectively in Baltic/Central/East-Europe) were associated with educational inequalities. Cancer mortality in Europe is largely driven by levels and trends of cancer mortality rates in lower-education groups. Even Nordic-countries, with a long-established tradition of equitable welfare and social justice policies, witness increases in cancer inequalities among women. These results call for a systematic measurement, monitoring and action upon the remarkable socioeconomic inequalities in cancer existing in Europe. This study was done as part of the LIFEPATH project, which has received financial support from the European Commission (Horizon 2020 grant number 633666), and the DEMETRIQ project, which received support from the European Commission (grant numbers FP7-CP-FP and 278511). SV and WN were supported by the French Institut National du Cancer (INCa) (Grant number 2018-116). PM was supported by the Academy of Finland (#308247, # 345219) and the European Research Council under the European Union's Horizon 2020 research and innovation programme (grant agreement No 101019329). The work by Mall Leinsalu was supported by the Estonian Research Council (grant PRG722).

THREE YEAR MORTALITY ANALYSIS AMONG HEMODIALYSIS PATIENTS: A SINGLE CENTER STUDY FROM MULTAN INSTITUTE OF KIDNEY DISEASES

This study evaluated the mortality among registered hemodialysis patients in a single center at Multan Institute Of Kidney Diseases (MIKD) Multan in south Punjab, Pakistan. A Retrospective cohort study was conducted at Multan Institute of Kidney Diseases, Multan, from 22 January 2019 to 22 December 2021 in three years. All adult patients of End-stage renal disease (ESRD) maintained on hemodialysis for more than three months registered with the dialysis unit of MIKD irrespective of their age, gender, serology with the biochemical test, morbidity, and cause of mortality were recorded in the study. SPSS version 22 was used for data entry and analysis. A p-value≥0.05 was considered significant. The ethical review committee approved the study ref# 08-14 dated 01-01-2022 to consent from all the included patients. Out of these 110 deaths, the mean age was 52.14±14.75, and male gender 80 (72.7%) were predominantly noted. Hypertension was the most common morbidity, followed by diabetes and diabetic nephropathy 103 (93.6%), 56 (50.9%), and 54 (49.1%), respectively. Predominant biochemical parameters of expired hemodialysis patients were hyperphosphatemia 64 (58.2%), anemia 51 (46.4%), hypoalbuminemia 43 (39.1%), hypocalcemia 35 (31.8%) and hypoparathyroidism 33 (30%). The leading cause of death was cardiovascular, 38 (34.5%). The most common viral marker in CVA was HBs Ag; HCV was the most common in CVD death patients (p&lt;0.001).The relative risk of mortality in the HD population is 20.6 times to the general population. The risk variables can be monitored and intervened on in a timely manner to reduce mortality in the future.

Associations with Blood Lead and Urinary Cadmium Concentrations in Relation to Mortality in the US Population: A Causal Survival Analysis with G-Computation

Using the parametric g-formula, we estimated the 27-year risk of all-cause and specific causes of mortality under different potential interventions for blood lead (BLLs) and urinary cadmium (UCd) levels. We used data on 14,311 adults aged ≥20 years enrolled in the NHANES-III between 1988 and 1994 and followed up through 31 Dec 31 2015. Time and cause of death were determined from the National Death Index records. We used the parametric g-formula with pooled logistic regression models to estimate the relative and absolute risk of all-cause, cardiovascular, and cancer mortality under different potential threshold interventions for BLLs and UCd concentrations. Median follow-up was 22.5 years. A total of 5167 (36%) participants died by the end of the study, including 1550 from cardiovascular diseases and 1135 from cancer. Increases in BLLs and creatinine-corrected UCd levels from the 5th to the 95th percentiles were associated with risk differences of 4.17% (1.54 to 8.77) and 6.22% (4.51 to 12.00) for all-cause mortality, 1.52% (0.09 to 3.74) and 1.06% (-0.57 to 3.50) for cardiovascular disease mortality, and 1.32% (-0.09 to 3.67) and 0.64% (-0.98 to 2.80) for cancer mortality, respectively. Interventions to reduce historical exposures to lead and cadmium may have prevented premature deaths, especially from cardiovascular disease.

