Mortality Status Research Articles

Factors Associated with Increased Fluoroscopy Time During Elective Endovascular Abdominal Aortic Aneurysm Repair and its Utilization as an Indicator of Intraoperative and Postoperative Outcomes

ObjectivesThis study explores the impact of prolonged fluoroscopy time (FT) on outcomes in endovascular aortic repair (EVAR) for abdominal aortic aneurysms (AAA). While total operative time includes multiple variables, FT precisely captures the technical precision of the EVAR procedure. By examining the factors that extend FT, we aim to establish FT as a critical quality metric for evaluating surgical performance and predicting postoperative outcomes. MethodsA retrospective review of the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) was conducted (2003-2021). The FT was studied based on a median dichotomy of ≤18 mins (Group I) and >18 mins (Group II). Primary outcomes of in-hospital mortality and discharge status were studied, along with numerous secondary outcomes pertaining to systemic complications. Factors associated with more extended FT were also measured. All the variables examined in multivariate analyses were estimated in odds ratios, and a p-value of <0.05 was deemed significant for all the analyses performed. Results41,841 patients were studied, of which 20,339 were categorized in Group I and 21,502 in Group II. The average fluoroscopy time in the selected patients was reported to be 23.2 minutes. Patients in Group II generally had overall poorer health status with multiple comorbidities and on various medications. Aortic aneurysm parameters can influence the FT, including the greater aorta-neck angle, neck angle, neck diameter, and neck length. Patients treated by high-volume surgeons were observed to have less likelihood of prolonged FT. On trends analysis, it was observed that the FT has been consistent over the study period. ConclusionVarious factors can influence the FT in patients undergoing EVAR, including the patient characteristics and the complexity of the aneurysm. Identifying the risk factors associated with prolonged FT can help prepare the surgeons and devise ways to ensure a high quality of care, better risk stratification, and enhanced safety, especially for more prolonged exposure to radiation and contrast volumes.

Immune reconstitution with high-dose chemotherapy and autologous stem cell transplantation in refractory and relapsed Hodgkin lymphoma: Prognostic factors and outcome from a single-center experience.

Autologous stem cell transplantation (ASCT) imposes significant immunogenic effects that may also underlie some of its anti-tumor effectiveness. Despite improvements in disease risk stratification and treatment approaches with high cure and response rate for newly diagnosed Hodgkin lymphoma (HL) with initial therapy in most patients, a significant proportion will be experiencing refractory or relapsed (R/R) following the initial front-line therapy. A high-dose chemotherapy followed by ASCT remains the standard treatment for relapsed Hodgkin disease in adult patients. The aim of our study was to identify the impact of ASCT on outcomes in R/R HL, considering various pre- and post-ASCT parameters as prognostic predictors, including disease status response, time of absolute neutrophils, and lymphocyte recovery counts post ASCT. We retrospectively investigated data of 118 patients with R/RHL from January 2014 to December 2022, whose ages ranged from 7 to 58 years old. The recorded data included: the early response type and mortality rate, at day 100 post-ASCT, as well as the end of the study outcomes such as survival, relapse, and mortality status. Patients were grouped according to gender, disease status pre-ASCT, number of chemotherapy protocols that were given pre-ASCT, time of absolute neutrophils and lymphocyte recovery counts post-ASCT. The mean age of our included patients was 25.1 (7-58) years. The male to female ratio was1.2:1with a mean duration of disease follow-up was 74.2 months. The mean duration time of absolute neutrophil and lymphocyte recovery count post-ASCT day was 11 ± 2.9 and 13 ± 2.6 days respectively. The outcome at 100 days post-ASCT was: 89.8 % of the patients showed complete remission, 6.8 % showed no response, and 3.4 % deceased. The three-year overall survival (OS) rate was 88.5 %, while the event free survival (EFS) rate was 72 %. Regarding the three-year EFS rate for patient with complete remission was 91 %, for patients with uncertain complete response was 71 %, also 71 % for partial remission and 45 % for stable disease. The EFS rate in relation to the number of chemotherapy protocols at three-year follow up was 80 % and 66 % for patients with ≥2 chemotherapy lines(P = 0.03). Autologous stem cell transplantation for R/R HL patients demonstrated a significant favorable outcome in terms of the overall survival rate and the progression-free disease, especially among those who exhibited earlier response to salvage chemotherapy at the pre-transplantation stage and unrelated to time of absolute neutrophil and lymphocyte recovery count.

