Short-and Long-term Prognosis Research Articles

Baseline NT-proBNP levels as a predictor of short-and long-term prognosis in COVID-19 patients: a prospective observational study

BackgroundUp to 20% of COVID-19 patients can suffer COVID-19-related myocardial injury. Elevated cardiac biomarkers, such as hs-cTnT and NT-proBNP, have been related to worse short-term prognosis. However, data on NT-proBNP and long-term prognosis are scarce. We have evaluated the potential association of baseline age-adjusted NT-proBNP levels and outcomes at one-year follow-up in COVID-19 patients.MethodsThis was a single-center prospective study of 499 COVID-19 patients in whom NT-proBNP was assessed at hospital admission. NT-proBNP levels were age-adjusted and patients were classified as high or low NT-proBNP. Clinical and demographic characteristics, comorbidities, laboratory results, and in-hospital complications and mortality were compared between the two groups. Survivors of the acute phase of COVID-19 were followed up for one year from admission to detect readmissions and mortality.ResultsThe 68 patients with high NT-proBNP levels at hospital admission were older, with more cardiovascular risk factors, cardiovascular disease, comorbidities, myocardial injury, and higher levels of inflammatory markers than patients with low NT-proBNP levels. They also had more in-hospital complications and a higher acute-phase mortality rate (60.3% vs. 10.2%, p < 0.001). High NT-proBNP levels were an independent marker of death during hospitalization (HR 1.95; CI 1.07–3.52). At one-year follow-up, high NT-proBNP levels were independently associated with mortality (HR 2.69; CI 1.47–4.89). Among survivors of the acute phase of COVID-19, there were no differences in hospital readmissions between those with high vs. low NT-proBNP levels, but survivors with high baseline NT-proBNP levels showed a higher 1-year mortality rate (7.4% vs. 1.3%, p = 0.018).ConclusionsHigh age-adjusted NT-proBNP levels at the time of hospital admission for COVID-19 are associated with poor short and long-term prognosis. High NT-proBNP seems also to be related to worse prognosis in survivors of the acute phase of COVID-19. A closer follow-up on these patients may be crucial.

Clinical outcomes of patients with rheumatoid arthritis who underwent percutaneous coronary intervention: A Korean nationwide cohort study.

Rheumatoid arthritis (RA) increases the risk of cardiovascular disease. This study aimed to investigate the short-and long-term prognosis of patients with and without RA who underwent percutaneous coronary intervention (PCI). The Korean National Health Insurance Service claims database was used to extract data on 236,134 patients (34,493 with RA and 201,641 without RA) who underwent PCI between 2008 and 2019. The primary outcome was major adverse cardiovascular events (MACE), including all-cause mortality, myocardial infarction, stroke, transient ischemic attack, or coronary revascularization with short-term (30-day) and long-term outcomes. The secondary outcomes were the individual components of MACE. During a 10-year follow-up, patients with RA showed a shorter median survival time from MACE than their counterparts (with RA: 4.29 years vs. without RA: 6.10 years). RA was significantly associated with an increased risk of MACEs in long-term outcomes (hazard ratio (HR) 1.07, 95% confidence intervals (CI) 1.06-1.09, p<0.001), but not with short-term outcomes (HR 1.02, 95% CI 0.99-1.06, p = 0.222). RA was an independent predictor of an increased risk of all the MACE components. In patients who underwent PCI, RA did not increase the risk of short-term cardiovascular outcomes but increased the risk of long-term adverse outcomes.

Association between epidural-related maternal fever and short-and long-term prognosis of parturients: A prospective observational study.

We aimed to explore the association between epidural-related maternal fever (ERMF) and prognosis of parturients. 159 parturients who underwent vaginal delivery under labor epidural analgesia (LEA) received noninvasive continuous core body temperature monitoring. 122 of them completed the 42-day postpartum follow-up. Parturients with body temperature ≥38°C during labor were categorized as the Fever group, while the others were categorized as the No-Fever group. Compared to No-Fever group, Fever group had a greater proportion of primiparas, greater gestational age of parturients, and longer third stage of labor. The cesarean section and forceps delivery rates, and the amount of intrapartum hemorrhage in Fever group were significantly higher. There were no significant between-group differences with respect to puerperal infection, and amniotic fluid turbidity degree, neither significant between-group difference at 42-days postpartum. We found that ERMF was associated with some short-term outcomes. However, it showed no relation with long-term prognosis of the parturients at 42-days postpartum.

