Significant Predictor Of Mortality Research Articles

The utility of temporal trends of blood biomarkers as predictors for bloodstream infections in left ventricular assist device recipients.

Temporal trends of routinely obtained parameters may provide valuable information for predicting BSIs, but this association has not yet been established in LVAD patients. This retrospective analysis included data from 347 consecutive recipients of three rotary LVAD types. Study endpoints included the incidence of BSI, the association of temporal trends of routinely obtained blood biomarkers with the development of BSIs, the incidence of BSIs, and survival on LVAD support. During follow-up, 47.8% (n = 166) of the patients developed BSI. In multivariate analyses, the development of BSI was a significant predictor of mortality (HR 5.78, 95% CI 4.08-8.19, p < 0.0001). In univariate analyses, after adjusting for potential confounders, albumin (SHR 0.94, 95% CI 0.91-0.97, p < 0.00010), creatinine (SHR 1.49, 95% CI 1.03-2.15, p = 0.033), and C-reactive protein (SHR 1.19, 95% CI 1.08-1.32, p = 0.0007) significantly predicted the development of BSIs during LVAD support. Notably, the strength of the association of parameter changes with the prediction of BSIs demonstrated a time-dependent correlation in the cases of albumin (p = 0.045) and creatinine (p = 0.003). Bloodstream infections are highly prevalent among LVAD recipients and are independent predictors of mortality. Temporal biomarker trends significantly predict the development of BSIs. These findings suggest opportunities for interventions aiming to reduce the incidence of BSIs.

Occupational inequalities in mortality from cardiovascular disease, 2020-2021.

In recent years previous declines in cardiovascular disease (CVD) have stalled. There are occupational risk factors for CVD mortality. This study seeks to examine inequalities in CVD mortality for working-age adults in the United States by occupation. Death certificate data for CVD deaths were obtained from the National Center for Health Statistics. Occupation data from these death certificates were coded to major occupation groups. Using information about the number of workers employed in these occupations obtained from the American Community Survey, we calculated mortality rates and rate ratios (RRs), adjusted for covariates associated with CVD mortality. After adjusting for age, sex, race/ethnicity, and educational attainment, workers in 11 occupations had significantly elevated RRs: food preparation and serving; construction and extraction; arts, design, entertainment, sports, and media; life, physical, and social science; farming, fishing, and forestry; legal; protective services; building and grounds cleaning and maintenance; healthcare practitioners and technical; personal care and service; and community and social services. Occupation appears to be a significant predictor of CVD mortality. Further research is needed to assess how occupational risk factors contribute to changing trends for CVD mortality. Interventions are needed to address workplace risk factors for CVD.

Pre-hospital heparin is not associated with infarct vessel patency and mortality in ST-segment elevation myocardial infarction patients with out-of-hospital cardiac arrest.

Pre-hospital heparin administration has been reported to improve prognosis in patients with out-of-hospital cardiac arrest (OHCA). This beneficial effect may be limited to the subgroup of ST-segment elevation myocardial infarction (STEMI) patients. To assess the impact of pre-hospital heparin loading on TIMI (Thrombolysis in Myocardial Infarction) flow grade and mortality in STEMI patients with OHCA, we analyzed data from 2,566 consecutive patients from two hospitals participating in the prospective Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction (FITT-STEMI) trial. In 394 participants with OHCA, 272 (69%) received heparin from the emergency medical service (EMS). Collapse witnessed by EMS (odds ratio (OR) = 3.53, 95%-confidence interval (CI) = 1.54-8.09; p = 0.003) and pre-hospital ECG recording (OR = 3.32, 95% CI = 1.06-10.35; p = 0.039) were identified as parameters significantly associated with pre-hospital heparin use. In univariate analysis, in-hospital mortality was lower in the group receiving heparin in the pre-hospital setting (26.8% vs. 42.6%, p = 0.002). However, in a regression model, pre-hospital heparin use was no longer a significant predictor of mortality (OR = 0.992; p = 0.981). Patency of the infarct artery prior to coronary revascularization, as measured by TIMI flow grade, was not associated with pre-hospital administration of heparin in OHCA patients (OR = 0.840; p = 0.724). In STEMI patients with OHCA, pre-hospital use of heparin is neither associated with improved early patency of the infarct artery nor with a better prognosis. Our results do not support the assumption of a positive effect of heparin administration in the pre-hospital treatment phase in STEMI patients with OHCA. ClinicalTrials.gov: NCT00794001.

