High Short-term Mortality in Hospitalized Patients With Advanced Dementia

ABSTRACT BACKGROUND: Individuals with cirrhosis have a chronic systemic inflammation associated with an immune dysfunction, affecting the progression of the liver disease. The neutrophil-lymphocyte ratio (NLR) was proposed as a marker of systemic inflammatory response and survival in patients with cirrhosis. OBJECTIVE: Evaluate the prognostic role of NLR in cirrhotic patients and its relation with inflammatory cytokines(IL-6, IL-10 and IL-17). METHODS: In this prospective study two groups were evaluated: 1) Stable cirrhotic in outpatient follow-up (n=193); 2) Hospitalized cirrhotic for acute decompensation for at least 48 hours (n=334) with admission and 48 hours tests evaluation. Circulating inflammatory cytokines were available for 130 hospitalized patients. RESULTS: In outpatients with stable cirrhosis, NLR correlated with MELD score and other variables associated with severity of disease. However, after a median of 32 months of follow up NLR was not associated with mortality (HR 1.058, 95%CI 0.900-1.243; P=0.495). In hospitalized patients, NLR at 48-hour after admission was independently associated with 90-day survival (HR 1.061, 95%CI 1.020-1.103; P=0.003) in multivariate Cox-regression analysis. The 90-day Kaplan-Meier survival probability was 87% for patients with a 48-hour NLR <3.6 and 62% for NLR ≥3.6 (P<0.001). Elevation of NLR in the first 48 hours was also independently associated with mortality (HR 2.038, 95%CI 1295-3207; P=0.002). The 90-day Kaplan-Meier survival probability was 83% when NLR did not increase and 62% when NLR increased (P<0.001). IL-6, IL-10 and IL-17 at admission were positively correlated with both admission and 48-hour NLR. Lower levels of baseline IL-10 were associated with NLR increase during first 48-hour. CONCLUSION: NLR evaluated at 48 hours of hospitalization and its early increase after admission were independently associated with short-term mortality in patients hospitalized for acute decompensation of cirrhosis.

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Glucocorticoids Are Associated With Increased Risk of Short-Term Mortality in Hospitalized Patients With Clostridium difficile-Associated Disease

The American Journal of Gastroenterology ◽

10.1038/ajg.2010.142 ◽

2010 ◽

Vol 105 (9) ◽

pp. 2040-2049 ◽

Cited By ~ 68

Author(s):

Rohit Das ◽

Paul Feuerstadt ◽

Lawrence J Brandt

Keyword(s):

Clostridium Difficile ◽

Hospitalized Patients ◽

Short Term ◽

Increased Risk ◽

Short Term Mortality

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Development of Imminent Mortality Predictor for Advanced Cancer (IMPAC), a Tool to Predict Short-Term Mortality in Hospitalized Patients With Advanced Cancer

Journal of Oncology Practice ◽

10.1200/jop.2017.023200 ◽

2018 ◽

Vol 14 (3) ◽

pp. e168-e175 ◽

Cited By ~ 6

Author(s):

Kerin Adelson ◽

Donald K.K. Lee ◽

Salimah Velji ◽

Junchao Ma ◽

Susan K. Lipka ◽

...

Keyword(s):

