Significant Risk Factor For Mortality Research Articles

Thoracic skeletal muscle mass predicts mortality in patients with surgery for pleural empyema: A case control study.

This study investigated the role of the thoracic skeletal muscle mass as a marker of sarcopenia on postoperative mortality in pleural empyema. All consecutive patients (n = 103) undergoing surgery for pleural empyema in a single tertiary referral center between January 2020 and December 2022 were eligible for this study. Thoracic skeletal muscle mass index (TSMI) was determined from preoperative computed tomography scans. The impact of TSMI and other potential risk factors on postoperative in-hospital mortality was retrospectively analyzed. A total of 97 patients were included in this study. The in-hospital mortality rate was 13.4%. In univariable analysis, low values for preoperative TSMI (p = 0.020), low preoperative levels of thrombocytes (p = 0.027) and total serum protein (p = 0.046) and higher preoperative American Society of Anesthesiologists (ASA) category (p = 0.007) were statistically significant risk factors for mortality. In multivariable analysis, only TSMI (p = 0.038, OR 0.933, 95% CI: 0.875-0.996) and low thrombocytes (p = 0.031, OR 0.944, 95% CI: 0.988-0.999) remained independent prognostic factors for mortality. TSMI was a significant prognostic risk factor for postoperative mortality in patients with pleural empyema. TSMI may be suitable for risk stratification in this disease with high morbidity and mortality, which may have further implications for the selection of the best treatment strategy.

Clinical characteristics and risk factors for mortality in Candida auris infections

AbstractBackgroundCandida auris infections pose a threat to public health, necessitating increased awareness in China. This study aimed to analyze the strains of C. auris, assess the infection status, and investigate clinical characteristics and risk factors for mortality.MethodsA retrospective analysis was conducted on 18 patients with Candida auris infection. We focused on evaluating basic characteristics, strain sources, and antibacterial susceptibility test results. Statistical methods were used to determine clinical features and identify risk factors for death.ResultsThe strain type, composition ratio, and specimen source of C. auris were not associated with mortality. Neither the infection index nor the length of hospitalization showed an association with the prognosis. However, significant risk factors for mortality included cerebral infarction, cardiac disease, renal dysfunction, hypoproteinemia, and anemia (all p < 0.05).ConclusionsCerebral infarction, cardiac disease, renal dysfunction, hypoproteinemia, and anemia are significant risk factors for death in C. auris infections. These findings indicate the importance of recognizing and addressing these factors in the clinical management of C. auris infection.

Impact of influenza related hospitalization in Spain: characteristics and risk factor of mortality during five influenza seasons (2016 to 2021)

BackgroundEstimating the global influenza burden in terms of hospitalization and death is important for optimizing prevention policies. Identifying risk factors for mortality allows for the design of strategies tailored to groups at the highest risk. This study aims to (a) describe the clinical characteristics of hospitalizations with a diagnosis of influenza over five flu seasons (2016–2017 to 2020–2021), (b) assess the associated morbidity (hospitalization rates and ICU admissions rate), mortality and cost of influenza hospitalizations in different age groups and (c) analyze the risk factors for mortality.MethodsThis retrospective study included all hospital admissions with a diagnosis of influenza in Spain for five influenza seasons. Data were extracted from the Spanish National Surveillance System for Hospital Data from 1 July 2016 to 30 June 2021. We identified cases coded as having influenza as a primary or secondary diagnosis (International Classification of Diseases, 10th revision, J09-J11). The hospitalization rate was calculated relative to the general population. Independent predictors of mortality were identified using multivariable logistic regression.ResultsOver the five seasons, there were 127,160 hospitalizations with a diagnosis of influenza. The mean influenza hospitalization rate varied from 5/100,000 in 2020–2021 (COVID-19 pandemic) to 92.9/100,000 in 2017–2018. The proportion of influenza hospitalizations with ICU admission was 7.4% and was highest in people aged 40–59 years (13.9%). The case fatality rate was 5.8% overall and 9.4% in those aged 80 years or older. Median length of stay was 5 days (and 6 days in the oldest age group). In the multivariable analysis, independent risk factors for mortality were male sex (odds ratio [OR] 1.14, 95% confidence interval [95% CI] 1.08–1.20), age (<5 years: OR 1; 5–19 years: OR 2.02, 95%CI 1.17–3.49; 20–39 years: OR 4.11, 95% CI 2.67–6.32; 40–59 years: OR 8.15, 95% CI 5.60–11.87; 60–79 years: OR 15.10, 95% CI 10.44–21.84; ≥80 years: OR 33.41, 95% CI 23.10–48.34), neurological disorder (OR 1.97, 95% CI 1.83–2.11), heart failure (OR 1.85, 95% CI 1.74–1.96), chronic kidney disease (OR 1.33, 95% CI 1.25–1.41), chronic liver disease (OR 2.95, 95% CI 2.68–3.27), cancer (OR 1.85, 95% CI 1.48–2.24), coinfection with SARS-CoV2 (OR 3.17, 95% CI 2.34–4.28), influenza pneumonia (OR 1.76, 95% CI 1.66–1.86) and admission to intensive care (OR 7.81, 95% CI 7.31–8.36).ConclusionInfluenza entails a major public health burden. People aged over 60—and especially those over 80—show the longest hospital stays. Age is also the most significant risk factor for mortality, along with certain associated comorbidities.

