Platelet/Lymphocyte Ratio and Risk of In-Hospital Mortality in Patients with ST-Elevated Myocardial Infarction - A Prospective Observational Study from KIMS, Hubli, Karnataka

2021 ◽  
Vol 8 (41) ◽  
pp. 3528-3533
Author(s):  
Uday Subhash Bande ◽  
Kalinga Bommanakatte Eranaik ◽  
Basawantrao Kailash Patil ◽  
Manjunath Shivalingappa Hiremani ◽  
Sushma Shankaragouda Biradar
Keyword(s):  
Myocardial Infarction ◽  
Observational Study ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Atherosclerotic Plaque ◽  
Prospective Observational Study ◽  
Receiver Operating Curve ◽  
Lymphocyte Ratio ◽  
Coronary Syndrome ◽  
Platelet Lymphocyte Ratio

BACKGROUND Cardiovascular disease is a significant health problem in India with an estimate 3.7 million deaths each year. Mechanisms of myocardial ischemia include inflammation, endothelial dysfunction, platelet aggregation and coagulation. Acute coronary syndrome occurs due to rupture of atherosclerotic plaque. Platelets play a role in both development and rupture of the atherosclerotic plaque. Lymphocytes play a role in chronic inflammation of atherosclerosis. Lower lymphocyte count has increased mortality after acute myocardial infarction. METHODS The study was conducted in Department of General Medicine, Karnataka Institute of Medical Sciences, Hubli from February 2019 to December 2020. It is a prospective observational study. Patients aged ≥ 18 years with ST-elevated myocardial infarction (STEMI) were included in the study. Total 156 cases were selected based on inclusion and exclusion criteria. Cardiovascular events during the in-hospital period were noted. The study population was divided into tertiles based on the platelet-lymphocyte ratio (PLR) values. The low PLR group (n = 104) was defined as having values in the lower 2 tertiles (PLR ≤ 148.4) and the high PLR group (n = 52) was defined as having values in the highest tertile (PLR > 148.4). A ‘P’ value < 0.05 was considered statistically significant. RESULTS Out of 156 patients, 103 (66 %) were males and 53 (34 %) cases were female. Mean age group was 59 ± 10 years. Percentage of patients who underwent thrombolysis was higher in high PLR group (65.38 % vs. 48.07 %, P = 0.041). Death rate was higher in high PLR group (28.84 % vs. 8.65 %, P = 0.001). PLR > 148.4 was found to be an independent predictor of in-hospital cardiovascular mortality in multivariate analyses (hazard ratio: 13.222 (2.113-21.749) P = 0.006 with 95 % confidence interval). Receiver operating curve (ROC) analyses, a PLR value of 148.4 for in-hospital mortality rate had sensitivity of 62.5 % and a specificity of 72 % (area under the curve = 0.627, 95% confidence interval 0.485 – 0.769). CONCLUSIONS In our study, higher PLR had significant association with in-hospital mortality in patients with STEMI. KEYWORDS ST Elevation Myocardial Infarction (STEMI), Platelet/Lymphocyte Ratio (PLR), Ischemic Heart Disease (IHD)

scholarly journals Neutrophil-to-lymphocyte ratio for predictor of in-hospital mortality in ST-segment elevation myocardial infarction: a meta-analysis

2020 ◽  
Vol 29 (2) ◽  
pp. 172-82
Author(s):  
Rodry Mikhael ◽  
Evan Hindoro ◽  
Sharleen Taner ◽  
Antonia Anna Lukito
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
St Segment Elevation ◽  
Lymphocyte Ratio ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality

BACKGROUND ST-segment elevation myocardial infarction (STEMI) is the most life-threatening condition of acute coronary syndrome that carries a poor prognosis of in-hospital mortality. Multiple scoring systems have been developed to predict in-hospital mortality and other cardiovascular events. Neutrophil-to-lymphocyte ratio (NLR) is hardly used as a predictor of in-hospital mortality. This study was aimed to determine the predictive value of NLR concerning in-hospital mortality in STEMI patients. METHODS Literature search and pooled analysis related to studies on MEDLINE/PubMed, EBSCO, Science Direct, Cochrane, and ProQuest were retrieved. Inclusion criteria were met if they were cohort studies, the subjects were STEMI patient, contained pretreatment NLR cut-off, and considered in-hospital mortality, which is defined as cardiac or all-cause mortality. Quality assessment was conducted using Newcastle-Ottawa scale. Review Manager version 5.3 (The Nordic Cochrane Centre, Copenhagen) was used for meta-analysis. RESULTS We found 12 studies with a total of 7,251 STEMI subjects with median NLR cut-off value of 5.6. Elevated NLR on admission carries a high risk of in-hospital mortality (odds ratio [OR] = 3.00, 95% confidence interval [CI] = 2.46–3.67). A slightly higher risk of all-cause mortality (OR = 2.74, 95% CI = 1.99–3.77) was observed compared with cardiac-related mortality (OR = 3.20, 95% CI = 2.47–4.14). No significant heterogeneity was observed between these studies (p = 0.46, I2 = 0%). CONCLUSIONS Elevated NLR predicts a higher in-hospital mortality rate of STEMI patients.

scholarly journals Management quality indicators and in-hospital mortality among acute coronary syndrome patients admitted to tertiary hospitals in Ethiopia: prospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Korinan Fanta ◽  
Fekede Bekele Daba ◽  
Elsah Tegene ◽  
Tsegaye Melaku ◽  
Ginenus Fekadu ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Mortality Rate ◽  
Observational Study ◽  
Hospital Mortality ◽  
Quality Indicators ◽  
Prospective Observational Study ◽  
Hospital Death ◽  
Coronary Syndrome ◽  
Management Quality ◽  
Tertiary Hospitals

Abstract Background Acute coronary syndrome (ACS) remains the leading cause of cardiovascular disease mortality and morbidity worldwide. While the management quality measures and clinical outcomes of patients with ACS have been evaluated widely in developed countries, inadequate data are available from sub-Saharan Africa countries. So, this study aimed to assess the clinical profiles, management quality indicators, and in-hospital outcomes of patients with ACS in Ethiopia. Methods A Prospective observational study was conducted at two tertiary hospitals in Ethiopia from March 2018 to November 2018. The primary outcome of the study was in-hospital mortality. Data were analyzed using SPSS version 23.0. Multivariable cox-regression was conducted to identify predictors of time to in-hospital mortality. Variable with p -value < 0.05 was considered statistically significant. Results Among 181 ACS patients enrolled, about (61%) were presented with ST-elevation myocardial infarction (STEMI). The mean age of the study participant was 55.8 ± 11.9 years and 62.4% were males. The use of guideline-directed medications within 24 h of hospitalization were sub-optimal (57%) [Dual antiplatelet (73%), statin (74%), beta-blocker (67%) and ACEI (61%)]. Only (7%) ACS patients received the percutaneous coronary intervention (PCI). Discharge aspirin and statin were high (> 90%) while other medications were sub-optimal (< 80%). The all-cause in-hospital mortality rate was 20.4% and the non-fatal MACE rate was 25%. Rural residence (AHR: 3.64, 95% CI: 1.81–7.29), symptom onset to hospital arrival > 12 h (AHR: 4.23, 95% CI: 1.28–13.81), and Cardiogenic shock (AHR: 7.20, 95% CI: 3.55–14.55) were independent predictors of time to in-hospital death among ACS patients. Conclusion In the present study, the use of guideline-directed in-hospital medications was sub-optimal. The overall in-hospital mortality rate was unacceptably high and highlights the urgent need for national quality-improvement focusing on timely initiation of evidence-based medications, reperfusion therapy, and strategies to reduce pre-hospital delay.

scholarly journals Implementation of earlier antibiotic administration in patients with severe sepsis and septic shock in Japan: a descriptive analysis of a prospective observational study

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Toshikazu Abe ◽  
◽  
Shigeki Kushimoto ◽  
Yasuharu Tokuda ◽  
Gary S. Phillips ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Observational Study ◽  
Hospital Mortality ◽  
Prospective Observational Study ◽  
Antibiotic Administration ◽  
Coronary Syndrome ◽  
Sepsis And Septic Shock ◽  
The Impact ◽  
Sepsis Care