Deep learning identified genetic variants for COVID-19-related mortality among 28,097 affected cases in UK Biobank.

Analysis of host genetic components provides insights into the susceptibility and response to viral infection such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). To reveal genetic determinants of susceptibility to COVID-19 related mortality, we train a deep learning model to identify groups of genetic variants and their interactions that contribute to the COVID-19 related mortality risk using the UK Biobank data (28,097 affected cases and 1656 deaths). We refer to such groups of variants as super variants. We identify 15 super variants with various levels of significance as susceptibility loci for COVID-19 mortality. Specifically, we identify a super variant (odds ratio [OR] = 1.594, p = 5.47 × 10-9 ) on Chromosome 7 that consists of the minor allele of rs76398985, rs6943608, rs2052130, 7:150989011_CT_C, rs118033050, and rs12540488. We also discover a super variant (OR = 1.353, p = 2.87 × 10-8 ) on Chromosome 5 that contains rs12517344, rs72733036, rs190052994, rs34723029, rs72734818, 5:9305797_GTA_G, and rs180899355.

Defining Posttraumatic Sepsis for Population-Level Research

Multiple classification methods are used to identify sepsis from existing data. In the trauma population, it is unknown how administrative methods compare with clinical criteria for sepsis classification. To characterize the agreement between 3 approaches to sepsis classification among critically ill patients with trauma and compare the sepsis-associated risk of adverse outcomes when each method was used to define sepsis. This retrospective cohort study used data collected between January 1, 2012, and December 31, 2020, from patients aged 16 years or older with traumatic injury, admitted to the intensive care unit of a single-institution level 1 trauma center and requiring invasive mechanical ventilation for at least 3 days. Statistical analysis was conducted from August 1, 2021, to March 31, 2022. Hospital-acquired sepsis, as classified by 3 methods: a novel automated clinical method based on data from the electronic health record, the National Trauma Data Bank (NTDB), and explicit and implicit medical billing codes. The primary outcomes were chronic critical illness and in-hospital mortality. Secondary outcomes included number of days in an intensive care unit, number of days receiving mechanical ventilation, discharge to a skilled nursing or long-term care facility, and discharge to home without assistance. Of 3194 patients meeting inclusion criteria, the median age was 49 years (IQR, 31-64 years), 2380 (74%) were male, and 2826 (88%) sustained severe blunt injury (median Injury Severity Score, 29 [IQR, 21-38]). Sepsis was identified in 747 patients (23%) meeting automated clinical criteria, 118 (4%) meeting NTDB criteria, and 529 (17%) using medical billing codes. The Light κ value for 3-way agreement was 0.16 (95% CI, 0.14-0.19). The adjusted relative risk of chronic critical illness was 9.9 (95% CI, 8.0-12.3) for sepsis identified by automated clinical criteria, 5.0 (95% CI, 3.4-7.3) for sepsis identified by the NTDB, and 4.5 (95% CI, 3.6-5.6) for sepsis identified using medical billing codes. The adjusted relative risk for in-hospital mortality was 1.3 (95% CI, 1.0-1.6) for sepsis identified by automated clinical criteria, 2.7 (95% CI, 1.7-4.3) for sepsis identified by the NTDB, and 1.0 (95% CI, 0.7-1.2) for sepsis identified using medical billing codes. In this cohort study of critically ill patients with trauma, administrative methods misclassified sepsis and underestimated the incidence and severity of sepsis compared with an automated clinical method using data from the electronic health record. This study suggests that an automated approach to sepsis classification consistent with Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) clinical criteria is feasible and may improve existing approaches to health services and population-based research in this population.

