Significant Risk Factor For Death Research Articles

A Study on Outcomes of Surgical Treatment of Depressed Skull Fractures

Introduction: Trauma is a significant issue in both industrialized and developing nations. A significant risk factor for death in the young population is head injury Objective: To assess the outcomes of surgical treatment of depressed skull fractures Methodology: The current study was prospective study was done at Neurosurgery department of Khyber teaching Hospital Peshawar. The study duration was one years from March 2022 to March 2023. Causes of the depressed skull fracture, time since the injury, the kind of fracture, the location of the fracture, the reason for the fracture, the clinical state, and the CT scan results were noted. All patients had CT scans. DSF greater than 5 mm, disfiguring cosmetic fractures, and sinus fractures were surgically treated. The whole set of data was examined using SPSS 23.00. Results: In our study, totally 80 patients were enrolled. The male patients in our study were 58 (72.5%) whereas female patients were 22 (27.5%). In the outcomes based on GCS, completely recovered patients were 58 (72.5%) patients, 11 (13.75%) were moderately disabled, 8(10%) severely disabled whereas 2(2.5%) patients were demised. Conclusion: Trauma from depressed fractures is common in neurosurgical wards. One of the most important variables influencing outcome prediction is the neurologic state as indicated by the Glasgow coma scale. About two-thirds of patients who undergo surgical therapy of depressed skull fractures get successful results while one- third of patients are still classified as having severe disabilities. Complications, including death, are common after a depressed skull fracture. Keywords: Outcome; surgical treatment: depressed skull fractures

The Trends of In-Patient Mortality between 2018 and 2019 at Kisumu County Level Four Hospital, Kenya

Introduction: Due to a lack of information on patient mortality, healthcare planners rarely use local data for resource allocation and hospital management. This results in missed opportunities to build hospital capacity to address common causes of death, as well as a poor hospital reputation, fewer patients seeking hospital care, increased medical errors, and increased inpatient mortality.
 Objective: To determine trends of hospital mortality between 2018 and 2019 at Level Four Kisumu County Hospital, Kenya.
 Methods: The study was a cross sectional retrospective study design. The study targeted files of patients who died between January 2018 and December 2022. Systematic sampling was used in which every file per ward was given a serial number. Each department formed a stratum. Sample size was determined using Yamane Taro formula (N/1+N(e2) which yielded 203 as sample size from population of 680. The risk of death based on the presence or absence of doctor and nurse was analyzed by odds ratio. Chi-square was used to check association of appropriateness of facility, delay of care and distance and mortality. Variation in ward mortalities was analyzed using ANOVA to assess and data presented as line graphs.
 Results: According to the current study, the medical ward had the highest 2-year in-hospital mortality rate of 13.86%, while obstetrics and gynecology (reproductive health) had the lowest mortality rate of 0.47 percent. Infections were responsible for 42% of hospital deaths in patients under the age of 35, while noncommunicable diseases were responsible for 41% of hospital deaths in patients over the age of 60. According to the study, 3% of hospital deaths could have been avoided. When a nurse and a doctor were all present, there was a significant difference in the odds of a patient dying (OR=0.697). Comorbidity was a significant risk factor for death among patients who died in 2018 and 2019 (p=0.05). Patient characteristics such as age, education level, and gender were not associated with hospital deaths (p>0.05).
 Conclusion: The study found that 3% of hospital deaths were avoidable. More deaths occurred in medical ward from infectious diseases such as pneumonia and pulmonary TB among patients aged <35 years while non-communicable diseases such as cancer, hypertension and diabetes mellitus were important causes of death among the people aged >60 years. The results seem to suggest that more deaths occurred during rainy season between February and August. Patient factors such as age, sex and education level were not significantly associated with hospital mortality. Comorbidities particularly the non-infectious diseases were associated with more deaths.

