Significant Difference In Mortality Research Articles

A Study on the Epidemiology of COVID-19-Related Guillain-Barré Syndrome in the United States.

Several neurological complications have been reported with COVID-19, including Guillain-Barré syndrome (GBS). We looked at incidence, baseline characteristics, and in-hospital outcomes of COVID-19-associated GBS in the United States. We conducted a retrospective analysis using the US National Inpatient Sample database to identify hospitalizations for COVID-19 and GBS, using International Classification of Disease, 10th Revision, codes G610 and G650 for GBS and U071 for COVID-19. The codes used in this study are listed in Supplemental Digital Content 1 (see e Appendix, http://links.lww.com/JCND/A69). In total, 13,705 GBS admissions were recorded nationwide in 2020; of these, 1155 (8.43%) were associated with COVID-19. The frequency of GBS in COVID-19 admissions was 0.07%, compared with 0.08% in non-COVID-19 admissions (P = 0.8166). COVID-19 cohort with GBS had higher utilization of invasive mechanical ventilation (20.8% vs. 11.8%, P < 0.001) in comparison with COVID-19 cohort without GBS. GBS admissions with COVID-19 exhibited significantly higher inpatient mortality (12.2% vs. 3%, P < 0.001) compared with GBS admissions without COVID-19. Our findings underscore GBS as a rare yet severe complication of COVID-19, highlighting a significant difference in mortality when compared with GBS not associated with COVID-19.

The Effectiveness and Safety of Nafamostat Mesylate in the Treatment of COVID-19: a Meta-Analysis.

Nafamostat mesylate, a synthetic serine protease inhibitor, has been shown to have antiviral activity against SARS-CoV-2 and anticoagulant properties that may be beneficial in the treatment of COVID-19. We conducted a meta-analysis to evaluate the effectiveness and safety of nafamostat mesylate for the treatment of COVID-19. PubMed, Embase, Cochrane Library, Scopus, Web of Science, medRxiv, and bioRxiv were searched up to July 2023 for studies comparing the outcomes of nafamostat mesylate treatment and no nafamostat mesylate treatment in patients with COVID-19. Mortality, disease progression, and adverse events were analyzed. Six studies involving 16,195 patients were included in the analysis. Meta-analysis revealed no significant difference in mortality (odds ratio [OR]: 0.88, 95% CI: 0.20-3.75, P = 0.86) or disease progression (OR: 2.76, 95% CI: 0.31-24.68, P = 0.36) between groups. However, nafamostat mesylate was associated with an increased risk of hyperkalemia (OR: 7.15, 95% CI: 2.66-19.24, P < 0.0001). Nafamostat mesylate did not improve mortality or morbidity in hospitalized patients with COVID-19. The risk of hyperkalemia is a serious concern that requires monitoring and preventive measures. Further research in different COVID-19 populations is required.

Comparison between Zone 2 and Zone 3 distal anastomoses for aortic arch replacement in terms of invasiveness.

Zone 2 anastomosis with total cervical branch reconstruction for acute type A aortic dissection and aortic arch aneurysms became possible after stent-graft introduction. This may be an easier procedure and reduce the risk of recurrent laryngeal nerve palsy. Therefore, this study aimed to compare the outcomes between Zone 2 and Zone 3 distal anastomoses. After evaluating the patient data in our institute between April 2016 and April 2022, the patients in whom distal anastomosis was performed at Zone 2 with a stent-graft were defined as the Zone 2 group (n = 70). The patients in whom distal anastomosis was performed at Zone 3 were defined as the Zone 3 group (n = 24). The incidence of new-onset recurrent nerve palsy was one patient (1.4%) in the Zone 2 group and six patients (25.0%) in the Zone 3 group (p < 0.001). The lower body perfusion arrest time was 44.3 ± 9.1min in the Zone 2 group and 52.9 ± 12.8min in the Zone 3 group (p = 0.005). There were no significant differences in in-hospital mortality and morbidities. Multivariable analysis showed that only age was an independent predictor of overall mortality. Performing distal anastomosis at Zone 2 with a frozen elephant trunk or stent-graft reduced the lower body perfusion arrest time and possibly prevented recurrent nerve palsy.

Association between elevated preoperative red cell distribution width and mortality after brain tumor craniotomy.