P-729. Prognostic Value of the Immunodeficiency Scoring Index for Respiratory Viral Infections in Hematopoietic Cell Transplant Recipients

Abstract Background Accurate prediction of the severity of respiratory viral infections (RVIs) may help in improving patients’ outcomes. The respiratory syncytial virus (RSV) immunodeficiency scoring index (ISI), which incorporates patients’ host factors, was predictive of progression to lower respiratory tract infection (LRI) or mortality in HCT recipients with RSV infections. Our study goal was to correlate the ISI with severe respiratory infection and 30-day mortality in HCT recipients infected with different respiratory viruses and with non-viral respiratory infections.Table 1:Baseline characteristics and clinical outcomes following respiratory infection.Abbreviations: BiPAP= bilevel positive airway pressure, BMI= Body mass index, CKD= chronic kidney disease, COPD= chronic obstructive pulmonary disease, CPAP= continuous positive airway pressure, ESRD= end-stage renal disease, GVHD= graft-versus-host disease, HCT= hematopoietic stem cell transplantation, HFNC= high-flow nasal cannula, ISI= immunodeficiency scoring index, IQR= interquartile range, LRI= lower respiratory tract infection, MRD= matched related donor, MUD= matched unrelated donor, RVI= respiratory virus infection, SD=standard deviation, URI= upper respiratory tract infection. Methods In this prospective study, we enrolled 50 patients who had undergone allogeneic or autologous HCT and were infected with RSV (n=10), influenza (n=10), parainfluenza (n=10), SARS-CoV-2 (n=10) or had a non-viral respiratory infection (n=10). We calculated the ISI at enrollment and followed the patients for 4 weeks. Primary outcomes of interest were progression to LRI, the severity of RVI (the use of a high-flow nasal cannula, BiPAP, CPAP, or mechanical ventilation), and 30-day all-cause mortality.Figure 1:Median immunodeficiency scoring index at presentation and severity of respiratory infection (n=50).*Mild-moderate infection is defined as the maximal O2 requirement of a nasal cannula or face mask, and severe infection as the need for high flow nasal cannula, BiPAP, CPAP, or mechanical ventilation. Abbreviations: BiPAP= bilevel positive airway pressure, CPAP= continuous positive airway pressure, ISI= immunodeficiency scoring index, PIV= parainfluenza virus, RSV= respiratory syncytial virus, RVI= respiratory virus infection. Results Among the 50 enrolled patients, the majority (78%) had undergone allogeneic HCT, while 22% had autologous HCT. Upon presentation, 44% were diagnosed with upper respiratory tract infection (URI), and 56% with LRI. Over the 30-day follow-up period, three patients with URI (14%) progressed to LRI, and four patients (8%) experienced severe infections leading to mortality (Table 1). For any viral pathogen, we observed higher ISI in patients with severe infections; in the non-viral respiratory infection group, relatively high ISI was noted at presentation but with no cases of severe infections (Figure 1). A higher ISI in HCT recipients with RVI was associated with 30-day mortality risk (median of 7 [IQR 5-8] vs. 3 [IQR 2-4], p=0.003) and severe infection (median of 7 [IQR 5-8] vs. 3 [IQR 2-4], p=0.003) (Figures 2, 3).Figure 2:Median immunodeficiency scoring index at presentation according to 30-day mortality status (among patients with RVI, n=40).Abbreviations: ISI= immunodeficiency scoring index, RVI= respiratory virus infection. Conclusion The ISI was associated with severe respiratory infections and 30-day mortality in a cohort of HCT recipients with different RVIs. The ISI can potentially be used to predict poor clinical outcomes in HCT recipients infected with any RVI and allow for early management of high-risk patients.Figure 3:Median immunodeficiency scoring index at presentation according to 30-day maximal oxygen requirements (among patients with RVI, n=40).Abbreviations: BiPAP= bilevel positive airway pressure, CPAP= continuous positive airway pressure, HFNC= high flow nasal cannula, ISI= immunodeficiency scoring index, RVI= respiratory virus infection. Disclosures Fareed Khawaja, MBBS, Eurofins Viracor: Grant/Research Support|Symbio: Grant/Research Support Roy F. Chemaly, MD/MPH, AiCuris: Advisor/Consultant|AiCuris: Grant/Research Support|Ansun Pharmaceuticals: Advisor/Consultant|Ansun Pharmaceuticals: Grant/Research Support|Astellas: Advisor/Consultant|Eurofins-Viracor: Grant/Research Support|InflaRX: Advisor/Consultant|Janssen: Advisor/Consultant|Karius: Advisor/Consultant|Karius: Grant/Research Support|Merck/MSD: Advisor/Consultant|Merck/MSD: Grant/Research Support|Moderna: Advisor/Consultant|Oxford Immunotec: Advisor/Consultant|Oxford Immunotec: Grant/Research Support|Roche/Genentech: Advisor/Consultant|Roche/Genentech: Grant/Research Support|Shinogi: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: Grant/Research Support|Tether: Advisor/Consultant

