Significant Predictors Of In-hospital Mortality Research Articles

Prognostic significance of preoperative osteosarcopenia on patient' outcomes after emergency surgery for gastrointestinal perforation.

Sarcopenia is a prognostic predictor in emergency surgery. However, there are no reports on the relationship between osteopenia and in-hospital mortality. This study clarified the effect of preoperative osteosarcopenia on patients with gastrointestinal perforation after emergency surgery. We included 216 patients with gastrointestinal perforations who underwent emergency surgery between January 2013 and December 2022. Osteopenia was evaluated by measuring the pixel density in the mid-vertebral core of the 11th thoracic vertebra. Sarcopenia was evaluated by measuring the area of the psoas muscle at the level of the third lumbar vertebra. Osteosarcopenia is defined as the combination of osteopenia and sarcopenia. Osteosarcomas were identified in 42 patients. Among patients with osteosarcopenia, older and female patients and those with an American Society of Anesthesiologists Physical Status of ≥ 3 were significantly more common, and the body mass index, hemoglobin value, and albumin level were significantly lower in these patients than in patients without osteosarcopenia. Furthermore, the osteosarcopenia group presented with more postoperative complications than patients without osteosarcopenia (P < 0.01). In the multivariate analysis, age ≥ 74years old (P = 0.04) and osteosarcopenia (P = 0.04) were independent and significant predictors of in-hospital mortality. Preoperative osteosarcopenia is a risk factor of in-hospital mortality in patients with gastrointestinal perforation after emergency surgery.

Development of Biomarkers and Prognosis Model of Mortality Risk in Patients with COVID-19.

As of 30 April 2023, the COVID-19 pandemic has resulted in over 6.9 million deaths worldwide. The virus continues to spread and mutate, leading to continuously evolving pathological and physiological processes. It is imperative to reevaluate predictive factors for identifying the risk of early disease progression. A retrospective study was conducted on a cohort of 1379 COVID-19 patients who were discharged from Xin Hua Hospital affiliated with Shanghai Jiao Tong University School of Medicine between 15 December 2022 and 15 February 2023. Patient symptoms, comorbidities, demographics, vital signs, and laboratory test results were systematically documented. The dataset was split into testing and training sets, and 15 different machine learning algorithms were employed to construct prediction models. These models were assessed for accuracy and area under the receiver operating characteristic curve (AUROC), and the best-performing model was selected for further analysis. AUROC for models generated by 15 machine learning algorithms all exceeded 90%, and the accuracy of 10 of them also surpassed 90%. Light Gradient Boosting model emerged as the optimal choice, with accuracy of 0.928 ± 0.0006 and an AUROC of 0.976 ± 0.0028. Notably, the factors with the greatest impact on in-hospital mortality were growth stimulation expressed gene 2 (ST2,19.3%), interleukin-8 (IL-8,17.2%), interleukin-6 (IL-6,6.4%), age (6.1%), NT-proBNP (5.1%), interleukin-2 receptor (IL-2R, 5%), troponin I (TNI,4.6%), congestive heart failure (3.3%) in Light Gradient Boosting model. ST-2, IL-8, IL-6, NT-proBNP, IL-2R, TNI, age and congestive heart failure were significant predictors of in-hospital mortality among COVID-19 patients.

In-hospital outcome and its predictors among patients with acute cardiogenic pulmonary oedema at a tertiary hospital in Harar, Eastern Ethiopia: a retrospective cohort study.

Acute cardiogenic pulmonary oedema is highly associated with poor in-hospital outcomes. This study aimed to determine the in-hospital outcome and its predictors among patients with acute cardiogenic pulmonary oedema at a tertiary hospital in Harar, Eastern Ethiopia, from May 1 to 20, 2023. A retrospective cohort study was employed among 204 patients with acute cardiogenic pulmonary oedema who were admitted between 1st May 2018 and 30th April 2023. The collected data were entered into Excel, and analysed using theSTATA software version 17. The hazard ratio with its 95% confidence interval was used and a P-value < 0.05 was considered a statistically significant association. The overall mortality rate was 17.60 (95% CI: 11.59-26.72) per 1000 person-day observation with mean (±SD) time to death was 2.88 (±2.06) days. Age (AHR: 1.35; 95% CI: 1.04-1.74 for every 10 years), being smoker (AHR: 3.26; 95% CI: 1.05-10.10), having respiratory rate of ≥40 breaths per minute (AHR: 5.46; 95% CI: 1.71-17.45), and having anaemia (AHR: 4.35; 95% CI: 1.23-15.33) were significant predictors of in-hospital mortality. More than one in ten patients in this study died in the hospital. Therefore, special attention needs to be considered for patients with those predictors of in-hospital mortality.

