Significant Predictors Of Poor Outcome Research Articles

Predictive role of selected biomarkers in differentiating gram-positive from gram-negative sepsis in surgical patients: a retrospective study.

Patients after major surgery are at high risk of developing sepsis, which is accompanied by elevated serum levels of C-reactive protein (CRP) and procalcitonin (PCT). This study aimed to examine the differences in serum biomarker levels concerning the causative agent of sepsis in surgical patients. A retrospective study was carried out in the surgical intensive care unit (ICU) and included 81 septic patients admitted from January 2019 to May 2022, who had positive blood cultures (BC). Serum levels of PCT, CRP, white blood cells (WBC) and platelet counts were recorded on the day of the positive BC and over the following 3 days. Patients with gram(-) sepsis had significantly higher PCT levels, and lower platelet count compared to patients with gram(+) sepsis. High PCT and low platelets levels in all measurements were a significant predictor of gram(-) isolate with the highest predictive value on the third day after BC sampling, with AUROC 0.821 (95% CI: 0.692-0.950), P = 0.001, and AUROC 0.676 (95% CI: 0.541-0.811), P = 0.02, respectively. In multivariate logistic regression, platelets the day after BC sampling and PCT on the third day made a significant contribution in distinguishing gam(+) from gram(-) BC. Age and high serum CRP levels were significant predictors of poor outcomes. PCT and platelets may be useful biomarkers for predicting the causative agent of sepsis in surgical patients.

Association of 24 h Blood Pressure on Functional Outcome in Patients with Acute Ischemic Stroke Post Intravenous Thrombolysis

Introduction: Elevated admission blood pressure (BP) and BP variability have been shown to be associated with poor outcomes in most studies, while few studies have not found such an association. We investigated the association of various BP parameters with 3-month functional outcomes, mortality, and symptomatic intracerebral hemorrhage (sICH) in patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis (IVT). Methods: Patients with AIS who received IVT between January 2012 and March 2020 were analyzed. Admission BP, 24 h mean BP, and BP variability were noted for all patients. Outcomes assessed were 3-month modified Rankin Scale (mRS), mortality, and sICH. Results: Of the 237 patients, 161 were males. The mean admission systolic BP (SBP), 24 h mean SBP, and BP variability were 158.1 mm Hg (SD 30.25), 138 mm Hg (SD 16.78), 19.42 (SD 12.79), respectively. At 3 months, 147 (62%) patients had a good outcome (mRS 0–2). Multivariate analysis showed prior stroke, NIHSS >15, mean SBP ≥160 mm Hg, and SBP variability >45 to be significant predictors of poor outcome (mRS > 2) at 3 months. Eleven patients (4.6%) developed sICH. Age more than 60 years, presence of atrial fibrillation, admission blood sugar ≥180 mg/Dl, and SBP variability >45 predicted sICH. None of the above factors were predictive of 3-month mortality. Conclusion: An elevated mean SBP and greater SBP variability were predictive of poor functional outcomes, whereas a high SBP variability predicted sICH. Our study emphasizes the need for BP control and minimizing large fluctuations to achieve good poststroke outcomes.

Predictors of Outcome of Aneurysmal Subarachnoid hemorrhage

Introduction: Aneurysmal Subarachnoid Hemorrhage (aSAH) is a devastating condition with high mortality and morbidity. Significant factors influencing the prognosis of aneurysmal subarachnoid hemorrhage (SAH) include the severity at presentation of the disease and delayed cerebral ischemia (DCI).
 Methods: This is a prospective study conducted in Upendra Devkota Memorial National Institute of Neurological and Allied Sciences (UDM-NINAS), Bansbari, Kathmandu, Nepal among patients who underwent clipping of aneurysm for subarachnoid hemorrhage. Various clinical and radiological prognostic factors were registered on admission and during the intensive care stay. Outcome was recorded. GOS>3 was considered good outcome and GOS ≤3 was considered poor outcome.
 Results: Seventy-two patients with ruptured aneurysm were surgically clipped. Good outcome was observed in 51 (70.83%) patients while poor outcome was seen among 21 (29.17%) patients including death among 16 (22.2%) patients. In univariate analysis, WFNS>2, Fisher grade >2, EVD placement for hydrocephalus and delayed cerebral ischemia (DCI) were found to have statistically significant in poor outcome. On Multivariate logistic regression model showed delayed cerebral ischemia was statistically significant predictor of poor outcome at p= 0.032 (OR= 7.34; 95% CI=1.280 to 17.702).
 Conclusion: WFNS >2, Fisher grade>2, EVD placement and DCI were found to have statistical significance in poor outcome while only DCI was an independent predictor of poor outcome following aneurysmal Subarachnoid Hemorrhage (aSAH).

