Risk Of 30-day Mortality Research Articles

Association between red cell distribution width-to-lymphocyte ratio and 30-day mortality in patients with ischemic stroke: a retrospective cohort study

ObjectivesIschaemic stroke (IS) has become a major health problem globally as it is one of the leading causes of long-term disability and death. This study aimed to evaluate the association between red cell distribution width (RDW) to lymphocyte (LYM) ratio (RLR) and 30-day mortality risk in patients with IS.MethodsThe present study employed a retrospectively cohort study design with the adult data extracted from the Medical Information Mart for Intensive Care (MIMIC-III, MIMIC-IV) databases between 2001 and 2019. The RLR was measured using RDW and LYM. Confounders were adjusted in Cox proportional hazards model. The outcome was 30-day mortality. Univariable and multivariable Cox proportional hazards models were establised. A further analysis was conducted on the basis of subgroup stratification by heart failure (HF) (yes or no), atrial fibrillation or flutter (yes or no), hypertension (yes or no), dyslipidemia (yes or no), sepsis (yes or no), and age (≥ 65 years and < 65 years).ResultsIn this study, 1,127 adult patients with IS were finally identified. Among them,818 patients survived (the survival group) and 309 patients died (the death group). The mean age was older in individuals from the death group than those from the survival group (70.19 years vs. 64.56 years). The elevated levels of RLR were linked to an increased risk of mortality within 30 days in patients with IS, with an HR of 1.70 (95% CI: 1.34–2.17). Subgroup analyses showed that high RLR levels was a significant risk factor for mortality at 30 days particularly in IS patients aged ≥ 65 years, HF, no atrial fibrillation or flutter, no hypertension, no dyslipidemia, and no sepsis.ConclusionOur study shows that high levels of RLR were associated with an increased risk of 30-day mortality in patients with IS, providing additional prognostic information for the treatment and supportive care of these patients.

Sex-Specific Obesity Paradox in Critically Ill Patients With Severe Acute Kidney Injury: A Retrospective Analysis.

Although obesity is typically correlated with adverse outcomes in various diseases, certain acute critical illnesses exhibit a phenomenon known as the obesity paradox. This study evaluated sex-specific differences in the prognostic implications of the body mass index (BMI) of patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). A multicenter retrospective cohort study. Data from eight tertiary hospitals in Korea. A total of 3805 critically ill patients receiving CRRT. Patients were categorized into four BMI groups: underweight, normal weight, overweight, and obese. None. There were 2308 male and 1497 female patients. The 90-day mortality risk significantly differed among BMI groups in the overall patient population and the male subpopulation but not the female subpopulation. Following adjustment for confounding variables, the 90-day mortality risk was higher in the underweight group than in the obese group (hazard ratio [HR], 1.20; 95% CI, 1.05-1.36; p = 0.006). Among male patients, the 90-day mortality risk was higher in both the underweight and normal weight groups than in the obese group (underweight: HR, 1.30; 95% CI, 1.10-1.53; p = 0.002 and normal weight: HR, 1.18; 95% CI, 1.04-1.35; p = 0.010); however, no such association was observed among female patients. Subgroup analysis demonstrated the obesity paradox in male patients of old age, with septic AKI, or with low albumin levels. There were sex differences in the association between BMI and mortality in critically ill patients with severe AKI. Although the precise distribution of fat mass and muscle mass was not identified, obese male patients had a more favorable prognosis, which was not evident among female patients. These findings highlight the importance of considering sex-specific factors in understanding the complex relationship between obesity and mortality in critically ill patients with AKI.

PRISMA-7 is a predictor of intensive care unit admission and mortality in older patients in an emergency department.