Biomarkers and Mortality in ST-Segment Elevation Myocardial Infarction

Biomarkers have been increasingly used in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) for diagnosis, stratification, and short-and long-term prognosis. However, they play a less decisive role in ST-segment elevation myocardial infarction (STEMI) where ST-segment elevation in ECG remains the most important tool for diagnosis and treatment decision. Troponin has been the most widely used biomarker to evaluate the prognosis in STEMI, but other biomarkers may also be used to assess the potential causes and complications of myocardial infarction (MI). High [...]

Urinary biomarkers may provide prognostic information for subclinical acute kidney injury after cardiac surgery

ObjectiveThis study aimed to determine the biomarker-specific outcome patterns and short-and long-term prognosis of cardiac surgery–asoociated acute kidney injury (AKI) identified by standard criteria and/or urinary kidney biomarkers. MethodsPatients enrolled (N = 200), originated a German multicenter study (NCT00672334). Standard risk injury, failure, loss, and end-stage renal disease classification (RIFLE) criteria (including serum creatinine and urine output) and urinary kidney biomarker test result (neutrophil gelatinase-associated lipocalin, midkine, interleukin 6, and proteinuria) were used for diagnosis of postoperative AKI. Primary end point was acute renal replacement therapy or in-hospital mortality. Long-term end points among others included 5-year mortality. Patients with single-biomarker-positive subclinical AKI (RIFLE negative) were identified. We controlled for systemic inflammation using C-reactive protein test. ResultsUrinary biomarkers (neutrophil gelatinase-associated lipocalin, midkine, and interleukin 6) were identified as independent predictors of the primary end point. Neutrophil gelatinase-associated lipocalin, midkine, or interleukin 6 positivity or de novo/worsening proteinuria identified 21.1%, 16.9%, 30.5%, and 48.0% more cases, respectively, with likely subclinical AKI (biomarker positive/RIFLE negative) additionally to cases with RIFLE positivity alone. Patients with likely subclinical AKI (neutrophil gelatinase-associated lipocalin or interleukin 6 positive) had increased risk of primary end point (adjusted hazard ratio, 7.18; 95% confidence interval, 1.52-33.93 [P = .013] and hazard ratio, 6.27; 95% confidence interval, 1.12-35.21 [P = .037]), respectively. Compared with biomarker-negative/RIFLE-positive patients, neutrophil gelatinase-associated lipocalin positive/RIFLE-positive or midkine-positive/RIFLE-positive patients had increased risk of primary end point (odds ratio, 9.6; 95% confidence interval, 1.4-67.3 [P = .033] and odds ratio, 14.7; 95% confidence interval, 2.0-109.2 [P = .011], respectively). Three percent to 11% of patients appear to be influenced by single-biomarker-positive subclinical AKI. During follow-up, kidney biomarker-defined short-term outcomes appeared to translate into long-term outcomes. ConclusionsUrinary kidney biomarkers identified RIFLE-negative patients with high-risk subclinical AKI as well as a higher risk subgroup of patients among RIFLE-AKI-positive patients. These findings support the concept that urinary biomarkers define subclinical AKI and higher risk subpopulations with worse long-term prognosis among standard patients with AKI.

HYPOLIPIDEMIC THERAPY IN PATIENTS AFTER HEART TRANSPLANTATION: STATINS

Statins should be used as a part of standard therapy in patients after heart transplantation. The effectiveness of statins is associated not only with their hypolipidemic action, but also with their immunomodulatory and antineoplastic properties. Statin therapy initiated early after heart transplantation improves the shortand long-term prognosis and outcomes, leading to a reduction in the incidence of cardiac allograft vasculopathy, acute rejection, and cancer.