Association of Perfusion Lesion Variables With Functional Outcome in Patients With Mild Stroke and Large Vessel Occlusion Managed Medically.

The best management of patients with mild stroke and large vessel occlusion (LVO) remains unclear. This study aimed to identify perfusion imaging predictors of poor functional outcome in such patients. This cohort study retrospectively selected patients enrolled in the International Stroke Perfusion Imaging Registry between August 2011 and April 2022. The registry enrolled patients with acute ischemic stroke and with baseline CT perfusion scanned within 24 hours of stroke onset. This study identified patients with mild symptoms, defined by an NIH Stroke Scale score of ≤5. Patients with LVO of anterior circulation were selected. This study further selected patients who received medical management and excluded patients who received endovascular treatment. The primary outcome was poor functional outcome defined as a modified Rankin Scale of 3-6 at 3 months. Perfusion lesion was defined by delay time > 3 seconds on CTP. Regression analyses were used to identify clinical and imaging variables that predicted poor functional outcome. A total of 139 patients with mild stroke were included, of whom 27 (19%) had poor functional outcome. Patients with poor outcome, compared with those with good outcome, had much larger perfusion lesion volume (median 80 mL vs 41 mL, p < 0.001). Perfusion lesion was a significant predictor of poor outcome in either univariable regression (crude OR = 1.02, 95% CI = [1.01-1.03]) or multivariable regression model (adjusted OR = 1.01, 95% CI = [1.01-1.02]), adjusting for occlusion site, good collaterals, baseline stroke severity, age, IV thrombolysis (IVT), and onset to scan time. A perfusion lesion of 65 mL was the optimal cutpoint to identify poor functional outcome (sensitivity = 59%, specificity = 77%). Patients with perfusion lesion ≥65 mL, compared with patients with perfusion lesion <65 mL, showed a much higher rate of poor functional outcome (38% vs 11%, p < 0.001). Of the 139 patients in this study, 95 received IVT. Patients treated with or without IVT did not influence their outcomes (crude OR = 0.74, 95% CI = [0.31-1.78]). A perfusion lesion of ≥65 mL predicted poor functional outcome in mild stroke patients with LVO.

Risk factors in deceased donor liver transplantation: a single centre experience

Deceased brain-dead donor liver transplantation (LT) is a high-risk intervention. The outcome depends on a large number of modifiable and non-modifiable factors. Objective: to analyze our own experience and identify preoperative and perioperative prognostic factors for poor outcomes in LT. Materials and methods. The study included 301 liver transplants performed between January 2016 and December 2021. Donor and recipient characteristics, intraoperative data, perioperative characteristics including laboratory test data, and the nature and frequency of complications were used for the analysis. Results. The 1-, 3- and 5-year recipient survival rates were 91.8%, 85.1%, and 77.9%, respectively; graft survival rates were 90.4%, 83.7%, and 76.7%, respectively. The most significant predictors of poor outcome of LT on the recipient side were biliary stents (HR 7.203, p &lt; 0.01), acutely decompensated cirrhosis (HR 2.52, p = 0.02); in the postoperative period, non-surgical infectious complications (HR 4.592, p &lt; 0.01) and number of reoperations (HR 4.063, p &lt; 0.01). Donor creatinine level (HR 1.004, p = 0.01, one factor analysis; HR 1.004, p = 0.016, multivariate analysis) was the only reliable prognostic negative factor. Conclusion. LT taking into account established risk factors will improve surgery outcomes and help personalize the therapy for each patient.

Prevalence, risk factors, severity and outcome of neonatal thrombocytopenia.