Influenza epidemiology and treatment in people with a visual disability: A retrospective cohort study

BackgroundVisual disabilities (VD) are expected to rise with an aging population. Persons with VD experience a higher prevalence of chronic and acute diseases. Despite the significance of influenza to this population, there is limited data comparing influenza care disparities between those with VD and those without. ObjectiveThe study aimed to determine the influenza burden and associated healthcare utilization in individuals with VD compared to those without disabilities. MethodsA retrospective cohort study was conducted using the Korean National Health Information Database, encompassing three influenza seasons (2011–2012 to 2013–2014). The influenza incidence and incidence rate ratio (IRR) was calculated. Adjusted IRRs were calculated using a zero-inflated Poisson model. We assessed the risk of admissions and 30-day post-influenza mortality, employing logistic regression or survival analysis. ResultsA total of 504,374 patients (252,964 patients with VD and 251,410 controls) were followed for 1,471,480 person-years. The influenza incidence was higher in the VD cohort than in the control (8.8 vs. 7.8 cases per 1000 person-years). VD cohort had a higher influenza IRR (adjusted IRR 1·13, 95% confidence interval [CI] 1·02–1·25). Severe VD exhibited higher hospitalization risk (adjusted odds ratio [OR] 1·29, 95% CI 1·10–1·20) and increased medical costs. Severe VD was a significant risk factor for mortality (adjusted Hazard Ratio 1·89, 95% CI 1·04–3·45). ConclusionsPeople with VD have a higher influenza incidence, while their outcomes are comparable to those without. Nevertheless, severe VD significantly contributes more to hospitalization, mortality, and medical costs than controls.

Risk factors for one-year mortality following discharge in patients with acute aortic dissection: development and validation of a predictive model in a cross-sectional study

PurposeThis study was aimed to identify the risk factors that influence the mortality risk in patients with acute aortic dissection (AAD) within one year after discharge, and aimed to construct a predictive model for assessing mortality risk.MethodsThe study involved 320 adult patients obtained from the Medical Information Mart for Intensive Care (MIMIC) database. Logistic regression analysis was conducted to identify potential risk factors associated with mortality in AAD patients within one year after discharge and to develop a predictive model. The performance of the predictive model was assessed using the receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA). To further validate the findings, patient data from the First Affiliated Hospital of Guangxi Medical University (157 patients) were analyzed.ResultsUnivariate and multivariate logistic regression analyses revealed that gender, length of hospital stay, highest blood urea nitrogen (BUN_max), use of adrenaline, and use of amiodarone were significant risk factors for mortality within one year after discharge (p < 0.05). The constructed model exhibited a consistency index (C-index) and an area under the ROC curve of 0.738. The calibration curve and DCA demonstrated that these indicators had a good degree of agreement and utility. The external validation results of the model also indicated good predictability (AUC = 0.700, p < 0.05).ConclusionThe personalized scoring prediction model constructed by gender, length of hospital stays, BUN_max levels, as well as the use of adrenaline and amiodarone, can effectively identify AAD patients with high mortality risk within one year after discharge.

The Impact of Physical Exercise on microRNAs in Hemodialysis Patients: A Review and a Protocol for an Ancillary Study.

