Short-term Mortality In Patients Research Articles

Sarcopenia is an independent risk factor for short-term mortality in patients undergoing transjugular intrahepatic portosystemic shunt.

Sarcopenia is common in patients with cirrhosis and is a risk factor for increased mortality. Transjugular intrahepatic portosystemic shunt (TIPS) placement has been utilized in cirrhosis patients with decompensation. We investigated the role of sarcopenia in predicting mortality in patients undergoing TIPS. We conducted a single-center retrospective study of 232 patients with cirrhosis who underwent TIPS between January 2010 and December 2015. Sarcopenia was defined by the psoas muscle index (PMI) cutoff value, calculated based on dynamic time-dependent outcomes using X-tile software. Kaplan-Meier analysis demonstrated the difference in survival in the sarcopenia group versus the non-sarcopenia group. . Univariate and multivariate analyses were used to identify the relationship between sarcopenia and post-TIPS mortality during a follow-up period of 1 year. For TIPS indications, 111 (47.84%) patients had refractory ascites, 69 (29.74%) patients had variceal bleeding, 12 (5.17%) patients had ascites, and 40 (17.24%) for other indications. The mean PMI was 4.40 ± 1.55. Sarcopenia was defined as a PMI value of <4.36 in males, and <3.23 in females. Sarcopenia was present in 96 (41.38%) of patients. . Kaplan-Meier analysis showed thatsarcopenia is associated with worse survival (log-rank P < 0.01). Multivariate Cox regression analysis showed that sarcopenia is independently associated with worse survival during the 1-year follow-up period with an hazard ratio of 2.435 (95% CI 1.346-4.403) (P < 0.01), after adjusting for age, BMI, indications for TIPS, etiology for cirrhosis, and MELD score and stratified by sex. Sarcopenia is an independent risk factor for 1-year mortality in patients undergoing TIPS and should be considered when patients are evaluated as a candidate for TIPS.

Effects of Energy Delivery Guided by Indirect Calorimetry in Critically Ill Patients: A Systematic Review and Meta-Analysis

Background: The utility of using indirect calorimetry (IC) to estimate energy needs and methods for its application to this purpose remain unclear. This systematic review investigated whether using IC to estimate energy expenditure in critically ill patients is more meaningful for improving survival than other estimation methods. Methods: Comprehensive searches were conducted in MEDLINE using PubMed, Cochrane Central Register of Controlled Trials, and Igaku-Chuo-Zasshi up to March 2023. Results: Nine RCTs involving 1178 patients were included in the meta-analysis. The evidence obtained suggested that energy delivery by IC improved short-term mortality (risk ratio, 0.86; 95% confidence interval [CI], 0.70 to 1.06). However, the use of IC did not appear to affect the length of ICU stay (mean difference [MD], 0.86; 95% CI, −0.98 to 2.70) or the duration of mechanical ventilation (MD, 0.66; 95% CI, −0.39 to 1.72). Post hoc analyses using short-term mortality as the outcome found no significant difference by target calories in resting energy expenditure, whereas more frequent IC estimates were associated with lower short-term mortality and were more effective in mechanically ventilated patients. Conclusions: This updated meta-analysis revealed that the use of IC may improve short-term mortality in patients with critical illness and did not increase adverse events.

Machine Learning for Short-Term Mortality in Acute Decompensation of Liver Cirrhosis: Better than MELD Score.

Prediction of short-term mortality in patients with acute decompensation of liver cirrhosis could be improved. We aimed to develop and validate two machine learning (ML) models for predicting 28-day and 90-day mortality in patients hospitalized with acute decompensated liver cirrhosis. We trained two artificial neural network (ANN)-based ML models using a training sample of 165 out of 290 (56.9%) patients, and then tested their predictive performance against Model of End-stage Liver Disease-Sodium (MELD-Na) and MELD 3.0 scores using a different validation sample of 125 out of 290 (43.1%) patients. The area under the ROC curve (AUC) for predicting 28-day mortality for the ML model was 0.811 (95%CI: 0.714- 0.907; p < 0.001), while the AUC for the MELD-Na score was 0.577 (95%CI: 0.435-0.720; p = 0.226) and for MELD 3.0 was 0.600 (95%CI: 0.462-0.739; p = 0.117). The area under the ROC curve (AUC) for predicting 90-day mortality for the ML model was 0.839 (95%CI: 0.776- 0.884; p < 0.001), while the AUC for the MELD-Na score was 0.682 (95%CI: 0.575-0.790; p = 0.002) and for MELD 3.0 was 0.703 (95%CI: 0.590-0.816; p < 0.001). Our study demonstrates that ML-based models for predicting short-term mortality in patients with acute decompensation of liver cirrhosis perform significantly better than MELD-Na and MELD 3.0 scores in a validation cohort.

