Short-term Case Fatality Rate Research Articles

Influence of Sepsis on the Middle-Term Outcomes for Urinary Tract Infections in Elderly People.

Urinary tract infection (UTI) is a common condition that predominantly affects elderly people, who are particularly susceptible to developing sepsis. Previous studies have indicated a detrimental effect of sepsis on short-term outcomes in elderly patients with UTI, but there is a lack of data about the middle-term prognosis. The aim of this study was to investigate the influence of sepsis on the middle-term prognosis of patients aged 65 years or older with complicated community-acquired UTIs. A prospective observational study of patients admitted to a hospital with UTI. We conducted a comparison of epidemiological and clinical variables between septic and nonseptic patients with UTI, as well as their 6-month case-fatality rate. A total of 412 cases were included, 47.8% of them with sepsis. Septic patients were older (83 vs. 80 years, p < 0.001), but did not have more comorbidities. The short-term case-fatality rate was higher in septic patients and this difference persisted at 6 months (34% vs. 18.6%, p = 0.003). Furthermore, age older than 75 years, Barthel index <40 and healthcare-associated UTI were also associated with the middle-term case-fatality rate. In conclusion, the detrimental impact of sepsis is maintained on the middle-term prognosis of elderly patients with UTI. Age, functional status and healthcare-associated UTIs also play significant roles in shaping patient outcomes.

Abomasitis in calves: A retrospective cohort study of 23 cases (2006‐2016)

BackgroundAbomasitis is a syndrome affecting young milk‐fed calves. The current veterinary literature describes mainly its necropsy findings.ObjectivesTo describe the clinical presentation, complementary tests, treatments, and case‐fatality rate of calves with a clinical diagnosis of abomasitis and to identify potential factors associated with outcome.MethodsObservational retrospective cohort study (2006‐2016). Review of the medical records of calves <3 months of age presented with abdominal and abomasal distension for <7 days that were clinically diagnosed with abomasitis at the Faculty of Veterinary Medicine of the Université de Montréal. A follow‐up examination was conducted by telephone interview.AnimalsTwenty‐three calves clinically diagnosed with abomasitis.ResultsMedian age of presentation was 3 days (range, 0‐62 days). The typical duration of the clinical course was <24 hours (15/23). On admission, the 2 most common clinical signs were anorexia (13/14) and positive succussion (13/14). Hyper‐l‐lactatemia (15/16) and increased γ‐glutamyl‐transferase activity (13/14) were the most common laboratory abnormalities. Hypoproteinemia (19/22) and a left shift (15/18) of the neutrophils also were observed. The short‐term case‐fatality rate was 52% (12/23). The clinical diagnosis was confirmed on all necropsied calves. Clostridium spp. and Escherichia coli were the most frequently isolated bacteria. Based on univariate statistical analysis, the surviving calves were significantly (P < .05) less hypothermic, less acidemic, less hyper‐l‐lactatemic, and had lower serum creatinine concentrations on admission than did the deceased calves.Conclusions and Clinical ImportanceIn our study, abomasitis was associated with a guarded prognosis.

Status epilepticus-related etiology, incidence and mortality: A meta-analysis

Status epilepticus (SE) is a severe medical condition. To determine its epidemiology and outcome of SE, we performed a meta-analysis to investigate the etiology, incidence and mortality of SE. We searched PubMed and Embase between Jan 1, 2000, and Oct 31, 2016, with no regional restrictions, for observational studies of the etiology, incidence and mortality of SE. Forty-three studies were included in the meta-analysis. The pooled crude annual incidence rate, the pooled case fatality rate and the pooled crude annual mortality rate of SE were 12.6/100,000 (95% CI: 10.0–15.3), 14.9% (95% CI: 11.7–118.7) and 0.98/100,000 (95% CI: 0.74–1.22), respectively. Elderly subjects with SE had a higher case fatality rate (28.4% (95% CI: 17.7–42.3)) and crude annual incidence rate (27.1% (95% CI: 15.8–38.2)). The most important etiology-specific attributable fraction of patients with SE was acute symptomatic etiology (OR 0.411, 95% CI: 0.315–0.507). Age and economic income contributed to differences in SE incidence and short-term case fatality rate.

Case fatality rate related to nosocomial and ventilator-associated pneumonia in an ICU: a single-centre retrospective cohort study.