Physical inactivity is considered a significant risk factor for mortality and morbidity among chronic hemodialysis (HD) patients. Therefore, physical exercise is recommended in the treatment of HD patients. Although the beneficial effects of physical exercise in HD patients are well-described in the literature, the underlying physiological mechanisms still need to be fully understood. Recently, microRNAs (miRNAs) have emerged as potential mediators of the therapeutic effects of physical exercise in healthy individuals. miRNAs are short, single-stranded, noncoding RNAs involved in gene expression regulation. Specifically, upon forming the RNA-induced silencing complex, miRNAs selectively bind to specific miRNAs within cells, reducing gene expression. miRNAs can be secreted by cells in an accessible form or enclosed within exosomes or extracellular vesicles. They can be detected in various body fluids, including serum (circulating miRNAs), facilitating the study of their diverse expression. Currently, there is no available data regarding the impact of physical exercise on the expression of miRNAs involved in osteogenic differentiation, a fundamental mechanism in the development of vascular calcification, for HD patients. Therefore, we have designed an observational and longitudinal case-control study to evaluate the expression of miR-9 and miR-30b in HD patients participating in a 3-month interdialytic physical exercise program. This paper aims to present the study protocol and review the expression of circulating miRNAs in HD patients and their modulation through physical exercise.

Diabetes and COVID-19 Outcomes: An Analysis of Freeman Health System Patients.

As COVID-19 continues to affect millions of people around the world, it has become vital to understandhow comorbidities such as diabetesaffect the health outcomes of these patients. While earlier studies have focused on major metropolitan areas, rural settings have been comparatively understudied. The goal of this study is to understand the effect on mortality that these two diseases have in the inpatient setting of a rural population. The electronic medical records of all adult patients admitted toFreeman Health System, Joplin, Missouri, United States, between April 1, 2020, and December 31, 2021, were reviewed for the presence of COVID-19 infection and/or diabetes (type I and type II).Freeman Healthis a major health system headquartered in Southwest Missouri. Diagnoses were obtained through the use of standard International Classification of Disease, 10th edition (ICD-10) codes. The initialdata set consisted of 19,323 admissions. After excluding duplicate admissions and those who had already been infected with COVID-19, 1,729 patients with COVID-19, 172 patients with type I diabetes, and 3,992 patients with type II diabetes were included in the analysis of inpatient all-cause mortality. We hypothesized that patients with type I and type II diabetes would both show an increased risk of all-cause mortality. Mortalityin the context of our study results refers to all-cause mortality. The all-cause mortality rate was 19.94% (137/687, with a 95% confidence interval (CI) of 16.95%-22.93%) in patients admitted with both diabetes (the combined type I and type II subsets) and COVID-19 (P1). The mortality rate was 16.03% (167/1042, with 95% CI of 13.80%-18.25%) in patients admitted with COVID-19 who did not have diabetes (P2). Patients admitted with a comorbid diagnosis of diabetesbut without COVID-19 (P5) had a much lower mortality rate of 5.98% (249/4164, with a 95% CI of 5.26%-6.70%). The combination of both COVID-19 and diabetes together was associated with a higher mortality rate than either of the two separately. The mortality rate was additionally elevated in patients with both type II diabetes and COVID-19 (P4) (134/663, mortality rate of 20.21% with 95% CI of 17.15%-23.27%) versus those with COVID-19 without diabetes (P2) (167/1042, 16.03% with 95% CI of 13.80%-18.25%), an overall difference of 4.18% (95% CI of 0.40%-7.94%). The subset of patients with type I diabetes with COVID-19 (P3) and type I diabetes without COVID-19 (P6) were too small to accurately power individual analysis. The subset of patients withdiabetes (type I and type II) and without COVID-19 (P5) had the lowest mortality rate of any subsetadequately powered for analysis at 5.98% (249/41464, CI of 5.26%-6.70%). Conclusions: The results of this study show that type II diabetes is a significant risk factor for mortality in admitted COVID-19 patients. P4had the highest overall mortality of any subset studied. The study was underpowered to show if type I diabetes patients, with and without COVID-19, had an increased mortality when analyzedseparately. COVID-19 significantly increased mortality in all subsets adequately powered for full analysis.