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

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

Effects of osteosynthesis of the bony thorax in the context of polytrauma compared to conservative treatment: a systematic review

PurposeOsteosynthesis seems to have effects regarding clinical outcomes in trauma patients. However, current knowledge on chest wall osteosynthesis in polytrauma patients is insufficient, leaving its potential unanswered. Therefore, the objective of this systematic review is to assess the safety and effects of chest wall osteosynthesis compared to conservative treatment on clinical outcomes in adult polytrauma patients.MethodsWe searched PubMed to identify completed and ongoing studies from inception of each database to May, 2022. We included systematic reviews including RCTs comparing chest wall osteosynthesis to conservative treatment in adult polytrauma patients.ResultsWe included one RCT with 50 patients (nosteosyntheses = 25, ncontrol = 25, median age 37.4 years, 82% male). We found that surgical rib fixation makes little or no difference to in-hospital mortality compared to conservative treatment (RR 2.00, 95% CI 0.40 to 9.95; RD 80 more per 1,000, 95% CI 48 fewer to 716 more; 1 study, 50 participants, low quality of evidence). We found that surgical rib fixation makes little or no difference to the need for mechanical ventilation compared to conservative treatment (RR 0.90, 95% CI -0.66 to 1.23; RD 80 fewer per 1,000, 95% CI 272 fewer to 184 more; 1 study, 50 participants, low certainty of evidence).ConclusionThere is limited evidence regarding chest wall osteosynthesis compared to conservative treatment in polytrauma patients. One RCT shows no effect of surgical rib fixation compared to conservative treatment regarding mortality and clinical status, but a potential benefit regarding ICU length of stay.

Association between depression and the prevalence and prognosis of prediabetes: Data from National Health and Nutrition Examination Survey (NHANES) 2013-2018.

Diagnosis and intervention of prediabetes is an emerging approach to preventing the progression and complications of diabetes. Inflammatory factors and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis have been suggested as potential mechanisms underlying the pathogenesis of both diabetes and depression. However, the relationship between depression levels and the prevalence of prediabetes and its prognosis remains elusive. This study aimed to explore the relationship between depression and the prevalence of prediabetes and to further explore the all-cause mortality of different levels of depression in patients with prediabetes. Our study used a data set from the National Health and Nutrition Examination Survey (NHANES). Participants were initially divided into two groups (depression vs. non-depression) and further stratified by different depression severity levels. We used a weighted multiple logistic regression model to analyze the association between depression and prediabetes prevalence and a Cox regression model to assess all-cause mortality in prediabetic patients. A total of 4384 participants were included, divided into depression group (n = 1379) and non-depression group (n = 3005). Results showed that people with depression were at higher risk of developing prediabetes. After adjusting for covariates, moderate to severe depression was positively associated with prediabetes (moderate to severe depression vs no depression: OR = 1.834, 95%CI: 0.713-4.721; severe depression vs no depression: OR = 1.004, 95% CI 0.429-2.351). In addition, we explored the relationship between all-cause mortality and depressive status in patients diagnosed with prediabetes (n = 2240) and found that moderate to severe depression (HR = 2.109, 95%CI 0.952-4.670) was associated with higher mortality in patients with prediabetes. Overall, the findings consistently suggest that depression is positively associated with both the prevalence and mortality risk among individuals with prediabetes. This suggests that depression may be a new and valuable indicator of prediabetes risk. Early treatment of depression improves outcomes in prediabetes.

