Significant Risk Factor For Mortality Research Articles

Teicoplanin versus \u03b2-lactam for febrile patients with Staphylococcus-like bacteremia: focus on methicillin-susceptible Staphylococcus aureus bacteremia

BackgroundMany studies have shown that vancomycin is inferior to β-lactam antibiotics in terms of effectiveness in the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. However, limited data are available regarding the comparison of clinical outcomes between patients receiving initial teicoplanin and those receiving β-lactam antibiotics for MSSA bacteremia.MethodsEighty-four adults with MSSA bacteremia were included: initial teicoplanin treatment group (n = 28) and β-lactam treatment group (n = 56). The two groups were further stratified based on propensity score matching according to the outcome analysis using a logistic regression model. We investigated the clinical outcomes between the groups before and after propensity score matching after treatment completion.ResultsPittsburgh bacteremia score ≥ 4 (odds ratio, 60.6; 95%CI, 7.4–496.8) was an independent risk factor for unfavorable outcome. After propensity score matching, the initial teicoplanin treatment group and the β-lactam treatment group consisted of 28 patients each. No statistically significant differences were observed in the proportions of patients with favorable outcomes and 30-day overall mortality rates between the groups before and after propensity score matching after the completion of teicoplanin or β-lactam treatment. The Kaplan-Meier 30-day survival curve also showed no significant difference between the patients receiving initial teicoplanin treatment and those receiving β-lactam treatment before and after matching (hazard ratio, 1.84, 95%CI, 0.60–5.64; and 3.12, 95%CI, 0.98–9.99, respectively).ConclusionsThere were no significant difference in clinical outcomes between initial teicoplanin treatment and β-lactam treatment among patients with MSSA bacteremia. Pittsburgh bacteremia score ≥ 4 was a significant risk factor for mortality.

Incidence and predictors of vascular events following end-stage kidney disease in childhood.

Cardiovascular death is a leading cause of mortality in paediatric end-stage kidney disease (ESKD). There is however little known about the clinically relevant vascular disease in this population. We aimed to describe the incidence of new onset vascular disease and vascular death in Australian children receiving renal replacement therapy (RRT). We also aimed to identify demographic or childhood risk factors for these endpoints, and whether vascular disease predicts mortality. Data on Australian patients who commenced RRT at <18 years of age from 1991 to 2017 were extracted from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). Multivariable competing risks regression was used to identify factors associated with vascular events. A cohort of 1268 patients were followed up for a median of 10.31 years. Vascular disease was reported in 5.4%, and vascular death in 4.1%. The cumulative incidence of any vascular event, that is, disease or death, at 10 and 20 years was 5.5% and 12.8%, respectively. Childhood vascular events were associated with non-Caucasian, non-Indigenous ethnicity, and for the 804 patients followed up after 18 years of age, vascular events were associated with lack of childhood transplantation, longer childhood dialysis duration and Indigenous ethnicity. Vascular disease was only reported for 25.49% of patients who had a vascular death, and although a significant risk factor for mortality, it had limited ability to predict mortality. Cumulative incidence of vascular events is significant after commencing RRT during childhood and is associated with ethnicity, longer childhood dialysis duration and lack of childhood transplantation.

A Deep Learning Radiomics Model to Identify Poor Outcome in COVID-19 Patients With Underlying Health Conditions: A Multicenter Study.

Objective: Coronavirus disease 2019 (COVID-19) has caused considerable morbidity and mortality, especially in patients with underlying health conditions. A precise prognostic tool to identify poor outcomes among such cases is desperately needed. Methods: Total 400 COVID-19 patients with underlying health conditions were retrospectively recruited from 4 centers, including 54 dead cases (labeled as poor outcomes) and 346 patients discharged or hospitalized for at least 7 days since initial CT scan. Patients were allocated to a training set (n = 271), a test set (n = 68), and an external test set (n = 61). We proposed an initial CT-derived hybrid model by combining a 3D-ResNet10 based deep learning model and a quantitative 3D radiomics model to predict the probability of COVID-19 patients reaching poor outcome. The model performance was assessed by area under the receiver operating characteristic curve (AUC), survival analysis, and subgroup analysis. Results: The hybrid model achieved AUCs of 0.876 (95% confidence interval: 0.752-0.999) and 0.864 (0.766-0.962) in test and external test sets, outperforming other models. The survival analysis verified the hybrid model as a significant risk factor for mortality (hazard ratio, 2.049 [1.462–2.871], P < 0.001) that could well stratify patients into high-risk and low-risk of reaching poor outcomes (P < 0.001). Conclusion: The hybrid model that combined deep learning and radiomics could accurately identify poor outcomes in COVID-19 patients with underlying health conditions from initial CT scans. The great risk stratification ability could help alert risk of death and allow for timely surveillance plans.