Effect of dysnatremia and dysglycemia on outcomes among surgical intensive care unit patients

Objectives: The objectives of this study were to evaluate the relationships between serum sodium and glucose concentrations and outcomes among patients admitted to the surgical intensive care unit. Materials and Methods: Patient records admitted to the surgical intensive care unit (SICU) between July 2020 and December 2020 were used in the study. Data included in the analysis were patient age, gender, comorbidities, surgical intervention, diagnosis of sepsis, sequential organ system failure scores, serum sodium concentrations, serum glucose concentrations, and surgical intensive care unit outcomes (discharged vs. deceased). A univariate logistic regression analysis was used to determine significant risk factors for mortality during a surgical intensive care unit stay. Results: A total of 194 patients with a mean age of 60±16 years were admitted to the SICU during the study period. Twenty-three percent of the patients were found to have sepsis with 18% mortality. Serum sodium and glucose concentrations were significantly higher (P-value ≤0.05) at all-time points in deceased patients compared to those who were discharged from the SICU. Conclusion: The results of the study indicate that serum sodium and glucose concentrations could be used as independent predictors of mortality in surgical intensive care unit patients with sepsis. However, further clinical trials are warranted before this application could be recommended in surgical intensive care units.

WT1 and TP53 as valuable diagnostic biomarkers for relapse after hematopoietic stem cell transplantation in acute myeloid leukemia.

Relapse following hematopoietic stem cell transplantation (HSCT) occurs relatively frequently and is a significant risk factor for mortality in patients with acute myeloid leukemia (AML). Early diagnosis is, therefore, of utmost importance and can provide valuable guidance for appropriate and timely intervention. Here, the diagnostic value of two molecular markers, Wilms tumor 1 (WT1) and tumor suppressor protein p53 (TP53), were studied. Twenty AML patients undergoing HSCT participated in this investigation. Some had relapsed following HSCT, while others were in remission. Peripheral blood (PB) and bone marrow (BM) samples were collected following relapse and remission. WT1 and TP53 messenger RNA (mRNA) expression was evaluated using reverse transcription-quantitative polymerase chain reaction (RT‒qPCR). The diagnostic value of genes was evaluated by utilizing receiver-operating characteristic (ROC) curve analysis. ROC analysis showed WT1 and TP53 as diagnostic markers for relapse after HSCT in AML patients. The mRNA expression level of WT1 was elevated in individuals who experienced relapse compared to those in a state of remission (p value < 0.01). Conversely, the expression level of TP53 mRNA was lower in individuals who had relapsed compared to those in remission (p value < 0.01). WT1 and TP53 possess the potential to serve as invaluable biomarkers in the identification of molecular relapse after HSCT in patients with AML. Further studies for a definitive conclusion are recommended.

Prognostic value of the systemic immune-inflammation index in patients with acute respiratory distress syndrome: A retrospective study

BackgroundInflammation is critical in the etiology and progression of acute respiratory distress syndrome (ARDS). This study aims to rigorously assess the predictive capacity of systemic immune-inflammation index (SII) in determining the outcomes of patients with ARDS. MethodsPatient data were extracted from version 2.2 of the Medical Information Mart for Intensive Care IV (MIMIC-IV). The Receiver Operating Characteristic (ROC) curve was deployed to determine the optimal cutoff value for the SII, facilitating the stratification of participants into distinct cohorts based on SII levels. The relationship between SII and survival outcomes was rigorously evaluated using Cox proportional hazards models. The association between SII and patient survival was rigorously examined using Cox proportional-hazard models. The impact of varying SII levels on mortality was quantitatively assessed through these models, with the results articulated as hazard ratios (HRs) and 95% confidence intervals (CIs). Three distinct models were formulated for this analysis: Model 1 employed univariate Cox regression to relate SII with mortality; Model 2 introduced adjustments for age and sex; and Model 3 extended these adjustments to include age, sex, race, SAPS II, APSIII, Hemoglobin, Albumin, Pneumonia, SpO2, and SBP. ResultsPost-application of the inclusion criteria, a cohort of 976 eligible patients was delineated for detailed examination. Univariate analysis focusing on 30-day mortality within the SII ≥1694, the hazard ratio (HR) was 1.42 (95% confidence interval (CI): 1.11, 1.81). However, after adjusting for confounding factors such as age, sex, race, Simplified Acute Physiology Score II (SAPS II), Acute Physiology Score (APS) III, Hemoglobin, Albumin, Pneumonia, SpO2, and Systolic Blood Pressure (SBP), an SII value of ≥1694 was identified as an independent and significant risk factor for mortality in patients with ARDS, with an HR of 1.38 (95% CI: 1.08–1.77, P = 0.0016). This trend was consistent for 90-day and one-year mortality rates. ConclusionsSII surfaced as an autonomous determinant of mortality in ARDS patients, affirming its status as an accessible and dependable prognostic indicator for individuals newly diagnosed with this critical condition. Additional research is imperative to further elucidate the prognostic implications of SII in the therapeutic management of patients with ARDS.