Takotsubo cardiomyopathy triggered by influenza A and complicated with cardiac arrest, a case report

Takotsubo cardiomyopathy is an increasingly recognized cardiac syndrome, characterized by a transient hypokinesis involving left ventricular apical or midventricular segments, and mimicking acute coronary syndrome, in the absence of significant coronary artery stenosis.1,2 The pathophysiology of Takotsubo cardiomyopathy is still unclear, although several mechanisms have been proposed1; moreover, Takotsubo has been related to pulmonary infection3 and influenza virus vaccination.4 Patients with Takotsubo cardiomyopathy have a favorable shortand long-term prognosis compared with those with acute myocardial infarction, secondary to the complete recovery of cardiac function. Nevertheless, cardiac arrest is a rare, but extremely lethal, complication.5

A Clinical Commentary on the Article “Biomaterials Advances in Patches for Congenital Heart Defect Repair”

Congenital heart disease remains the most common birth defect affecting almost 1% of the population and if one considers congenitally bicuspid aortic valves, the number of affected individuals rises to as much as 4% by many estimates. The spectrum of congenital heart disease is broad. Patients may have very complex structural anomalies including an absence of a ventricle (single ventricle), lack of connection to a great artery (aortic or pulmonary atresia), anomalies of venous connections (systemic or pulmonary venous), valvar abnormalities (semilunar and/or atrioventricular), abnormal connections (transposition or malalignment), and vascular hypoplasia (aortic coarctation, hypoplasia, or interruption). Individuals affected by variations of these problems may present with acute circulatory compromise immediately at birth, later in infancy or on more rare occasions, later in life. The physiology at presentation relates to the structural morphology and may include cyanosis, low cardiac output (shock), arterial or venous obstruction, excessive pulmonary blood flow, and congestive heart failure. It has long been recognized that infants presenting with symptomatic congenital heart disease have an overall very poor prognosis if left untreated. On the less structurally complex end of the spectrum, patients may present with defects between cardiac chambers in isolation or in combination with other problems. Defects of the atrial or ventricular septa are most commonly observed. Again, there is very broad range of symptomatology and physiology relating to the type, size, location, and number of septal defects. For larger defects, with significant intracardiac shunting of blood, the patient’s shortand long-term prognosis may be significantly affected if the lesion is left untreated. Surgical, and more recently, catheter-based treatments for serious congenital cardiac defects represent a true success story of modern medicine. The earliest palliative surgeries, performed in the 1930s (ligation of patent ductus arteriosus and coarctation repair) and 1940s (creation of a systemicto-pulmonary artery shunt) ushered in the era of physiologic treatment for congenital heart disease. In subsequent decades, enormous progress was made in addressing more and more complex conditions including aggressive reconstructions. In the 1950s, cardiopulmonary bypass to support the systemic circulation offered the prospect of intracardiac correction (tetralogy of Fallot, atrioventricular canal, and atrial/ventricular septal defects). In the 1960s and 1970s, durable palliations were developed for single ventricle (Glenn and Fontan procedures). The 1980s saw increasingly aggressive operations for serious defects in newborns and small babies (transposition of the great arteries, truncus arteriosus, aortic interruption, and ultimately, very complex lesions including hypoplastic left heart syndrome). In the 1990s and the first decade of the new millennium, treatments have been further refined to improve operative survival, reduce morbidity, and consider long-term outlook including neurodevelopmental opportunities. Recent striking advances have included successful surgical correction of complex lesions in very small, preterm neonates, the development and implementation of catheter-based treatments for many conditions, and in utero interventions for fetuses with critical cardiac conditions. This article is a commentary on the following article: 10.1007/s12265011-9289-8.

Macrolide combination antibiotic therapy should be prudently considered in complicated CAP cases and in regions with low macrolide susceptibility