Serum syndecan-1 reflects organ dysfunction in critically ill patients

Syndecan-1 (SDC-1) is found in the endothelial glycocalyx and shed into the blood during systemic inflammatory conditions. We investigated organ dysfunction associated with changing serum SDC-1 levels for early detection of organ dysfunction in critically ill patients. To evaluate the effect of SDC-1 on laboratory parameters measured the day after SDC-1 measurement with consideration for repeated measures, linear mixed effects models were constructed with each parameter as an outcome variable. A total of 94 patients were enrolled, and 831 samples were obtained. Analysis using mixed effects models for repeated measures with adjustment for age and sex showed that serum SDC-1 levels measured the day before significantly affected several outcomes, including aspartate aminotransferase (AST), alanine transaminase (ALT), creatinine (CRE), blood urea nitrogen (BUN), antithrombin III, fibrin degradation products, and D-dimer. Moreover, serum SDC-1 levels of the prior day significantly modified the effect between time and several outcomes, including AST, ALT, CRE, and BUN. Additionally, increasing serum SDC-1 level was a significant risk factor for mortality. Serum SDC-1 may be a useful biomarker for daily monitoring to detect early signs of kidney, liver and coagulation system dysfunction, and may be an important risk factor for mortality in critically ill patients.

Epidemiology, risk factors and outcomes of bloodstream infection caused by ESKAPEEc pathogens among hospitalized children

BackgroundBloodstream infection (BSI) resulting from ESKAPEEc pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp) is relevant to high mortality and economic cost. Data concerning the impact of BSI due to ESKAPEEc in pediatric population was virtually scant. Our purpose was to summarize the epidemiology, risk factors and outcomes of ESKAPEEc BSI among hospitalized children.MethodsInpatients diagnosed with BSI with definite etiology between January 2016 and December 2018 were enrolled retrospectively at the West China Second University Hospital. Data were systematically reviewed on patients’ clinical characteristics and laboratory findings to ascertain independent predictors, clinical features and outcomes.ResultsOf the 228 patients with BSI, 174 (76.3%) were caused by ESKAPEEc (124 MDR-ESKAPEEc). Multivariate analysis demonstrated that premature and/ or low birth weight (odds ratio [OR] = 2.981, P = 0.036), previous surgery and/or trauma (OR = 5.71, P = 0.029) and source of urinary tract infection (OR = 10.60, P = 0.004) were independently associated with ESKAPEEc BSI. The independent risk factor for MRD-ESKAPEEc BSI was nosocomial infection (OR = 3.314, P = 0.037). The overall mortality rate in patients with ESKAPEEc BSI was 14.4% (25/174), and no significant difference was ascertained in mortality between MRD-ESKAPEEc and non-MRD ESKAPEEc BSI groups (13.7% vs. 11.4%, P = 0.692). In addition, previous surgery and/or trauma, thrombocytopenia, and mechanical ventilation were significant risk factors for mortality caused by ESKAPEEc BSI.ConclusionsMore than two-thirds of BSI among hospitalized children were caused by ESKAPEEc. Previous surgery and/or trauma, thrombocytopenia and mechanical ventilation increased the risk rate for mortality in ESKAPEEc BSI. The risk factors ascertained could assist physicians to early suspect ESKAPEEc BSI and MDR ESKAPEEc BSI.