Red cell distribution width (RDW) has been recognized as a potential inflammatory biomarker, with elevated levels associated with adverse outcomes in various diseases. However, its role in predicting outcomes after brain tumor craniotomy remains unclear. We aimed to assess whether preoperative RDW influences mortality and postoperative complications in patients undergoing brain tumor craniotomy. This retrospective cohort study analyzed serum RDW levels in patients undergoing brain tumor craniotomy at West China Hospital. RDW was evaluated in two forms: RDW-CV and RDW-SD, and was categorized into four quartiles for analysis by using logistic regression and multivariate analysis to adjust for confounding. The study encompassed 10,978 patients undergoing brain tumor craniotomy. our analysis revealed no significant difference in 30-day mortality across various RDW-CV levels. However, we observed a dose-response relationship with preoperative RDW-CV levels in assessing long-term mortality risks. Specifically, patients with RDW-CV levels of 12.6-13.2% (HR 1.04, 95% CI 1.01-1.18), 13.2-13.9% (HR 1.12, 95% CI 1.04-1.26), and > 13.9% (HR 1.34, 95% CI 1.18-1.51) exhibited a significantly higher hazard of long-term mortality compared to those with RDW-CV < 12.6%. When preoperative RDW-CV was analyzed as a continuous variable, for each 10% increase in RDW-CV, the adjusted OR of long-term mortality was 1.09 (95% CI 1.05-1.13). we also observed significant associations between preoperative higher RDW-CV levels and certain postoperative complications including acute kidney injury (OR 1.46, 95% CI: 1.10-1.94), pneumonia infection (OR 1.19 95% CI: 1.05-1.36), myocardial infarction (OR 1.32, 95% CI: 1.05-1.66), readmission (OR 1.15, 95% CI: 1.01-1.30), and a prolonged length of hospital stay (OR 1.11, 95% CI: 1.02-1.21). For RDW-SD levels, there was no significant correlation for short-term mortality, long-term mortality, and postoperative complications. Our study showed elevated preoperative RDW-CV is significantly associated with increased long-term mortality and multiple postoperative complications, but no such association is observed with RDW-SD. These findings show the prognostic importance of RDW-CV, reinforcing its potential as a valuable tool for risk stratification in the preoperative evaluation of brain tumor craniotomy patients.

The role of sarcopenia in fragility fractures of the pelvis – is sarcopenia an underestimated risk factor?

BackgroundFragility fractures of the pelvis (FFPs) represent a significant health burden, particularly for the elderly. The role of sarcopenia, an age-related loss of muscle mass and function, in the development and impact of these fractures is not well understood. This study aims to investigate the prevalence and impact of osteoporosis and sarcopenia in patients presenting with FFPs.MethodsThis retrospective study evaluated 140 elderly patients with FFPs. The diagnosis of sarcopenia was assessed by psoas muscle area (PMA) and the height-adjusted psoas muscle index (PMI) measured on computed tomography (CT) scans. Clinical data, radiological findings and functional outcomes were recorded and compared with the presence or absence of sarcopenia and osteoporosis.ResultsOur study cohort comprised 119 female (85.0%) and 21 (15.0%) male patients. The mean age at the time of injury or onset of symptoms was 82.26 ± 8.50 years.Sarcopenia was diagnosed in 68.6% (n = 96) patients using PMA and 68.8% (n = 88) using PMI. 73.6% (n = 103) of our study population had osteoporosis and 20.0% (n = 28) presented with osteopenia. Patients with sarcopenia and osteoporosis had longer hospital stays (p < 0.04), a higher rate of complications (p < 0.048) and functional recovery was significantly impaired, as evidenced by a greater need for assistance in daily living (p < 0.03). However, they were less likely to undergo surgery (p < 0.03) and the type of FFP differed significantly (p < 0.04). There was no significant difference in mortality rate, pre-hospital health status, age or gender.ConclusionOur study highlights the important role of sarcopenia in FFPs in terms of the serious impact on health and quality of life in elderly patients especially when osteoporosis and sarcopenia occur together.Identifying and targeting sarcopenia in older patients may be an important strategy to reduce pelvic fractures and improve recovery. Further research is needed to develop effective prevention and treatment approaches that target muscle health in the elderly.

Nutritional status in patients admitted to pediatric intensive care unit and its corelation with outcome

Background: The incidence of malnutrition in children admitted to pediatric intensive care unit (PICU), has always been significant. In addition, nutritional status of critically ill children deteriorates further during their PICU stay and may have negative effect on patients` outcome. This study aims to determine the critically ill children, to analyse and document its impact on outcome and to survey current nutritional practices and support in PICU. Methods: This was a prospective observational study done over a period of 10 months on critically ill patients admitted in PICU of department of pediatrics at Baroda medical college and Sir Sayajirao Gaekwad hospital, Vadodara. Results: Total of 350 patients admitted in PICU of S. S. G. hospital, Vadodara were enrolled in the study. Malnutrition was higher in age 6-60-month age group (57%) of patients admitted in PICU, 81% of severe acute malnutrition patients required mechanical ventilation and 19% required HFNC support, there was statistically significant difference in mortality (51.1%) of SAM patients as compared to normal patients. Conclusions: Malnutrition is one of the leading causes of mortality in patients admitted to PICU, with more complications with prolonged ventilator support, longer duration of stay in PICU.