Platelet-to-Lymphocyte Ratio (PLR), Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), and Eosinophil-to-Lymphocyte Ratio (ELR) as Biomarkers in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD).

The study comprehensively evaluated the prognostic roles of the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), basophil-to-lymphocyte ratio (BLR), and eosinophil-to-lymphocyte ratio (ELR) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Six hundred and nineteen patients with AECOPD and 300 healthy volunteers were retrospectively included into the study. The clinical characteristics of the patients with AECOPD and the complete blood counts (CBCs) of the healthy volunteers were collected. The associations of PLR, NLR, MLR, BLR, and ELR with airflow limitation, hospital length of stay (LOS), C-reactive protein (CRP), and in-hospital mortality in patients with AECOPD were analyzed. Compared with the healthy volunteers, PLR, NLR, MLR, BLR, and ELR were all elevated in COPD patients under stable condition. PLR, NLR, MLR, and BLR were further elevated while ELR was lowered during exacerbation. In the patients with AECOPD, PLR, NLR, and MLR were positively correlated with hospital LOS as well as CRP. In contrast, ELR was negatively correlated with hospital LOS as well as CRP. Elevated PLR, NLR, and MLR were all associated with more severe airflow limitation in AECOPD. Elevated PLR, NLR, and MLR were all associated with increased in-hospital mortality while elevated ELR was associated with decreased in-hospital mortality. Binary logistic regression analysis showed that smoking history, FEV1% predicted, pneumonia, pulmonary heart disease (PHD), uric acid (UA), albumin, and MLR were significant independent predictors ofin-hospital mortality. These predictors along with ELR were used to construct a nomogram for predicting in-hospital mortality in AECOPD. The nomogram had a C-index of 0.850 (95% CI: 0.799-0.901), and the calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) further demonstrated its good predictive value and clinical applicability. In summary, PLR, NLR, MLR, and ELR served as useful biomarkers in patients with AECOPD.

Morbidity and In-Hospital Mortality in Diabetic Patients Undergoing Cardiac Surgery: A Retrospective Cohort Study

Objective: To evaluate the impact of diabetes mellitus (DM) in hospital mortality and morbidity after cardiac surgery. Materials and Methods: The authors performed a retrospective cohort study in a tertiary medical center. One thousand two hundred fifteen patients had cardiac surgery between June 2015 and July 2021, divided into two groups, 824 non-diabetic, and 391 diabetic patients. Results: In-hospital mortality rates were comparable in diabetic and non-diabetic patients at 7.2% versus 6.6% (p=0.786). However, chronic kidney disease, high American Society of Anesthesiologists physical status, preoperative arrhythmias, and non-valvular surgery were statistically significant predictors of in-hospital mortality. In-hospital morbidities were higher in diabetic patients compared with non-diabetic patients (p&lt;0.001) with neurological complications at 11.3% versus 7% (p=0.018), pulmonary complications at 57.5% versus 37.9% (p&lt;0.001), renal complications at 39.4% versus 17.2% (p&lt;0.001), infectious complications at 15.9% versus 7.3% (p&lt;0.001), and arrhythmias at 26.6% versus 17.6 (p&lt;0.001). After risk adjustment, DM remained a risk factor for postoperative arrhythmias with an odds ratio of 1.63 (p=0.005), neurological complications with an odds ratio of 2.03 (p=0.007), pulmonary complications with an odds ratio of 1.96 (p&lt;0.001), infectious complications with an odds ratio of 2.76 (p&lt;0.001), and renal complications with an odds ratio of 2.78 (p&lt;0.001). Conclusion: Diabetic and non-diabetic patients have similar in-hospital mortality rates. DM was an independent predictor for postoperative complications. Keywords: Diabetic mellitus; Cardiac surgery; Mortality; Postoperative complications

Predictors of Non-invasive Ventilation Failure and Associated Factors Among the COVID-19 Patients Admitted to Intensive Care Unit.