POS-060 CHRONIC KIDNEY DISEASE IN PEDIATRIC ACUTE KIDNEY INJURY SURVIVORS FROM INTENSIVE CARE UNIT: PROSPECTIVE STUDY FROM A DEVELOPING COUNTRY

Acute kidney injury (AKI) is an independent risk factor for mortality in critically il. Incidence of AKI in PICU ranges from 8-30%. Despite advances in therapy, mortality is still high and survivors are at risk of CKD. A hospital based prospective cohort study was conducted on critically ill children and neonates with AKI admitted to SAT Hospital, a tertiary care teaching hospital in South India over a period of 1 year with the objective to assess the immediate and long term outcome and risk factor involved in adverse outcome. Adverse outcome is defined as mortality or development of CKD in survivors. AKI was defined by pRIFLE and nRIFLE criteria respectively in children and neonates. Those with pre-existing CKD or CAKUT were excluded. The demographic profile, etiology, organ dysfunction, inotrope support, mechanical ventilation, AKI severity, need for dialysis and condition at discharge were assessed. Survivors were followed up with assessment of blood pressure, proteinuria and e GFR by Schwartz formula at 3 months, 6 months and 1 year. GFR below 90 mL/min/1.73 m2 or a normal GFR with proteinuria and/or hypertension were used to identify CKD. Statistical analysis was done with SPSS 20.0 .Chi square test was used for discrete variables, t test and ANOVA for quantitative variables. Univariate analysis and binary logistic regression were done for assessment of factors affecting the outcome. 155 critically ill babies- 87 neonates and 68 children were diagnosed with AKI during the study period. Male to Female ratio was 4.1:1 for new-born and 1.8:1 for children. Out of the 87 neonates 25.3% (22) were at risk, 43.7 % (38) in injury and 31 % (27) had failure. Dehydration due to faulty feeding and lactation failure formed the major cause of neonatal AKI (50.6%) followed by septicaemia (28.7%). Of the 68 children 17.7% (12), 23.5 % (16) and 58.8% (40) were in risk, injury and failure respectively. Acute Glomerulonephritis was the major etiology (23.5%) followed by sepsis with MODS (19.1%). Significant association was found between mortality and severity of AKI in both neonates and children. (P 0.002, P 0.00). Significant risk factors of mortality are given in Table 1.View Large Image Figure ViewerDownload Hi-res image Download (PPT) 13 out of 87 neonates expired (14.9%). 83.7% had normal GFR at discharge. 8.6% (3/35) with Injury and 53% (9/17) with Failure had partial recovery. 74 survivors were followed up for 1 year. 12 were lost to follow up and 1 died at 3 months. 4/61 babies (6.5%) developed CKD - 11% with injury and 14.2% with failure. Of the 68 children, 15 expired (22%). Among 53 survivors, 27 (51%) – {33.3 % (5/15) with injury and 80.8 % (21/26)} had abnormal GFR at discharge. 48 children were followed up till 1 year. 22.9% (11) had CKD . Of this 20% (3/15) were with injury and 36% (8/22) with failure. Severity of AKI correlated with adverse outcome. Risk factors for CKD were anuric AKI, MODS, need for dialysis, component therapy, inotrope support, abnormal GFR and hypertension at discharge. Anuric AKI and need for dialysis were the independent risk factors by multivariate analysis for development of CKD (Table 2). 22.9% children and 6.5% neonates surviving an AKI episode had CKD at 1 year follow up. Regardless of the severity, all AKI survivors after critical illness should be monitored regularly for long-term kidney damage so that early intervention becomes possible to retard the progression.

Risk factors for mortality in infants with congenital diaphragmatic hernia: asingle center experience.