To compare the performance of the Programme of Research on the Integration of Services for the Maintenance of Autonomy (PRISMA-7), which is used to assess the frailty of older patients visiting emergency departments, with the quick Sepsis Related Organ Failure Assessment (qSOFA) and Emergency Severity Index (ESI) in terms of 28-day mortality and intensive care unit (ICU) admission. This study was prospective and observational. All patients above the age of 65 who were admitted to the Sivas Republic University Medical Faculty Hospital from March 1 to April 30 in the year 2024 were included in the study. Patients' all-cause mortality values and ICU acceptance rates were evaluated for a 28-day period following their applications. The area under the receiver operating characteristic curve stood for the 28-day mortality, while the values for PRISMA-7, ESI, and qSOFA were, respectively, 0.81 (95% confidence interval [CI]: 0.78-0.84), 0.78 (95% CI: 0.72-0.83), and 0.71 (95% CI: 0.65-0.77). Our findings have demonstrated PRISMA-7 to be more effective than ESI and qSOFA in terms of hospitalization predictions. However, while it was found to be more effective than qSOFA in mortality predictions, it was determined that, despite PRISMA-7 having a larger AUC than ESI, no meaningful difference existed between PRISMA-7 and ESI. In conclusion, PRISMA-7, which is thought of as a reliable and valid tool for the determination of frailty in emergency departments, has predictive value for individuals' 28-day mortality risk as well as for their acceptance to the ICU. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2024; ••: ••-••.

Association of serum potassium levels with mortality in critically ill patients with sepsis during hospitalization.

Electrolyte disturbances are prevalent complications in critically ill patients with sepsis, significantly impacting patient prognosis. However, the specific association between serum potassium levels and mortality risk in this population remains poorly understood. This study aimed to investigate the association between serum potassium levels during hospitalization and the risk of 28-day and 90-day mortality in critically ill patients with sepsis. Data were obtained from the Medical Information Mart for Intensive Care (MIMIC-IV) database, and patients with severe sepsis requiring ICU admission were stratified into quartiles based on their mean serum potassium levels. Outcomes assessed included 28-day and 90-day mortality. A multivariate Cox proportional hazards model was used to investigate the association between serum potassium levels and mortality, with restricted cubic splines to identify potential nonlinear correlations. A dichotomous Cox proportional hazards model was applied to analyze the association further, and Kaplan-Meier analysis assessed the mortality risk across different potassium ranges. A total of 25,203 patients were included, with 28-day and 90-day mortality rates of 27.84% and 40.48%, respectively. Multivariate analysis showed a significant association between serum potassium levels and mortality. Restricted cubic splines identified an inflection point at 4.4 mmol/L, with potassium levels above this threshold associated with higher mortality (28-day mortality: HR 2.96, 95% CI = 2.43-3.60; 90-day mortality: HR 2.19, 95% CI = 1.81-2.64). Kaplan-Meier analysis confirmed a significantly higher risk of death for patients with serum potassium levels above 4.4 mmol/L compared to those within the 3.5-4.4 mmol/L range (P<0.001). In critically ill patients with sepsis, serum potassium levels exceeding 4.4 mmol/L are associated with an increased risk of death. Maintaining the average serum potassium level within the range of 3.5-4.4 mmol/L appears to be safe and may contribute to better outcomes in this patient population.

Diabetes does not increase in-hospital or short-term mortality in patients undergoing surgical repair for type A aortic dissection: insight from the national readmission database

BackgroundPrevious studies have reported a protective effect of type 2 diabetes on the incidence and progression of aortic aneurysms. We investigated whether this protective effect extends to aortic dissections.MethodsData from the US Nationwide Readmission Database (2016–2019) were analyzed. Patients admitted for open surgery repair of acute type A aortic dissection (TAAD) were initially analyzed (index group). Those discharged alive were followed for up to 30 days (readmission group). The co-primary outcomes were in-hospital and 30-day mortality.ResultsBetween 2016 and 2019, 7,324 patients were admitted for open surgical repair of acute TAAD, of whom 965 (13.2%) had diabetes. Patients with diabetes were older and had a higher prevalence of obesity, hypertension, smoking, dyslipidemia, and chronic kidney disease (CKD). 15.2% of patients with diabetes and 14.6% without diabetes died; hence, diabetes did not have a significant impact on in-hospital mortality (adjusted odd ratio [aOR] = 1.02 [0.84–1.24]). Similarly, diabetes was not associated with a higher adjusted risk of atrial fibrillation (aOR = 1.03 [0.89–1.20]), stroke (aOR = 0.83 [0.55–1.26]), cardiogenic shock (aOR = 1.18 [0.98–1.42]), but increased the risk of acute renal failure (aOR = 1.20 [1.04–1.39]). Within 30 days of discharge, 154 (15.9%) patients with diabetes and 952 (15%) from the non-diabetes group were readmitted. Readmitted patients with diabetes were older and had a higher prevalence of cardiovascular comorbidities. We didn’t observe any significant difference in the adjusted risk of 30-day mortality between the diabetes and non-diabetes groups (adjusted hazard ratio [aHR] = 0.81 [0.41–1.60]). However, diabetes was associated with a lower risk of readmission (aHR = 0.81 [0.68–0.97]). Age was the most significant predictor of all outcomes. CKD was the most significant predictor of 30-day mortality, with the risk increasing five-fold in patients with diabetes (HR = 5.58 [2.58–6.62]. Cardiovascular-related conditions were the most common causes of readmission in both groups. However, respiratory-related conditions were more prevalent in the diabetes group compared to the non-diabetes group (19.5% vs. 13%, respectively, p = 0.032).ConclusionsDiabetes does not increase in-hospital or short-term mortality in patients undergoing surgical repair for Type A aortic dissection.Graphical abstract