Analysis of time-dependent effects of ambient temperatures on health by vulnerable groups in Korea in 1999–2018

This study compared the relative risks of heat days on mortalities by vulnerable groups (elderly, single-person households, less-educated) in the past decade (1999–2008) and the recent decade (2009–2018) in four cities, Seoul, Incheon, Daegu, and Gwangju, in Korea. It has been known that the health impacts of heatwaves have gradually decreased over time due to socio-economic development, climate adaptation, and acclimatization. Contrary to general perception, we found that the recent relative risk of mortality caused by heat days has increased among vulnerable groups. It may associate with recent increasing trends of severe heat days due to climate change. The increasing relative risk was more significant in single-person households and less-educated groups than in the elderly. It implies that the impacts of climate change-induced severe heat days have been and will be concentrated on vulnerable groups. It suggests that social polarization and social isolation should be addressed to reduce heatwave impacts. Furthermore, this study shows the necessity of customized heatwave policies, which consider the characteristics of vulnerable groups.

1332 PREVALENCE AND OUTCOMES OF FRAILTY IN OLDER PEOPLE WITH UNPLANNED HOSPITAL ADMISSIONS: SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background Guidelines recommend screening for frailty in all hospitalised older adults to inform care, based mainly on studies in outpatient and speciality-specific settings. However, most hospital bed-days in older people are for acute, non-elective admissions to general medicine, for which the prevalence and prognostic value of frailty might differ. Therefore, we undertook a systematic review of frailty prevalence and outcomes in older people with unplanned hospital admissions. Methods We searched MEDLINE, EMBASE and CINAHL up to 30/04/2021 for observational studies using validated frailty measures in unplanned adult hospital-wide or general medicine admissions. We related frailty prevalence to measurement tool, setting and risk of bias (RoB). Relative risks (RR) for mortality, length of stay (LOS), discharge destination and readmission were pooled using random-effects models where appropriate, and area-under-the-ROC-curves calculated. Heterogeneity was explored with meta-regression. Dose-response effects were assessed with the Cochran-Armitage test. Results Among 38 cohorts (median/SD age=80/5 years; n=37,733,147 admissions), the median prevalence of moderate-severe frailty was 40.5% (IQR=33.2-53.2; low-moderate RoB=23/38), with considerable heterogeneity (PQ&amp;lt;0.001) apparently unrelated to measure, setting or RoB. Nevertheless, frailty still predicted mortality (RR range=1.08-16.06), long LOS (range=1.35-3.04) and discharge destination (range=1.97-3.45) in all studies with more severe frailty associated with worse outcomes, although associations with 30-day readmission were conflicting (range=0.52-1.64). Studies reporting lower frailty prevalence showed stronger associations between frailty and mortality (beta=-0.009, P=0.03, R=49.6%), with the most consistent (PQ=0.11) associations found in studies using prospective measures (pooled RR=2.57, 95%CI=2.30-2.88) and little attenuation after adjustment for age, sex and comorbidity. Ordinal cut-points appeared to provide superior discrimination to dichotomous thresholds. Conclusions Frailty is common in older patients with acute, non-elective hospital admissions and remains an independent predictor of mortality, LOS and discharge home in the acute setting, justifying more widespread implementation of screening using prospective tools and consideration of the degree of frailty in guidance.

Unplanned 30-day readmissions, comorbidity and impact on one-year mortality following incident heart failure hospitalisation in Western Australia, 2001–2015