Objective: To find out prevalence, risk factors, severity and outcome of neonatal thrombocytopenia (TCP). Study Design: Prospective Observational study. Setting: Neonatal Intensive Care Unit (NICU) of Children Hospital Complex Multan. Period: January 2020 to January 2021. Material &amp; Methods: A total of 191 neonates admitted to NICU during the study period were enrolled. A special proforma was designed to record all study information while SPSS version 26.0 was utilized for data analysis. Prevalence of TCP was noted among neonates admitted in NICU during the study period. Maternal risk factors, neonatal risk factors, severity of TCP and outcome were recorded. Results: In a total of 191 neonates, 110 (57.6%) were male while overall mean age was recorded to be 2.98+2.46 days. The prevalence of TCP was recorded to be 47.1% (90/191). Pregnancy induced hypertension (p=0.0003), premature rupture of membrane (p=0.0105) and eclampsia (0.0215) were found to have significant association with the presence of TCP. Preterm neonates (p&lt;0.0001), small for gestational age (p&lt;0.0001), sepsis (p&lt;0.0001) and nectrozing enterocolitis (p=0.0014) were found to have significant association with TCP. A total of 13 (6.8%) neonates died, out of which, 5 (38.5%) were having severe TCP. Conclusion: Prevalence of neonatal thrombocytopenia at neonatal intensive care unit was found to be high (47.1%). Pregnancy induced hypertension, premature rupture of membrane and eclampsia were found to have significant association with neonatal thrombocytopenia. Preterm, small for gestational age, sepsis and necrotizing enterocolitis were noted to be significantly associated with neonatal thrombocytopenia. Severe thrombocytopenia was noted to be a significant predictor of poor outcomes.

Iliac Artery Tortuosity, Calcification and Abnormal Shape Augment Aortic Aneurysm Anatomy in Predicting Complications After Endovascular Aneurysm Repair

Post-surgical complications following endovascular aneurysm repair (EVAR) remain a risk, arising from technical difficulties imposed by highly calcified or tortuous iliac arteries. Automated methods enable segmentation of the iliac artery to potentially better define perioperative risk prediction. This study uses imaging software to characterise segmental iliac artery anatomy and aims to establish if iliac artery abnormalities can predict adverse outcomes following EVAR. Pre-operative clinical information and CT angiograms were obtained from 189 patients who underwent elective EVAR. Patients were followed for up to 3 years to detect stent-related complications and mortality. Aneurysm morphology was manually measured on CT scans. Automated measurements of vessel shape, curvature and calcification were taken for multiple subdivisions of the common and external iliac arteries. Logistic regression models were trained to assess the influence of iliac artery and aneurysm morphology on outcomes. Combining iliac and aortic features improved predictions of both stent-related complications and morbidity over using either alone. Models predicting death and both early and late stent complications had respective areas under the curve (AUCs) of 0.761, 0.935 and 0.833. Iliac artery calcification and curvature were significant predictors of poor outcomes. Automated morphological assessment of the common and external iliac artery improves the prediction of complications following EVAR. The improved power of iliac morphology to predict late complications and death implies that regional abnormalities of the iliac arteries are important when assessing surgical risk. This allows further rationalisation of the selection of individuals for treatment and may improve patient outcomes.

Immune status does not independently influence cutaneous squamous cell carcinoma metastasis and death when stratified by tumor stage: A dual-center retrospective cohort analysis of primary N0 disease

Although immunocompromised patients have a higher risk of developing cutaneous squamous cell carcinomas, it is unknown whether immune status is an independent risk factor for poor outcomes. To compare cutaneous squamous cell carcinoma outcomes in immunocompromised and immunocompetent patients when controlling for T-stage. We performed a retrospective cohort study at 2 tertiary care centers, examining 989 primary tumors from 814 immunocompromised patients (solid organ transplant: 259 [31.7%], chronic lymphocytic leukemia: 113 [13.9%]) and 6608 tumors from 4198 immunocompetent patients. Our primary outcome was the composite of disease-specific death or tumor metastasis ("poor outcomes"). Immunocompromised patients had 50% more high T-stage tumors (ie, Brigham and Women's Hospital stage T2b and T3), than immunocompetent patients (3.3% vs 4.9%, respectively; P<.001). Significant predictors of poor outcomes included tumor stage (sub hazards ratio [SHR], 14.8 for high T-stage tumors; 95% confidence interval [CI], 8.0-27.6; P<.001) and male sex (SHR, 2.3; 95% CI, 1.4-3.8; P=.002). Immune status was not a significant predictor (SHR, 1.04; 95% CI, 0.69-1.6; P=.85). This study is retrospective. Although immunocompromised patients had 50% more high T-stage tumors than immunocompetent patients, immunocompromised patients had a similar chance of metastasis and disease-specific death when adjusting for T-stage in our cohort of primary tumors.

