Significant Predictor Of Mortality Research Articles

Impact of impaired renal function on kinetics of high-sensitive cardiac troponin following cardiac surgery.

Impaired renal function can increase cardiac troponin levels due to reduced elimination, potentially affecting its diagnostic utility. Limited data exist on high-sensitivity cardiac troponin I (hs-cTnI) kinetics after cardiac surgery relative to renal function. This study evaluates how impaired renal function influences hs-cTnI kinetics following cardiac surgery, distinguishing between patients with and without postoperative myocardial infarction (PMI). We conducted a retrospective analysis of adult patients who underwent elective cardiac surgery at our hospital from January 2013 to May 2019. Serial hs-cTnI measurements were taken from baseline up to 48h post-surgery. Renal function was assessed using the MDRD formula, defining impaired renal function as a GFR < 60ml/min. Acute kidney injury (AKI) was based on postoperative creatinine levels, and PMI was defined by ARC-2 criteria. Predictors of long-term all-cause mortality were analyzed using Cox regression. Out of 14,355 patients (51.4% CABG, 39.4% valvular procedures, 9.2% thoracic aortic procedures), 139 (1.0%) had PMI. Hs-cTnI levels were higher in patients with impaired renal function across the cohort and in those without PMI. However, in patients with PMI, hs-cTnI levels did not vary significantly with renal function. Elevated hs-cTnI ≥ 213 times the upper limit of normal was a significant predictor of long-term mortality regardless of renal function (hazard ratio: 1.28, 95% CI: 1.17-1.40, p < 0.001), but early postoperative hs-cTnI measures held poor discriminatory yield to predict PMI with an AUC of 0.55 (95% confidence intervals: 0.54-0.56). Renal function and acute kidney injury affect hs-cTnI kinetics post-surgery only in patients without PMI. Elevated hs-cTnI remains a strong predictor of long-term mortality, independent of renal function, but early postoperative detection of PMI requires additional metrics, including ECG, transthoracic echocardiography (TTE), and signs of hemodynamic instability.

Impact of nutritional status and pulmonary function on short- and long-term overall survival in hemodialysis patients.

End-stage renal disease (ESRD) patients frequently experience protein-energy wasting (PEW), which increases their morbidity and mortality rates. This study explores the effects of nutritional status and pulmonary function on the short- and long-term mortality of ESRD patients undergoing hemodialysis. 67 consecutive ESRD patients on maintenance hemodialysis were included in the study. The primary outcomes were all-cause one-year and five-year mortality. Data on demographic characteristics, comorbidities, and laboratory findings were collected. Pulmonary function tests were conducted along with body composition measurements using bioelectrical impedance analysis (BIA). Malnutrition was assessed using the Prognostic Nutritional Index (PNI). The median age of the patients was 60.9 ± 12.4 years, with 58.3% being male. Pulmonary function parameters (FEV1 and FVC) were significantly associated with short-term mortality. The PNI was a significant predictor of both short-term and long-term mortality. A PNI score ≤ 39.01 was associated with increased short-term mortality (HR: 0.65, 95% CI: 0.48-0.88, p = 0.006), while a score ≤ 40 was linked to increased long-term mortality (HR: 0.80, 95% CI: 0.67-0.95, p = 0.015). Additionally, older age (HR: 1.06, 95% CI: 1.01-1.12, p = 0.021) and higher glomerular filtration rate (GFR) (HR: 1.23, 95% CI: 1.02-1.42, p = 0.024) were related to increased long-term mortality risk. The study demonstrates that PNI, age, and pulmonary function are critical factors influencing the survival of hemodialysis patients. These findings underscore the importance of comprehensive nutritional and pulmonary assessment to improve clinical outcomes in this population.

Effect of ranolazine on cardiac remodeling and pulmonary artery pressure in patients with acute pulmonary embolism

Background. The development of right ventricular (RV) dysfunction is the most significant predictor of in-hospital mortality and one of the most important factors affecting the short- and long-term prognosis of pulmonary embolism (PE). Therefore, the development of treatment regimens aimed at inhibiting the progression of RV dysfunction and the fastest possible restoration of its function, as well as preventing the development and progression of pulmonary hypertension, is an important area of reducing mortality in acute PE. One of the most promising drugs that can theoretically reduce both RV and pulmonary damage is ranolazine. The purpose of the study was to evaluate the feasibility and efficacy of prescribing ranolazine to patients with PE, focusing on its impact on echocardiographic parameters. Materials and methods. The study included 70 patients diagnosed with acute PE verified bу CT pulmonary artery angiogram performed on the first 1–2 days and after 8–10 days of treatment. Patients were divided into two groups: group 1 consisted of 29 people who received ranolazine at a dose of 500 mg twice daily starting from day 1–2 of standard treatment, for 1 month; group 2 included 49 patients who did not receive ranolazine. All patients underwent a standard general clinical examination with an assessment of risk factors for PE and early death according to the 2019 European Society of Cardiology guidelines, with subsequent statistical processing of the data. Results. When analyzing the dynamics of indicators in the groups, a statistically significant decrease was found in the size of the right atrium (p = 0.0009), RV (p = 0.046), mean pulmonary artery pressure (mPAP) (p = 0.027), pulmonary artery systolic pressure (sPAP) (p = 0.00004) in the group 1. In the group without ranolazine, there also was a decrease in the size of the right atrium (p = 0.002), mPAP (p = 0.009), and sPAP (p = 0.03), but with no effect on the size of the RV. When comparing the difference in parameters on day 1 and 8–10, i.e., the shift of the parameters during treatment, a statistically significant decrease in sPAP was obtained in the ranolazine group compared to the group without its use (p = 0.03). Conclusions. Adding ranolazine to standard therapy for pulmonary embolism reduces right ventricular and atrial remodeling, as well as pulmonary artery pressure.

