Analysis Of Risk Factors For Mortality Research Articles

Analysis of mortality risk factors in children with severe adenovirus pneumonia: A single-center retrospective study.

Human adenovirus (HAdV) is one of the most common viruses causing respiratory infections among young children. Most adenovirus infections are mild and self-limited; however, these infections may occasionally cause severe pneumonia and even death. The mortality risk factors for severe adenovirus pneumonia are not completely clear. This study aimed to evaluate the mortality risk factors in children with severe adenovirus pneumonia. A retrospective study of children with severe adenovirus pneumonia hospitalized in Guangzhou Women and Children's Hospital between July 2018 and January 2020 was performed. Binary logistic regression analysis was used to identify independent mortality risk factors for severe adenovirus pneumonia after univariate analysis. Our study included 189 patients (123 males and 66 females). Among them, 13 patients did not survive with a mortality of 6.88%. In multivariate analysis, the independent mortality risk factors in children with severe adenovirus pneumonia were age less than 1 year (OR=18.513, 95% CI: 2.157-158.883, p=0.008), hypoxia (OR=62.335, 95% CI: 2.385-1629.433, p=0.013), and thrombocytopenia (platelet <100∗10ˆ9/L) (OR=13.324, 95% CI: 1.232-144.075, p=0.033). In children with severe adenovirus pneumonia who are younger than one year old, hypoxia and platelet counts less than 100∗10ˆ9/L represent mortality risk factors.

314.5: The Difference Between Delta and Omicron Variants in Solid Organ Transplant Recipients

Introduction: Solid Organ Transplant (SOT) recipients are vulnerable to SARS-CoV-2 infection. Delta variant has been reported to have worse outcomes as compared to other variants to date. The Omicron variant has been reported more transmissible but less virulent in general population. However, this phenomenon has not been validated in SOT recipients. Method: This is a retrospective cohort study, conducted in two phases, between July 1st and December 10th, 2021(Delta dominant phase), and January 1st and January 31st, 2022 (Omicron dominant phase) in one of the biggest SOT centers in the United States. Patient demographics including transplanted organ, immunosuppressive medication, vaccination status, and treatment modalities were obtained. We also compared clinical outcomes including hospitalization, ICU admission rate and mortality between two groups. Chi squared or fisher’s exact test were performed for categorical variables, whichever appropriate. For continuous variables, Mann Whitney U-test was performed. Multiple logistic regression model with stepwise backward elimination was developed to identify the risk factors for mortality. We put variables whose p value was less than 0.2. Of note, the institutional treatment protocol has not changed during the study period. Result: We identified 64 and 95 SOT recipients while delta and omicron variants were dominant, respectively. The rate of kidney transplant, age, gender, African American race, and the rate of at least received one dose vaccination were not significantly different between two groups. Of note, the hospital admission rate (68.8% vs 36.2%, p<0.001), ICU admission rate (20.3% vs. 6.3%, p=0.012), and mortality (20.9% vs. 4.2%) were higher during the delta variant versus omicron variant phase. For the risk factor analysis for mortality, we put age, African American race, COVID-19 variant, kidney transplant and vaccination status into multiple logistic regression model. Finally, delta variant was the only statistical significant risk factor for mortality (p<0.001, Odds ratio 9.35, 95% confidence interval 2.52-34.5). Conclusion: This is the first study comparing the outcomes between Delta variant dominant and Omicron variant dominant phase in SOT recipients. Even though there was no treatment protocol changed, the identified risk factor for mortality was delta variant dominant phase. However, still, the hospital admission rate (36.2%) should have been observed while Omicron variant phase and required significant aggressive treatment. Thus, we should prepare and may need to change the treatment protocol based on the variant in the future.

314.10: Controlling the Cytokine Stom With Therapeutic Plasma Exchange: The MTI Experience With Solid Organ Transplant Recipients