Non-invasive ventilation (NIV) is a method of oxygenation supply that eliminates the need for an endotracheal airway. Non-invasive ventilation failure is defined as the necessity for endotracheal intubation or death during the NIV trial. This study aimed to identify the predictors and associated factors of NIV failure in coronavirus disease 2019 (COVID-19) patients admitted to an intensive care unit (ICU). This retrospective, longitudinal cohort study utilized electronic medical records of COVID-19 patients admitted to the ICU. A total of 150 patients were included in the study. Patient demographics, medical history, laboratory tests, partial pressure of carbon dioxide (PCO2), oxygen saturation (SpO2), heart rate, acidosis, consciousness, oxygenation, and respiratory rate (HACOR score), and the ratio of oxygen saturation (ROX) index (the SpO2/fraction of inspired oxygen [FIO2] to respiratory rate [SF] ratio) were recorded. Non-invasive ventilation failure was determined based on the need for endotracheal intubation or cardiac-respiratory arrest while on NIV. Of 150 patients, 55.3% were male (mean age: 55.9 years), with an NIV failure rate of 67.3%, a mortality rate of 66.7%, and 3.3% of patients requiring tracheostomy after NIV failure. The ROX index consistently decreased over time, and an increase in the HACOR score and PCO2 after 6 hours of commencing NIV were the predictors of NIV failure. Additionally, higher levels of lactate dehydrogenase, lower SF ratios, and higher APACHE scores upon ICU admission were significantly associated with NIV failure. Notably, the erythrocyte sedimentation rate (ESR) as an inflammatory index, SF ratio upon ICU admission, HACOR score, ROX index, and PCO2 after 12 hours were significant predictors of in-hospital mortality in patients receiving NIV. The ROX index, HACOR scale, and PCO2 are significant predictors of both NIV failure and in-hospital mortality.

The burden of head trauma in rural and remote North Queensland, Australia

BackgroundHead trauma is a leading cause of death and disability worldwide. Young males, Indigenous people, and rural/remote residents have been identified as high-risk populations for head trauma, however, Australian research is limited. Our aim was to define and describe the incidence, demographics, causes, prehospital interventions, and outcomes of head trauma patients transported by aeromedical services within North Queensland, Australia. We hypothesized that young, Indigenous males living remotely would be disproportionately affected by head trauma. MethodsWe conducted a retrospective study of all head trauma patients transferred by air to or between Townsville, Cairns, Mount Isa and Mackay Hospitals between January 1, 2016 and December 31, 2018. Patients were identified from the Trauma Care in the Tropics data registry and followed for a median 30-months post-injury. Primary endpoints were patient and injury characteristics. Secondary outcome measures were hospital stay and mortality. ResultsA total of 981 patients were included and 31.1 % were Indigenous. Sixty-seven percent of injuries occurred remotely and the median time from injury to hospital was 5.8-hours (range 67–3780 min). Eighty percent of severe head injuries occurred in males (p = 0.007). Indigenous and remote patients were more likely to sustain mild injuries. The most common mechanism of injury overall was vehicle accident (37.5 %), compared to assault in the Indigenous subgroup (46.6 %, p<0.001). The overall mortality rate was 4.9 %, with older age and lower initial Glasgow Coma Score significant predictors of in-hospital mortality. Prehospital intubation was associated with a 7-fold increased risk of mortality (p = 0.056), while patients that received tranexamic acid (TXA) were almost 5-times more likely to die. ConclusionsIn North Queensland, young Indigenous males are at highest risk of traumatic head injuries. Vehicle accidents are an important preventable cause of head injury in the region. TXA administration is an important consideration for remote head trauma retrievals, in which time to emergency care is prolonged. Appropriate treatment and risk stratification strategies considering time to definitive care, severity of injury, and other prehospital patient factors require further investigation.

Morbidity and mortality among neonates with esophageal atresia and/or tracheoesophageal fistula in the United States.