Decreasing medication errors in Alexandria Main University Hospital Critical Care Unit 3 using sensitization program

ABSTRACT Introduction The occurrence of medication errors in hospital settings presents considerable public health challenges, as they significantly affect patient morbidity and mortality, especially with an increasing frequency in critical care units. Material and methods A prospective before-and-after study conducted in Critical Care Unit 3 at Alexandria Main University Hospital involved 1440 observations of medication errors in 16-bed units over three months, encompassing 181 patients using a checklist. After implementing a sensitization program, a follow-up study was conducted with 1472 observations involving 185 patients over another three months. The comprehensive study focuses on the impact of the sensitization program on medication errors and its reporting, employing a prospective before-after design. Results No statistically significant difference in mortality was observed between Control and Postintervention groups (p = 0.258). Prescription errors accounted for 52.0%, transcription errors 19.2%, dispensing errors 1.2%, preparation errors 13.9%, and administration errors 13.6% of total medication errors. In the Control group, 38.7% experienced at least one medical error, compared to 21.6% in the Postintervention group (p < 0.001). There were 396 medication errors (27.5% of observations) in the Control group versus 250 errors (17.0% of observations) in the Postintervention group (p < 0.001). Errors reporting increased from 3.8% to 30% (p < 0.001). Conclusions The non-technological sensitization program effectively reduced medication errors in our resource-limited unit and improved error reporting.

Andexanet Alfa versus Four-Factor Prothrombin Complex Concentrate for the Reversal of Factor Xa (FXa) Inhibitor-Associated Intracranial Hemorrhage: A Systematic Review of Retrospective Studies

Background/Objectives: There are limited data on the risks and benefits of using Andexanet alfa (AA) compared with four-factor prothrombin complex concentrate (4F-PCC) for the reversal of factor Xa inhibitor-associated intracranial hemorrhage (ICH). Our aim was to describe a compilation of the information available in the literature to date. Methods: PubMed, Embase, Web of Science (Clarivate Analytics) and the Cochrane Central Register of Controlled Trials were searched until December 2023. Following the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines, our systematic literature review included studies that were retrospective in design and evaluated both drugs to control bleeding and complications (death and thromboembolic events). Two researchers re-examined the studies for relevance, extracted the data and assessed the risk of bias. No meta-analyses were performed for the results. Results: In this limited patient sample, we found no differences between published articles in terms of neuroimaging stability or thrombotic events. However, some studies show significant differences in mortality, suggesting that one of the AAs may be superior to 4F-PCC. Conclusions: Our qualitative analysis shows that AA has a better efficacy profile compared with 4F-PCC. However, further studies monitoring these patients and a multicenter collaborative network dedicated to this topic are needed.

Left ventricular global longitudinal strain is a long-term predictor of pacemaker-associated cardiomyopathy

Abstract Background Implantation of a permanent pacemaker is an effective treatment for symptomatic bradycardia. However, chronic right ventricular pacing (RVP) may lead to compromised left ventricular (LV) function, atrial fibrillation, heart failure, and increased mortality via pacing induced electrical and mechanical dyssynchrony. A decrease in LV ejection fraction (LVEF) of ≥ 10% with a baseline LVEF &amp;gt; 50% prior to RVP and no alternative explanation for the decline in LVEF is termed pacing-induced cardiomyopathy (PICM). Predictive clinical and imaging-derived measures to identify patients at high risk for pacemaker induced cardiomyopathy (PMIC) are lacking, but essential. Objective The study is a prospective, single center, double-blinded trial evaluating the impact of right ventricular pacing on left ventricular function and clinical outcome. Methods In 105 patients (59 male / 46 female), who underwent a dual-chamber pacemaker implantation at the Charité Campus Virchow Klinikum, RVP burden, LVEF and left ventricular global longitudinal strain (LV-GLS) were obtained. Mean follow-up per patient was 29.6 ±13.9 months. We used a stepwise analytic approach including ROC analysis, univariate testing, binary regression as well as Cox-regression models and Kaplan-Meier analysis to compare low RVP burden (&amp;lt; 30%) and high RVP burden (≥ 30%) cohorts according to change in echocardiographic parameters and clinical outcome (all-cause mortality). Results Mean LVEF was 61 ± 6% and mean LV-GLS was 18 ± 4% at baseline. We identified 7 patients with a LVEF decline in the course of the study. In Pearson’s Chi-squared test, patients with a high RVP burden were more likely to develop LVEF and LV-GLS deterioration (6 patients versus 1 patient for LVEF, p&amp;lt;0.05; 28 versus 16 patients for LV-GLS, p&amp;lt;0.001). In multivariable binary logistic regression, LV-GLS (OR: 1.410, 95% CI: 1.201-1.610, p&amp;lt;0.001) deterioration was significantly associated with a LVEF decline and a high RVP burden ≥ 30% (OR: 1.358, 95% CI: 1.160-1.534, p&amp;lt;0.01). In a log-rank test, time to LVEF decline was significantly shorter in patients with a RVP burden ≥ 30% compared to a RVP burden &amp;lt; 30% (45.2±2.9 versus 55.7±1.0 months, p&amp;lt;0.05). In the Cox-regression analysis, LV-strain decline within 12 months (HR: 7.210, 95% CI: 4.239-9.516, p&amp;lt;0.05) was a significant predictor for a later LVEF decline. In a log-rank test, time to LVEF deterioration was significantly shorter in patients with LV-strain decline within 12 months compared to those without (34.7 ± 4.2 versus 53.7 ± 1.4 months, p&amp;lt;0.001). No significant difference in all-cause mortality between patients with a high RVP burden compared to those with low RVP burden (log-rank test, p=0.2). Conclusion A decline in LV-GLS is a sensitive long-term parameter of subsequent LVEF deterioration in patients with normal preimplant LVEF, who require RVP ≥ 30%. and is associated with a poor clinical outcome.

