Short-term Prognosis Of Patients Research Articles

Travmatik Akut Subdural Hematom ve İnmelerde Dekompresif Kraniektomi Sonrası Kısa Dönem Prognoz ve Mortalite Riskinin Olası Belirteçleri

Objective: Decompressive craniectomy can reduce mortality in selected patients with stroke and traumatic acute subdural hematoma. This study aimed to explore predictive markers for short-term prognosis and mortality risk in patients who underwent decompressive craniectomy due to traumatic acute subdural hematoma or malignant middle cerebral artery occlusion using clinical, radiological, and routine blood biochemistry findings.Material and Methods: Eleven traumatic acute subdural hematoma patients and 11 stroke patients were included in this study. On admission to hospital, for each patient, age, gender, Glasgow Coma Scale scores, anisocoria, time elapsed for decompressive craniectomy administration, midline shift level, duration of stay in Intensive Care Unit and in hospital, and Glasgow Outcome Scale scores on discharge from hospital and blood biochemistry findings were examined.Results: The Glasgow Outcome Scale score was found 3.5 (2-5) in surviving patients and it was seen that short-term prognosis of patients could be associated with lymphocyte, neutrophil, and platelet count, neutrophil-lymphocyte ratio, and serum C-reactive protein level. However, mortality rate in both groups was found 77.2%, and it was thought that age, leukocyte, monocyte and platelet count, and serum blood urea nitrogen level could be associated with mortality risk.Conclusion: As a result, it could be said that decompressive craniectomy could not reduce mortality risk in both groups. However, it was suggested that lymphocyte, neutrophil, and platelet counts, neutrophil-lymphocyte ratio, and serum C-reactive protein levels could be assumed as markers for short-term prognosis. Furthermore, it was concluded that age, leukocyte, monocyte, and platelet counts, and serum blood urea nitrogen levels could be predictors of mortality risk.

Clinical and Laboratory Markers in Determination of Treatment Modalities and Short-Term Prognosis in Patients with Traumatic Acute Subdural Hematoma: Original Study

Abstract Objective In patients with traumatic acute subdural hematoma (ASH), it has not been yet fully elucidated which patients can benefit from surgery or from clinical follow-up. This study was constructed to predict treatment modality and short-term prognosis in patients with ASH using their clinical, radiological, and biochemical laboratory findings during admission to hospital. Methods Findings of patients with ASH determined on their CT scan between 2015 and 2018 were evaluated. Patients were grouped in terms of ASH-FOL (patients followed-up without surgery, n = 13), ASH-OP (patients treated surgically, n = 10), and ASH-INOP (patients considered as inoperable, n = 5) groups. They also were divided into “survived (n = 14)” and “nonsurvived (n = 14)” groups. Results ASH developed as a result of fall from a height in 15 patients and traffic accidents in 13 patients. In deciding for surgery, it was determined that Glasgow coma scale (GCS) scores < 8, midline shift (MLS) level > 5 mm, MLS-hematoma thickness ratio > 0.22, leukocyte count > 12730 uL, and presence of anisocoria could be used as predictive markers. It was determined that GCS scores < 8, hematoma thickness value > 8 mm, and the presence of anisocoria could be considered as biomarkers in prediction of mortality likelihood. Conclusion It could be suggested that GCS scores, MLS level, MLS-hematoma thickness ratio, presence of anisocoria, and leukocyte count value could help in determination of the treatment modality in patients with ASH. Additionally, GCS scores, hematoma thickness value, and presence of anisocoria could each be used as a marker in the prediction of early-stage prognosis and mortality likelihood of these patients.

Effect of Admission Hyperglycemia on Short-Term Prognosis of Patients with Non-ST Elevation Acute Coronary Syndrome without Diabetes Mellitus.

Objective To evaluate the effect of admission hyperglycemia on the short-term prognosis of patients with non-ST elevation acute coronary syndrome (NSTE-ACS) without diabetes mellitus. Methods The clinical data of 498 patients with NSTE-ACS admitted to the Department of Cardiology of the First Affiliated Hospital of Henan University of Science and Technology between March 2018 and November 2020 were analyzed. Based on the blood glucose (BG) level at admission, patients were divided into three groups: A (BG < 7.8 mmol/L), B (7.8 mmol/L ≤ BG < 11.1 mmol/L), and C (BG ≥ 11.1 mmol/L). The clinical data of the three groups were compared. Results There was no significant difference between the three groups in terms of age, sex, hypertension, hyperlipidemia, smoking, and history of myocardial infarction (p > 0.05). However, there were significant differences in the incidences of multivessel disease, renal insufficiency, pump failure, and emergency percutaneous coronary intervention, and levels of high-sensitivity C-reactive protein, cardiac troponin T, and creatine kinase isoenzyme MB among the three groups (p < 0.05 for all). The incidences of severe pump failure, malignant arrhythmias, and death were significantly higher in groups B and C compared to group A (p < 0.05). Additionally, the incidences of severe pump failure, malignant arrhythmias, and death were significantly higher in group C compared to group B (p < 0.05). Multivariate logistic regression analysis showed that hyperglycemia, renal insufficiency, Killip grade III/IV, and age were risk factors of in-hospital death. Conclusion Hyperglycemia at admission is a risk factor for adverse in-hospital clinical outcomes in patients with NSTE-ACS.