Anemia and anti-tuberculosis treatment outcome in persons with pulmonary tuberculosis: A multi-center prospective cohort study

BackgroundTuberculosis (TB) remains a major plague of humanity. People with TB (PWTB) are commonly anemic. Here, we assessed whether the severity of anemia in PWTB prior to anti-TB treatment (ATT) was a risk factor for an unfavorable outcome. MethodsPatients ≥ 18 years old with culture-confirmed drug-susceptible pulmonary TB enrolled between 2015 and 2019 in a multi-center Brazilian cohort were followed for up to 24 months and classified according to anemia severity (mild, moderate, and severe), based on hemoglobin levels. A multinomial logistic regression model was employed to assess whether anemia was associated with unfavorable outcome (death, failure, loss to follow-up, regimen modification or relapse), compared to treatment success (cure or treatment completion). ResultsAmong 786 participants who met inclusion criteria, 441 (56 %) were anemic at baseline. Patients with moderate/severe anemia were more HIV-seropositive, as well as more symptomatic and had higher frequencies of unfavorable outcomes compared to the other groups. Moderate/severe anemia (adjusted OR [aOR]: 7.80, 95 %CI:1.34–45.4, p = 0.022) was associated with death independent of sex, age, BMI, HIV and glycemic status. ConclusionModerate/severe anemia prior to ATT was a significant risk factor for death. Such patients should be closely monitored given the high risk of unfavorable ATT outcomes.

Magnetic Resonance Imaging (MRI) of Metastatic Scalp, Skull and Dural Tumors in a Case of Ewing’s Sarcoma, with Literature Review

The prognosis of patients with initially metastatic ES is very poor. Significant risk factors for death include affectation at combined local and distant sites and soft tissue involvement. For the diagnosis, an initial radiographic and/or computed tomography (CT) is performed. Both techniques are outstanding in evaluating the affected bones. However, when primary Ewing´s tumor or its metastases involves soft tissues, these might be misdiagnosed if magnetic resonance imaging (MRI) is not applied. The purpose of the present case is to expose the role of MRI in the assessment of a rare and aggressive ES with metastases affecting bones and soft tissue of the head.

Predictive value of cardiovascular risk factors in the formation of cardiovascular and all-cause mortality: results of a 27-year cohort prospective study

Aim. To study the prognostic significance of cardiovascular risk factors (RFs) in the formation of all-cause and cardiovascular mortality based on the results of a 27-year prospective cohort study of Tomsk population of both sexes aged 20-59 years.Material and methods. The object of study was random house-to-house sample of Tomsk population. In total, 1546 people (630 men and 916 women) aged 20-59 were examined. In 1988-1991, the prevalence of following cardiovascular RFs was studied: hypertension (HTN), overweight, smoking, alcohol consumption, hypercholesterolemia (HCE), low high-density lipoprotein cholesterol levels (hypo-HDL-emia), hypertriglyceridemia (HTG). All examination methods used were strictly standardized. To determine the RF, the criteria generally accepted in epidemiological studies were used. Over 27 years of follow-up, 330 deaths were recorded, including 142 due to cardiovascular disease.Results. In the multivariate Cox proportional hazard model, the following va­riables were studied: HTN, overweight, smoking, alcohol consumption, HCE, hypo-HDL-emia, HTG, coronary artery disease (CAD) (according to epi­demio­logical criteria), and age. The strongest predictor of of all-cause death was frequent alcohol use (relative risk (RR) 2,75). Smoking increased the risk of death by 2,72 times. Among former smokers, the risk of all-cause death was 1,9 times higher compared to non-smokers. HTN increases the death risk by 1,61 times. Each year of life lived increases the death risk by 1,06 times. The most significant risk factor for death from CVD was frequent alcohol consumption (RR 3,01). Smoking increases the cardiovascular death risk by 2,28 times. Among former smokers, the RR of cardiovascular death was 1,91. HTN increases the risk of cardiovascular mortality by 1,84 times compared with people with normal blood pressure. Each year of life lived increases the risk of cardiovascular death by 1,1 times. In multivariate analysis, overweight, HCE, hypo-HDL-emia, HTG did not have a significant independent effect on the all-cause and cardiovascular death risk.Conclusion. In a 27-year cohort prospective study, independent predictors of all-cause and cardiovascular mortality, along with hypertension and age, were lifestyle risk factors, such as smoking and frequent alcohol consumption.