Atrial imaging and cardiac Rhythm In cryptogenic Embolic Stroke: the ARIES study

Abstract Background One of the underlying causes of cryptogenic stroke is an unknown cardioembolic etiology, and the most frequent is atrial fibrillation (AF). It is not unusual to find non-sustained (&amp;lt;30 s) "microfibrillatory" atrial tachycardias (nsAT) or frequent atrial ectopic beats (AE) during the work-up but its pathological significance remains uncertain. Purpose Our aim is to analyze the risk of developing AF or nsAT in patients with cryptogenic stroke and compare their atrial function using advanced echocardiography and their clinical outcome during the follow-up. Methods The ARIES study (Atrial imaging and cardiac Rhythm In cryptogenic Embolic Stroke) is an observational, prospective study in patients admitted for recent cryptogenic stroke in a comprehensive Stroke Unit. We analyze the frequency of detecting AF and nsAT in two 30-day ECG records with a wearable device and we compare echocardiographic signs of left atrial (LA) dysfunction according to rhythm classification: AF, high-burden nsAT/AE (&amp;gt;2 nsAT/24 hours or &amp;gt;3.000 AE/24 hours respectively) and normal sinus rhythm (NSR). Finally, we evaluate stroke recurrence and mortality at 12-months and report changes in classification of stroke etiology during the follow-up. Results In total prolonged rhythm study (1st and 2nd 1-month wearable EKG), AF was found in 35 (32.1%) patients, high-burden nsAT/AE in 27 patients (24.8%) and normal rhythm was found in 47 patients (43.1%). Patients with AF compared with patients with NSR presented higher values in LA volume (69.9±21.8 vs 49.4±26.5, p&amp;lt;0.001) , LA index volume (38.8±11.2 vs 27.3±11.8 ml/m2, p&amp;lt;0.001), 3D LA index volume (50.6±17.2 vs 34.0±15.4 ml/m2, p&amp;lt;0.001), 3D-telediastolic LA volume (89.5±27.7 vs 66.8 ±31.9 ml/m2, p=0.002), 3D-telesistolic LA volume (43.6±15.3 vs 25.3±17.4 ml/m2, p &amp;lt;0.001), lower rates of LA ejection fraction (50 ±14.6 vs 62.7±11.8, p=0.001) and LA strain in reservoir (22.0±8.6 vs 30.4±10.5, p&amp;lt;0.001) and contraction (10.5±8.18 vs 17.1±7.5, p&amp;lt;0.001). After multivariable regression analysis (age, HTA and CHASDS2VASC) all the differences remained significative. High-burden nsAT/AE and NSR patients presented significant differences in LA index volume (33.4±12.4 vs 27.3±11.8 ml/m2, p=0.043) and LA strain in reservoir (26.6±12.5) vs 31.0±10.1, p=0.034) that disappeared after multivariate regression analysis. There were no significant differences in ischemic recurrence or mortality between the three groups. Conclusions In patients with cryptogenic stroke, we registered a high rate of AF and high-burden nsAT/AE. AF patients showed notable alterations in LA volume, LA function and reservoir and contraction strain, while patients with high-burden nsAT/AE showed less structural alteration in echocardiography without difference in stroke recurrence among groups.