Dear Editor, In response to the article by MartinLoeches et al. [1] regarding improved survival in intubated patients with community-acquired pneumonia treated with combination antibiotic therapy with macrolides, we would like to address several points regarding macrolide resistance and study population. In the recent decade, susceptibility of pneumococcus to macrolides in Asia has been very low. Erythromycin susceptibility is \20% in Taiwan and Korea, and about 25% in Hong Kong and China [2]. Macrolideresistant strains (ermB and mefA) are widely circulating in Asia. Low susceptibility of pneumococci to macrolides is difficult to deny. According to a study in Taiwan, macrolide susceptibility of pneumococci remains low, even though macrolide usage has been decreasing for many years. The rate of erythromycin resistance in streptococcal pneumonia showed an increasing trend, from 80.2% in 1999 to 92% in 2003 [3, 4]. The 2007 ATS/IDSA guidelines for community-acquired pneumonia (CAP) were based on epidemiology studies in the USA. In the USA and Europe, appropriate therapies, in which a macrolide would be combined with a beta-lactam, showed that macrolides may be effective in treating bacteremic pneumococcal pneumonia, CAP, severe sepsis, and septic shock due to CAP [1, 5]. However, synergic effects of macrolides and beta-lactams in treating invasive pneumococcal pneumonia in Asia may not be as good as in the USA and Europe. Macrolides may be used only to empirically cover atypical pathogens such as Legionella or Mycoplasma. Moreover, in this article, MartinLoeches et al. did not indicate such detailed characteristics as underlying diseases, pathogens, disease severity, or number of days of intensive care unit (ICU) stay for the empirical antimicrobial therapy group that was treated with a macrolide or for the empirical antimicrobial therapy group treated with fluoroquinolones. The authors only indicated ICU mortality and that overall mortality in the macrolide group was lower than in the fluoroquinolones group. Furthermore, according to the 2007 ATS/IDSA guidelines for CAP, subjects who were suggested to be treated by a fluoroquinolone and a beta-lactam combination were those with possible Pseudomonas infection. In this study, compared with the macrolide and betalactam combination group, cases receiving fluoroquinolone and betalactam combination had lower proportions receiving third-generation cephalosporins and higher proportions receiving fourth-generation cephalosporins, carbapenem, and piperacillin/ tazobactam. Therefore, cases receiving fluoroquinolone and beta-lactam combinations may have more complicated conditions than those receiving macrolide and beta-lactam combinations. Since cases receiving a fluoroquinolone tended to have more complicated predisposing factors, we could not expect that they would have better shortand long-term prognosis. Accordingly, prudent antibiotic use remains essential in complicated cases with severe CAP in regions with low macrolide susceptibility.

Effects of blood transfusion on short-and long-term prognosis of patients following hepatectomy for large hepatocellular carcinoma

目的 研究输血对大肝癌切除术后近期并发症和远期存活率的影响.方法 回顾性分析177例大肝癌切除术病例,结合随访分析输血对近期并发症和远期存活率的影响.结果 本组大肝癌围手术期输血率为74.6%.近5年输血量及输血率较5年前显著减少(P＜0.01).不输血组并发症率低于输血组(P＜0.05).单因素分析显示,年龄、肝门阻断、术中出血量、输血量以及手术时间与术后并发症发生有关.多因素分析显示,年龄、肝门阻断、输血量以及手术时间是决定术后并发症的4个独立的预测指标.本组大肝癌1、3、5年总存活率为67%、44%和34%,1、3、5年无瘤存活率为51%、31%和31%.不输血组和输血组的总存活率以及无瘤存活率无显著差别.结论 输血是决定大肝癌切除术后并发症发生的独立危险因素之一,但输血对大肝癌切除术后存活率无显著影响.肝脏外科医生应积极采取各种方法尽可能避免大肝癌切除术围手术期的输血。

Short-and long-term prognosis of elderly patients with first acute inferior myocardial infarctions

Short-and long-term prognosis of elderly patients with first acute inferior myocardial infarctions

Short-and long-term prognosis, functional outcome following ICU for elderly

Among 1532 ICU patients we analysed 295 elderly patients (19%) aged more than 70-years-old. We determined prospectively the immediate and subsequent one-year outcome with a study of the predictive value of their ICU admission parameters. Then we followed the ICU survivors over the year after discharge (1, 6, 12 months) by quality of life questionnaires. ICU mortality was 26.7%; SAPS was the only predictor of short term mortality. On ICU discharge, 216 elderly were followed at 1, 6, 12 months; the one-year cumulative mortality was 49% from ICU discharge, majority of deaths occurring over the first month. Age, previous health status and SAPS had a predictor value of one-year mortality for ICU survivors. 103 patients were alive at one year: 88% returned to home, 72% had a relatively good functional status allowing an independent life, and 82% had the same or improved functional status.