BackgroundReadmissions within 30 days after heart failure (HF) hospitalisation is considered an important healthcare quality metric, but their impact on medium-term mortality is unclear within an Australian setting. We determined the frequency, risk predictors and relative mortality risk of 30-day unplanned readmission in patients following an incident HF hospitalisation.MethodsFrom the Western Australian Hospitalisation Morbidity Data Collection we identified patients aged 25–94 years with an incident (first-ever) HF hospitalisation as a principal diagnosis between 2001 and 2015, and who survived to 30-days post discharge. Unplanned 30-day readmissions were categorised by principal diagnosis. Logistic and Cox regression analysis determined the independent predictors of unplanned readmissions in 30-day survivors and the multivariable-adjusted hazard ratio (HR) of readmission on mortality within the subsequent year.ResultsThe cohort comprised 18,241 patients, mean age 74.3 ± 13.6 (SD) years, 53.5% males, and one-third had a modified Charlson Comorbidity Index score of ≥ 3. Among 30-day survivors, 15.5% experienced one or more unplanned 30-day readmission, of which 53.9% were due to cardiovascular causes; predominantly HF (31.4%). The unadjusted 1-year mortality was 15.9%, and the adjusted mortality HR in patients with 1 and ≥ 2 cardiovascular or non-cardiovascular readmissions (versus none) was 1.96 (95% confidence interval (CI) 1.80–2.14) and 3.04 (95% CI, 2.51–3.68) respectively. Coexistent comorbidities, including ischaemic heart disease/myocardial infarction, peripheral arterial disease, pneumonia, chronic kidney disease, and anaemia, were independent predictors of both 30-day unplanned readmission and 1-year mortality.ConclusionUnplanned 30-day readmissions and medium-term mortality remain high among patients who survived to 30 days after incident HF hospitalisation. Any cardiovascular or non-cardiovascular readmission was associated with a two to three-fold higher adjusted HR for death over the following year, and various coexistent comorbidities were important associates of readmission and mortality risk. Our findings support the need to optimize multidisciplinary HF and multimorbidity management to potentially reduce repeat hospitalisation and improve survival.

Real-World Effectiveness of Sotrovimab for the Early Treatment of COVID-19 During SARS-CoV-2 Delta and Omicron Waves in the USA.

Sotrovimab, a recombinant human monoclonal antibody (mAb) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had US Food and Drug Administration Emergency Use Authorization for the treatment of high-risk outpatients with mild-to-moderate coronavirus disease 2019 (COVID-19) from 26 May 2021 to 5 April 2022. Real-world clinical effectiveness of sotrovimab in reducing the risk of 30-day all-cause hospitalization and/or mortality was evaluated for the period when the prevalence of circulating SARS-CoV-2 variants changed between Delta and Omicron in the USA. A retrospective analysis was conducted of de-identified patients diagnosed with COVID-19 between 1 September 2021 to 30 April 2022 in the FAIR Health National Private Insurance Claims database. Patients meeting high-risk criteria were divided into two cohorts: sotrovimab and not treated with a mAb ("no mAb"). All-cause hospitalizations and facility-reported mortality ≤ 30days of diagnosis ("30-day hospitalization or mortality") were identified. Multivariable and propensity score-matched Poisson and logistic regressions were conducted to estimate the adjusted relative risk (RR) and odds of 30-day hospitalization or mortality in each cohort. Compared with the no mAb cohort (n = 1,514,868), the sotrovimab cohort (n = 15,633) was older and had a higher proportion of patients with high-risk conditions. In the no mAb cohort, 84,307 (5.57%) patients were hospitalized and 8167 (0.54%) deaths were identified, while in the sotrovimab cohort, 418 (2.67%) patients were hospitalized and 13 (0.08%) deaths were identified. After adjusting for potential confounders, the sotrovimab cohort had a 55% lower risk of 30-day hospitalization or mortality (RR 0.45, 95% CI 0.41-0.49) and an 85% lower risk of 30-day mortality (RR 0.15, 95% CI 0.08-0.29). Monthly, from September 2021 to April 2022, the RR reduction for 30-day hospitalization or mortality in the sotrovimab cohort was maintained, ranging from 46% to 71% compared with the no mAb cohort; the RR estimate in April 2022 was uncertain, with wide confidence intervals due to the small sample size. Sotrovimab was associated with reduced risk of 30-day all-cause hospitalization and mortality versus no mAb treatment. Clinical effectiveness persisted during Delta and early Omicron variant waves and among all high-risk subgroups assessed.

Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy

BackgroundIt is currently unclear if active left ventricular (LV) unloading should be used as a primary treatment strategy or as a bailout in patients with cardiogenic shock (CS) treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). ObjectivesThis study sought to evaluate the association between timing of active LV unloading and implantation of VA-ECMO with outcomes of patients with CS. MethodsData from 421 patients with CS treated with VA-ECMO and active LV unloading at 18 tertiary care centers in 4 countries were analyzed. Patients were stratified by timing of device implantation in early vs delayed active LV unloading (defined by implantation before up to 2 hours after VA-ECMO). Adjusted Cox and logistic regression models were fitted to evaluate the association between early active LV unloading and 30-day mortality as well as successful weaning from ventilation. ResultsOverall, 310 (73.6%) patients with CS were treated with early active LV unloading. Early active LV unloading was associated with a lower 30-day mortality risk (HR: 0.64; 95% CI: 0.46-0.88) and a higher likelihood of successful weaning from ventilation (OR: 2.17; 95% CI: 1.19-3.93) but not with more complications. Importantly, the relative mortality risk increased and the likelihood of successful weaning from ventilation decreased almost proportionally with the time interval between VA-ECMO implantation and (delayed) initiation of active LV unloading. ConclusionsThis exploratory study lends support to the use of early active LV unloading in CS patients on VA-ECMO, although the findings need to be validated in a randomized controlled trial.

Suicide and other causes of death among Chernobyl cleanup workers from Estonia, 1986 − 2020: an update

Mortality was studied in a cohort of 4831 men from Estonia who participated in the environmental cleanup of the radioactively contaminated areas around Chernobyl in 1986–1991. Their mortality in 1986–2020 was compared with the mortality in the Estonian male population. A total of 1503 deaths were registered among the 4812 traced men. The all-cause standardized mortality ratio (SMR) was 1.04 (95% CI 0.99–1.09). All-cancer mortality was elevated (SMR 1.16, 95% CI 1.03–1.28). Radiation-related cancers were in excess (SMR 1.20, 95% CI 1.03–1.36); however, the excesses could be attributed to tobacco and alcohol consumption. For smoking-related cancers, the SMR was 1.20 (95% CI 1.06–1.35) and for alcohol-related cancers the SMR was 1.56 (95% CI 1.26–1.86). Adjusted relative risks (ARR) of all-cause mortality were increased among workers who stayed in the Chernobyl area ≥ 92 days (ARR 1.20, 95% CI 1.08–1.34), were of non-Estonian ethnicity (ARR 1.33, 95% CI 1.19–1.47) or had lower (basic or less) education (ARR 1.63, 95% CI 1.45–1.83). Suicide mortality was increased (SMR 1.31, 95% CI 1.05–1.56), most notably among men with lower education (ARR 2.24, 95% CI 1.42–3.53). Our findings provide additional evidence that unhealthy behaviors such as alcohol and smoking play an important role in shaping cancer mortality patterns among Estonian Chernobyl cleanup workers. The excess number of suicides suggests long-term psychiatric and substance use problems tied to Chernobyl-related stressors, i.e., the psychosocial impact was greater than any direct carcinogenic effect of low-dose radiation.

Effects of magnesium, phosphate, or zinc supplementation in intensive care unit patients-A systematic review and meta-analysis.

Low-serum levels of magnesium, phosphate, and zinc are observed in many intensive care unit (ICU) patients, but clinical equipoise exists regarding supplementation strategies. We aimed to assess the desirable and undesirable effects of supplementation with magnesium, phosphate, or zinc in adult ICU patients. We conducted a systematic review with meta-analysis of randomised clinical trials assessing the effects of supplementation with magnesium, phosphate, or zinc in adult ICU patients. Primary outcomes were mortality and duration of mechanical ventilation. We registered the protocol, followed the Preferred Reporting Items for Systematic Review and Meta-Analysis statement, used the Cochrane risk of bias 2 tool, and the grading of recommendations, assessment, development and evaluation (GRADE) approach for assessing the certainty of the evidence. We identified no low risk of bias trials. For magnesium supplementation, we included three trials (n= 235); the relative risk (RR) for mortality was 0.54, 95% confidence interval (CI) 0.30-0.96 compared to no supplementation (very low certainty of evidence). For zinc supplementation, two trials were included (n= 168); the RR for mortality was 0.73, 95% CI 0.41-1.28 compared to control. No trials assessed the effects of phosphate supplementation on mortality. For outcomes other than mortality, only zero or one trial was available. In adult ICU patients, the certainty of evidence for the effects of supplementation with magnesium, phosphate, or zinc was very low. High-quality trials are needed to assess the value of supplementation strategies in these patients.