Introduction: The solid organ transplant recipient (SOTr) have suffered a tremendous impact from coronavirus pandemic. The use of immunosuppressants and frequent associated medical comorbidities put this population at extreme risk for developing SARS-CoV-2 associated pneumonia. SARS-CoV-2-related mortality is higher in SOTr. It has been hypothesized that cytokine release storm (CRS) is the leading cause of ARDS in COVID-19 and timely control of this inflammatory response may improve outcomes. We report our experience of using therapeutic plasma exchange (TPE) to improve outcomes by tackling CRS in a timely manner. Methods: This is a single-center, retrospective cohort study of SOTr diagnosed with SARS-CoV-2 infection from April 2020 to April 2021. All the patients received severity stratified institutional protocolized treatment and TPE was initiated based on clinical and inflammatory parameters of CRS and ARDS. TPE patients received Methylprednisolone 250 mg x 3 days then 125 mg x 2 days, followed by Prednisone 60 mg x 2 days and then 30 mg x 2 days. All patients received prophylaxis with omeprazole, ivermectin 0.2 mg/Kg daily for 2 days followed by 2 additional doses 2 weeks later, and trimethoprim/sulfamethoxazole (renally adjusted) 3 times weekly for 3 months. Laboratory markers, immunosuppression, WHO severity score pre- and post-TPE therapy and outcomes including mortality were analyzed. For risk factor analysis for mortality, we performed logistic regression analysis for univariate analysis. After that, based on the univariate analysis, we developed multivariate model. We conducted multiple logistic regression analysis with stepwise backward elimination. Results: 62 patients were followed for median of 141 days (range 8-376). The median age was 60 years (range 28-78), 65% were male, 76% had hypertension, 55% had diabetes and 81% were overweight with a BMI > 25 kg/m2. 90% were of Hispanics and Afro-Caribbean ethnicity. The most common transplanted organ was kidney with 54 patients (87%), followed by liver with 4 patients (6.5%). Time from transplant to diagnosis was 10 months(median, IQR 4-37) and time from symptoms to admission was 3 days (median, IQR 2-5). 79% of the patients were admitted to an intensive care unit (ICU). Tacrolimus (77%) and mycophenolate mofetil (87%) were the most common immunosuppressant drugs used with mycophenolate mofetil being held in 75% of the patients. The median of TPE sessions was 5 (range 1-20). Prior to TPE, there were 27 patients (44%) requiring ventilatory support and additional support (vasopressors, Renal Replacement Therapy (RRT) or Extracorporeal Membrane Oxygenation (ECMO)). A reduction of 32% support on the 27 patients was observed after TPE. The WHO severity score pre- and post-TPE therapy was statistically significant (p<0.001). The overall mortality was 26/62 patients (42%). Secondary infections were diagnosed in 35/62 (56%) of patients with 77 % leading to mortality and of those, 38 % were fungal infections. The median length of stay was 42 days (range 2-207). 4/54 (7%) kidney transplant recipients developed graft failure at 9, 18, 139 and 344 days respectively; and 4/54 (7%) had episodes of acute rejections at 1,14, 22 and 124 days of COVID diagnosis, respectively. Univariable analysis showed that older age and elevated LDH pre TPE and the lack of decline on LDH, D Dimer, CRP and ferritin values post TPE were risk factors for mortality (p=0.001; 0.022; 0.006; 0.004; 0.0002 and 0.043, respectively). The presence of a secondary infection was correlated with increased likelihood of death from 25% to 55% and it occurred with a mean of 8 days (range 1-65) from its diagnosis. Multivariate analysis showed older age and CRP values post TPE as risk factors for mortality (p=0.015 and 0.04, respectively). Conclusion: SARS-CoV-2 infection with cytokine storm leading to ARDS leads to high mortality, especially in the SOTr. TPE appears to be a valuable tool to control the cytokine storm by reducing the systemic inflammatory response and improving the overall critical state. Alongside with older age, we observed that high levels of LDH pre TPE and the persistent high levels of the other inflammatory parameters, specifically CRP post TPE and secondary infections, were predictors of mortality. Further research is needed to establish if these findings can lead to clinical guidelines.

Analysis of Mortality Risk Factors in Children with Pneumonia in RSUD Dr Soetomo Surabaya

Background: Pneumonia is one of the leading causes of under-five morbidity and mortality. We carried out a comprehensive study to identify risk factors contributing to both mortality and morbidity rate in children less than 5 years of age that were hospitalized with pneumonia. Objective: To evaluate mortality risk factors in children with pneumonia in RSUD Dr. Soetomo Surabaya. Methods: This is an analytic observational study using secondary data that was taken from medical record of hospitalized children with pneumonia between 2015-2018. Data was analysed using Chi-square test or Fisher’s exact test and logistic regression (p&lt;0.05). Results: A total of 817 children with pneumonia were enrolled in this study. In children aged 2–59 months, the risk factors significantly associated with death included age, low birth weight, prematurity, breastfeeding status, pleural effusion, atelectasis, and comorbidity. Logistic regression revealed status of breastfeeding, pleural effusion, and comorbidities, influenced the mortality outcome of pneumonia. Conclusion: Nonexclusive breastfeeding, pleural effusion and comorbidities are the independent predictors of mortality in children with pneumonia. Thus, early identification and prompt management of these simple clinically recognizable predictors of death may help reduce mortality rate in such population.

