Value For In-hospital Mortality Research Articles

Biomarkers of cardiohepatic syndrome in the cardiac intensive care unit

Abstract Introduction Non-cardiovascular end-organ dysfunction is an important determinant of outcomes in cardiac intensive care unit (CICU) patients. We examined the association between in-hospital mortality with the severity and extent of admission liver function test (LFT) abnormalities in a heterogeneous CICU population. Purpose We hypothesized that a greater severity or extent of LFT abnormalities would be associated with higher in-hospital mortality. Methods We included consecutive unique adult CICU patients with available data for one or more of the admission LFT values of interest. Admission laboratory values were defined as those closest to CICU admission. We used the NIH Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 to categorize the severity of each LFT abnormality from Grade 0 (normal) to Grade 4 (life-threatening). We defined the extent of LFT abnormality as the number of individual LFTs meeting criteria for CTCAE Grade 1 or greater. The primary outcome of interest was all-cause in-hospital mortality. Odds ratio (OR) and 95% confidence interval (CI) values for in-hospital mortality were estimated using logistic regression, before and after multivariable adjustment. Results Of 12,428 unique CICU patients, 5,144 were excluded due to a lack of available data for any admission LFT values. The remaining 7,284 patients comprised the final study population. Among patients with available data for each individual LFT, abnormal values were present in: AST, 2,743/5,733 (47.8%); ALT 1,576/5,512 (28.6%); ALK 611/3,684 (16.6%); and TB 898/5,155 (17.4%). A total of 864 (11.9%) patients died during hospitalization. In-hospital mortality was higher for patients with one or more LFTs meeting criteria for CTCAE Grade 1 or greater (17.9% vs. 6.4%, adjusted OR 1.54 [1.27-1.86], p <0.001). A stepwise increase in in-hospital mortality was observed with increasing CTCAE grade, both overall (adjusted OR 1.25 per each higher CTCAE grade [1.16-1.34], p <0.001); (Figure 1A), and for each individual LFT (Figure 1B). Conclusion Cardiohepatic syndrome is an important predictor of prognosis in CICU patients, as the extent and severity of LFT abnormalities are strongly associated with in-hospital mortality. This is the first large-scale study to examine the association between the magnitude of hepatic biomarker derangement with in-hospital mortality in unselected CICU patients. Patients with markedly elevated LFT values exhibited the highest risk of in-hospital mortality. This analysis advocates for the inclusion of commonly obtained LFTs in future risk-prediction tools for enhanced prognostication.

The value of C-reactive protein velocity (CRPv) on mortality in sepsis patients who are emergently hospitalized in the ICU: A retrospective single-center study

PurposeThe C-reactive protein (CRP) velocity (CRPv) is an indicator of the change in CRP over time. In individuals with sepsis, the second values of CRP and CRPv have been shown to have more importance than the first CRP value measured at admission. This study examined the importance of CRPv for mortality among individuals who were hospitalized in the intensive care unit (ICU). MethodsThe study was conducted between January 2021 and December 2022. CRPv was calculated according to the change in the second CRP value compared to the first. ResultsThe median age of the patients was 79 years (interquartile range (IQR), 69–85 years), and 53.2 % were male. The in-hospital mortality rate was 45.5 %. The presence of diabetes increased the odds of mortality by 2.17 times (confidence interval (CI): 1.06–4.4, p=0.032). Each increase in CRPv by 1 mg/dl/hour increased the odds of mortality by 1.07 times (CI: 1.01–1.14, p=0.015), while each one-point increase in the Sequential Organ Failure Assessment (SOFA) score increased the odds of mortality by 1.21 times (CI: 1.07–1.35, p=0.002). The SOFA score had the highest area under the curve (AUC) value for in-hospital mortality (AUC = 0.699 p=<0.001). When the SOFA was >7, its sensitivity in predicting mortality was 46.7 %, and its specificity was 85.1 %. The AUC value of CRPv in predicting mortality was 0.629 (p=0.006). When CRPv was >0.75, its sensitivity in predicting mortality was 68.2 %, and its specificity was 57 %. ConclusionCRPv performed well in predicting mortality and had satisfactory discriminative ability. Additionally, diabetes, SOFA score, and CRPv elevation were significant risk factors for mortality.