Increase of Myocardial Ischemia Time and Short-Term Prognosis of Patients with Acute Myocardial Infarction during the First COVID-19 Pandemic Wave.

Background and objectives: early reports showed a decrease in admission rates and an increase in mortality of patients with acute myocardial infarction (AMI) during the first wave of COVID-19 pandemic. We sought to investigate whether the COVID-19 pandemic and associated lockdown had an impact on the ischemia time and prognosis of patients suffering from AMI in the settings of low COVID-19 burden. Materials and Methods: we conducted a retrospective data analysis from a tertiary center in Lithuania of 818 patients with AMI. Data were collected from 1 March to 30 June in 2020 during the peri-lockdown period (2020 group; n = 278) and compared to the same period last year (2019 group; n = 326). The primary study endpoint was all-cause mortality during 3 months of follow-up. Secondary endpoints were heart failure severity (Killip class) on admission and ischemia time in patients with acute ST segment elevation myocardial infarction (STEMI). Results: there was a reduction of 14.7% in admission rate for acute myocardial infarction (AMI) during the peri-lockdown period. The 3-month mortality rate did not differ significantly (6.9% in 2020 vs. 10.5% in 2019, p = 0.341 for STEMI patients; 5.3% in 2020 vs. 2.6% in 2019, p = 0.374 for patients with acute myocardial infarction without ST segment elevation (NSTEMI)). More STEMI patients presented with Killip IV class in 2019 (13.5% vs. 5.5%, p = 0.043, respectively). There was an increase of door-to-PCI time (54.0 [42.0–86.0] in 2019; 63.5 [48.3–97.5] in 2020, p = 0.018) and first medical contact (FMC)-to-PCI time (101.0 [82.5–120.8] in 2019; 115 [97.0–154.5] in 2020, p = 0.01) during the pandemic period. Conclusions: There was a 14.7% reduction of admissions for AMI during the first wave of COVID-19. FMC-to-PCI time increased during the peri-lockdown period, however, it did not translate into worse survival during follow-up.

Association Between Procalcitonin and Post-hepatectomy Liver Failure in Hepatocellular Carcinoma Patients.

Objectives: Procalcitonin (PCT) has long been proved as an early diagnostic signal for postoperative outcomes. The purpose of this study is to explore the value of serum procalcitonin levels in predicting post-hepatectomy liver failure (PHLF), and further to declarethe relationship between postoperative PCT and short-term prognosis in patients after hepatectomy. Methods: Clinical data of patients with hepatocellular carcinoma (HCC) who underwent hepatectomy from June 1st, 2019 to September 31st, 2020 at Shanghai Eastern Hepatobiliary Surgery Hospital had been retrospectively analyzed. Logistic regression analysis was used to evaluate the risk factors related to PHLF. The Kaplan-Meier method was used to calculate the PHLF rate and 30-day survival after surgery. Results: A total of 885 patients with complete data were finally included in analysis, 311 of them with elevated serum PCT (≥1 ng/ml). Results of the logistic regression analysis suggested a significant association between PCT and PHLF [HR, 95%CI; 3.801 (1.825, 7.917), p < 0.001]. Other significant risk factors for PHLF included portal hypertension, portal blocking time (>30 min) and blood transfusion (>200 ml). Kaplan-Meier analysis also suggested a higher PHLF rate in elevated PCT patients [9.0% (95% CI, 7.3 to 12.8 VS. 1.9% (95% CI, 1.1–4.3)); p < 0.001]. For secondary outcomes, elevated PCT was also highly associated with postoperative sepsis, ICU admission, 30-day mortality and 3-month mortality. Conclusion: Elevated procalcitonin level in patients after hepatectomy is related to higher PHLF rate, with lower 30-day survival and poor short-term postoperative outcomes.