Clinical characteristics and prognosis of patients treated as invasive pulmonary aspergillosis outside of severe immunosuppression

This study aimed to identify clinical characteristics and develop a prognostic model for non-neutropenic patients with invasive pulmonary aspergillosis (IPA). A retrospective analysis of 151 IPA patients was conducted, with patients categorized into survival (n = 117) and death (n = 34) groups. Clinical data, including demographics, laboratory tests, and imaging, were collected. Multivariate Cox regression analysis identified glucocorticoid use (odds ratio [OR] = 30.223, 95% confidence interval [CI]: 2.676–341.306), intensive care unit admission (OR = 0.133, 95% CI: 0.023–0.758), and the arterial oxygen partial pressure/fractional inspired oxygen ratio (OR = 0.994, 95% CI: 0.990–0.999) as significant predictors of 28-day mortality. A prognostic model was developed based on these factors, showing high predictive accuracy (receiver operating characteristic curve area of 0.918). The model’s clinical applicability was validated through calibration curves, bootstrap internal validation, decision curve analysis, and clinical impact curves. Kaplan–Meier analysis further confirmed its utility, indicating a worse prognosis for high-risk patients within 50 days and the highest survival rate at 14 days. This novel model offers valuable insights for predicting survival in non-neutropenic IPA patients.

The severely injured older patient: identifying patients at high risk for mortality using the Dutch National Trauma Registry

PurposeThe incidence of severely injured older trauma patients is increasing globally, portraying high mortality rates. Exploring the demographics and clinical outcomes of this subgroup is essential to further improve specialised care at the right place. This study was performed to identify severely injured older patients at high risk for mortality by examining their characteristics and identifying prognostic factors contributing to mortality.MethodsA retrospective cohort study was conducted using data from the Dutch National Trauma Registry to identify all trauma patients aged 70 years and older from 2016 to 2022. Subgroup analyses for characteristics and outcomes were performed based on Injury Severity Score (ISS) 16–24 and ISS ≥ 25, as well as age groups of 70–79, 80–89 and ≥ 90 years. A logistic, backwards regression analysis was performed to identify predictors for mortality within each ISS groups.ResultsIn total, 10,901 patients were included. The mean age was comparable between the ISS groups (80.48 ± 6.8 vs. 80.54 ± 6.6 years). The main trauma mechanisms in both the ISS 16–24 and ISS ≥ 25 were low energy falls and bicycle accidents. The head and thorax were the most frequently injured body regions, with a significantly higher proportion of severe head injuries in the ISS ≥ 25 group (32.6% vs. 73.4%). Mortality rates increased significantly with higher injury severity (13.9% vs. 48.9%) and advancing age (22.6% vs. 32.4% vs. 35.8%). The most significant predictors of mortality in the ISS 16–24 group were an increase in ASA score and a GCS 3–8 at arrival (OR for GCS: 7.2 (95% CI 5.7–9.1), AUC 0.76). Similarly, in the ISS ≥ 25 group, an increased ASA score and a GCS 3–8 at arrival were the most significant predictors of mortality as well (OR for GCS: 10.8 (9.1–12.9), AUC 0.79). Although increasing age was also associated with a higher risk of mortality in both ISS groups, its impact was less significant than the aforementioned variables.ConclusionSevere injuries in older patients are predominantly caused by low energy falls and bicycle accidents, leading to high mortality rates. A low GCS at arrival and high ASA scores are most strongly associated with an increased risk for mortality. Notably, despite the prevalence of severe injuries among the oldest patients, the proportion of intensive care unit admissions decreases markedly with age. This raises the question what feasible care for these often frail patients should comprise of and where this care should be provided, especially for those with severe pre-existent comorbidities.Level of evidence and study typeLevel III, prognostic/epidemiological.

Predictive strength of inflammatory scores for in-hospital mortality in infective endocarditis.