Venous thromboembolism prophylaxis and mortality in patients with spinal fractures in ICUs.

Spinal fracture is a common traumatic condition in orthopaedics, accounting for 5%-6% of total body fractures, and is a high-risk factor for venous thromboembolism (VTE), which seriously affects patient prognosis. The aim of this study was to determine the impact of VTE prophylaxis on the prognosis of patients with spinal fractures in intensive care units (ICUs) and to provide a scientific basis for clinical treatment and nursing. A retrospective study of patients with spinal fractures from the multicenter eICU Collaborative Research Database. The outcomes of this study were ICU mortality and in-hospital mortality. Patients were divided into the VTE prophylaxis (VP) and no VTE prophylaxis (NVP) groups according to whether they had undergone VTE prophylaxis during their ICU admission. The association between groups and outcomes were analysed using Kaplan-Meier (KM) survival curve, log-rank test and the Cox proportional-hazards regression model. This study included 1146 patients with spinal fractures: 330 in the VP group and 816 in the NVP group. KM survival curves and log-rank tests revealed that both ICU and in-hospital survival probabilities in the VP group were significantly higher than in the NVP group. After the Cox model was adjusted for all covariates, the hazard ratio for ICU mortality in the VP group was 0.38 (0.19-0.75); the corresponding value for in-hospital mortality in the VP group was 0.38 (0.21-0.68). VTE prophylaxis is associated with reduced ICU and in-hospital mortality in patients with spinal fractures in ICUs. More research is necessary to further define specific strategies and optimal timing for VTE prophylaxis. This study provides the basis that VTE prophylaxis may be associated with improved prognosis in patients with spinal fractures in ICUs. In clinical practice, an appropriate modality should be selected for VTE prophylaxis in such patients.

Serum Bicarbonate: Reconsidering the Importance of a Neglected Biomarker in Predicting Clinical Outcomes in Sepsis.

BackgroundDespite being an important pathophysiological component, information on the predictive value of serum bicarbonate level in sepsis is limited.Study design and methodThis is a single-centered retrospective study involving 4176 patients admitted to the medical ICU (MICU) with a diagnosis of sepsis. Patients were divided into two groups based on the presence or absence of chronic kidney disease (CKD) on admission: CKD and non-CKD, respectively. Each group was then divided into three sub-groups based on serum bicarbonate level at presentation (in mEq/l)- low (<22), normal (22-28), and high (>28). We compared the clinical outcomes between the sub-groups in each group, with in-hospital mortality as the primary endpoint. Secondary endpoints included vasopressor-free days, ventilator-free days, ICU-free days, and hospital-free days.ResultIn both the CKD and non-CKD groups, low serum bicarbonate was associated with significantly increased in-hospital mortality. There was no difference in the mortality between the sub-groups with normal and high serum bicarbonate. When adjusted for other known predictors of mortality, the association of low serum bicarbonate with increased in-hospital mortality was statistically significant only in the patient group with a Sequential Organ Failure Assessment (SOFA) score of ≥9. Additionally, the SOFA score had a better predictive value for in-hospital mortality, ICU-free days, and ventilator-free days when the serum bicarbonate level was <22.InterpretationSerum bicarbonate is a good predictor of clinical outcomes in sepsis and can be used along with other markers of sepsis to predict clinical outcomes.