Association between endothelial activation and stress index and 30-day mortality risk in acute myocardial infarction patients: a study based on the medical information mart for intensive care-IV database

ObjectiveThis study aimed to evaluate the association between the Endothelial Activation and Stress Index (EASIX) and 30-day mortality risk in acute myocardial infarction (AMI) patients.MethodsUsing a retrospective cohort design, data were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database between 2008 and 2019. Patients diagnosed with AMI at intensive care unit (ICU) admission were included. EASIX score was calculated as follows: lactate dehydrogenase (LDH) level (U/L) × creatinine level (mg/dL)/platelet count (109/L). Cox regression models assessed the association between EASIX and 30-day mortality, with subgroup analyses based on age, gender, AMI subtype, and sepsis status.ResultsA total of 1,036 patients were analyzed, among whom 323 did not survive beyond 30 days post-ICU admission. Higher EASIX scores were associated with increased 30-day mortality in AMI patients [Hazard ratio (HR): 1.70, 95% confidence interval (CI): 1.17–2.46, P = 0.005). Subgroup analyses supported these findings and revealed significant interactions between EASIX and variables such as gender and AMI subtype (P < 0.05).ConclusionElevated EASIX scores are significantly correlated with increased 30-day mortality risk in AMI patients, suggesting EASIX as a valuable prognostic tool that may inform clinical management strategies to improve outcomes in AMI.Clinical trial numberNot applicable.

High level of systemic immune inflammation index elevates delirium risk among patients in intensive care unit

Evidence regarding the effect of systemic immune-inflammation index on delirium occurrence is limited. This study aimed to investigate the association between SII and delirium in intensive care unit (ICU) patients. Methods: Information was extracted from Medical Information Mart for Intensive Care-IV. Four logistic regression model was established and incorporated with subgroup analysis and restricted cubic spline (RCS). The cutoff value of SII was acquired from receiver operator characteristic curve (ROC), and propensity score matching (PSM) was utilized to attenuate the confounding effect. Survival analysis was utilized to evaluate the relationship between SII and 30-day or 90-day all-cause mortality. Results: Among the 7,518 participants, 1,685 cases of delirium occurred. Individuals in the highest quartile of SII exhibited a heightened delirium risk, with a significant multivariable-adjusted odds ratio (OR) of 3.12(2.24,4.33). Tendency analysis, subgroup analysis and PSM together confirmed the positive relationship. Results of Cox regression displayed the risk of both 30-day and 90-day mortality increased about 50% in the higher-SII group. Conclusion: Higher levels of SII is positively associated with the occurrence of delirium and increased all-cause mortality risk.

Sex-Related Differences in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Systematic Review and Meta-analysis.