Inflammatory markers have been proposed as prognostic tools for predicting in-hospital mortality in infective endocarditis (IE). Nonetheless, it is unclear whether these markers provide additional prognostic value over established indicators. This study compared nine different inflammation scores to assess their effectiveness in enhancing the prediction of in-hospital mortality. Patients with IE diagnosed between 2017 and 2023 at two cardiology centers in Istanbul were included in this study. Pre-treatment inflammatory markers were obtained from the hospital electronic database system. In-hospital mortality prognostication was assessed using Cox proportional hazards models. Atotal of 122 patients who were diagnosed with IE were included in the analysis. Overall, 38patients died during the hospital stay. The patients were categorized into two groups based on their mortality status. The prognostic nutritional index (PNI), platelet-to-lymphocyte ratio (PLR), and modified Glasgow prognostic score (mGPS) were identified as statistically significant predictors of in-hospital mortality. Based on the results of Cox regression analysis, the PNI (hazard ratio [HR]: 0.921, 95%confidence interval [CI]: 0.853-0.994, p = 0.035) emerged as the only independent predictor of in-hospital mortality of IE patients. Nine inflammatory scores were evaluated in this study. The PNI, PLR, and mGPS were statistically significant predictors of in-hospital mortality in patients with IE. The PNI was identified as the optimal score.

Expiration-Triggered Sinus Arrhythmia Predicts Mortality Risk in the General Elderly Population

Reduced respiratory sinus arrhythmia, quantified as expiration-triggered sinus arrhythmia (ETA) from simultaneous electrocardiogram and respiration recordings, is a strong long-term mortality predictor in myocardial infarction survivors. Here, we investigated whether ETA also predicts mortality risk in the general elderly population. ETA was quantified from 30-min electrocardiogram and respiration recordings in 1788 general population subjects aged ≥60 years, who were then followed for a median of 4.0 years (median age 72 years, 58% female). Four-year all-cause mortality was 4.6%. Abnormal ETA using a predefined cutoff (≤0.19 ms) was associated with a 4-year mortality of 6.9%, compared to 3.7% in the remaining participants (p = 0.0022). ETA remained a significant mortality predictor in multivariable Cox analysis, also considering a modified Framingham score incorporating sex, age, smoking, cholesterol, blood pressure, antihypertensive medication, family history, diabetes and clinical atherosclerosis (multivariable hazard ratio 1.81; 95% confidence interval 1.17–2.81; p = 0.008). Combined risk prediction by ETA (using an optimized cutoff of ≤0.86 ms) and the Framingham score stratified patients into a low-risk (both parameters normal), an intermediate-risk (one parameter abnormal) and a high-risk group (both parameters abnormal), with 4-year mortality rates of 1.9%, 4.4% and 10.1%, respectively. We conclude that in elderly general population subjects, ETA is a mortality risk predictor that complements classical clinical risk stratification.

Association of Liver Fibrosis Markers with Mortality Outcomes in Patients with Chronic Kidney Disease and Coronary Artery Disease: Insights from the NHANES 1999-2018 Data.

The objective of this research is to explore the possible link between markers of liver fibrosis and survival rates in a group of adults who have been diagnosed with both chronic kidney disease (CKD) and coronary artery disease (CAD). The National Health and Nutrition Examination Survey (NHANES) data (1999-2018) for participants with both CAD and CKD were analyzed. The Fibrosis-4 Index (FIB-4), Nonalcoholic Fatty Liver Score (NFS), Forns index and Aspartate Aminotransferase/Alanine Aminotransferase (AST/ALT) ratio were identified as crucial biomarkers. All-cause and cardiovascular disease (CVD) mortality were primary outcomes, assessed using Cox models, Kaplan-Meier curves, and ROC analysis. A total of 1,192 CKD and CAD patients were included. The Cox regression analysis revealed substantial correlations between elevated FIB-4, NFS, Forns index and AST/ALT levels and a heightened risk of all-cause (HR 1.188, 95%CI 1.108-1.274; HR 1.145, 95%CI 1.069-1.227; HR 1.142, 95%CI 1.081-1.201; HR 1.316, 95%CI 1.056-1.639, respectively) and CVD mortality (HR 1.133, 95%CI 1.007-1.275; HR 1.155, 95%CI 1.024-1.303; HR 1.208, 95%CI 1.109-1.316 and HR 1.636, 95%CI 1.203-2.224, respectively). The ROC analysis indicated comparable predictive accuracy for all three biomarkers, with AST/ALT showing slightly superior performance. Liver fibrosis markers, including AST/ALT, NFS, Forns index and FIB-4, are significant mortality predictors in CAD-CKD patients. The AST/ALT ratio, being easily measurable, may serve as an effective predictive tool for risk stratification in this population.