Abstract 12144: Prognostic Value of Preoperative Cardiac Troponin I and T in Patients With Acute Coronary Syndromes Undergoing Coronary Artery Bypass Grafting: A Current Report of the North-Rhine-Westphalia Surgical Myocardial Infarction Registry

Introduction: The extent of myocardial injury is a major determinant of morbidity and mortality in patients undergoing coronary artery bypass grafting (CABG) with acute coronary syndromes (ACS). More recently, cardiac biomarkers such as troponin I and T have been suggested as predictors for unfavorable outcome. We aimed to evaluate the predictive value of cardiac troponin (I and T) on a multicentric basis. Methods: We obtained multicentric data from a national surgical myocardial infarction registry with 2432 patients undergoing CABG with ACS between 01/2010 and 12/2018. Primary study endpoint was all-cause, in-hospital mortality (IHM) and postoperative major adverse cardiac and cerebrovascular events (MACCE). Multivariable logistic regression models and receiver-operating curve (ROC) analyses were applied to assess predictive value of preoperative cTnI and T for IHM and MACCE following CABG. Results: Patients were 68±11years of age, 78% male, 24.5% had unstable angina (UAP), 50.0% NSTEMI, and 25.4% STEMI, presenting a logEuroSCORE-I of 15.1±15.1% in UAP, 20.3±20.1% in NSTEMI and 23.5±20.0% in STEMI. Preoperative cTnI or T was obtained on admission and preoperatively with 5.4±19.5 and 3.6±10.0ng/mL for cTnI and 0.93±1.7 and 0.90±1.8ng/mL for cTnT. Preoperative cTnI and T was significantly increased between survivors and non-survivors (cTnI:4.2±11.9 vs. 22.4±59.5ng/mL, P &lt;0.05 and cTnT:0.9±1.7 vs. 1.3±1.9ng/mL; P &lt;0.05). STEMI patients demonstrated higher cardiac biomarker levels and worse IHM (12.6%) compared to NSTEMI (7.3%; P &lt;0.01) and UAP patients (4.2%; P &lt;0.01). Multivariable logistic regression analysis revealed cTnI but not cTnT to be a strong and independent predictor for IHM and MACCE ( P &lt;0.001). Preoperative cTnI and T &gt;2xURL showed a significant predictive value for IHM ( P &lt;0.003) and MACCE ( P &lt;0.001). In a ROC analysis, a cTnI value of 10.1ng/mL with an area under curve (AUC) of 0.65 ( P&lt; 0.01) was identified as an optimal cut-off value for IHM and 6.8ng/mL with an AUC of 0.65 ( P &lt;0.001) for MACCE. Conclusions: In this large-scaled national registry, we can confirm that preoperative cardiac troponin I but not T indicates important prognostic information of in-hospital mortality and MACCE rate in ACS patients undergoing CABG surgery.

Thiamine combined with vitamin C in sepsis or septic shock: a systematic review and meta-analysis.

Thiamine and vitamin C have been increasingly used in patients with sepsis or septic shock because of their potential for improving metabolism and reducing mortality. We aim to determine if thiamine combined vitamin C can reduce mortality in patients with sepsis or septic shock. We comprehensively searched the PubMed, Embase, Cochrane Library, and Web of Science databases from their inception dates through 1 January 2021. Literature works evaluating the efficacy of thiamine combined vitamin C in patients with sepsis or septic shock were considered. Two reviewers extracted data and assessed study quality. A meta-analysis was performed to calculate an odds ratio (OR), 95% confidence intervals (CIs), and P values for in-hospital mortality (primary outcome). Secondary outcomes included duration of ICU stay, duration of hospital stay, duration of vasopressor use, and change in sequential organ failure assessment (SOFA) scores. Seven randomized controlled trials were identified, encompassing a total of 868 patients. There was no statistical difference between groups for in-hospital mortality (OR: 1.11; 95% CI [0.79-1.56]; P = 0.55). Other than improving SOFA score during the first 72 h after enrollment and duration of vasopressor use, we found no other significant associations. Despite widespread enthusiasm for thiamine combined with vitamin C for sepsis and septic shock, we only found an association with reduced SOFA score and time of vasopressor use. There was no association with in-hospital mortality.

