Lower Levels of Blood Zinc Associated with Intradialytic Hypertension in Maintenance Hemodialysis Patients

Abstract Intradialytic hypertension (iHTN) has been related with an increased risk of mortality, with imbalances in trace elements being frequent in maintenance hemodialysis (MHD) patients. The aim of this study was to analyze the relationships between the levels of blood trace elements and iHTN in MHD patients. A total of 144 MHD patients were enrolled in September, 2019 (66 females; 5616 hemodialysis treatments), with a mean age of 64.33 ± 13.39 years and median vintage of 33.50 (16.25–57.50) months. Patients exhibited an average peridialytic systolic blood pressure (SBP) change of − 4.18 ± 20.22 mm Hg in the next 3 months. Thirty-four (23.6%) patients had persistent iHTN (piHTN). These patients were characterized by older age, higher rate of hypozincemia, and modified Charlson comorbidity score, whereas lower blood zinc and hemoglobin, at the time of their recruitment. No significant difference in the levels of other blood trace elements was observed between groups. A general linear mixed (GLM) model showed that with every mg/L point lower mean blood zinc at baseline, the peridialytic SBP change was increased by 4.524 mm Hg (P < 0.001). Binary logistic model in modulate of the GLM model revealed that the lower level of blood zinc was associated with piHTN (OR = 0.433, 95 % CI 0.295 to 0.637, P < 0.001). Multivariate analysis confirmed both above results. Our study indicated that lower blood zinc was independently associated with piHTN in patients undergoing MHD, but prospective studies with larger population are still needed.

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Low Blood ALT Activity and High FRAIL Questionnaire Scores Correlate with Increased Mortality and with Each Other. A Prospective Study in the Internal Medicine Department

Journal of Clinical Medicine ◽

10.3390/jcm7110386 ◽

2018 ◽

Vol 7 (11) ◽

pp. 386 ◽

Cited By ~ 12

Author(s):

Gringauz Irina ◽

Cohen Refaela ◽

Brom Adi ◽

Davidi Avia ◽

Hofstetter Liron ◽

...

Keyword(s):

Internal Medicine ◽

Prospective Study ◽

Medicine Department ◽

Internal Medicine Department ◽

Risk Of Mortality ◽

Increased Risk ◽

Significant Difference ◽

L 14 ◽

A Prospective Study ◽

Alt Activity

Background: Low blood ALT, Alanine aminotransferase activity and high FRAIL (Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight) questionnaire scores were previously shown to be associated with frailty and increased risk of mortality. We aimed to correlate these tools with mortality and each other in patients hospitalized in an internal medicine department. Methods: This is a prospective study in a large tertiary hospital. We assessed the predictive value for clinical outcomes of both low ALT blood activity and the pre-frail and frail categories of the “FRAIL” questionnaire. Results: During a 15 months study, 179 consecutive patients were recruited, of whom 20 died. When all study participants were divided to three groups according to admission ALT levels (below 10 IU/L, 11 to 19 IU/L and above 20 IU/L) we found a statistically significant difference in the rate of mortality: 4 patients died within the group of ALT < 10 IU/L, 14 patients died in the group of 10 IU/L < ALT < 19 IU/L and in the group of patients with ALT > 20 IU/L, only 2 patients died (p = 0.042). A higher score on the FRAIL questionnaire was associated, with statistical significance, with higher risk of mortality (p = 0.029). There was a significant correlation (p = 0.038) between blood ALT activity and the pre-frailty and frailty classifications by the FRAIL Questionnaire. Conclusions: Both the FRAIL questionnaire and blood ALT activity are simple and practical tools for frailty assessment and risk stratification of patients hospitalized in the internal medicine department. Both tool’s results also correlate with each other.