Clinical profile, treatment patterns and one-year outcome of heart failure patients admitted in tertiary care hospital of North India

ABSTRACT Introduction: Because of wide heterogeneity in the epidemiology of heart failure among different populations, it is imperative to establish population-specific databases. Aims and Objectives: To describe the clinical profile, treatment patterns, and outcomes of heart failure patients admitted to our tertiary care hospital. Material and Methods: The study was a prospective observational study conducted over two years at our tertiary care hospital. It included patients admitted with acute and acute-on-chronic heart failure. Results: We recruited 264 patients. Mean age of the study population was 57.8 ± 15.14 years. Males were 157 (59.5%). Dilated cardiomyopathy was the most common cause followed by ischemic heart disease. Most common risk factors were hypertension, tobacco use, anemia, and diabetes. Heart failure with reduced ejection fraction was present in 154 (62%) patients. Acute de novo heart failure was present in 91 (34.5%) patients. The most common precipitant for heart failure exacerbation was infection, followed by ischemic causes and non-adherence to drugs. The mean duration of hospital stay was 7.5 ± 3.1 days. The in-hospital mortality was 8.7%, and cumulative six-month and one-year mortality was 23% and 28%, respectively. In multivariate analysis, renal failure, readmission, and not being on guideline-directed medical treatment were significant predictors of mortality. Conclusion: Our patients were younger, predominantly males, with dilated and ischemic cardiomyopathy as commonest etiology. Hypertension and tobacco smoking were most common risk factors, with infections as most common precipitants. Only one-third of patients were on guideline-directed medical therapy. The one-year mortality was 28% and was higher in those without guideline-directed medical therapy.

Burden and determinants of renal dysfunction and in-hospital mortality among acute stroke patients in Ethiopia: A hospital-based observational study.

Stroke, a leading global cause of mortality and neurological impairment, is often complicated by renal failure, exacerbating in-hospital risks and mortality. Limited understanding exists regarding renal failure prevalence in Ethiopian acute stroke patients. This study examines renal function abnormalities in acute stroke patients at Jimma Medical Center (JMC). A hospital-based cross-sectional study was conducted at JMC from December 5, 2023, to March 15, 2024. A structured data collection tool was developed after comprehensive review of pertinent literature, encompassing variables pertinent to the study objectives. Following data quality assurance, information was coded and inputted into EpiData version 3.1, subsequently analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Multivariable logistic regression analysis was performed to adjust for confounding variables, with statistical significance set at P < .05. The mean age of participants was 60.5 ± 15.5 years, with 129 (64.5%) being male. Forty-five participants (22.5%, 95% confidence interval [CI] = 16.9, 28.9) exhibited renal dysfunction. Advanced age (≥70 years), hypertension, diabetes mellitus (DM), cardiac disease, history of transient ischemic attack (TIA)/stroke, and hemorrhagic stroke type were identified as significant predictors of renal dysfunction among hospitalized stroke patients. The mortality rate was 3.7 times higher in stroke patients with renal dysfunction compared to those with normal renal function (adjusted odds ratio [AOR] = 3.7, 95% CI: 1.41, 6.22). Renal function abnormalities were prevalent among hospitalized acute stroke patients, emphasizing the significance of renal dysfunction as a frequent comorbidity. Older age, hypertension, DM, cardiac disease, history of TIA/stroke, and hemorrhagic stroke type emerged as statistically significant predictors of renal dysfunction. Furthermore, renal dysfunction was identified as a significant predictor of in-hospital mortality following stroke.

Uric acid elevation in pediatric patients with dilated cardiomyopathy and prediction of mortality.