Incidence and outcomes of pancreatic encephalopathy in patients with acute pancreatitis: a systematic review and meta-analysis.

Pancreatic encephalopathy (PE) is a lethal complication of acute pancreatitis (AP), but its clinical characteristics and prognosis remain obscure. Herein, we performed a systematic review and meta-analysis to evaluate the incidence and outcomes of PE in AP patients. PubMed, EMBASE, and China National Knowledge Infrastructure were searched. Based on the data from cohort studies, the incidence and mortality of PE in AP patients were pooled. Based on the individual data from case reports, logistic regression analyses were performed to identify the risk factors for death in PE patients. Among 6702 papers initially identified, 148 were included. Based on 68 cohort studies, the pooled incidence and mortality of PE in AP patients were 11% and 43%, respectively. The causes of death were clearly reported in 282 patients, of which the most common was multiple organ failure (n = 197). Based on 80 case reports, 114 AP patients with PE were included. The causes of death were clearly reported in 19 patients, of which the most common was multiple organ failure (n = 8). Univariate analyses showed that multiple organ failure (OR = 5.946; p = 0.009) and chronic cholecystitis (OR = 5.400; p = 0.008) were the significant risk factors of death among patients with PE. PE is not a rare complication of AP and indicates poor prognosis. Such a high mortality of PE patients may be attributed to its coexistence of multiple organ failure.

Survival Rate Analysis of Heart Failure Patients at Arbaminch General Hospital, Southern Ethiopia, 2022

Chronic heart failure happens when the heart’s muscle is incapable of circulate sufficient blood to satisfy the requirements of the body for both oxygen and blood. In other sense, the heart is overwhelmed by its load. The goal of this study is to pinpoint the risk variables accountable for the variability in congestive heart failure patients’ survival times from January 2017 to December 2021 at ArbaMinch General Hospital in South Ethiopia. Utilizing cox proportional hazard models, the data was examined. A retrospective investigation was conducted. Data was gathered from the cards of 199 congestive heart failure patients who were being followed up on using a straightforward random sampling approach. We discovered that 21.6 percent of the 199 patients with congestive heart failure investigated died, while the remaining 78.4% were censoring. Patients’ mean baseline left ventricular ejection fraction was 43.18 percent (with a standard deviation of 13.928 percent), implying that each pulse expels 43.18 percent of the blood in the left ventricle. Patients with heart failure who tested positive for tuberculosis had a substantially increased chance of death. Left ventricular ejection fraction, tuberculosis, diabetes militias, etiology of heart failure, type of congestive heart failure, smoking status, and chorionic kidney disease were originate to be significant risk factors for death in patients with congestive heart failure. As a result, physicians are encouraged to pay greater attention to heart failure patients.

Analysis of Postoperative Outcomes and Extrauterine Growth Retardation in Preterm Infants with Necrotizing Enterocolitis: A Retrospective Study.

High mortality and extrauterine growth retardation (EUGR) remain serious problems in preterm infants after necrotizing enterocolitis (NEC) surgery. This study investigated the risk factors for mortality and EUGR in preterm infants after NEC surgery. The risk factors were analyzed retrospectively by univariate analysis and multivariate logistic regression analysis in 52 preterm infants, who underwent NEC surgery and were hospitalized in neonatology department of Shanghai Children's Hospital between May 2014 and December 2021. Patients were divided into survival and death groups. Survivors were divided into two groups according to whether EUGR occurred when they achieved full enteral feeding after surgery. The mortality of preterm infants after NEC surgery was 26.9% (14/52). About 55.3% (21/38) of survivors developed postoperative EUGR. (1) Age at surgery, proportion of shock, and intestinal perforation differed significantly between the survival and death groups (p = 0.001, 0.005, and 0.02, respectively). Shock (p = 0.02, odds ratio [OR] = 8.86, 95% confidence interval [CI]: 1.43-55.10) and intestinal perforation (p = 0.03, OR = 6.12, 95% CI: 1.16-32.41) were significant risk factors for death. (2) Compared with the non-EUGR group, proportion of preoperative EUGR, postoperative 1-week calories, and parenteral nutrition time differed significantly in EUGR group (p = 0.001, 0.01, and 0.04, respectively). Preoperative EUGR (p = 0.02, OR = 18.63, 95%CI: 1.77-196.42) was a significant risk factor for postoperative EUGR. Shock and intestinal perforation are significant risk factors for death in preterm infants after NEC surgery. Survivors are prone to EUGR, and preoperative EUGR is a significant risk factor. In addition, adequate caloric intake and achievement of full enteral feeding as soon as possible may be beneficial to improve EUGR of preterm infants after NEC surgery. · Shock and intestinal perforation are risk factors for death in preterm infants after NEC surgery.. · Preoperative EUGR is a risk factor for postoperative EUGR in preterm infants after NEC surgery.. · Active correction of shock and avoiding intestinal perforation may help improve the outcomes..