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Ten-year single-centre experience with type II endoleaks: Intervention versus observation

Vascular Medicine ◽

10.1177/1358863x17704315 ◽

2017 ◽

Vol 22 (4) ◽

pp. 316-323 ◽

Cited By ~ 9

Author(s):

Ikram-Ul Haq ◽

Arun Kelay ◽

Meryl Davis ◽

Jocelyn Brookes ◽

Tara M Mastracci ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Time Frame ◽

Type Ii ◽

Risk Of Mortality ◽

Surveillance Imaging ◽

Increased Risk ◽

Significant Difference ◽

Aneurysm Growth ◽

Aneurysm Repair

Our objective was to determine the relative merits of intervention or observation of type II endoleaks (T2Ls). A retrospective analysis was performed on 386 infra-renal endovascular aneurysm repair (IR-EVAR) patients from 2006 to 2015. Annual surveillance imaging of patients undergoing EVAR at our centre were analysed, and all endoleaks were subjected to a multidisciplinary team meeting for consideration and treatment. In the 10-year time frame, 386 patients (79.5±8.7 years) underwent an IR-EVAR. Eighty-one patients (21.0%) developed a T2L and intervention was undertaken in 28 (34.6%): 17 (60.7%) were treated via a transarterial approach (TA) and 11 (39.3%) using the translumbar approach (TL). Fifty-three patients (65.4%) with T2Ls were managed conservatively. Patients who received T2L treatment had a greater proportion of recurrent T2Ls than patients who were conservatively managed ( p=0.032). T2Ls associated with aneurysmal growth were more resistant to treatment than those where there was no change or a decrease in aneurysm size during follow-up (0.033). There was no significant difference in the TA and TL approach with respect to endoleak repair success ( p=0.525). Treatment of a T2L did not confer a survival advantage compared to conservative management ( p=0.449) nor did the choice of either the TA or TL approach ( p=0.148). Our study suggests the development of a T2L associated with aneurysm growth may represent an aggressive phenotype that is resistant to treatment. However, this did not lead to an increased risk of mortality over follow-up. Neither a transarterial nor a translumbar approach to treating a T2L conferred superiority.

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664 The ICON Trauma Study: The Impact of the COVID-19 Lockdown on Major Trauma Workload in the UK

British Journal of Surgery ◽

10.1093/bjs/znab134.074 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Adiamah ◽

A i Thompson ◽

C Lewis-Lloyd ◽

E Dickson ◽

L Blackburn ◽

...

Keyword(s):

Major Trauma ◽

Injury Severity ◽

Multivariable Analysis ◽

Similar Time ◽

Historical Cohort ◽

Risk Of Mortality ◽

Major Trauma Centre ◽

Increased Risk ◽

Significant Difference ◽

The Impact

Abstract Introduction Anecdotal evidence suggest a direct impact of the SARS-COV-2-pandemic on presentation and severity of major trauma. Method This observational study from a UK Major Trauma Centre matched a cohort of patients admitted during a 10-week period of the SARS-CoV-2-pandemic (09/03/2020 to 18/05/2020) to a historical cohort admitted during a similar time period in 2019 (11/03/2019 to 20/05/2019). Demographic differences, injury method and severity were compared using Fisher’s and Chi-squared tests. Multivariable logistic regression examined the associated factors predicting 30-day mortality. Results Of 642 patients, 405 and 237 were in the 2019 and 2020 cohorts respectively. 1.69%(4/237) of the 2020 cohort tested SARS-CoV-2 positive. There was a 41.5% decrease in trauma admissions in 2020. The 2020 cohort was older (median 46 vs.40 years), more comorbid and frailer (p < 0.0015). There was a significant difference in injury method with a decrease in vehicle related trauma, but an increase in falls. There was a 2-fold increased risk of mortality in the 2020 cohort that in adjusted models, was explained by higher injury severity and frailty. Positive SARS-CoV-2 status was not associated with increased mortality on multivariable analysis. Conclusions Patients admitted during the SARS-CoV-2-pandemic were older, frailer, more co-morbid and had an increased risk of mortality.

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The ICON Trauma Study: the impact of the COVID-19 lockdown on major trauma workload in the UK

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01593-w ◽

2021 ◽

Author(s):

Alfred Adiamah ◽

◽

Amari Thompson ◽

Christopher Lewis-Lloyd ◽

Edward Dickson ◽

...

