Background Although the age,creatinine,and ejection fraction(ACEF)score effectively predicts risk in general populations with ST segment elevation myocardial infarction(STEMI),its performance specifically in elderly p...Background Although the age,creatinine,and ejection fraction(ACEF)score effectively predicts risk in general populations with ST segment elevation myocardial infarction(STEMI),its performance specifically in elderly patients-who are often underrepresented in validation studies and present with unique pathophysiology-is not well established.This study was designed to directly evaluate and compare the predictive value of the ACEF score for short-term mortality in elderly versus non-elderly STEMI patients,addressing a critical gap in its clinical application.Methods We enrolled 934 consecutive STEMI patients undergoing percutaneous coronary intervention,categorized into a non elderly group(<65 years,n=534)and an elderly group(≥65 years,n=400).The ACEF score was calculated as age/left ventricular ejection fraction+1(if serum creatinine>2 mg/dL).Its predictive ability for in hospital and one year mortality was assessed.Results Overall,in hospital and one year mortality rates were 4.4%and 8.2%,respectively.Elderly patients had significantly worse in hospital outcomes,including higher all cause mortality(6.5%vs.2.8%,P=0.006)and major adverse cardiovascular events(16.0%vs.9.2%,P=0.002).The predictive performance of the ACEF score for in hospital mortality was lower in the elderly group than in the non elderly group(area under the curve:0.753 vs.0.828,P=0.047).The optimal cut off value for ACEF was 1.65 in both groups.In multivariate analysis,an ACEF score>1.65 independently predicted in hospital mortality[adjusted odds ratio(OR):11.58,P=0.001]and one year mortality[adjusted hazard ratio(HR):7.12,P<0.001]in non elderly patients.Similar associations were observed in elderly patients(in hospital mortality:adjusted OR:3.26,P=0.027;one year mortality:adjusted HR:2.79,P=0.003).Conclusions Despite a relatively lower discriminatory ability for short-term mortality in elderly STEMI patients,the ACEF score still demonstrated significant predictive value and might serve as a practical,initial tool for identifying high-risk individuals in clinical settings.展开更多
Background Elevated N-terminal pro-brain natriuretic peptide(NT-pro-BNP)is a recognized predictor of poor prognosis in heart failure and infectious diseases.We aimed to investigate its predictive value for short-term ...Background Elevated N-terminal pro-brain natriuretic peptide(NT-pro-BNP)is a recognized predictor of poor prognosis in heart failure and infectious diseases.We aimed to investigate its predictive value for short-term mortality in patients with infective endocarditis(IE)complicated by sepsis.Methods A total of 416 consecutive patients diagnosed with IE and sepsis at Guangdong Provincial People's Hospital were enrolled.The patients were divided into three groups according to the tertiles of NT-pro-BNP level of the first blood collection within 24 hours after admission:<2000 pg/mL(n=138),2000-7167 pg/mL(n=140),and>7167 pg/mL(n=138).Univariate and multivariate regression analysis were used to explore the predictive value of NT-pro-BNP for short-term mortality,and the best cut-off value was determined by receiver operating characteristic(ROC)curve.Results In-hospital and 6-month death occurred in 65 and 94 patients,respectively.Higher in-hospital mortality was found in patients with higher serum NT-pro-BNP levels(9.4%vs.13.6%vs.23.9%,P=0.003).ROC curve analysis identified an optimal NT-pro-BNP cutoff level of 1357 pg/mL[area under curve(AUC):0.652,95%CI:0.588-0.717,P<0.001].Multivariate regression analysis showed that both log-transformed NT-pro-BNP(in-hospital mortality:OR:1.987,95%CI:1.045-3.778,P=0.036;6-month mortality:HR:1.714,95%CI:1.072-2.7400,P=0.025)and NT-pro-BNP>1357 pg/mL(in-hospital mortality:OR:8.059,95%CI:1.813-35.818,P=0.006;6-month mortality:HR:5.193,95%CI:1.806-14.938,P=0.002)were both independent risk factors for in-hospital and 6-month mortality.Conclusions Serum NT-pro-BNP could serve as an independent predictor of in-hospital and 6-month mortality in patients with IE complicated with sepsis.展开更多
Shen et al’s retrospective study aims to compare the utility of two separate scoring systems for predicting mortality attributable to gastrointestinal(GI)injury in critically ill patients[the GI Dysfunction Score(GID...Shen et al’s retrospective study aims to compare the utility of two separate scoring systems for predicting mortality attributable to gastrointestinal(GI)injury in critically ill patients[the GI Dysfunction Score(GIDS)and the Acute Gastroin-testinal Injury(AGI)grade].The authors note that this study is the first proposal that suggests an equivalence between the ability of both scores to predict mor-tality at 28 days from intensive care unit(ICU)admission.Shen et al retrospec-tively analysed an ICU cohort of patients utilising two physicians administering both the AGI grade and GIDS score,using electronic healthcare records and ICU flowsheets.Where these physicians disagreed about the scores,the final decision as to the scores was made by an associate chief physician,or chief physician.We note that the primary reason for the development of GIDS was to create a clear score for GI dysfunction,with minimal subjectivity or inter-operator variability.The subjectivity inherent to the older AGI grading system is what ultimately led to the development of GIDS in 2021.By ensuring consensus between physicians administering the AGI,Shen et al have controlled for one of this grading systems biggest issues.We have concerns,however,that this does not represent the real-world challenges associated with applying the AGI compared to the newer GIDS,and wonder if this arbitration process had not been instituted,would the two scoring systems remain equivalent in terms of predicted mortality?展开更多
Background Sepsis is a dysregulated host response to an infection with high prevalence and mortality in elderly population. The predictive value of N-terminal pro-B-type natriuretic peptide(NT-pro BNP) in elderly sept...Background Sepsis is a dysregulated host response to an infection with high prevalence and mortality in elderly population. The predictive value of N-terminal pro-B-type natriuretic peptide(NT-pro BNP) in elderly septic patients is yet unknown. Method Elderly patients(≥60 years old) with sepsis, that admitted to the Guangzhou Panyu Central Hospital from January 2019 to December 2021 were consecutively recruited. All patients were followed up for 28 days since admission and the event of death was recorded. The Cox regression analysis and receiver operation characteristic(ROC) analysis were performed to study the association between NT-pro BNP and mortality. Results A total of 490 patients were included, and divided into: survival group(n=304, 62.0%)and death group(n=186, 38.0%). The multivariate Cox regression analysis showed that higher lg(NT-pro BNP)(HR=1.60, 95% CI 1.24-2.06, P<0.001, Table 2), liver disease(HR=5.22, 95% CI 2.26-12.03, P<0.001, Table 2),higher serum lactic acid(HR=1.09, 95% CI 1.05-1.14, P<0.001, Table 2) were independently associated with28-day mortality in sepsis. ROC analysis for NT-pro BNP in predicting 28-day mortality demonstrated an AUC of0.663(95%CI 0.614-0.712), with NT-pro BNP=7233 pg/ml as the optimal cut-off value. The sensitivity was 50.5%and the specificity was 73.7%. Conclusion NT-pro BNP could be a feasible predictor for mortality in elderly patients with sepsis.展开更多