Abstract 9056: The Association Between Thoracic Injuries Due to Chest Compression and Short-Term Prognosis in Patients With Non-traumatic Out-of-Hospital Cardiac Arrest

Background: The current guidelines emphasize that high-quality chest compression is essential for improving the survival in out-of-hospital cardiac arrest (OHCA) patients. However, it may lead to thoracic injuries which is a potential factor of poor prognosis. Method: Between June 2017 to July 2019, we collected Utstein-style data on 384 consecutive adult patients with non-traumatic OHCA who were transferred to our hospital. Full-body CT scan was performed and thoracic injuries were defined as rib fracture, sternum fracture, hemorrhagic pleural effusion, pneumothorax, sternum posterior bleeding, mediastinal hematoma, or mediastinal emphysema. We identified the predictors for thoracic injuries and evaluated the relationship between thoracic injuries and prognosis. Results: Patients with thoracic injuries (Group-T) were 234 (76%). The duration of chest compression in Group-T was 43 min, which was significantly longer than that in patients without thoracic injuries (Group-N, 32 min, p&lt;0.001). ROC curve analysis identified a duration of chest compression of 35 minutes as the optimal cut off for predicting thoracic injuries (area under the curve 0.73). Multivariate analysis revealed that age (OR: 1.03, 95%CI: 1.01-1.05, p=0.005) and duration of chest compression (OR: 1.07, 95%CI: 1.04-1.09, p&lt;0.001) were independent predictors of thoracic injuries. The rate of obtaining return of spontaneous circulation (ROSC), 30-day survival and favorable neurologic outcome were larger in Group-N than Group-T. In patients with achieving ROSC, Kaplan-Meier curves showed a significantly higher cumulative survival rates in Group-N compared to that in Group-T during follow-up of 30 days (Log-rank test p=0.009). Conclusion: Age and duration of chest compression were independent predictors for thoracic injuries due to chest compression in non-traumatic OHCA patients. Moreover, the presence of thoracic injuries was associated with poor short-term prognosis.

A Novel CT-based Radiomics-Clinical Nomogram for the Prediction of Short-Term Prognosis in Deep Intracerebral Hemorrhage

To develop and validate a radiomics-clinical nomogram for the prediction of short-term prognosis in patients with deep intracerebral hemorrhage (DICH) on admission. A total of 326 patients with DICH (development cohort= 187; testing cohort= 81; validation cohort= 58) were retrospectively included. Radiomics features were extracted from computed tomography (CT) images and optimal features were selected using least absolute shrinkage and selection operator regression. A radiomics score (R-score) was developed using the optimal features. Univariate and multivariate analyses were used to determine independent risk factors for poor outcomes at 30 days. A radiomics-clinical (R-C) nomogram was developed and validated in the three cohorts. Receiver operating characteristic curve (ROC), calibration curve and decision curve analyses were conducted to evaluate the performances of the R-C nomogram. Only 4 of 396 radiomics features were selected to develop R-scores. Age, onset-to-CT time, Glasgow Coma Scale score, midline shift, and R-score were detected as independent predictors of poor prognosis of DICH. The R-C nomogram was developed by the independent predictors and showed acceptable discrimination with areas under ROCs of 0.80, 0.79, and 0.70 in the development, testing and validation cohorts, respectively. The R-C nomogram showed good agreement between thepredicted probability and the actual probability (all P>0.05) and clinical applicability in each cohort. The R-C nomogram is a stable and effective tool for predicting the short-term prognosis of DICH, which may help clinicians perform individual risk assessments and make decisions for patients with DICH.

Cardiovascular predictors associated with poor short-term prognosis in patients diagnosed with SARS-CoV-2 in Spain

Abstract Background On January 2020, the first patient with coronavirus 2 (SARS-CoV-2) was detected in Spain. Since then, 3 280 000 cases have been confirmed and 75.305 people have died. We aimed to clarify the epidemiological and clinical characteristics related with poor short-term prognosis in patients diagnosed with SARS-CoV-2. Methods Observational, retrospective single-center study including consecutive patients (≥40yo) diagnosed with SARS-CoV-2 through PCR, since March 2nd to 20th 2020 in our center in Spain. The primary endpoint (PE) was the combined of all-cause death or need for orotracheal intubation within the first 30 days of infection symptoms. Results 704 patients were included (table). A follow-up period of thirty-days was fully completed in 692 of 704 patients (98.3%). At the end of this period, 148 patients (21.4%) met the PE; they were older, more frequently male, obese and smokers. Patients who met the PE had a higher prevalence of hypertension, diabetes, dyslipidemia, ischemic heart disease, heart failure, peripheral and cerebrovascular disease, cancer and lung pathologies. They received more frequently therapies with renin-angiotensin system inhibitors, betablockers, calcium channel blockers and statins, as well as antiplatelet and anticoagulant therapies Multivariate analysis showed that age (OR 1.99 for every 10 years, 95% CI [1.637–2.4], p&amp;lt;0.001), female sex (OR 0.49, [0.30–0.80], p=0.004), diabetes (OR 2.09, [1.17–3.71], p=0.012), lung disease (OR 1.99, [1.14–3.44], p=0.014) and body mass index (OR 1.33 for each 5 kg/m2 increased, [1.05–1.68], p=0.017) were predictors of the PE. Hypertension was not significantly related to the PE (OR 1.55, [0.93–2.60], p=0.09) Conclusion In our group of patients with SARS-CoV-2, age, male sex, diabetes, lung disease and obesity were found to be independent predictors of the combined of all case death or need for orotracheal intubation within the first 30 days of infection symptoms. Larger studies are needed to confirm these results. Funding Acknowledgement Type of funding sources: None. Description of studied populationOdds-ratio and CI for the combined PE