SummaryBackgroundDespite current progress in research of congenital diaphragmatic hernia, its management remains challenging, requiring an interdisciplinary team for optimal treatment.ObjectiveAim of the present study was to evaluate potential risk factors for mortality of infants with congenital diaphragmatic hernia.MethodsA single-center chart review of all patients treated with congenital diaphragmatic hernia over a period of 16 years, at the Medical University of Vienna, was performed. A comparison of medical parameters between survivors and non-survivors, as well as to published literature was conducted.ResultsDuring the observational period 66 patients were diagnosed with congenital diaphragmatic hernia. Overall survival was 84.6%. Left-sided hernia occurred in 51 patients (78.5%) with a mortality of 7.8%. In comparison, right-sided hernia occurred less frequently (n = 12) but showed a higher mortality (33.3%, p = 0.000). Critically instable patients were provided with venoarterial extracorporeal membrane oxygenation (ECMO, 32.3%, n = 21). Survival rate among these patients was 66.7%. Right-sided hernia, treatment with inhaled nitric oxide (iNO) over 15 days and the use of ECMO over 10 days were significant risk factors for mortality.ConclusionThe survival rate in this cohort is comparable to the current literature. Parameters such as the side of the diaphragmatic defect, duration of ECMO and inhaled nitric oxide were assessed as mortality risk factors. This analysis of patients with congenital diaphragmatic hernia enhances understanding of risk factors for mortality, helping to improve management and enabling further evaluation in prospective clinical trials.

Impact of nutritional index on contrast-associated acute kidney injury and mortality after percutaneous coronary intervention

The risk of malnutrition in acute kidney injury and mortality in coronary artery disease patients has not been studied. This study aimed to evaluate whether nutritional status assessed by Onodera’s prognostic nutritional index (PNI) was related to percutaneous coronary intervention (PCI) outcomes. A total of 3731 patients who received PCI between January 2010 and December 2018 were included. The relationship between PNI at the time of PCI and the occurrence of contrast-associated acute kidney injury (AKI) and all-cause death was evaluated using logistic regression and Cox proportional hazards models, respectively. AKI occurred in 271 patients (7.3%). A low PNI was independently associated with an increased risk of AKI on multivariate logistic regression analysis (OR 0.96, 95% CI 0.94–0.98, P = 0.001). During the median follow-up of 4.3 years, Kaplan–Meier analysis showed that patients with AKI/low PNI < 47.8 had a higher death rate. After adjusting for various risk factors, a low PNI was a significant risk factor for mortality (HR 0.98, CI 0.96–0.99, P = 0.003). A low level of PNI was associated with increased mortality, especially in the group aged over 70 years and female sex. PNI was closely associated with acute kidney outcomes and patient mortality after PCI.

Predictors of Survival in Chronic Hemodialysis Patients: A 10-Year Longitudinal Follow-Up Analysis

Background: Risk factors of mortality in chronic hemodialysis patients have not yet been sufficiently evaluated. In particular, chronological transits and interactions of the impact of risk factors have rarely been described. Methods: This study is a post hoc analysis of the participants in the Olme­sartan Clinical Trial in Okinawan Patients under OKIDS (OCTOPUS) study conducted between June 2006 and June 2011. We additionally followed up on the prognosis of the participants until July 31, 2018. Standardized univariable and multivariable Cox regression analyses were used to evaluate the influences of the participants’ baseline characteristics on all-cause mortality. We also evaluated chronological changes in the impacts of risk factors, interactions among predictors, and the influence of missing values using sensitivity analyses. Results: Of the 469 original trial participants, 461 participants were evaluated. The median time of follow-up was 10.2 years. A total of 211 (45.8%) participants were deceased. The leading causes of death were infection (n = 72, 34.1%) and cardiovascular disease (n = 66, 31.3%). Univariate and multivariate Cox regression analyses revealed that the impact of diabetes mellitus, history of coronary intervention, and hypoalbuminemia were significant risk factors for mortality during the whole follow-up period. During the early follow-up period (≤3 years), standardized univariate Cox regression analyses revealed that history of amputation (hazard ratio [HR] = 4.61, p < 0.001), lower dry weight, higher cardiothoracic ratio, and lower potassium levels were statistically significant risks. In those who survived for longer than 3 years, a history of stroke (HR = 1.73, p = 0.006), higher systolic blood pressure, lower serum sodium levels, and higher levels of hemoglobin, and serum phosphate were significant risks. We also observed a stable interaction between the impacts of serum phosphate and albumin on all-cause mortality. Conclusion: In chronic hemodialysis patients, targets to improve the short-term prognosis and long-term prognosis are not equivalent. Hyperphosphatemia was a significant risk factor for the all-cause mortality among patients with normal serum albumin levels but not among patients with compromised albumin levels.