On the analysis of mortality risk factors for hospitalized COVID-19 patients: A data-driven study using the major Brazilian database.

BackgroundBrazil became the epicenter of the COVID-19 epidemic in a brief period of a few months after the first officially registered case. The knowledge of the epidemiological/clinical profile and the risk factors of Brazilian COVID-19 patients can assist in the decision making of physicians in the implementation of early and most appropriate measures for poor prognosis patients. However, these reports are missing. Here we present a comprehensive study that addresses this demand.MethodsThis data-driven study was based on the Brazilian Ministry of Health Database (SIVEP-Gripe) regarding notified cases of hospitalized COVID-19 patients during the period from February 26th to August 10th, 2020. Demographic data, clinical symptoms, comorbidities and other additional information of patients were analyzed.ResultsThe hospitalization rate was higher for male gender (56.56%) and for older age patients of both sexes. Overall, the lethality rate was quite high (41.28%) among hospitalized patients, especially those over 60 years of age. Most prevalent symptoms were cough, dyspnoea, fever, low oxygen saturation and respiratory distress. Cardiac disease, diabetes, obesity, kidney disease, neurological disease, and pneumopathy were the most prevalent comorbidities. A high prevalence of hospitalized COVID-19 patients with cardiac disease (65.7%) and diabetes (53.55%) and with a high lethality rate of around 50% was observed. The intensive care unit (ICU) admission rate was 39.37% and of these 62.4% died. 24.4% of patients required invasive mechanical ventilation (IMV), with high mortality among them (82.98%). The main mortality risk predictors were older age and IMV requirement. In addition, socioeconomic conditions have been shown to significantly influence the disease outcome, regardless of age and comorbidities.ConclusionOur study provides a comprehensive overview of the hospitalized Brazilian COVID-19 patients profile and the mortality risk factors. The analysis also evidenced that the disease outcome is influenced by multiple factors, as unequally affects different segments of population.

Survival and cause-specific mortality of harvested willow ptarmigan (Lagopus lagopus) in central Norway.

Survival is a key demographic component that often varies as a result of human activities such as recreational harvest. Detailed understanding of seasonal variation in mortality patterns and the role of various risk factors is thus crucial for understanding the link between environmental variation and wildlife population dynamics and to design sustainable harvest management systems. Here, we report from a detailed seasonal and cause‐specific decomposition of mortality risks in willow ptarmigan (Lagopus lagopus) in central Norway. The analyses are based on radio‐collared (n = 188) birds that were monitored across all seasons, and we used time‐to‐event models for competing risks to estimate mortality patterns. Overall, annual survival was estimated at 0.43 (SE: 0.04), with no distinct difference among years (2015/16 to 2018/19) or between sexes. Analysis of mortality risk factors revealed that on the annual basis, the risk of harvest mortality was lower than the risk of dying from natural causes. However, during the autumn harvest season (September–November), survival was low and the dominating cause of mortality was harvest. During winter (December–March) and spring seasons (April–May), survival was in general high and did not vary between males and females. However, during the spring season, juveniles (i.e., birds born last year) of both sexes had lower survival than adults, potentially because they are more prone to predation. During the summer season (June–August), females experienced a higher hazard than males, underlining the greater parental investment of females during egg production, incubation, and chick rearing compared to males. Our analyses provide unique insight into demographic and seasonal patterns in willow ptarmigan mortality risks in a harvested population and revealed a complex interplay across seasons, risk factors, and demographic classes. Such insight is valuable when designing sustainable management plans in a world undergoing massive environmental perturbations.