Pediatric dilated cardiomyopathy (DCM) is a primary cause of heart failure, highlighting the urgent need for effective prognostic markers. We performed a single-center retrospective study involving 145 children diagnosed with DCM, with a median follow-up period of 4.0 months (interquartile range: 6.2-108.4 months). The relationship between serum uric acid (SUA) levels and all-cause mortality was assessed using Kaplan-Meier survival curves, multivariate Cox proportional hazard models, and restricted cubic spline (RCS) models. Of the 145 children with DCM (median age 5.7 years; 61.4% male), 45 (31%) died within 1 year, and 65 (44.8%) died during the maximum follow-up period. In adjusted multivariate Cox regression models, each log2 SUA increase was linked to a higher risk of 1-year mortality [hazard ratio (HR), 2.66; 95% confidence interval (CI), 1.41-5.01] and overall mortality (HR, 1.97; 95% CI, 1.15-3.37). The highest SUA tertile showed a greater risk of mortality at 1 year (HR, 4.26; 95% CI: 1.5-12.06) and during the maximum follow-up (HR, 2.56; 95% CI: 1.06-6.16) compared with the lowest tertile. RCS models indicated an inverted L-shaped association between baseline SUA levels and overall mortality risk, with age-stratified analyses revealing a linear and U-shaped relationship in children ≤10 and >10 years, respectively. Further age-stratified analyses highlighted the modifying effect of age on this association. Elevated SUA levels are a significant predictor of mortality in pediatric DCM, with a pronounced impact on children under 10 years of age. Therefore, SUA levels could serve as potential biomarkers for risk stratification in this population.

Relationship between imaging-derived parameters and circulating microRNAs to study the degree of lung involvement in hospitalized geriatric patients with COVID-19 pneumonia.

Chest computed tomography (CT) scan is useful to evaluate the type and extent of lung lesions in coronavirus disease 2019 (COVID-19) pneumonia. This study explored the association between radiological parameters and various circulating serum-derived markers, including microRNAs, in older patients with COVID-19 pneumonia. A retrospective analysis was designed to study geriatric patients (≥75 years) with COVID-19 pneumonia, who underwent chest CT scan on admission, and for whom clinical data and serum samples were obtained. To quantify the extent of lung involvement, CT-score, the percentage of healthy lung (HL%), the percentage of ground glass opacity (GGO%),and the percentage of lung consolidation were assessed using computer-aided tools. The association of these parameters with two circulating microRNAs, miR-483-5p and miR-320b, previously identified as biomarkers of mortality risk in COVID-19 geriatric patients, was tested. A total of 73 patients with COVID-19 pneumonia were evaluable (median age 85 years; interquartile range 82-90 years). Among chest CT-derived parameters, thepercentage of lung consolidation (HR 1.08, 95% CI 1.02-1.14), CT-score (HR 1.14, 95% CI 1.03-1.25), and HL% (HR 0.97, 95% CI 0.95-0.99) emerged as significant predictors of mortality, whereas non-significant trends toward increased mortality were observed in patients with higher GGO%. We also found a significant positive association between serum miR-483-5p and GGO% (correlation coefficient 0.28; P = 0.018) and a negative association with HL% (correlation coefficient -0.27; P = 0.023). Overall, the extent of lung consolidation can be confirmed as a prognostic parameter of COVID-19 pneumonia in older patients. Among various serum-derived markers, miR-483-5p can help in exploring the degree of lung involvement, due to its association with higher GGO% and lower HL%. Geriatr Gerontol Int 2024; ••: ••-••.

Importance of hospital and clinical factors for early mortality in Takotsubo syndrome: Insights from the Swedish Coronary Angiography and Angioplasty Registry

BackgroundTakotsubo syndrome (TTS) is an acute heart failure syndrome with symptoms similar to acute myocardial infarction. TTS is often triggered by acute emotional or physical stress and is a significant cause of morbidity and mortality. Predictors of mortality in patients with TS are not well understood, and there is a need to identify high-risk patients and tailor treatment accordingly. This study aimed to assess the importance of various clinical factors in predicting 30-day mortality in TTS patients using a machine learning algorithm.MethodsWe analyzed data from the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR) for all patients with TTS in Sweden between 2015 and 2022. Gradient boosting was used to assess the relative importance of variables in predicting 30-day mortality in TTS patients.ResultsOf 3,180 patients hospitalized with TTS, 76.0% were women. The median age was 71.0 years (interquartile range 62–77). The crude all-cause mortality rate was 3.2% at 30 days. Machine learning algorithms by gradient boosting identified treating hospitals as the most important predictor of 30-day mortality. This factor was followed in significance by the clinical indication for angiography, creatinine level, Killip class, and age. Other less important factors included weight, height, and certain medical conditions such as hyperlipidemia and smoking status.ConclusionsUsing machine learning with gradient boosting, we analyzed all Swedish patients diagnosed with TTS over seven years and found that the treating hospital was the most significant predictor of 30-day mortality.