Risk Factors and Prognostic Implications of Perioperative Stroke after Heart Transplantation: An Analysis of the United Network for Organ Sharing Database 2009-2019

<h3>Purpose</h3> The purpose of our study was to evaluate risk factors and prognostic implications of perioperative stroke in heart transplantation. <h3>Methods</h3> We conducted a retrospective review of the UNOS database between 2009 and 2019 to identify adult patients (≥18years) who underwent orthotopic heart transplantation (OHT). Patients who received a multi‐organ transplant or second heart transplant were excluded. Patients were divided according to the presence or absence of perioperative stroke. Baseline characteristics and clinical status were recorded. The primary endpoint was all‐cause mortality. <h3>Results</h3> During the study period, there were 26,518 isolated heart transplants, we excluded 4,266 because of age, 615 because of the previous history of transplantation, and 211 because of missing stroke information. A total of 21,426 patients were included in the study, among them 588 (2.7%) experienced a perioperative stroke during the index hospitalization. In the multivariable analysis, ECMO (Extracorporeal membrane oxygenation) (adjusted Odds Ratio (aOR): 5.46, 95% Confidence Interval (CI) 2.09-14.3; p <0.001), presence left ventricular assist device (OR 1.68, 95%CI 1.32-2.15; p<0.001), prior cardiac surgery (aOR 1.49, 95%CI 1.17-1.90; p=0.0012), higher serum bilirubin concentrations (aOR: 1.07, 95% CI 1.02-1.11; P=0.015) were associated with perioperative stroke. During a mean follow-up of 1289 days, patients with perioperative stroke had a significantly higher mortality rate than those without. The presence of perioperative stroke was identified as a significant risk factor for mortality (adjusted hazard ratio; 3.39, 95% CI; 2.88-3.99, p<0.001)<b>. Figure 1</b> <h3>Conclusion</h3> Perioperative stroke after heart transplantation is infrequent but associated with increased mortality. The presence of ECMO, prior LVAD, and prior cardiac surgery were among the risk factors identified.

Factors influencing length of intensive care unit stay following a bidirectional cavopulmonary shunt.

The goal of this study was to identify the risk factors for prolonged length of stay (LOS) in the intensive care unit (ICU) after a bidirectional cavopulmonary shunt (BCPS) procedure and its impact on the number of deaths. In total, 556 patients who underwent BCPS between January 1998 and December 2019 were included in the study. Eighteen patients died while in the ICU, and 35 died after discharge from the ICU. Reduced ventricular function was significantly associated with death during the ICU stay (P = 0.002). In patients who were discharged alive from the ICU, LOS in the ICU [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.02-1.06; P < 0.001] and a dominant right ventricle (HR 2.41, 95% CI 1.03-6.63; P = 0.04) were independent risk factors for death. Receiver operating characteristic analysis identified a cut-off value for length of ICU stay of 19 days. Mean pulmonary artery pressure (HR 1.03, 95% CI 1.01-1.05; P = 0.04) was a significant risk factor for a prolonged ICU stay. Prolonged LOS in the ICU with a cut-off value of 19 days after BCPS was a significant risk factor for mortality. High pulmonary artery pressure at BCPS was a significant risk factor for a prolonged ICU stay.

Impact of comorbidity burden on mortality in patients with COVID-19 using the Korean health insurance database