Although rare, esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) can lead to severe morbidity and mortality. A known complication of EA and/or TEF repair is vocal fold motion impairment (VFMI). To characterize the prevalence of VFMI among repaired EA and/or TEF at a national level and to identify factors associated with in-patient mortality and common clinical endpoints in this population (tracheostomy and gastrostomy tube dependence). This is a retrospective cohort study of inpatient neonate admissions with EA and/or TEF in the 2016 Kids' Inpatient Database (KID). Patients with a history of EA and/or TEF were identified with ICD-10 codes. VFMI prevalence was assessed by observed frequencies and percentages. Clinical endpoints included gastrostomy (G-)tube placement, tracheostomy status, and inpatient mortality. Potential predictors of these three primary outcomes included cardiac anomalies, airway disorders, chromosomal anomalies, surgery within 24h of admission, prematurity, and low birthweight (LBW). Chi-squared analysis was performed between each parameter and the primary outcomes. Significant associations (p-value<0.05) were further assessed with multivariate logistic regression. Of 1062 neonates with history of EA and/or TEF, 24 (2.3%) had VFMI. Among this population, 27 patients underwent tracheostomies and 63 required G-tubes. There was a significantly higher likelihood of tracheostomy in patients with VFMI compared to patients without (16.7% versus 2.2%; p<0.01). After multivariate analysis, birthweight less than 1.5kg (BW<1.5kg; OR=2.5, 95% CI: 1.03-6.10), extreme prematurity (OR=7.5, 95% CI: 2.00-28.07), cardiac anomalies (OR=1.8, 95% CI: 1.01-3.04) and chromosomal anomalies (OR=4.2, 95% CI: 2.39-7.44) were significantly associated with in-hospital mortality. Bronchopulmonary dysplasia (BPD; OR=4.7, 95% CI: 1.73-12.78) and BW<1.5kg (OR=2.4, 95% CI: 1.05-5.49) were significant predictors for G-tube status. For tracheostomy, BPD (OR=15.8, 95% CI: 4.70-52.83) and subglottic stenosis (SS, OR=11.2, 95% CI: 1.85-68.02) remained significant predictors after multivariate regression. The national prevalence of VFMI among neonates following EA and/or TEF repair was 2.3% and was associated with an increased likelihood of tracheostomy in the KID 2016. Significant predictors of in-hospital mortality were cardiac anomalies, chromosomal anomalies, extreme prematurity, and BW<1.5kg. BPD and SS were significant predictors of tracheostomy, and BPD and BW<1.5kg were significant predictors for G-tube requirements.

Geriatric nutritional risk index was associated with in-hospital mortality among cardiac intensive care unit patients.

Identifying risk factors associated with cardiac intensive care unit (CICU) patients' prognosis can help clinicians intervene earlier and thus improve their prognosis. The correlation between the geriatric nutrition risk index (GNRI), which reflects nutritional status, and in-hospital mortality among CICU patients has yet to be established. The present study retrospectively enrolled 4,698 CICU patients. Based on the nutritional status, the participants were categorized into four groups. The primary endpoint was in-hospital mortality. The length of hospital stay and length of CICU stay were the secondary endpoints. To explore the correlation between nutritional status and in-hospital mortality, a logistic regression analysis was conducted. The nonlinear associations of GNRI with in-hospital mortality were evaluated using restricted cubic spline (RCS). Furthermore, subgroup analyses were conducted to evaluate the effect of the GNRI on in-hospital mortality across different subgroups, with calculation of the p for interaction. A higher risk of malnutrition was significantly linked to an increased incidence of in-hospital mortality (High risk vs. No risk: 26.2% vs. 4.6%, p < 0.001), as well as a longer length of hospital stay (High risk vs. No risk: 15.7, 9.1-25.1 vs. 8.9, 6.9-12.9, p < 0.001) and CICU stay (High risk vs. No risk: 6.4, 3.8-11.9 vs. 3.2, 2.3-5.1, p < 0.001). An elevated GNRI was significantly associated with an increased risk of in-hospital mortality even after controlling for pertinent confounding factors (High risk vs. No risk: OR, 95% CI: 2.37, 1.67-3.37, p < 0.001, p for trend <0.001). Additionally, the RCS model showed a linear relationship between GNRI and in-hospital mortality, with the risk of in-hospital mortality significantly decreasing as GNRI increased (non-linear p = 0.596). Furthermore, in the subgroups of hypertension, ventricular arrhythmias, cardiac arrest, shock, and chronic kidney disease, there was a significant interaction between nutritional status and in-hospital mortality. Among CICU patients, a low GNRI was a significant predictor of in-hospital mortality. Furthermore, patients with a higher risk of malnutrition, as indicated by low GNRI values, experienced significantly longer hospital and CICU stays.