Ecological Study on Global Health Effects due to Source-Specific Ambient Fine Particulate Matter Exposure.

Ambient air pollution of fine particulate matter with diameters less than 2.5 μm (PM2.5) is associated with millions of premature deaths per year, recognized as a leading global health concern. The dose-response relation between ambient PM2.5 exposure and mortality risk is the most fundamental information for assessments of the health effects of PM2.5. The existing dose-response relations were generally developed based on the assumption of equal contribution to toxicity from various sources. However, the sources of PM2.5 may significantly influence health effects. In this study, we conducted an ecological study to investigate the global long-term correlation between source-specific PM2.5 exposure and cause-specific mortality risk (SPECM) based on the regional aggregate data of the publically available official health databases from 528 regions worldwide with a total registered population of 3.2 billion. The results provided preliminary epidemiological evidence for differing chronic health effects across various sources. The relative mortality risks of lung cancer and circulatory diseases were closely correlated with the primary emissions from industrial and residential combustion sources. Chronic lower respiratory diseases were mostly associated with the mass concentration of particulate matter.

Utility of Ranson score, computed tomography severity index, and CRP criteria in risk stratification on the day of hospital admission in patients with acute pancreatitis: A cross-sectional analysis.

The early identification of severe acute pancreatitis (AP) remains a great challenge in clinical practice and novel predictors are needed to complement available scoring systems. This study aimed to investigate utility of Ranson score, and computed tomography severity index (CTSI) and C-reactive protein (CRP) criteria in determination of risk prognostic status in AP. A total of 104 patients with AP (median age: 71.5 (range, 21-102) years, (59.6% were males) were included in this cross-sectional study. Patients were divided into two groups according to risk prognostic status including good prognosis (n=67) and poor prognosis (n=37) groups, based on presence of at least one of the poor prognostic criteria including Ranson score ≥3, presence of pseudocyst and necrotizing fluid collection on ultrasonography or computed tomography imaging and CRP levels >15 mg/L. Data on patient demographics, etiology of AP, smoking, blood biochemistry and hemogram findings and inflammatory markers including CRP (mg/L), mean platelet volume (fL), neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio were recorded. Overall, 37 (35.6) patients with at least one these criteria comprised the poor prognosis group. Most of patients were considered to be in the poor prognosis group based on CTSI only (35.1%), CTSI + CRP (18.9%), and CTSI + Ranson (16.2%). Overall, 6 (5.8%) patients died, and all of them were in the poor prognosis group (p=0.002). Patients with poor versus good prognosis had significantly higher median (min-max) values for creatinine (1 [0.57-10.0] vs. 0.76 [0.5-8.4] mg/dL, p=0.004) and urea (48.0 [9.0-247.0] vs. 27.0 [10.0-111.0] mg/dL, p<0.001), and lower albumin values (3.5 [2.4-4.3] vs. 3.6 [2.7-4.6] g/L, p=0.021). Kappa values indicated presence of a moderate agreement between CTSI and CRP (kappa: 0.408), a fair agreement between CTSI and Ranson (kappa: 0.312), and a none to slight agreement between Ranson and CRP (kappa: 0.175). CTSI was able to discriminate all 6 patients (100.0%) with mortality, whereas Ranson and CRP each discriminated only 2 (33.3%) of 6 patients with mortality. Our findings suggest a stronger individual prognostic value of CTSI alone, rather than CRP or Ranson score alone, in risk stratification of AP patients for severity of disease and related mortality risk on the day of admission, whereas emphasize the likelihood of using CRP or Ranson score complementary to CTSI to enable further identification of poor prognostic status.