Nosocomial pneumonia (NP) and ventilator associated pneumonia (VAP) have been associated with financially significant economic burden and increased case fatality rate in adult intensive care units (ICUs). This study was designed to evaluate case fatality rate among patients with NP and VAP in a respiratory ICU. In 2008-2013, VAP and NP in the ICUs were included in this retrospective single-centre cohort study. Data on demographics, co-morbidities, severity of illness, mechanical ventilation, empirical treatment, length of hospital stay and laboratory findings were recorded in each group, as were case fatality rate during ICU admission and after discharge including short-term (28-day) and long-term (a year) case fatality rate. A total of 108 patients with VAP (n = 64, median (IQR) age: 70 (61-75) years, 67.2% were men) or NP (n = 44, median (IQR) age: 68 (62-74) years, 68.2% were men) were found. Appropriate empirical antibiotic therapy was identified only in 45.2 and 42.9% of patients with VAP and NP, respectively. Overall case fatality rate in VAP and NP (81.3 vs 84.1), ICU case fatality rate (42.2 vs 45.5%), short-term case fatality rate (15.6 vs 27.3%) and long-term case fatality rate (23.4 vs 11.4%) were similar between VAP and NP groups along with occurrence 50% of case fatality rate cases in the first 2 months and 90% within the first year of discharge. Multivariate analysis showed that chronic obstructive pulmonary disease (COPD) (HR: 3.15, 95% CI: 1.06-9.38; p = 0.039) and presence of septic shock (HR: 3.83, 95% CI: 1.26-11.60; p = 0.018) were independently associated with lower survival. In conclusion, our findings in a retrospective cohort of respiratory ICU patients with VAP or NP revealed high ICU, short- and long-term case fatality rates within 1 year of diagnosis, regardless of the diagnosis of NP after 48 h of initial admission or after induction of ventilator support. COPD and presence of septic shock are associated with high fatality rate and our findings speculate that as increasing compliance with infection control programs and close monitoring especially in 2 months of discharge might reduce high-case fatality rate in patients with VAP and NP.

Use of snus and acute myocardial infarction: pooled analysis of eight prospective observational studies

The use of snus (also referred to as Scandinavian or Swedish moist smokeless tobacco), which is common in Sweden and increasing elsewhere, is receiving increasing attention since considered a tobacco smoke "potential reduction exposure product". Snus delivers a high dose of nicotine with possible hemodynamic effects, but its impact on cardiovascular morbidity and mortality is uncertain. The aim of this study was to investigate whether snus use is associated with risk of and survival after acute myocardial infarction (AMI). Data from eight prospective cohort studies set in Sweden was pooled and reanalysed. The relative risk of first time AMI and 28-day case-fatality was calculated for 130,361 men who never smoked. During 2,262,333 person-years of follow-up, 3,390 incident events of AMI were identified. Current snus use was not associated with risk of AMI (pooled multivariable hazard ratio 1.04, 95% confidence interval 0.93 to 1.17). The short-term case fatality rate appeared increased in snus users (odds ratio 1.28, 95% confidence interval 0.99 to 1.68). This study does not support any association between use of snus and development of AMI. Hence, toxic components other than nicotine appear implicated in the pathophysiology of smoking related ischemic heart disease. Case fatality after AMI is seemingly increased among snus users, but this relationship may be due to confounding by socioeconomic or life style factors.

Abstract P275: Incidence and Case-Fatality Rates of Acute Myocardial Infarction in the United States: A Systematic Review

Introduction: Beginning in the late 1960s, the death rates attributed to coronary heart disease (CHD) in the U.S. declined, including deaths due to acute myocardial infarction (AMI). The decline in AMI related mortality is likely related to both a decrease in the incidence rates of new events in addition to declines in case-fatality rates (CFRs). The purpose of this summary over view is to describe long-term trends in the incidence and short-term CFRs after AMI in the US based on data from population-based community surveillance studies and, secondarily, to examine possible demographic differences in any observed trends. Methods: Systematic review of published studies providing data on incidence and/or CFRs after AMI in the U.S. published in English between 1980 and 2009. Results: Twenty one out of 436 retrieved articles met our eligibility criteria. Our findings are based on the results of 9 community surveillance studies covering different geographic locations and time periods. Eight studies where done in predominantly White populations. Incidence rates: Studies that had no upper age limits failed to show significant declines in overall incidence rates of AMI over the periods under study. Studies that had an upper age limit reported declines (Minnesota Heart Survey (MHS) 25% decline) or no changes (Atherosclerosis Risk in the Community (ARIC)) in the incidence rates of AMI. Declines were primarily observed in younger White men. Case-fatality rates: All studies reported declining short-term (hospital) CFRs (50% decline since the late 1960s). Declines were greatest among younger individuals. Unadjusted CFRs were 1.5 fold higher in women and non-Whites compared to men and Whites, respectively. Conclusion: Our review demonstrated encouraging declines in short-term CFRs after AMI while incidence rates did not show similar trends. Aging of the population and changes in AMI definitions might have played a role in the observed trends in AMI incidence rates. Advances in pre-hospital care, management, and critical cardiac care likely contributed to the declines in CFRs observed.