AIM To assess the performance of proposed scores specific for acute-on-chronic liver failure in predicting shortterm mortality among patients with alcoholic hepatitis.METHODS We retrospectively collected data from 264...AIM To assess the performance of proposed scores specific for acute-on-chronic liver failure in predicting shortterm mortality among patients with alcoholic hepatitis.METHODS We retrospectively collected data from 264 patients with clinically diagnosed alcoholic hepatitis from January to December 2013 at 21 academic hospitals in Korea. The performance for predicting short-term mortality was calculated for Chronic Liver FailureSequential Organ Failure Assessment(CLIF-SOFA), CLIF Consortium Organ Failure score(CLIF-C OFs), Maddrey'sdiscriminant function(DF), age, bilirubin, international normalized ratio and creatinine score(ABIC), Glasgow Alcoholic Hepatitis Score(GAHS), model for end-stage liver disease(MELD), and MELD-Na.RESULTS Of 264 patients, 32(12%) patients died within 28 d. The area under receiver operating characteristic curve of CLIF-SOFA, CLIF-C OFs, DF, ABIC, GAHS, MELD, and MELD-Na was 0.86(0.81-0.90), 0.89(0.84-0.92), 0.79(0.74-0.84), 0.78(0.72-0.83), 0.81(0.76-0.86), 0.83(0.78-0.88), and 0.83(0.78-0.88), respectively, for 28-d mortality. The performance of CLIF-SOFA had no statistically significant differences for 28-d mortality. The performance of CLIF-C OFs was superior to that of DF, ABIC, and GAHS, while comparable to that of MELD and MELD-Na in predicting 28-d mortality. A CLIF-SOFA score of 8 had 78.1% sensitivity and 79.7% specificity, and CLIF-C OFs of 10 had 68.8% sensitivity and 91.4% specificity for predicting 28-d mortality.CONCLUSION CLIF-SOFA and CLIF-C OF scores performed well, with comparable predictive ability for short-term mortality compared to the commonly used scoring systems in patients with alcoholic hepatitis.展开更多
BACKGROUND The prognosis of critically ill patients is closely linked to their gastrointestinal(GI)function.The acute GI injury(AGI)grading system,established in 2012,is extensively utilized to evaluate GI dysfunction...BACKGROUND The prognosis of critically ill patients is closely linked to their gastrointestinal(GI)function.The acute GI injury(AGI)grading system,established in 2012,is extensively utilized to evaluate GI dysfunction and forecast outcomes in clinical settings.In 2021,the GI dysfunction score(GIDS)was developed,building on the AGI grading system,to enhance the accuracy of GI dysfunction severity assessment,improve prognostic predictions,reduce subjectivity,and increase reproducibility.AIM To compare the predictive capabilities of GIDS and the AGI grading system for 28-day mortality in critically ill patients.METHODS A retrospective study was conducted at the general intensive care unit(ICU)of a regional university hospital.All data were collected during the first week of ICU admission.The primary outcome was 28-day mortality.Multivariable logistic regression analyzed whether GIDS and AGI grade were independent risk factors for 28-day mortality.The predictive abilities of GIDS and AGI grade were compared using the receiver operating characteristic curve,with DeLong’s test assessing differences between the curves’areas.RESULTS The incidence of AGI in the first week of ICU admission was 92.13%.There were 85 deaths(47.75%)within 28 days of ICU admission.There was no initial 24-hour difference in GIDS between the non-survival and survival groups.Both GIDS(OR 2.01,95%CI:1.25-3.24;P=0.004)and AGI grade(OR 1.94,95%CI:1.12-3.38;P=0.019)were independent predictors of 28-day mortality.No significant difference was found between the predictive accuracy of GIDS and AGI grade for 28-day mortality during the first week of ICU admission(Z=-0.26,P=0.794).CONCLUSION GIDS within the first 24 hours was an unreliable predictor of 28-day mortality.The predictive accuracy for 28-day mortality from both systems during the first week was comparable.展开更多
Background The elderly subjects affected by ST-segment elevation myocardial infarction(STEMI)have the highest risk of mortality.This study was to explore the the prognostic impact of blood urea nitrogen(BUN)for short-...Background The elderly subjects affected by ST-segment elevation myocardial infarction(STEMI)have the highest risk of mortality.This study was to explore the the prognostic impact of blood urea nitrogen(BUN)for short-term mortality in elderly STEMI patients receiving percutaneous coronary intervention(PCI).Methods A total of 777 consecutive patients with STEMI undergoing PCI were enrolled and divided into three groups according to the tertiles of BUN level at admission:<4.6 mmol/L(n=258),4.6-6.7 mmol/L(n=256)and≥263 mmol/L(n=263).The association of BUN with in-hospital and 1-year mortality was evaluated.Results The incidence of in-hospital death was 6.0%,which was significantly higher in patients with a high BUN level(1.6%vs.4.3%vs.12.2%,P<0.001).The receiver operating characteristic(ROC)curve showed that BUN>7 mmol/L had a sensitivity of 68.1%and specificity of 70.7%for predicting in-hospital death[area under curve(AUC):0.727,95%confidential interval(CI):0.660-0.795,P<0.001].Kaplan-Meier survival curves showed that patients with BUN>7 mmol/L had a higher one-year mortality than those without(Log-rank test:44.7,P<0.001).Multivariate analysis showed an independent relationship between BUN>7 mmol/L and in-hospital[odds ratio(OR):2.37,95%CI:1.11-5.07,P=0.026]and one-year mortality[hazard ratio(HR):2.18,95%CI:1.32-3.59,P=0.002].Conclusions BUN may be a potential predictor for short-term mortality in patients with STEMI,which provided some references for identifying and managing high-risk populations early in clinical practice.展开更多
Objective This study aims to investigate the joint associations of sarcopenia and social isolation with mortality risk.Methods Using data from the Chinese Longitudinal Healthy Longevity Survey(CLHLS)and the UK Biobank...Objective This study aims to investigate the joint associations of sarcopenia and social isolation with mortality risk.Methods Using data from the Chinese Longitudinal Healthy Longevity Survey(CLHLS)and the UK Biobank,sarcopenia was diagnosed according to European and Asian Working Groups for Sarcopenia criteria.Social isolation was assessed using standardized questionnaires,including questions on solitude,frequency of social activities,contact with others,and marital status(for the CLHLS only).Results During the follow-up period,8,249 deaths occurred in the CLHLS and 26,670 deaths in the UK Biobank groups.While no significant interaction was observed between sarcopenia and social isolation in predicting all-cause mortality in the CLHLS cohort,the association between social isolation and mortality was stronger among individuals with sarcopenia in the UK Biobank(P-interaction=0.03,relative risk due to interaction:0.23,95%confidence interval[CI]:0.06–0.41).Further joint analyses showed that participants with sarcopenia and high levels of social isolation had the highest mortality risk(hazard ration[HR]:1.99;95%CI:[1.74–2.28]in the CLHLS and 1.69[1.55–1.85]in the UK Biobank)compared to those without either condition.Conclusion The combination of social isolation and sarcopenia synergistically increases the risk of mortality in middle-aged and older adults across diverse populations.展开更多