Prognostic factors in patients hospitalized with community-acquired aspiration pneumonia

IntroductionPatients with aspiration pneumonia (AP) exhibit higher mortality than those with non-AP. However, data regarding predictors of short-term prognosis in patients with community-acquired AP are limited. MethodsPatients hospitalized with community-acquired pneumonia (CAP) were retrospectively classified into aspiration pneumonia (AP) and non-AP groups. The AP patients were further divided into nonsurvivors and survivors by 30-day mortality, and various clinical variables were compared between the groups. ResultsOf 1249 CAP patients, 254 (20.3%) were classified into the AP group, of whom 76 patients (29.9%) died within 30 days. CURB-65, pneumonia severity index (PSI), and Infectious Diseases Society of America/American Thoracic Society criteria for severe CAP (SCAP) showed only modest prognostic performance for the prediction of 30-day mortality (c-statistics, 0.635, 0.647, and 0.681, respectively). Along with the PSI and SCAP, Eastern Cooperative Oncology Group performance status (ECOG-PS) and blood biomarkers, including, N-terminal of prohormone brain natriuretic peptide (NT-proBNP) and albumin, were independent predictors of 30-day mortality. In models based on clinical prediction rules, including CURB-65, PSI, and SCAP, the addition of ECOG-PS further improved their c-statistics compared to the clinical prediction rules alone. In the four combinations based on SCAP, ECOG-PS, and two blood biomarkers (NT-proBNP and albumin), the c-statistics further increased to reach approximately 0.8. ConclusionsCURB-65, PSI, and SCAP exhibited only modest discriminatory power in predicting the 30-day mortality of patients with community-acquired AP. The addition of performance status and blood biomarkers, including NT-proBNP and albumin, further increased prognostic performance, showing good predictive accuracy in the SCAP-based model.

Abnormal Liver Tests during Hospitalization Predict Mortality in Patients with COVID-19: A Multicenter Study from South America

Background The role of liver function tests (LFT) as prognostic factors in patients admitted with COVID-19 has not been fully investigated, particularly outside resource-rich countries. We aimed at evaluating the prognostic value of abnormal LFT on admission and during hospitalization of patients with COVID-19. Methods We performed a retrospective study that included 298 adult patients hospitalized for COVID-19, between 05/2020 and 02/2021, in 6 hospitals from 5 countries in South America. We analyzed demographic and comorbid variables and laboratory tests on admission and during hospitalization. LFT over twice the upper limit of normal (ALEx2) were also evaluated in relation to a variety of factors on admission and during hospitalization. De novo-ALEx2 was defined as the presence of ALEx2 at one week of hospitalization in patients without ALEx2 on admission. Patients were followed until hospital discharge or death. Multivariable analysis was used to evaluate the association between ALEx2 on admission and during hospitalization and mortality. Results Of the total of 298 patients, 60% were male, with a mean age of 60 years, and 74% of patients had at least one comorbidity. Of those, 137 (46%) patients were transferred to the intensive care unit and 66 (22.1%) patients died during hospitalization. ALEx2 on admission was present in 87 (29.2%) patients and was found to be independently associated with 1-week mortality (odds ratio (OR) = 3.55; 95% confidence interval (95%CI) 1.05–12.05). Moreover, 84 (39.8%) out of 211 patients without ALEx2 at admission developed de novo-ALEx2, which was independently associated with mortality during second week of hospitalization (OR = 6.09; 95%CI 1.28–29) and overall mortality (OR = 2.93, 95%CI 1.05–8.19). Conclusions A moderate elevation of LFT during admission was associated with a poor short-term prognosis in patients hospitalized with COVID-19. In addition, moderate elevation of LFT at one week of hospitalization was an independent risk factor for overall mortality in these patients.

Correlation analysis between TSP2, MMP-9 and perihematoma edema, as well as the short-term prognosis of patients with hypertensive intracerebral hemorrhage.

