Significant Predictors Of 30-day Mortality Research Articles

Individual- and Community-Level Predictors of Hospital-at-Home Outcomes.

Advanced Care at Home is a Mayo Clinic hospital-at-home (HaH) program that provides hospital-level care for patients. The study examines patient- and community-level factors that influence health outcomes. The authors performed a retrospective study using patient data from July 2020 to December 2022. The study includes 3 Mayo Clinic centers and community-level data from the Agency for Healthcare Research and Quality. The authors conducted binary logistic regression analyses to examine the relationship among the independent variables (patient- and community-level characteristics) and dependent variables (30-day readmission, mortality, and escalation of care back to the brick-and-mortar hospital). The study examined 1433 patients; 53% were men, 90.58% were White, and 68.2% were married. The mortality rate was 2.8%, 30-day readmission was 11.4%, and escalation back to brick-and-mortar hospitals was 8.7%. At the patient level, older age and male gender were significant predictors of 30-day mortality (P-value <0.05), older age was a significant predictor of 30-day readmission (P-value <0.05), and severity of illness was a significant predictor for readmission, mortality, and escalation back to the brick-and-mortar hospital (P-value <0.01). Patients with COVID-19 were less likely to experience readmission, mortality, or escalations (P-value <0.05). At the community level, the Gini Index and internet access were significant predictors of mortality (P-value <0.05). Race and ethnicity did not significantly predict adverse outcomes (P-value >0.05). This study showed promise in equitable treatment of diverse patient populations. The authors discuss and address health equity issues to approximate the vision of inclusive HaH delivery.

Analysis of current mortality risk scores for acute type A aortic dissection: The Siena experience.

In literature, various risk scores have been described to predict in-hospital mortality of patients undergoing surgery for acute type A dissection. We want to evaluate which factors are most correlated with a negative outcome and testing the validity of the current scores in literature analyzing our experience of over 20 years in the surgery of type A aortic dissections. A total of 324 patients were included in the study. Patients were divided into two groups according to 30-day survival or mortality. The preoperative variables analyzed are the parameters necessary for the calculation of scores: Penn Classification, Leipzig Halifax and adjusted Leipzig Halifax score, GERAADA score and EuroSCORE II. Intra- and post-operative mortality were 10.2% and 17.5%, respectively. In multivariate analysis, the preoperative predictors of 30-day mortality were age greater than 70 years, low eject fraction levels, visceral and coronary malperfusion. Both GERAADA and EuroSCORE II were statistically significant predictors of 30-day mortality. However, EuroSCORE II underestimates the mortality compared to GERAADA score probably due to the lack of evaluation of fundamental preoperative factors in the course of type A aortic dissection. The study has demonstrated the efficacy of the GERAADA score in predicting the outcome of patients undergoing surgery and the underestimation of the mortality of EuroSCORE II in our population.

Relationship between blood culture time to positivity, mortality rate, and severity of bacteremia

ObjectivesWe investigated the association between patient severity or mortality and time to positivity in bacteremia caused by various pathogens. Patients and methodsThis single-center retrospective study included patients with positive blood culture results. ResultsLonger time to positivity was associated with 30-day mortality for Staphylococcus aureus (221 cases, time to positivity: 17.4 h in the 30-day mortality group vs. 14.1 h in the survival group). Age, chronic kidney disease, cerebrovascular disease, hypertensive drug use, consciousness disorder, and minimal systolic blood pressure were significant predictors of 30-day mortality. For S. aureus, mortality within 30 days was significantly higher when time to positivity was > 24 h (p = 0.04). The time to positivity of Streptococcus pneumoniae, α, β-hemolytic Streptococcus, Enterococcus sp., Enterobacteriaceae, glucose-nonfermenting Gram-negative rods, Candida sp., and anaerobe was not significantly associated with 30-day mortality. ConclusionsAmong various pathogens, time to positivity > 24 h was associated with 30-day mortality for S. aureus.

Is aggressive intravenous fluid prescription the answer to reduce mortality in severe pancreatitis? The FLIP study: Fluid resuscitation in pancreatitis.