An assessment of long-term complications following prehospital intraosseous access: A nationwide study

BackgroundThe guidelines for Advanced Life Support issued by the European Resuscitation Council recommend considering drug delivery through intraosseous access if intravenous access to the vascular bed is not feasible or unsuccessful. Emergency prehospital intraosseous cannulation may theoretically lead to an increased risk of long-term complications such as osteomyelitis, osteonecrosis, or compartment syndrome. Such complications have previously been reported in case reports or small sample case series. We systematically investigated long-term complications potentially associated with intraosseous cannulation using validated Danish health registries. MethodsData sources were the nationwide electronic Prehospital Patient Record system, the Danish National Patient Registry, and the Danish Civil Personal Registry. We investigated all patients who were subjected to prehospital intraosseous cannulation in Denmark from January 2016 through December 2019. During a follow-up period of 180 days from the index date we extracted information concerning mortality status and potential long-term complications defined as osteomyelitis, osteonecrosis, or compartment syndrome from the day of prehospital intraosseous cannulation. ResultsOf the 5,387 patients receiving intraosseous access, 375 were unidentified and lost to follow-up. Of the 5012 remaining patients, 4,775 were adults, and 237 were children. No children and “less than five” adults had long-term complications. No osteonecrosis, osteomyelitis or compartment syndrome appeared later than 175 days after an intraosseous cannulation. ConclusionsLong-term complications such as osteomyelitis, osteonecrosis, or compartment syndrome following prehospital intraosseous cannulation and drug delivery occurred in less than 0.1% of the cases. Our findings indicate that prehospital intraosseous cannulation may be safe across age groups.

Comparative Analysis of COVID-19 Severity and Mortality Among Vaccinated and Unvaccinated Individuals During the Delta Variant Surge in a Tertiary Care Center: A Cohort Study.

On March 11, 2020, the World Health Organization declared Coronavirus disease 2019 (COVID-19) as a pandemic. The spread of the Delta variant of coronavirus started in June 2021 and accounted for the fifth peak of COVID-19 in Iran in July 2021. According to reports from other countries, vaccination protects against severe diseases caused by COVID-19, including the Delta variant. Studies have also shown that vaccination provides strong protection against SARS-CoV-2 infection, COVID-19-related hospitalization, and mortality. This retrospective cohort study was designed based on the medical care monitoring center database of Sayyad Shirazi Hospital. COVID-19 confirmed patients' data were extracted for this study from June 22, 2021, to September 22, 2021 including demographic characteristics, signs and symptoms, ICU admission, need for aggressive oxygen therapy, including intubation, mortality, and vaccination status. A total of 2962 patients were enrolled. Being vaccinated was associated with a 4.14-fold increase in survival (adjusted OR = 4.14; 95% CI: 2.22-7.69; p < 0.01), and individuals in a younger age group demonstrated a 5.58-fold higher likelihood of surviving (adjusted OR = 5.58; 95% CI: 4.25-8.14; p < 0.01). The risk of severe COVID-19 was significantly lower in vaccinated individuals, showing a 3.12-fold decrease in risk (adjusted OR = 3.12; 95% CI: 2.06-4.72; p < 0.01), and in younger age groups, the risk exhibited a 3.28-fold decrease (adjusted OR = 3.28; 95% CI: 2.66-4.04; p < 0.01). The present results suggest that receiving at least one dose of COVID-19 vaccine had a significant relationship with decreased COVID-19 severity and mortality in vaccinated patients compared to unvaccinated patients.

CALLY index, but not HALP score, is associated with mortality in cirrhosis patients

Abstract Background Cirrhosis is a chronic liver disease that is characterized by inflammation and fibrosis, as well as liver dysfunction. The CALLY index and HALP score have recently provided crucial data in the diagnosis, follow-up, and prognosis of numerous diseases, particularly those of a malignant nature and those affecting the gastrointestinal system. The objective of this study was to ascertain whether the CALLY index and HALP score are appropriate indicators of mortality in patients with cirrhosis. Methods This study was conducted retrospectively in patients with liver cirrhosis between 01.01.2022-01.10.2024. The HALP and CALLY scores were calculated from the blood samples taken from the patients at the time of admission. The in-hospital mortality status of the patients was recorded. The effects of the parameters on mortality were compared. Results The study cohort comprised 235 participants, of whom 23 died. The median CALLY value was found to be 0.44 in patients who died and 1.19 in surviving patients. A significant decrease in the CALLY score was observed in patients who died (p=0.019). However, the HALP score did not show a significant difference in mortality between the two groups (p=0.262). Conclusions Based on the results of our study, CALLY index is an easily applicable index that can be used as an indicator of mortality in cirrhosis patients, but the HALP score is not a suitable marker for this purpose.

Association between emergency medical services' response times, low socioeconomic status, and poorer outcomes in out-of-hospital cardiac arrest: the MEDIC multicenter retrospective cohort study for disparities in access to prehospital critical care in the Paris metropolitan area.