OS02.7.A The role of epilepsy in elderly patients with Glioblastoma: An Austrian multicenter analysis

Abstract Background Higher age is a significant predictor of poor outcome in glioblastoma multiforme (GBM) patients. Thus, acquisition of a better understanding of additional prognostic factors in these often-frail patients is of utmost importance. Epileptic seizures correlate with improved overall survival (OS) in low-grade gliomas; however, the impact of epilepsy in GBM patients on outcome parameters is poorly defined. Furthermore, persisting epilepsy significantly influences the patients’ quality of life (QoL). This study aims at specifically evaluating the impact of epilepsy in elderly GBM patients. Material and Methods Two Austrian academic neurosurgical centers retrospectively analyzed all elderly (≥65 years) GBM patients with de-novo tumors, who underwent tumor resections between 09/2006 and 07/2021. Epidemiological, histopathological and survival data were gained from patients’ electronic charts and screened for presence of epilepsy preoperatively or during follow-up. Results 391 patients (55% males, 45% females) with a median age at surgery of 73 years (Interquartile Range (IqR) 68.5-77.5) were analyzed. The mean predicted OS was recorded to be 12.4 months (CI95% 10.9-14.0). Median preoperative Modified Rankin Scale (mRS) was 2 (IqR 1-3), and median preoperative Karnofsky performance score was 80 (IqR 60-90). Mean follow-up was 10.4 months (CI95% 9.1-11.6) in our cohort. 95/391 patients (24%) suffered from preoperative epilepsy. 17 (18%) patients still suffered from epilepsy after tumor resection with eight patients who developed new postoperative seizures, and four patients (1.0%) showed a worsening of already preoperatively diagnosed seizures. Major surgery-associated neurological complications included new motor deficits in 29 (7%) and new aphasia in 16 (4%) patients. Logistic regression showed, patients with seizures had significantly lower mRS (OR=0.735 [CI95% 0.563 0.961], p=0.032) and less frequently occipital tumor location (OR=0.347 [CI95% 0.152-0.791], p=0.018). Postoperative epilepsy resulted in significantly prolonged hospitalization after the surgery (OR=2.622[CI95% 1.496-3.979], p=0.009). Survival did not correlate with preoperative epilepsy (p&amp;gt;0.05). However, Cox regression revealed that multifocal tumor location (HR=1.777 [CI95% 1.197-2.639], p=0.025) as well as thalamic involvement (HR=11.121 [CI95% 3.431-36,046], p=0.030) negatively influenced OS. Furthermore, surgery-associated complications shortened OS significantly (HR=1.945 [CI95% 1,296-2,916], p=0.025). Conclusion Even though epilepsy was not found to directly impact survival in elderly GBM patients, we found that surgery led to epilepsy freedom in a significant proportion of our patient cohort, thereby potentially leading to improved QoL. Greatest focus should be set on avoiding any surgery-associated deficits, since these severely influence the OS.

Incidence of Brain Metastases in Women Treated With Neoadjuvant Chemotherapy for Breast Cancer: Implications for Screening

PurposePatients with metastatic breast cancer may develop brain metastases. Our study identified high-risk patients to refine selection criteria for BM screening approaches. PatientsWe reviewed breast cancer patients treated with neoadjuvant chemotherapy (NAC) at a single university center between 2005 and 2019. MethodsCompeting risks analysis was performed with the Fine and Gray model to analyze the cumulative incidence of BM and loco-regional recurrence. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Meier and log-rank tests. Multivariable analysis was performed with Cox proportional hazards regression to identify factors predictive for development of BM. Statistical significance was determined as a 2-sided P value of <.05. ResultsIn total, 112 patients experienced distant failure (DF) and 49 patients developed BM. Twenty patients with BM (41%) presented with symptoms requiring craniotomy +/- whole brain radiation treatment. Patients with BM were significantly more likely to have local (P < .01) and regional (P < .01) failure. On multivariable analysis, age <40 years (P = .011), presence of lung metastases (P < .0001), and residual nodal disease with >4 lymph nodes positive after NAC (P = .024) all predicted for increased likelihood of BM. Patients with these criteria had higher likelihoods of having BM (P = .013) and worse PFS (P = .044). On multivariable analysis for OS, presence of lung metastases was the most significant predictor of poor outcome (P < .0001). ConclusionWe propose a study of screening brain MRI for young (<40 years) patients with breast cancer receiving NAC and patients who develop metastatic disease post-NAC, especially those with lung involvement.