Survival of Chinese people with type 2 diabetes and diabetic kidney disease: a cohort of 12 -year follow-up

BackgroundThe prevalence of type 2 diabetes has grown significantly in China. However, little is known about the survival outcome of people with type 2 diabetes and diabetic kidney disease (DKD). The purpose of this study is to examine the survival of this population and the risk factors for mortality in one suburb cohort of Beijing, China.MethodsFour hundred and forty-five people with DKD (48.8% male, age at onset of diabetes 48.8 ± 11.0 years, age at enrollment 57.5 ± 11.6 years) were enrolled in one suburb of Beijing, China between January 1st, 2003 and December 31st, 2015. Mortality ascertainment was censored by December 31st, 2015. Survival analysis was performed by Kaplan–Meier analysis, and Cox proportional hazards regression models were served for risk factor analysis of mortality. The Chiang method was used to estimate life expectancy by age.ResultsA total of 78 deaths were identified during the 3232 person-years of follow-up. Multivariate Cox regression analysis showed significantly higher risks of mortality with respect to older age, higher systolic blood pressure (SBP), lower body mass index (BMI) and lower estimated glomerular filtration rate (eGFR). The life expectancy at age of 50 was estimated to be 12.3 (95%, CI: 9.0–16.1) years. Circulatory disease was the leading cause of death in this population (accounting for 43.6% of all deaths), followed by diabetic complications (33.3%) and respiratory disease (6.4%).ConclusionsData from one Chinese cohort from 2003 through 2015 showed that people with DKD faced higher risk of death and shorter life expectancy. Factors significantly increasing risk of death included older age, higher SBP, lower BMI and lower eGFR. There is an urgent need to early detection, closely monitoring and effective intervention on DKD.

Mathematical Modeling and Risk Factor Analysis for Mortality of Sepsis

Mathematical Modeling and Risk Factor Analysis for Mortality of Sepsis

Impact of Pseudomonas aeruginosa bacteraemia in a tertiary hospital: Mortality and prognostic factors

Background and objectivesPseudomonas aeruginosa bacteraemia is associated with a very high mortality, conditioned by comorbidity, source, severity of the episode and lack of adequate treatment. The aim of the study is to know the mortality and prognostic factors of bacteraemia by P. aeruginosa in our hospital. Patients and methodsWe conducted a retrospective study of P. aeruginosa bacteraemia detected between 2009 and 2014. Epidemiological, clinical and microbiological characteristics were described. A risk factor analysis for mortality was performed. ResultsWe analysed 110 episodes of bacteraemia, which was more frequent in men of advanced age and with a history of hospitalisation, comorbidity and immunosuppression. Most of the bacteraemias were secondary (mainly of respiratory or urinary source) and led to a significant clinical deterioration. The presence of antibiotic resistance was very high, with 27.3% of multiresistant strains. Empirical treatment was adequate in 60.0% and 92.3% for definite treatment. Overall mortality was 37.3% and attributable mortality was 29.1%. The most important prognostic factors were Charlson index ≥3, history of haematologic malignancy, neutropenia and previous use of corticosteroids, source of bacteraemia, Pitt index ≥4, renal insufficiency, adequate definite treatment, empiric treatment with piperacillin/tazobactam in severe episodes and focus control. ConclusionP. aeruginosa bacteraemia is associated with a very high mortality, possibly more related to previous comorbidity and severity of the episode than to the treatment chosen. However, the main goal in management remains to optimise treatment, including focus control.

Impacto de la bacteriemia por Pseudomonas aeruginosa en un hospital de tercer nivel: mortalidad y factores pronósticos

Background and objectivesPseudomonas aeruginosa bacteraemia is associated with a very high mortality, conditioned by comorbidity, source, severity of the episode and lack of adequate treatment. The aim of the study is to know the mortality and prognostic factors of bacteraemia by P.aeruginosa in our hospital. Patients and methodsWe conducted a retrospective study of P.aeruginosa bacteraemia detected between 2009 and 2014. Epidemiological, clinical and microbiological characteristics were described. A risk factor analysis for mortality was performed. ResultsWe analysed 110 episodes of bacteraemia, which was more frequent in men of advanced age and with a history of hospitalisation, comorbidity and immunosuppression. Most of the bacteraemias were secondary (mainly of respiratory or urinary source) and led to a significant clinical deterioration. The presence of antibiotic resistance was very high, with 27.3% of multiresistant strains. Empirical treatment was adequate in 60.0% and 92.3% for definite treatment. Overall mortality was 37.3% and attributable mortality was 29.1%. The most important prognostic factors were Charlson index ≥3, history of haematologic malignancy, neutropenia and previous use of corticosteroids, source of bacteraemia, Pitt index ≥4, renal insufficiency, adequate definite treatment, empiric treatment with piperacillin/tazobactam in severe episodes and focus control. ConclusionP.aeruginosa bacteraemia is associated with a very high mortality, possibly more related to previous comorbidity and severity of the episode than to the treatment chosen. However, the main goal in management remains to optimise treatment, including focus control.