We aimed to investigate the impact of comorbidity burden on mortality in patients with coronavirus disease (COVID-19). We analyzed the COVID-19 data from the nationwide health insurance claims of South Korea. Data on demographic characteristics, comorbidities, and mortality records of patients with COVID-19 were extracted from the database. The odds ratios of mortality according to comorbidities in these patients with and without adjustment for age and sex were calculated. The predictive value of the original Charlson comorbidity index (CCI) and the age-adjusted CCI (ACCI) for mortality in these patients were investigated using the receiver operating characteristic (ROC) curve analysis. Among 7590 patients, 227 (3.0%) had died. After age and sex adjustment, hypertension, diabetes mellitus, congestive heart failure, dementia, chronic pulmonary disease, liver disease, renal disease, and cancer were significant risk factors for mortality. The ROC curve analysis showed that an ACCI threshold > 3.5 yielded the best cut-off point for predicting mortality (area under the ROC 0.92; 95% confidence interval 0.91–0.94). Our study revealed multiple risk factors for mortality in patients with COVID-19. The high predictive power of the ACCI for mortality in our results can support the importance of old age and comorbidities in the severity of COVID-19.

Outcomes in Dialysis-Dependent Indigenous and Non-Indigenous Patients Undergoing Cardiac Surgery at Townsville University Hospital

Dialysis-dependent patients have a high risk of cardiovascular death but also a high risk for perioperative mortality in cardiac surgery. Our study examined surgical complications and mortality in Indigenous and non-Indigenous dialysis-dependent patients undergoing cardiac surgery at a single centre. The retrospective study reviewed 72 consecutive dialysis-dependent patients who underwent cardiac surgery between 2008 and 2018. Data was prospectively collected, and follow-up was obtained from physicians and general practitioners. Multivariable analysis was performed to determine predictors of mortality. The median age of Indigenous Australian patients was 60 years, compared with 65 years for non-Indigenous patients. Indigenous Australian patients had a significantly higher rate of return to theatre (43% versus 17%). The predominant reason for return to theatre for the whole cohort was postoperative bleeding (n=16, 22%). The overall early mortality rate was 10%. There were 35 late deaths (49%) and overall survival at 5 years was 40.92±6.8% (95% CI: 28-54%). History of arrhythmia (p=0.019) was a significant risk factor for mortality, whilst patients who underwent isolated coronary artery bypass grafting (p=0.004), and those who received internal mammary artery grafts (p=0.021) had a reduced hazard ratio for mortality. The median follow-up time was 29 months (IQR 10-52 mo). Dialysis-dependent Indigenous Australian patients present younger for cardiac surgery, with a higher prevalence of co-morbid diabetes and more extensive coronary artery disease. There was no statistically significant difference in early or late mortality between Indigenous and non-Indigenous patients. However, there was a higher rate of return to theatre amongst the Indigenous Australian cohort.

Association between denture use, chewing ability, and all-cause mortality in middle-aged and older adults who exercised regularly in Korea

Herein, using data from the Korean Longitudinal Study of Aging (2006–2018), we evaluated denture use and chewing ability to determine the status of oral health in middle-aged adults who exercised regularly; further, we investigated the relationship of oral health with all-cause mortality. From the basic survey conducted in 2006, we interviewed 10,254 participants who were followed up until death. The participants were grouped based on regular exercise into REG (n = 3921) and non-REG (n = 6290) groups. The mortality rate was higher in the non-REG group than in the REG group (35.8% versus 26.9%; p < 0.001). The mortality rate was higher in denture users (versus non-denture users), non-drinkers (versus alcohol drinkers), and those on medical aid (versus national health insurance). The mortality rate was higher in participants with poor masticatory ability, lower education level, and poor subjective health perception (p < 0.001). Denture use and masticatory discomfort were not significant risk factors for mortality in the non-REG group (p > 0.05). In conclusion, masticatory discomfort was a risk factor for increased mortality in middle-aged Korean adults who exercised regularly, at least once a week. Thus, assessment of masticatory ability could be a useful indicator of life expectancy in middle-aged adults.