Keyword(s):

Major Trauma ◽

Injury Severity ◽

Care Delivery ◽

Mechanism Of Injury ◽

Historical Cohort ◽

Risk Of Mortality ◽

Major Trauma Centre ◽

Increased Risk ◽

Significant Difference ◽

The Impact

Abstract Background The global pandemic caused by SARS-CoV-2 has impacted population health and care delivery worldwide. As information emerges regarding the impact of “lockdown measures” and changes to clinical practice worldwide; there is no comparative information emerging from the United Kingdom with regard to major trauma. Methods This observational study from a UK Major Trauma Centre matched a cohort of patients admitted during a 10-week period of the SARS-CoV-2-pandemic (09/03/2020–18/05/2020) to a historical cohort of patients admitted during a similar time period in 2019 (11/03/2019–20/05/2019). Differences in demographics, Clinical Frailty Scale, SARS-CoV-2 status, mechanism of injury and injury severity were compared using Fisher’s exact and Chi-squared tests. Univariable and multivariable logistic regression analyses examined the associated factors that predicted 30-days mortality. Results A total of 642 patients were included, with 405 in the 2019 and 237 in the 2020 cohorts, respectively. 4/237(1.69%) of patients in the 2020 cohort tested positive for SARS-CoV-2. There was a 41.5% decrease in the number of trauma admissions in 2020. This cohort was older (median 46 vs 40 years), had more comorbidities and were frail (p < 0.0015). There was a significant difference in mechanism of injury with a decrease in vehicle related trauma, but an increase in falls. There was a twofold increased risk of mortality in the 2020 cohort which in adjusted multivariable models, was explained by injury severity and frailty. A positive SARS-CoV-2 status was not significantly associated with increased mortality when adjusted for other variables. Conclusion Patients admitted during the COVID-19 pandemic were older, frailer, more co-morbid and had an associated increased risk of mortality.

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A Functional Ser413/Ser413 PAI-2 Polymorphism Is Associated With Susceptibility and Damage Index Score in Systemic Lupus Erythematosus

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029607308868 ◽

2008 ◽

Vol 15 (2) ◽

pp. 233-238 ◽

Cited By ~ 11

Author(s):

Claudia A. Palafox-Sánchez ◽

Mónica Vázquez-Del Mercado ◽

Gerardo Orozco-Barocio ◽

Ignacio García-De la Torre ◽

Norma Torres-Carrillo ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Healthy Subjects ◽

Damage Index ◽

Index Score ◽

Systemic Lupus ◽

Risk Of Mortality ◽

Increased Risk ◽

Significant Difference

Systemic lupus erythematosus in some cases is characterized for development of thrombotic events with a significantly increased risk of mortality. The frequencies and clinical associations of Ser413/Cys413 PAI-2 polymorphism in 40 systemic lupus erythematosus, 50 rheumatoid arthritis patients, and 100 healthy subjects were investigated. The Ser413/Ser413 genotype frequency was 53% (lupus), 36% (rheumatoid arthritis), and 35% (healthy subjects). The Ser413 allele was associated with systemic lupus erythematosus ( P = .04, odds ratio = 1.76, 95% confidence interval = 1.01-3.06). In all, 4 patient carriers of Ser413/Ser413 genotype, developed thrombotic events. The lupus patients identified with Ser 413/Ser413 genotype showed an increased damage (57%), compared with Ser413/Cys413 and Cys413/Cys413 genotypes, with significant difference ( P = .03). These findings suggest an association of Ser413/Ser413 genotype with greater damage index score and Ser413 allele with systemic lupus erythematosus. Besides, PAI-2 polymorphism could be related with thrombotic phenomena in systemic lupus erythematosus

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Effect of Antipyretic Therapy on Mortality in Critically Ill Patients with Sepsis Receiving Mechanical Ventilation Treatment