This review aims to analyze sex-related differences in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). 10 studies were retrieved from PubMed and Embase comparing outcomes between men and women admitted with AMI complicated by CS. Pooled log odds ratios (OR) were calculated for binary outcomes using the Mantel-Haenszel method, and Hedges' g with the inverse-variance method was used for continuous outcomes. The primary endpoints were in-hospital mortality and 30-day mortality. The secondary endpoints were reinfarction rate, length of hospital stay (LOS), requirement of renal replacement therapy (RRT), and stroke (ischemic and hemorrhagic). Males exhibited a lower risk of in-hospital mortality (OR 0.77, 95% CI 0.69-0.85, I2 = 97%, p < 0.0001), 30-day mortality (OR 0.69, 95% CI: 0.61-0.78, I² = 0%, p < 0.0001) and stroke (OR 0.91, 95% CI 0.87-0.95, I2 = 36%, p < 0.0001) compared to females. In contrast, males were more likely to require renal replacement therapy (RRT) (OR 1.27, 95% CI 1.09-1.48, I2 = 69% p = 0.0017). However, there were no statistically significant differences between females and males in terms of reinfarction rate (OR 0.88, 95% CI 0.66-1.18, I2 = 56%, p = 0.3936) or length of hospital stay during hospitalization (Hedges's g 0.35 days, 95% CI -0.38-1.07, I2 = 100%, p = 0.34). Females with AMI and CS have higher in-hospital mortality, 30-day mortality, and stroke risk than men. Men are more likely to require RRT. Further research is needed to understand underlying mechanisms and improve outcomes for both genders.

Potassium levels and short-term outcomes in heart failure with mildly reduced ejection fraction

ObjectiveThe study investigates the prognostic impact of dyskalemias in patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF). BackgroundAlthough dyskalemias represent a common complication in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF), data concerning the prevalence and prognostic impact of dyskalemias in HFmrEF is limited. MethodsConsecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. The prognostic impact of potassium levels was assessed comparing patients with K > 3.3 to ≤4.5 mmol/L, ≤3.3 mmol/L and > 4.5 mmol/L. The primary endpoint was all-cause mortality at 30 days. Results2079 patients with HFmrEF and potassium measurement were included (median potassium level: 4.4 mmol/L; mean 4.2 mmol/L). 84 % of patients hospitalized with HFmrEF presented with potassium levels in the norm range, 8 % with hypokalemia and 8 % with hyperkalemia, respectively. The risk of all-cause mortality at 30 days was higher in patients with hyperkalemia compared to patients with normokalemia (7 % vs 4 %; log rank p = 0.026), whereas the presence of hypokalemia (6 %; log rank p = 0.075) was not significantly associated with the risk of 30-days all-cause mortality. Compared to patients with normokalemia, the presence of hyperkalemia was still associated with an increased risk of 30-day all-cause mortality within a multivariable Cox regression analysis (HR = 2.002; 95 % CI 1.004–3.992; p = 0.049). ConclusionIn patients hospitalized with HFmrEF, hyperkalemia – but not hypokalemia – was independently associated with an increased risk of all-cause mortality at 30 days.

Impact of Inflammation After Cardiac Surgery on 30-day Mortality and Machine Learning Risk Prediction

Impact of Inflammation After Cardiac Surgery on 30-day Mortality and Machine Learning Risk Prediction

Vitamin D supplementation can improve the 28-day mortality rate in patients with sepsis-associated acute kidney injury.

Vitamin D levels are generally lower in septic patients and are associated with poor prognosis. Observational studies suggest improved renal recovery in acute kidney injury (AKI) patients with increased vitamin D levels. Still, large RCTs did not show significant clinical benefits, possibly due to the limited number of sepsis or AKI patients included. This study aimed to examine the impact of vitamin D supplementation on 28-day all-cause mortality in patients with sepsis-associated acute kidney injury (S-AKI). A retrospective cohort study was conducted using data from the MIMIC-IV (v2.0) database, which included 18,713 ICU patients with S-AKI. Propensity score matching (PSM) was used to adjust for confounding factors, and multivariate Cox regression was employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Patient survival and clinical characteristics will be assessed utilizing Kaplan-Meier curves, with comparisons conducted using the log-rank test. Kaplan-Meier survival analysis revealed significant differences in survival between the groups. Multivariate Cox regression indicated a reduced risk of 28-day mortality associated with vitamin D supplementation (HR: 0.73, 95% CI: 0.67-0.80, p < 0.001). The results after PSM were consistent with those of the original cohort. Similar results were observed for in-hospital mortality and 90-day mortality. The Restricted Cubic Spline curve (RCS) indicated an increasing trend in the therapeutic effect of vitamin D with increasing SOFA score. Vitamin D supplementation is associated with decreased all-cause mortality in patients with S-AKI, and those with more severe conditions may benefit even more.

