Hospital mortality and long-term mortality among hospitalized patients with various admission serum ionized calcium levels

Abstract Aim The aim of this study is to assess the association between admission serum albumin and short- and long-term mortality in all hospitalized patients. Design A single-center cohort study. Methods A retrospective cohort of all adult hospitalized patients at a tertiary referral hospital between January 2009 and December 2013 were analysed. Admission serum albumin was stratified into six groups: ≤2.4, 2.5–2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4 and ≥4.5 g/dl. The outcomes of interest were in-hospital mortality, length of hospital stay and 1-year mortality. Serum albumin of 4–4.4 g/dl was selected as a reference group for outcome comparison. Results A total of 14 075 patients were studied. Admission serum albumin of ≥4.5 g/dl had the lowest in-hospital and 1-year mortality with progressively increased in-hospital mortality observed with decreased admission serum albumin. In adjusted analysis, compared with serum albumin of 4.0–4.4 g/dl, serum albumin of ≤2.4, 2.5–2.9, 3.0–3.4 and 3.5–3.9 were significantly associated with increased in-hospital and 1-year mortality. In contrast, serum albumin of ≥4.5 g/dl was significantly associated with lower 1-year mortality but not in-hospital mortality. Admission serum albumin <4.0 g/dl was significantly associated with a prolonged hospital stay, while admission serum albumin of ≥4.5 g/dl was significantly associated with shorter hospital stay, compared with serum albumin of 4.0–4.4 g/dl. Conclusion Low albumin level at admission was progressively associated with increased short- and long-term mortality in all hospitalized patients even when albumin level was considered in normal range.

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Age and Other Risk Factors Influencing Long-Term Mortality in Patients With Traumatic Cervical Spine Fracture

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318770882 ◽

2018 ◽

Vol 9 ◽

pp. 215145931877088 ◽

Cited By ~ 2

Author(s):

Matthew Bank ◽

Katie Gibbs ◽

Cristina Sison ◽

Nawshin Kutub ◽

Angelos Papatheodorou ◽

...

Keyword(s):

Cervical Spine ◽

Hospital Mortality ◽

Spine Fracture ◽

Cervical Spine Fracture ◽

Spine Fractures ◽

Term Survival ◽

Factors Influencing ◽

Cervical Spine Fractures ◽

Long Term Mortality

Objective: To identify clinical or demographic variables that influence long-term mortality, as well as in-hospital mortality, with a particular focus on the effects of age. Summary and Background Data: Cervical spine fractures with or without spinal cord injury (SCI) disproportionately impact the elderly who constitute an increasing percentage of the US population. Methods: We analyzed data collected for 10 years at a state-designated level I trauma center to identify variables that influenced in-hospital and long-term mortality among elderly patients with traumatic cervical spine fracture with or without SCI. Acute in-hospital mortality was determined from hospital records and long-term mortality within the study period (2003-2013) was determined from the National Death Index. Univariate and multivariate regression analyses were used to identify factors influencing survival. Results: Data from patients (N = 632) with cervical spine fractures were analyzed, the majority (66%) of whom were geriatric (older than age 64). Most patients (62%) had a mild/moderate injury severity score (ISS; median, interquartile range: 6, 5). Patients with SCI had significantly longer lengths of stay (14.1 days), days on a ventilator (3.5 days), and higher ISS (14.9) than patients without SCI ( P < .0001 for all). Falls were the leading mechanism of injury for patients older than age 64. Univariate analysis identified that long-term survival decreased significantly for all patients older than age 65 (hazard ratio [HR]: 1.07; P < .0001). Multivariate analysis demonstrated age (HR: 1.08; P < .0001), gender (HR: 1.60; P < .0007), and SCI status (HR: 1.45, P < .02) significantly influenced survival during the study period. Conclusion: This study identified age, gender, and SCI status as significant variables for this study population influencing long-term survival among patients with cervical spine fractures. Our results support the growing notion that cervical spine injuries in geriatric patients with trauma may warrant additional research.

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Abstract WP379: Sex-specific Effects of Comorbid Diabetes and Depression on Post-stroke Mortality in Individuals With Atrial Fibrillation

Stroke ◽

10.1161/str.51.suppl_1.wp379 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Jodi Edwards ◽

Jessica Colby-Milley ◽

Jiming Fang ◽

Limei Zhou ◽

Baiju R Shah ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hospital Mortality ◽