Acute pancreatitis is an emergency presentation, which can range from mild to life threatening. Intravenous fluids are the cornerstone of management. Although the WATERFALL trial described the optimal fluid rate in mild/moderate pancreatitis, this trial excluded patients with moderate-severe/severe pancreatitis. The aim of this study was to establish clinical practice regarding intravenous fluid administration in acute pancreatitis and assess its effect on mortality. Prospective multi-centre audit of patients with acute pancreatitis was conducted. Data were collected regarding intravenous fluid administration within 72 hours of admission. The primary outcome was 30-day mortality. Multivariable logistic regression was used to identify predictors of 30-day mortality. Those with severe pancreatitis received more fluid; median 5.7 L versus 4 L in 72 hours (p = 0.003). Participants with severe pancreatitis who died within 30 days received a median of 2,750 mL in the first 24 hours, compared to 4,000 mL in those who survived. The following factors were significant predictors of 30-day mortality: age, Glasgow score, C-reactive protein, ischaemic heart disease, and pancreatitis aetiology. Overall, volume of intravenous fluid was not associated with mortality. However, the effect of intravenous fluid volume on mortality differed significantly depending on pancreatitis severity. In severe pancreatitis, increased volume of intravenous fluid was associated with significant reductions in mortality (odds ratio = 0.655; 0.459-0.936; p = 0.020). In severe pancreatitis, more aggressive fluid prescription was associated with decreased mortality; however, this was not the case in milder disease. Further prospective trials guiding fluid resuscitation in severe pancreatitis are needed, as the impact of fluid on this population appears to differ from that in those with milder disease.

Prevalence and clinical significance of deep vein thrombosis in Hispanic patients with acute pulmonary embolism.

The prevalence of concomitant deep vein thrombosis (DVT) and its impact on 30-day outcomes in Hispanic patients with acute pulmonary embolism (PE) is unknown. We retrospectively studied a cohort of Hispanic patients admitted for acute PE to determine the relationship of concomitant DVT to clot burden on chest computer tomography (CT), right heart strain, and 30-day mortality. We identified 391 patients admitted with acute PE; 168 (42.9%) had concomitant DVTs on admission; 39 patients (9.9%) died during the 30-day follow-up: 12 patients without concomitant DVT and 27 with concomitant DVT, respectively (p < .001). The presence of a proximal DVT independently predicted 30-day mortality even after adjusting for age, gender and admission PE severity index scores (PESI) (hazard ratio [HR] 2.0; 95% confidence interval [CI]: 1.4-3.0, p = .001). Proximal DVTs remained a significant predictor of 30-day mortality in patients with low and intermediate PESI scores (HR 2.5; 95% CI: 1.1-6.0, p = .035). The prevalence of concomitant DVT in Hispanic patients presenting with acute DVT is relatively lower than other ethnic groups. However, a proximal location of a DVT is of significant prognostic relevance. Hispanic patients with acute PE should routinely undergo compression doppler ultrasonography (CDUS) of the lower extremities.

A multi-institutional study of short-term mortality in COVID-positive patients undergoing hip fracture surgery: is survival better than expected?

Early reports of 30-day mortality in COVID-positive patients with hip fracture were often over 30% and were higher than historical rates of 10% in pre-COVID studies. We conducted a multi-institutional retrospective cohort study to determine whether the incidence of 30-day mortality and complications in COVID-positive patients undergoing hip fracture surgery is as high as initially reported. A retrospective chart review was performed at 11 level I trauma centers from January 1, 2020 to May 1, 2022. Patients 50years or older undergoing hip fracture surgery with a positive COVID test at the time of surgery were included. The primary outcome measurements were the incidence of 30-day mortality and complications. Post-operative outcomes were reported using proportions with 95% confidence interval (C.I.). Forty patients with a median age of 71.5years (interquartile range, 50-87years) met the criteria. Within 30-days, four patients (10%; 95% C.I. 3-24%) died, four developed pneumonia, three developed thromboembolism, and three remained intubated post-operatively. Increased age was a statistically significant predictor of 30-day mortality (p = 0.01), with all deaths occurring in patients over 80years. In this multi-institutional analysis of COVID-positive patients undergoing hip fracture surgery, 30-day mortality was 10%. The 95% C.I. did not include 30%, suggesting that survival may be better than initially reported. While COVID-positive patients with hip fractures have high short-term mortality, the clinical situation may not be as dire as initially described, which may reflect initial publication bias, selection bias introduced by testing, or other issues. Therapeutic Level III.

Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

BackgroundThis study analyzed mortality after radiotherapy for bone metastases (287 courses). Endpoints such as treatment in the last month of life and death within 30, 35 and 40 days from start of radiotherapy were evaluated.MethodsDifferent baseline parameters including but not limited to blood test results and patterns of metastases were assessed for association with early death. After univariate analyses, multi-nominal logistic regression was employed.ResultsOf 287 treatment courses, 42 (15%) took place in the last month of life. Mortality from start of radiotherapy was 13% (30-day), 15% (35-day) and 18% (40-day), respectively. We identified three significant predictors of 30-day mortality (performance status (≤ 50, 60–70, 80–100), weight loss of at least 10% within 6 months (yes/no), pleural effusion (present/absent)) and employed these to construct a predictive model with 5 strata and mortality rates of 0–75%. All predictors of 30-day mortality were also associated with both, 35- and 40-day mortality.ConclusionEarly death was not limited to the first 30 days after start of radiotherapy. For different cut-off points, similar predictive factors emerged. A model based on three robust predictors was developed.

Preoperative Laboratory Values Are Predictive of Adverse Postoperative Outcomes in Patients Older Than 65 Years Undergoing Brain Tumor Resection: A National Surgical Quality Improvement Program Study

In this study, we used a large national database to assess the effect of preoperative laboratory value (PLV) derangements on postoperative outcomes in patients older than 65 years undergoing brain tumor resection. Data was collected for patients >65 years old undergoing brain tumor resection from 2015 to 2019 (N= 10,525). Univariate and multivariate analysis were performed for 11 PLVs and 6 postoperative outcomes. Hypernatremia (odds ratio [OR], 4.707; 95% confidence interval [CI], 1.695-13.071; P < 0.01) and increased creatinine level (OR, 2.556; 95% CI, 1.291-5.060; P < 0.01) were the most significant predictors of 30-day mortality. The most significant predictor of Clavien-Dindo grade IV complications was increased creatinine level (OR, 1.667; 95% CI, 1.064-2.613; P < 0.05), whereas, significant predictors of major complications were hypoalbuminemia (OR, 1.426; 95% CI, 1.132-1.796; P < 0.05) and leukocytosis (OR, 1.347; 95% CI, 1.075-1.688; P < 0.05). Predictors of readmission were anemia (OR, 1.326; 95% CI, 1.047-1.680; P < 0.05) and thrombocytopenia (OR, 1.387; 95% CI, 1.037-1.856; P < 0.05), whereas, hypoalbuminemia (OR, 1.787; 95% CI, 1.280-2.495; P < 0.001) was predictive of reoperation. Increased partial thromboplastin time and hypoalbuminemia were predictors of extended length of stay (OR, 2.283, 95% CI, 1.360-3.834, P < 0.01 and OR, 1.553, 95% CI, 1.553-1.966, P < 0.001, respectively). Hypernatremia (OR, 2.115; 95% CI, 1.181-3.788; P < 0.05) and hypoalbuminemia (OR, 1.472; 95% CI, 1.239-1.748; P < 0.001) were the most significant predictors of NHD. Seven of 11 PLVs were associated with adverse postoperative outcomes. PLV derangements were significantly associated with adverse postoperative outcomes in patients older than 65 years undergoing brain tumor resection. The most significant predictors of adverse postoperative outcomes were hypoalbuminemia and leukocytosis.

Characteristics and outcomes for patients undergoing revisional bariatric surgery due to persistent obesity: a retrospective cohort study of 10,589 patients.