Canadian Respiratory Journal ◽

10.1155/2017/3087505 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Sheng Ye ◽

Dan Xu ◽

Chenmei Zhang ◽

Mengyao Li ◽

Yanyi Zhang

Keyword(s):

Mechanical Ventilation ◽

Regression Model ◽

Critically Ill ◽

Mortality Risk ◽

Critically Ill Patients ◽

Risk Of Death ◽

External Cooling ◽

Risk Of Mortality ◽

Increased Risk ◽

Significant Difference

Purpose. The study aimed to investigate the effectiveness of antipyretic therapy on mortality in critically ill patients with sepsis requiring mechanical ventilation. Methods. In this study, we employed the multiparameter intelligent monitoring in intensive care II (MIMIC-II) database (version 2.6). All patients meeting the criteria for sepsis and also receiving mechanical ventilation treatment were included for analysis, all of whom suffer from fever or hyperthermia. Logistic regression model and R language (R version 3.2.3 2015-12-10) were used to explore the association of antipyretic therapy and mortality risk in critically ill patients with sepsis receiving mechanical ventilation treatment. Results. A total of 8,711 patients with mechanical ventilator were included in our analysis, and 1523 patients died. We did not find any significant difference in the proportion of patients receiving antipyretic medication between survivors and nonsurvivors (7.9% versus 7.4%, p=0.49). External cooling was associated with increased risk of death (13.5% versus 9.5%, p<0.001). In our regression model, antipyretic therapy was positively associated with mortality risk (odds ratio [OR]: 1.41, 95% CI: 1.20–1.66, p<0.001). Conclusions. The use of antipyretic therapy is associated with increased risk of mortality in septic ICU patients requiring mechanical ventilation. External cooling may even be deleterious.

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Platelet-to-lymphocyte ratio as a prognostic predictor of mortality for sepsis: interaction effect with disease severity—a retrospective study

BMJ Open ◽

10.1136/bmjopen-2018-022896 ◽

2019 ◽

Vol 9 (1) ◽

pp. e022896 ◽

Cited By ~ 6

Author(s):

Yanfei Shen ◽

Xinmei Huang ◽

Weimin Zhang

Keyword(s):

Sofa Score ◽

Logistic Model ◽

Kidney Injury ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Risk Of Mortality ◽

Increased Risk ◽

Failure Assessment ◽

Vasopressor Use

ObjectiveThe role of platelet-to-lymphocyte ratio (PLR) as an indicator of inflammation has been the focus of research recently. We aimed to investigate theprognosticvalue of PLR for sepsis.DesignA retrospective cohort study.Setting and participantsData were extracted from the Multiparameter Intelligent Monitoring in Intensive Care III database. Data on 5537 sepsis patients were analysed.MethodsLogistic regression was used to explore the association between PLR and hospital mortality. Subgroup analyses were performed based on vasopressor use, acute kidney injury (AKI) and a Sequential Organ Failure Assessment (SOFA) score >10.ResultsIn the logistic model with linear spline function, a PLR >200 was significantly (OR 1.0002; 95% CI 1.0001 to 1.0004) associated with mortality; the association wasnon-significantfor PLRs ≤200 (OR 0.997; 95% CI 1.19 to 1.67). In the logistic model using the PLR as a design variable, only high PLRs were significantly associated with mortality (OR 1.29; 95% CI 1.09 to 1.53); the association with low PLRs wasnon-significant(OR 1.15; 95% CI 0.96 to 1.38). In the subgroups with vasopressor use, AKI and a SOFA score >10, the association between high PLR and mortality wasnon-significant; this remained significant in the subgroups without vasopressor use (OR 1.39; 95% CI 1.08 to 1.77) and AKI (OR 1.54; 95% CI 1.20 to 1.99) and with a SOFA score ≤10 (OR 1.51; 95% CI 1.17 to 1.94).ConclusionsHigh PLRs at admission were associated with an increased risk of mortality. In patients with vasopressor use, AKI or a SOFA score >10, this association wasnon-significant.