1368 BEREAVEMENT IN THE TIME OF COVID-19: LEARNING FROM EXPERIENCES OF THE BEREAVED

Abstract Introduction The COVID-19 pandemic has resulted in many people experiencing bereavement in challenging circumstances. In April 2020 at a large London Trust, a “Bereavement Welfare Hub” (BWH) was established to offer support and advice by telephone to relatives and carers of all adults who died as inpatients. Data from these calls has been used to examine and learn from experiences of the bereaved at this time. Methods Data from BWH call records regarding 809 adults who died at the Trust in March - May 2020 were collated and analysed quantitatively. A random selection of 149 call records were examined using thematic analysis. Results 809 adults died at the Trust between March and May 2020. The mean age at death was 76 (SD=14) and 86% of deaths occurred on medical wards (outside intensive care). Bereavement calls were completed in 663 (82%) of cases. From analysis of call records, several themes that influenced the bereavement experience were identified. These included support from family and community, communication and contact with the dying person, support from bereavement services and ability to carry out usual rituals associated with dying. Conclusions Age is a significant risk factor for death from COVID-19 and the majority of deaths have occurred on medical wards. Improving hospital care of dying patients during the pandemic or at any time is relevant to geriatricians and other healthcare professionals working with older people. Our analysis identifies several factors which positively or negatively influenced the experiences of people bereaved during the first wave of COVID-19. From these findings, recommendations have been made which have the potential to improve the bereavement experience, particularly during the pandemic era.

Cox Proportional Hazard Regression Interaction Model and Its Application to Determine The Risk of Death in Breast Cancer Patients after Chemotherapy

Introduction: This research is based on medical record data of breast cancer patients who seek treatment at the Central General Hospital, dr. Sardjito Yogyakarta, from 2018-2021 has as many as 105 patients. Several risk factors for cancer include demographic factors, clinical factors, tumor factors, and therapy. These factors lead to different psychological states of patients, resulting in the rate of recovery and death of patients.
 Objective: To determine the risk of death in breast cancer patients after chemotherapy.
 Methods: The method used in this study is Cox Proportional Hazard survival analysis with an interaction model. The variables studied were age, marital status, profession, insurance, BMI, comorbidities, duration of chemotherapy, chemotherapy agent, chemotherapy type, and tumor size.
 Results: The analysis results using SPSS software obtained the best hazard and survival model with four significant variables, namely the duration of chemotherapy, chemotherapy agents, chemotherapy types, and the interaction between BMI and chemotherapy types.
 Conclusions: The most significant risk factor for death was palliative chemotherapy type with HR 27.195 and 3-5 chemotherapy agents with HR 4.997. Meanwhile, the long duration of chemotherapy and the interaction between lean BMI and palliative chemotherapy reduced the risk of death by HR 0.967 and 0.128, respectively.

Clinical Characteristics and Prognosis of the Modified Probable Pneumocystis jirovecii Pneumonia in Korean Children, 2001-2021.