Risk factor analysis for mortality among infants requiring tracheostomy.

An increasing number of tracheostomies are performed in infants with complex comorbidities including bronchopulmonary dysplasia (BPD) and congenital heart disease (CHD). With this shift in indications, there is an urgent need to characterize outcomes in this population. This 5-year retrospective chart review assessed rates of 12-month mortality in infants who were ≤12 months of age at the time of tracheostomy at a tertiary care pediatric hospital and risk factors associated with death. Patient characteristics evaluated included chronologic age and post-menstrual age at tracheostomy placement, gestational age and weight, sex, ethnicity, indication for tracheostomy, and comorbidities including BPD, CHD, subglottic stenosis (SGS), craniofacial syndromes, and chromosomal trisomy syndromes. Subgroup analysis was performed in infants with CHD. One hundred thirty-two tracheostomies were performed during the study period with an overall 12-month mortality of 14.4% (19/132). Mortality was increased in patients with CHD (35%) and decreased in patients with SGS (3.7%). No other patient characteristics were associated with differences in mortality. There was a trend towards improved mortality outcomes among patients born at earlier gestational ages. Among infants with tracheostomy in this cohort, overall mortality rates were relatively low but not insignificant. CHD was associated with increased mortality; however, children with SGS showed more favorable outcomes. Other patient characteristics were not associated with differences in mortality. These data clarify outcomes in a group of infants with tracheostomy.

Mortality prediction in patients with acute kidney injury requiring renal replacement therapy after cardiac surgery

Background and objectiveAcute kidney injury (AKI) is a common and potentially serious postoperative complication after cardiac surgery, and it remains a cause of major morbidity and mortality. The aim of our study was to assess the prognostic illness severity score and to estimate the significant risk factors for poor outcome of patients with AKI requiring renal replacement therapy (RRT) after cardiac surgery. Materials and methodsWe retrospectively analyzed data of adult (>18 years) patients (n=111) who underwent open heart surgery and had developed AKI with need for RRT. Prognostic illness severity scores were calculated and perioperative risk factors of lethal outcome were assessed at the RRT initiation time. We defined three illness severity scores: Acute Physiology and Chronic Health Evaluation (APACHE II) as a general score, Sequential Organ Failure Assessment (SOFA) as an organ failure score, and Liano score as a kidney-specific disease severity score. Logistic regression was also used for the multivariate analysis of mortality risk factors. ResultsHospital mortality was 76.5%. More than 7% of patients remained dialysis-dependent after their discharge from the hospital. The prognostic abilities of the scores were assessed for their discriminatory power. The area under the receiver-operating characteristic (ROC) curve of SOFA score was 0.719 (95% CI, 0.598–0.841), of Liano was 0.661 (95% CI, 0.535–0.787) and 0.668 (95% CI, 0.550–0.785) of APACHE II scores. From 16 variables analyzed for model selection, we reached a final logistic regression model, which demonstrated four variables significantly associated with patients’ mortality. Glasgow coma score<14 points (OR=3.304; 95% CI, 1.130–9.662; P=0.003), mean arterial blood pressure (MAP)<63.5mmHg (OR=3.872; 95% CI, 1.011–13.616; P=0.035), serum creatinine>108.5μmol/L (OR=0.347; 95% CI, 0.123–0.998; P=0.046) and platelet count<115×109/L (OR=3.731; 95% CI, 1.259–11.054; P=0.018) were independent risk factors for poor patient outcome. ConclusionsOur study demonstrated that SOFA score estimation is the most accurate to predict the fatal outcome in patients with AKI requiring RRT after cardiac surgery. Lethal patient outcome is related to Glasgow coma score, mean arterial blood pressure, preoperative serum creatinine and postoperative platelet count.