Impact of severe acute kidney injury on short-term mortality in urosepsis.

To evaluate the impact of severe acute kidney injury (AKI) on short-term mortality in patients with urosepsis. This prospective cohort study evaluated 207 patients with urosepsis. AKI was diagnosed in accordance with the Kidney Disease Improving Global Outcomes criteria, and severe AKI was defined as stage 2 or 3 AKI. Patients were divided into two groups: patients who developed severe AKI (severe AKI group) and patients who did not (control group). The primary endpoint was all-cause mortality within 30days. The secondary endpoints were 90-day mortality and in-hospital mortality. The exploratory outcomes were the risk factors for severe AKI development. The median patient age was 79years. Of the 207 patients, 56 (27%) developed severe AKI. The 30-day mortality rate in the severe AKI group was significantly higher than that in the control group (20% vs. 2.0%, respectively; P < 0.001). In the multivariable analysis, performance status and severe AKI were significantly associated with 30-day mortality. The in-hospital mortality and 90-day mortality rates in the severe AKI group were significantly higher than those in the control group (P < 0.001 and P < 0.001, respectively). In the multivariable analysis, age, urolithiasis-related sepsis, lactate values, and disseminated intravascular coagulation were significantly associated with severe AKI development. Severe AKI was a common complication in patients with urosepsis and contributed to high short-term mortality rates.

The Role of Pretreatment Serum Interleukin 6 in Predicting Short-Term Mortality in Patients with Advanced Pancreatic Cancer.

Pancreatic ductal adenocarcinoma (PDAC) is notorious for its aggressive progression and dismal survival rates, with this study highlighting elevated interleukin 6 (IL-6) levels in patients as a key marker of increased disease severity and a potential prognostic indicator. Analyzing pre-treatment serum from 77 advanced PDAC patients via ELISA, the research determined optimal cutoff values for IL-6 and the IL-6:sIL-6Rα ratio using receiver operating characteristic curve analysis, which then facilitated the division of patients into low and high IL-6 groups, showing significantly different survival outcomes. Notably, high IL-6 levels correlated with adverse features such as poorly differentiated histology, higher tumor burden, and low albumin levels, indicating a stronger likelihood of poorer prognosis. With a median follow-up of 9.28 months, patients with lower IL-6 levels experienced markedly better median overall survival and progression-free survival than those with higher levels, underscoring IL-6's role in predicting disease prognosis. Multivariate analysis further confirmed IL-6 levels, alongside older age, and elevated neutrophil-to-lymphocyte ratio, as predictors of worse outcomes, suggesting that IL-6 could be a critical biomarker for tailoring treatment strategies in advanced PDAC, warranting further investigation into its role in systemic inflammation and the tumor microenvironment.

The effects of antioxidant supplementation on short-term mortality in sepsis patients