To analyze the correlation between thrombospondin-2 (TSP2), matrix metalloproteinase (MMP)-9, and perihematomal edema, as well as the short-term prognosis of patients with hypertensive intracerebral hemorrhage. The clinical data of 114 patients with hypertensive intracerebral hemorrhage admitted to our hospital from January 2018 to February 2020 were collected and divided into groups according to the levels of TSP2 and MMP-9. We compared edema indexes in patients with different levels of TSP2 and MMP-9, and analyzed the correlation between TSP2, MMP-9 and relative edema volume index (REI), edema change index (AEI). We also assessed the TSP2 and MMP-9 levels in patients with different prognoses, and analyzed the predictive value of TSP2 and MMP-9 for poor prognosis of patients. (I) There was no difference in the REI and AEI values between the low and high TSP2 groups at admission and 24 h after admission (P>0.05), while the REI and AEI values of the high TSP2 group at 5 and 15 d after admission were significantly lower than those of the low TSP2 group (P<0.05); (II) the REI and AEI values of patients with different MMP-9 levels were not different between admission and 24 h after admission (P>0.05), while the REI and AEI values of the high MMP-9 group were significantly higher than those of the low MMP-9 group at 5 and 15 d after admission (P<0.05); (III) Pearson correlation analysis showed that MMP-9 was positively correlated with REI and AEI, while TSP2 was negatively correlated (P<0.05); (IV) among 114 patients, 39 had poor prognosis, 75 had good prognosis The MMP-9 levels of patients with a poor prognosis were significantly higher than those of patients with a good prognosis, and the TSP2 level was the opposite (P<0.05); (V) receiver operating characteristic (ROC) curve showed that the sensitivity, specificity and the area under the curve (AUC) of the TSP2 + MMP-9 combination in the diagnosis of hypertensive cerebral hemorrhage were significantly higher than when TSP2 and MMP-9 were tested separately (P<0.05). In patients with hypertensive intracerebral hemorrhage, TSP2 is negatively correlated with edema around the hematoma, while MMP-9 is positively correlated.

Different clinicopathologic features predispose to different patterns of distant metastasis with heterogeneous short-term prognosis in patients with differentiated thyroid cancer.

Limited studies have focused on the associated clinicopathologic features and short-term prognostic impacts of metastatic patterns at initial diagnosis in differentiated thyroid cancer (DTC). Overall, 530 individuals with distant DTC diagnosed between 2010 and 2014 were identified from Surveillance, Epidemiology, and End Results (SEER) database. Multinomial logistic regression model was used to assess the clinicopathologic factors influencing the pattern of distant metastasis. Kaplan-Meier method and multivariable Cox regression were used to estimate the short-term effects of metastatic patterns on overall (OS) and thyroid cancer-specific survival (TCSS). Fifty, 111, 263, 59 and 47 patients presented with distant lymph node (LN)-only, bone-only, lung-only, bone plus lung, and liver and/or brain metastases (Mets), respectively. Regional lymph node metastasis (LNM) and follicular histotype were the only confirmed risk factors for distant LN-only Mets and bone-only Mets, respectively. Larger tumour size, extrathyroidal extension (ETE) and papillary histotype were associated with lung-only Mets. Synchronous bone and lung Mets were more likely to occur in older patients. In addition, patients with distant LN-only Mets had hardly any negative effect on OS and TCSS, whereas those with synchronous bone and lung or liver/brain Mets predicted unfavourable short-term outcomes, regardless of whether they received total thyroidectomy and radioisotopes. Different clinicopathologic factors predispose to different patterns of metastases with profound short-term survival differences among DTC patients. Our findings may help to determine effective pretreatment screening for aggressive metastatic patterns at initial diagnosis, and thus to provide additional treatment or access of clinical trials for these patients.

Prognostic Implications of Reductions in Heart Rates in Patients With Acute Heart Failure and Atrial Fibrillation.

Atrial fibrillation (AF) is a common arrhythmia in patients with acute heart failure (AHF). Heart rate (HR) also changes significantly over time. However, the association between changes in HR in AF patients and prognosis is uncertain.Methods and Results:We investigated the association between HR reduction in AF achieved within 48 h of admission and 60-day mortality in patients with AHF from the REALITY-AHF study. The percentage HR (%HR) reduction was calculated as (baseline HR-HR at 48 h) / baseline HR × 100. The primary endpoint was 60-day all-cause mortality. In 468 patients with confirmed AF at both admission and 48 h after admission, the median HR at these time points was 105±31 and 84±18 beats/min, respectively. The median %HR reduction was 15.4% (interquartile range 2.2-31.4%). During the 60 days of admission, 39 deaths (8.3%) were recorded, and the %HR reduction within 48 h was significantly associated with 60-day mortality in the unadjusted model (hazard ratio [HR] 0.85; 95% confidence interval [CI] 0.77-0.95; P=0.005) and after adjusting for other covariates (HR 0.81; 95% CI 0.68-0.96; P=0.016).Furthermore, the %HR reduction was associated with a significant reduction in 60-day mortality in patients with higher baseline HR. %HR reduction is associated with a better short-term prognosis in patients with AHF presenting with AF, particularly in those with a rapid ventricular response.