Prolonged emergency medical services' response times (EMS-RT) are associated with poorer outcomes in out-of-hospital cardiac arrest (OHCA). The patient access time interval (PATI), from vehicle stop until contact with patient, may be increased in areas with low socioeconomic status (SES). The objective of this study is to identify predictors of prolonged EMS-RT intervals, and to evaluate associations with clinical outcomes in OHCAs occurring in the largest metropolitan area in France. Using the Utstein-style, prospectively implemented, population-based SDEC registry for OHCAs, we conducted a multicenter, region-wide, retrospective cohort study of EMS dispatches for OHCA cases occurring in the 124 cities of the Greater Paris area, France, between January 1, 2017 and December 31, 2018. Adult, nontraumatic, EMS-assessed, non-EMS witnessed OHCAs. Geographic location and scene-level SES. The primary outcome was the EMS-RT interval, from activation until arrival at patient's side. As secondary outcomes, we evaluated patient access outcomes of: (1) dispatch-to-patient contact interval ('EMS-RT'); and (2) vehicle scene arrival-to-patient contact interval (PATI); and patient clinical outcomes of: (1) death; and (2) unfavorable neurological status, both at 30 days. Area-level SES was assessed at census tract level using the European Deprivation Index (EDI; continuous, and divided into quintiles, Q5 = most deprived). We fitted multilevel mixed-effects regression models to identify predictors of patient access outcomes, and their association with clinical outcomes. We included 4082 cases; the median EMS-RT was 10.85 min (interquartile range [8.87-13.15]), and 138 (3.4%) survived to hospital discharge. Independent predictors of increased EMS-RT and PATI were age >65, female sex, residential location, occurrence at elevated floors, arrest unwitnessed by a bystander, and low EDI (all P < 0.018). After multivariable analysis, an overall EMS-RT interval >8 min was associated with higher mortality and poorer neurological status at hospital discharge (both P < 0.001). In OHCA cases occurring in the Greater Paris metropolitan area, after adjustment for scene characteristics, EMS delays until patient contact were longer in neighborhoods of low SES, and were associated with poorer clinical outcomes.

Exploring Clinical Profiles, Patterns, and Outcomes of Heart Failure Patients in Selected Hospitals of Chennai: A Descriptive Study

Background: Cardiovascular disease is still the most common cause of death and disability in industrialized nations, and its prevalence is rising rapidly. Heart failure is associated with shorter life expectancy, increased frequency of hospitalization and poor quality of life (QoL) Methods: This study was conducted in selected hospitals, Chennai, India among 200 patients, who were selected by consecutive sampling technique. Ethical approval was obtained from Institutional Ethics Committee. The data was collected using Patients demographic variables proforma, Clinical variables proforma and selected patient outcomes proforma. Follow-up data for patient outcome included re-hospitalizations and mortality status of the patient. Results: Majority of the patients were aged ≥60 years (73.5%), males (67.5%), married (96%), and residing in urban areas (66.5%), non-vegetarians (70%). Regarding other variables, 41.5% of patients were overweight, and 37.5% had been unwell for more than 24 months. With regard to risk factors, in 84.5% of instances, cardiac reasons were the main precipitant with 70% having coronary artery disease and 77% having hypertension as a comorbid illness. The mortality rates at one month and two months were 3% and 9 % respectively. The readmission rate was the, 8.5% and 15.5 % in 1 month and 2 months. Conclusion: Heart failure is becoming more prevalent, especially in adults over 60, and is often linked to comorbidities such as obesity, diabetes, coronary artery disease and hypertension. Nurses play a vital role in managing heart failure by providing education, monitoring symptoms, coordinating care, and promoting lifestyle changes. Comprehensive nursing care improves quality of life, reduces hospitalizations, and enhances survival outcomes.

Hearing Loss Is Associated With Increased Mortality in a Cohort of Older Construction Trades Workers.