Effect of body mass index on survival after spinal cord injury.

Increased mortality after acute and chronic spinal cord injury (SCI) remains a challenge and mandates a better understanding of the factors contributing to survival in these patients. This study investigated whether body mass index (BMI) measured after acute traumatic SCI is associated with a change in mortality. A prospective longitudinal cohort study was conducted with 742 patients who were admitted to the Acute Spine Unit of the Vancouver General Hospital between 2004 and 2016 with a traumatic SCI. An investigation of the association between BMI on admission and long-term mortality was conducted using classification and regression tree (CART) and generalized additive models (spline curves) from acute care up to 7.7 years after SCI (chronic phase). Multivariable models were adjusted for (i) demographic factors (e.g., age, sex, and Charlson Comorbidity Index) and (ii) injury characteristics (e.g., neurological level and severity and Injury Severity Score). After the exclusion of incomplete datasets (n = 602), 643 patients were analyzed, of whom 102 (18.5%) died during a period up to 7.7 years after SCI. CART identified three distinct mortality risk groups: (i) BMI: > 30.5 kg/m2, (ii) 17.5-30.5 kg/m2, and (iii) < 17.5 kg/m2. Mortality was lowest in the high BMI group (BMI > 30.5 kg/m2), followed by the middle-weight group (17.5-30.5 kg/m2), and was highest in the underweight group (BMI < 17.5 kg/m2). High BMI had a mild protective effect against mortality after SCI (hazard ratio 0.28, 95% CI: 0.09-0.88, p = 0.029), concordant with a modest "obesity paradox". Moreover, being underweight at admission was a significant risk factor for mortality up to 7.7 years after SCI (hazard ratio 5.5, 95% CI: 2.34-13.17, p < 0.001). Mortality risk (1 month to 7.7 years after SCI) was associated with differences in BMI at admission. Further research is needed to better understand the underlying mechanisms. Given an established association of BMI with metabolic determinants, these results may suggest unknown neuro-metabolic pathways that are crucial for patient survival.

Sedation with Ketamine-Propofol in Patients Undergoing Transcatheter Aortic Valve Implantation: A Comparative Retrospective Study on General Anesthesia.

Transcatheter aortic valve implantation (TAVI) is used for patients with severe aortic stenosis who are at high risk for surgery. Since these patients are elderly and have comorbidities, their management is of great importance. This retrospective study compares two anesthesia techniques during TAVI: sedation (ketamine and propofol) and general anesthesia. Patients with severe aortic stenosis undergoing TAVI during 2021 in our hospital were retrospectively screened. Demographic data, comorbidities, anesthesia management, complications, and mortality of the patients were obtained from the records. There were 137 patients treated with TAVI; 74 (54%) patients had sedation and 63 (46%) had general anesthesia. When the anesthesia management was evaluated, no significant difference in mortality was observed between the patients who received general anesthesia and sedation. After univariate and multivariate logistic regression analyses were performed to investigate factors having an impact on mortality, anemia (only in univariate analysis) in the whole study population was a statistically significant risk factor for mortality in patients undergoing TAVI (p<0.014). There was no significant difference in mortality in terms of anesthesia management. Anemia was a risk factor for mortality (only in univariate analysis) in the whole study population. We concluded that conscious sedation with ketamine and propofol is effective and safe for TAVI procedures compared to general anesthesia.