Comparison of serum GP73 and p62 measurement to predict short-term prognosis in patients with HBV-related acute-on-chronic liver failure

Objective: To analyze the clinical value and predictive difference of serum Golgi protein 73 (GP73) and serum autophagy-related protein p62 levels in the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (ACLF). Methods: Clinical data of admitted cases to our hospital from October 2018 to April 2020 were retrospectively analyzed. Simultaneously, there were 32 cases with HBV-related ACLF in group A, 65 cases with hepatitis B virus-related cirrhosis in group B and C (Child-Pugh Class A, 34 cases as B group, and Child-Pugh B/C class, 31 cases as group C), and another 30 healthy subjects served as the control group (group D). The serum GP73 and p62 levels of the four selected groups were measured. ACLF group patients were followed up for 3 months to analyze the prognosis of the patients. The serum GP73 and p62 levels of patients who died and survived during hospitalization were compared. The data were analyzed by one-way analysis of variance, independent sample t-test, and Pearson's correlation analysis. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of GP73 and p62 levels in surviving patients. Results: GP73 levels in the four groups A, B, C and D were (284.30 ± 70.55) ng/ml, (125.33 ± 20.57) ng/ml, (159.82 ± 31.20) ng/ml, and (45.46 ± 10.22) ng/ml, respectively. The p62 levels were (1.30 ± 0.35) ng/ml, (2.88 ± 0.58) ng/ml, (2.02 ± 0.545) ng/ml, and (4.68 ± 1.03) ng/ml, respectively. GP73 detection value was significantly higher in group A than the other three groups (P < 0.05). Group D had significantly lower value than the other three groups (P < 0.05), and group C had significantly higher value than group B (P < 0.05). The detection value of p62 in group A was significantly lower than the other three groups (P < 0.05). Group D had significantly higher value than the other three groups (P < 0.05), and group B had slightly higher value than group C, and the differences were statistically significant (P < 0.05). There was a negative correlation between GP73 and p62 (r = -0.695, P < 0.001). Survived patients GP73 level in the ACLF group was significantly lower than dead patients [(212.17 ± 22.47) ng/ml and (340.08 ± 32.91) ng/ml, t = 12.493, P < 0.05], and p62 level was significantly higher than dead patients [(1.46 ± 0.28) ng/ml and (1.18 ± 0.35) ng/ml, t = 2.445, P < 0.05]. According to the ROC curve analysis results, the area under the curve (AUC) of GP73 was 0.865, the AUC of p62 was 0.750, and the combined AUC of the both was 0.968. Conclusion: Both GP73 and p62 have a certain predictive value for the short-term prognosis of HBV-related ACLF patients, but the combination of the two indicators has a higher predictive value.

Influencing Factors of Early Neurological Deterioration and Short-Term Prognosis after Intravenous Thrombolysis in Patients with Acute Ischemic Stroke

Objective To explore the factors affecting the early neurological deterioration (END) and short-term prognosis of patients with acute ischemic stroke (AIS) after intravenous thrombolysis. Methods The clinical data of 212 patients with AIS who received intravenous thrombolysis in our hospital from July 2017 to November 2020 were selected and divided into the END group (n = 71) and the non-END group (n = 141) according to the National Institute of Health Stroke Scale (NIHSS) score and divided into the poor prognosis group (n = 85) and the good prognosis group (n = 127) according to the modified Rankin scale (mRS) score at discharge. The basic data of patients, vascular risk factors, imaging examinations, and laboratory indicators were collected. A logistic regression model was used to analyze the influencing factors of END and the short-term prognosis of AIS patients after intravenous thrombolysis. Results Univariate analysis showed that the patient's age, time from onset to treatment (OTT), NIHSS score, diabetes, hypertension, atrial fibrillation, TOAST classification, infarct size, carotid artery stenosis, white blood cell count (WBC), C-reactive protein (CRP), and D-dimer (DD) were associated with END (P < 0.05). Multiple logistic regression analysis found that NIHSS score, diabetes, atrial fibrillation, infarct size, carotid stenosis, and CRP were independent influencing factors of END after intravenous thrombolysis in AIS patients (P < 0.05). Univariate analysis showed that the patient's age, OTT, NIHSS score, diabetes, hypertension, atrial fibrillation, infarct size, carotid stenosis, and the occurrence of END were all related to the short-term prognosis of AIS patients (P < 0.05). Multiple logistic regression analysis showed that age, NIHSS score, infarct size, carotid artery stenosis, and the occurrence of END were all independent factors affecting the short-term prognosis of AIS patients. Conclusion High NIHSS score, combined with diabetes, atrial fibrillation, moderate to severe carotid stenosis, and elevated CRP are all risk factors for END after intravenous thrombolysis in AIS patients. Moreover, advanced age, high NIHSS score, moderate to severe carotid stenosis, and occurrence of END are risk factors for poor short-term prognosis after intravenous thrombolysis in AIS patients.