Incidence and determinants of mortality among patients with colorectal cancer in oncology centers of Amhara region, Ethiopia, 2024: multicenter retrospective follow up study

IntroductionColorectal cancer is a significant cause of mortality globally, with several factors impacting patient outcomes, including access to healthcare, early detection, and treatment. Despite this, the specific factors affecting incidence of death among colorectal cancer patients in the Amhara region have not been thoroughly investigated. Thus, this study seeks to assess incidence and determinants of mortality among colorectal cancer patients in Amhara Region oncology centers.ResultsThe mean age of the participants was 48.6 years (SD ± 15). Median survival time was 23.8 months. The overall incidence rate or incidence density of a colorectal cancer mortality rate was 2.9 per 100 person-months (95% CI: 2.5–3.4). Survival rates of colorectal cancer patients 1and 5 year was 69.78% and 16.1%, respectively. The result of the multivariable analysis showed that colorectal cancer patients who had presenting symptoms [AHR = 2.67 (95% CI: 1.95, 3.67)], Base line HGB level < 12.5 mg/dl [AHR = 1.63 (95% CI: 1.12, 2.37)], WHO or ECOG poor performance status [AHR = 2.99 (95% CI: 2.17, 4.12), late stage of cancer [AHR = 2.32 (95% CI: 1.42, 3.79)] and location of tumor on colorectal [AHR = 1.76 (95% CI: 1.20, 2.55)] were significantly associated with mortality of colorectal cancer.Conclusion and recommendationThe study highlights significant findings on the survival and mortality of colorectal cancer patients. The overall mortality rate was 2.9 per 100 person-months. Multivariable analysis identified presenting symptoms, low baseline hemoglobin levels, poor performance status, late-stage cancer, and tumor location as significant predictors of mortality. Highlighting the need for early detection and targeted care strategies.

Prioritizing Patient Selection in Clinical Trials: A Machine Learning Algorithm for Dynamic Prediction of In-Hospital Mortality for ICU Admitted Patients Using Repeated Measurement Data.

Background: A machine learning prognostic mortality scoring system was developed to address challenges in patient selection for clinical trials within the Intensive Care Unit (ICU) environment. The algorithm incorporates Red blood cell Distribution Width (RDW) data and other demographic characteristics to predict ICU mortality alongside existing ICU mortality scoring systems like Simplified Acute Physiology Score (SAPS). Methods: The developed algorithm, defined as a Mixed-effects logistic Random Forest for binary data (MixRFb), integrates a Random Forest (RF) classification with a mixed-effects model for binary outcomes, accounting for repeated measurement data. Performance comparisons were conducted with RF and the proposed MixRFb algorithms based solely on SAPS scoring, with additional evaluation using a descriptive receiver operating characteristic curve incorporating RDW's predictive mortality ability. Results: MixRFb, incorporating RDW and other covariates, outperforms the SAPS-based variant, achieving an area under the curve of 0.882 compared to 0.814. Age and RDW were identified as the most significant predictors of ICU mortality, as reported by the variable importance plot analysis. Conclusions: The MixRFb algorithm demonstrates superior efficacy in predicting in-hospital mortality and identifies age and RDW as primary predictors. Implementation of this algorithm could facilitate patient selection for clinical trials, thereby improving trial outcomes and strengthening ethical standards. Future research should focus on enriching algorithm robustness, expanding its applicability across diverse clinical settings and patient demographics, and integrating additional predictive markers to improve patient selection capabilities.

Temporal changes and implications of diffusion tensor imaging metrics and cerebral white matter volume in patients undergoing carotid endarterectomy - a prospective study.

To test utility of diffusion MRI-derived indices in carotid endarterectomy (CEA), change of diffusion tensor imaging (DTI) metrics, cerebral white matter (WM) volumes were evaluated and predictors of overall mortality determined. Prospectively enrolled participants had preoperative, immediate and late postoperative DTI after CEA. WM volumes, DTI metrics (fractional anisotropy, FA; axial, radial, mean diffusivities; AD, RD, MD, respectively) were calculated for the index/contralateral hemispheres at all time points. Temporal changes, predictors of log2-transformed WM volumes, DTI values were analyzed using linear mixed model. Uni- and multivariable Cox proportional hazards models were used to identify predictors of mortality. 60 subjects (57% male, 69.5 ± 7.2years) were included. Significantly increased AD and MD was observed in both hemispheres comparing the preoperative and immediate postoperative DTI metrics (index AD: β = 0.02 [95%CI:0.01,0.02], p < 0.001; index MD: β = 0.02 [95%CI:0.01,0.03], p < 0.001; contralateral AD: β = 0.01 [95%CI:0.01,0.02], p = 0.001; contralateral MD: β = 0.02 [95%CI:0.01,0.03], p = 0.003). The index MD decreased (β = 0.01 [95%CI:0.01,0.001], p = 0.04), bilateral WM volumes (index WM: β = 0.04 [95%CI:0.02,0.07], p < 0.001; contralateral WM: β = 0.05 [95%CI:0.03,0.07], p < 0.001) decreased significantly between the immediate and late postoperative scans. Postoperative contralateral FA correlated significantly with lower mortality (HR = 0.001 [95%CI:0.001,0.19], p = 0.02); postoperative contralateral RD (HR = 3.74 × 104 [95%CI:1.62,8.60 × 108], p = 0.04) and MD (HR = 1.19 × 105 [95%CI:1.03,1.37 × 1010], p = 0.049) were significant predictors of mortality. The increase of various DTI metrics from pre-to-postoperative may be indicative of microstructural deterioration following CEA. Temporal changes between the immediate and late postoperative scans suggest, however, reversal of detrimental WM changes and clearance of presumed subclinical WM edema. Our results also imply, that preserved cerebral properties are protective after CEA.