BackgroundThe occurrence and development of sepsis are related to the excessive production of oxygen free radicals and the weakened natural clearance mechanism. Further dependable evidence is required to clarify the effectiveness of antioxidant therapy, especially its impact on short-term mortality. ObjectivesThe purpose of this systematic review and meta-analysis was to evaluate the effect of common antioxidant therapy on short-term mortality in patients with sepsis. MethodsAccording to PRISMA guidelines, a systematic literature search on antioxidants in adults sepsis patients was performed on PubMed/Medline, Embase, and the Cochrane Library from the establishment of the database to November 2023. Antioxidant supplements can be a single-drug or multi-drug combination: HAT (hydrocortisone, ascorbic acid, and thiamine), ascorbic acid, thiamine, N-acetylcysteine and selenium. The primary outcome was the effect of antioxidant treatment on short-term mortality, which included 28-day mortality, in-hospital mortality, intensive care unit mortality, and 30-day mortality. Subgroup analyses of short-term mortality were used to reduce statistical heterogeneity and publication bias. ResultsSixty studies of 130,986 sepsis patients fulfilled the predefined criteria and were quantified and meta-analyzed. Antioxidant therapy reduces the risk of short-term death in sepsis patients by multivariate meta-analysis of current data, including a reduction of in-hospital mortality (OR = 0.81, 95% CI 0.67 to 0.99; P = 0.040) and 28-day mortality (OR = 0.81, 95% CI 0.69 to 0.95]; P = 0.008). Particularly in subgroup analyses, ascorbic acid treatment can reduce in-hospital mortality (OR = 0.66, 95% CI 0.90 to 0.98; P = 0.006) and 28-day mortality (OR = 0.43, 95% CI 0.24 to 0.75; P = 0.003). However, the meta-analysis of RCTs found that antioxidant therapy drugs, especially ascorbic acid, did substantially reduce short-term mortality(OR = 0.78, 95% CI 0.62 to 0.98; P = 0.030; OR = 0.57, 95% CI 0.36 to 0.91; P = 0.020). ConclusionsAccording to current data of RCTs, antioxidant therapy, especially ascorbic acid, has a trend of improving short-term mortality in patients with sepsis, but the evidence remains to be further demonstrated.

Pneumonia Severity Index And CURB-65 Scores Are Poor Predictors For Long-Term Mortality In Hospitalized Patients With Community-Acquired Pneumonia

Introduction The Pneumonia Severity Index (PSI) and CURB-65 scores are well-defined as tools to predict short-term mortality in patients with community-acquired pneumonia (CAP). The role of these scores in predicting long-term mortality is not well-defined. The objective of this study was to evaluate the role of PSI and CURB-65 as predictors of long term mortality in patients discharged alive after an episode of CAP. Methods This was a secondary analysis of the University of Louisville Pneumonia Study (ULPS) database. The PSI and CURB-65 were calculated at the time of hospital admission. For patients discharged alive, mortality was evaluated one-year after hospital discharged. Receiver operating characteristic (ROC) analysis was performed to determine the diagnostic performance of the PSI and CURB-65 in predicting long-term mortality. Results From a total study population of 6,870 patients, 1,744 (25%) patients died within one-year post discharge, and 5,126 (75%) patients were alive one-year post-discharge. Areas under the curve (AUC) for PSI was 0.72 and for CURB-65 was 0.66. Conclusion Even though the PSI is more accurate than CURB-65, both scores are weak predictors of long-term mortality in hospitalized patients with CAP. Future research studies are necessary to improve the prediction of long-term mortality in hospitalized patients with CAP.

The new biomarker that predicts in-hospital mortality in myocardial infarction: glucose/potassium ratio

Aims: Acute myocardial infarction (AMI) remains one of the leading causes of cardiovascular mortality. However, the parameters used to predict short-term mortality are limited. Glucose-potassium ratio (GPR) is a new biomarker that has been recently used. This study aimed to investigate the usefulness of GPR in predicting short-term mortality in patients diagnosed with AMI in the emergency department. Methods: This retrospective cohort study was conducted between January 1, 2022, and June 30, 2022, and included patients registered in the hospital emergency health system with IRB (Institutional Review Board) approval. Patients were identified based on inclusion criteria, and their demographic data, laboratory findings, and outcomes were recorded in the hospital registration system. Data comparisons between deceased and non-deceased patients were performed using the Student's t-test. Correlation analysis was performed using Spearman's correlation coefficients. A binary logistic regression model was created to determine the predictive parameters, and odds ratios and 95% confidence intervals (CI) were presented. Results: A total of 665 patients diagnosed with AMI were included in the study, with 75.9% of all patients being male and an average age of 62.14±11.62. A total of 6.6% of the patients included in the study died due to various causes during hospitalization. When laboratory values of deceased AMI patients were examined, statistically significant increases in glucose, urea, creatinine, WBC, neutrophil, lymphocyte, troponin, ckmb, and lactate levels were observed. The effects of GPR, NLR, PLR, lactate, and troponin levels on in-hospital mortality were analyzed using univariate logistic regression. GPR (95% CI 1.015-1.036, p=0.000), troponin (95% CI 1.001-1.001, p=0.000), and lactate (95% CI 1.437-1.908, p=0.000) were found to be the most important factors associated with mortality in patients with AMI. The ability to predict in-hospital mortality in AMI was compared, and GPR was found to have a higher predictive ability than troponin, a biomarker of myocardial damage (AUC: 0.729; P?=?0.000; Sensitivity:70%; Specificity:70%; Cut-off: 38.21). Conclusion: GPR, as a new and inexpensive biomarker, can be used to determine in-hospital mortality in patients with AMI. This index has a better predictive ability than troponin, NLR, and PLR, but is weaker than lactate.

