Irrespective of the degree of hyperlactatemia, similar lactate levels were associated with a lower mortality rate in metformin users compared with non-users: beware of confounders!

Abstract Background Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whether the association between lactate levels around ICU admission and mortality is different in metformin users compared to metformin nonusers. Methods This cohort study included patients admitted to ICUs in northern Denmark between January 2010 and August 2017 with any circulating lactate measured around ICU admission, which was defined as 12 h before until 6 h after admission. The association between the mean of the lactate levels measured during this period and 30-day mortality was determined for metformin users and nonusers by modelling restricted cubic splines obtained from a Cox regression model. Results Of 37,293 included patients, 3183 (9%) used metformin. The median (interquartile range) lactate level was 1.8 (1.2–3.2) in metformin users and 1.6 (1.0–2.7) mmol/L in metformin nonusers. Lactate levels were strongly associated with mortality for both metformin users and nonusers. However, the association of lactate with mortality was different for metformin users, with a lower mortality rate in metformin users than in nonusers when admitted with similar lactate levels. This was observed over the whole range of lactate levels, and consequently, the relation of lactate with mortality was shifted rightwards for metformin users. Conclusion In this large observational cohort of critically ill patients, early lactate levels were strongly associated with mortality. Irrespective of the degree of hyperlactataemia, similar lactate levels were associated with a lower mortality rate in metformin users compared with metformin nonusers. Therefore, lactate levels around ICU admission should be interpreted according to metformin use.

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Body & brain: Thin isn't always better in diabetes: Obese have lower mortality rate than normal-weight people

Science News ◽

10.1002/scin.5591820514 ◽

2012 ◽

Vol 182 (5) ◽

pp. 13-13

Author(s):

Meghan Rosen

Keyword(s):

Mortality Rate ◽

Normal Weight ◽

Lower Mortality

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Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study

Journal of Neurosurgery ◽

10.3171/jns.1989.70.4.0530 ◽

1989 ◽

Vol 70 (4) ◽

pp. 530-535 ◽

Cited By ~ 380

Author(s):

Ludwig M. Auer ◽

Wolfgang Deinsberger ◽

Kurt Niederkorn ◽

Günther Gell ◽

Reinhold Kleinert ◽

...

Keyword(s):

Mortality Rate ◽

Medical Treatment ◽

Functional Recovery ◽

Randomized Study ◽

Treated Group ◽

Surgical Patients ◽

Lower Mortality ◽

Intracerebral Hematoma ◽

Content Type ◽

Fine Print

✓ A controlled randomized study of endoscopic evacuation versus medical treatment was performed in 100 patients with spontaneous supratentorial intracerebral (subcortical, putaminal, and thalamic) hematomas. Patients with aneurysms, arteriovenous malformations, brain tumors, or head injuries were excluded. Criteria for inclusion were as follows: patients' age between 30 and 80 years; a hematoma volume of more than 10 cu cm; the presence of neurological or consciousness impairment; the appropriateness of surgery from a medical and anesthesiological point of view; and the initiation of treatment within 48 hours after hemorrhage. The criteria of randomization were the location, size, and side of the hematoma as well as the patient's age, state of consciousness, and history of hypertension. Evaluation of outcome was performed 6 months after hemorrhage. Surgical patients with subcortical hematomas showed a significantly lower mortality rate (30%) than their medically treated counterparts (70%, p < 0.05). Moreover, 40% of these patients had a good outcome with no or only a minimal deficit versus 25% in the medically treated group; the difference was statistically significant for operated patients with no postoperative deficit (p < 0.01). Surgical patients with hematomas smaller than 50 cu cm made a significantly better functional recovery than did patients of the medically treated group, but had a comparable mortality rate. By contrast, patients with larger hematomas showed significantly lower mortality rates after operation but had no better functional recovery than the medically treated group. This effect from surgery was limited to patients in a preoperatively alert or somnolent state; stuporous or comatose patients had no better outcome after surgery. The outcome of surgical patients with putaminal or thalamic hemorrhage was no better than for those with medical treatment; however, there was a trend toward better quality of survival and chance of survival in the operated group.

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Efficacy of mesenchymal stem cell therapy for sepsis: A meta-analysis of preclinical studies

10.21203/rs.3.rs-15951/v2 ◽

2020 ◽

Author(s):

xueyi sun ◽

xianfei ding ◽

huoyan liang ◽

xiaojuan zhang ◽

shaohua liu ◽

...