Short-Term Case Fatality Rate and Associated Factors among Inpatients with Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State: A Hospital-Based Analysis over a 15-Year Period

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are usually life threatening, but the recent trend of 28-day case-fatality and associated risk factors including Charlson index have not been known. Our aim was to evaluate the 28-day case-fatality rate among hospitalized DKA and HHS patients in a teaching hospital in Taiwan from 1991 to 2005. DKA and HHS admissions, identified from in-patient electronic database, were linked to Taiwan's national death registry. Kaplan-Meier analysis was used to determine the 28-day case-fatality rates of DKA and HHS, and to compare the trend of case-fatality over three consecutive 5-year periods (i.e, 1991-1995, 1996-2000, 2001-2005). We also used the Cox proportional hazard regression model to explore the determinants of 28-day case-fatality of the study patients. The 28-day case-fatality rates for DKA and HHS were 6.10% and 18.83%, and the lowest ones were observed in 2001-2005 (2.65% and 11.63% in DKA and HHS, respectively). Pneumonia was a significant predictor for increased 28-day case-fatality in both illnesses. Additionally, older age and stroke were significantly associated with increased case-fatality in DKA patients while myocardial infarction and higher Charlson index were significant predictors for higher case-fatality in HHS patients. Improvements in case-fatality in recent years for both DKA and HHS were found in the study hospital. Further reduction of the case-fatality rate among DKA and HHS patients can be achieved by optimal management of certain co-morbidities.

Exploratory study of plasma total homocysteine and its relationship to short-term outcome in acute ischaemic stroke in Nigerians

BackgroundHyperhomocysteinemia is a potentially modifiable risk factor for stroke, and may have a negative impact on the course of ischaemic stroke. The role of hyperhomocysteinemia as it relates to stroke in Africans is still uncertain. The objective of this study was to determine the prevalence and short-term impact of hyperhomocysteinemia in Nigerians with acute ischaemic stroke. We hypothesized that Hcy levels are significantly higher than in normal controls, worsen stroke severity, and increase short-term case fatality rates following acute ischaemic stroke.MethodsThe study employed both a case-control and prospective follow-up design to study hospitalized adults with first – ever acute ischaemic stroke presenting within 48 hours of onset. Clinical histories, neurological evaluation (including National Institutes of Health Stroke Scale (NIHSS) scores on admission) were documented. Total plasma Hcy was determined on fasting samples drawn from controls and stroke cases (within 24 hours of hospitalization). Outcome at 4 weeks was assessed in stroke patients using the Glasgow Outcome Scale (GOS).ResultsWe evaluated 155 persons (69 acute ischaemic stroke and 86 healthy controls). The mean age ± SD of the cases was 58.8 ± 9.8 years, comparable to that of controls which was 58.3 ± 9.9 years (T = 0.32; P = 0.75). The mean duration of stroke (SD) prior to hospitalization was 43.5 ± 38.8 hours, and mean admission NIHSS score was 10.1 ± 7.7. Total fasting Hcy in stroke patients was 10.2 ± 4.6 umol/L and did not differ significantly from controls (10.1 ± 3.6 umol/L; P = 0.88). Hyperhomocysteinemia, defined by plasma Hcy levels > 90th percentile of controls (>14.2 umol/L in women and >14.6 umol/L in men), was present in 7 (10.1%) stroke cases and 11 (12.8%) controls (odds ratio 0.86, 95% confidence interval 0.31 – 2.39; P > 0.05). In multiple regression analysis admission NIHSS score (but not plasma Hcy) was a significant determinant of 4 week outcome measured by GOS score (P < 0.0001).ConclusionThis exploratory study found that homocysteine levels are not significantly elevated in Nigerians with acute ischaemic stroke, and admission Hcy level is not a determinant of short-term (4 week) stroke outcome.