Mortality Patterns in Pediatric Pulmonary Vein Stenosis: Insights Into Right Ventricular Systolic Pressure Associations.

Pulmonary vein stenosis in children is associated with a poor prognosis. However, the cause and risk factors for mortality remain uncertain. This retrospective, single-center study identified children with primary and secondary pulmonary vein stenosis through a cardiac catheterization database. Kaplan-Meier analysis, log-rank tests, and Cox regression analysis were performed to assess outcome and identify significant predictors of mortality. Among 56 children with pulmonary vein stenosis (33 male children, 59%), 20 (36%) died at a median age of 10 months (interquartile range,4-24 months). All patients underwent cardiac catheterization, with 45 (80%) undergoing at least 1 interventional procedure. Causes of death included multiorgan failure (35%), progressive respiratory failure (20%), and sudden cardiac death (15%). Prematurity, chronic lung disease, a genetic syndrome, or the number of affected pulmonary veins did not significantly correlate with mortality. However, right ventricular (RV) systolic pressure greater than half systemic pressure was associated with mortality (hazard ratio [HR], 5.5 [95% CI, 2.2-14.1]; P<0.001). The final predictive model for mortality included RV systolic pressure greater than half systemic pressure (HR, 4.0 [95% CI, 1.6-10.4]; P=0.004), moderately or severely diminished RV systolic function (HR, 3.6 [95% CI, 1.1-11.5]; P=0.032), and the presence of congenital heart disease (HR, 2.4 [95% CI, 0.9-6.7]; P=0.084). This report is the first to indicate that RV systolic pressure and RV dysfunction are significant independent predictors of mortality in children with pulmonary vein stenosis. A greater understanding of mortality in this population is necessary, particularly in those with RV systolic pressure less than half systemic.

The Effect of Coronary Artery Disease on the Prognosis of Hypertrophic Cardiomyopathy: A Multi-Center Cohort Study.

There is a shortage of patients with hypertrophic cardiomyopathy (HCM) with concurrent coronary artery disease (CAD), and the influence of CAD on the prognosis of patients with HCM is uncertain. This real-world cohort study was conducted to evaluate the prognosis of patients with patients with CAD. This cohort study of patients with HCM was conducted from May 2003 to September 2021. The total number of patients enrolled was 2167, and the mean follow-up period was 6.4 years (interquartile range 2.8-9.5 years). Sudden cardiac death (SCD), cardiovascular death, and all-cause mortality were assessed as outcomes. Using logistic regression, nine indicators were selected for 1:1 propensity score matching (PSM). Additionally, Kaplan-Meier survival curves and Cox proportional hazards regression analyses were used to assess the impact of CAD on the prognosis of patients with HCM. During an average of 6.4 years of follow-up, of the 2167 patients enrolled, 446 (20.6%) died. The patients were classified into two groups: CAD (n = 480) and non-CAD (n = 1,687). After imputation of missing values using the mean and 1:1 propensity score matching, there was no difference in SCD (log-rank χ2 = 0.4, p = 0.540), cardiovascular death (log-rank χ2 = 0.1, p = 0.995) and all-cause mortality (log-rank χ2 = 0.1, p = 0.776) between the CAD and non-CAD groups. After imputation of missing values using the median and 1:1 propensity score matching, patients with and without CAD were not significantly different in terms of SCD (log-rank χ2 = 0.1, p = 0.948), cardiovascular death (log-rank χ2 = 0.1, p = 0.811), and all-cause mortality (log-rank χ2 = 0.5, p = 0.499). In the Cox analysis, CAD was not a significant independent predictor of SCD, cardiovascular death, or all-cause mortality in patients with HCM. In this study, it was observed that there was no statistically significant disparity in mortality rates between patients diagnosed with HCM who concurrently had CAD and those who did not exhibit CAD. This finding underscores the notion that the presence of CAD did not exert a notable influence on the incidence of SCD, cardiovascular death, or all-cause mortality, thereby emphasizing the complexity and multifaceted nature of mortality risk factors in HCM patients.

Ionised calcium levels during trauma resuscitation in predicting outcomes-a prospective cohort study.

Haemorrhage remains the leading cause of preventable mortality following trauma, often aggravated by the acidosis, hypothermia and coagulopathy-the lethal triad of trauma. However, the impact of trauma-induced hypocalcemia on the haemorrhage remains unclear. It is intuitive to consider perturbations of ionised calcium early during trauma resuscitation in acutely injured patients given its pathophysiological significance for an improved outcome. Thus, we conducted a prospective study to analyse the role of ionized calcium ion levels during trauma resuscitation and its association with the need for blood transfusion(s) requirement and mortality. A prospective study was conducted on acutely injured patients with haemorrhage getting admitted to a Level 1 trauma center in India between September 2020 and June 2022. Ionised calcium was measured on arrival, after 6h, and on day two of the injury to assess the prevalence. The amount of blood transfusion received by the patient was noted along with other demographic and in-hospital details. The association of hypocalcemia with blood transfusion and mortality was also evaluated. Of the 1961 patients screened for eligibility, 200 patients were recruited and analysed. 72.5% of patients were hypocalcaemic on emergency department (ED) admission. Ionized hypocalcaemia was significantly associated with the need for blood transfusion(s) (p-value < 0.01). A significant association was also noted between ionized hypocalcaemia and mortality (p-value: 0.0085). On the univariate and multivariable analysis, ionized hypocalcaemia was a significant predictor of mortality. Ionized hypocalcaemia is widely prevalent among acutely injured. Trauma-induced hypocalcaemia at admission is associated with increased need for blood transfusions and increased mortality.