Identification and validation of respiratory subphenotypes in patients with COVID-19 acute respiratory distress syndrome undergoing prone position

BackgroundThe heterogeneity of acute respiratory distress syndrome (ARDS) patients is a challenge for the development of effective treatments. This study aimed to identify and characterize novel respiratory subphenotypes of COVID-19 ARDS, with potential implications for targeted patient management.MethodsConsecutive ventilated patients with PCR-confirmed COVID-19 infection, in which prone positioning was clinically indicated for moderate or severe ARDS, were included in a prospective cohort. The patients were assigned to development or validation cohorts based on a temporal split. The PaO2/FiO2 ratio, respiratory compliance, and ventilatory ratio were assessed longitudinally throughout the first prone session. The subphenotypes were derived and validated using machine learning techniques. A K-means clustering implementation designed for joint trajectory analysis was utilized for the unsupervised classification of the development cohort. A random forest model was trained on the labeled development cohort and used to validate the subphenotypes in the validation cohort.Results718 patients were included in a prospective cohort analysis. Of those, 504 were assigned to the development cohort and 214 to the validation cohort. Two distinct subphenotypes, labeled A and B, were identified. Subphenotype B had a lower PaO2/FiO2 response during the prone session, higher ventilatory ratio, and lower compliance than subphenotype A. Subphenotype B had a higher proportion of females (p < 0.001) and lung disease (p = 0.005), higher baseline SAPS III (p = 0.002) and SOFA (p < 0.001) scores, and lower body mass index (p = 0.05). Subphenotype B had also higher levels of the pro-inflammatory biomarker IL-6 (p = 0.017). Subphenotype B was independently associated with an increased risk of 60-day mortality (OR 1.89, 95% CI 1.51–2.36). Additionally, Subphenotype B was associated with a lower number of ventilator-free days on day 28 (p < 0.001) and a lower hospital length of stay (p < 0.001). The subphenotypes were reproducible in the validation cohort.ConclusionOur study successfully identified and validated two distinct subphenotypes of COVID-19 ARDS based on key respiratory parameters. The findings suggest potential implications for better patient stratification, risk assessment, and treatment personalization. Future research is warranted to explore the utility of these novel subphenotypes for guiding targeted therapeutic strategies in COVID-19 ARDS.

The Association Between Body Mass Index and 28-day Mortality in Patients With Sepsis: A Retrospective Cohort Study.

Sepsis is a severe clinical syndrome with high morbidity and mortality in intensive care units (ICUs). Body Mass Index (BMI) shows a rising trend of obese patients being admitted to ICUs. The relationship between BMI and the clinical outcome of sepsis remains highly debated. The data used in this study were sourced from the Intensive Care Information Center IV (MIMIC-IV) database. Baseline information extracted within 24 hours of ICU admission was categorized according to World Health Organization (WHO)'s BMI classifications. A multivariate Cox regression model and curve fitting assessed the independent correlation between BMI and the primary outcome. A total of 7836 patients were included in the study and categorized into five groups based on BMI. The overall 28-day mortality rate was 21.94% (1719/7836). Class I obesity (17.14%) and class II/III obesity (13.49%) individuals tended to be younger and male. Compared to patients with normal BMI (32.55%), those with low BMI (5.79%) had a 47% increased risk of 28-day mortality (HR 1.47, 95% CI 1.16-1.85, P = 0.0013), while class II/III obesity patients had a 17% lower 28-day mortality rate (HR 0.83, 95% CI 0.71-0.97, P = 0.0218). Curve fitting revealed a nonlinear relationship between BMI and 28-day mortality. The Kaplan-Meier survival analysis highlighted variations in survival rates across the five groups (P = 0.0123), with underweight patients exhibiting poorer survival outcomes. In sepsis patients, a low BMI is related to higher 28-day mortality compared to those with a normal BMI. Conversely, patients with a BMI≥35kg/m2 have significantly reduced mortality risks.