The Challenge of Overcoming Antibiotic Resistance in Carbapenem-Resistant Gram-Negative Bacteria: "Attack on Titan".

The global burden of bacterial resistance remains one of the most serious public health concerns. Infections caused by multidrug-resistant (MDR) bacteria in critically ill patients require immediate empirical treatment, which may not only be ineffective due to the resistance of MDR bacteria to multiple classes of antibiotics, but may also contribute to the selection and spread of antimicrobial resistance. Both the WHO and the ECDC consider carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Acinetobacter baumannii (CRAB) to be the highest priority. The ability to form biofilm and the acquisition of multiple drug resistance genes, in particular to carbapenems, have made these pathogens particularly difficult to treat. They are a growing cause of healthcare-associated infections and a significant threat to public health, associated with a high mortality rate. Moreover, co-colonization with these pathogens in critically ill patients was found to be a significant predictor for in-hospital mortality. Importantly, they have the potential to spread resistance using mobile genetic elements. Given the current situation, it is clear that finding new ways to combat antimicrobial resistance can no longer be delayed. The aim of this review was to evaluate the literature on how these pathogens contribute to the global burden of AMR. The review also highlights the importance of the rational use of antibiotics and the need to implement antimicrobial stewardship principles to prevent the transmission of drug-resistant organisms in healthcare settings. Finally, the review discusses the advantages and limitations of alternative therapies for the treatment of infections caused by these "titans" of antibiotic resistance.

Gender Disparities in Presentation, Management, and Outcomes of Acute Pulmonary Embolism

Pulmonary embolism (PE) is the third most common cause of cardiovascular death; however, gender disparities in PE remain understudied. All PE cases at a single institution between January 2013 and June 2019 were retrospectively reviewed. The clinical presentation, treatment modalities, and outcomes were compared between men and women using univariate and multivariate analyses adjusting for differences in baseline characteristics. A total of 1,345 patients were diagnosed with acute PE, of whom 56.3% were women (n=757). Women had a significantly higher mean body mass index (29.4 vs 28.4) and a higher frequency of hypertension (53% vs 46%) and hormone use (6.6% vs 0%; all p <0.02). Men had a higher frequency of smoking (45% vs 33%, p <0.0001). Women had significantly lower PE severity index classifications (p=0.0009). The rates of intensive care unit admission, vasopressor requirements, extracorporeal membrane oxygenation cannulation, and mechanical ventilation were similar between the genders. There was no significant difference in the treatment modality used between the genders. Although the risk factors and PE severity index class differed between the genders, there was no significant difference in resource utilization or treatment modality. Gender was also not a significant predictor of in-hospital mortality, moderate or severe bleeding, increased length of stay, or readmission in the study population.

High-flow oxygen therapy for ventilator weaning patients with tracheostomy cannula

Introduction. To date, information of the use of high-flow oxygen therapy (HFOT) in patients with tracheostomy cannulas is limited. The use of HFOT in this group of patients at the ventilator weaning may improve outcomes.Objective. Improving results of treatment of patients with tracheostomy cannulas with hypoxemic ARF of various origin through the use of HFOT at the ventilator weaning after prolonged mechanical ventilation (MV).Materials and methods. The prospective open cohort study included 50 patients aged 45 (from 37 to 57) years, the duration of invasive mechanical ventilation was 8.68 ± 3.83 days. Patients were randomized into two groups: in group A, weaning from the respirator was performed through a combination of traditional low-flow oxygen therapy (LFO) and assisted modes of MV; in group B – through a combination of HFOT and assisted modes of MV. The groups compared gas exchange rates, the duration of weaning from the respirator, the incidence of complications (pulmonary and extrapulmonary), the duration of treatment, mortality in the ICU and in the hospital. In all patients, the most significant predictors of in-hospital mortality were analyzed.Results. The use of HFOT in patients in group B revealed significant benefits in terms of the studied parameters in the early and late stages of the study. Mortality in the groups did not differ. The most significant risk factors for in-hospital mortality were cannulation after transfer from the OR (OR = 9,667; 95% CI: 2.414–38,713; p = 0,001).Conclusions. The use of HFOT in patients with tracheostomy cannulas is more clinically effective than COT. Risk factors assessment in every patient will allow optimal use HFOT.

Hypocalcemia on Admission Is a Predictor of Disease Progression in COVID-19 Patients with Cirrhosis: A Multicenter Study in Hungary.