Recurrent Stroke ◽

Stroke Patients ◽

Comorbid Depression ◽

Term Care ◽

Post Stroke ◽

Specific Effects ◽

Long Term Mortality

Background: Comorbid diabetes and depression are highly prevalent in atrial fibrillation (AF) and increase the risk of stroke. Women with AF show higher mortality rates and have worse functional outcomes post-stroke. However, the sex-specific effects of comorbid diabetes and depression on mortality and other adverse outcomes in stroke patients with a history of AF is unclear. Methods: Prospectively collected consecutive patients with ischemic stroke and known AF presenting to designated stroke centres in Ontario (2003-2013). Multinomial regression was used to determine sex-specific associations between diabetes and depression and in-hospital mortality post-stroke in individuals with AF. Cox proportional hazards regression was used to estimate the adjusted hazard of long-term mortality post-stroke and competing risks models to estimate hazards of recurrent stroke/TIA, admission to long-term care, and incident dementia post-discharge. Results: Among 5082 stroke patients with known AF (median age=80, IQR:73-85), female patients were more likely to have comorbid depression than males (63.5% vs. 36.5%) and those with comorbid diabetes and depression were younger (77 yrs) and had more vascular history (HTN, CAD, hyperlipidemia) than those with AF only. For males, comorbid diabetes increased the likelihood of in-hospital mortality post-stroke by 53% (OR=1.53, 95% CI=1.16-2.02), after adjustment for stroke severity, demographic and clinical factors, while comorbid depression did not significantly impact in-hospital mortality and neither diabetes or depression affected in-hospital mortality post-stroke for females. However, diabetes was independently associated with increased hazard of long-term mortality for both female (HR=1.15, 95%CI=1.02-1.29) and male AF stroke patients (HR=1.35, 95%CI=1.19-1.53). No associations with recurrent stroke/TIA, institutionalization or dementia post-stroke were observed for either females or males. Conclusion: In stroke patients with known AF, comorbid diabetes but not depression was independently associated with increased in-hospital mortality for males and increased long-term mortality post-stroke for both females and males.

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Comparing the Prognostic Value of Hematological Indices in Patients With ST Segment Elevation Myocardial Infarction: “A Head to Head” Analysis

Angiology ◽

10.1177/0003319720977754 ◽

2020 ◽

pp. 000331972097775

Author(s):

Serhat Sigirci ◽

Özgür Selim Ser ◽

Kudret Keskin ◽

Süleyman Sezai Yildiz ◽

Ahmet Gurdal ◽

...

Keyword(s):

Myocardial Infarction ◽

Mortality Rate ◽

Hospital Mortality ◽

Hematological Indices ◽

St Segment Elevation ◽

Lymphocyte Ratio ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Long Term Mortality

Although there are reviews and meta-analyses focusing on hematological indices for risk prediction of mortality in patients with ST segment elevation myocardial infarction (STEMI), there are not enough data with respect to direct to head-to-head comparison of their predictive values. We aimed to investigate which hematological indices have the most discriminatory capability for prediction of in-hospital and long-term mortality in a large STEMI cohort. We analyzed the data of 1186 patients with STEMI. In-hospital and long-term all-cause mortality was defined as the primary end point of the study. In-hospital mortality rate was 8.6% and long-term mortality rate 9.0%. Although the neutrophil to lymphocyte ratio (NLR) and age were found to be independent predictors of in-hospital mortality in the multivariate regression analyses; Cox regression analysis revealed that age, ejection fraction, red cell distribution width (RDW), and monocyte to high-density lipoprotein ratio (MHDLr) were independently associated with long-term mortality. Neutrophil to lymphocyte ratio had the highest area under curve value in the receiver operating characteristic curve analyses for prediction of in-hospital mortality. In conclusion, while NLR may be used for prediction of in-hospital mortality, RDW and MHDLr ratio are better hematological indices for long-term mortality prediction after STEMI than other most common indices.

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Hospital-Acquired Serum Ionized Calcium Derangements and Their Associations with In-Hospital Mortality

Medicines ◽

10.3390/medicines7110070 ◽

2020 ◽

Vol 7 (11) ◽

pp. 70

Author(s):

Charat Thongprayoon ◽

Panupong Hansrivijit ◽

Tananchai Petnak ◽

Michael A. Mao ◽

Tarun Bathini ◽

...

Keyword(s):

Hospital Mortality ◽

Reference Range ◽

Medical Center ◽

Normal Serum ◽

Ionized Calcium ◽

Normal Reference Range ◽

Serum Ionized Calcium ◽

Hospital Acquired ◽

Relationship Of ◽

The Relationship

Background: The objective of this study was to report the incidence of in-hospital serum ionized calcium derangement and its impact on mortality. Methods: We included 12,599 non-dialytic adult patients hospitalized at a tertiary medical center from January 2009 to December 2013 with normal serum ionized calcium at admission and at least 2 in-hospital serum ionized calcium values. Using serum ionized calcium of 4.60–5.40 mg/dL as the normal reference range, in-hospital serum ionized calcium levels were categorized based on the presence of hypocalcemia and hypercalcemia in hospital. We performed logistic regression to assess the relationship of in-hospital serum ionized calcium derangement with mortality. Results: Fifty-four percent of patients developed new serum ionized calcium derangements: 42% had in-hospital hypocalcemia only, 4% had in-hospital hypercalcemia only, and 8% had both in-hospital hypocalcemia and hypercalcemia. In-hospital hypocalcemia only (OR 1.28; 95% CI 1.01–1.64), in-hospital hypercalcemia only (OR 1.64; 95% CI 1.02–2.68), and both in-hospital hypocalcemia and hypercalcemia (OR 1.73; 95% CI 1.14–2.62) were all significantly associated with increased in-hospital mortality, compared with persistently normal serum ionized calcium levels. Conclusions: In-hospital serum ionized calcium derangements affect more than half of hospitalized patients and are associated with increased in-hospital mortality.