Hearing loss has been associated with increased mortality, and there is evidence that regular use of hearing aids reduces the mortality risk. However, these associations have not been sufficiently studied in worker populations at high risk for noise-induced hearing loss. Medical examination data for 19,379 workers employed in US Department of Energy (DOE) facilities were used. Speech-frequency pure-tone average hearing loss and hearing aid use were ascertained. Mortality status through 2021 was obtained from the National Death Index. Cox regression examined the association between hearing loss and mortality and the impact of hearing aid use. Eight thousand eighty-one workers (41.3%) had speech-frequency hearing loss and 2228 (15.3%) of these workers reported use of hearing aids. A total of 5398 deaths occurred over a median follow-up of 11.1 years. Hearing loss was an independent risk factor for higher mortality with an adjusted hazard ratio (HR) of 1.10 (95% CI = 1.03-1.17). The HR increased with hearing loss severity but the relationship was non-linear. Hearing aid users were at 30% reduced risk of mortality compared to those not using hearing aids (HR = 0.70, 95% CI = 0.63-0.77). Results are consistent with research linking hearing loss with increased mortality and the preventive impact of hearing aid use. These findings should inform workers' compensation programs in favor of: (1) better coverage of hearing loss for noise-exposed workers, and (2) inclusion of hearing aids in medical benefits. Reduction in noise exposures is a priority and workers with hearing loss should be encouraged to use hearing aids.

Pathological Q waves at presentation of anterior ST segment elevation myocardial infarction predict heart failure: a Southeast Asian perspective.

Pathological Q waves at presentation in ST segment elevation myocardial infarction (STEMI) have been associated with poorer clinical outcomes including heart failure. This observational study highlights the prognostic value of pathological Q waves at presentation in the Southeast Asian population. Multiethnic Asian patients presenting with STEMI and treated with primary coronary intervention were recruited from 2015 to 2019. The presenting ECG was reviewed for pathological Q waves and patients were divided into groups with and without Q waves. The confirmatory multivariate analyses concerning the presence of Q wave, occurrence of heart failure, time to heart failure at 1 year, and the mortality status were performed with generalized structural equation model. A total of 1385 patients were included. Patients with pathological Q waves were more likely to suffer from anterior myocardial infarction (55.6 vs. 43.6%) and classified as Killip class >2 (13.5 vs. 8.0%). Among them, fewer reported ST segment resolution >50% (66.5 vs. 79.7%). They reported significantly lower LVEF (45.5 vs. 51.1%), longer symptom onset to ECG (168 vs. 111 min), and longer symptom-onset-to-balloon time (228 vs. 176 min). In addition, patients with Q waves were likely to stay longer in hospital (6.4 vs. 6.1 days) and faced a higher risk of heart failure (5.2 vs. 2.5%) in a year. We highlight the important morbidity associated with Q waves at presentation and found not only that heart failure occurrence was higher in the Q wave group, but there was also an acceleration of and shorter onset to heart failure.

Prognostic accuracy of blood cell count ratios in predicting adverse outcomes in crush syndrome patients

The rationale behind this study was the lack of an accurate predictor to facilitate treatment management and anticipate prognosis in crush syndrome. Our research aimed to investigate the following: (1) Is there a correlation between the ratios of blood cell counts upon admission and the adverse outcomes of crush syndrome? and (2) if such a correlation exists, what are the precise thresholds of blood cell count ratios for predicting these adverse outcomes? In this single-centered and retrospective design study, we analyzed all patients admitted to our hospital after Kahramanmaras Earthquake. The data on length of stay in the ICU and mortality status were obtained using our hospital system. Ratios of blood cell count were calculated and recorded at the time of admission. The NLR values in admission were significantly higher in patients with amputation, patients who received intensive care unit (ICU), and patients who died. (p < 0.001, p < 0.001 and p = 0.001, respectively). The MLR values were significantly increased in patients who underwent amputation and patients who received ICU (p < 0.001 and p = 0.003, respectively). NAR values in admission were significantly higher in patients with amputation, patients who received intensive care unit (ICU), and patients who died (p < 0.001, p < 0.001, and p = 0.002, respectively). In addition, according to binary logistic regression analysis, with a CLR value of > 109.844, the risk of amputation increases 8.188 fold; with a CLR value of > 64.518, the possibility of ICU admission requirement increases 10.117 fold, and with a CLR value of > 116.00, the risk of death increases 5.519 fold. Ratios of blood cell count such as NLR, MLR, NAR, and CLR offer a reasonable prognostic accuracy in predicting adverse outcomes and mortality in patients with crush syndrome. Therefore, for better disaster management in the future, the determination of these values at admission should be used as an adjunct tool for predicting prognosis in patients with crush syndrome.

Independent Association of Individual Lipid Abnormalities with Cardiovascular All-cause Mortality: A Prospective Cohort Study.