Hypocalcemia is a common condition in liver cirrhosis and is associated with the severity of SARS-CoV-2 infection. However, there is a lack of data demonstrating the prognostic value of hypocalcemia in COVID-19 patients with cirrhosis. This study aimed to evaluate the prognostic value of hypocalcemia for COVID-19 severity, mortality and its associations with abnormal liver function parameters. We selected 451 COVID-19 patients in this retrospective study and compared the laboratory findings of 52 COVID-19 patients with cirrhosis to those of 399 COVID-19 patients without cirrhosis. Laboratory tests measuring albumin-corrected total serum calcium were performed on admission, and the levels were monitored during hospitalization. The total serum calcium levels were significantly lower in cirrhosis cases (2.16 mmol/L) compared to those without cirrhosis (2.32 mmol/L). Multivariate analysis showed that hypocalcemia in COVID-19 patients with cirrhosis was a significant predictor of in-hospital mortality, with an OR of 4.871 (p < 0.05; 95% CI 1.566-15.146). ROC analysis showed the AUC value of total serum calcium was 0.818 (95% CI 0.683-0.953, p < 0.05), with a sensitivity of 88.3% and a specificity of 75%. The total serum calcium levels showed a significant negative correlation with the Child-Turcette-Pugh score (r = -0.400, p < 0.05). Hypocalcemia on admission was a significant prognostic factor of disease progression in COVID-19 patients with cirrhosis.

Acute Kidney Injury in Cirrhosis of Liver: it’s Clinical Spectrum and Association of Various Clinical Outcomes with Advancing Cirrhosis of the Liver

Background &amp; Objectives: Pakistan in tandem marks mortality of advance cirrhosis due to complications like hepatic encephalopathy, upper gastrointestinal bleeding and Acute kidney injury (AKI) contributing further morbidity and mortality. The study aimed to determine frequency, types and severity of AKI among cirrhotics and find association between AKI with various clinical outcomes among advance cirrhotics. Methods: All cirrhotics (both genders), age &gt; 18 years of various aetiologies with confirmed AKI were included and analysed retrospectively. Clinical, antiviral treatment and biochemical predictors of mortality in AKI were analysed by univariate regression however independent risk factors were analysed by multi regression (significant P values &lt; 0.05). Results: Out of 271 cirrhotics, 188 (69.37%) had AKI. Commonest to least common AKI pattern was pre-renal (59.5%), intrinsic (37.7%) post-renal (2.1%). Majority (45.2%) had international club of ascites (ICA-AKI) stage 3, (33.5%) ICA-AKI stage 2 and (21.3%) ICA-AKI stage 1. The overall mortality with AKI at 1,6 and 12 months were 12.8%, 39.1% and 54.3% respectively (significant p 0.001). Increased creatinine, international normalized ratio (INR), bilirubin, albumin, Child Turcotte Pugh (CTP) and Model of end stage liver disease (MELD) were in-hospital predictors of mortality where INR and albumin proved significant. Conclusion: AKI being frequent challenge among cirrhotics has commonest pattern as pre-renal with majority having severe AKI, ICA-Stage 3. Patients with AKI had higher mortality versus non-AKI. Rising creatinine, serum bilirubin, severity of cirrhosis (CTP and MELD score) were the significant predictors of in-hospital mortality where INR and albumin were most significant. Keywords: Acute kidney injury, international club of ascites, cirrhosis of liver, child Turcotte Pugh, International normalized ratio

Extracorporeal Cardiopulmonary Resuscitation in Infants: Outcomes and Predictors of Mortality