Revisional bariatric surgery in an option for patients who experience weight regain or inadequate weight loss after primary elective bariatric procedures. However, there is conflicting data on safety outcomes of revisional procedures. We aim to characterize patient demographics, procedure type, and safety outcomes for those undergoing revisional compared to initial bariatric interventions to guide management of these patients. The 2020 Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) registry was analyzed, comparing primary elective to revisional bariatric procedures for inadequate weight loss. Bivariate analysis was performed to determine between group differences. Multivariable logistic regression determined factors associated with serious complications or mortality. We evaluated 158,424 patients, including 10,589 (6.7%) revisional procedures. Patients undergoing revisional procedures were more like to be female (85.5% revisional vs. 81.0% initial; p < 0.001), had lower body mass index (43.6 ± 7.8kg/m2 revisional vs. 45.2 ± 7.8kg/m2 initial; p < 0.001), and less metabolic comorbidities than patients undergoing primary bariatric surgery. The most common revisional procedures were Roux-en-Y gastric bypass (48.4%) and sleeve gastrectomy (32.5%). Revisional procedures had longer operative duration compared to primary procedures. Patients undergoing revisional procedures were more likely to experience readmission to hospital (4.8% revisional vs. 2.9% initial; p < 0.001) and require reoperation (2.4% revisional vs. 1.0% initial; p < 0.001) within 30days of the procedure. Revisional procedures were independently associated with increased serious complications (OR 1.49, CI 1.36-1.64, p < 0.001) but were not a significant predictor of 30-day mortality (OR 0.74, CI 0.36-1.50, p = 0.409). In comparison to primary bariatric surgery, patients undergoing revisional procedures have less metabolic comorbidities. Revisional procedures have worse perioperative outcomes and are independently associated with serious complications. These data help to contextualize outcomes for patients undergoing revisional bariatric procedures and to inform decision making in these patients.

Incidence and Clinical Characteristics of Anaerobic Bacteremia at a University Hospital in Hungary: A 5-Year Retrospective Observational Study.

Strict anaerobes have been reported to account for 0.5–13% of episodes of bacteremia in the adult population, with a growing awareness among clinicians regarding anaerobic bacteremia, especially in patients with specific predisposing factors. The aim of our present study was to assess the incidence and clinical characteristics of anaerobic bacteremia during a 5-year period (2016–2020) at a tertiary care teaching hospital, and to compare our findings with other studies in Hungary. Overall, n = 160 strict anaerobes were detected, out of which, 44.4% (n = 71; 0.1% of positive blood cultures, 0.1/1000 hospitalizations, 3.3/100,000 patient days) were clinically significant, while Cutibacterium spp. accounted for 55.6% (n = 89) of isolates. Among relevant pathogens, the Bacteroides/Parabacteroides spp. group (32.4%; n = 23), Clostridium spp. (22.5%; n = 16) and Gram-positive anaerobic cocci (15.5%; n = 11) were the most common. The mean age of patients was 67.1 ± 14.1 years, with a male majority (59.2%; n = 42). A total of 38.0% of patients were affected by a malignancy or immunosuppression, while an abscess was identified in 15.5% of cases. A total of 74.7% (n = 53) of patients received antibiotics prior to blood culture sampling; in instances where antimicrobials were reported, anaerobic coverage of the drugs was appropriate in 52.1% (n = 37) of cases. The 30-day crude mortality rate was 39.4% (n = 28); age ≥ 75 years was a significant predictor of 30-day mortality (OR: 5.0; CI: 1.8–14.4; p = 0.003), while malignancy and immunosuppression, lack of anti-anaerobic coverage or female sex did not show a significant relationship with the mortality of these patients. Early recognition of the role played by anaerobes in sepsis and timely initiation of adequate, effective antimicrobial treatment have proven efficient in reducing the mortality of patients affected by anaerobic bacteremia.