There are few data about Pneumocystis jirovecii pneumonia (PCP) in children, particularly in developed countries. This study investigated the clinical characteristics and prognosis of the clinical PCP in non-HIV-infected Korean children. Children with positive results for the staining and/or polymerase chain reaction (PCR) for P. jirovecii between 2001 and 2021 were identified. Patients were grouped into clinical PCP, which comprised proven and modified probable cases, and non-PCP groups. Modified probable PCP (mp-PCP) indicate the case which P. jirovecii was detected by conventional PCR rather than real-time PCR test. The differences in demographic and clinical characteristics were analyzed between the groups. A total of 110 pneumonia cases with positive results for P. jirovecii PCR and/or stain were identified from 107 children. Of these, 28.2% were classified as non-PCP, 12.7% of proven PCP, and 59.1% of mp-PCP. Compared with the non-PCP group, the mp-PCP group had a significantly higher rate of solid organ transplantation (3.2% vs. 24.6%), fever (58.1% vs. 76.9%), tachypnea (25.8% vs. 66.2%), dyspnea (48.4% vs. 83.1%), desaturation (48.4% vs. 80.0%), and bilateral ground-glass opacity on chest radiograph (19.4% vs. 73.8%). However, when the mp-PCP group was compared with the proven PCP group, there was no statistically significant difference. For children with clinical PCP, age under 5 years of age (odds ratio [OR] 10.7), hospital-onset (OR 6.9), and desaturation as initial symptom (OR 63.5) were significant risk factors for death in multivariable analysis. Modified probable PCP might reliably reflect true PCP in terms of patient’s demographic, clinical features, treatment response, and prognosis. Immunocompromised children with hospital-onset pneumonia who are younger than 5 years of age and have desaturation would be more cautiously and aggressively managed for survival through the screening for P. jirovecii by conventional PCR on appropriate lower respiratory specimens.

Impact of Asymptomatic Superior Mesenteric Vein Thrombosis on the Outcomes of Patients with Liver Cirrhosis.

The impact of asymptomatic superior mesenteric vein (SMV) thrombosis on the outcomes of cirrhotic patients remains uncertain. Nonmalignant cirrhotic patients who were consecutively admitted between December 2014 and September 2021 and underwent contrast-enhanced computed tomography/magnetic resonance imaging scans were screened. Portal venous system thrombosis (PVST) was identified. Death and hepatic decompensation were the outcomes of interest. Nelson-Aalen cumulative risk curve analysis and competing risk regression analysis were performed to evaluate the impact of asymptomatic SMV thrombosis and portal vein thrombosis (PVT) on the outcomes. Overall, 475 patients were included, of whom 67 (14.1%) had asymptomatic SMV thrombosis, 95 (20%) had PVT, and 344 (72.4%) did not have any PVST. Nelson-Aalen cumulative risk curve analyses showed that the cumulative incidences of death (p = 0.653) and hepatic decompensation (p = 0.630) were not significantly different between patients with asymptomatic SMV thrombosis and those without PVST, but the cumulative incidences of death (p = 0.021) and hepatic decompensation (p = 0.004) were significantly higher in patients with PVT than those without PVST. Competing risk regression analyses demonstrated that asymptomatic SMV thrombosis was not a significant risk factor for death (subdistribution hazard ratio [sHR] = 0.89, p = 0.65) or hepatic decompensation (sHR = 1.09, p = 0.63), but PVT was a significant risk factor for death (sHR = 1.56, p = 0.02) and hepatic decompensation (sHR = 1.50, p = 0.006). These statistical results remained in competing risk regression analyses after adjusting for age, sex, and Child-Pugh score. Asymptomatic SMV thrombosis may not influence the outcomes of cirrhotic patients. The timing of intervention for asymptomatic SMV thrombosis in liver cirrhosis should be further explored.

Comorbid Depression is Associated with Increased Major Adverse Limb Events in Peripheral Arterial Disease: A Systematic Review and Meta-analysis

Depression is a significant risk factor for death in coronary artery disease. Conversely, the research surrounding depression and peripheral arterial disease is limited. This review aimed to systematically evaluate the available literature on the impact of comorbid depression on adverse outcomes in peripheral arterial disease.