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Prevalence of Hypothyroidism Among Patients With COVID-19, Tehran, Iran

10.21203/rs.3.rs-858279/v1 ◽

2021 ◽

Author(s):

Fatemeh Esfahanian ◽

SeyedAhmad SeyedAlinaghi ◽

Nazanin Janfaza ◽

Marcarious M. Tantuoyir

Keyword(s):

Virus Disease ◽

Normal Population ◽

University Hospital ◽

P Value ◽

Demographic Information ◽

Risk Of Death ◽

Disease Prognosis ◽

Risk Of Mortality ◽

Increased Risk ◽

Significant Difference

Abstract Objective: Numerous comorbidities are involved in the severity of Corona Virus Disease 2019 (COVID-19). Hypothyroidism's impact on COVID-19 is yet to be understood properly. Cellular immunity and different cytokines, on the other hand, are thought to play a role in the development and progress of COVID-19 and thyroid disease, according to earlier research. The goal of this study was to find out how common (prevalent) hypothyroidism was among COVID-19 patients and its possible influence on the disease prognosis on hospitalized patients at a Tehran University Hospital.Methods: Demographic information and other data related to our study, mainly comorbidities, were collected from 493 COVID-19 patients’ medical records and analyzed.Results: We identified that hypothyroidism was significantly prevalent in hospitalized COVID-19 patients than in the general population. Overall, in patients with hypothyroidism (n=65), n=21(32.3%) patients expired of whom 14 (66.7%) patients were females and 7 (33.3%) were males. In these patients, no statistically significant difference was observed between the expired and discharged groups (Adjusted Odds Ratio (ORadj): 1.04 (95% Confidence Interval (CI): 0.59-1.83 p-value=0.87). As a result, hypothyroidism was not linked to an increased risk of death.Conclusion: In this current study, we demonstrated that the prevalence of hypothyroidism was higher in hospitalized COVID-19 patients than in the normal population especially in females but without significant adverse effects on the risk of mortality from this disease.

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Mortality Associated With Intubation and Mechanical Ventilation in Patients with COVID-19

10.1101/2020.08.13.20174524 ◽

2020 ◽

Author(s):

Patrick Zimmerman ◽

Stephanie Stroever ◽

Timothy Burton ◽

Karri Hester ◽

Minha Kim ◽

...

Keyword(s):

Mechanical Ventilation ◽

Mortality Rate ◽

Hospital Mortality ◽

Mechanically Ventilated ◽

Patients Âgés ◽

Risk Of Mortality ◽

Increased Risk ◽

Significant Difference ◽

Race Ethnicity ◽

Overall Mortality

Objective: The need for critical care, hemodynamic support, renal replacement therapy, and mechanical ventilation have emerged as key features of the SARS-nCoV-2 (COVID-19) pandemic. The primary aim of this study was to determine the in-hospital mortality rate of mechanically ventilated patients. We also sought to determine the risk of in-hospital mortality by age, gender, race, ethnicity, and body mass index. Methods: We performed a retrospective cohort study to determine the mortality rate among inpatient adults with COVID-19 on mechanical ventilation in the Nuvance Health system between March 1, 2020 and July 17, 2020. Patients were included if they were 18 years or older, had a laboratory confirmed COVID-19 diagnosis, were admitted to hospitals within the Nuvance Health network (7 hospitals), and were on mechanical ventilation at any time during their inpatient stay. Results: Overall mortality in our cohort of 304 patients was 53.3 percent. Multivariable logistic regression including age, gender, race, ethnicity, and BMI demonstrated patients over 71 years old had greater risk of mortality compared to patients ages 61-70, and females had half the risk compared to males. There was no significant difference in risk of mortality given race, ethnicity, or BMI. Conclusions: In adult patients with confirmed COVID-19 infection requiring mechanical ventilation and intensive care, advanced age (>71 years old) and male gender are associated with increased risk of mortality. This information contributes to a collective body of evidence to support ongoing planning and decision-making among clinicians and for directed infection prevention programming.

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