SP10.2.1 The FLIP Study – Fluid Resuscitation in Pancreatitis

Abstract Aim Acute pancreatitis (AP) is an emergency surgical presentation which can range in severity from mild to life-threatening. Intravenous fluids are the cornerstone of management. However, there is poor quality evidence regarding optimal intravenous fluid administration. We aimed to establish clinical practice regarding intravenous fluid administration in AP and the effect this has on mortality. Methods Prospective multi-centre audit of patients with AP. Data was collected on intravenous fluid administration within 72-hours of admission. Primary outcome was 30-day mortality and multivariable logistic regression was used to identify predictors of this. Results 254 participants were included. Volume of intravenous fluid delivered over the first three days (median and range) are as follows; Day 1=2L (0–10.5L), Day 2=1L (0–5L), Day 3=0L (0–7.5L). Those with severe pancreatitis (Glasgow score&amp;gt;=3) received more fluid; median 5.7L versus 4L in 72hrs (P=0.003). The following factors were significant predictors of 30-day mortality in our multivariable model: age, Glasgow score, CRP, IHD and pancreatitis aetiology. Overall, volume of intravenous fluid was not associated with mortality in this model (adjusted OR=0.932;0.766–1.134;P=0.483). However, the effect of intravenous fluid volume on mortality differed significantly depending on pancreatitis severity (interaction term P=0.042). In the severe pancreatitis group increased volume of intravenous fluid was associated with significant reductions in mortality (OR=0.655;0.459–0.936;P=0.020). Conclusion In severe pancreatitis more aggressive fluid prescribing is associated with decreased mortality. This is not the case in milder disease. The lack of published literature regarding the impact of fluid regime on outcomes in acute pancreatitis is reflected by the variation of fluid prescribing.

Predictors of all-cause mortality for patients undergoing transvenous lead extraction

Abstract Funding Acknowledgements Type of funding sources: None. Background Risk assessment of TLE patients may be challenging due to incomplete knowledge about possible risk factors for post-TLE outcomes. The aim of this study was to identify predictors of 30-day and 1-year mortality in a large retrospective series of patients undergoing TLE at a high-volume centre. Methods Medical journals of 893 consecutive patients undergoing TLE between January 1, 2010 and December 31, 2018 were analysed. Univariate logistic regression analysis was performed to identify risk factors. Results A total of 893 patients were identified. Local infection was the dominant TLE indication (40.5%), and pacemaker was the most common CIED (49.4%). Mean age was 65 + 16 years and 73.0% were males. The median follow up was 3.9 years (IQR, 2.0-6.4 years). Staphylococcus aureus was the most common microorganism found in blood cultures of the systemic infection group (39.9%). A total of 179 (69.4%) systemic infection patients had vegetations on echocardiography, where majority engaged the lead(s). The 30-day and 1 year mortality rates were 2.5% (86.4% had systemic infection) and 9.7% (64.4% had systemic infection), respectively. Per-procedural mortality occurred in 1 patient with systemic infection. Significant predictors of 30-day mortality were low haemoglobin, systemic infection as TLE-indication, clinical frailty scales (CFS) 5-7 and stage 5 chronic kidney disease (CKD). In case of 1-year mortality, age, CRT-P/D (vs ICD), reduced ejection fraction, anaemia, BMI &amp;lt;25 kg/m2, CFS 4-7 and CKD stages 3-5 were identified as significant predictors. In the systemic infection subgroup, elevated white blood cell (WBC) count was associated with 30-day and 1 year mortality. Additionally CRP interval 200-300, low WBC count and WBC interval 8.8-15 correlated signigicantly with 1-year mortality within the systemic infection cohort. In the local infection subgroup, a significant correlation between CRP interval 100-150 and 1-year mortality was found. Conclusions Systemic infection as TLE-indication carries a high 30-days post-TLE all-cause mortality rate and is significantly correlated with short and long-term mortality, where elevated inflammatory parameters carried additional mortality risk in this subgroup. Anaemia, chronic kidney disease, CRT compared to ICD, reduced EF and patient-related features as high clinical frailty scale levels and BMI &amp;lt;25 kg/m2 predicted worse prognosis in the entire TLE-cohort.