Predictive models and determinants of mortality among T2DM patients in a tertiary hospital in Ghana, how do machine learning techniques perform?

BackgroundThe increasing prevalence of type 2 diabetes mellitus (T2DM) in lower and middle – income countries call for preventive public health interventions. Studies from Africa including those from Ghana, consistently reveal high T2DM-related mortality rates. While previous research in the Ho municipality has primarily examined risk factors, comorbidity, and quality of life of T2DM patients, this study specifically investigated mortality predictors among these patients.MethodThe study was retrospective involving medical records of T2DM patients. Data extracted included mortality outcome (dead or alive), sociodemographic characteristics (age, sex, marital status, educational level, occupation and location), family history of diseases (diabetes, cardiovascular disease (CVD), or asthma), lifestyle (smoking and alcohol intake), comorbidities (such as skin infections, sickle cell disease, urinary tract infections, and pneumonia) and complications of diabetes (CVD, nephropathy, neuropathy, foot ulcers, and diabetic ketoacidosis) were analyzed using Stata version 16.0 and Python 3.6.1 programming language. Both descriptive and inferential statistics were done to describe and build predictive models respectively. The performance of machine learning (ML) techniques such as support vector machine (SVM), decision tree, k nearest neighbor (kNN), eXtreme Gradient Boosting (XGBoost) and logistic regression were evaluated using the best-fitting predictive model for T2DM mortality.ResultsOf the 328 participants, 183 (55.79%) were female, and the percentage of mortality was 11.28%. A 100% mortality was recorded among the T2DM patients with sepsis (p-value = 0.012). T2DM in-patients were 3.83 times as likely to die [AOR = 3.83; 95% CI: (1.53–9.61)] if they had nephropathy compared to T2DM in-patients without nephropathy (p-value = 0.004). The full model which included sociodemographic characteristics, family history, lifestyle variables and complications of T2DM had the best prediction of T2DM mortality outcome (ROC = 72.97%). The accuracy for (test and train datasets) were as follows: (90% and 90%), (100% and 100%), (90% and 90%), (90% and 88%) and (88% and 90%) respectively for the various ML classification techniques: logistic regression, Decision tree classifier, kNN classifier, SVM and XGBoost.ConclusionThis study found that all in-patients with sepsis died. Nephropathy was the identified significant predictor of T2DM mortality. Decision tree classifier provided the best classifying potential.

A novel nomogram for predicting mortality risk in young and middle-aged patients undergoing maintenance hemodialysis: a retrospective study.

The annual growth in the population of maintenance hemodialysis (MHD) patients is accompanied by a trend towards younger age groups among new cases. Despite the escalating mortality risk observed in MHD patients, there remains a dearth of research focused on young and middle-aged individuals in this cohort, leading to a deficiency in specialized predictive instruments for this demographic. This research seeks to explore the critical determinants impacting mortality risk in young and middle-aged MHD patients and to construct a prediction model accordingly. This study involved 127 young and middle-aged patients undergoing MHD in the Blood Purification Center of Chaohu Hospital of Anhui Medical University from January 2019 to January 2022. The follow-up period for each patient ended either at the time of death or on January 31, 2024. Participants were monitored to determine their survival status and categorized into two groups: those who survived (98 patients) and those who deceased (29 patients). Clinical data were gathered for analysis. Logistic regression was utilized to pinpoint independent risk factors for mortality among these patients. Subsequently, a nomogram was established to predict mortality risk. The efficacy of this model was assessed through the area under the receiver operating characteristic curve (AUC-ROC), alongside a calibration curve and the Hosmer-Lemeshow test to examine its fit. Additionally, decision curve analysis (DCA) was conducted to ascertain the clinical relevance of the predictive model. The study incorporated 127 young and middle-aged patients undergoing MHD, with a mortality rate recorded at 22.83% (29 cases). A logistic regression analysis revealed that age, hemoglobin (HB), serum magnesium (Mg), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-albumin ratio (PAR) were significant independent predictors of mortality among these patients. Utilizing these variables, a nomogram was developed to predict mortality risk, achieving an AUC of 0.899 (95% CI: 0.833-0.966). The model exhibited a specificity of 83.67% and a sensitivity of 82.76%, demonstrating substantial discriminative ability. The model's robustness was confirmed through internal validation with 1,000 bootstrap samples, yielding an AUC of 0.894 (95% CI: 0.806-0.949). The calibration curve closely aligned with the ideal curve, and the Hosmer-Lemeshow goodness-of-fit test yielded a χ 2 value of 6.312 with a p-value of 0.612, verifying the model's high calibration accuracy. Additionally, the DCA indicated that the model provides a net benefit across a wide range of decision thresholds from 0 to 0.99, underscoring its clinical utility. The nomogram developed from variables including age, HB levels, serum Mg, NLR, and PAR exhibits high levels of discrimination and calibration. This model effectively predicts mortality risk among young and middle-aged patients undergoing MHD, proving its clinical relevance.