Keyword(s):

Stem Cell ◽

Mortality Rate ◽

Animal Models ◽

Mesenchymal Stem Cell ◽

Fixed Effects ◽

Meta Analysis ◽

Experimental Models ◽

Lower Mortality ◽

Cochrane Library ◽

Fixed Effects Model

Abstract Background: Multiple studies have reported that mesenchymal stem cell (MSC) therapy has beneficial effects in experimental models of sepsis. However, this finding remains inconclusive. This study was performed to systematically determine the connection between MSC therapy and mortality in sepsis animal models by pooling and analyzing data from newly published studies. Methods: A detailed search of related studies from 2009 to 2019 was conducted in four databases, including MEDLINE, EMBASE, Cochrane Library, and Web of Science. After browsing and filtering out articles that met the inclusion criteria for statistical analysis, the inverse variance method of the fixed effects model was used to calculate the pooled odds ratios (ORs) and their 95% confidence intervals (CIs). Results: Twenty-nine animal studies, including 1,266 animals, were identified. None of the studies were judged to have a low risk of bias. The meta-analysis demonstrated that MSC therapy was related to a significantly lower mortality rate (OR 0.29, 95% CI 0.22–0.38, P <0.001). Subgroup analyses performed based on the MSC injection dose (<1.0 × 10 6 cells, OR=0.33, 95% CI 0.20–0.56, P <0.001; 1.0 × 10 6 cells, OR=0.24, 95% CI 0.16–0.35, P <0.001) and injection time (<1 hour, OR=0.24, 95% CI 0.13–0.45, P <0.001; 1 hour, OR=0.28, 95% CI 0.17–0.46, P <0.001) demonstrated that treatment with MSCs significantly reduced the mortality rate of animals with sepsis. Conclusion: This up-to-date meta-analysis showed a connection between MSC therapy and lower mortality in sepsis animal models, supporting the potential therapeutic effect of MSC treatment in future clinical trials. The results in this study contradict a previous meta-analysis with regards to the ideal dose of MSC therapy. Thus, further research is required to support these findings.

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Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore

BMJ Open ◽

10.1136/bmjopen-2018-027220 ◽

2019 ◽

Vol 9 (5) ◽

pp. e027220 ◽

Cited By ~ 4

Author(s):

Ian Yi Han Ang ◽

Chuen Seng Tan ◽

Milawaty Nurjono ◽

Xin Quan Tan ◽

Gerald Choon-Huat Koh ◽

...

Keyword(s):

Emergency Department ◽

Mortality Rate ◽

Health System ◽

Emergency Admission ◽

Healthcare Utilisation ◽

Lower Mortality ◽

Post Discharge ◽

Discharge Care ◽

High Acuity ◽

The Impact

ObjectiveTo evaluate the impact on healthcare utilisation frequencies and charges, and mortality of a programme for frequent hospital utilisers and a programme for patients requiring high acuity post-discharge care as part of an integrated healthcare model.DesignA retrospective quasi-experimental study without randomisation where patients who received post-discharge care interventions were matched 1:1 with unenrolled patients as controls.SettingThe National University Health System (NUHS) Regional Health System (RHS), which was one of six RHS in Singapore, implemented the NUHS RHS Integrated Interventions and Care Extension (NICE) programme for frequent hospital utilisers and the NUHS Transitional Care Programme (NUHS TCP) for high acuity post-discharge care. The programmes were supported by the Ministry of Health in Singapore, which is a city-state nation located in Southeast Asia with a 5.6 million population.ParticipantsLinked healthcare administrative data, for the time period of January 2013 to December 2016, were extracted for patients enrolled in NICE (n=554) or NUHS TCP (n=270) from June 2014 to December 2015, and control patients.InterventionsFor both programmes, teams conducted follow-up home visits and phone calls to monitor and manage patients’ post-discharge.Primary outcome measuresOne-year pre- and post-enrolment healthcare utilisation frequencies and charges of all-cause inpatient admissions, emergency admissions, emergency department attendances, specialist outpatient clinic (SOC) attendances, total inpatient length of stay and mortality rates were compared.ResultsPatients in NICE had lower mortality rate, but higher all-cause inpatient admission, emergency admission and emergency department attendance charges. Patients in NUHS TCP did not have lower mortality rate, but had higher emergency admission and SOC attendance charges.ConclusionsBoth NICE and NUHS TCP had no improvements in 1 year healthcare utilisation across various setting and metrics. Singular interventions might not be as impactful in effecting utilisation without an overhauling transformation and restructuring of the hospital and healthcare system.

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OP109 Comparison Of The Health System Establishment Periods In Eighty-Eight Countries

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462318001381 ◽

2018 ◽

Vol 34 (S1) ◽

pp. 41-42

Author(s):

Xuan Cheng ◽

Hai-Chao Lei ◽

Yu-Jie Yang ◽

Na-Na Fan ◽

Yi-Ming Pan ◽

...