Artículo traducido] Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco)

ObjectivesCompare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. DesignRetrospective comparative study. SettingThree university hospitals in Biscay province (Basque Country, Spain). Patients77 patients over 65 years-old with PFF (AO 31-A and 31-B). InterventionStudy conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. Main outcome measurements30-Day mortality rate and risk factors for mortality. ResultsOf a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. ConclusionsSARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality. Level of evidenceLevel III study.

Inflammatory biomarkers are not useful for predicting prognosis in nursing and healthcare-associated pneumonia: A prospective, cohort study

IntroductionWhether inflammatory biomarkers including procalcitonin (PCT) and C-reactive protein (CRP) are useful for predicting prognosis in nursing and healthcare-associated pneumonia (NHCAP) is unknown. The aim of the present study was to investigate the utility of serial PCT and CRP measurements for predicting prognosis and treatment efficacy for hospitalized NHCAP patients. MethodsThis prospective, observational, cohort study enrolled consecutive NHCAP patients hospitalized at Kurashiki Central Hospital from October 2010 to September 2017. PCT and CRP were measured twice, once on admission and again within 48–72 h after admission. The primary outcome was 30-day all-cause mortality, and the secondary outcome was initial treatment failure. ResultsA total of 299 patients were included. The 30-day mortality rate was 8.4% (25/299), and the initial treatment failure rate was 15.4% (46/299). On multivariate analysis, performance status [odds ratio (OR) (95% confidence interval (CI)): 2.25 (1.34–3.77), P = 0.002], temperature [OR (95%CI): 0.53 (0.32–0.88), P = 0.02], heart rate [OR (95%CI): 1.03 (1.01–1.06), P = 0.007], albumin [OR (95%CI): 0.42 (0.18–0.95), P = 0.04], and blood urea nitrogen [OR (95%CI): 1.02 (1.00–1.05), P = 0.04] were significant prognostic factors, and CRP D3 [OR (95%CI): 1.07 (1.02–1.11), P = 0.003] and PSI [OR (95%CI): 1.01 (1.00–1.02), P = 0.01] were the predictors of initial treatment failure. Consecutive measurements of PCT and CRP were not significant predictors of 30-day mortality. ConclusionsInflammatory biomarkers including PCT and CRP were not useful for predicting prognosis and treatment efficacy in NHCAP patients. We should carefully evaluate the patients’ vital signs and comorbidities when managing NHCAP patients.

Short- and long-term predictive power of the preoperative Geriatric Assessment components in older cancer patients undergoing high-risk abdominal surgery

IntroductionThe pathological stage of the cancer and presence of postoperative complications are the most important predictors of survival in older oncologic patients. Therefore, determining biological age, and risks connected with it, should be the key factor in the preoperative assessment. It may be accomplished by using a Geriatric Assessment (GA). However, it is not established which components are most useful for predicting short- and long-term postoperative outcomes in cancer patients undergoing high-risk abdominal surgery. Materials and methodsA total of 334 consecutive cancer patients aged ≥70 years underwent elective abdominal surgery and were followed-up prospectively for 12 months. The preoperative GA consisted of eight domains: functional, physical activity, comorbidity, polypharmacotherapy, nutritional, cognition, mood, and social support. Logistic regression analyses were used to analyse the predictive ability. ResultsAll components of GA were independent risk factors of 30-day major morbidity apart from ADL, BOMC, Polypharmacy (OR 0.6–1.3; p < 0.001). However, ADL, TUG, the polypharmacy and the MOS-SSS turned out to be significant predictors of 30-day mortality (OR 0.72–1.46; p < 0.001). In turn, only ADL, CDT and MOS-SSS were valid predictors of 12-months mortality (OR 0.46–0.85; p < 0.001). Frailty (surrogate of the biological age), not the chronological age, were also independent predictors of all outcomes (OR 4.71–8.56 p < 0.001). ConclusionNot the chronological age but components of GA and frailty are significant predictors of both 30-day postoperative outcome and 12-months mortality in older cancer patients undergoing high-risk abdominal surgery.

Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country)

ObjectivesCompare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. DesignRetrospective comparative study. SettingThree university hospitals in Biscay province (Basque Country, Spain). Patients: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). InterventionStudy conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. Main outcome measurements30-day mortality rate and risk factors for mortality. ResultsOf a total 77 patients, 10 were diagnosed with SARS CoV-2 infection. Mean age was 85 years. Patients with SARS-Cov-2 infection had higher BMI (29.53kg/m2) compared to patients without infection (24.09kg/m2) (p=0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p<0.001). Thirty-days mortality was higher (p=0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥91 years-old, ASA class IV and BMI >25kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. ConclusionsSARS CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality.

Prevalence and Impact of Metabolic Syndrome on Short-Term Prognosis in Patients with Acute Coronary Syndrome: Prospective Cohort Study

PurposeDespite the increasing burden of metabolic syndrome (MS) and ischemic heart disease in sub-Saharan Africa, data on the prevalence of MS among patients with acute coronary syndrome (ACS) from the regions are limited. Hence, this study is aimed to evaluate the prevalence and impact of MS on 30-day all-cause mortality in patients hospitalized with ACS.Patients and MethodsWe prospectively assessed 176 ACS patients, who were admitted to two tertiary hospitals in Ethiopia. MS was diagnosed based on a harmonized definition of MS. In-hospital major adverse cardiovascular events (MACE) and 30-day mortality were recorded. Multivariable cox-regression was used to identify predictors of 30-day mortality.ResultsAmong 176 ACS patients enrolled, 62 (35.2%) had MS. Majority of the patients (62.5%) were male with the mean age of 56±11.9 years. ACS patients with MS were older, presented with atypical symptoms, and they had history of hypertension, diabetes, dyslipidemia and coronary artery disease compared to those without MS. MS was also significantly associated with in-hospital MACE (30.6% vs 17.5%; p= 0.046) and 30-day mortality [adjusted hazard ratio (AHR) = 3.25, 95% CI=1.72–6.15]. The other significant predictors of 30-day mortality were pre-hospital delay >12h (HR= 4.32, 95% CI=1.68–11.100), killip class ≥2 (HR=10.7, 95% CI= 2.54–44.95), and ejection fraction <40 (HR= 2.59 95% CI=1.39–4.84).ConclusionThe prevalence of MS among patients with ACS in Ethiopia is high. MS was significantly associated with high in-hospital MACE and it was an independent predictor of 30-day mortality. Initiating appropriate strategies on MS prevention and timely diagnosis of MS components could decrease the burden of ACS and improve patient’s outcome.

Analysis of Predictors of 30-Day Mortality for Patients Undergoing Surgical Repair of Post-Myocardial Infarction Ventricular Septal Defect

Aims: Despite the existence of numerous studies devoted to predictors of 30-day mortality in patients with post-myocardial infarction (MI) ventricular septum defect (VSD), the choice of surgical treatment tactics for post-MI VSD remains an item of discussion. The purpose of the research was to determine the most significant risk factors of 30-day mortality in patients with post-MI VSD in order to optimize the tactics of such patients’ surgical repair.&#x0D; Study design: The retrospective analysis of the results of a comprehensive examination and surgical treatment of 88 in-patients with post-MI VSD for the period of 2002-2019 was carried out.&#x0D; Results: As follows of the research findings, independent predictors of 30-day mortality in patients with post-MI VSD were determined. The predictors identified were combined into a Scoring system to stratify the risk of surgical failure in patients with post-MI VSD. Modelling the surgery outcomes makes it possible to optimize the tactics of surgical treatment of patients with post-MI VSD.&#x0D; Conclusion: we have identified the most significant predictors of 30-day mortality in patients with post-MI VSD. The Score designed for mortality risk assessment is easy in use compared to other existing tools used in clinical practices when planning the surgical intervention in post-MI VSD patients. This Score may allow the stratification of post-MI VSD patients.

Improvement in Midline Shift Is a Positive Prognostic Predictor for Malignant Middle Cerebral Artery Infarction Patients Undergoing Decompressive Craniectomy.

