scholarly journals TNFR1 is associated with short-term mortality in patients with diabetes and acute dyspnea seeking care at the emergency department

2020 ◽  
Vol 57 (10) ◽  
pp. 1145-1150 ◽  
Author(s):  
P. Wändell ◽  
A. C. Carlsson ◽  
A. Larsson ◽  
O. Melander ◽  
T. Wessman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cox Regression ◽  
Secondary Analysis ◽  
Medical Emergency ◽  
Acute Dyspnea ◽  
Short Term ◽  
Patients With Diabetes ◽  
Short Term Mortality ◽  
Study Association ◽  
Circulating Levels

Abstract Background Circulating levels of TNF alpha receptor 1 (TNFR1) and 2 (TNFR2) are associated with increased long-term mortality and impaired kidney function. Aim To study association between circulating levels of TNFR1 and TNFR2 and short-term mortality in patients with diabetes and dyspnea. Population and methods Patients aged ≥ 18 years seeking at emergency department (ED) during daytime on weekdays between December 2013 and July 2018, with diabetes and acute dyspnea, identified at the triage process, were included. Participants (n = 291) were triaged according to Medical Emergency Triage and Treatment System-Adult score, and blood samples were collected. Association between TNFR1 and TNFR2, respectively, and 90-day mortality were estimated by Cox regression models adjusted for age, sex, BMI, creatinine and CRP. Results Univariate models showed significant associations between TNFR1 and TNFR2, respectively, and CRP, age and creatinine. TNFR1 and TNFR2 tended to be elevated in patients with the highest triage level, compared to patients with lower triage levels (ns). In longitudinal analyses, TNFR1 but not TNFR2 was associated with increased short-term mortality, HR adjusted for age, BMI and creatinine 1.43 (95% CI 1.07–1.91), but not in the model also adjusted for CRP, HR 1.29 (95% CI 0.94–1.77). In secondary analysis for quartile 4 versus quartiles 1–3 of TNFR1, corresponding HRs were 2.46 (95% CI 1.27–5.15) and 2.21 (95% CI 1.07–2.56). Conclusions We found a trend for the association between circulating TNFR1 levels and short-term mortality in patients with diabetes and acute dyspnea at the ED, possibly suggesting an inflammatory pathway for the association.

scholarly journals Systolic blood pressure and short-term mortality in the emergency department and prehospital setting: a hospital-based cohort study

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
Author(s):  
Anders Kasper Bruun Kristensen ◽  
Jon Gitz Holler ◽  
Søren Mikkelsen ◽  
Jesper Hallas ◽  
Annmarie Lassen
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Cohort Study ◽  
Systolic Blood Pressure ◽  
Prehospital Setting ◽  
Short Term ◽  
Short Term Mortality

scholarly journals An Investigation of Risk Factors Affecting Short Term Mortality of Patients Referring to the Hospital Emergency Department

2020 ◽  
Author(s):  
Elham Peyravi ◽  
Hadid Hamrah ◽  
Mohammad Sadegh Masoudi ◽  
Milad Ahmadi Marzaleh ◽  
Mahmoudreza Peyravi
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Emergency Department ◽  
Systolic Blood Pressure ◽  
Fars Province ◽  
Hospital Emergency ◽  
Short Term ◽  
Factors Affecting ◽  
Emergency Department Overcrowding ◽  
Short Term Mortality

Abstract Background and Objective: One of the causes of short-term mortality in patients is the lower quality of services provided by hospital emergency departments. Given the particular importance of the hospital emergency system and the presence of numerous problems, as well as short term mortality rates in hospitals, this study aimed to investigate the risk factors affecting short term mortality of patients presenting to the Emergency Department at Nemazi Hospital in Shiraz, Fars province in 2019.Methods: This is a retrospective study with a case control-analytical design. The sample size was 768 subjects. In the present study, the emergency department overcrowding was measured by the NEDOCS (National Emergency Department Overcrowding Scale) criterion. The severity of the disease was also evaluated based on the level of the triage of patients through the Emergency Severity Index (ESI) system and vital signs.Results: With each year increase in age, the chance of short-term mortality increases by 0.8%. People with O2 sat% <90% are 7.3 times more likely to experience short term mortality in an emergency department compared to people with O2 sat%> 90%. A significant relationship was noted between short term mortality and SBP (systolic blood pressure) in the hospital's emergency department. It was also found out that as the triage score increases, short term mortality decreases significantly. As hospital stay increases, the chance of the patients' mortality decreases by 0.5%.Conclusion: The percentage of arterial blood oxygen saturation, systolic blood pressure, respiration rate per minute, triage score, the way the patient arrives at the hospital, working shifts, hospitalization duration, age, and comorbidities were regarded as the risk factors for short term mortality. Therefore, promoting professional knowledge and skills of nurses and physicians in the hospitals' emergency department and up-to-dating and reviewing emergency protocols as well as similar research can greatly help reduce short term mortality in the hospital's emergency department.

scholarly journals Validating the RISE UP score for predicting prognosis in patients with COVID-19 in the emergency department, a retrospective study

2020 ◽  
Author(s):  
Paul M.E.L. van Dam ◽  
Noortje Zelis ◽  
Patricia M. Stassen ◽  
Daan J.L. van Twist ◽  
Peter W. de Leeuw ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adverse Outcome ◽  
Vital Signs ◽  
Favourable Outcome ◽  
Secondary Outcome ◽  
Care Hospital ◽  
Short Term ◽  
Short Term Mortality ◽  
Patients At Risk ◽  
System Information

AbstractObjectiveTo mitigate the burden of COVID-19 on the healthcare system, information on the prognosis of the disease is needed. The recently developed RISE UP score has very good discriminatory value with respect to short-term mortality in older patients in the emergency department (ED). It consists of six items: age, abnormal vital signs, albumin, blood urea nitrogen (BUN), lactate dehydrogenase (LDH), and bilirubin. We hypothesized that the RISE UP score could have discriminatory value with regard to 30-day mortality in ED patients with COVID-19.SettingTwo EDs of the Zuyderland Medical Centre (MC), secondary care hospital in the Netherlands.ParticipantsThe study sample consisted of 642 adult ED patients diagnosed with COVID-19 between March 3rd until May 25th 2020. Inclusion criteria were: 1) admission to the hospital with symptoms suggestive of COVID-19, and 2) positive result of the polymerase chain reaction (PCR), or (very) high suspicion of COVID-19 according to the chest computed tomography (CT) scan.OutcomePrimary outcome was 30-day mortality, secondary outcome was a composite of 30-day mortality and admission to intensive care unit (ICU).ResultsWithin 30 days after presentation, 167 patients (26.0%) died and 102 patients (15.9%) were admitted to ICU. The RISE UP score showed good discriminatory value with respect to 30-day mortality (AUC 0.77, 95% CI 0.73-0.81), and to the composite outcome (AUC 0.72, 95% CI 0.68-0.76). Patients with RISE UP scores below 10% (121 patients) had favourable outcome (0% mortality and 5% ICU admissions). Patients with a RISE UP score above 30% (221 patients) were at high risk of adverse outcome (46.6% mortality and 19% ICU admissions).ConclusionThe RISE UP score is an accurate prognostic model for adverse outcome in ED patients with COVID-19. It can be used to identify patients at risk of short-term adverse outcome, and may help guiding decision-making and allocating healthcare resources.

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