Extracorporeal cardiopulmonary resuscitation (E-CPR) plays an indispensable role when resuscitation fails; however, extracorporeal life support (ECLS) in infants is different from that in adults. The objective of this study was to evaluate the outcomes of E-CPR in infants. A single-center retrospective study was conducted, analyzing 51 consecutive patients (age <1 year) who received E-CPR for in-hospital cardiac arrest between 2010 and 2021. The median age and body weight was 51 days (interquartile range [IQR], 17-111 days) and 3.4 kg (IQR, 2.9-5.1 kg), respectively. The cause of arrest was cardiogenic in 45 patients (88.2%), and 48 patients (94.1%) had congenital cardiac anomalies. The median conventional cardiopulmonary resuscitation (C-CPR) time before the initiation of ECLS was 77 minutes (IQR, 61-103 minutes) and duration of ECLS was 7 days (IQR, 3-12 days). There were 36 in-hospital deaths (70.6%), and another patient survived after heart transplantation. In the multivariate analysis, single-ventricular physiology (odds ratio [OR], 5.05; p=0.048), open sternum status (OR, 8.69; p=0.013), and C-CPR time (OR, 1.47 per 10 minutes; p=0.021) were significant predictors of in-hospital mortality. In a receiver operating characteristic curve, the optimal cut-off of C-CPR time was 70.5 minutes. The subgroup with early E-CPR (C-CPR time <70.5 minutes) showed a tendency for lower in-hospital mortality tendency (54.5% vs. 82.8%, p=0.060), albeit not statistically significant. If resuscitation fails in an infant, E-CPR could be a life-saving option. It is crucial to improve C-CPR quality and shorten the time before ECLS initiation.

The association of glucose control on in-hospital mortality in the cardiac intensive care unit

BackgroundCurrent guidelines recommend maintaining serum blood glucose (BG) levels between 150 and 180 mg/dL for patients admitted to the intensive care unit (ICU); however, these recommendations are based on randomized controlled trials among general ICU patients and observational studies among specific subgroups. Little is known about the impact of glucose control among patients cared for in the cardiac intensive care unit (CICU). MethodsThis was a retrospective cohort analysis of patients >18 years of age admitted to the University of Michigan CICU from December 2016 through December 2020 with at least one BG measurement during CICU admission. The primary outcome was in-hospital mortality. The secondary outcome was CICU length of stay. ResultsA total of 3217 patients were included. When analyzed based on quartiles of mean CICU BG, there were significant differences in in-hospital mortality across BG quartiles for those with diabetes mellitus (DM) and those without DM. In multivariable logistic regression, age, Elixhauser comorbidity score, use of mechanical ventilation, any hypoglycemic event, and any BG value >180 mg/dL were significant predictors for in-hospital mortality in both patients with and without DM, yet average BG was only predictive of in-hospital mortality in patients without DM. ConclusionsThis study highlights the importance of glucose control in critically ill adult patients admitted to the CICU. The trends in mortality based on quartiles and deciles of average BG suggest a difference in optimal blood glucose levels in those with and without DM. However, regardless of diabetes status, mortality increases with higher average BG.

Clinical and economic burden of healthcare-associatedinfections: A prospective cohort study.

Healthcare-associated infections (HAIs) have become a serious public health problem. Despite the fact that implementing evidence-based infection control strategies could prevent HAIs and save billions of dollars, Ethiopia lacks national surveillance studies on the rate, economic, and clinical burden of HAIs. To assess the clinical and economic burden of HAIs in hospitalized patients at Ayder comprehensive specialized hospital. A prospective cohort study design was conducted in patients with and without HAIs. A review of medical records, interviews, and patient bills was used to extract necessary information. The patients in the two arms were matched based on age, sex, Charlson comorbidity index, and ward type. Measurable factors were compared between infected and uninfected patients using the paired ttest or McNemar's test, as appropriate. Logistic regression was used to identify predictors of in-hospital mortality. Stata 14.1 was used to conduct all analyses. A total of 408 patients, 204 with HAIs and 204 without HAIs were included in the study. In-hospital mortality was higher in patients with HAI (14.7% vs 7.8%, P = 0.028). Patients with HAI stayed an average of 8.3 days longer than controls (18.85 vs 10.59, P<0.001). The average direct medical costs for patients with HAI were 3033 Ethiopian birrs (ETB) higher than controls (4826 vs 1793, P<0.001). The presence of HAIs (AOR: 2.22, 95% CI: 1.13-4.39) and admission to intensive care units (AOR: 3.39, 95% CI: 1.55-7.40) were significant predictors of in-hospital mortality. HAIs have a significant impact on in-hospital mortality, the length of extra hospital stays, and extra costs for medical care. Patients admitted to intensive care units and those with HAIs were found to be significant predictors of in-hospital mortality. Interventions must be implemented to prevent HAIs, especially in patients admitted to intensive care units.