Methylglyoxal-induced glycation stress promotes aortic stiffening: Putative mechanistic roles of oxidative stress and cellular senescence.

Here, we assessed the role of the advanced glycation end-product (AGE) precursor methylglyoxal (MGO) and its non-crosslinking AGE MGO-derived hydroimidazolone (MGH)-1 in aortic stiffening and explored the potential of a glycation stress-lowering compound (Gly-Low) to mitigate these effects. Young (3-6 month) C57BL/6 mice were supplemented with MGO (in water) and Gly-Low (in chow). Aortic stiffness was assessed in vivo via pulse wave velocity (PWV) and ex vivo through elastic modulus. Putative mechanisms underlying MGO- and MGH-1-induced aortic stiffening were explored using complementary experimental approaches in aortic tissue and cultured human aortic endothelial cells (HAECs). Moreover, aortic stiffness was assessed in old (24 month) mice after consumption of Gly-Low-enriched chow. MGO-induced glycation stress increased PWV in young mice by 21% (P<0.05 vs. control), which was prevented with Gly-Low (P=0.93 vs. control). Ex vivo, MGO increased aortic elastic modulus 2-fold (P<0.05), superoxide production by ∼40% (P<0.05), and MGH-1 expression by 50% (P<0.05), which were all mitigated by Gly-Low. Chronic MGO exposure elevated biomarkers of cellular senescence in HAECs, comparable to a known senescence inducer Doxorubicin, an effect partially blocked by Gly-Low. Moreover, elevated aortic elastic modulus induced by Doxorubicin (P<0.05 vs. control) was prevented with Gly-Low (P=0.71 vs. control). Aortic RNA sequencing implicated preservation of endogenous cellular detoxification pathways with Gly-Low following exposure to MGH-1. Old mice supplemented with Gly-Low had lower PWV (P<0.05) relative to old control mice. MGO-induced glycation stress contributes to aortic stiffening and glycation stress lowering compounds hold promise for mitigating these effects. This study provides the first comprehensive line of evidence that methylglyoxal (MGO)-induced glycation stress directly contributes to aortic stiffening and does so through mechanisms involving oxidative stress and cellular senescence. Using complementary in vivo , ex vivo , and in vitro experimental models, we establish that MGO-mediated glycation stress independently induces aortic stiffening. Furthermore, we demonstrate that the glycation-lowering compound, Gly-Low, mitigates MGO-induced aortic stiffening by mitigating excessive oxidative stress and cellular senescence, and can lower aortic stiffness in old mice. Mechanistically, activation of the detoxification enzyme, glyoxalase-1 (Glo-1), is a novel pathway by which Gly-Low mediates its therapeutic effects on aortic stiffening. Lastly, we show that Gly-Low holds promise for lowering aortic stiffness in old age. Aortic stiffening is a major risk factor for cardiovascular diseases (CVD) and a significant predictor of CV-related morbidity and mortality. Yet, the underlying mechanisms driving this process remain incompletely understood. This study identifies MGO-derived glycation stress as a critical and modifiable factor contributing to aortic stiffening through pathways involving excessive oxidative stress and cellular senescence. By establishing the efficacy of Gly-Low in mitigating these effects, our findings underscore the importance of targeting glycation stress in the context of aging, and likely in other settings of glycation stress, to improve arterial health and reduce CVD risk. These findings have significant clinical implications, as they demonstrate that glycation stress is a viable and modifiable therapeutic target for the prevention and treatment of aortic stiffening. Gly-Low offers a promising therapeutic approach to ameliorate glycation stress- and age-related aortic stiffening, by directly targeting excess glycation stress, oxidative stress, and cellular senescence. Additionally, the involvement of the Glo-1 detoxification pathway suggests a specific molecular target for future interventions aimed at improving arterial health and mitigating the progression of CVD.

Blood urea nitrogen-to-albumin ratio as a new prognostic indicator of 1-year all-cause mortality in patients with IPF.

Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease characterized by chronic inflammation and progressive fibrosis. The blood urea nitrogen-to-albumin ratio (BAR) is a comprehensive parameter associated with inflammation status; however, it is unknown whether the BAR can predict the prognosis of IPF. This retrospective study included 176 patients with IPF, and 1-year all-cause mortality of these patients was recorded. A receiver operating characteristic (ROC) curve was used to explore the diagnostic value of BAR for 1-year all-cause mortality in IPF patients, and the survival rate was further estimated using the Kaplan-Meier survival curve. Cox proportional hazards regression model and forest plot were used to assess the association between the BAR and 1-year all-cause mortality in IPF patients. The BAR of IPF patients was significantly higher in the non-survivor group than in the survivor group [0.16 (0.13-0.23) vs. 0.12 (0.09-0.17) mmol/g, p = 0.002]. The area under the ROC curve for predicting 1-year all-cause mortality in IPF patients was 0.671, and the optimal cut-off value was 0.12 mmol/g. The Kaplan-Meier survival curve showed that the 1-year cumulative survival rate of IPF patients with a BAR ≥0.12 was significantly decreased compared with the patients with a BAR <0.12. The Cox regression model and forest plot showed that the BAR was an independent prognostic biomarker for 1-year all-cause mortality in IPF patients (HR = 2.778, 95% CI 1.020-7.563, p = 0.046). The BAR is a significant predictor of 1-year all-cause mortality of IPF patients, and high BAR values may indicate poor clinical outcomes.

Mortality in Antinuclear Antibody-Positive Patients with and Without Rheumatologic Immune-Related Disorders: A Large-Scale Population-Based Study.

Background & Objectives: To explore the potential association between positive ANA serology and all-cause mortality in a large cohort of patients, including those with and without rheumatological conditions and other immune-related diseases. Material and Methods: A retrospective cohort study analyzed all-cause mortality among 205,862 patients from Clalit Health Services (CHS), Israel's largest health maintenance organization (HMO). We compared patients aged 18 and older with positive ANA serology (n = 102,931) to an equal number of ANA-negative controls (n = 102,931). Multivariable Cox regression models were used to assess hazard ratios (HR) for mortality, adjusting for demographic and clinical factors. Results: ANA positivity was strongly associated with increased mortality (adjusted HR [aHR] 4.62; 95% CI 4.5-4.7, p < 0.001). Significant predictors of mortality included male gender (39.2% vs. 24.4%, p < 0.001), older age at testing (72.4 ± 13.0 vs. 50.1 ± 17.3 years, p < 0.001), and Jewish ethnicity (89.6% vs. 83.2%, p < 0.001). Certain ANA patterns, such as mitochondrial (and dense fine speckled (DFS-AC2)), were highly predictive of mortality, with aHRs of 36.14 (95% CI 29.78-43.85) and 29.77 (95% CI 26.58-33.34), respectively. ANA-positive patients with comorbid rheumatological immune-related disorders (RIRDs) demonstrated a higher survival rate compared to those without such a condition (aHR 0.9, 95% CI 0.86-0.95, p < 0.001). This finding remained significant after adjusting for several parameters, including age. Conclusions: ANA positivity is associated with increased all-cause mortality, particularly in individuals without rheumatologic disorders, after adjusting for confounders such as age. This may indicate occult malignancies, cardiovascular pathology, or chronic inflammatory states, necessitating more vigilant surveillance.

Assessment of Treatment Outcomes and Associated Factors Among Pediatric Patients With Burkitt Lymphoma at Kenyatta National Hospital.

In developing countries, the treatment outcomes of Burkitt lymphoma are poor due to the poorly equipped healthcare systems. In addition, there is limited comprehensive data within the African continent, including Kenya, about the outcomes of treatment for this cancer. To assess treatment outcomes and variables associated with an increased risk of death from disease progression or treatment-related toxicities among Burkitt lymphoma pediatric patients at the Kenyatta National Hospital (KNH). A retrospective one-arm cohort study was conducted to examine the treatment outcomes of pediatric patients with Burkitt lymphoma. All eligible Burkitt lymphoma pediatric patients treated between January 1, 2016 and December 31, 2022 were included. The patients were retrospectively monitored from the initial cancer diagnosis until either death or the last follow-up appointment visit in the facility. Data analysis of factors associated with treatment and disease progression-related death was carried out using the SPSS version 29.0 software. Kaplan-Meier survival and Cox regression analyses were employed to determine the survival time and predictors of mortality, respectively. The median age of the patients at diagnosis was 6 years (range: 3-13 years). The majority of patients were diagnosed with Stage IV disease accounting for 46.7% of all patients. Of the 75 patients studied, 24% (18) of them were died. The 5-year overall survival rate was 70%, and most patients had stable disease during the follow-up period. Patients with Stage IV disease who were treated with full-fuse chemotherapy were 19.2 (AHR = 19.2, 95% CI = 5.2-48.5, p < 0.001) and 7.4 times (AHR = 7.4, 95% CI = 2.2-19.9, p = 0.003) more hazard of dying as compared to patients without metastasis and received a combination of radiation and reduced-dose chemotherapy, respectively. However, the age, gender, stage of cancer, histological type of cancer, and co-morbidity were not significant predictors of survival. Because of the retrospective nature of the study design, the data accuracy relied on the proper documentation of medical records in the study setting. The 5-year overall survival rate among pediatric burkitt's lymphoma patients was above average as compared to other African countries. Most patients had reduced tumor size and stable disease during the follow-up period. Metastases and full-fuse chemotherapy were significant predictors of mortality.