BACKGROUND:Serum osmolality is a prognostic indicator in critically ill patients.This study aimed to evaluate the association between high osmolality and 28-day mortality in patients with cardiac arrest(CA)admitted to...BACKGROUND:Serum osmolality is a prognostic indicator in critically ill patients.This study aimed to evaluate the association between high osmolality and 28-day mortality in patients with cardiac arrest(CA)admitted to the intensive care unit(ICU).METHODS:Baseline data of adult patients with CA who were admitted to the ICU from 2008 to 2019 were collected from the Medical Information Mart for Intensive Care(MIMIC)-IV.Patients were divided into survivor and non-survivor groups according to the 28-day prognosis.Serum concentrations of sodium,potassium,glucose,and urea nitrogen on the fi rst day of ICU admission were used to determine serum osmolarity.The primary endpoint of this study was 28-day all-cause mortality.Propensity score matching(PSM)analysis was performed to reduce bias between the survivor and nonsurvivor groups.RESULTS:Among the 798 included CA patients,the high osmolarity on the first day of ICU admission remained significantly associated with increased 28-day mortality(62.0%vs.35.5%,P<0.001)and reduced cumulative survival(log-rank P<0.05)after PSM.Cox regression identifi ed the high osmolarity on the fi rst day of ICU admission as an independent predictor.High serum osmolarity on the fi rst day of ICU admission eff ectively predicted 1-,3-,7-,and 28-day all-cause mortality,with the strongest predictive performance for 1-day mortality both before and after PSM(all P<0.05).CONCLUSION:In this study,elevated serum osmolarity on the first day of ICU admission was independently associated with increased 28-day mortality in CA patients and could serve as a prognostic marker.展开更多
BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suita...BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suitable for rapid clinical application.METHODS:In this multi-center retrospective cohort study,AAS patient data from three hospitals were analyzed.The modeling cohort included data from the First Affiliated Hospital of Zhengzhou University and the People’s Hospital of Xinjiang Uygur Autonomous Region,with Peking University Third Hospital data serving as the external test set.Four machine learning algorithms—logistic regression(LR),multilayer perceptron(MLP),Gaussian naive Bayes(GNB),and random forest(RF)—were used to develop predictive models based on 34 early-accessible clinical variables.A simplifi ed model was then derived based on fi ve key variables(Stanford type,pericardial eff usion,asymmetric peripheral arterial pulsation,decreased bowel sounds,and dyspnea)via Least Absolute Shrinkage and Selection Operator(LASSO)regression to improve ED applicability.RESULTS:A total of 929 patients were included in the modeling cohort,and 210 were included in the external test set.Four machine learning models based on 34 clinical variables were developed,achieving internal and external validation AUCs of 0.85-0.90 and 0.73-0.85,respectively.The simplifi ed model incorporating fi ve key variables demonstrated internal and external validation AUCs of 0.71-0.86 and 0.75-0.78,respectively.Both models showed robust calibration and predictive stability across datasets.CONCLUSION:Both kinds of models were built based on machine learning tools,and proved to have certain prediction performance and extrapolation.展开更多
Rowlands et al.1present an analysis of accelerometer data from the UK Biobank cohort,examining variations in the duration,intensity,and accumulation of moderate-intensity physical activity(MPA)and vigorous-intensity p...Rowlands et al.1present an analysis of accelerometer data from the UK Biobank cohort,examining variations in the duration,intensity,and accumulation of moderate-intensity physical activity(MPA)and vigorous-intensity physical activity(VPA)sufficient to reduce the risk of all-cause mortality.In this study,the authors questioned if shorter durations(i.e.,1,2,3,4,5,10,15,and 20 min/day)of MPA and VPA performed continuously or accumulated throughout the day would equally reduce the risks of all-cause mortality as longer duration MPA and VPA recommended in the physical activity(PA)guidelines.展开更多
Objective To determine whether frailty is a risk factor for hospitalization and mortality in older adults enrolled in the "Chronic Heart Failure Program" at a hospital in Lima, Peru, between 2018–2021.Metho...Objective To determine whether frailty is a risk factor for hospitalization and mortality in older adults enrolled in the "Chronic Heart Failure Program" at a hospital in Lima, Peru, between 2018–2021.Methods This was an ambispective cohort study. A total of 85 older adults participating in the Chronic Heart Failure Program at Guillermo Almenara National Hospital were included. Each had an initial frailty assessment, forming two cohorts: frail and non-frail older adults. Medical records were reviewed, and patients were followed for one year to track events of interest(hospitalization and mortality). Overall survival and risk factors for hospitalization and death were determined.Results During follow-up, 15.3% of the older adults died, and frailty was identified in 58.8% of the patients. Overall survival using the Kaplan-Meier method was 96.5% at 3 months after entering the Chronic Heart Failure Program;92.9% at 6 months;and85.9% at one year. Multivariate analysis using Poisson regression found that frailty was not a risk factor for hospitalization(a RR =0.92;95% CI: 0.42–2.03). Survival analysis using the Cox proportional hazards model showed that frailty was also not a risk factor for mortality after one year of follow-up(a HR = 1.32;95% CI: 0.27–6.53).Conclusions Our research does not confirm frailty as a risk factor for hospitalization or mortality in older adults enrolled in the“Chronic Heart Failure Program” after one year of follow-up.展开更多
Background Elderly patients(age≥60 years)with ST-segment elevation myocardial infarction(STEMI)are at an elevated risk of mortality.This study aimed to investigate the association of the creatinine to ejection fracti...Background Elderly patients(age≥60 years)with ST-segment elevation myocardial infarction(STEMI)are at an elevated risk of mortality.This study aimed to investigate the association of the creatinine to ejection fraction ratio(CER)with in-hospital and 1-year death in elderly patients with STEMI.Methods A total of 753 consecutive elderly patients(age≥60 years)with STEMI undergoing percutaneous coronary intervention(PCI)were enrolled and divided into three groups according to the tertiles of CER at admission:<1.5(n=250),1.5-2.2(n=249)and>2.2(n=254).Multivariate analyses were performed to evaluate the prognostic value of CRE for short-term death in this population.Results The in-hospital and 1-year mortality reached 6.0%and 13.3%,respectively.Patients with higher CER exhibited a higher in-hospital mortality(0.8%vs.2.8%vs.14.2%,P<0.001).An optimal cut-off value of 2.5 for CER was identified for predicting in-hospital death by receiver operating characteristic curve analysis,yielding a sensitivity of 77.8%and a specificity of 76.1%[area under curve(AUC):0.791,95%confidence interval(CI):0.734-0.847,P<0.001].Multivariate regression analyses revealed that CER>2.5 was an independent risk factor for both in-hospital[adjusted odds ratio(OR):9.006,95%CI:2.707-29.967,P<0.001]and 1-year mortality[adjusted hazard ratio(HR):5.082,95%CI:2.462-10.490,P<0.001].Conclusions Elevated CER is associated with adverse short-term mortality in elderly STEMI patients undergone PCI,offering valuable insights for the early identification and management of high-risk individuals in clinical practice.展开更多
BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains u...BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains undefined.AIM To assess the correlation between ascites characteristics and clinical prognosis in AP patients by comparing color depth and turbidity of early ascites.METHODS This study included 667 AP patients with ascites,categorized by color and turbidity into yellow clear(n=54),yellow turbid(n=293),red brown(n=320).The trendχ2 test was employed to analyze the incidence of organ failure(OF),infected pancreatic necrosis(IPN),and mortality across groups.Receiver operating charac teristic(ROC)curves were used to evaluate the predictive value of ascites cell count,amylase,protein,and lactate dehydrogenase(LDH)for abdominal compartment syndrome(ACS)and intra-abdominal hemorrhage.RESULTS AP patients with ascites exhibited higher scores of scoring systems(such as Bedside index for severity in AP,Acute Physiology and Chronic Health Examination II,etc.)and increased complications and mortality rates(all P<0.05)compared to those without ascites.A linear association was observed between ascites color depth and turbidity and the incidence of OF,pancreatic necrosis,IPN,and mortality(P<0.05).LDH in ascites demonstrated high accuracy in predicting ACS and intra-abdominal hemorrhage,with areas under the ROC curve of 0.77 and 0.79,respectively.CONCLUSION Early in AP,ascites correlates with OF,IPN,and mortality,showing linear associations with color depth and turbidity.Ascitic LDH reliably predicts ACS and intra-abdominal hemorrhage in AP patients.展开更多
Since the London fog in 1952, numerous epidemioLogical studies have revealed that both short-term and long-term exposure to air pollutants is associated with the development of diseases[1]. Up to date, the assessment ...Since the London fog in 1952, numerous epidemioLogical studies have revealed that both short-term and long-term exposure to air pollutants is associated with the development of diseases[1]. Up to date, the assessment of air quality on health and air quality standard establishment in developing countries were mainly relied on extrapolation based on the results from long-term cohort studies conducted in Europe and North America.展开更多
BACKGROUND:Electrolyte imbalance is common following traumatic brain injury(TBI)and can significantly impact patient outcomes.We aimed to explore the occurrence,patterns,and consequences of electrolyte imbalance in ad...BACKGROUND:Electrolyte imbalance is common following traumatic brain injury(TBI)and can significantly impact patient outcomes.We aimed to explore the occurrence,patterns,and consequences of electrolyte imbalance in adult patients with TBI.METHODS:A retrospective study was conducted from 2016 to 2021 at a level 1 trauma center among hospitalized TBI patients.On admission,the levels of serum electrolytes,including sodium,potassium,calcium,magnesium,and phosphate,were analyzed.Demographics,injury characteristics,and interventions were assessed.The primary outcome was the in-hospital mortality.Multivariate logistic regression analysis was performed to identify independent predictors of mortality in TBI patients.RESULTS:A total of 922 TBI patients were included in the analysis,of whom 902(98%)had electrolyte imbalance.The mean age of patients with electrolyte imbalance was 32.0±15.0 years.Most patients were males(94%).The most common electrolyte abnormalities were hypocalcemia,hypophosphatemia,and hypokalemia.The overall in-hospital mortality rate was 22%in the entire cohort.In multivariate logistic analysis,the predictors of mortality included age(odds ratio[OR]=1.029,95%confidence intervals[CI]:1.013-1.046,P<0.001),low GCS(OR=0.883,95%CI:0.816-0.956,P=0.002),high Injury Severity Score(ISS)scale(OR=1.051,95%CI:1.026-1.078,P<0.001),hypernatremia(OR=2.175,95%CI:1.196-3.955,P=0.011),hyperkalemia(OR=4.862,95%CI:1.222-19.347;P=0.025),low serum bicarbonate levels(OR=0.926,95%CI:0.868-0.988,P=0.020),high serum lactate levels(OR=1.128,95%CI:1.022-1.244,P=0.017),high glucose levels(OR=1.072,95%CI:1.014-1.133,P=0.015),a longer activated partial thromboplastin time(OR=1.054,95%CI:1.024-1.084,P<0.001)and higer international normalized ratio(INR)(OR=3.825,95%CI:1.592-9.188,P=0.003).CONCLUSION:Electrolyte imbalance is common in TBI patients,with the significant prevalence of hypocalcemia,hypophosphatemia,and hypokalemia.However,hypernatremia and hyperkalemia were associated with the risk of mortality,emphasizing the need for further research to comprehend electrolyte dynamics in TBI patients.展开更多
BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term...BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater mortality.AIM To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize bias.METHODS This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare organizations.The study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer patients.Newly prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)users.The primary outcome was all-cause mortality.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.Multivariable Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these findings.In a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individuals who have never used PPIs,providing insights into the long-term effects of past PPI use.In addition,at 1-year follow-up,the analysis revealed a significant difference in mortality rates between former PPI users and non-users(HR:1.84;95%CI:1.82-1.96).CONCLUSION PPI use among cancer patients was associated with a higher risk of all-cause mortality compared to non-users or H2RA users.These findings emphasize the need for cautious use of PPIs in cancer patients and suggest that alternative treatments should be considered when clinically feasible.However,further studies are needed to corroborate our findings,given the significant adverse outcomes in cancer patients.展开更多
Geographical variations in all-cause mortality rates may be influenced by residents’ place of residence and the time period under study. Understanding these variations is essential for designing effective public heal...Geographical variations in all-cause mortality rates may be influenced by residents’ place of residence and the time period under study. Understanding these variations is essential for designing effective public health interventions and optimizing resource allocation. This study aimed to identify small area level factors associated with all-cause mortality and to map hotspots of excess deaths across a region. The analysis produced relative mortality rates and exceedance probabilities to pinpoint areas with an excess burden of death. Results showed that all-cause mortality was particularly concentrated in the upper central and northern regions of the region, where many rural counties are located. Key factors associated with higher mortality rates included lower median income, younger median age, and a lower percentage of Hispanic population in the counties studied. These findings highlight the importance of addressing income disparity in high-mortality areas, particularly in rural regions, to guide resource allocation and develop targeted interventions that can most effectively reduce mortality rates where they are needed most.展开更多
Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was c...Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was carried out at the Coronthie Community Medical Center. It was a cross-sectional, descriptive and analytical study lasting 6 months, from July 01 to December 31, 2021. Parturients whose term was ≥28 SA and who agreed to participate in the study were included. Excluded were those with a term Results: The frequency of quality care is 36.7%. The average age of parturients was 28.6 ± 5 years. Most parturients (89.7%) were married women with secondary education (35%) and self-employed (32%). Pauciparous women accounted for 43.80%, and most parturients (59.8%) were delivered by Caesarean section. We found that 21.5% of parturients had developed complications. These complications were perineal trauma and post-partum haemorrhage. There were no maternal deaths, and the neonatal mortality rate was 20/1000 NV. Acute fetal distress was the main cause of perinatal death. Conclusion: Correct management of factors influencing childbirth could improve maternal and neonatal prognosis.展开更多
Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with ...Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.展开更多
文摘Background Although the age,creatinine,and ejection fraction(ACEF)score effectively predicts risk in general populations with ST segment elevation myocardial infarction(STEMI),its performance specifically in elderly patients-who are often underrepresented in validation studies and present with unique pathophysiology-is not well established.This study was designed to directly evaluate and compare the predictive value of the ACEF score for short-term mortality in elderly versus non-elderly STEMI patients,addressing a critical gap in its clinical application.Methods We enrolled 934 consecutive STEMI patients undergoing percutaneous coronary intervention,categorized into a non elderly group(<65 years,n=534)and an elderly group(≥65 years,n=400).The ACEF score was calculated as age/left ventricular ejection fraction+1(if serum creatinine>2 mg/dL).Its predictive ability for in hospital and one year mortality was assessed.Results Overall,in hospital and one year mortality rates were 4.4%and 8.2%,respectively.Elderly patients had significantly worse in hospital outcomes,including higher all cause mortality(6.5%vs.2.8%,P=0.006)and major adverse cardiovascular events(16.0%vs.9.2%,P=0.002).The predictive performance of the ACEF score for in hospital mortality was lower in the elderly group than in the non elderly group(area under the curve:0.753 vs.0.828,P=0.047).The optimal cut off value for ACEF was 1.65 in both groups.In multivariate analysis,an ACEF score>1.65 independently predicted in hospital mortality[adjusted odds ratio(OR):11.58,P=0.001]and one year mortality[adjusted hazard ratio(HR):7.12,P<0.001]in non elderly patients.Similar associations were observed in elderly patients(in hospital mortality:adjusted OR:3.26,P=0.027;one year mortality:adjusted HR:2.79,P=0.003).Conclusions Despite a relatively lower discriminatory ability for short-term mortality in elderly STEMI patients,the ACEF score still demonstrated significant predictive value and might serve as a practical,initial tool for identifying high-risk individuals in clinical settings.
文摘Background Elevated N-terminal pro-brain natriuretic peptide(NT-pro-BNP)is a recognized predictor of poor prognosis in heart failure and infectious diseases.We aimed to investigate its predictive value for short-term mortality in patients with infective endocarditis(IE)complicated by sepsis.Methods A total of 416 consecutive patients diagnosed with IE and sepsis at Guangdong Provincial People's Hospital were enrolled.The patients were divided into three groups according to the tertiles of NT-pro-BNP level of the first blood collection within 24 hours after admission:<2000 pg/mL(n=138),2000-7167 pg/mL(n=140),and>7167 pg/mL(n=138).Univariate and multivariate regression analysis were used to explore the predictive value of NT-pro-BNP for short-term mortality,and the best cut-off value was determined by receiver operating characteristic(ROC)curve.Results In-hospital and 6-month death occurred in 65 and 94 patients,respectively.Higher in-hospital mortality was found in patients with higher serum NT-pro-BNP levels(9.4%vs.13.6%vs.23.9%,P=0.003).ROC curve analysis identified an optimal NT-pro-BNP cutoff level of 1357 pg/mL[area under curve(AUC):0.652,95%CI:0.588-0.717,P<0.001].Multivariate regression analysis showed that both log-transformed NT-pro-BNP(in-hospital mortality:OR:1.987,95%CI:1.045-3.778,P=0.036;6-month mortality:HR:1.714,95%CI:1.072-2.7400,P=0.025)and NT-pro-BNP>1357 pg/mL(in-hospital mortality:OR:8.059,95%CI:1.813-35.818,P=0.006;6-month mortality:HR:5.193,95%CI:1.806-14.938,P=0.002)were both independent risk factors for in-hospital and 6-month mortality.Conclusions Serum NT-pro-BNP could serve as an independent predictor of in-hospital and 6-month mortality in patients with IE complicated with sepsis.
文摘Shen et al’s retrospective study aims to compare the utility of two separate scoring systems for predicting mortality attributable to gastrointestinal(GI)injury in critically ill patients[the GI Dysfunction Score(GIDS)and the Acute Gastroin-testinal Injury(AGI)grade].The authors note that this study is the first proposal that suggests an equivalence between the ability of both scores to predict mor-tality at 28 days from intensive care unit(ICU)admission.Shen et al retrospec-tively analysed an ICU cohort of patients utilising two physicians administering both the AGI grade and GIDS score,using electronic healthcare records and ICU flowsheets.Where these physicians disagreed about the scores,the final decision as to the scores was made by an associate chief physician,or chief physician.We note that the primary reason for the development of GIDS was to create a clear score for GI dysfunction,with minimal subjectivity or inter-operator variability.The subjectivity inherent to the older AGI grading system is what ultimately led to the development of GIDS in 2021.By ensuring consensus between physicians administering the AGI,Shen et al have controlled for one of this grading systems biggest issues.We have concerns,however,that this does not represent the real-world challenges associated with applying the AGI compared to the newer GIDS,and wonder if this arbitration process had not been instituted,would the two scoring systems remain equivalent in terms of predicted mortality?
文摘Background Sepsis is a dysregulated host response to an infection with high prevalence and mortality in elderly population. The predictive value of N-terminal pro-B-type natriuretic peptide(NT-pro BNP) in elderly septic patients is yet unknown. Method Elderly patients(≥60 years old) with sepsis, that admitted to the Guangzhou Panyu Central Hospital from January 2019 to December 2021 were consecutively recruited. All patients were followed up for 28 days since admission and the event of death was recorded. The Cox regression analysis and receiver operation characteristic(ROC) analysis were performed to study the association between NT-pro BNP and mortality. Results A total of 490 patients were included, and divided into: survival group(n=304, 62.0%)and death group(n=186, 38.0%). The multivariate Cox regression analysis showed that higher lg(NT-pro BNP)(HR=1.60, 95% CI 1.24-2.06, P<0.001, Table 2), liver disease(HR=5.22, 95% CI 2.26-12.03, P<0.001, Table 2),higher serum lactic acid(HR=1.09, 95% CI 1.05-1.14, P<0.001, Table 2) were independently associated with28-day mortality in sepsis. ROC analysis for NT-pro BNP in predicting 28-day mortality demonstrated an AUC of0.663(95%CI 0.614-0.712), with NT-pro BNP=7233 pg/ml as the optimal cut-off value. The sensitivity was 50.5%and the specificity was 73.7%. Conclusion NT-pro BNP could be a feasible predictor for mortality in elderly patients with sepsis.