Incidence of Death and Its Predictors of COVID-19 in Amhara Region, Ethiopia: A Retrospective Follow Up Study

BackgroundRisk factors associated with COVID-19 incidence of death would aid to notify the most favorable management strategies, hang about undecided, Moreover, studies regarding this issue are limited in Ethiopia and no region-wise study is conducted. Hence, the study investigated the COVID-19 incidence of death and its predictors in the Amhara regional state, Ethiopia.MethodsA facility-based retrospective survey was conducted at all Amhara regional state COVID-19 treatment centers from 13 March 2020, through 13 January 2022. Epidata version 3.1 and STATA version 14 were used for data entry and analysis, respectively. Linearized survey analysis in a stratified Cox regression model was fitted to identify independent risk factors. P-value with 95% CI for hazard ratio was used for testing the significance at alpha 0.05.ResultsA total of 28,533 study participants were analyzed in this study. Of these, 2873 (11.2%) died and 25,660 (88.8%) were recovered from COVID-19. The death rate was 11.78 per 1000 person-days of observation with a median survival time of 32 days with IQR [12, 44]. Patients with co-morbidities (AHR = 1.54: 95% CI: 1.51–1.55), patients with age <5-year (AHR = 1.69: 95% CI: 1.78–1.81) and patients with age 60+ years (AHR = 2.91: 95% CI: 1.79–3.99), patients with asymptomatic diseases condition (AHR =1.15: 95% CI: 1.01–1.19), and being male (AHR = 1.22: 95% CI: 1.18–1.27) were independent significant risk factors of death from COVID-19.ConclusionA relatively high incidence of death from COVID-19 was found in this study. Significant risk factors were identified as patients with age <5 years, patients with age 60+ Years, being male, patients having at least one comorbid condition, and patients with asymptomatic disease conditions. These factors should be taken into consideration for a strategy of quarantining and treating COVID-19 patients.

Risk factors for graft loss and death among kidney transplant recipients: A competing risk analysis.

Kidney transplantation is the best therapeutical option for CKD patients. Graft loss risk factors are usually estimated with the cox method. Competing risk analysis could be useful to determine the impact of different events affecting graft survival, the occurrence of an outcome of interest can be precluded by another. We aimed to determine the risk factors for graft loss in the presence of mortality as a competing event. A retrospective cohort of 1454 kidney transplant recipients who were transplanted between July 1, 2008, to May 31, 2019, in Colombiana de Trasplantes, were analyzed to determine risk factors of graft loss and mortality at 5 years post-transplantation. Kidney and patient survival probabilities were estimated by the competing risk analysis. The Fine and Gray method was used to fit a multivariable model for each outcome. Three variable selection methods were compared, and the bootstrapping technique was used for internal validation as split method for resample. The performance of the final model was assessed calculating the prediction error, brier score, c-index and calibration plot. Graft loss occurred in 169 patients (11.6%) and death in 137 (9.4%). Cumulative incidence for graft loss and death was 15.8% and 13.8% respectively. In a multivariable analysis, we found that BKV nephropathy, serum creatinine and increased number of renal biopsies were significant risk factors for graft loss. On the other hand, recipient age, acute cellular rejection, CMV disease were risk factors for death, and recipients with living donor had better survival compared to deceased-donor transplant and coronary stent. The c-index were 0.6 and 0.72 for graft loss and death model respectively. We developed two prediction models for graft loss and death 5 years post-transplantation by a unique transplant program in Colombia. Using a competing risk multivariable analysis, we were able to identify 3 significant risk factors for graft loss and 5 significant risk factors for death. This contributes to have a better understanding of risk factors for graft loss in a Latin-American population. The predictive performance of the models was mild.

Prognostic factors in dogs with common causes of proteinuria.

Little is known about the prognostic value of increased urine protein to creatinine ratios (UPC) comparing different underlying diseases in dogs. Therefore, between 2014 and 2015, dogs with a UPC of 2,0 or higher measured were retrospectively analysed at least once. They were divided into groups of the most common underlying diseases, namely primary glomerulopathy, Cushing's disease, leishmaniasis and in a group of different diseases. Possible prognostic factors, like UPC at time of diagnosis, creatinine, urine specific gravity, albumin and haematocrit, were assessed. Eighty-nine dogs with severe proteinuria were included in the study. Median time of survival was 42 days. UPC and time of survival did not differ significantly between the groups. Among the dogs with primary glomerulopathy, identified significant risk factors for death included increased UPC (p=0,03), increased creatinine (p.