GDF-15: a novel biomarker of heart failure predicts short-term and long-term heart-failure rehospitalization and short-term mortality in patients with acute heart failure syndrome

BackgroundAcute heart failure (AHF) is a potentially life-threatening clinical syndrome, usually requiring hospital admission. Growth Differentiation Factor-15 (GDF-15) is a distant member of the transforming growth factor-β. The increased expression of GDF-15 has been observed during heart failure (HF) and is associated with worse outcomes. However, the relationship between GDF-15 and AHF is not well understood with limited evidence among Thai patients.PurposeInvestigate the correlation between biomarker levels (measured upon admission and discharge) and short- and long-term adverse outcomes, encompassing all-cause mortality and heart-failure (HF) rehospitalization (at 30, 90, and 180 days, as well as throughout the entire follow-up duration) in individuals experiencing acute HF.MethodsThis is a prospective single-center investigation involving patients admitted for AHF. Biomarkers, including GDF-15, high-sensitivity troponin T (hsTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP), were assessed upon admission and discharge. Outcomes, including all-cause mortality and HF rehospitalization, were examined. Logarithmic transformations were applied to the biomarker variables for subsequent analysis. Univariate and multivariate analyses of cause-specific hazards were conducted using the Cox proportional hazards regression model, while subdistribution hazards were assessed using the Fine-Gray regression model to evaluate outcomes.ResultsA total of 84 patients were enrolled (mean age of 69 years, 52% females). The GDF-15 level significantly decreased during admission (median at the time of admission 6,346 pg/mL, median at the time of discharge 5,711 pg/mL; p < 0.01). All-cause mortality at 30 days and 180 days were 6.0% and 16.7%, respectively. HF rehospitalization at 30 days and 180 days were 15.5% and 28.6%, respectively. Univariate analysis showed that total orthoedema congestion score (p = 0.02) and admission GDF-15 level (p = 0.01) were associated with 30-day all-cause mortality, whereas hsTnT or NT-proBNP levels did not show significant associations. However, higher levels of NT-proBNP upon admission were associated with all-cause mortality when considering the entire follow-up period (p < 0.01). Both univariate and multivariate analyses demonstrated that lower discharge GDF-15 levels and a greater reduction in GDF-15 levels from admission to discharge were associated with a lower risk of 30-day rehospitalization. Similarly, univariate analysis revealed that a greater reduction in NT-proBNP levels from admission to discharge was associated with lower 30-day rehospitalization rates. At 180 days, a greater reduction in GDF-15 levels remained associated with lower hazards and incidence of rehospitalization.ConclusionThe significant decrease in Growth Differentiation Factor-15 (GDF-15) levels during hospitalization suggests its potential as a dynamic marker reflecting the course of AHF. Importantly, higher GDF-15 levels at admission were associated with an increased risk of 30-day all-cause mortality, highlighting its prognostic value in this patient population. Moreover, lower discharge GDF-15 levels, reductions in GDF-15 from admission to discharge, and decreases in NT-proBNP from admission to discharge were associated with a reduced risk of 30-day rehospitalization.