Assessment of the Modified CHA2DS2VASc Risk Score in Predicting Mortality in Patients Hospitalized With COVID-19

Since the modified CHA2DS2VASC (M-CHA2DS2VASc) risk score includes the prognostic risk factors for COVID-19; we assumed that it might predict in-hospital mortality and identify high-risk patients at an earlier stage compared with troponin increase and neutrophil-lymphocyte ratio (NLR). We aimed to investigate whether M-CHA2DS2VASC RS is an independent predictor of mortality in patients hospitalized with COVID-19 and to compare its discriminative ability with troponin increase and NLR in terms of predicting mortality. A total of 694 patients were retrospectively analyzed and divided into 3 groups according to M-CHA2DS2VASC RS which was simply created by changing gender criteria of the CHA2DS2VASC RS from female to male (Group 1, score 0-1 (n = 289); group 2, score 2-3 (n = 231) and group 3, score ≥4 (n = 174)). Adverse clinical events were defined as in-hospital mortality, admission to intensive care unit, need for high-flow oxygen and/or intubation. As the M-CHA2DS2VASC RS increased, adverse clinical outcomes were also significantly increased (Group 1, 3.8%; group 2, 12.6%; group 3, 20.8%; p <0.001 for in-hospital mortality). The multivariate logistic regression analysis showed that M-CHA2DS2VASC RS, troponin increase and neutrophil-lymphocyte ratio were independent predictors of in-hospital mortality (p = 0.005, odds ratio 1.29 per scale for M-CHA2DS2VASC RS). In receiver operating characteristic analysis, comparative discriminative ability of M-CHA2DS2VASC RS was superior to CHA2DS2VASC RS score. Area under the curve (AUC) values for in-hospital mortality was 0.70 and 0.64, respectively. (AUCM-CHA2DS2-VASc vs. AUCCHA2DS2-VASc z test = 3.56, p 0.0004) In conclusion, admission M-CHA2DS2VASc RS may be a useful tool to predict in-hospital mortality in patients with COVID-19.

Predictive risk score model for severe fever with thrombocytopenia syndrome mortality based on qSOFA and SIRS scoring system

BackgroundSevere fever with thrombocytopenia syndrome (SFTS) is a severe systemic virus infectious disease usually having multi-organ dysfunction which resembles sepsis.MethodsData of 321 patients with laboratory-confirmed SFTS from May 2013 to July 2017 were retrospectively analyzed. Demographic and clinical characteristics, calculated quick sequential organ failure assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria for survivors and nonsurvivors were compared. Independent risk factors associated with in-hospital mortality were obtained using multivariable logistic regression analysis. Risk score models containing different risk factors for mortality in stratified patients were established whose predictive values were evaluated using the area under ROC curve (AUC).ResultsOf 321 patients, 87 died (27.1%). Age (p < 0.001) and percentage numbers of patients with qSOFA≥2 and SIRS≥2 (p < 0.0001) were profoundly greater in nonsurvivors than in survivors. Age, qSOFA score, SIRS score and aspartate aminotransferase (AST) were independent risk factors for mortality for all patients. qSOFA score was the only common risk factor in all patients, those age ≥ 60 years and those enrolled in the intensive care unit (ICU). A risk score model containing all these risk factors (Model1) has high predictive value for in-hospital mortality in these three groups with AUCs (95% CI): 0.919 (0.883–0.946), 0.929 (0.862–0.944) and 0.815 (0.710–0.894), respectively. A model only including age and qSOFA also has high predictive value for mortality in these groups with AUCs (95% CI): 0.872 (0.830–0.906), 0.885(0.801–0.900) and 0.865 (0.767–0.932), respectively.ConclusionsRisk models containing qSOFA have high predictive validity for SFTS mortality.

New prehospital scoring system for traumatic brain injury to predict mortality and severe disability using motor Glasgow Coma Scale, hypotension, and hypoxia: a nationwide observational study.