Use of intraaortic balloon pump in cardiogenic shock patients.

The relevance of the use of intra-aortic balloon pump (IABP) in cardiogenic shock (CS) has been discussed over the past years. The aim of this study is to describe asingle-centre 10-year experience with IABP and analyse the risk factors for 30-day mortality. The data for this single-centre, observational, retrospective study were drawn from records dated from January 2012 to May 2022 pertaining to patients presenting with CS, treated with IABP and hospitalised at the Department of Acute Cardiology, Institute for Clinical and Experimental Medicine, Prague. Among the patients included in the study, 87% patients presented with newly developed heart failure. The leading cause of CS was acute myocardial infarction accounting for 86% of cases. Hospital mortality was recorded at 39% and the 30-day mortality reached 43%. Upon multi-variable analysis, only the vasoactive inotropic score on day 5 emerged as astatistically significant predictor for 30-day mortality (p=0.0055). Cox regression analysis revealed that the presence of mechanical complications was the only variable identified as yielding astatistically significant impact on the 30-day survival (Log-rank p=0.014, HR 2.19, 95% CI: 1.15‒4.15). There was no statistically significant difference in the 30-day mortality across the SCAI classes. The main cause of CS was anewly developed acute heart failure secondary to acute myocardial infarction. Despite the implementation of mechanical circulatory support, both in-hospital and 30-day mortality rates remained high. Increased vasoactive inotropic score and presence of mechanical complications were identified as significant predictors the 30-day survival (Tab. 6, Fig. 1, Ref. 36). Text in PDF www.elis.sk Keywords: cardiogenic shock, IABP, risk factors, mortality, Czech Republic, AMICS.

20 Years of triple-valve surgery in the UK: demographic and outcome trends.

To describe evolving demographic trends and early outcomes in patients undergoing triple-valve surgery in the UK between 2000 and 2019. We planned a retrospective analysis of national registry data including patients undergoing triple-valve surgery for all aetiologies of disease. We excluded patients in a critical preoperative state and those with missing admission dates. The study cohort was split into 5 consecutive 4-year cohorts (groups A, B, C, D and E). The primary outcome was in-hospital mortality, and secondary outcomes included prolonged admission, re-exploration for bleeding, postoperative stroke and postoperative dialysis. Binary logistic regression models were used to establish independent predictors of mortality, stroke, postoperative dialysis and re-exploration for bleeding in this high-risk cohort. We identified 1750 patients undergoing triple-valve surgery in the UK between 2000 and 2019. Triple valve surgery represents 3.1% of all patients in the dataset. Overall mean age of patients was 68.5 ± 12 years, having increased from 63 ±12 years in group A to 69 ± 12 years in group E (P < 0.001). Overall in-hospital mortality rate was 9%, dropping from 21% in group A to 7% in group E (P < 0.001). Overall rates of re-exploration for bleeding (11%, P = 0.308) and postoperative dialysis (11%, P = 0.066) remained high across the observed time period. Triple valve replacement, redo sternotomy and poor preoperative left ventricular ejection fraction emerged as strong independent predictors of mortality. Triple-valve surgery remains rare in the UK. Early postoperative outcomes for triple valve surgery have improved over time. Redo sternotomy is a significant predictor of mortality. Attempts should be made to repair the mitral and/or tricuspid valves where technically possible.