Torcular Dural Sinus Malformation: Fetal and Postnatal Imaging Findings and Their Associations With Clinical Outcomes

BackgroundTorcular dural sinus malformations (tDSMs) are rare vascular malformations that present in fetuses and infants. Existing data on prognostic imaging features, as well as the associated morbidity and mortality, are limited and variable. We therefore reviewed cases of tDSMs diagnosed on fetal magnetic resonance imaging (MRI) at our referral center to identify pre- and postnatal MRI imaging features associated with long-term outcomes. MethodsWe searched our imaging database for fetal and postnatal MRI reports of tDSM cases. The electronic medical record was then reviewed for pre- and postnatal clinical data, including follow-up imaging. Neurological outcomes were characterized using the previously reported scale based on the Bicêtre Score. Imaging features association with outcome scores were compared using the Fisher exact test. ResultsSixteen cases of tDMS diagnosed by fetal MRI with postnatal clinical follow-up were identified, 11 of whom underwent postnatal MRI. The majority of cases of tDSM (73%) decreased in size or resolved on postnatal follow-up study without treatment. Restricted diffusion and parenchymal hemorrhage on fetal MRI were the only imaging features identified significantly associated with unfavorable neurological outcome or death, present in two patients with poor outcomes (two of two) and only one with a normal outcome (one of 14) (P = 0.025). ConclusionsFindings of tDSM on fetal MRI most often regress and/or resolve with normal or mild neurological outcomes, with the most significant predictor of poor outcome being the presence of parenchymal injury on fetal MRI. In addition, a subset will present with venolymphatic malformations.

Functional Outcome in Patients with Chronic Subdural Hematoma: Postoperative Delirium and Operative Procedure.

Chronic subdural hematoma (CSDH) is a common neurosurgical condition and neurological condition improves after treatment in most patients. Recently more patients have poor prognosis because of aging of the population and presence of multiple comorbidities. The risk factors for poor prognosis, including postoperative delirium, were retrospectively evaluated to assess appropriate operative procedures. This study included 108 patients who underwent primary surgery from 2016 to 2017 at a single center. Operative procedures were drainage with or without irrigation. Functional outcome at discharge assessed the effect of various factors including postoperative delirium and operative procedure. Twenty-nine of 108 patients (27%) had worsened modified Rankin Scale (mRS) score at discharge, most with mobility disturbance or deteriorated cognitive function. Multivariate analysis found higher age (odds ratio [OR] = 5.13; 95% confidence interval [CI] = 1.0-1.14), poor pre-hospital mRS score (OR = 1.57; 95% CI = 1.0-2.46), and preoperative consciousness disturbance caused by CSDH (OR = 5.13; 95% CI = 1.27-20) were significant predictors of poor outcome. Operative procedure was not significantly related to functional outcome or recurrence, but irrigation was significantly related to postoperative delirium (OR = 4.83; 95% CI = 1.09-21.7). Patients with postoperative delirium were likely to require longer hospitalization stays (P = 0.028). Higher age, poor pre-hospital mRS, and preoperative consciousness disturbance caused by CSDH are the risk factors for poor recovery after CSDH. Irrigation is significantly likely to cause postoperative delirium and longer hospital stay.