Abnormalities in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) are each associated with increased cardiovascular risk, after adjusting for non-lipid risk factors. However, whether and to what extent the association for each lipid measure is confounded by other lipid measures is less understood. This study aims to investigate the association of each lipid measure with cardiovascular and all-cause mortality while precluding the confounding caused by abnormalities in other lipid measures. The study utilized data from the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and ten cycles of continuous NHANES (1999-2018). The study cohort included 23,761 participants who were 20 years or older, not pregnant, not receiving lipid-lowering treatment, and had complete data on all four lipid measures and mortality status. Participants were categorized into seven subgroups based on their lipid profiles. Kaplan-Meier survival curves and Cox proportional hazards models were used to examine the association between lipid abnormalities and mortality. During a median follow-up of 140 months, 5,003 participants (14.1%) died, with 1,665 deaths (4.2%) attributable to cardiovascular causes. Compared with the reference group in which the four lipid measures were all normal, the subgroups with isolated high TC, two to three lipid abnormalities, and four lipid abnormalities were associated with increased risks for both cardiovascular and all-cause mortality in univariate analysis. However, only those with isolated high TC (for cardiovascular mortality, HR 1.52, 95% CI 1.13-2.06) and four lipid abnormalities (for all-cause mortality, HR 1.34, 95% CI 1.04-1.72) remained statistically significant after adjusting for non-lipid risk factors. Of note, compared with the reference group, the profile of non-lipid risk factors was apparently less favorable in the subgroup with two to three lipid abnormalities but similar (and some factors even more favorable) in the subgroup with isolated high TC. When the lipid measures were analyzed as continuous variables, a U-shaped relationship between HDL-C and mortality risk was observed for both cardiovascular and all-cause mortality, and very low LDL-C level was associated with increased mortality risk. No statistically significant association was found between TG levels and mortality risk. Isolated high TC, very low LDL-C, and concurrent abnormalities in all four lipid measures were associated with increased mortality risk, whereas isolated high TG was not. A U-shaped relationship may exist between HDL-C level and mortality. Overall, these findings underscore the need for integrated management of dyslipidemia that takes all four lipid measures as well as non-lipid cardiovascular risk factors into account, particularly for those with concurrent abnormalities in two or more lipid measures.

Survival status and predictors of mortality in extreme preterm babies: A decade of experience at a tertiary care centre in Sri Lanka

Survival status and predictors of mortality in extreme preterm babies: A decade of experience at a tertiary care centre in Sri Lanka

Impact of Anemia and Acquired Anemia on in-Hospital Mortality of Acute Coronary Syndrome Patients.

To investigate the associations of anemia-related parameters, with in-hospital mortality after acute coronary syndrome (ACS), as well as factors associated with prior anemia (PA) and hospital-acquired anemia (HAA) in patients with ACS. This was a retrospective cohort study conducted between June 2021 and May 2023. The data of patients diagnosed with ACS who were hospitalized and treated in our hospital were recorded, including age and sex, smoking and comorbidity status, laboratory findings, CHA2DS2-VASc scores, prior medication use, left ventricular ejection fraction, ACS type, the synergy between percutaneous intervention with taxus drug-eluting stents and cardiac surgery (SYNTAX) scores, stent thrombosis status and mortality status. Mortality was assessed according to in-hospital death. Patients were grouped based on anemia presence (PA and HAA). A total of 329 patients were included in the study. Of these, 219 (66.56%) were in the no anemia group, 58 (17.63%) in the PA group, and 52 (15.81%) in the HAA group. The mean age of all participants was 61.27±12.45 years and 76.29% of them were male. 14 (4.26%) patients died during hospitalization. Multivariable logistic regression analysis had revealed that, prior coronary artery disease (OR: 3.779, 95% CI: 1.141-12.508, p=0.030), PA (OR: 7.043, 95% CI: 1.574-31.517, p = 0.011), HAA (OR: 5.857, 95% CI: 1.260-27.236, p=0.024) and high WBC (OR: 1.190, 95% CI: 1.028-1.378, p=0.020) were independently associated with the increased risk of in-hospital mortality. Consequently, the risk of in-hospital mortality is higher in patients with a previous history of coronary artery disease, PA, HAA and high WBC, and additional precautions should be taken in these patients.

Trends and disparities in age, sex, ethnoracial background, and urbanization status in adult mortality due to thoracic aortic aneurysm: a retrospective nationwide study in the United States.