Abstract Background Time to antibiotic administration is a key element in sepsis care; however, it is difficult to implement sepsis care bundles. Additionally, sepsis is different from other emergent conditions including acute coronary syndrome, stroke, or trauma. We aimed to describe the association between time to antibiotic administration and outcomes in patients with severe sepsis and septic shock in Japan. Methods This prospective observational study enrolled 1184 adult patients diagnosed with severe sepsis based on the Sepsis-2 criteria and admitted to 59 intensive care units (ICUs) in Japan between January 1, 2016, and March 31, 2017, as the sepsis cohort of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) study. We compared the characteristics and in-hospital mortality of patients administered with antibiotics at varying durations after sepsis recognition, i.e., 0–60, 61–120, 121–180, 181–240, 241–360, and 361–1440 min, and estimated the impact of antibiotic timing on risk-adjusted in-hospital mortality using the generalized estimating equation model (GEE) with an exchangeable, within-group correlation matrix, with “hospital” as the grouping variable. Results Data from 1124 patients in 54 hospitals were used for analyses. Of these, 30.5% and 73.9% received antibiotics within 1 h and 3 h, respectively. Overall, the median time to antibiotic administration was 102 min [interquartile range (IQR), 55–189]. Compared with patients diagnosed in the emergency department [90 min (IQR, 48–164 min)], time to antibiotic administration was shortest in patients diagnosed in ICUs [60 min (39–180 min)] and longest in patients transferred from wards [120 min (62–226)]. Overall crude mortality was 23.4%, where patients in the 0–60 min group had the highest mortality (28.0%) and a risk-adjusted mortality rate [28.7% (95% CI 23.3–34.1%)], whereas those in the 61–120 min group had the lowest mortality (20.2%) and risk-adjusted mortality rates [21.6% (95% CI 16.5–26.6%)]. Differences in mortality were noted only between the 0–60 min and 61–120 min groups. Conclusions We could not find any association between earlier antibiotic administration and reduction in in-hospital mortality in patients with severe sepsis.

scholarly journals Circulating Levels of Dephosphorylated-Uncarboxylated Matrix Gla Protein in Patients with Acute Coronary Syndrome

Molecules ◽  
2021 ◽  
Vol 26 (4) ◽  
pp. 1108
Author(s):  
Admira Bilalic ◽  
Tina Ticinovic Kurir ◽  
Marko Kumric ◽  
Josip A. Borovac ◽  
Andrija Matetic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Hospital Mortality ◽  
Vascular Calcification ◽  
Matrix Gla Protein ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
St Elevation

Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.

Predictive value of thyroxine for prognosis in pediatric septic shock: a prospective observational study

2020 ◽  
Vol 33 (5) ◽  
pp. 653-659
Author(s):  
Jia Song ◽  
Yun Cui ◽  
Chunxia Wang ◽  
Jiaying Dou ◽  
Huijie Miao ◽  
...  
Keyword(s):  
Septic Shock ◽  
Thyroid Hormone ◽  
Observational Study ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Prospective Observational Study ◽  
Threshold Value ◽  
Nonthyroidal Illness ◽  
Hormone Levels ◽  
Thyroid Hormone Levels

AbstractBackgroundThyroid hormone plays an important role in the adaptation of metabolic function to critically ill. The relationship between thyroid hormone levels and the outcomes of septic shock is still unclear. The aim of this study was to assess the predictive value of thyroid hormone for prognosis in pediatric septic shock.MethodsWe performed a prospective observational study in a pediatric intensive care unit (PICU). Patients with septic shock were enrolled from August 2017 to July 2019. Clinical and laboratory indexes were collected, and thyroid hormone levels were measured on PICU admission.ResultsNinety-three patients who fulfilled the inclusion criteria were enrolled in this study. The incidence of nonthyroidal illness syndrome (NTIS) was 87.09% (81/93) in patients with septic shock. Multivariate logistic regression analysis showed that T4 level was independently associated with in-hospital mortality in patients with septic shock (OR: 0.965, 95% CI: 0.937–0.993, p = 0.017). The area under receiver operating characteristic (ROC) curve (AUC) for T4 was 0.762 (95% CI: 0.655–0.869). The cutoff threshold value of 58.71 nmol/L for T4 offered a sensitivity of 61.54% and a specificity of 85.07%, and patients with T4 < 58.71 nmol/L showed high mortality (60.0%). Moreover, T4 levels were negatively associated with the pediatric risk of mortality III scores (PRISM III), lactate (Lac) level in septic shock children.ConclusionsNonthyroidal illness syndrome is common in pediatric septic shock. T4 is an independent predictor for in-hospital mortality, and patients with T4 < 58.71 nmol/L on PICU admission could be with a risk of hospital mortality.