SCAI cardiogenic shock classification for predicting short-term mortality in acute myocardial infarction

Background: Cardiogenic shock (CS) remains a critical complication of acute myocardial infarction (AMI) with severe outcomes. The Society for Cardiovascular Angiography and Interventions (SCAI) classification is a valuable tool for assessing the severity and progression of CS. Objectives: Our study aimed to evaluate the association between initial SCAI classification and 30-day mortality in AMI patients and assess the prognostic value of SCAI changes within 24 hours post-admission. Methods: All patients with AMI were classified according to the SCAI stages at admission and re-evaluated after 24 hours. 30-day mortality rates were compared across SCAI stages, and Cox regression analysis was used to assess the risk of death based on 24-hour transition SCAI classification. Results: At admission, among 232 AMI patients, 50.8% were classified as SCAI A, 21.6% as SCAI B, 23.3% as SCAI C, and 4.3% as SCAI D/E. The 30-day mortality rates for each classification were 1.7% for SCAI A, 30.0% for SCAI B, 68.5% for SCAI C, and 90% for SCAI D/E. Within 24 hours of admission, 14.5% of patients experienced a worsening SCAI stage, 73.4% remained unchanged SCAI, and 12.1% showed improved SCAI. Patients with a worsening SCAI classification had a significantly higher risk of 30-day mortality, with an adjusted hazard ratio (HR) of 50.4 compared to those with stable SCAI status (p log-rank = 0.00001). Conversely, patients with stable or improved SCAI stages had notably lower mortality rates. Conclusion: The initial SCAI stage at admission and its changes within 24 hours are crucial predictors of 30-day mortality in AMI patients with CS.

Triglyceride levels are associated with 30-day mortality in intensive care patients: a retrospective analysis in the MIMIC-IV database

BackgroundPrevious studies suggest that septic patients often have elevated triglyceride levels due to various factors, and higher levels may indicate a poorer prognosis. However, few studies have investigated whether lower triglycerides are associated with a better prognosis.MethodsThe Medical Information Mart for Intensive Care IV (MIMIC-IV) database provided all the data. To assess the association between triglycerides and prognosis, we used logistic regression analysis (LR), least absolute shrinkage and selection operator (LASSO) and Cox proportional hazards models.ResultsInclusion criteria were met by a total of 804 patients with a mean triglyceride of 103 mg/dL. We found that patients had a higher risk of 30-day ICU mortality when triglycerides were in the second quartile (74–103 mg/dL). Interestingly, this group of patients seems to benefit more from the use of atorvastatin.ConclusionOur study showed that septic patients with triglyceride levels in the second quartile (74–103 mg/dL) have a higher 30-day ICU mortality rate compared to those with triglyceride levels in other quartiles.

Impact of inappropriate empirical antibiotic therapy on in-hospital mortality: a retrospective multicentre cohort study of patients with bloodstream infections in Chile, 2018–2022

IntroductionEmpirical antibiotic therapy is essential for treating bloodstream infections (BSI), yet there is limited evidence from resource-limited settings. We quantified the association of inappropriate empirical antibiotic therapy (IEAT) with in-hospital...

Association between early fluid balance and outcomes in patients receiving continuous renal replacement therapy for cardiac surgery-associated acute kidney injury