Analysis of readmissions data among frail and non-frail patients presenting for acoustic neuroma

The incidence of acoustic neuromas in the United States is 1.09 per 100,000 with 23,739 newly diagnosed cases in the years 2004 to 2010. Because the recent literature has supported that frailty can serve as a more accurate predictor of patient outcomes when evaluated with age, and is an important variable to consider in the course of patient treatment. The objective of this study was to compare the outcomes of frail patients who had undergone surgery for acoustic neuroma with their non-frail counterparts.The authors conducted a retrospective cohort study of geriatric patients receiving cranial neurosurgery for acoustic neuroma between 2016 and 2017 by using the Nationwide Readmission Database. A total of 396 frail patients and 402 non-frail patients were identified through the database of undergoing surgery for acoustic neuroma. Frail patients had statistically higher rates of readmission (p < 0.01), post-operative infection (p < 0.01), facial paralysis (p < 0.01), urinary tract infection (p < 0.01), hydrocephalus (p < 0.01), and dysphagia (p < 0.01). These post-op morbidities likely led to the increased length of stay (p < 0.01), non-routine discharge (p < 0.01), and all payer cost seen in frail patients (p < 0.01). However, no significant difference was found between frail and non-frail patients with regards to CSF leak, post hemorrhagic anemia, myocardial infarction, and mortality. Patient frailty status is a significant predictor of poor outcomes in the postoperative sequelae of acoustic neuroma surgery. Further, models including patient frailty plus age outperformed those using age alone for prediction of several postoperative complications.

Disparities in Stroke: Associating Socioeconomic Status With Long‐Term Functional Outcome After Mechanical Thrombectomy

Background Socioeconomic status is regarded as a significant predictor of poor outcomes after ischemic stroke. However, there is sparse evidence of its effect in patients undergoing mechanical thrombectomy. This study aimed to explore the effect of socioeconomic status on long‐term functional outcomes after mechanical thrombectomy. Methods A retrospective, self‐adjudicated, single‐center study comparing favorable and unfavorable functional outcomes through risk factors, demographic factors, and neighborhood socioeconomic status was performed. Functional outcome was defined by modified Rankin scale scores evaluated at 90 days after thrombectomy. Results Factors that were independently associated with favorable functional outcome included age (odds ratio [OR], 0.97; 95% CI, 0.96–0.98 [ P &lt;0.001]), baseline National Institutes of Health Stroke Scale scores (OR, 0.94; 95% CI, 0.92–0.97 [ P &lt;0.001]), baseline modified Rankin scale scores (OR, 3.02; 95%CI, 1.46–6.25 [ P =0.003]), ischemic core size at presentation (OR, 0.47; 95% CI, 0.26–0.84 [ P =0.011]), symptomatic intracranial hemorrhage (OR, 0.3; 95% CI, 0.14–0.66 [ P =0.003]), puncture‐to‐recanalization time (OR, 0.99; 95% CI, 0.98–1.00 [ P =0.007]), median income based on zip code (OR, 1.01; 95% CI, 1.00–1.02 [ P =0.016]), and final modified thrombolysis in cerebral infarction (OR, 6.05; 95% CI, 2.23–16.08 [ P &lt;0.001]). Conclusions Patients from zip codes with higher median income who achieved successful reperfusion during mechanical thrombectomy were more likely to achieve a long‐term favorable functional outcome.

High sensitivity Troponins In Patients with elevated prohormone of beta natriuretic peptide and acute heart failure (HIGH TRIP Trial)

In patients presented to emergency rooms, Pro hormone of Natriuretic Peptide (Pro BNP) essay is overly sensitive test to rule out heart failure but less specific in predicting outcomes in follow-ups, in this study we ought to find the added value of High Sensitivity cardiac Troponin I (Hs-cTn I), in patients presented acutely with heart failure and its impact on mortality when Pro BNP is highly elevated. Prospective cohort study, inclusion criteria were age above 18 and clearly positive NT Pro BNP > 1000 pg/ml, with 12 months follow up period, primary end point was mortality from heart failure, secondary endpoint was need for rehospitalization. 95 patients were enrolled, divided into overt and non-overt pulmonary edema groups. Mean (Pro BNP) was 6184 and 5927 pg/ml and mean (Hs-cTn I) were 19.27 and 0.17 ng/ml respectively, Mean Ejection fraction was 48 ± 7 and 47 ± 7 for each group sequentially. Mortality rate was 4 (13%) in the higher Hs-c Tn I group, and 1 (1.6%) in the low troponin level group p = .03, odd ratio was 8.5, 95% CI (0.9–80). Need for re-hospitalization was present in 12 (38%) Vs 7 (8%) patients, p = .0081, odd ratio 4.8, 95% CI (1.7–14.2). In COX proportional hazard analysis, only Hs-cTn I was a significant predictor of poor outcome in this high-risk cohort with p = 0.0001. Adding (Hs-cTrop I) assay to the panel of laboratory testing, in patients presented to ER with acute heart failure and with high Pro-BNP > 1000, may further predicts mortality and rehospitalization rate.