Prevalence and characteristics of paediatric burns at the National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Ghana

IntroductionBurn injuries among children have emerged as a significant global public health concern, accounting for substantial morbidity and mortality worldwide. Low and Middle-Income Countries bear a significant burden of paediatric burn injuries. In Ghana, limited data exists on the prevalence, characteristics and outcomes of paediatric burns. This study provides vital data on the local burden and epidemiology of paediatric burns at Ghana’s main burns treatment center. The findings have significant value in informing prevention strategies, allocating resources, and improving quality of paediatric burn care. Study objectiveTo establish the prevalence and characteristics of paediatric burns injuries in Ghana’s leading burn center. MethodologyA retrospective cohort study analyzed data from 662 adult and paediatric patients who presented with burns from all over Ghana between 2020 and 2022. The study encompassed medical records of paediatric burn cases (aged 0–14 years) admitted to the center from January 2020 to December 2022. A purposive sampling technique was used to select cases based on the inclusion criteria and elimination of cases with 20 % missing data. A total of 335 paediatric records were reviewed. Data analytical methodsDescriptive statistics, such as frequencies, mean, percentages were used to establish period prevalence and demographic characteristics of paediatric burns. Chi-square analysis and univariate logistic regression was utilized to explore associations between categorical variables, and predictors of burn outcome. ResultsThe period prevalence of paediatric burns was found to be 50.6 %. Paediatric burn cases predominantly affected males (57.6 %). Majority of cases fell within the age range of 1 to 5 years (70.1 %). Hot water emerged as the leading cause (58.4 %), whiles superficial partial thickness burns (51.9 %) was the predominant type of burn. Most cases involved burns affecting less than 20 % Total Body Surface Area (59.0 %). Multi-part body injuries were common (87.2 %), with the lower limb being the most affected (25.36 %). The mortality rate was calculated to be 21.0 %. Higher TBSA was a significant predictor of mortality (p < 0.001). ConclusionThis study found a high prevalence of paediatric burns with hot water and foods being the predominant causes. Higher TBSA predicted lower chances of survival. The findings have scientific value in informing prevention strategies, allocating resources, and improving the quality of care.

Validation of the HeartMate 3 survival risk score in a large left ventricular assist device center.

The HeartMate 3 survival risk score was recently validated in the Multicenter study Of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 to predict patient-specific survival in HeartMate 3 left ventricular assist device candidates. The HeartMate 3 survival risk score stratifies individuals into tertiles according to survival probability. We performed a single-center retrospective review of all HeartMate 3 left ventricular assist device recipients between September 2017 and August 2022. Baseline characteristics were collected from the electronic medical records. HeartMate 3 survival risk scores were calculated for all eligible patients. One- and 2-year Kaplan-Meier survival analyses were conducted. A univariate and multivariable Cox regression model was used to identify predictors. A total of 181 patients were included in this final analysis. The median age was 62years, 83% were male, and 26% were Interagency Registry for Mechanically Assisted Circulatory Support Profile 1. The mean HeartMate 3 survival risk score for the entire cohort was 2.66±0.66. Two-year survivals in the high, average, and low survival groups were 93.5%±3.2%, 81.6%±7.4%, and 82.0%±6.6%, respectively. As a continuous variable, the unadjusted HeartMate 3 survival risk score was a significant predictor of mortality (hazard ratio, 2.20; 95% CI, 1.08-4.45; P=.029). The areas under the curve were 0.70 and 0.66 at 1 and 2years, respectively. We were unable to demonstrate the discriminatory ability of the HeartMate 3 survival risk score using the original stratification, but we found significantly increased survival in the high survival group using a binary cutoff (hazard ratio, 4.8; 95% CI, 1.01-20.9; P=.038). The unadjusted HeartMate 3 survival risk score was associated with postimplant survival in patients outside of the Multicenter study Of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 but did not remain an independent predictor after adjusting for ischemic etiology and severe diabetes. The HeartMate 3 survival risk score was able to identify patients at high survival using a binary cutoff, but we were unable to demonstrate its discriminatory ability among the previously published risk tertiles.

National Trends of Inpatient Radiation Cystitis: 2016-2019.