#321 Hemodiafiltration for ESRD patients

Abstract Background and Aims This systematic review and meta-analysis were designed to determine the effect of hemodiafiltration (HDF), or hemofiltration (HF) compared to hemodialysis on the prognosis of end-stage renal disease (ESRD) patients. Method PubMed, Embase, and Web of Science were searched for published studies from reception to 18 September 2023, and updated search on October 15, 2023. Randomized clinical trials (RCTs) or cohort studies evaluated prognosis of hemodiafiltration, or hemofiltration compared to hemodialysis in patients with ESRD were included. Data was synthesized based on heterogeneity with corresponding model selected, and trial sequential analyses were conducted. The primary outcome was all-cause mortality, and secondary outcome was cardiovascular mortality and dialysis adequacy. Outcomes were reported as relative risk (RR), hazard ratio (HR), or mean difference (MD) with a 95% confidence interval (95% CI). Results There were 26 RCTs, 10 cohort studies, and total of 36 articles included in the meta-analysis. Pooled results of RCTs showed a statistically significant difference in all-cause mortality between HDF/HF group and standard hemodialysis group (RR = 0.86; 95% CI 0.78-0.96; I2 = 29%; Fig. 1). Trial sequence analysis (TSA) showed that the all-cause mortality curve crossed the traditional and TSA boundaries, but it was not yet as informative as desired. Subgroup analysis found that ESRD patients treated with hemodiafiltration had a 13% lower risk of death (RR = 0.87; 95% CI 0.78-0.97; Fig. 1) with no heterogeneity (I2 = 0%). In contrast, the effect of hemofiltration on mortality risk in ESRD patients was not significant (RR = 0.70; 95% CI 0.39-1.29; Fig. 1). A similarly statistically significant difference in cardiovascular mortality (RR = 0.747; 95% CI 0.607-0.917; I2 = 0%; Fig. 2) for RCTs. In addition, HDF/HF treatment was significantly associated with improved dialysis adequacy (Assessed by Kt/V) in ESRD patients (MD: 0.09; 95% CI 0.01-0.17; I2 = 96%). The combined results of cohort studies showed a 28.6% reduction in mortality risk in ESRD patients treated with HDF (HR = 0.714; 95% CI 0.575-0.886; I2 = 84%; Fig. 3), with an HR for cardiovascular mortality of 0.708 (95% CI 0.604-0.829; I2 = 0%; Fig. 4). Conclusion Overall, HDF/HF was associated with reduced all-cause mortality and cardiovascular mortality in patients with ESRD and contributed to improved dialysis adequacy.

#1987 The current status of deceased donor kidney discard in Korea with a very long waiting time

Abstract Background and Aims Increasing rates of end stage kidney disease in Asia, including Korea, are very high; however, the rates of deceased donation in this area is much lower than those in the Western countries, leading to a serious discrepancy between donor organ need and supply. Therefore, efficient utilization of deceased donor kidneys with minimizing organ discard is essential. This nationwide study analyzed the current status of donor kidney discard in Korea. Method This study included deceased donor kidneys which are candidate for kidney transplantation between 2013 and 2018 in the Korean Network for Organ Sharing. Kidneys were procured bilaterally or unilaterally, or discarded bilaterally. Unilaterally- or bilaterally-procured kidneys were used for deceased donor kidney transplantation or discarded later. Kidney discard was defined as no-procurement or discard after procurement. We analysed risk factors affecting donor kidney discard using multivariable logistic regression analysis. Moreover, we analysed graft failure rate and mortality in kidney transplant patients according to discard pattern using Log rank test and multivariable Cox regression analysis. Results Among 5,592 deceased donor kidneys, numbers of no-procurement, single-procurement, and double-procurement were 385, 63, and 5,144, respectively. Most of unilaterally-procured kidneys were transplanted, whereas one kidney was discarded later. Bilaterally-procured kidneys were accompanied by two transplantations (n = 5,058), one transplantation with discard of the other kidneys (n = 33), or discard of both kidneys (n = 20). The kidney discard rate was 7.9% (n = 439), which seemed to be lower compared to that in the Western countries. The causes of no-procurement were universally organ damage and the common causes of kidney discard after procurement were organ damage (66.6%) and absence of available candidates (12.9%). While mean kidney donor profile index (KDPI) in the discard group (1.9 ± 0.7) was higher than that of transplantation group (1.5 ± 10.5, P &amp;lt; 0.001), a large overlap in the quality was observed. Risk factors for kidney discard were female sex (adjusted odds ratio [OR], 1.68; 95% confidence interval [CI], 1.31-2.15), hypertension (OR, 1.65; 95% CI, 1.27-2.14), diabetes mellitus (OR, 2.82; 95% CI, 2.12-3.75), high serum creatinine levels (OR, 1.89; 95% CI, 1.78-2.01), low hemoglobin levels (OR, 0.84; 95% CI, 0.79-0.90), and non-cerebrovascular cause of death (OR, 0.70; 95% CI, 0.55-0.89). When kidney transplantation using contralateral kidneys in the discard group was compared with that in the no-discard group, there were no significant differences in either graft failure rate or mortality between the two groups (P = 0.300). Furthermore, multivariable analysis showed that discard of the contralateral kidneys did not have a negative impact on either graft survival (hazard ratio 1.67; 95% CI, 0.74-3.77; P = 0.216) or patient survival (hazard ratio 0.86; 95% CI, 0.35-2.12; P = 0.749). Conclusion The discard rate of deceased donor kidneys was low in Korea with a very long waiting time and kidney transplant outcomes using contralateral kidneys in the discard group were comparable to those in the no-discard group, supporting maximal utilization of deceased donor kidneys would contribute to expanding a donor pool without compromising post-transplant outcomes.