Association between glycemic variability and short-term mortality in patients with acute kidney injury: a retrospective cohort study of the MIMIC-IV database

Acute kidney injury (AKI) represents a significant challenge to global public health problem and is associated with poor outcomes. There is still considerable debate about the effect of mean blood glucose (MBG) and coefficient of variation (CV) of blood glucose on the short-term mortality of AKI patients. This retrospective cohort study aimed to explore the association between glycemic variability and short-term mortality in patients with AKI. Data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were analyzed, including 6,777 adult AKI patients. MBG and CV on the first day of ICU admission were calculated to represent the overall glycemic status and variability during the ICU stay in AKI patients. The primary outcome indicator was ICU 30-day mortality of AKI patients. Multivariate Cox regression analysis and smoothed curve fitting were used to assess the relationship between blood glucose levels and mortality. Eventually, the ICU 30-day mortality rate of AKI patients was 23.5%. The increased MBG and CV were significantly correlated with ICU 30-day mortality (hazards ratio (HR) = 1.20, 95% confidence interval (CI) 1.14–1.27; HR = 1.08, 95% CI 1.03–1.13). The smoothed curve fitting showed a U-shaped relationship between MBG on the first day of ICU admission and ICU 30-day mortality (inflection point = 111.3 mg/dl), while CV had a linear relationship with 30-day ICU mortality. Thus, we conclude that MBG and CV were significantly associated with short-term mortality in intensive care patients with AKI. Tighter glycemic control may be an effective measure to improve the prognosis of patients with AKI.

Relationship between ultra-short heart rate variability and short-term mortality in hospitalized COVID-19 patients

ObjectiveTo assess the association between ultra-short heart rate variability (US-HRV) and short-term mortality in patients with COVID-19 and develop prognostic prediction models to identify high-risk patients as early as possible. MethodsA retrospective cohort study was performed on 488 patients diagnosed with COVID-19 and hospitalized in the First Affiliated Hospital of Fujian Medical University from December 2022 to January 2023. 10-s electrocardiogram (ECG) data were available for these patients. The US-HRV parameters including standard deviation of all normal-to-normal R-R intervals (SDNN) and root mean square of successive differences between normal-to-normal R-R intervals (rMSSD) were calculated using Nalong ECG software. The endpoint was short-term mortality, including in-hospital mortality or mortality within 1 week after discharge. ResultsOf the 488 patients, 76 (15.6%) died. The SDNN and rMSSD in the death group were significantly lower than those in the survival group (P < 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) for SDNN and rMSSD to predict mortality was 0.761 and 0.715, respectively. The combined use of SDNN and rMSSD had an AUC of 0.774. The mortality rate in the group with SDNN ≤7.5 ms was higher than that of SDNN >7.5 ms group (P < 0.05). With the decrease of SDNN, the mortality of patients showed an upward trend, and the mortality of patients with SDNN ≤2 ms was the highest (66.7%). Multivariate logistic regression analysis identified SDNN as an independent predictor of prognosis (odds ratio (OR) = 5.791, 95% confidential interval (CI) 1.615–20.765, P = 0.007). The AUC of Model 1 (simple model) was 0.866 (95% CI 0.826–0.905). The AUC of Model 2 (comprehensive model) was 0.914 (95% CI 0.881–0.947). ConclusionSDNN was associated with short-term mortality and provided the additional discriminatory power of the risk stratification model for hospitalized COVID-19 patients.

High-Sensitivity Cardiac Troponin T and Frailty Predict Short-Term Mortality in Patients ≥75 Years Undergoing Emergency Abdominal Surgery: A Prospective Observational Study.