Risk Factors for Mortality among HIV/AIDS Patients

Background: Morbidity and mortality of HIV/AIDS infections is still high and as a global health problem particularly in Low-Middle Income Countries (LMICs). Indonesia ranks third in Asia Pacific in increasing HIV infection. A Study on risk factors for mortality in HIV/AIDS patients in Dr. Kariadi General Hospital has never been conducted. This study analyzed the risk factors for mortality among HIV/AIDS patients.Methods: Case control study, data from medical records of inpatients and outpatients in Dr. Kariadi General Hospital from January 2015 to December 2017.Results: Study subject: Two hundred and ten HIV/AIDS patients, were included; 105 (56.75%) as cases and 105 (9.65%) control patients. The significant risk factors for mortality were as follow: male sex (p = 0.030); age ≥ 45 years (p = 0.035); non compliance to treatment (p = 0,000); WHO clinical stage III and IV (p = 0,000); co-infection of pulmonary tuberculosis (p = 0,000); CD4 cell count &lt; 200 cells/mm3 (p = 0,000); eGFR &lt; 60 mL/minute/1.72 m2 (p = 0.001) and Haemoglobin level &lt; 10 g/dL (p = 0.008). The non-significant risk factors for mortality were as follow: level of education (p = 0.650); Hepatitis B co-infection (p = 0.153) and Hepatitis C co-infection (p = 0.506). The most important risk factors for mortality in this study in were non compliance to treatment (p = 0.003; OR = 3.285) and CD4 count &lt; 200 cells/mm3 (p = 0.014; OR = 5.480).Conclusion: In this study, the risk factors for mortality in HIV/AIDS patients were male sex; age ≥ 45 years; non compliance to treatment; WHO clinical stage III and IV; co-infection of pulmonary tuberculosis, CD4 count &lt; 200 cells/mm3; eGFR &lt; 60 mL/minute/1.72 m2 and Hb level &lt; 10 g/dL. The most important risk factors for mortality were non compliance to treatment and CD4 count &lt; 200 cells / mm3.

Lumbosacral Radiculoplexus Neuropathy: Neurologic Outcomes and Survival in a Population-Based Study.

To determine whether patients in the community with lumbosacral radiculoplexus neuropathy (LRPN) have milder neuropathy than referral patients, we characterized the outcomes and survival of population-based compared to referral-based LRPN cohorts. Previously, we found that the incidence of LRPN is 4.16/100,000/y, a frequency greater than other inflammatory neuropathies. The survival of patients with LRPN is uncharacterized. Sixty-two episodes in 59 patients with LRPN were identified over 16 years (2000-2015). Clinical findings were compared to previous referral-based LRPN cohorts. Survival data were compared to those of age- and sex-matched controls. At LRPN diagnosis, median age was 70 years, median Neuropathy Impairment Score (NIS) 22 points, 92% had pain, 95% had weakness, 23% were wheelchair-bound, and median modified Rankin Scale score (mRS) was 3 (range 1-4). At last follow-up, median NIS improved to 17 points (p < 0.001) with 56% having ≥4 points improvement, 16% were wheelchair-bound, and median mRS was 2. Compared to referral-based LRPN cohorts, community patients with LRPN had less impairment, less bilateral disease (37% vs 92%), and less wheelchair usage (23% vs 49%). LRPN survival was 86% at 5 years and 55% at 10 years. Compared to age- and sex-matched controls, patients with LRPN had 76% increased risk of death (p = 0.016). In multivariate analysis, diabetes, age, stroke, chronic kidney disease, peripheral artery disease, and coronary artery disease were significant mortality risk factors but LRPN was not. LRPN is a painful, paralytic, asymmetric, monophasic, sometimes bilateral pan-plexopathy that improves over time but leaves patients with impairment. Although having LRPN increases mortality, this increase is probably due to comorbidities (diabetes) rather than LRPN itself.

Post-thyroidectomy bleeding: analysis of risk factors from a national registry.

Post-thyroidectomy haemorrhage occurs in 1-2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.

Candidemia in Children: A 16-year Longitudinal Epidemiologic Study.