Pathogen-wise Clinical Profile, Outcome and Antibiotic Sensitivity Profile of Septic Newborns in Level III Neonatal Intensive Care Unit of a Tertiary Teaching Hospital: A Retrospective Study

Introduction: Culture positive sepsis remains to be a leading cause of death in Neonatal Intensive Care Unit (NICU) mainly among preterm and low birth weight newborns. The objective was to analyze the initial signs of sepsis, antibiotic sensitivity, and outcome of septic newborns in NICU. Methods: The demographic data, initial clinical features at suspicion of sepsis, diagnosis, laboratory abnormalities, pathogen isolated and antibiotic sensitivity patterns of the septic neonates, and their outcome were documented from their case records. Results: A total of 161 culture positive septic newborns, 76.4% were preterm and 54 died of sepsis (33.54%). Early and late onset sepsis was seen in 56 and 109 neonates, respectively. The initial clinical findings at suspicion of sepsis which had a statistical significance were tachycardia in Escherichia coli and Pseudomonas sepsis, hyperglycemia in Burkholderia, fever in Candida, sclerema in Klebsiella pneumoniae (KP), and seizures in E. coli sepsis. The cerebrospinal fluid culture positive newborns commonly presented with apnea, poor perfusion, and lethargy. Raised C reactive protein was seen in a higher proportion of newborns with Candida (60%) sepsis and E. coli (50%) sepsis. Severe thrombocytopenia was seen in 53%–62% newborns with gram-negative and fungal sepsis. Metabolic acidosis was seen in all gram-negative sepsis neonates, particularly in &gt;80% cases of Klebsiella and Candida sepsis. Mortality was highest and statistically significant in KP (55.4%) and Citrobacter koseri (55.6%) sepsis ( p = .004). The statistically significant risk factors for mortality included neonates with raised C Reactive Protein (CRP). Most of the gram-negative pathogens were sensitive to colistin and aminoglycosides and resistant to carbapenems. Conclusion: Observing the initial clinical features at suspicion of sepsis may help predicting the likely pathogen awaiting the final blood/CSF culture report and knowing the antibiotic sensitivity profile of commonly isolated organisms in our NICU helps in the selection of a rational empirical antibiotic.

Does maintaining the number of present and functional teeth benefit the longevity of life in older people requiring nursing care?: A prospective cohort study.

This prospective cohort study examined the effects of the number of present and functional teeth on mortality among older Japanese adults requiring nursing care in an environment of comprehensive oral hygiene and nutritional management. The study included 174 older adults (mean age: 84.4 ± 8.3 years; male/female: 49/125) in need of support or long-term care, who resided in either a local specialized healthcare facility or their own homes, and received daily oral hygiene and nutritional support at facilities in Okayama, Japan. The initial clinical oral examination along with assessment of general physical condition and nursing environment of the participants were performed in July 2013 and followed up for one year. All-cause mortality occurred in 28 (mean age: 88.7 ±13.4 years; male/female: 6 /22) individuals during the follow-up period. Cox proportional hazard analysis indicated that older age, low performance in activities of daily living (Barthel Index <40), and underweight status (body mass index <18.5) were significant risk factors for mortality. The number of present and functional teeth were not found to be significant risk factors for mortality. During the one-year follow-up period, the number of present and functional teeth did not have a significant impact on mortality among older Japanese adults requiring nursing care in a well-managed environment of oral hygiene and nutritional status.

Risk factors and clinical outcomes of cytomegalovirus diseases in hematologic malignancy patients without hematopoietic stem-cell transplantation.

This study aims to evaluate the risk factors and prognosis for CMV diseases in hematologic malignancy patients without hematopoietic stem-cell transplantation (HSCT). We performed a case-control study (1:2) between 2012 and 2022. Adults with pathologic-confirmed CMV diseases (n=60) among hematologic malignancy patients were matched and compared to whom without CMV disease. Lymphoma was the most common underlying malignancy, and gastrointestinal tract involvement was the most common CMV disease. In the case group, high-dose steroid administration and transfusion within one month before diagnosis were higher (p<0.001). Steroid administration (aOR=5.78; 95% confidence interval: 1.25-26.68, p=0.024), red blood cell transfusion within one month (aOR=14.63; 2.75-77.76, p=0.002), low BMI (aOR=13.46, 2.07-87.45, p=0.006), and hypoalbuminemia (aOR=26.48, 5.93-118.17, p<0.001) were independent risk factors associated with CMV disease. The 30-day mortality was higher in the case group and CMV disease was significantly associated with all-cause mortality (aOR=14.41, 3.23-64.31, p<0.001). In hematologic malignancy patients without HSCT, risk factors for CMV organ disease included high-dose steroid administration and RBC transfusion within one month, low BMI, and hypoalbuminemia. Overall mortality was significantly higher with CMV disease, and CMV disease occurrence was a significant risk factor for mortality.