Radiation cystitis with hematuria (RCH) is a potentially devastating complication after pelvic radiation. The cumulative incidence of RCH is debated, and certain severe manifestations may require hospital admission. We aimed to evaluate demographics and outcomes of patients hospitalized for RCH. We performed a retrospective review of hospitalized patients with a primary or secondary diagnosis of RCH from 2016 to 2019 using the National Inpatient Sample. Our unit of analysis was inpatient encounters. Our primary outcome was inpatient mortality. Secondary outcomes included need for inpatient procedures, transfusion, length of stay (LOS), and cost of admission. We then performed multivariate analysis using either a logistic or linear regression to identify predictors of mortality and LOS. Cost was analyzed using a generalized linear model controlling for LOS. We identified 21,320 weighted cases of hospitalized patients with RCH. The average patient age was 75.4 years, with 84.7% male and 69.3% White. The median LOS was 4 days, and the median cost was $8767. The inpatient mortality rate was 1.3%. The only significant predictor for mortality was older age. The only significant predictor of both higher cost and longer LOS was an Elixhauser Comorbidity Score ≥ 3. RCH represents a significant burden to patients and the health care system, and we observed an increasing number of hospitalized patients over time. Additional research is needed to identify underlying causes of RCH and effective treatments for this sometimes-severe complication of pelvic radiation.

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as predictors of mortality in acute pulmonary embolism: A systematic review and meta-analysis.

The purpose of this review was to examine the association between neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and mortality rates in patients with acute pulmonary embolism (PE). PubMed Central, Scopus, Web of Science, and Embase were searched for studies reporting the association between NLR and PLR with mortality up to March 17th 2023. Adjusted ratios were sourced from studies and combined to generate pooled outcomes as odds ratio (OR) in a random-effects model. Risk of bias was assessed using the Newcastle Ottawa Scale. Fifteen studies were included. Meta-analysis showed that NLR was a significant predictor of mortality in patients with PE (OR: 1.42 95% CI: 1.26, 1.61 I2=92%). Results were unchanged on sensitivity analysis and subgroup analysis based on study location, method of diagnosis, sample size, overall mortality rates, cut-offs, and follow-up. Pooled analysis failed to demonstrate PLR as a predictor of mortality in patients with PE (OR: 1.00 95% CI: 1.00, 1.01 I2=57%). Results were unchanged on sensitivity analysis and subgroup analysis based on study location, diagnosis of PE, overall mortality rates, and cut-off. Current evidence from retrospective studies shows that NLR can independently predict mortality in acute PE. Data on PLR was limited and failed to indicate an independent role in the prognosis of PE patients. Registration No. PROSPERO (CRD42023407573).

Modelling long-term outcomes for patients with systemic lupus erythematosus

BackgroundNew treatments for systemic lupus erythematosus (SLE) aim to improve tolerability and disease activity control over standard of care (SoC) treatment. SoC typically includes daily glucocorticoid (GC) which carries a risk of organ damage over time. This study sought to develop natural history models to identify predictors of long-term outcomes with current SoC SLE treatment. MethodsGeneralized linear and parametric accelerated failure time survival models (GLM) and parametric accelerated failure time (AFT) survival models were designed to identify predictors of disease activity, flare rate, GC use, organ damage, and mortality beyond the first year of treatment in patients with SLE. Models were run using a longitudinal retrospective analysis of prospectively collected Toronto Lupus Cohort (TLC) study data, collected between 1997 and 2020. Covariates of clinical and statistical significance were selected by bivariate- then multi-variate regression to find the model of best fit. FindingsOf the 1255 subjects included, 89 % were female 89 % and 65 % Caucasian. Mean follow-up was 10·5 years. At first visit, 51 % of patients had moderate-to-severe disease activity (SLEDAI-2 K score ≥ 6). Mean organ damage scores gradually increased over the years following diagnosis. Median survival of the cohort was ∼35 years from study entry. In the GLM models, SLEDAI-2 K yearly average, and average GC dose were key for predicting change in SLEDAI-2 K, GC use/ dose, and flare (any/rate). Together, adjusted mean SLEDAI-2 K and GC dose were shown to be predictors of mortality and damage in at least 9 of 12 organ systems considered. InterpretationThese comprehensive, longitudinal, predictive models show that disease activity and GC use are significant predictors of organ damage and mortality in a patient population with predominantly moderate to severe SLE. This deepens understanding of SLE natural history and underscores the need for new treatment approaches that reduce disease activity and GC use with an aim to improve long-term SLE outcomes. FundingThis study was funded by AstraZeneca.

Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study

Background: Major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care. Methods: This was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression. Results: A total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and probability of survival scores. Factors independently predictive of mortality were increasing age (OR 1.06, p &lt;0.001) and GCS &lt;15 on admission (OR 7.21, p &lt;0.001). Ps19 was the best predictor of mortality (p &lt;0.001 for each score category), with an AUROC of 0.90. Conclusions: The significant mortality predictors were age, fall from &lt;2 metres, injury of head or limbs, GCS &lt;15 and Ps19. Contrary to previous studies CCI and APACHE II did not significantly predict mortality. Although Ps19 was found to be the best current prognostic score, trauma prognostication would benefit from a single validated scoring system incorporating both physiological variables and injury patterns.

Emergency Department Thoracotomy: A National Trauma Databank analysis

IntroductionEmergency Department Thoracotomy (EDT) warrants further investigation in the pediatric population due to concerns about its futility. Our study evaluates how patient demographics, injury characteristics, and physiologic status influence pediatric EDT outcomes in blunt and penetrating trauma. MethodsThis retrospective study analyzed patients ≤19 years who received EDT within 1 hour of arrival to the ED from the National Trauma Data Bank. Cases were stratified by blunt and penetrating trauma. Descriptive statistics and univariate analysis were used to identify predictors of survival post-EDT. ResultsOf the 1,075 pediatric patients who underwent Emergency Department Thoracotomy (EDT), 79.6 % experienced penetrating trauma and 20.4 % blunt trauma, with survival rates at 25.9 % and 9.1 %, respectively. Survivors of penetrating trauma typically presented with more stable vital signs, such as pulse rate, oximetry, and Glasgow Coma Scale (GCS) scores, and lower Injury Severity Scores (ISS), all correlating with survival (p < 0.05). Survivors of blunt trauma were distinguished by higher respiratory rates and temperatures (p < 0.05). Risk factor analysis indicated that age-adjusted bradycardia, age-adjusted hypotension, and pre-hospital cardiac arrest were significant predictors of mortality across trauma types (penetrating trauma: OR = 18.7, 6.2, and 20.7; blunt trauma: OR = 12, 2.69, and 6.4, all p < 0.05). Notably, pre-hospital respiratory support was associated with a reduced risk of mortality for both types of trauma (OR = 0.32 for penetrating, and OR = 0.23 for blunt, p < 0.05). ConclusionsThe study affirms the significance of pre-hospital care, showing that stable vitals and respiratory support enhance pediatric thoracotomy outcomes. Ongoing research into pediatric-specific trauma protocols are needed. Type of StudyRetrospective cohort Level of EvidenceIII

Associations between body composition and intradialytic hypotension (IDH), and between IDH and prognosis, in hemodialysis patients

BackgroundPrevious studies describing relationships among body compositions, intradialytic hypotension (IDH), and mortality yielded inconsistent results. We studied associations between body composition and IDH, and between IDH and prognosis, in patients on hemodialysis (HD).MethodsParticipants were patients on maintenance HD and predilution online hemodiafiltration (HDF) (n = 303). IDH was defined as nadir systolic blood pressure (SBP) < 90 mmHg for ≥ 2 of 10 dialysis sessions during the exposure period (days 1–22). Clinical data at day 1 and post-dialysis body compositions using bioelectrical impedance analysis conducted once during the exposure period were collected. Differences between the IDH and non-IDH groups were analyzed. Kaplan–Meier survival curves of the IDH and non-IDH groups, logistic regression analyses of IDH, and Cox proportional hazard analyses of all-cause and cardiovascular (CV) mortality in all participants were also performed.ResultsIn all participants, the median (median [interquartile range]) age was 67 [56–74] years, median dialysis duration was 76 [37–145] months, and diabetes prevalence was 42.6% (129/303). Compared with the non-IDH group (n = 274), the IDH group (n = 29) had a lower mean pre-dialysis SBP during the exposure period, longer dialysis duration, lower serum albumin levels, and higher median fat tissue index (10.7 [8.6–14.9] versus 9.5 [6.8–11.9] kg/m2, P < 0.05). The IDH group had lower 3-year survival for all-cause and CV mortality (P < 0.05). When adjusted for mean pre-dialysis SBP, mean ultrafiltration volume during the exposure period, HDF, dialysis duration, and serum albumin, fat tissue index, and lean tissue index were associated with IDH (P < 0.05), but body mass index and overhydration/extracellular water were not. After additional adjustments for age, sex, and diabetes mellitus, only fat tissue index was a significant predictor for IDH [odds ratio: 1.12 (95% confidence interval 1.02–1.25), P < 0.05]. IDH was also a significant predictor of 3-year all-cause and CV mortality (P < 0.05).ConclusionsIncreased fat tissue index was a significant risk factor for IDH in HD and HDF patients. Furthermore, IDH was a significant predictor of 3-year all-cause and CV mortality in HD and HDF patients.