Calf Management: Individual or Paired Housing Affects Dairy Calf Health and Welfare

Previous research has indicated that preweaned dairy calves reared in pairs compared with individually have improved performance and indicators of animal welfare. One hundred and thirty Holstein female calves completed the trial, with eighty-five being allocated to paired housing and forty-five calves being allocated to individual housing. Daily live weight gain (DLWG), treatments and mortality were recorded throughout the preweaning period. Salivary cortisol, latency to feed and latency to approach a novel object were assessed at batching. There were no significant differences in DLWG, mortality and disease treatments between the average of the pair and the individually housed calves, although the pair-reared calves were quicker to approach the milk feed after batching and interacted more quickly with a novel object. The heaviest born calves within the pair had the highest DLWG from birth to weaning, with a higher percentage of calves approaching the novel object, compared with the lightest born calf within the pair. This study shows that calves within a pair may have significantly different performance and welfare during the preweaning period, with the heavier calf outperforming and displaying less fear and more exploratory behaviour than the lighter calf within a pair.

Off-Pump Reduces Risk of Coronary Bypass Grafting in Patients with High MELD-XI Score.

This study aimed to assess the influence of the model of end-stage liver disease without International Normalized Ratio (INR) (MELD-XI) score on outcomes after elective coronary artery bypass surgery (CABG) without (Off-Pump) or with (On-Pump) cardiopulmonary bypass. We calculated MELD-XI (5.11 × ln serum bilirubin + 11.76 × ln serum creatinine in + 9.44) for 3,535 consecutive patients having undergone elective CABG between 2009 and 2020. A MELD-XI threshold was determined using the Youden Index based on receiver operating characteristics. Propensity score matching and logistic regression was performed to identify risk factors for inhospital mortality and Major Adverse Cardiac and Cerebrovascular Event (MACCE). Patients were 68 ± 10 years old (76% male). Average MELD-XI was 10.9 ± 3.25. The MELD-XI threshold was 11. Patients below this threshold had somewhat lower EuroSCORE II than those above (3.5 ± 4 vs. 4.1 ± 4.7, p < 0.01), but mortality was almost four times higher above the threshold (below 1.5% vs. above 6.2%, p < 0.001). Two-thirds of patients received Off-Pump CABG. There was a trend towards higher risk in Off-Pump patients. Mortality was numerically but not statistically different to On-Pump below the MELD XI threshold (1.3 vs. 2.2%, p = 0.34) and was significantly lower above the threshold (4.9 vs. 8.9%, p < 0.02). Off-Pump above the threshold was also associated with less low-output syndrome and fewer strokes. Equalizing baseline differences by propensity matching verified the significant mortality difference above the threshold. Multivariable regression analysis revealed MELD-XI, On-Pump, atrial fibrillation, and the De Ritis quotient (Aspartate aminotransferase (ASAT)/Alanine Aminotransferase (ALAT)) as independent predictors of mortality. Elective CABG patients with elevated MELD-XI scores are at increased risk for perioperative mortality and morbidity. This risk can be significantly mitigated by performing CABG Off-Pump.

Risk factors and prognosis of postoperative acute myocardial infarction in elderly hip fracture patients combined with coronary heart disease

IntroductionThis article mainly studies the risk factors for postoperative acute myocardial infarction (AMI) in elderly hip fracture patients combined with coronary heart disease (CHD), constructs a prediction model, and evaluates the prognosis of all the patients.MethodsThis article retrospectively collected elderly patients with hip fracture and CHD who underwent hip fracture surgery at the Third Hospital of Hebei Medical University from January 2019 to December 2021. Demographic data, laboratory indicators, and imaging examination results were collected from the medical case system. The risk factors of postoperative AMI were determined by univariate and multivariate logistic regression, and a nomogram prediction model was established. The ROC curve, calibration curve and DCA decision curve were plotted by R language software. The patients in the training set were followed up for 2 years to evaluate their survival situation.Results1094 eligible patients were divided into a training set (n = 824 from January 1, 2019 to September 31, 2021) and a validation set (n = 270 from October 1, 2021 to December 31, 2022). In the training set, women accounted for 58.6%; The average age of the patients was 79.45 years old; The main type of fracture was intertrochanteric fracture. There were 64.7% patients taken B receptor blockers; A total of 166 (20.1%) patients underwent percutaneous coronary intervention (PCI); Hypertension accounted for 55.5%; 520 (63.1%) patients had a preoperative waiting time greater than 3 days; The average hemoglobin value upon admission was 101.36 g/L; The average intraoperative bleeding volume was 212.42 ml; The average surgical time was 2.5 ± 0.3 h; Reginal anesthesia accounted for 29.7%; 63 (68.5%) AMI patients had no obvious clinical symptoms; 68 (73.9%) AMI patients did not show ST-segment elevation in ECG; The risk factors of postoperative AMI were age, hemoglobin at admission, diabetes, chronic kidney disease, intraoperative bleeding, and reginal anesthesia. The AUC of the nomogram prediction model was 0.729. The AUC in the validation set was 0.783. Survival analysis showed a significant statistical difference in 2-year mortality between patients with AMI and without AMI, among all the patients with AMI, patients with ECG ST-segment elevation has higher mortality than patients without ECG ST-segment elevation.ConclusionOur research results found that the incidence of postoperative AMI in elderly patients with hip fractures and CHD was 11.1%. Age, diabetes, hemoglobin at admission, regional anesthesia, chronic kidney disease, and intraoperative bleeding are risk factors. The AUC of the nomogram in training set is 0.729. The 2-year mortality rate of the patients with AMI is higher than that of patients without AMI.