COGNITIVE FRAILTY: PREVALENCE, RISK FACTORS, AND THE RISK OF MORTALITY IN CHINESE MIDDLE-AGED AND OLDER ADULTS

Abstract To examine the age-specific prevalence, risk factors, and magnitude of the association between cognitive frailty and all-cause mortality in Chinese middle-aged and older adults. We used baseline (2011) and follow-up waves (2013, 2015, and 2018) data from the China Health and Retirement Longitudinal Study (CHARLS). The age group was categorized as middle-aged, old, and very old. Factors associated with cognitive frailty and the associations between cognitive frailty statuses and mortality were examined using multinomial logistic regression and Cox proportional hazards models, respectively. Totally 7947 participants were included in this study, and the overall prevalence of cognitive frailty was 12% (middle-aged, 11%; old, 10%; very old, 26%; P&amp;lt; 0.0001). Cognitive frailty was independently associated with rural residential status, long sleep duration, lack of social participation, depressive symptoms, and multimorbidity among all the age groups. Over the 7-year follow-up, participants with cognitive frailty were at a higher risk for all-cause mortality than the robust group (HR 1.70, 95%CI 1.12-2.57 for the middle-aged group, HR 1.70, 95%CI 1.02-2.84 for the old group, and HR 2.06, 95%CI 1.17-3.65 for the very old group). Pre-cognitive frailty was associated with a higher mortality risk in the middle-aged group only (HR 1.34, 95%CI 1.01-1.79). The prevalence of cognitive frailty in middle-aged adults was comparable with that in the old group. Cognitive frailty, a significant risk factor for mortality, was associated with multiple factors in middle-aged and older adults, calling for integrated cognitive frailty prevention strategies. Noticeably, pre-cognitive frailty in middle-aged people increases mortality risk and requires special attention.

Emergency Department Length of Stay and in-Hospital Mortality of Non-Traumatic Patients in a University Hospital

Objective: To assess the emergency department length of stay (EDLOS) and mortality in each Emergency Severity Index (ESI) triage level. In addition to identifying the cut-off point of EDLOS to predict 72-hour in-hospital mortality among adult non-traumatic patients in the ED of a university hospital.Material and Methods: A cross-sectional study was conducted by retrieving patient data from the hospital information system; from January 1, 2014, to December 31, 2018. Patient characteristics, EDLOS, and in-hospital mortality rates were analyzed using the R program. The cut-off values of EDLOS, via the area under the curve for the best prediction of 72-hour in-hospital mortality in patients at different ESI levels, were analyzed by multivariate analysis. Statistical significance was defined as a p-value of ≤0.05.Results: Data from 71,247 patients with 123,356 visits were enrolled. EDLOS significantly decreased across ESI levels and the in-hospital mortality rates were highest in ESI 1, followed by ESI 2 and ESI 3. The predictive ability of EDLOS was the highest for ESI 4, followed by ESI 3. The cut-off point of EDLOS at 3.58 hours showed the best sensitivity, which was a significant risk factor for mortality after adjusting for other significant variables. An EDLOS longer than 4 hours was a significant factor for poor survival in patients with ESI 2 and ESI 3.Conclusion: A practical cut-off point of 4 hours EDLOS can be used to predict 72-hour in-hospital mortality. Healthcare providers in the ED should consider EDLOS as a safety indicator for quality assurance.

Prognostic impact of preoperative atrial fibrillation in patients undergoing heart surgery in cardiogenic shock