The effects of serum ischemia modified albumin on diagnosis of cerebral infarction and vertebral basilar artery stenosis

ABSTRACT Objectives Serum ischemia-modified albumin (IMA) is higher in patients with cerebral infarction (CI). In this study, we aimed at studying the association between IMA and CI. Methods Patients with CI were divided to severe stenosis group and mild stenosis group according to the stenosis of vertebrobasilar artery. Digital subtraction angiography (DSA) and magnetic resonance imaging (MRI) were used for diagnosis. Cobalt-combined with Albumin test was used to determine the serum IMA levels. Serum IMA levels in patients with CI and healthy volunteers were compared by t test. Receiver operating characteristic (ROC) curve was performed for evaluating the diagnostic efficiency of serum IMA for CI. The correlation between IMA level and the National Institute of Health Stroke Scale(NIHSS) score after treatment was analyzed. Results Serum IMA levels in patients with CI was increased compared to healthy volunteers(P < .05). Patients in severe stenosis group had a higher serum IMA level than mild stenosis group(P < .05). Serum IMA level at admission was associated with NIHSS score on the 7th day after treatment(P < .05). Conclusions Serum IMA level was correlated with vertebrobasilar artery stenosis and short-term prognosis in patients with acute CI.

Baseline Neutrophil-to-Lymphocyte Ratio Is Independently Associated With 90-Day Transplant-Free Mortality in Patients With Cirrhosis.

Background: Patients with cirrhosis have an increased risk of short-term mortality, however, few studies quantify the association between neutrophil-to-lymphocyte ratio (NLR) and 90-day transplant-free mortality in cirrhotic patients.Methods: We prospectively analyzed 3,970 patients with chronic liver diseases from two multicenter cohorts in China (January 2015 to December 2016 and July 2018 to January 2019). Restricted cubic splines (RCS) were used to analyze the relation of NLR and all-causes 90-day transplant-free mortality in cirrhosis.Results: A total of 2,583 cirrhotic patients were enrolled in our study. Restricted cubic splines showed that the odds ratio (OR) of all causes 90-day transplant-free mortality started to increase rapidly until around NLR 6.5, and then was relatively flat (p for non-linearity <0.001). The risk of 90-day transplant-free mortality in cirrhotic patients with NLR < 6.5 increased with an increment of 23% for every unit increase in NLR (p < 0.001). The patients with NLR < 4.5 had the highest risk (OR: 2.34, 95% CI 1.66–3.28). In multivariable-adjusted stratified analyses, the increase in the incidence of 90-day transplant-free mortality with NLR increasing was consistent (OR >1.0) across all major prespecified subgroups, including infection group (OR: 1.04, 95% CI 1.00–1.09) and non-infection (OR: 1.06, 95% CI 1.02–1.11) group. The trends for NLR and numbers of patients with organ failure varied synchronously and were significantly increased with time from day 7 to day 28.Conclusions: We found a non-linear association between baseline NLR and the adjusted probability of 90-day transplant-free mortality. A certain range of NLR is closely associated with poor short-term prognosis in patients with cirrhosis.

Influence of portal vein thrombosis on the prognosis of patients with liver cirrhosis based on propensity score matching

Objective To investigate the influence of portal vein thrombosis (PVT) on the short-term prognosis of patients with liver cirrhosis and the risk factors for the prognosis of patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical data of the patients with liver cirrhosis who were hospitalized in our hospital from September 2018 to March 2020, among whom 58 patients with PVT were enrolled as PVT group and 116 patients without PVT were enrolled as non-PVT group, and 44 patients were selected from each group based on propensity score matching (PSM) at a ratio of 1∶ 1 to balance the covariates between groups. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. The Kaplan-Meier method and the log-rank method were used to analyze survival status and bleeding before and after PSM, and the Cox risk model was used to analyze the risk factors for the prognosis of patients with liver cirrhosis. Results Before PSM, the non-PVT group had a significantly higher overall survival rate than the PVT group (P=0.008), while after PSM, there was no significant difference in overall survival rate between the two groups (P=0.076). Before PSM, the non-PVT group had significantly lower incidence rates of upper gastrointestinal bleeding or rebleeding than the PVT group before and after PSM (P Conclusion Liver cirrhosis with PVT increases the risk of upper gastrointestinal bleeding or rebleeding, but it is not an independent risk factor for short-term death in patients with liver cirrhosis. MELD score ≥15 is an independent risk factor for short-term death in patients with liver cirrhosis.