REAL WORLD IMPACT OF BLOOD PRESSURE CHANGES ON MORBIDITY AND MORTALITY IN TYPE 2 DIABETES

Objective: To assess the impact of BP changes on the risk of cardiovascular events and mortality in type 2 diabetes. Design and method: The sample was selected using the HER of the Valencian Community. Type 2 diabetics were selected through ICD codes and retrospectively evaluated from January 2012 to December 2016. To evaluate BP changes, the follow-up time was divided in six-month blocks and the average of BP for each interval was considered. SBP was categorized: &lt; 120 mmHg; 120–129 mmHg (reference); 130–139 mmHg; 140–149 mmHg; &gt; 150 mmHg. To evaluate the influence of DBP, the population was stratified according to categories of average DBP: &lt; 60 mmHg; 60–69 mmHg; 70–79 mmHg; &gt; 80 mmHg. Information about cardiovascular events, including Stroke and Acute Coronary Syndrome (ACS) was extracted from the ICD codes. Total mortality was determined by matching records and death certificates. Time-varying Cox regression for SBP stratified by DBP categories was used to assess the risk associated with changes of SBP. The models were adjusted by age, sex, HBA1c, KDIGO, previous cardiovascular events and use of cardiovascular drugs. Results: 156 363 type 2 diabetics patients were included (mean age 69.5(11.5), 48.7% females, mean glycated Hb 7.05 (1.35%) 21% in secondary prevention, 21.4% under insulin treatment). The average number of BP measurements was 14. During an average follow-up of 4.18 y, there were 13399 deaths, 15100 strokes and 6295 ACS. In the fully adjusted time-varying Cox regression, having a SBP&lt; 120 mmHg was a significant risk factor for death across all categories of DBP, whereas SBP&gt; 130 mmHg conferred protection. For the case of ACS and stroke, a J-curve phenomenon was observed with significantly higher risk for those with SBP&gt; 150 mmHg or &lt; 120 mmHg across categories with DBP&gt; 60 mmHg. This J-curve phenomenon was also observed graphically using restricted cubic splines (Figure). Conclusions: Although difficult to achieve in clinical practice, lower boundaries for BP goals in diabetics have to be taking into account.

Performance of a single-ventricle home-monitoring programme: survival and predictors of adverse outcome.

Mortality between stages 1 and 2 single-ventricle palliation is significant. Home-monitoring programmes are suggested to reduce mortality. Outcomes and risk factors for adverse outcomes for European programmes have not been published. To evaluate the performance of a home-monitoring programme at a medium-sized United Kingdom centre with regards survival and compare performance with other home-monitoring programmes in the literature. All fetal and postnatal diagnosis of a single ventricle were investigated with in-depth analysis of those undergoing stage 1 palliation and entered the home-monitoring programme between 2016 and 2020. The primary outcome was survival. Secondary outcomes included multiple parameters as potential predictors of death or adverse outcome. Of 217 fetal single-ventricle diagnoses during the period 2016-2020, 50.2% progressed to live birth, 35.4% to stage 1 and 29.5% to stage 2. Seventy-four patients (including 10 with postnatal diagnosis) entered the home-monitoring programme with six deaths making home-monitoring programme mortality 8.1%. Risk factors for death were the hybrid procedure as the only primary procedure (OR 33.0, p < 0.01), impaired cardiac function (OR 10.3, p < 0.025), Asian ethnicity (OR 9.3, p < 0.025), lower mean birth-weight (2.69 kg versus 3.31 kg, p < 0.01), and lower mean weight centiles during interstage follow-up (mean centiles of 3.1 versus 10.8, p < 0.01). Survival in the home-monitoring programme is comparable with other home-monitoring programmes in the literature. Hybrid procedure, cardiac dysfunction, sub-optimal weight gain, and Asian ethnicity were significant risk factors for death. Home-monitoring programmes should continue to raise awareness of these factors and seek solutions to mitigate adverse events. Future work to generalise home-monitoring programme and single-ventricle fetus to stage 2 outcomes in the United Kingdom will require multi-centre collaboration.