Candida species are the most common cause of systemic fungal infections in children. Risk factors for candidemia vary in different patient populations, posing challenges for clinical prediction of infection. We describe the epidemiology and clinical disease of candidemia in children admitted to a tertiary pediatric hospital. Retrospective audit of children ≤18 years of age with candidemia at a tertiary pediatric hospital over a 16-year period. There were 139 episodes of candidemia in 124 children. A central venous catheter was present in 94% of episodes, prior antibiotic exposure in 86% and parenteral nutrition in 43%. During the study period, the proportion of candidemia due to non-albicans Candida spp. increased primarily due to a rise in C. krusei. Colonization with Candida spp. in the 30 days before developing candidemia was identified in 40% of episodes and the species was concordant in 60%. Infection at other sites was rare, including pulmonary dissemination (9/38, 24%), renal fungal disease (9/114, 8%), fungal endophthalmitis (8/102, 8%) and hepatosplenic nodules (5/92, 5%). Overall, 8/127 (6%) isolates were fluconazole-resistant (7 C. krusei and 1 C. glabrata) and 7/127 (6%) had intermediate susceptibility to fluconazole. The overall 30-day mortality was 12% and significant risk factors for mortality on multivariate analysis were male sex, liver disease and mucositis. Our study outlines low rates of disseminated candidiasis and low mortality associated with candidemia at our institution. Additionally, it suggests that prior colonization may be an important risk factor, however, this should be validated in large prospective controlled studies.

Does early bloodstream infection pose a significant risk of in-hospital mortality in adults with burns?

Bloodstream infections (BSI) are common in patients with major burns, but its effect on mortality remains controversial. This study was aimed to investigate if BSI is significant risk factor of mortality? This is a retrospective chart review study included 266 adult patients admitted to our burn center from 2000 to 2019. Age, sex, inhalation injuries, total burn surface area (TBSA), duration of stay in intensive care unit, BSI and mortality were variables studied. Fisher exact test, Mann-Whitney test and logistic regression was used for statistical analysis. There were 234 survivors and 32 non-survivors. Male was predominant. The overall incidence of BSI was 18.8%, and the overall crude mortality was 12%. Burns ≥30% TBSA and BSI were significant risk factors. A predictive function based on30% TBSA and BSI within 14 days after the onset of burns (BSI-14) was derived. The function has a sensitivity of 0.97, specificity of 0.42 and achieved a maximum Youden Index at functional value ≥0.05727. The mortality probability of BSI-14 in burns ≥30% TBSA was 40.8%. BSI and burns ≥30% TBSA were significant risk factors of mortality. Early detection of BSI-14 is critical in burn care as its probability of mortality can be as high as 40% in patients ≥30% TBSA of burns. To reduce the risk of mortality, early in ventilator withdrawal, invasive lines and tubes removal, and early grafting should be emphasized besides infection control and appropriate use of antibiotics.

Does Vancomycin Resistance Increase Mortality? Clinical Outcomes and Predictive Factors for Mortality in Patients with Enterococcus faecium Infections.

The prevalence of enterococcal infection, especially E. faecium, is increasing, and the issue of the impact of vancomycin resistance on clinical outcomes is controversial. This study aimed to investigate the clinical outcomes of infection caused by E. faecium and determine the risk factors associated with mortality. This retrospective study was performed at the Phramongkutklao Hospital during the period from 2014 to 2018. One hundred and forty-five patients with E. faecium infections were enrolled. The 30-day and 90-day mortality rates of patients infected with vancomycin resistant (VR)-E. faecium vs. vancomycin susceptible (VS)-E. faecium were 57.7% vs. 38.7% and 69.2% vs. 47.1%, respectively. The median length of hospitalization was significantly longer in patients with VR-E. faecium infection. In logistic regression analysis, VR-E. faecium, Sequential Organ Failure Assessment (SOFA) scores, and bone and joint infections were significant risk factors associated with both 30-day and 90-day mortality. Moreover, Cox proportional hazards model showed that VR-E. faecium infection (HR 1.91; 95%CI 1.09–3.37), SOFA scores of 6–9 points (HR 2.69; 95%CI 1.15–6.29), SOFA scores ≥ 10 points (HR 3.71; 95%CI 1.70–8.13), and bone and joint infections (HR 0.08; 95%CI 0.01–0.62) were significant risk factors for mortality. In conclusion, the present study confirmed the impact of VR-E. faecium infection on mortality and hospitalization duration. Thus, the appropriate antibiotic regimen for VR-E. faecium infection, especially for severely ill patients, is an effective strategy for improving treatment outcomes.