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The nutritional risk and short-, medium- and long-term mortality of hospitalized patients with atrial fibrillation

Aging Clinical and Experimental Research ◽

10.1007/s40520-019-01152-3 ◽

2019 ◽

Vol 31 (12) ◽

pp. 1775-1781

Author(s):

Jesús Díez-Manglano ◽

Carolina Clemente-Sarasa

Keyword(s):

Atrial Fibrillation ◽

Hospitalized Patients ◽

Nutritional Risk ◽

Long Term Mortality

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Prehospital tele-electrocardiographic triage improves the management of acute coronary syndrome in rural populations: A systematic review and meta-analysis

Journal of Telemedicine and Telecare ◽

10.1177/1357633x20960627 ◽

2020 ◽

pp. 1357633X2096062

Author(s):

Gilbert Lazarus ◽

HL Kirchner ◽

Bambang B Siswanto

Keyword(s):

Acute Coronary Syndrome ◽

Hospital Mortality ◽

Rural Areas ◽

Emergency Services ◽

Meta Analysis ◽

Coronary Syndrome ◽

Evidence Quality ◽

Poor Outcomes ◽

Long Term Mortality

Introduction Acute coronary syndrome (ACS) patients residing in rural areas are predisposed to higher risk of poor outcomes due to substantial delays in disease management, emphasising the importance of emerging telecardiology technologies in delivering emergency services in such settings. This meta-analysis aimed to investigate the impacts of prehospital telecardiology strategies on the clinical outcomes of rural ACS patients. Methods A literature search was performed of articles published up to April 2020 through six databases. Included studies were assessed for bias risk using the ROBINS-I tool, and a random-effects model was utilised to estimate effect sizes. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results Twelve studies with a total of 3989 patients were included in this review. Prehospital telecardiology in the form of tele-electrocardiography (tele-ECG) enabled prompt diagnosis and triage, resulting in a decreased door-to-balloon (DTB) time (mean difference = –25.53 minutes, 95% confidence interval (CI) –36.08 to –14.97 minutes; I2 = 98%), as well as lower in-hospital mortality (odds ratio (OR) = 0.57, 95% CI 0.36–0.92) and long-term mortality (OR = 0.52, 95% CI 0.39–0.69) rates, both with negligible heterogeneity ( I2 = 0%). GRADE assessment yielded very low to moderate certainty of evidence. Conclusion Prehospital tele-ECG appeared to be an effective and worthwhile approach in the management of rural ACS patients, as shown by moderate quality evidence on lower long-term mortality. Given the uncertainties of the evidence quality on DTB time and in-hospital mortality, future studies with a higher quality of evidence are required to confirm our findings.

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Effect of Dynamic Potassium Change on In-Hospital Mortality, Ventricular Arrhythmias, and Long-Term Mortality in STEMI

Angiology ◽

10.1177/0003319718784127 ◽

2018 ◽

Vol 70 (1) ◽

pp. 69-77 ◽

Cited By ~ 6

Author(s):

Adnan Kaya ◽

Muhammed Keskin ◽

Mustafa Adem Tatlisu ◽

Osman Kayapinar

Keyword(s):

Regression Analysis ◽

Ventricular Arrhythmia ◽

Hospital Mortality ◽

Mortality Risk ◽

Ventricular Arrhythmias ◽

Cox Regression ◽

Cox Regression Analysis ◽

Normal Ranges ◽

Long Term Mortality

We evaluated the effect of serum potassium (K) deviation on in-hospital and long-term clinical outcomes in patients with ST-segment elevation myocardial infarction who were normokalemic at admission. A total of 2773 patients with an admission serum K level of 3.5 to 4.5 mEq/L were retrospectively analyzed. The patients were categorized into 3 groups according to their K deviation: normokalemia-to-hypokalemia, normokalemia-to-normokalemia, and normokalemia-to-hyperkalemia. In-hospital mortality, long-term mortality, and ventricular arrhythmias rates were compared among the groups. In a hierarchical multivariable regression analysis, the in-hospital mortality risk was higher in normokalemia-to-hypokalemia (odds ratio [OR] 3.03; 95% confidence interval [CI], 1.72-6.82) and normokalemia-to-hyperkalemia groups (OR 2.81; 95% CI, 1.93-4.48) compared with the normokalemia-to-normokalemia group. In a Cox regression analysis, long-term mortality risk was also higher in normokalemia-to-hypokalemia (hazard ratio [HR] 3.78; 95% CI, 2.07-7.17) and normokalemia-to-hyperkalemia groups (HR, 2.97; 95% CI, 2.10-4.19) compared with the normokalemia-to-normokalemia group. Ventricular arrhythmia risk was also higher in normokalemia-to-hypokalemia group (OR 2.98; 95% CI, 1.41-5.75) compared with normokalemia-to-normokalemia group. The current study showed an increased in-hospital ventricular arrhythmia and mortality and long-term mortality rates with the deviation of serum K levels from normal ranges.

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