The Incidence and Risk Factors of Intraoperative Cardiac Arrest: A 5-Year Experience from a University Hospital in Thailand

Objective: To investigate the incidence, characteristics, and outcomes of intraoperative cardiac arrest (IOCA) and identify risk factors for death in IOCA patients. Materials and Methods: The present study was a retrospective descriptive study at Srinagarind Hospital, a tertiary care university hospital. Anesthesia incident reports between 2016 and 2020 were screened, and IOCA reports were identified. Demographics, characteristics, causes, antecedents within 24 hours of the operation, rate of return of spontaneous circulation (ROSC), and survival outcomes were among the data collected. Logistic regression analysis was used to identify the factors associated with death in IOCA patients. Results: During the present study period, 67 IOCAs occurred out of 91,139 anesthetics, with an incidence of 7.3 per 10,000 anesthetics. The incidence of IOCA was high in patients with the American Society of Anesthesiologists Physical Status (ASA-PS) 4 and 5 at 103.9 and 1337.6 per 10,000 anesthetics, respectively. The majority of IOCAs occurred during anesthesia maintenance (61.7%) and the initial electrocardiogram (EKG) were non-shockable rhythms (77.6%). The main cause of IOCA was poor patient conditions (46.3%). At the time of ICU discharge, 28 patients (41.8%) had survived, with 21 (31.3%) of these achieving full cerebral recovery. The mortality was 39 (58.2%). Patients with ASA-PS 4 or 5 (OR 4.05, 95% CI 1.45 to 11.34), poor patient conditions (OR 2.73, 95% CI 1.06 to 7.54), and non-shockable EKG (OR 9.00, 95% CI 2.23 to 36.33) were significant risk factors for death in IOCA patients, according to the univariate analysis. Only non-shockable EKG (adjusted OR 6.98, 95% CI 1.15 to 42.47) was found to be a significant risk factor for mortality after multivariate analysis. Conclusion: Although IOCA was uncommon, it was associated with a high mortality rate. The highest rate of IOCA was found in ASA-PS 5. The main cause of IOCA was poor patient condition. Non-shockable EKG increased the risk of death in IOCA. Keywords: Incidence study; Intraoperative; Cardiac arrest; IOCA

Clinical management of COVID-19 in hospitals and the community: A snapshot from a medical insurance database in South Africa

BackgroundLittle is known about the clinical care, use of medicines, and risk factors associated with mortality among the population with private health insurance with COVID-19 in South Africa. MethodsThis was a retrospective cross-sectional study using claims data of patients with confirmed COVID-19. Sociodemographics, comorbidities, severity, concurrent/progressive comorbidity, drug treatment, and outcomes were extracted from administrative data. Univariate and multivariate logistic regression models were used to explore the risk factors associated with in-hospital death. ResultsThis study included 154,519 patients with COVID-19; only 24% were categorized as severe because they received in-hospital care. Antibiotic (42.8%) and steroid (30%) use was high in this population. After adjusting for known comorbidities, concurrent/progressive diagnosis of the following conditions were associated with higher in-hospital death odds: acute respiratory distress syndrome (aOR = 1.55; 95% CI = 1.44–1.68), septic shock (aOR = 1.55; 95% CI = 2.00–4.12), pneumonia (aOR = 1.35; 95% CI = 1.24–1.47), acute renal failure (aOR = 2.30; 95% CI = 2.09–2.5), and stroke (aOR = 2.09; 95% CI = 1.75–2.49). The use of antivirals (aOR = 0.47; 95% CI= 0.40–0.54), and/or steroids (aOR = 0.46; 95% CI = 0.43–0.50) were associated with decreased death odds. The use of antibiotics in-hospital was not associated with increased survival (aOR = 0.97; 95% CI = 0.91–1.04). ConclusionsComorbidities remain significant risk factors for death mediated by organ failure. The use of antibiotics did not change the odds of death, suggesting inappropriate use.