Short versus long duration of ceftaroline combination therapy and outcomes in persistent or high-grade MRSA bacteremia: A retrospective single-center study.

Methicillin-resistant Staphylococcus aureus (MRSA) is associated with high mortality rates. Despite antibiotic therapy, persistent bacteremia is challenging to treat. Combination therapy with ceftaroline has emerged as a potential treatment option; however, the optimal duration and clinical implications after bacteremia clearance are unknown. This retrospective cohort study examined patients with high-grade or persistent MRSA bacteremia who were treated with ceftaroline combination therapy at the University of New Mexico Hospital between January 2014 and June 2021. Patients were categorized into short- (<7 days) or long-duration (≥7 days) groups based on the duration of combination therapy after bacteremia clearance. Outcomes included 30-day all-cause mortality, bacteremia recurrence, post-bacteremia clearance length of stay, and adverse events. A total of 32 patients were included in this study. The most common sources of bacteremia were bone/joint and endovascular (28.1%, 9/32 each). The median duration of combination therapy after clearance was seven days (IQR 2.8, 11). Patients in the long-duration group had a lower Charlson comorbidity index (1.0 vs 5.5, p = 0.017) than those in the short-duration group. After adjusting for confounders, there was no significant difference in the 30-day all-cause mortality between the groups (AOR 0.17, 95% CI 0.007-1.85, p = 0.18). No association was found between combination therapy duration and recurrence (OR 2.53, 95% CI 0.19-inf, p = 0.24) or adverse drug events (OR 3.46, 95% CI 0.39-74.86, p = 0.31). After controlling for total hospital length of stay, there was no significant difference in the post-bacteremia clearance length of stay between the two groups (p = 0.37). Prolonging ceftaroline combination therapy after bacteremia clearance did not significantly improve outcomes in patients with persistent or high-grade MRSA bacteremia. The limitations of this study warrant cautious interpretation of its results. Larger studies are needed to determine the optimal duration and role of combination therapy for this difficult-to-treat infection.

Predictive value of Cmmi-MHR combined with thromboelastography parameters in acute cerebral infarction.

Cerebral infarction is a common neurological disease with high rates of morbidity, mortality, and recurrence, posing a great threat to human life and health. Cerebral infarction is the second leading cause of death in the world and the leading cause of long-term disability in humans. The results of the third national retrospective sampling survey on causes of death in 2008 showed that cerebral infarction has become the leading cause of death in China and its mortality rate is 4-5 times that of European and American countries. Therefore, this article proposed a study on the predictive value of Cmmi-MHR combined with thromboelastography parameters that was performed for acute cerebral infarction. This paper mainly proposed a high frame rate imaging technology and analyzed its algorithm. In this article, in the experimental part, an in-depth analysis of the predictive value of the Monocyte-to-high-density lipoprotein cholesterol ratio (MHR) combined with thromboelastography parameters was performed for acute cerebral infarction. The final experimental results showed that HDL (OR = 1.695%, P-trend = 0.049) had a probability of death within 90days of hospitalization (OR = 0.81, 95% CI = 1.06-3.11, P-trend = 0.523). There were no significant differences in mortality rate after 90days. Regardless of adjusting for confounders such as age, gender, and NIHSS score, there was no significant difference in the risk of MHR or monocyte count within 90days of hospitalization. The conclusion indicates that the combination of Cmmi-MHR and thromboelastography parameters provides a new perspective and method for the diagnosis and treatment of cerebral infarction, and provides important support for personalized treatment and management of cerebral infarction.