Diabetes is associated with poor short-term prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure.

Background/purposeAssociations between the disturbances in glucose homeostasis and prognosis in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) remain unclear. This study was conducted to investigate the clinical characteristics of disturbances in glucose homeostasis and their associations with 90-day mortality in patients with HBV-related ACLF.MethodsNinety-six patients with HBV-related ACLF without pre-existing diabetes were prospectively included. Glucose abnormalities were diagnosed based on fasting plasma glucose and oral glucose tolerance test results on admission and during follow-up. Homeostasis model assessment was used to establish insulin resistance (HOMA2-IR), insulin sensitivity (HOMA2-IS) and HOMA2-β-cell function (HOMA2-β). Multivariate Cox proportional hazards analysis was used to identify independent risk factors for death within 90 days after admission.ResultsAmong 96 patients with ACLF, 51 (53.1%) had diabetes, 29 (30.2%) had impaired glucose tolerance (IGT), and 17 (17.7%) had hypoglycemia. Patients with diabetes had significantly lower levels of HOMA2-β than did patients with normal glucose tolerance. Of 22 patients with diabetes or IGT and without anti-hyperglycemic treatment, 8 (36.4%) exhibited regression of their glucose metabolism disorders after a follow-up of 32.8 ± 28.8 days, and higher platelet levels were associated with regression. Twenty-five patients (25.0%) with ACLF died of liver failure within 90 days. Diabetes [odds ratio (OR) 3.601, 95% confidence interval (CI) 1.342–9.661] and age (OR 1.045, 95% CI 1.010–1.082) were the independent risk factors associated with mortality.ConclusionImpaired pancreatic β-cell function is related to diabetes development, and diabetes is associated with high mortality in patients with chronic HBV-related ACLF.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12072-021-10243-1.

Relationship between Admission Electrolyte Level and Short-term Prognosis of Patients with Acute ST-segment Elevation Myocardial Infarction after Percutaneous Coronary Intervention.

Objective The objective of this study is to analyze the relationship between the electrolyte level of patients with acute ST-segment elevation myocardial infarction (STEMI) and short-term prognosis after percutaneous coronary intervention (PCI). Methods The clinical data of 142 patients with acute STEMI who underwent PCI in our hospital from September 2018 to September 2019 were retrospectively analyzed. According to the level of serum sodium, potassium, and chloride in patients admitted to the hospital, they were divided into the normal electrolyte group (n = 78), the mild decline group (n = 46), and the severe decline group (n = 16). Univariate and logistic regression multivariate analysis of the relationship between patient electrolyte levels and general clinical data is performed. Statistical analysis of patients' adverse events within 90 days was performed. The Kaplan–Meier survival curve analyzed the relationship between the survival period and electrolyte levels in patients with acute STEMI without major acute cardiovascular events (MACE) within 90 days. Results The levels of creatine kinase-MB (CK-MB), cardiac troponin I (cTnI), myocardial infarction area, and Gensini score in patients with mild decline were significantly higher than those in the normal group, left ventricle ejection fractions (LVEF) value was significantly lower than the normal group, and patients with severe decline were significantly higher in creatine kinase (CK) level than the normal group (P < 0.05). The levels of CK-MB, CK, cTnI, and myocardial infarction area of the patients in the severe decline group were significantly higher than those in the mild decline group, and the LVEF values were significantly lower than those in the mild decline group (P < 0.05). The levels of CK-MB, CK, cTnI, the area of myocardial infarction, and Gensini score in patients with acute STEMI have an independent effect on their electrolyte levels. The patients in the mild decline group and severe decline group had significantly higher rates of cardiogenic shock, heart failure, ventricular aneurysm formation, ventricular septal perforation, or death within 90 days after PCI. The median without MACE survival time of patients with mildly and severely reduced electrolyte levels was significantly lower than that of patients with normal electrolyte levels. Conclusion Patients with acute STEMI are prone to electrolyte disturbances, and their CK-MB, CK, and cTnI levels; myocardial infarction area; and Gensini score have independent effects on electrolyte levels. Patients with electrolyte disturbances are prone to poor prognosis after PCI, and their survival period without MACE at 90 days is significantly lower than that of normal patients.