Surgical intervention in the setting of cardiogenic shock (CS) is burdened with high mortality. Due to acute condition, detailed diagnoses and risk assessment is often precluded. Atrial fibrillation (AF) is a risk factor for perioperative complications and worse survival but little is known about AF patients operated in CS. Current analysis aimed to determine prognostic impact of preoperative AF in patients undergoing heart surgery in CS. We analyzed data from the Polish National Registry of Cardiac Surgery (KROK) Procedures. Between 2012 and 2021, 332,109 patients underwent cardiac surgery in 37 centers; 4852 (1.5%) patients presented with CS. Of those 624 (13%) patients had AF history. Cox proportional hazards models were used for computations. Propensity score (nearest neighbor) matching for the comparison of patients with and without AF was performed. Median follow-up was 4.6 years (max.10.0), mean age was 62 (± 15) years and 68% patients were men. Thirty-day mortality was 36% (1728 patients). The origin of CS included acute myocardial infarction (1751 patients, 36%), acute aortic dissection (1075 patients, 22%) and valvular dysfunction (610 patients, 13%). In an unadjusted analysis, patients with underlying AF had almost 20% higher mortality risk (HR 1.19, 95% CIs 1.06–1.34; P = 0.004). Propensity score matching returned 597 pairs with similar baseline characteristics; AF remained a significant prognostic factor for worse survival (HR 1.19, 95% CI 1.00–1.40; P = 0.045). Among patients with CS referred for cardiac surgery, history of AF was a significant risk factor for mortality. Role of concomitant AF ablation and/or left atrial appendage occlusion or more aggressive perioperative circulatory support should be addressed in the future.

Multidrug-Resistant Infections After Liver Transplantation, Etiology and Risk Factors: A Single-Center Experience.

Patients undergoing liver transplant are at an increased risk of morbidity and mortality due to the development of infections. We aimed to evaluate the risk factors affecting the incidence of infectious diseases after liver transplant and to present the epidemiological data. We investigated patients aged ≥18 years who underwent liver transplant between 2012 and 2020 at our center. We collected infections, causative microorganisms, and antibacterial resistance patterns seen during the first 6 months posttransplant. Risk factors affecting the development of infectious diseases were also analyzed and evaluated. Of 112 patients included in our study, 76 (67.9%) were men, and the median age was 50 years (range, 20-66 years). Within month 1 and month 6 after transplant, at least 1 episode of infection occurred in 67 (59.8%) and 80 (71.4%) patients, respectively. Bacterial infections were the most common type (n = 78, 95.1%), followed by fungal (n = 2, 2.4%) and viral (n = 2, 2.4%) infections. The rate of multidrug resistance in bacterial infections was high (n = 38, 52.7%) and was also a risk factor for mortality in the first 6 months after transplant (P < .001). Pretransplant values of international normalized ratio, creatinine, bilirubin, and posttransplant intensive care unit stay, as well as the presence of encephalopathy, were shown to increase the risk of infection after transplant. Multidrug-resistant bacterial infections are a significant risk factor for mortality in liver transplant patients. Many risk factors that contribute to the development of infections aftertransplant have been included in prognostic scoring systems of liver failure. Consequently, the severity of end-stage liver failure is directly related to the risk of posttransplant infections.

Prevalence and outcome of chronic hepatitis C patients admitted with COVID-19 to intensive care units: a blessing in disguise

BackgroundManaging COVID-19 pneumonia is, in reality, one of the biggest challenges in the history of intensive care medicine. The link between comorbidity and COVID-19 remains unclear. Worldwide, Egypt has the highest prevalence of hepatitis C virus (HCV). The study’s objectives were to assess the prevalence of chronic hepatitis C as a risk factor among COVID-19 patients and to investigate the impact of it and the prior exposure to different HCV management protocols on the clinical characteristics and outcome of COVID-19 patients.ResultsOf 2106 confirmed cases of COVID-19, CLD, malignancy, and chronic kidney disease were significant risk factors for death [OR (95% CI) = 2.78 (1.29–5.98), 2.72 (1.14–6.46) and 3.79 (1.39–10.36) respectively]. The mortality rate was 24.3%. A total of 99 cases (4.7%) with CLD were investigated during the study period; 69 patients (3.3%) were categorized as HCV-positive. Among the positive HCV cases, 49 patients (2.3%) received anti-hepatitis C medications. The mortality rate was 46.4% and 73.3% between HCV and non-HCV hepatic patients, respectively. Triple therapy showed a statistically significant association with a better outcome (p value = 0.009).ConclusionsIn the present report, chronic liver diseases, chronic kidney disease, and malignancy were significant risk factors for mortality among COVID-19 patients. The Egyptian mass management of chronic hepatitis C may explain the favorable outcome of COVID-19 among these patients. Intervention trials are required to prove that direct-acting antivirals are effective in preventing COVID-19.