Time-to-surgery paradigms: wait time and surgical outcomes in critically Ill patients who underwent emergency surgery for gastrointestinal perforation

BackgroundWaiting time for emergency abdominal surgery have been known to be linked to mortality. However, there is no clear consensus on the appropriated timing of surgery for gastrointestinal perforation. We investigated association between wait time and surgical outcomes in emergency abdominal surgery.MethodsThis single-center retrospective cohort study evaluated adult patients who underwent emergency surgery for gastrointestinal perforations between January 2003 and September 2021. Risk-adjusted restricted cubic splines modeled the probability of each mortality according to wait time. The inflection point when mortality began to increase was used to define early and late surgery. Outcomes among propensity-score matched early and late surgical patients were compared using percent absolute risk differences (RDs, with 95% CIs).ResultsMortality rates began to rise after 16 h of waiting. However, early and late surgery groups showed no significant differences in 30-day mortality (11.4% vs. 5.7%), ICU stay duration (4.3 ± 7.5 vs. 4.3 ± 5.2 days), or total hospital stay (17.4 ± 17.0 vs. 24.7 ± 23.4 days). Notably, patients waiting over 16 h had a significantly higher ICU readmission rate (8.6% vs. 31.4%). The APACHE II score was a significant predictor of 30-day mortality.ConclusionsAlthough we were unable to reveal significant differences in mortality in the subgroup analysis, we were able to find an inflection point of 16 h through the RCS curve technique.Trial registrationFormal consent was waived due to the retrospective nature of the study, and ethical approval was obtained from the institutional research committee of our institution (B-2110–714-107) on 6 October 2021.

Outcomes of peritoneal dialysis in cirrhosis: A systematic review and meta-analysis.

Cirrhosis and end-stage kidney disease (ESKD) are significant global health concerns, contributing to high mortality and morbidity. Haemodialysis (HD) is frequently used to treat ESKD in patients with cirrhosis. However, it often presents challenges such as haemodynamic instability during dialysis sessions, leading to less than optimal outcomes. Peritoneal dialysis (PD), while less commonly used in cirrhotic patients, raises concerns about the risks of peritonitis and mortality. Our systematic review and meta-analysis aimed to assess outcomes in PD patients with cirrhosis. We executed a comprehensive search in Ovid MEDLINE, EMBASE and Cochrane databases up to 25 September 2023. The search focused on identifying studies examining mortality and other clinical outcomes in ESKD patients with cirrhosis receiving PD or HD. In addition, we sought studies comparing PD outcomes in cirrhosis patients to those without cirrhosis. Data from each study were aggregated using a random-effects model and the inverse-variance method. Our meta-analysis included a total of 13 studies with 15,089 patients. Seven studies compared ESKD patients on PD with liver cirrhosis (2753 patients) against non-cirrhosis patients (9579 patients). The other six studies provided data on PD (824 patients) versus HD (1943 patients) in patients with cirrhosis and ESKD. The analysis revealed no significant difference in mortality between PD and HD in ESKD patients with cirrhosis (pooled odds ratio (OR) of 0.77; 95% confidence interval (CI), 0.53-1.14). In PD patients with cirrhosis, the pooled OR for peritonitis compared to non-cirrhosis patients was 1.10 (95% CI: 1.03-1.18). The pooled ORs for hernia and chronic hypotension in cirrhosis patients compared to non-cirrhosis controls were 2.48 (95% CI: 0.08-73.04) and 17.50 (95% CI: 1.90-161.11), respectively. The pooled OR for transitioning from PD to HD among cirrhotic patients was 1.71 (95% CI: 0.76-3.85). Mortality in cirrhosis patients on PD was comparable to non-cirrhosis controls, with a pooled OR of 1.05 (95% CI: 0.53-2.10). Our meta-analysis demonstrates that PD provides comparable mortality outcomes to HD in ESKD patients with cirrhosis. In addition, the presence of cirrhosis does not significantly elevate the risk of mortality among patients undergoing PD. While there is a higher incidence of chronic hypotension and a slightly increased risk of peritonitis in cirrhosis patients on PD compared to those without cirrhosis, the risks of hernia and the need to transition from PD to HD are comparable between both groups. These findings suggest PD as a viable and effective treatment option for ESKD patients with cirrhosis.

Tight Versus Liberal Blood Glucose Control in Patients With Diabetes in the ICU: A Meta-Analysis of Randomized Controlled Trials.

Introduction: Glycemia is an important factor among critically ill patients in the intensive care unit (ICU). There is conflicting evidence on the preferred strategy of blood glucose control among patients with diabetes in the ICU. We aimed to conduct a meta-analysis comparing tight with liberal blood glucose in critically ill patients with diabetes in the ICU. Methods: We systematically searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing tight versus liberal blood glucose control in critically ill patients with diabetes from inception to December 2023. We pooled odds-ratios (OR) and 95% confidence intervals (CI) with a random-effects model for binary endpoints. We used the Review Manager 5.17 and R version 4.3.2 for statistical analyses. Risk of bias assessment was performed with the Cochrane tool for randomized trials (RoB2). Results: Eight RCTs with 4474 patients were included. There was no statistically significant difference in all-cause mortality (OR 1.11; 95% CI 0.95-1.28; P = .18; I² = 0%) between a tight and liberal blood glucose control. RoB2 identified all studies at low risk of bias and funnel plot suggested no evidence of publication bias. Conclusion: In patients with diabetes in the ICU, there was no statistically significant difference in all-cause mortality between a tight and liberal blood glucose control. PROSPERO registration: CRD42023485032.