An elevated cardiac troponin concentration is a prognostic factor for perioperative cardiac morbidity and mortality. In elderly patients undergoing emergency abdominal surgery, frailty is a recognized risk factor, but little is known about the prognostic value of cardiac troponin in these vulnerable patients. Therefore, we investigated the prognostic significance of elevated high-sensitivity cardiac troponin T (hs-cTnT) concentration and frailty in a cohort of elderly patients undergoing emergency abdominal surgery. We included consecutive patients ≥75 years of age who presented for emergency abdominal surgery, defined as abdominal pathology requiring surgery within 72 hours, in a university hospital in Norway. Patients who underwent vascular procedures or palliative surgery for inoperable malignancies were excluded. Preoperatively, frailty was assessed using the Clinical Frailty Scale (CFS), and blood samples were measured for hs-cTnT. We evaluated the predictive power of CFS and hs-cTnT concentrations using receiver operating characteristic (ROC) curves and Cox proportional hazard regression with 30-day mortality as the primary outcome. Secondary outcomes included (1) a composite of 30-day all-cause mortality and major adverse cardiac event (MACE), defined as myocardial infarction, nonfatal cardiac arrest, or coronary revascularization; and (2) 90-day mortality. Of the 210 screened and 156 eligible patients, blood samples were available in 146, who were included. Troponin concentration exceeded the 99th percentile upper reference limit (URL) in 83% and 89% of the patients pre- and postoperatively. Of the participants, 53% were classified as vulnerable or frail (CFS ≥4). The 30-day mortality rate was 12% (18 of 146). Preoperatively, a threshold of hs-cTnT ≥34 ng/L independently predicted 30-day mortality (hazard ratio [HR] 3.14, 95% confidence interval [CI], 1.13-9.45), and the composite outcome of 30-day mortality and MACE (HR 2.58, 95% CI, 1.07-6.49). In this model, frailty (continuous CFS score) also independently predicted 30-day mortality (HR 1.42, 95% CI, 1.01-2.00) and 30-day mortality or MACE (HR 1.37, 95% CI, 1.02-1.84). The combination of troponin and frailty, 0.14 × hs-cTnT +4.0 × CFS, yielded apparent superior predictive power (area under the receiver operating characteristics curve [AUC] 0.79, 95% CI, 0.68-0.88), compared to troponin concentration (AUC 0.69, 95% CI, 0.55-0.83) or frailty (AUC 0.69, 95% CI, 0.57-0.82) alone. After emergency abdominal surgery in elderly patients, increased preoperative troponin concentration and frailty were independent predictors of 30-day mortality. The combination of increased troponin concentration and frailty seemed to provide better prognostic information than troponin or frailty alone. These results must be validated in an independent sample.

Factors in Predicting Short Term Mortality in ST Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

Background: Percutaneous coronary angiography and intervention have been applied in the diagnosis and treatment of coronary artery disease at Gia Dinh People's Hospital since April 2009 until now with very positive results, contributing to improving the quality of diagnosis and treatment. Treating cardiovascular patients with high technology. However, there is currently no research to help evaluate performance as well as prognostic factors affecting treatment outcomes at this unit. Therefore, we conducted this study with the research question: Short-term mortality rate in patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention at Gia Dinh People's Hospital. What is the year 2022 - 2023? What factors predict short-term mortality in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Materials and methods: There were 163 patients at the Gia Dinh People's Hospital from November 2022 to September, 2023. This was a cohort study. Results: In-hospital and 30-day mortality rates after intervention were 4.29% and 4.91%, respectively. Short-term mortality prognostic factors include systolic blood pressure &lt; 100 mmHg, arrhythmia at admission, TIMI score &gt; 6, cardiogenic shock before the procedure, blood potassium concentration with mortality rate within 30 days after PCI, with p &lt; 0.05. Conclusion: In clinical practice, attention should be paid to factors predicting 30-day mortality in STEMI patients include systolic blood pressure &lt; 100 mmHg, arrhythmia at admission, TIMI score &gt; 6, cardiogenic shock before the procedure, blood potassium concentration with mortality rate within 30 days after PCI.

The predictive value of the HALP score for no-reflow phenomenon and short-term mortality in patients with ST-elevation myocardial infarction