The effects of temperature and humidity on mortality in acute medical admissions

The full effects of meteorological variables on mortality have not yet been elucidated. This study’s aim was to investigate whether 30-day in-hospital mortality in emergency hospital admissions for non-respiratory diseases were sensitive to the effects of humidity and ambient temperature on the day of admission. We studied all emergency medical admissions to St. James’s Hospital, Dublin, during 2002-2018 (n=113,807) and investigated temperature and humidity on day of admission. We employed multivariable logistic regression to identify temperature and humidity mortality predictors, adjusting for underlying comorbidities. Lower temperatures on day of admission predicted higher 30-day in-hospital mortality (adjusted OR: 1.12, 95% CI: 1.06-1.17), but lower humidity levels did not (adjusted OR: 0.97, 95% CI: 0.91-1.03). There was no interaction between meteorological variables and comorbidities on mortality. In conclusion, temperature may be a more significant predictor of in-hospital mortality than humidity for non-respiratory patients.

Abstract 15366: Identifying Factors Associated With In-Hospital Mortality in Patients With Takatsubo Cardiomyopathy Utilizing a Machine Learning Algorithm

Introduction: Takatsubo cardiomyopathy (TTS), also known as stress induced cardiomyopathy has a reported in-hospital mortality as high as 5% in the US. While overall risk factors have been previously reported, data regarding in-hospital contributors of mortality in TTS is lacking. In our study, we have utilized a Machine Learning (ML) algorithm to identify predictors of in-hospital mortality in patients with TTS. Hypothesis: Machine learning algorithms may be used to identify factors associated with in-hospital mortality in patients with TTS. Methods: We identified all unweighted hospitalizations with a primary diagnosis of TTS from 2016-2019 using International Classification of Diseases, Tenth Revision, diagnosis codes from the National Inpatient Sample (NIS). This is the largest publicly available database of US hospitalizations comprising a 20% stratified sample of all discharges. Data regarding demographics, hospital characteristics and associated diagnoses were abstracted and analyzed using a decision-tree ML algorithm. Results: We identified 7,517 patients who were hospitalized with a primary diagnosis of TTS. In this cohort, in-hospital mortality was noted to be 1.5%. 4 branches, 5 leaves and 8 nodes were identified by the decision-tree algorithm. In our model, the identified covariates associated with high in-hospital mortality were sudden cardiac arrest (p&lt;0.001), cardiogenic shock (p&lt;0.001), sepsis (p&lt;0.001) and Charlson Comorbidity burden (p&lt;0.001) in hierarchical order. Conclusions: ML based algorithms are being increasingly used to analyze clinical data. Our decision-tree ML algorithm was able to identify sudden cardiac arrest, cardiogenic shock, sepsis and Charlson comorbidity burden to be statistically significant predictors of in-hospital mortality amongst 77 other covariates.

Abstract 11407: A Novel Electronic Frailty Index as a Predictor of Clinical Outcomes After ST-Elevation Myocardial Infarction in Older Patients

Introduction: Adverse outcomes after ST-elevation myocardial infarction (STEMI) are significant in frail patients. Standard metrics of frailty may not be reliable in acute STEMIs. This study aims to assess a novel, health record-based Electronic Frailty Index (eFI) to evaluate clinical outcomes after STEMI. Methods: Single site, retrospective study of 120 STEMI patients aged ≥65 years from 10/2017-1/2021. Data came from the ACC Chest Pain-MI Registry and health record. Patients were grouped as Fit (eFI ≤0.1) and Not Fit (eFI ≥0.1). Analysis included descriptive statistics and binary logistic regression. Primary outcome was mortality; other outcomes included MACE, bleeding complications, resource utilization, and discharge medications. Results: Mean age and standard deviation of the cohort was 75 (±7.49) years; 45 (38%) were female. 89 (74%) were classified as Not Fit (eFI ≥0.1). Individuals in this group had lower systolic blood pressure (SBP) on presentation, longer times to revascularization, and more comorbidities (Table 1). In-hospital mortality was significantly higher in the Not Fit group (19% vs. 3%, p 0.03); no significant difference in other outcomes (Table 2). Binary logistic regression analysis identified only initial SBP as a significant predictor of in-hospital mortality and not eFI. Conclusions: Increasing frailty, as assessed by the eFI, is associated with greater in-hospital mortality after STEMI. This association was driven by lower initial SBP, which is likely a result of decreased physiological reserve associated with frail status. Larger studies may provide better understanding on the use of eFI in risk stratification of STEMI patients.