A Summed Score From Cardiopulmonary Exercise Test Parameters Predicts 1-Year Mortality in Newly Diagnosed Interstitial Lung Disease.

Cardiopulmonary exercise testing (CPET) is a unique diagnostic tool that assesses the functional capacity of the heart, lungs, and peripheral oxidative system in an integrated manner. However, the clinical utility of CPET for evaluating interstitial lung disease (ILD) remains uncertain. The objective of this study was to determine the predictive value of CPET for mortality in subjects with ILD. We prospectively enrolled subjects with ILD who underwent CPET at a tertiary medical center in Taiwan and followed up their survival status for 12 months. Mortality prediction was based on comparing CPET parameters between subjects who survived and those who died. We further analyzed CPET parameters that showed significant differences using receiver operating characteristic curves to identify their optimal cutoff values. A total of 106 newly diagnosed subjects with ILD underwent CPET, and the 1-y mortality rate was 7.5%. Six CPET variables were found to be significant predictors of mortality: peak oxygen consumption, oxygen pulse, end-tidal partial pressure of carbon dioxide, heart rate recovery 1 min after CPET, minute ventilation to carbon dioxide output slope, and functional aerobic impairment. We calculated a summed score by adding the number of CPET variables that exceeded their cutoff values. Subjects with a summed score of 6 had a 1-y survival rate of only 25%, whereas subjects with scores of 0-5 had a survival rate of 98%. In conclusion, the summed score represents a useful tool for screening patients with ILD who can undergo a CPET to determine their prognosis.

The role of urine chloride in acute heart failure

In our retrospective study, we aimed to investigate the relationship between urinary chloride (uCl−) and selected clinical and laboratory biomarkers, renal function, and patient outcomes in the acute heart failure (AHF) population. We divided 248 adult patients (≥ 18 years) with AHF into two groups: low uCl− (< 115 mmol/L) and high uCl−. The mean age of the patient group was 70.2 ± 12.6, and 182 patients were male (73.4%). Clinical endpoints included in-hospital mortality, one-year mortality, and a composite endpoint of one-year mortality and rehospitalization for heart failure. Patients were followed up for at least one year. Relevant clinical and baseline biomarker data were collected, including markers concerning inflammation, liver and kidney function, perfusion and congestion, iron status, cardiac remodeling, gasometry, renin and aldosterone. Low uCl− was associated with worse in-hospital outcomes, including higher in-hospital mortality (7.7% vs. 1.4%, p = 0.014), the need for inotropic support (20.19% vs. 2.08%, p ≤ 0.001), worsening of HF during therapy (17.31% vs. 4.86%, p ≤ 0.001), and the need for treatment in an intensive cardiac care unit (33.65% vs. 15.28%, p ≤ 0.001). Low uCl− was a significant predictor of one-year mortality (40.4% vs. 16.7%, p < 0.05) and the composite outcome (HR 2.42, 95% CI 1.43–4.08, p < 0.001). In the multivariable analysis, uCl− was independently associated with the risk of one-year mortality (HR 0.92, 95% CI 0.87–0.98, p < 0.05) and the composite outcome (HR 0.95, 95% CI 0.92–0.99, p < 0.05). Our findings suggest that low uCl− is a marker of more advanced heart failure, activation of the renin–angiotensin–aldosterone system and is related to worse one-year outcomes.