Blood Lactate Levels And Lactate Clearance As Predictors Of Mortality In Neonatal Sepsis.

Sepsis is life-threatening organ dysfunction caused by dysregulated host response to infection. Aim of the study is Neonatal sepsis refers to infection involving the blood stream in neonates. It is major health problem causing neonatal mortality and morbidity in developing countries. Our study aimed to assess the correlation between lactate clearance and blood lactate levels with outcome of neonatal sepsis. Seventy-three eligible neonates recruited with convenience sampling technique. Study was conducted at the Neonatology department, The Children's Hospital & the Institute of Child Health, Lahore. After approval from institutional review board, and informed consent of parents/guardians, neonates with sepsis were selected through a present inclusion and exclusion criteria. Data was collected with the predetermined demographics, inflammatory markers and lactate levels. This research revealed 37% (n=27) mortality rate among septic neonates who were having higher blood lactate levels and low lactate clearance at 6 hours of admission in nursery. Hence higher serum lactate levels and low lactate clearance (<10%) at 6 hours were significant predictors of poor outcome in septic neonates (p-Value, <0.05). The lactate level of neonates who could not survive was 5.68±1.22 as compared to who were discharged 4.11±1.14 (p-Value, <0.05). Higher blood lactate levels and lactate clearance of less than 10% at 6 hours of admission in nursery are significant predictors of mortality in neonatal sepsis. Early lactate stabilization and sepsis management can improve the clinical outcomes.

Metabolic syndrome and the risk of adverse cardiovascular events in patients with myocardial infarction with non-obstructive coronary arteries

Background and aimsMetabolic syndrome (MeS) is recognized as a significant predictor of poor outcomes in coronary artery disease. However, its prognostic implications in myocardial infarction with non-obstructive coronary arteries (MINOCA) have not been examined. We aimed at investigating the role of MeS on the clinical outcomes in MINOCA patients. Methods and resultsPatients diagnosed with MINOCA between 2015 and 2019 were included. MeS was defined according to modified NCEP-ATPIII criteria. The primary endpoint was major adverse cardiovascular events (MACE). Cox regression analysis was used to evaluate the correlation between MeS and the hazard of MACE. The integrated discrimination improvement (IDI) and net reclassification index (NRI) were performed to assess MeS incremental predictive value. Of 281 MINOCA patients, 83 (29.5%) patients satisfied the MeS criteria. During a median follow-up duration of 28 months, MINOCA patients with MeS had a notably higher rate of MACE than those without MeS (30.1% vs. 17.6%, respectively P = 0.020). Cox regression analysis revealed that MeS was associated with an increased hazard of MACE (adjusted HR 2.126; 95% CI: 1.193–3.787, P = 0.010). When each component of MeS was analyzed as a categorized variable separately, only high fasting blood glucose and BMI ≥25 kg/m2 were associated with an increased hazard of MACE. Moreover, MeS had an incremental predictive ability for MACE when added to a model with clinical risk factors. ConclusionMeS is relatively common in patients with MINOCA. The presence of MeS significantly increased the hazard of MACE among the MINOCA population.

Platelet Distribution Width: A Significant Predictor of Poor Outcome After Mechanical Thrombectomy

ObjectivesElevated platelet distribution width (PDW) is a recognized marker of platelet activity. Herein, we investigated the association between admission PDW values and clinical outcome at 3 months in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). Materials and MethodsWe retrospectively collected consecutive patients diagnosed with AIS following MT from two stroke centers. PDW was measured on admission. Subjects were divided into two groups according to the clinical outcome using the modified Rankin Scale at 3 months. Multiple regression analyses and receiver operating characteristic (ROC) curves were performed to determine the associations between admission PDW values, clinical parameters, and functional outcome. ResultsA total of 162 subjects were enrolled. Patients in the poor outcome group had a significantly higher percentage of PDW >16.0 fL compared with the good outcome group (57.3% vs. 26.9%, P < 0.001). After adjusting for a range of confounding factors, multiple regression analysis showed that PDW >16.0 fL was an independent predictor of poor outcome at 3 months (odds ratio 4.572, 95% confidence interval 1.896–11.026, P = 0.001). ROC curve analysis revealed that PDW >16.0 fL predicted poor outcome with 57.3% sensitivity and 73.1% specificity (the area under the ROC curve 0.637, 95% confidence interval 0.558–0.711, P = 0.004). ConclusionsElevated PDW is an independent predictor of poor functional outcome in patients with anterior circulation AIS undergoing MT at 3 months.