Objective: To evaluate the association between fluid balance within 48 hours after initiating continuous renal replacement therapy (CRRT) and 90-day mortality of patients with cardiac surgery-associated acute kidney injury (CSA-AKI). Methods: Adult patients who received CRRT for CSA-AKI for more than 24 hours between January 2016 and December 2021 in the First Affiliated Hospital of Nanjing Medical University were prospectively included. Exposures were fluid input, fluid output, fluid balance and percentage of fluid overload change (defined as weight-standardized fluid input/output difference) within 48 hours after CRRT initiation. The primary outcome was 90-day mortality. The relationship between the exposures and 90-day mortality was determined by restricted cubic spline and segmented Cox regression. Results: The study enrolled 262 patients, and 90-day mortality was 60.3% (158/262). There were 171 males and 91 females, with a median age of 64 (54, 71) years. The dead patients (n=158) had more fluid input [6.43 (5.62, 7.34) L vs 6.07 (5.09, 6.90) L, P=0.013], greater fluid balance [-0.01 (-1.36, 1.34) L vs -0.65 (-1.71, 0.42) L, P=0.005] and higher percentage of fluid overload change [-0.01% (-2.17%, 2.01%) vs -0.85% (-2.49%, 0.52%), P=0.013] within 48 hours after CRRT initiation than the survived patients (n=104). The cumulative fluid balance and fluid overload changes have a "J" curve relationship with 90-day mortality. Higher positive fluid balance (adjusted HR per 1 L increase above 0.5 L=1.33, 95%CI: 1.17-1.50) and greater proportion of fluid overload changes (adjusted HR per 1% increase above 0.7%=1.20, 90%CI: 1.11-1.30) were associated with an increased risk of death. Cumulative fluid input was linearly related to the 90-day mortality. Higher input (adjusted HR per 1 L increase=1.13, 95%CI: 1.03-1.24) was associated with an increased risk of death. The cumulative fluid output showed a U-shaped relationship with risk of death. Both lower output (adjusted HR per 1 L increase below 6.7 L=0.73, 95%CI: 0.58-0.90) and higher output (adjusted HR per 1 L increase above 6.7 L=1.24, 95%CI: 1.01-1.53) were associated with increased risk of death. Conclusion: In patients with CSA-AKI, excessive fluid input, insufficient or excessive output and a positive fluid balance or percentage of fluid overload change within the first 48 hours after CRRT initiation are associated with increased risk of 90-day mortality.

Cardiogenic shock mortality according to Aetiology in a Mediterranean cohort: Results from the Shock-CAT study.

Mortality in cardiogenic shock (CS) remains elevated, with the potential for CS causes to impact prognosis and risk stratification. The aim was to investigate in-hospital prognosis and mortality in CS patients according to aetiology. We also assessed the prognostic accuracy of CardShock and IABP-SHOCK II scores. Shock-CAT study was a multicentre, prospective, observational study conducted from December 2018 to November 2019 in eight university hospitals in Catalonia, including non-selected consecutive CS patients. Data on clinical presentation, management, including mechanical circulatory support (MCS) were analysed comparing acute myocardial infarction (AMI) related CS and non-AMI-CS. The accuracy of CardShock and IABP-SHOCK II scores to assess 90day mortality risk were also compared. A total of 382 CS patients were included, age 65.3 (SD 13.9) years, 75.1% men. Patients were classified as AMI-CS (n=232, 60.7%) and non-AMI-CS (n=150, 39.3%). In the AMI-CS group, 77.6% were STEMI. Main aetiologies for non-AMI-CS were heart failure (36.2%), arrhythmias (22.1%) and valve disease (8.0%). AMI-CS patients required more MCS than non-AMI-CS (43.1% vs. 16.7%, P<0.001). In-hospital mortality was higher in AMI-CS (37.1 vs. 26.7%, P=0.035), with a two-fold increased risk after multivariate adjustment (odds ratio 2.24, P=0.019). The IABP-SHOCK II had superior discrimination for predicting 90day mortality when compared with CardShock in AMI-CS patients [area under the curve (AUC) 0.74 vs. 0.66, P=0.047] although both scores performed similarly in non-AMI-CS (AUC 0.64 vs. 0.62, P=0.693). In our cohort, AMI-CS mortality was increased by two-fold when compared with non-AMI-CS. IABP-SHOCK II score provides better 90day mortality risk prediction than CardShock score in AMI-CS, but both scores performed similar in non-AMI-CS patients.