Objective: The aim of this retrospective study is to evaluate the risk factors of malignant middle cerebral artery infarction (MMCAI) patients and explore an applicable prognostic predictor for MMCAI patients undergoing decompressive craniectomy (DC).Methods: Clinical data from the period 2012–2017 were retrospectively evaluated. Forty-three consecutive MMCAI patients undergoing DC were enrolled in this study. The 30-day mortality was assessed, and age, location, hypertension, pupil dilation, onset to operation duration, midline shift, and Glasgow Coma Scale (GCS) score were identified by univariate analysis and binary logistic regression.Results: In this retrospective study for DC patients, the 30-day mortality was 44.2%. In the univariate analysis, advanced age (≥60 years), right hemispheric location, hypertension, pupil dilation, shorter onset to operation duration (<48 h), improved midline shift (t = 4.214, p < 0.01), and lower pre-operation GCS score were significant predictors of death within 30 days. In binary logistic regression analysis, age [odds ratio (OR) = 1.141, 95% CI 1.011–1.287], the improvement of the midline shift (OR = 0.764, 95% CI 0.59–0.988), and pupillary dilation (OR = 15.10, 95% CI 1.374–165.954) were independent influencing factors. For the receiver operating characteristic (ROC) analysis of the relationship between post-operation outcomes and midline shift improvement, the area under the curve (AUC) was 0.844, and the cutoff point of midline shift improvement was 0.83 cm.Conclusion: Improved midline shift was a significant predictor of 30-day mortality. The improved midline shift of >0.83 cm indicated survival at 30 days.

Patient characteristics and cardiac surgical outcomes at a tertiary care hospital in Kenya, 2008-2017: a retrospective study.

BackgroundCardiac surgeries are high risk procedures that require specialized care and access to these procedures is often limited in resource-poor countries. Although fatalities for surgical patients across Africa are twice that of the global rate, cardiac surgical mortality continent-wide is only slightly higher than all-surgical mortality. Understanding demographic and health characteristics of patients and the associations of these characteristics with morbidity and mortality events is important in guiding care decisions. Therefore, the objectives of this study were to: (a) describe the characteristics of cardiac surgical patients; (b) identify the associations between these characteristics and morbidity and mortality events following cardiac surgery.MethodsPatient characteristics and post-surgical complications were abstracted for all cardiac surgical patients treated at a tertiary care hospital in Kenya from 2008 to 2017. Descriptive analyses of demographic factors, co-morbidities, peri-operative conditions, and post-surgical complications were conducted for adult and pediatric patients. Cochran-Armitage trend test was used to assess temporal trends in risk of death. Multivariable ordinary logistic and Firth logistic models were used to investigate predictors of surgical outcomes.ResultsThe study included a total of 181 patients (150 adult and 31 pediatric patients). Most (91.3%) adult patients had acquired conditions while 45.2% of the pediatric patients had congenital defects. Adult patients tended to have co-morbid conditions including hypertension (16.7%), diabetes mellitus (7.3%), and nephropathy (6.7%). Most patients (76.0% adults and 96.8% pediatric patients) underwent ≤ 2 surgical procedures during their hospital stay. Seventy percent of adult and 54.8% of the pediatric patients experienced at least one post-surgical complication including mediastinal hemorrhage, acute kidney injury and death. Patient characteristics played the greatest roles in predicting post-surgical complications. For adult patients, significant predictors of acute kidney injury included atrial fibrillation (OR = 18.25; p = .001), mitral valve replacement (OR = 0.14; p = .019), and use of cardiopulmonary bypass (OR = 0.06; p = .002). Significant predictors of 30-day mortality were age (OR = 1.05; p = .015) and atrial fibrillation (OR = 4.12, p = .018). Although the number of surgeries increased over the decade-long study period, there were no significant (p = .467) temporal trends in the risk of death.ConclusionsAwareness of demographic and peri-surgical factors that are predictors of complications is useful in guiding clinical decisions to reduce morbidity and mortality. Identification of co-morbidities as the most useful predictors of post-surgical complications suggests that patient characteristics may be a larger contributor to the incidence of complications than surgical practices.