N-Terminal Pro-B-Type Natriuretic Peptide as a Predictor of Adverse Outcomes After Off-Pump Coronary Artery Bypass Surgery: A Prospective Study

The strength of association between preoperative natriuretic peptide levels and adverse outcomes after cardiac surgery recently has been studied in different research, but results still are diversely variable. Sixty-five consecutive patients undergoing elective off-pump coronary artery bypass grafting prospectively were recruited. Preoperative levels of NTproBNP were measured in venous blood samples collected before induction of anesthesia. The average age was 57.62 ± 7.21. Of the patients, 86.15% were male. Euro-scoreII averaged 1.76 ± 0.34. The mean preoperative NTproBNP levels were 312.41 ± 329.93 pg/mL. Only two patients died (3%). Three patients required prolonged mechanical ventilation (4.6%). Four patients (6%) suffered from new onset postoperative AF. Five patients (7.6%) had low cardiac output, of which three needed IABP, and four patients (6%) had postoperative myocardial infarction. The mean ICU stay was 3.37 ± 0.84 days, and the mean hospital stay was 6.38 ± 1.3 days. There were no significant differences in preoperative NTproBNP levels in patients who had or didn't have any of the postoperative complications or in-hospital mortality (P > .05). Our study showed no significant correlation between preoperative NTproBNP levels and postoperative low cardiac output, atrial fibrillation, postoperative myocardial infarction, length of ICU stay, prolonged mechanical ventilation, length of hospital stay as well as in-hospital mortality following elective off-pump CABG. Therefore, more prospective specific studies are needed to delineate the role of preoperative natriuretic peptides as significant predictors of poor outcomes after CABG surgery.

Thioredoxin reductase-1 levels are associated with NRF2 pathway activation and tumor recurrence in non-small cell lung cancer

Activating mutations in the KEAP1/NRF2 pathway characterize a subset of non-small cell lung cancer (NSCLC) associated with chemoresistance and poor prognosis. We herein evaluated the relationship between 64 oxidative stress-related genes and overall survival data from 35 lung cancer datasets. Thioredoxin reductase-1 (TXNRD1) stood out as the most significant predictor of poor outcome. In a cohort of NSCLC patients, high TXNRD1 protein levels correlated with shorter disease-free survival and distal metastasis-free survival post-surgery, including a subset of individuals treated with platinum-based adjuvant chemotherapy. Bioinformatics analysis revealed that NSCLC tumors harboring genetic alterations in the NRF2 pathway (KEAP1, NFE2L2 and CUL3 mutations, and NFE2L2 amplification) overexpress TXNRD1, while no association with EGFR, KRAS, TP53 and PIK3CA mutations was found. In addition, nuclear accumulation of NRF2 overlapped with upregulated TXNRD1 protein in NSCLC tumors. Functional cell assays and gene dependency analysis revealed that NRF2, but not TXNRD1, has a pivotal role in KEAP1 mutant cells’ survival. KEAP1 mutants overexpress TXNRD1 and are less susceptible to the cytotoxic effects of the TXNRD1 inhibitor auranofin when compared to wild-type cell lines. Inhibition of NRF2 with siRNA or ML-385, and glutathione depletion with buthionine-sulfoximine, sensitized KEAP1 mutant A549 cells to auranofin. NRF2 knockdown and GSH depletion also augmented cisplatin cytotoxicity in A549 cells, whereas auranofin had no effect. In summary, these findings suggest that TXNRD1 is not a key determinant of malignant phenotypes in KEAP1 mutant cells, although this protein can be a surrogate marker of NRF2 pathway activation, predicting tumor recurrence and possibly other aggressive phenotypes associated with NRF2 hyperactivation in NSCLC.