基金Supported by the Korean Association for the Study of the Liver (KASL) and the Korean Liver Foundation
文摘AIM To assess the performance of proposed scores specific for acute-on-chronic liver failure in predicting shortterm mortality among patients with alcoholic hepatitis.METHODS We retrospectively collected data from 264 patients with clinically diagnosed alcoholic hepatitis from January to December 2013 at 21 academic hospitals in Korea. The performance for predicting short-term mortality was calculated for Chronic Liver FailureSequential Organ Failure Assessment(CLIF-SOFA), CLIF Consortium Organ Failure score(CLIF-C OFs), Maddrey'sdiscriminant function(DF), age, bilirubin, international normalized ratio and creatinine score(ABIC), Glasgow Alcoholic Hepatitis Score(GAHS), model for end-stage liver disease(MELD), and MELD-Na.RESULTS Of 264 patients, 32(12%) patients died within 28 d. The area under receiver operating characteristic curve of CLIF-SOFA, CLIF-C OFs, DF, ABIC, GAHS, MELD, and MELD-Na was 0.86(0.81-0.90), 0.89(0.84-0.92), 0.79(0.74-0.84), 0.78(0.72-0.83), 0.81(0.76-0.86), 0.83(0.78-0.88), and 0.83(0.78-0.88), respectively, for 28-d mortality. The performance of CLIF-SOFA had no statistically significant differences for 28-d mortality. The performance of CLIF-C OFs was superior to that of DF, ABIC, and GAHS, while comparable to that of MELD and MELD-Na in predicting 28-d mortality. A CLIF-SOFA score of 8 had 78.1% sensitivity and 79.7% specificity, and CLIF-C OFs of 10 had 68.8% sensitivity and 91.4% specificity for predicting 28-d mortality.CONCLUSION CLIF-SOFA and CLIF-C OF scores performed well, with comparable predictive ability for short-term mortality compared to the commonly used scoring systems in patients with alcoholic hepatitis.
基金approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang Chinese Medical University(No.2024-KLS-369-02).
文摘BACKGROUND The prognosis of critically ill patients is closely linked to their gastrointestinal(GI)function.The acute GI injury(AGI)grading system,established in 2012,is extensively utilized to evaluate GI dysfunction and forecast outcomes in clinical settings.In 2021,the GI dysfunction score(GIDS)was developed,building on the AGI grading system,to enhance the accuracy of GI dysfunction severity assessment,improve prognostic predictions,reduce subjectivity,and increase reproducibility.AIM To compare the predictive capabilities of GIDS and the AGI grading system for 28-day mortality in critically ill patients.METHODS A retrospective study was conducted at the general intensive care unit(ICU)of a regional university hospital.All data were collected during the first week of ICU admission.The primary outcome was 28-day mortality.Multivariable logistic regression analyzed whether GIDS and AGI grade were independent risk factors for 28-day mortality.The predictive abilities of GIDS and AGI grade were compared using the receiver operating characteristic curve,with DeLong’s test assessing differences between the curves’areas.RESULTS The incidence of AGI in the first week of ICU admission was 92.13%.There were 85 deaths(47.75%)within 28 days of ICU admission.There was no initial 24-hour difference in GIDS between the non-survival and survival groups.Both GIDS(OR 2.01,95%CI:1.25-3.24;P=0.004)and AGI grade(OR 1.94,95%CI:1.12-3.38;P=0.019)were independent predictors of 28-day mortality.No significant difference was found between the predictive accuracy of GIDS and AGI grade for 28-day mortality during the first week of ICU admission(Z=-0.26,P=0.794).CONCLUSION GIDS within the first 24 hours was an unreliable predictor of 28-day mortality.The predictive accuracy for 28-day mortality from both systems during the first week was comparable.
文摘Background The elderly subjects affected by ST-segment elevation myocardial infarction(STEMI)have the highest risk of mortality.This study was to explore the the prognostic impact of blood urea nitrogen(BUN)for short-term mortality in elderly STEMI patients receiving percutaneous coronary intervention(PCI).Methods A total of 777 consecutive patients with STEMI undergoing PCI were enrolled and divided into three groups according to the tertiles of BUN level at admission:<4.6 mmol/L(n=258),4.6-6.7 mmol/L(n=256)and≥263 mmol/L(n=263).The association of BUN with in-hospital and 1-year mortality was evaluated.Results The incidence of in-hospital death was 6.0%,which was significantly higher in patients with a high BUN level(1.6%vs.4.3%vs.12.2%,P<0.001).The receiver operating characteristic(ROC)curve showed that BUN>7 mmol/L had a sensitivity of 68.1%and specificity of 70.7%for predicting in-hospital death[area under curve(AUC):0.727,95%confidential interval(CI):0.660-0.795,P<0.001].Kaplan-Meier survival curves showed that patients with BUN>7 mmol/L had a higher one-year mortality than those without(Log-rank test:44.7,P<0.001).Multivariate analysis showed an independent relationship between BUN>7 mmol/L and in-hospital[odds ratio(OR):2.37,95%CI:1.11-5.07,P=0.026]and one-year mortality[hazard ratio(HR):2.18,95%CI:1.32-3.59,P=0.002].Conclusions BUN may be a potential predictor for short-term mortality in patients with STEMI,which provided some references for identifying and managing high-risk populations early in clinical practice.
基金supported by grants from the National Key Research and Development Program of China(No.2023YFC3606300,No.2022YFC3600300)the National Natural Science Foundation of China(No.82325043)the National Key Research and Development Program of Hubei Province(2022BCA036)。
文摘Objective This study aims to investigate the joint associations of sarcopenia and social isolation with mortality risk.Methods Using data from the Chinese Longitudinal Healthy Longevity Survey(CLHLS)and the UK Biobank,sarcopenia was diagnosed according to European and Asian Working Groups for Sarcopenia criteria.Social isolation was assessed using standardized questionnaires,including questions on solitude,frequency of social activities,contact with others,and marital status(for the CLHLS only).Results During the follow-up period,8,249 deaths occurred in the CLHLS and 26,670 deaths in the UK Biobank groups.While no significant interaction was observed between sarcopenia and social isolation in predicting all-cause mortality in the CLHLS cohort,the association between social isolation and mortality was stronger among individuals with sarcopenia in the UK Biobank(P-interaction=0.03,relative risk due to interaction:0.23,95%confidence interval[CI]:0.06–0.41).Further joint analyses showed that participants with sarcopenia and high levels of social isolation had the highest mortality risk(hazard ration[HR]:1.99;95%CI:[1.74–2.28]in the CLHLS and 1.69[1.55–1.85]in the UK Biobank)compared to those without either condition.Conclusion The combination of social isolation and sarcopenia synergistically increases the risk of mortality in middle-aged and older adults across diverse populations.