Modernized standards in burns management: A comparative study in Komfo Anokye Teaching Hospital, Kumasi, Ghana

BackgroundManagement of burns patients before May 2009 was very difficult at the Komfo Anokye Teaching Hospital (KATH). AimTo compile burns patients’ information in the new Burns Intensive Care Unit (BICU), analyze it and draw comparisons to information from the old BICU at KATH. MethodsThis retrospective study involves data from May 2007 to April 2009 (Group 1 –old BICU) and May 2009 to April 2011 (Group 2 –new BICU). The parameters of burn patients recorded included: record of admission, gender, age, aetiology of injury, Total Burns Surface Area (TBSA), the patients’ treatment regime and record of discharge/death. This information was analyzed with SPSS version 18.0. ResultsThe total number of patients in the study was 511; Group 1 constituted 47.36% (n=242) patients; males (n=307, 61%) outnumbering females (n=204, 39%). The overall mean, median and interquartile range (IQR) ages of the patients were 12.4±2; 9.5 and 18.0 years respectively. The main aetiology of burns in Group 1 was flame burns (n=115, 47.5%) and for Group 2 was scald (n=151, 56.1%). The median TBSA recorded for Groups 1 and 2 were 32% and 41% respectively. A mortality rate of 19.1% (n=46) and 12.7% (n=34) were recorded for Groups 1 and 2 respectively which was statistically significant (p<0.05). We found no differences for age and TBSA (P=0.7168 and P=0.8020 respectively). A Chi Square analysis for gender and aetiology of burn revealed no significant difference between Groups 1 and 2. A risk factor analysis for mortality within the Groups (using multiple regression analysis) identified only aetiology of burn in Group 1 to be a factor (P=0.044). ConclusionThis comparative study reveals that a significant difference in mortality was recorded for both groups. The mortality difference does not appear to be due to socio-demographic features. This study may demonstrate that modernized and advanced equipment with the adequate personnel play an essential role in burn management in low income countries such as Ghana.

Impact of Cognitive Impairment in a Multicentric Cohort of Polypathological Patients

Little is known about the prevalence and impact of cognitive impairment in polypathological patients (PPs). To assess the prevalence of cognitive impairment (CI) and delirium, their associated risk factors, and their impact on survival of a multicenter population of PPs. Prospective cohort study. Descriptive analysis of the prevalence, main clinical features of PPs with basal CI (by means of Short Portable Mental Status Questionnaire), and delirium (Confusion Assessment Method); and bivariate as well as multivariate assessment of the factors associated with both conditions. Survival analysis after 12 months follow-up by means of Kaplan–Meier curves, and multivariate analysis of mortality risk factors in PPs with CI, and those with delirium. CI was present in 39% [28% mild to moderate (3–7 errors), and 11% severe (≥ 8 errors)] of the 1434 PPs assessed [in the remaining 11% ( n = 198) delirium was detected]; only 26% of them had been previously diagnosed with dementia. One-year mortality was 46%/31.4% in those with/without CI [ p < 0.0001; relative risk (RR) = 1.8 (1.5–2.3)]. Mean survival was 305 ± 4/266 ± 5 days in those with/without CI ( p < 0.0001). One-year mortality was 54.5%/34.8% in PPs with/without delirium, [ p < 0.0001, RR = 2.25 (1.65–3)]. Mean survival after inclusion was 296 ± 4/241 ± 10 days in those with/without delirium ( P < 0.0001). Factors independently associated with mortality in PPs with CI were the presence of a concomitant active neoplasm [ p = 0.007; RR = 3 (1.3–6.7)], severe dyspnea ( p = 0.04; RR = 1.6 (1.02–2.6)], higher comorbidity load ( p = 0.003; RR = 1.2 (1.07–1.4)], and ≥ 4 hospital admissions in the previous 12 months [ p < 0.0001; RR = 5.2 (2.4–11.5)]. Factors associated with mortality in PPs with delirium were age ≥ 85 years [ p = 0.021, RR = 2.3 (1.14–4.6)], chronic liver disease ( p = 0.019, RR = 5.9 (1.3–25)], severe dyspnea [ p = 0.007; RR = 2.7 (1.3–5.4)], plasma creatinine levels > 2 mg/dL [ p = 0.003; RR = 7.8 (2–26)], and polypharmacy [ p = 0.0019; RR = 3.1 (1.2–8.1)]. CI, as well as delirium, is common in PPs. Both play a deleterious role in 12-month survival. A systematic cognitive assessment as well as prevention and early detection of delirium should be included in the clinical care of all PPs.