ABSTRACT Objective ST-elevation myocardial infarction (STEMI) is a medical emergency demanding immediate intervention, and primary percutaneous coronary intervention (pPCI) is the standard of care for this condition. While PCI has proven highly effective, a subset of patients experience the devastating no-reflow phenomenon, and some face increased short-term mortality. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score, a novel biomarker-based tool, has recently surfaced as an innovative predictor of these adverse outcomes. This study aims to investigate the groundbreaking findings that designate a low HALP score as a robust risk factor for no-reflow and short-term mortality in STEMI patients. Methods 1817 consecutive STEMI patients who underwent pPCI were included in this retrospective study, and the patients were divided into two groups according to whether no-reflow developed or not, and the HALP scores of the groups were compared. In addition, short-term mortality was compared between the study groups according to their HALP score values. The predictive ability of the HALP score for no-reflow was evaluated using a receiver operating characteristic curve. Results No-reflow developed in 198 (10.1%) of the patients included in the study. HALP score value was found to be significantly lower in the no-reflow group (27 ± 13 vs 47 ± 24, p < 0.001). After multivariable adjustment, the HALP score was an independent predictor of no-reflow (OR, 0.923, 95% CI, 0.910–0.935, p < 0.001). Furthermore, the HALP score showed good discrimination for no-reflow (AUC, 0.771, 95% CI, 0.737–0.805, p < 0.001). In addition, HALP score was determined to be an independent predictor for short-term mortality (HR, 0.955, 95% CI, 0.945–0.966, p < 0.001). Conclusions HALP score can independently predict the development of no-reflow and short-term mortality in STEMI patients undergoing pPCI.

Long-Term Persistence of COVID-Induced Hyperglycemia: A Cohort Study.

Although the short-term mortality of patients with COVID-19 infection and hyperglycemia has been well documented, there is little available data regarding longer-term prognosis. The presence of diabetes has not only influenced disease severity but has also impacted its transmission dynamics. In this study, we followed a historical cohort of patients without previous history of diabetes who presented with moderate to severe COVID-19 and were found to have hyperglycemia (random blood glucose >140 mg/dL) at the time of admission. We evaluated the need for antidiabetic therapy in these patients at the end of 6 months and the risk factors associated with persistent hyperglycemia determined by monthly values of self-monitored blood glucose. Of the seventy participants who were followed telephonically, 54 (77%) continued to receive antidiabetic therapy or have persistent hyperglycemia (>140 mg/dL) at the end of 6 months. Persistent hyperglycemia at the end of follow-up, was found to be associated with a higher blood glucose at presentation.

The CHA2DS2-Vasc Score's Role as A Standalone Predictor for Suboptimal Reperfusion and Short-Term Mortality Post Primary PCI in Individuals Diagnosed with Acute ST-Segment Elevation Myocardial Infarction

Background: The CHA2DS2-VASc score is an established clinical prediction tool for assessing stroke risk in patients with atrial fibrillation. However, its potential utility in predicting outcomes following primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) has not been extensively explored. The no-reflow phenomenon and in-hospital mortality are critical endpoints in the management of STEMI patients undergoing PCI. Objective: This study aimed to evaluate the independent predictive value of the CHA2DS2-VASc score for suboptimal reperfusion and short-term mortality in patients with acute STEMI undergoing primary PCI. Methods: In a prospective cohort study involving 116 patients with confirmed STEMI at the National Institute of Cardiovascular Diseases in Karachi, participants were categorized based on their CHA2DS2-VASc score into low (&lt;3) and high (≥3) risk groups. Primary PCI was performed following standard treatment protocols, and variables such as initial TIMI flow, thrombus grade, and lesion complexity were documented. Statistical analysis, including multivariate regression, was conducted using SPSS Version 25. Results: Patients with a high CHA2DS2-VASc score (≥3) exhibited a significantly increased risk of no-reflow (p-value range 0.00-0.03) and in-hospital mortality (11.1%) compared to those with a low score (&lt;3; 1.3% mortality). Other significant findings included an association between high CHA2DS2-VASc scores and larger stent lengths (28.75±5.67 mm), smaller stent diameters (2.69±0.6 mm), higher creatinine levels (1.00±0.202 mg/dL), and increased incidence of diabetes mellitus (36.1%). The odds ratio for mortality associated with a high CHA2DS2-VASc score was 1.58 (95% CI: 1.14–2.13, p-value &lt; 0.00). Conclusion: The CHA2DS2-VASc score is a significant independent predictor of both no-reflow post-PCI and short-term in-hospital mortality in STEMI patients. These findings suggest the score's potential role in the pre-PCI risk stratification, which could guide clinical decision-making and potentially improve patient outcomes.

Evaluation of short-term mortality in patients with Medicare undergoing endovascular interventions for chronic limb-threatening ischemia.