Keyword(s):

Cold War ◽

Mortality Rate ◽

Health System ◽

Health Systems ◽

Health Expenditure ◽

Lower Mortality ◽

Dependency Ratio ◽

System Establishment ◽

Per Capita ◽

The Cold War

Introduction:Health system reform is considered a tough issue worldwide. Great efforts have been made toward health system building and strengthening. However, it is still unclear which health system is appropriate for different countries. This study aimed to systematically compare the characteristics of the establishment periods between eighty-eight counties of National Health Service (NHS) and Social Health Insurance (SHI).Methods:Forty-eight NHS countries and forty SHI countries with data availability were selected. The establishment years of current health systems and other eighteen indicators in economics, society, population and health during establishment periods were collected. Comparison between NHS and SHI was conducted by descriptive analysis of every indicator.Results:Most NHS countries were established during the cold war, while SHI had been set up since the cold war ended. The median of gross domestic product (GDP) per capita, urbanization rate and aging rate of SHI were USD 1535 in current dollars, 58.2 percent and 9.8 percent, respectively; compared with USD 1387, 41.2 percent and 4.7 percent, respectively of NHS. NHS countries had a smaller total population, lower mortality rate and elderly dependency ratio, while the birth rate and children's dependency ratio were higher. SHI countries showed a higher life expectancy and lower mortality rate in infants and children. NHS countries spent less in total health expenditure and a lower proportion of GDP. The median health expenditure per capita of SHI and NHS were USD 188 and USD 131 in current dollars, respectively. There was little difference among maternal mortality rates, and public and private health expenditure proportions.Conclusions:NHS and SHI countries had different characteristics during the health system establishment periods. NHS was established earlier than SHI overall, so that SHI revealed higher levels in economic and social development. Health outcomes of NHS countries were slightly lower than SHI ones, while health expenditure was more in SHI countries. Specific social, economic, demographic and health conditions should be considered when countries are building their own health systems.

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The effect of treatment during first winter on the subsequent performance of Scottish Blackface ewes

Animal Science ◽

10.1017/s0003356100022066 ◽

1964 ◽

Vol 6 (3) ◽

pp. 273-284 ◽

Cited By ~ 8

Author(s):

A. F. Purser ◽

R. C. Roberts

Keyword(s):

Mortality Rate ◽

Live Weight ◽

Lower Mortality ◽

Subsequent Performance ◽

Effect Of Treatment ◽

The Cost ◽

The Hill

Data on 1,795 Scottish Blackface sheep were examined to see what effect treatment during the animal's first winter had on subsequent performance. Two treatments were used, wintering on the hill with the breeding ewe flock, or wintering away on low-ground farms. Away-wintered sheep gained on average about 16 lb. more than hill-wintered sheep between 6 and 12 months of age. These live-weight differences declined with age to about ⅔lb. at 5–6 years of age. Away-wintered sheep also had heavier first fleeces by about fIb. on average and had a lower mortality rate. However, differences in subsequent fleece weights and lamb production were small and not sufficient to cover the cost of away wintering.

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Effect of surgical stabilization of rib fractures in polytrauma - an analysis of the TraumaRegister DGU®

10.21203/rs.3.rs-414852/v1 ◽

2021 ◽

Author(s):

Lars Becker ◽

Stefan Schulz-Drost ◽

Christopher Spering ◽

Axel Franke ◽

Marcel Dudda ◽

...

Keyword(s):

Intensive Care ◽

Mortality Rate ◽

Hospital Stay ◽

Operative Treatment ◽

Rib Fractures ◽

Lower Mortality ◽

Matched Pair ◽

Data Set ◽

Multiple Rib Fractures ◽

Operative Care

Abstract Purpose: In severely injured patients with multiple rib fractures the beneficial effect of surgical stabilization is still unknown. The existing literature shows divergent results and especially the indication and the right timing of an operation are subject of a broad discussion. The aim of this study was to determine the influence of a surgical stabilization of rib fractures (SSRF) on the outcome in a multi-center database with special regard to the duration of ventilation, intensive care and overall hospital stay.Methods: Data from the TraumaRegister DGU® collected between 2008 and 2017 were used to evaluate patients over 16 years with severe rib fractures (AIS ≥3). In addition to the basic comparison a matched pair analysis of 395 pairs was carried out in order to find differences and to increase comparability.Results: In total 483 patients received an operative treatment and 29,447 were treated conservatively. SSRF was associated with a significantly lower mortality rate (7.6% vs. 3.3%, p = 0.008) but a longer ventilation time and longer stay as well as in the intensive care unit (ICU) as the overall hospital stay. Both matched pair groups showed a good or very good neurological outcome according to the Glasgow Outcome Scale (GOS) in 4 of 5 cases. Contrary to the existing recommendations most of the patients were not operated within 48 hours.Conclusions: In our data set obviously most of the patients were not treated according to the recent literature and showed a delay in the time for operative care of well over 48 hours. This may lead to an increased rate of complications and a longer stay at the ICU and the hospital in general. Despite of these findings patients with operative treatment show a significant lower mortality rate.