Thoracic aortic aneurysms (TAA) are a significant health concern, with the true prevalence likely underestimated due to undiagnosed cases. Outcomes in TAA are influenced by factors like age, sex, and comorbidities such as hypertension. This study examines mortality trends and disparities associated with TAA in US adults. This study analyzed death certificates from 1999 to 2020 using the CDC WONDER Database to identify TAA-related deaths in individuals aged 25 and older using ICD-10 codes I71.1 and I71.2. Age-adjusted mortality rates (AAMRs) per 1000000 and annual percent changes (APCs) were calculated and stratified by year, sex, age group, race/ethnicity, region, and urbanization status. Between 1999 and 2020, 47136 TAA-related deaths were reported among US adults. The AAMR decreased from 16.2 to 8.2 per 1000000, with a significant decline from 1999 to 2013 (APC: -5.00; 95% CI: -5.54 to -4.54; P<0.001). Older adults had the highest AAMRs at 44.6 per 1000000. Men had higher AAMRs than women (11.2 vs. 9). AAMRs were highest among non-Hispanic (NH) Black (11), followed by NH White (10.3), NH Asian or Pacific Islander (9.5), NH American Indian or Alaska Native (7.8), and Hispanic (5.2) populations. Nonmetropolitan areas had higher AAMRs than metropolitan areas (11 vs. 9.8). The analysis showed a significant decline in TAA mortality since 1999, with recent stabilization. However, disparities persist, with higher AAMRs among men, older adults, NH Black adults, and nonmetropolitan residents, highlighting the need for targeted and equitable interventions.

Abdominal Obesity: A Lethal Factor in Elderly Male Osteoporosis Patients—Insights from NHANES

Background and AimThis study aims to investigate the relationship between A Body Shape Index (ABSI) Z-score and all-cause mortality among osteoporotic patients using data from the National Health and Nutrition Examination Survey (NHANES). Methods and ResultsWe analyzed NHANES data from 2005 to 2010, 2013 to 2014, and 2017 to 2018, focusing on individuals aged 50 and above with complete bone mineral density (BMD) data. The ABSI Z-score, calculated by adjusting waist circumference (WC) for height and weight, was used to independently assess abdominal fat beyond Body Mass Index (BMI). Mortality status was confirmed by linking NHANES data with the National Death Index (NDI), with follow-up until December 31, 2019. Weighted Cox proportional hazards models were employed for analysis, adjusting for age, gender, race, fracture history, anti-osteoporosis treatment history, diabetes, and cardiovascular disease (CVD). The study included 1,596 participants. Higher ABSI Z-scores were significantly associated with increased all-cause mortality risk, especially among elderly male osteoporotic patients. This association remained robust after adjusting for multiple potential confounders. ConclusionThe ABSI Z-score serves as a valuable non-invasive screening tool that effectively identifies osteoporotic patients at higher risk of mortality. These findings emphasize the importance of body management in health, supporting further research to explore the practical utility of ABSI Z-score in osteoporotic patients and how body management can enhance long-term survival rates.

High immunity and low mortality after Omicron and mass event in Cameroon despite low vaccination.

Little is known about the evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunity in African communities. We evaluated changes in anti-SARS-CoV-2 antibodies, mortality and vaccination status in Cameroon between August 2021 and September 2022 to begin describing the evolution of the pandemic in Africa. The study was conducted across Cameroon's 10 regional capitals, between 2021 and 2022 as the country hosted a mass gathering. We conducted a cross-sectional population-based survey in 2022, including SARS-CoV-2 seroprevalence testing and retrospective mortality estimation using two-stage cluster sampling. We estimated and compared seroprevalence and crude mortality rates (CMR) to a survey conducted in 2021 using the same methodology. We performed serologic testing on 8400 individuals and collected mortality data from 22 314 individuals. Approximately 5% in each survey reported SARS-CoV-2-vaccination. Rapid diagnostic test-based seroprevalence increased from 11.2% (95% confidence interval [CI]: 10-12.5) to 59.8% (95% CI: 58.3-61.2) between 2021 and 2022, despite no increase in the proportion vaccinated. The CMR decreased from 0.17 to 0.06 deaths per 10 000 persons per day between 2021 and 2022. In 2022, no deaths were reportedly attributable to COVID-19 as compared to 17 deaths in 2021. Over a 12-month period encompassing two waves of omicron variant SARS-CoV-2 and a mass gathering, SARS-CoV-2 seropositivity in Cameroon approached 60%, and deaths declined despite low vaccination coverage. This study challenges the assumption that high immunisation coverage is the sole determinant of epidemic control in the African context and encourages policymakers to increasingly rely on local research when designing response strategies for more effective outbreak management.