Prognostic effects of glycaemic variability on diastolic heart failure and type 2 diabetes mellitus: insights and 1-year mortality machine learning prediction model

BackgroundDiastolic heart failure (DHF) and type 2 diabetes mellitus (T2DM) often coexist, causing increased mortality rates. Glycaemic variability (GV) exacerbates cardiovascular complications, but its impact on outcomes in patients with DHF and T2DM remains unclear. This study examined the relationships between GV with mortality outcomes, and developed a machine learning (ML) model for long-term mortality in these patients.MethodsPatients with DHF and T2DM were included from the Medical Information Mart for Intensive Care IV, with admissions (2008–2019) as primary analysis cohort and admissions (2020–2022) as external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the associations of GV with 90-day, 1-year, and 3-year all-cause mortality. The primary analysis cohort was split into training and internal validation cohorts, then developing ML models for predicting 1-year all-cause mortality in training cohort, which were validated using the internal and external validation cohorts.Results2,128 patients with DHF and T2DM were included in primary analysis cohort (meidian age 71.0years [IQR: 62.0–79.0]; 46.9% male), 498 patients with DHF and T2DM were included in the external validation cohort (meidian age 75.0years [IQR: 67.0–81.0]; 54.0% male). Multivariate Cox proportional hazards models showed that high GV tertiles were associated with higher risk of 90-day (T2: HR 1.45, 95%CI 1.09–1.93; T3: HR 1.96, 95%CI 1.48–2.60), 1-year (T2: HR 1.25, 95%CI 1.02–1.53; T3: HR 1.54, 95%CI 1.26–1.89), and 3-year (T2: HR 1.31, 95%CI: 1.10–1.56; T3: HR 1.48, 95%CI 1.23–1.77) all-cause mortality, compared with lowest GV tertile. Chronic kidney disease, creatinine, potassium, haemoglobin, and white blood cell were identified as mediators of GV and 1-year all-cause mortality. Additionally, GV and other clinical features were pre-selected to construct ML models. The random forest model performed best, with AUC (0.770) and G-mean (0.591) in internal validation, with AUC (0.753) and G-mean (0.599) in external validation.ConclusionGV was determined as an independent risk factor for short-term and long-term all-cause mortality in patients with DHF and T2DM, with a potential intervention threshold around 25.0%. The ML model incorporating GV demonstrated strong predictive performance for 1-year all-cause mortality, highlighting its importance in early risk stratification management of these patients.

Tele-Critical Care, Severity of Illness, and 30-Day Mortality Risk: A Retrospective, Cohort Analysis.

Introduction: Studies have shown that tele-critical care (TCC) improves outcomes in intensive care unit (ICU) settings with low baseline performance. Evidence also suggests that TCC outcomes may be modified by heterogenous baseline severity of illness. We examined the association of admission Acute Physiology and Chronic Health Evaluation IV (APACHE IV) score quartiles (APQ1-APQ4) and TCC exposure with 30-day mortality. Methods: Retrospective, cohort study of 151,780 consecutive ICU patients admitted to nine hospitals within Cleveland Clinic Health System from 2010 to 2019. Data were abstracted from an institutional ICU Datamart and APACHE IV registry. Analyses included summary statistics for demographics, unadjusted survival functions, and incidence rates across ascending APACHE quartiles (APQ1-APQ4). Multivariate Poisson regression modeled covariates associated with incidence rate ratio (IRR) for mortality, across quartiles including statistical interaction between TCC exposure and APACHE quartiles. Results: Unadjusted mortality risk ratios of TCC/no TCC were statistically different across APQ1 (0.83; 95% confidence interval [CI] 0.71-0.97), APQ3 (0.63; 95% CI 0.57-0.69), and APQ4 (0.77; 95% CI 0.74-0.82) (all p < 0.05) but not in APQ2 (0.98; 95% CI 0.88-1.10; p = 0.77). Multivariate Poisson modeling found reduced IRR with TCC (IRR 0.82; 95% CI 0.70-0.97). Relative to APQ1, risk was increased across quartiles, APQ2 (IRR 2.15; 95% CI 1.83-2.52), APQ3 (IRR 3.93; 95% CI 3.39-4.56), and APQ4 (IRR 9.30; 95% CI 8.10-10.67). Interaction with TCC significantly reduced risk in APQ3 (IRR 0.80; 95% CI 0.67-0.96). Conclusion: TCC exposure is associated with reduced 30-day mortality, affected by various clinical factors, to provide heterogenous impact. Mortality benefit appears to particularly accrue among patients with higher, but not the highest quartile for severity of illness, based on their APACHE IV scores.