ObjectiveAssessing the severity of injury and predicting outcomes are essential in traumatic brain injury (TBI). However, the respiratory rate and Glasgow Coma Scale (GCS) of the Revised Trauma Score (RTS) are difficult to use in the prehospital setting. This investigation aimed to develop a new prehospital trauma score for TBI (NTS-TBI) to predict mortality and disability.MethodsWe used a nationwide trauma database on severe trauma cases transported by fire departments across Korea in 2013 and 2015. NTS-TBI model 1 used systolic blood pressure <90 mmHg, peripheral capillary oxygen saturation <90% measured via pulse oximeter, and motor component of GCS. Model 2 comprised variables of model 1 and age >65 years. We assessed discriminative power via area under the curve (AUC) value for in-hospital mortality and disability defined according to the Glasgow Outcome Scale with scores of 2 or 3. We then compared AUC values of NTS-TBI with those of RTS.ResultsIn total, 3,642 patients were enrolled. AUC values of NTS-TBI models 1 and 2 for mortality were 0.833 (95% confidence interval [CI], 0.815 to 0.852) and 0.852 (95% CI, 0.835 to 0.869), respectively, while AUC values for disability were 0.772 (95% CI, 0.749 to 0.796) and 0.784 (95% CI, 0.761 to 0.807), respectively. AUC values of NTS-TBI model 2 for mortality and disability were higher than those of RTS (0.819 and 0.761, respectively) (P<0.01).ConclusionOur NTS-TBI model using systolic blood pressure, motor component of GCS, oxygen saturation, and age was feasible for prehospital care and showed outstanding discriminative power for mortality.

The effect of hypertension on the prognosis of acute aortic dissection

Objective To investigate the clinical characteristics and prognosis of patients with acute aortic dissection (AAD) and hypertension, and explore other related prognostic factors in AAD. Methods The present study enrolled consecutive patients diagnosed with AAD who were admitted to Peking University People's Hospital between January 2000 to December 2015. Patients diagnosed with AAD by CT angiography, aortography or magnetic resonance imaging within 14 days of onset were included. Patients with infectious diseases, haematological diseases, malignancies, autoimmune diseases and patients without clearly clinical diagnosis or incomplete data were excluded. The patients were initially divided into two groups based on their history of hypertension, and their clinical characteristics were compared and analyzed. We further divided AAD patients into survival group and death group according to their in-patient outcomes, and factors related to their prognoses were analyzed. Logistic regression analysis was applied to analyze the independent risk factors related to hospital death in AAD patients with P<0.05 as the significant value. Results The hypertensive group contained 237/346 cases included (68.45%), patients in this group were generally older than their non-hypertensive counterparts, accompanied by increased prevalence of comorbidities (coronary heart diseases or diabetes) and a statistical significant elevated admission blood pressures (systolic and diastolic, P 0.05). Hypertensive patients were less likely to receive surgical treatment compared with those without hypertension(P 0.05). Further logistic regression analysis revealed the presence of hypertension did not independently predict in-hospital mortality of AAD patients. Factors such as age, Stanford classification of the AAD, NLR and platelet counts were found to have independent predictive values for in-hospital mortality (P<0.05). Conclusion AAD patients with hypertension are generally older, have more comorbidities such as coronary heart diseases and diabetes. The presence of hypertension itself is not directly associated with in-hospital mortality in AAD patients, while the Stanford classification, age, NLR and platelet counts are independent risk predictors. Key words: Hypertension; Acute aortic dissection; Prognosis; Neutrophil to Lymphocyte ratio; Platelet counts

Development and validation of prediction models for the risks of diabetes-related hospitalization and in-hospital mortality in patients with type 2 diabetes