Analysis on prognostic indicators of acute kidney injury in intensive care uint

Objective To determine the prognostic indicators of acute kidney injury by comprehensive anal-ysis of the mortality risk factors for AKI. Method It' s a retrospective study. The clinical date form March 2008 to August 2009 were collected and analyzed, including gender, age,case history of chronic diseases, the worst values of laboratory examinations within 24 hours of diagnosis (including routine blood tests, blood gas analysis, liver andrenal function, the levels of serum CystatinC , blood electrolytes). According to the 60-day survival of the state will be divided into the survival group and dead groups, Calculation acute physiology and Chronic health evaluation (A-PACHE) Ⅱ scores and mortality.First,univariate analysis was used to screen the variables that related to Prognosis,Calculate odds ratios (OR) and 95% confidence interval (CI) .then Proceeded multiple-factor analysis with Logis-tic regression among to Perform the variables. Results Of the 98 acute kidney injury cases analyzed, 60 cases were males and 38 females, age ranged form 19 to 89 years (mean age 52.4± 16.1 years) .The overall mortality was 34.7%(34/98) within 60d of final diagnosis.The APACHE Ⅱ scores of the non-survivors (17.4 ± 4.3) were higher than that of the survivors(14.2±4.8, P ＜ 0.05). The mortality of the patients with high Cystatin C(＞ 1.3mg/L) was 50% (24/48), which was higher than that of the patients with low Cystatin C (＜ 1.3 mg/L)(20%,10/50; P ＜0.05).Tne results of the univariate analysis indicated that Organ failure≥ 2, Oliguria、 A-PACHEI1 ＞ 15 scores,Cys C ＞ 1.3 mg/L Cys C ＞ 1.3 mg/L Combined APACHEⅡ＞ 15 scores,were the risk factors of AKI. However the logistic reggression suggessted that Organ failure≥2, Oliguria, Cys C ＞ 1.3 mg/L Combined APACHEⅡ＞ 15 scores are the independent risk factors of AKI. Conclusions Cys C ＞ 1.3 mg/L Combined APACHE Ⅱ＞ 15 scores may be used for the prognosis the patients AKI. Key words: Intensive Care Unit; Acute kidney injury; Serum Cystatin C; APACHE II ; 01iguria; Prognosis; Retrospective studies

Aortic Arch Replacement: Effects of Age on Outcome, and Risk Factor Analysisfor Mortality and Long Term Survival in Patients Aged 70 Years or Older

Aortic Arch Replacement: Effects of Age on Outcome, and Risk Factor Analysisfor Mortality and Long Term Survival in Patients Aged 70 Years or Older

Risk factor analysis of Swedish Left Ventricular Assist Device (LVAD) patients

Background The use of left ventricular assist devices (LVADs) is established as a bridge to heart transplantation. Methods All Swedish patients on the waiting list for heart transplantation, treated with LVAD since 1993 were retrospectively collected into a database and analyzed in regards to risk factors for mortality and morbidity. Results Fifty-nine patients (46 men) with a median age of 49 years (range, 14 to 69 years), Higgins score median of 9 (range, 3 to 15), EuroScore median of 10 (range, 5 to 17) were investigated. Dominating diagnoses were dilated cardiomyopathy in 61% (n = 36) and ischemic cardiomyopathy in 18.6% (n = 11). The patients were supported with LVAD for a median time of 99.5 days (range, 1 to 873 days). Forty-five (76%) patients received transplants, and 3 (5.1%) patients were weaned from the device. Eleven patients (18.6%) died during LVAD treatment. Risk factor analysis for mortality before heart transplantation showed significance for a high total amount of autologous blood transfusions ( p < 0.001), days on mechanical ventilation postoperatively ( p < 0.001), prolonged postoperative intensive care unit stay ( p = 0.007), and high central venous pressure 24 hours postoperatively and at the final measurement ( p = 0.03 and 0.01, respectively). Mortality with LVAD treatment was 18.6% (n = 11). High C-reactive protein ( p = 0.001), low mean arterial pressure ( p = 0.03), and high cardiac index ( p = 0.03) preoperatively were risk factors for development of right ventricular failure during LVAD treatment. Conclusions The Swedish experience with LVAD as a bridge to heart transplantation was retrospectively collected into a database. This included data from transplant and nontransplant centers. Figures of mortality and morbidity in the database were comparable to international experience. Specific risk factors were difficult to define retrospectively as a result of different protocols for follow-up among participating centers.