Incident coronary events and case fatality in relation to common carotid intima‐media thickness

To evaluate the incidence of coronary events (CE) and case fatality in relation to common carotid intima-media thickness (IMT) and carotid plaque over a median follow up of 7 years. A total of 5163 Swedish middle-aged men and women with no prior myocardial infarction and/or stroke. The associations amongst B-mode ultrasound determined common carotid IMT, carotid plaque (focal IMT > 1.2 mm) and carotid stenosis (lumen reduction of >15%) and incident CE, were investigated in relation to cardiovascular risk factor levels. Age- and sex-adjusted common carotid IMT, carotid plaque and carotid stenosis were significantly (P < 0.05) related to future CE. Adjustment for established risk factors generally reduced the hazard rate ratios. However, the continuous measure of common carotid IMT, carotid plaque and carotid stenosis were significantly related to incident CE, even after risk factor adjustment. The strength of the associations between common carotid IMT and CE was only to a small extent reduced after adjustment for presence of carotid plaque. There were no statistically significant associations between common carotid IMT, carotid plaque or carotid stenosis and short-term case-fatality rates (28-days mortality) or long-term case-fatality rates (5-years mortality). The results show an association between common carotid IMT and incident CE, independently of cardiovascular risk factors and carotid plaque. However, there was no association with short-term or long-term mortality after a CE.

Using north carolina medicare data to assess excess prostate cancer mortality among african americans

PURPOSE: To investigate the basis for the higher prostate cancer mortality rate for African American (AA) men, which is twice the rate for White men.METHODS: 221 AA and 979 White men with a primary diagnosis code of prostate cancer (“patients”) in the North Carolina Medicare Hospitalization claims from 1997 were compared with 1,326 AA and 5,874 White men of the same age with no cancer hospitalizations (“beneficiaries”) selected from the NC Medicare Enrollment files. Mortality rates were calculated as the cumulative percent of deaths using the hospital discharge date as day 1. AA and White age distributions were similar.RESULTS: Cumulative mortality percentages at 6, 12, and 18 months were, respectively, 4.5, 7.7, 10.9 for AA patients; 2.8, 6.5, 9.2 for White patients; 2.3, 3.8, 7.4 for AA beneficiaries; and 1.8, 3.1, 6.1 for White beneficiaries.CONCLUSIONS: AA prostate cancer patients had higher overall mortality than did White prostate cancer patients during the first year, but by 12-months the White-Black survival advantage for prostate cancer patients was similar in magnitude to the White-Black survival advantage among the non-cancer Medicare beneficiaries. AAs' higher prostate cancer mortality may derive from higher short-term case fatality rates, which may reflect differences in treatment and access to quality medical care, co-morbidities, and tumor characteristics such as stage and grade at diagnosis, and in part from the survival disadvantage for AA in the general population.

Primary intracerebral haemorrhage in the Jyväskylä region, central Finland, 1985-89: incidence, case fatality rate, and functional outcome.

The age and sex specific incidence rates, the case fatality rates, and the functional outcome of patients with primary intracerebral haemorrhage occurring in a population of 116,000 during a period of four years four months are presented. A total of 158 patients were identified, the diagnosis was confirmed in 78% by CT, and in 22% by necropsy. The crude annual incidence rate was 31/100,000 population, the age specific rates increased from two to 222/100,000 from the age of 30-39 to over 80 years. Men had higher incidence rates between the ages of 40 and 79 years. The short term case fatality rate was high, 27% of patients dying during the first day after onset of symptoms, and 50% were dead at 30 days. After the first month the probability of survival did not differ from an age- and sex-matched average population. Large haematoma volume had an adverse effect on the short term, old age (greater than 70 years) on the long term survival. Ventricular extension, especially when combined with hydrocephalus was a bad omen for short term survival. Infratentorial and large basal ganglionic haematomas, and primary intraventricular haemorrhage carried a worse prognosis than haematomas of other locations. At the end of a median 32 month follow up 55 (35%) of the patients were alive, 51% of these were independent in activities of daily living, 45% were dependent on outside help, and 4% needed constant nursing care. Old age (greater than 70 years), but not the haematoma volume or location, was associated with a poor functional recovery.