Life Expectancy ◽

End Of Life ◽

Advanced Cancer ◽

Median Survival ◽

End Of Life Care ◽

Hospitalized Patients ◽

Life Care ◽

Short Term ◽

Prognostic Tool ◽

Short Term Mortality

Purpose: End-of-life care for patients with advanced cancer is aggressive and costly. Oncologists inconsistently estimate life expectancy and address goals of care. Currently available prognostication tools are based on subjective clinical assessment. An objective prognostic tool could help oncologists and patients decide on a realistic plan for end-of-life care. We developed a predictive model (Imminent Mortality Predictor in Advanced Cancer [IMPAC]) for short-term mortality in hospitalized patients with advanced cancer. Methods: Electronic health record data from 669 patients with advanced cancer who were discharged from Yale Cancer Center/Smilow Cancer Hospital were extracted. Statistical learning techniques were used to develop a tool to estimate survival probabilities. Patients were randomly split into training (70%) and validation (30%) sets 20 times. We tested the predictive properties of IMPAC for mortality at 30, 60, 90, and 180 days past the day of admission. Results: For mortality within 90 days at a 40% sensitivity level, IMPAC has close to 60% positive predictive value. Patients estimated to have a greater than 50% chance of death within 90 days had a median survival time of 47 days. Patients estimated to have a less than 50% chance of death had a median survival of 290 days. Area under the receiver operating characteristic curve for IMPAC averaged greater than .70 for all time horizons tested. Estimated potential cost savings per patient was $15,413 (95% CI, $9,162 to $21,665) in 2014 constant dollars. Conclusion: IMPAC, a novel prognostic tool, can generate life expectancy probabilities in real time and support oncologists in counseling patients about end-of-life care. Potentially avoidable costs are significant.

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Lower Serum Sodium Is Associated With Increased Short-Term Mortality in Hospitalized Patients With Worsening Heart Failure

Circulation ◽

10.1161/01.cir.0000165065.82609.3d ◽

2005 ◽

Vol 111 (19) ◽

pp. 2454-2460 ◽

Cited By ~ 313

Author(s):

Liviu Klein ◽

Christopher M. O’Connor ◽

Jeffrey D. Leimberger ◽

Wendy Gattis-Stough ◽

Ileana L. Piña ◽

...

Keyword(s):

Heart Failure ◽

Serum Sodium ◽

Hospitalized Patients ◽

Short Term ◽

Lower Serum ◽

Short Term Mortality

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Characteristics and Risk Factors Associated with Early Mortality in Patients with Polymicrobial Bloodstream Infection: A Retrospective Clinical Study

10.21203/rs.3.rs-35866/v1 ◽

2020 ◽

Author(s):

Lantian Pang ◽

SenZhong Chen ◽

Tiantian Ge ◽

Chao Chen ◽

Lichen Xu ◽

...

Keyword(s):

Risk Factors ◽

Blood Cell ◽

White Blood Cell ◽

Antimicrobial Therapy ◽

Hospitalized Patients ◽

Short Term ◽

Survival Group ◽

Empirical Antimicrobial Therapy ◽

Retrospective Clinical Study ◽

Short Term Mortality

Abstract Background and Objective Polymicrobial bloodstream infections (PBSI) in hospitalized patients are associated with increased mortality, while few studies have characterized the clinical features in this population. This study aimed to assess the risk factors and short-term prognosis of PBSI in hospitalized patients.Materials and Methods 4066 patients with culture-positive blood were included between January 1, 2015 and December 31, 2017 in the First Affiliated Hospital of Zhejiang University School of Medicine (Hangzhou, China) in our study. 218 patients were diagnosed as PBSI. The patients were divided into two groups according to the outcome after 30-day follow-up. The number of survival group were 129, while the number of non-survival group were 89. The clinical data, identified microorganisms and severity models were compared between the two groups. A cox regression model was used to identify the risk factors of 30-day mortality in PBSI patients. Five prediction models were compared by Z-test to test the value of these models to predict outcome of PBSI.Results The patients in the non-survival group were more likely to receive inappropriate antibiotic therapy at the time of PBSI and showed more severe in systemic inflammatory. They were more likely to develop to be septic shock and to be admitted in ICU than the patients in the survival group. Inappropriate initial empirical antimicrobial therapy (HR=1.713 95% CI: 1.063-2.760, p=0.027), white blood cell (HR=1.740 95% CI: 1.002-3.020, p=0.049) and platelet (HR=2.940 95% CI: 1.754-4.930, p<0.001) were independent risk factors for 30-day mortality in PBSI patients. SOFA (AUROC=0.882, 95% CI=0.832-0.922) scores was a good prognostic scoring system for predicting short-term mortality in PBSI patients. The SOFA score was more valuable than the other four models in predicting the outcome of PBSI according to the Z-test (p<0.05).Discussion and Conclusions Inappropriate initial empirical antimicrobial therapy, white blood cell and platelet were closely associated with short-term mortality.

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