The registry of the international society for heart and lung transplantation: Fifth Official Pediatric Report–2001 to 2002

Pediatric thoracic organ transplant recipients are an important and biologically unique component of the overall experience in thoracic organ transplantation. Issues of immunologic naivete, growth and development make the pediatric recipient an important biologic model to aid in our understanding of overall thoracic organ transplantation. This report documents stability in the number of pediatric recipients and notes the continued trend of markedly improved survival for heart recipients in the most recent years. Despite improved survival, the overall number of reported pediatric recipients has remained stable, underlining the rate-limiting step of donor organ availability. Compared with previous years, this report offers an expanded analysis of donor and recipient characteristics. Risk factor analysis for mortality is expanded to include parameters important for 5-year survival. A more thorough description of immunosuppressive medication usage and actuarial freedom from morbidity curves represent new analyses of the pediatric data. These data are intended to analyze our experience to date and also to highlight areas where our experience and knowledge base need expansion in the future. HEART TRANSPLANTION Transplant Volumes and Indications

Long-Term Capd Survival and Analysis of Mortality Risk Factors: 12-Year Experience of a Single Mexican Center

To evaluate patient and technique survival, and to analyze mortality risk factors in a large Mexican single-center continuous ambulatory peritoneal dialysis (CAPD) program. Cohort study. Tertiary care, teaching hospital located in Mexico City. All patients from our CAPD program (1985-1997) were retrospectively studied. Clinical and biochemical variables at the start of dialysis were recorded and considered in the analysis of risk factors. End points were patient (alive, dead, or lost to follow-up) and technique status at the end of the study (December 1997). 627 patients, 37% with diabetes mellitus (DM), were included. Median patient survival (+/- SE) was 5.1 +/- 0.6 years. In the univariate analysis, the following variables were associated (p < 0.05) with mortality: DM, old age, hypoalbuminemia, low serum creatinine, low serum phosphate, and lymphopenia. In the multivariate analysis, the only significant mortality risk factors were DM (RR 2.56, p < 0.0001), old age (RR 1.01, p = 0.01), hypoalbuminemia (RR 0.77, p = 0.04), and lymphopenia (RR 0.98, p = 0.05). Median technique survival was 4.0 +/- 0.2 years. Peritonitis, hypoalbuminemia, lymphopenia, old age, and DM were all significantly associated (p < 0.05) with technique failure in the univariate analysis, while in the multivariate analysis, only DM (RR 1.78, p = 0.001), peritonitis (RR 1.13, p = 0.004), lymphopenia (0.98, p = 0.04), and hypoalbuminemia (RR 0.80, p = 0.06) were technique failure predictors. Patient survival in our setting is similar to that reported in other series. Diabetes mellitus, lymphopenia, and hypoalbuminemia were the strongest predictive factors for mortality and technique failure on CAPD. Our 12-year CAPD program is one of the largest single-centers reported in CAPD literature.

Latin American Registry of dialysis and renal transplantation: 1993 annual dialysis data report.

The Latin American Registry of Dialysis and Transplantation was created in October 1991 and comprises the National Societies of Nephrology from 21 countries with a total population of 468.56 million inhabitants. This report includes data from 21,181 patients from Argentina, Brazil, Chile, El Salvador, Panama, Paraguay, Peru, Puerto Rico, Uruguay, and Venezuela who were receiving chronic dialysis treatment during 1993. Data was collected by individual patient questionnaires except from Chile and Brazil where the data was obtained from a local centre questionnaire. The prevalence rate averaged 131.1 per million population. The mean age of the 8972 incident patients was 50.5 years, with 58.2% males. The more frequent causes of renal failure were glomerulopathies (22.6%), vascular nephropathy (20.9%) and diabetes (16.9%). Haemodialysis was the most used treatment (88.3%). Gross mortality was 21.1% and the more frequent causes of death were cardiac complications and infections. The analysis of mortality risk factors using a logistic regression model showed that diabetics patients older than 65 years had the highest probability of death (43.0%) and patients with glomerulonephritis, younger than 65 years had the lowest (8.0%). The adjusted mortality rate was 241 deaths/1000 patient-years at risk when the USRDS 1987-1989 white mortality rate by age groups and primary diseases was used as standard. In spite of the economic difficulties, very important efforts have been made to treat ESRD patients and gross mortality statistics in some countries are similar to those reported by other regional registries.