ObjectivesDiabetes is a major cause of hospitalization and in-hospital mortality. However, a scoring system that can be used to identify diabetic patients at risk of diabetes-related hospitalization and in-hospital mortality is lacking. MethodsWe included 32,653 patients in this retrospective cohort study. All recruited patients had type 2 diabetes, were 30–84 years of age, and were enrolled in the National Diabetes Care Management Program over the period of 2001–2003. We used the Cox proportional hazard regression model to derive risk scores. The predictive accuracy of the models was evaluated using receiver operating characteristic curves. We conducted the Hosmer–Lemeshow test to assess the agreement between predicted and observed risks. ResultsOver a follow-up period of eight years, 6243 patients were hospitalized for diabetes-related events, and 2048 deaths were registered in hospital records. For the one-, three-, five-, and eight-year periods, the areas under the curve (AUC) for diabetes-related hospitalization in the validation set were 0.80, 077, 0.76, and 0.74, respectively. The corresponding values for in-hospital mortality in the validation set were 0.87, 080, 0.77, and 0.76. The goodness-of-fit test showed that the predicted and observed probabilities in the one-, three-, five-, and eight-year periods were similar for diabetes-related hospitalization and in-hospital mortality in the validation set (all p values > 0.05). ConclusionWe developed models for the estimation of the risks of diabetes-related hospitalization and in-hospital mortality in patients with type 2 diabetes. The models may be used to identify diabetic patients who are at high risk for hospital admission and in-hospital mortality.

REGIONAL ALGORITHM OF CARE IN ST ELEVATION MYOCARDIAL INFARCTION

The aim of the study — to present the developed and applied algorithms of ST elevation myocardial infarction (STEMI) patients. The data analyzed on the medical care provision for STEMI in Tatarstan Republic in 2009-2015 y. Application of algorithms with considered regional specifics and resources makes to significantly decrease the values of in-hospital mortality in STEMI.

Clinical and prognostic characteristics associated with age and gender in acute myocardial infarction: a multihospital perspective in the Murcia region of Spain.

Age and female gender have been associated with poor prognosis in acute myocardial infarction (AMI). Data currently available about the prognostic significance of gender in AMI might well have led to inappropriate/incomplete conclusions. A multicenter, prospective study on 1239 patients with AMI was conducted. Clinical characteristics, complications during the acute phase and one-year follow-up were monitored. Women constituted 24.1% of all patients. Female patients were older with more prevalence of diabetes, hypertension, and previous congestive heart failure. Compared with men, the following complications were more frequently found in women: heart failure, 43% vs. 22% (p < 0.001); reinfarction, 5% vs. 2% (p < 0.05); use of pacemaker, 7% vs. 4% (p < 0.05). Women had higher mortality: early, during the first 24 hours post-admission, 10.7 vs. 3.1%; in-hospital, 23% vs. 8.1%; and 1-year, 33.7% vs. 16% (p < 0.001 for all the 3 cases of mortality). In the age-groups considered (<65, 65-74, and > or =75 years), 1-year mortality increased exponentially with ageing in men: 7.8%, 21.3%, and 38.9%, whereas in women the figures were: 15.3%, 41.5%, and 38.8%. Multivariate analysis showed that, among other variables, age and female gender had independent prognostic value for in-hospital mortality whereas gender lost its prognostic significantly for 1-year mortality. Multivariate analysis restricted to those patients aged over 75 years showed that age but not gender had independent prognostic value. In conclusion, age and female sex have independent prognostic value for predicting mortality in patients with AMI. Mortality increases exponentially with ageing in men whereas it stabilises in the case of women over 65 years. Female gender loses its independent value for predicting mortality in patients over 75 years.

A prospective study of the predictive value for in-hospital mortality of mandibulodiaphragmatic distance and mandibular dentition on portable anteroposterior chest radiographs

Mandibulodiaphragmatic distance, measured on the portable anteroposterior chest radiograph and applied to the predictive equation developed in this study, is a strong tool for the prediction of in-hospital mortality that could find wide application in clinical practice and provide vital information for risk stratification and resource allocation in a wide variety of acutely ill patients.