Patients with chronic limb-threatening ischemia (CLTI) have high mortality rates after revascularization. Risk stratification for short-term outcomes is challenging. We aimed to develop machine-learning models to rank predictive variables for 30-day and 90-day all-cause mortality after peripheral vascular intervention (PVI). Patients undergoing PVI for CLTI in the Medicare-linked Vascular Quality Initiative were included. Sixty-six preprocedural variables were included. Random survival forest (RSF) models were constructed for 30-day and 90-day all-cause mortality in the training sample and evaluated in the testing sample. Predictive variables were ranked based on the frequency that they caused branch splitting nearest the root node by importance-weighted relative importance plots. Model performance was assessed by the Brier score, continuous ranked probability score, out-of-bag error rate, and Harrell's C-index. A total of 10,114 patients were included. The crude mortality rate was 4.4% at 30 days and 10.6% at 90 days. RSF models commonly identified stage 5 chronic kidney disease (CKD), dementia, congestive heart failure (CHF), age, urgent procedures, and need for assisted care as the most predictive variables. For both models, eight of the top 10 variables were either medical comorbidities or functional status variables. Models showed good discrimination (C-statistic 0.72 and 0.73) and calibration (Brier score 0.03 and 0.10). RSF models for 30-day and 90-day all-cause mortality commonly identified CKD, dementia, CHF, need for assisted care at home, urgent procedures, and age as the most predictive variables as critical factors in CLTI. Results may help guide individualized risk-benefit treatment conversations regarding PVI.

LILLE-4 vs. LILLE-7 to predict short-term mortality in patients with severe alcoholic hepatitis

LILLE-4 vs. LILLE-7 to predict short-term mortality in patients with severe alcoholic hepatitis

Evaluation of the Blood Urea Nitrogen-to-Left Ventricular Ejection Fraction Ratio in Predicting Mortality in Patients Presenting to the Emergency Department with Heart Failure Symptoms.

Heart failure is a clinical syndrome. In this study, the significance of the blood urea nitrogen-to-left ventricular ejection fraction (BUNLVEF) ratio in predicting short-term mortality in patients with heart failure symptoms was evaluated. This retrospectively designed study was conducted by evaluating the records of patients with a history of heart failure who presented to the emergency department with heart failure symptoms and signs from 01 January 2018 to 01 January 2020. One hundred and seventy-three patients were included in the sample within the last six months presented to the emergency department with the symptoms of acute heart failure. Blood urea nitrogen (BUN) and the BUNLVEF ratio had a significant relationship with mortality (p=0.004 and <0.010, respectively). In patients with a known history of heart failure presenting to the emergency department with heart failure symptoms, it would be more appropriate to evaluate poor outcomes with the BUNLVEF ratio rather than the LVEF or BUN value alone. Key Words: Blood urea nitrogen, Prognosis, Left ventricular dysfunction.

Glycemic Variability As a Prognostic Factor for Mortality in Patients With Critical Illness: A Systematic Review and Meta-Analysis.

To perform a systematic review and meta-analysis to evaluate the association of various measures of glycemic variability, including time-domain and complexity-domain, with short-term mortality in patients with critical illness. We searched Embase Classic +, MEDLINE, and the Cochrane Database of Systematic Reviews from inception to November 3, 2023. We included English language studies that assessed metrics of glycemic variation or complexity and short-term mortality in patients admitted to the ICU. Two authors performed independent data abstraction and risk-of-bias assessments. We used a random-effects model to pool binary and continuous data and summarized estimates of effect using odds ratios and mean difference. We used the Quality in Prognosis Studies tool to assess risk of bias and the Grading of Recommendations, Assessment, Development and Evaluations to assess certainty of pooled estimates. We included 41 studies (n = 162,259). We demonstrate that increased sd, coefficient of variance, glycemic lability index, and decreased time in range are probably associated with increased mortality in critically ill patients (moderate certainty) and that increased mean absolute glucose, mean amplitude of glycemic excursion, and detrended fluctuation analysis may be associated with increased mortality (low certainty). We found a consistent association between increased measures of glycemic variability and higher short-term mortality in patient with critical illness. Further research should focus on standardized measurements of glycemic variation and complexity, along with their utility as therapeutic targets and prognostic markers.