基金funded by the Shenzhen Science and Technology Program(JCYJ20230807112007014 to PG)the Shenzhen Key Medical Discipline Construction Fund(SZXK046 to PG).
文摘BACKGROUND:Serum osmolality is a prognostic indicator in critically ill patients.This study aimed to evaluate the association between high osmolality and 28-day mortality in patients with cardiac arrest(CA)admitted to the intensive care unit(ICU).METHODS:Baseline data of adult patients with CA who were admitted to the ICU from 2008 to 2019 were collected from the Medical Information Mart for Intensive Care(MIMIC)-IV.Patients were divided into survivor and non-survivor groups according to the 28-day prognosis.Serum concentrations of sodium,potassium,glucose,and urea nitrogen on the fi rst day of ICU admission were used to determine serum osmolarity.The primary endpoint of this study was 28-day all-cause mortality.Propensity score matching(PSM)analysis was performed to reduce bias between the survivor and nonsurvivor groups.RESULTS:Among the 798 included CA patients,the high osmolarity on the first day of ICU admission remained significantly associated with increased 28-day mortality(62.0%vs.35.5%,P<0.001)and reduced cumulative survival(log-rank P<0.05)after PSM.Cox regression identifi ed the high osmolarity on the fi rst day of ICU admission as an independent predictor.High serum osmolarity on the fi rst day of ICU admission eff ectively predicted 1-,3-,7-,and 28-day all-cause mortality,with the strongest predictive performance for 1-day mortality both before and after PSM(all P<0.05).CONCLUSION:In this study,elevated serum osmolarity on the first day of ICU admission was independently associated with increased 28-day mortality in CA patients and could serve as a prognostic marker.
基金supported by the special fund of the National Clinical Key Specialty Construction Program[(2022)301-2305].
文摘BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suitable for rapid clinical application.METHODS:In this multi-center retrospective cohort study,AAS patient data from three hospitals were analyzed.The modeling cohort included data from the First Affiliated Hospital of Zhengzhou University and the People’s Hospital of Xinjiang Uygur Autonomous Region,with Peking University Third Hospital data serving as the external test set.Four machine learning algorithms—logistic regression(LR),multilayer perceptron(MLP),Gaussian naive Bayes(GNB),and random forest(RF)—were used to develop predictive models based on 34 early-accessible clinical variables.A simplifi ed model was then derived based on fi ve key variables(Stanford type,pericardial eff usion,asymmetric peripheral arterial pulsation,decreased bowel sounds,and dyspnea)via Least Absolute Shrinkage and Selection Operator(LASSO)regression to improve ED applicability.RESULTS:A total of 929 patients were included in the modeling cohort,and 210 were included in the external test set.Four machine learning models based on 34 clinical variables were developed,achieving internal and external validation AUCs of 0.85-0.90 and 0.73-0.85,respectively.The simplifi ed model incorporating fi ve key variables demonstrated internal and external validation AUCs of 0.71-0.86 and 0.75-0.78,respectively.Both models showed robust calibration and predictive stability across datasets.CONCLUSION:Both kinds of models were built based on machine learning tools,and proved to have certain prediction performance and extrapolation.
文摘Rowlands et al.1present an analysis of accelerometer data from the UK Biobank cohort,examining variations in the duration,intensity,and accumulation of moderate-intensity physical activity(MPA)and vigorous-intensity physical activity(VPA)sufficient to reduce the risk of all-cause mortality.In this study,the authors questioned if shorter durations(i.e.,1,2,3,4,5,10,15,and 20 min/day)of MPA and VPA performed continuously or accumulated throughout the day would equally reduce the risks of all-cause mortality as longer duration MPA and VPA recommended in the physical activity(PA)guidelines.
文摘Objective To determine whether frailty is a risk factor for hospitalization and mortality in older adults enrolled in the "Chronic Heart Failure Program" at a hospital in Lima, Peru, between 2018–2021.Methods This was an ambispective cohort study. A total of 85 older adults participating in the Chronic Heart Failure Program at Guillermo Almenara National Hospital were included. Each had an initial frailty assessment, forming two cohorts: frail and non-frail older adults. Medical records were reviewed, and patients were followed for one year to track events of interest(hospitalization and mortality). Overall survival and risk factors for hospitalization and death were determined.Results During follow-up, 15.3% of the older adults died, and frailty was identified in 58.8% of the patients. Overall survival using the Kaplan-Meier method was 96.5% at 3 months after entering the Chronic Heart Failure Program;92.9% at 6 months;and85.9% at one year. Multivariate analysis using Poisson regression found that frailty was not a risk factor for hospitalization(a RR =0.92;95% CI: 0.42–2.03). Survival analysis using the Cox proportional hazards model showed that frailty was also not a risk factor for mortality after one year of follow-up(a HR = 1.32;95% CI: 0.27–6.53).Conclusions Our research does not confirm frailty as a risk factor for hospitalization or mortality in older adults enrolled in the“Chronic Heart Failure Program” after one year of follow-up.
文摘Background Elderly patients(age≥60 years)with ST-segment elevation myocardial infarction(STEMI)are at an elevated risk of mortality.This study aimed to investigate the association of the creatinine to ejection fraction ratio(CER)with in-hospital and 1-year death in elderly patients with STEMI.Methods A total of 753 consecutive elderly patients(age≥60 years)with STEMI undergoing percutaneous coronary intervention(PCI)were enrolled and divided into three groups according to the tertiles of CER at admission:<1.5(n=250),1.5-2.2(n=249)and>2.2(n=254).Multivariate analyses were performed to evaluate the prognostic value of CRE for short-term death in this population.Results The in-hospital and 1-year mortality reached 6.0%and 13.3%,respectively.Patients with higher CER exhibited a higher in-hospital mortality(0.8%vs.2.8%vs.14.2%,P<0.001).An optimal cut-off value of 2.5 for CER was identified for predicting in-hospital death by receiver operating characteristic curve analysis,yielding a sensitivity of 77.8%and a specificity of 76.1%[area under curve(AUC):0.791,95%confidence interval(CI):0.734-0.847,P<0.001].Multivariate regression analyses revealed that CER>2.5 was an independent risk factor for both in-hospital[adjusted odds ratio(OR):9.006,95%CI:2.707-29.967,P<0.001]and 1-year mortality[adjusted hazard ratio(HR):5.082,95%CI:2.462-10.490,P<0.001].Conclusions Elevated CER is associated with adverse short-term mortality in elderly STEMI patients undergone PCI,offering valuable insights for the early identification and management of high-risk individuals in clinical practice.