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Emergency Laparotomy in the Critically Ill: Futility at the Bedside

Critical Care Research and Practice ◽

10.1155/2018/6398917 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Niels D. Martin ◽

Sagar P. Patel ◽

Kristen Chreiman ◽

Jose L. Pascual ◽

Benjamin Braslow ◽

...

Keyword(s):

Mortality Rate ◽

Critically Ill ◽

High Mortality ◽

Kidney Injury ◽

Acute Care Surgery ◽

Emergency Laparotomy ◽

Abdominal Exploration ◽

Lactate Levels ◽

American Society ◽

Care Surgery

Background. Critically ill patients are often evaluated for an intra-abdominal catastrophe. In the absence of a preoperative diagnosis, abdominal exploration may be offered despite desperate circumstances. We hypothesize that (1) abdominal exploration for such patients is associated with a high mortality and (2) commonly obtained physiologic measures at laparotomy anticipate mortality. Methods. All acute care surgery (ACS) patients undergoing emergency laparotomy at a quaternary referral center during a 3-year period were reviewed. Inclusion was defined by emergency laparotomy in the operating room (OR) in a patient with an American Society of Anesthesiologists (ASA) score ≥4 or bedside laparotomy in the ICU (BSL). Mortality was the primary endpoint and was stratified by demographics, admitting service, surgical findings, and physiology. Comparisons between OR and BSL were by Fisher’s exact and Mann–Whitney tests. Results. 144 patients underwent emergency laparotomy (45 BSL vs. 99 OR). Overall mortality was 55.6% (77.8% BSL vs. 45.5% OR; p<0.001). Mortality by admitting service was cardiac 71.4% (n=42), medical 70% (n=30), ACS 42% (n=50), and other 36.4% (n=22) services. Preoperative lactate levels were higher in nonsurvivors (2.7 vs. 8.5 mmol/L, p<0.001), as was vasopressor use (62.5% vs. 97.5%, p<0.001), acute kidney injury (51.6% vs. 72.5%, p<0.01), leukocytosis (53.1% vs. 71.3%, p<0.04), and anemia (45.3% vs. 71.3%, p<0.01). The presence of any identifiable abdominal pathology established a 90% mortality rate. Conclusions. The need for BSL portends an extremely high mortality rate and is likely useful in preintervention counselling. Emergency OR laparotomy leads to mortality in nearly half of such patients and is anticipatable based on concurrent abnormal physiology.

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Pituitary Apoplexy Leading to Cerebral Infarction: A Systematic Review

European Neurology ◽

10.1159/000507190 ◽

2020 ◽

Vol 83 (2) ◽

pp. 121-130

Author(s):

Qiuhong Jiang ◽

Su Xiao ◽

Liming Shu ◽

Xinyi Huang ◽

Xiuhui Chen ◽

...

Keyword(s):

Systematic Review ◽

Mortality Rate ◽

Conservative Treatment ◽

Cerebral Infarction ◽

Pituitary Apoplexy ◽

Clinical Symptoms ◽

Lower Mortality ◽

Delayed Surgery ◽

Disturbance Of Consciousness ◽

Sudden Headache

Background: Cerebral infarction caused by pituitary apoplexy (PA) is rare. To characterize the clinical features of cerebral infarction caused by PA, we performed a systematic review. Summary: The clinical symptoms are mainly sudden headache, hemiplegia, visual impairment, disturbance of consciousness, and ophthalmalgia in patients with cerebral infarction caused by PA. Treatment for this type of infarction is different from treatment for general acute cerebral infarction. Compared to patients who underwent emergency surgery and conservative treatment, patients treated with delayed surgery showed a better prognosis and a lower mortality rate. Compared to patients who underwent craniotomy or conservative treatment, patients who underwent transsphenoidal surgery (TSS) not only improved well but also showed a lower mortality rate. Key Messages: PA rarely causes cerebral infarction, which is a critical condition with a poor prognosis and is more common in men. Delayed surgery and TSS appear to confer a better prognosis in patients with this condition.

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