基金Supported by National Natural Science Foundation of China,No.82360136Jiangxi Clinical Research Center for Gastroenterology,No.20223BCG74011.
文摘BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains undefined.AIM To assess the correlation between ascites characteristics and clinical prognosis in AP patients by comparing color depth and turbidity of early ascites.METHODS This study included 667 AP patients with ascites,categorized by color and turbidity into yellow clear(n=54),yellow turbid(n=293),red brown(n=320).The trendχ2 test was employed to analyze the incidence of organ failure(OF),infected pancreatic necrosis(IPN),and mortality across groups.Receiver operating charac teristic(ROC)curves were used to evaluate the predictive value of ascites cell count,amylase,protein,and lactate dehydrogenase(LDH)for abdominal compartment syndrome(ACS)and intra-abdominal hemorrhage.RESULTS AP patients with ascites exhibited higher scores of scoring systems(such as Bedside index for severity in AP,Acute Physiology and Chronic Health Examination II,etc.)and increased complications and mortality rates(all P<0.05)compared to those without ascites.A linear association was observed between ascites color depth and turbidity and the incidence of OF,pancreatic necrosis,IPN,and mortality(P<0.05).LDH in ascites demonstrated high accuracy in predicting ACS and intra-abdominal hemorrhage,with areas under the ROC curve of 0.77 and 0.79,respectively.CONCLUSION Early in AP,ascites correlates with OF,IPN,and mortality,showing linear associations with color depth and turbidity.Ascitic LDH reliably predicts ACS and intra-abdominal hemorrhage in AP patients.
基金supported by the National Basic Research Program (973 program) of China (2011CB503802)the Gong-Yi Program of the Chinese Ministry of Environmental Protection (201209008)+2 种基金Shanghai Municipal Committee of Science and Technology (12dz1202602)Shanghai Health Bureau (GWDTR201212)the Scholarship Award for Excellent Doctoral Student granted by Ministry of Education (2011)
文摘Since the London fog in 1952, numerous epidemioLogical studies have revealed that both short-term and long-term exposure to air pollutants is associated with the development of diseases[1]. Up to date, the assessment of air quality on health and air quality standard establishment in developing countries were mainly relied on extrapolation based on the results from long-term cohort studies conducted in Europe and North America.
文摘BACKGROUND:Electrolyte imbalance is common following traumatic brain injury(TBI)and can significantly impact patient outcomes.We aimed to explore the occurrence,patterns,and consequences of electrolyte imbalance in adult patients with TBI.METHODS:A retrospective study was conducted from 2016 to 2021 at a level 1 trauma center among hospitalized TBI patients.On admission,the levels of serum electrolytes,including sodium,potassium,calcium,magnesium,and phosphate,were analyzed.Demographics,injury characteristics,and interventions were assessed.The primary outcome was the in-hospital mortality.Multivariate logistic regression analysis was performed to identify independent predictors of mortality in TBI patients.RESULTS:A total of 922 TBI patients were included in the analysis,of whom 902(98%)had electrolyte imbalance.The mean age of patients with electrolyte imbalance was 32.0±15.0 years.Most patients were males(94%).The most common electrolyte abnormalities were hypocalcemia,hypophosphatemia,and hypokalemia.The overall in-hospital mortality rate was 22%in the entire cohort.In multivariate logistic analysis,the predictors of mortality included age(odds ratio[OR]=1.029,95%confidence intervals[CI]:1.013-1.046,P<0.001),low GCS(OR=0.883,95%CI:0.816-0.956,P=0.002),high Injury Severity Score(ISS)scale(OR=1.051,95%CI:1.026-1.078,P<0.001),hypernatremia(OR=2.175,95%CI:1.196-3.955,P=0.011),hyperkalemia(OR=4.862,95%CI:1.222-19.347;P=0.025),low serum bicarbonate levels(OR=0.926,95%CI:0.868-0.988,P=0.020),high serum lactate levels(OR=1.128,95%CI:1.022-1.244,P=0.017),high glucose levels(OR=1.072,95%CI:1.014-1.133,P=0.015),a longer activated partial thromboplastin time(OR=1.054,95%CI:1.024-1.084,P<0.001)and higer international normalized ratio(INR)(OR=3.825,95%CI:1.592-9.188,P=0.003).CONCLUSION:Electrolyte imbalance is common in TBI patients,with the significant prevalence of hypocalcemia,hypophosphatemia,and hypokalemia.However,hypernatremia and hyperkalemia were associated with the risk of mortality,emphasizing the need for further research to comprehend electrolyte dynamics in TBI patients.
文摘BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater mortality.AIM To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize bias.METHODS This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare organizations.The study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer patients.Newly prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)users.The primary outcome was all-cause mortality.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.Multivariable Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these findings.In a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individuals who have never used PPIs,providing insights into the long-term effects of past PPI use.In addition,at 1-year follow-up,the analysis revealed a significant difference in mortality rates between former PPI users and non-users(HR:1.84;95%CI:1.82-1.96).CONCLUSION PPI use among cancer patients was associated with a higher risk of all-cause mortality compared to non-users or H2RA users.These findings emphasize the need for cautious use of PPIs in cancer patients and suggest that alternative treatments should be considered when clinically feasible.However,further studies are needed to corroborate our findings,given the significant adverse outcomes in cancer patients.
文摘Geographical variations in all-cause mortality rates may be influenced by residents’ place of residence and the time period under study. Understanding these variations is essential for designing effective public health interventions and optimizing resource allocation. This study aimed to identify small area level factors associated with all-cause mortality and to map hotspots of excess deaths across a region. The analysis produced relative mortality rates and exceedance probabilities to pinpoint areas with an excess burden of death. Results showed that all-cause mortality was particularly concentrated in the upper central and northern regions of the region, where many rural counties are located. Key factors associated with higher mortality rates included lower median income, younger median age, and a lower percentage of Hispanic population in the counties studied. These findings highlight the importance of addressing income disparity in high-mortality areas, particularly in rural regions, to guide resource allocation and develop targeted interventions that can most effectively reduce mortality rates where they are needed most.
文摘Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was carried out at the Coronthie Community Medical Center. It was a cross-sectional, descriptive and analytical study lasting 6 months, from July 01 to December 31, 2021. Parturients whose term was ≥28 SA and who agreed to participate in the study were included. Excluded were those with a term Results: The frequency of quality care is 36.7%. The average age of parturients was 28.6 ± 5 years. Most parturients (89.7%) were married women with secondary education (35%) and self-employed (32%). Pauciparous women accounted for 43.80%, and most parturients (59.8%) were delivered by Caesarean section. We found that 21.5% of parturients had developed complications. These complications were perineal trauma and post-partum haemorrhage. There were no maternal deaths, and the neonatal mortality rate was 20/1000 NV. Acute fetal distress was the main cause of perinatal death. Conclusion: Correct management of factors influencing childbirth could improve maternal and neonatal prognosis.
文摘Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.