CLINICAL OUTCOMES OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AFTER PERCUTANEOUS CORONARY INTERVENTION AMONG CARDIAC REHABILITATION AND NON CARDIAC REHABILITATION GROUPS-A PROSPECTIVE OBSERVATIONAL STUDY

2021 ◽  
pp. 25-27
Author(s):  
Saroj Mandal ◽  
Vignesh. R ◽  
Sidnath Singh
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Observational Study ◽  
Cardiac Rehabilitation ◽  
Prospective Observational Study ◽  
Coronary Intervention ◽  
Cardiac Mortality ◽  
Percutaneous Coronary ◽  
All Cause Mortality

OBJECTIVES To determine clinical outcome and to nd out the association between participation of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) in cardiac rehabilitation programme. DESIGN A Prospective observational study. STUDY AREA : Department of Cardiology, Institute of Postgraduate Medical Education and Research,Kolkata. PARTICIPANTS: Patients aged ≥18 years who underwent PCI due to AMI. OUTCOME MEASURES The outcomes were subsequent myocardial infarction, revascularisation, all-cause readmission, cardiac readmission, all-cause mortality and cardiac mortality. RESULT: The data of 1107 patients were included and 60.07%% of them participated in CR program. The risks of revascularisation, all cause readmission and cardiac readmission among CR participants were compared. The results of those analysis were consistent and showed that the CR participants had lower allcause mortality ,cardiac mortality,all cause readmission, cardiac admission. However no effect was observed for subsequent myocardial infarction or revascularisation. CONCLUSIONS: It was suggested CR participation may reduce the risk of all-cause mortality ,cardiac mortality, all cause readmission and cardiac admission.

scholarly journals Platelet-Lymphocyte Ratio as a New Predictor of In-hospital Mortality in Cardiac Intensive Care Unit Patients

2021 ◽  
Author(s):  
Guangyao Zhai ◽  
Biyang Zhang ◽  
Jianlong Wang ◽  
Yuyang Liu ◽  
Yujie Zhou
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiovascular Diseases ◽  
Hospital Mortality ◽  
Subgroup Analysis ◽  
Cardiac Intensive Care Unit ◽  
Lymphocyte Ratio ◽  
Platelet Lymphocyte Ratio ◽  
Cardiac Intensive Care ◽  
The Relationship

Abstract Background: It has been discovered that both inflammation and platelet aggregation could cause crucial effect on the occurrence and development of cardiovascular diseases. As a combination of platelet and lymphocyte, platelet-lymphocyte ratio (PLR) was proved to be correlated with the severity as well as prognosis of cardiovascular diseases. Exploring the relationship between PLR and in-hospital mortality in cardiac intensive care unit (CICU) patients was the purpose of this study. Method: PLR was calculated by dividing platelet count by lymphocyte count. All patients were grouped by PLR quartiles and the primary outcome was in-hospital mortality. The independent effect of PLR was determined by binary logistic regression analysis. The curve in line with overall trend was drawn by local weighted regression (Lowess). Subgroup analysis was used to determine the relationship between PLR and in-hospital mortality in different subgroups. Result: We included 5577 CICU patients. As PLR quartiles increased, in-hospital mortality increased significantly (Quartile 4 vs Quartile 1: 13.9 vs 8.3, P <0.001). After adjusting for confounding variables, PLR was proved to be independently associated with increased risk of in-hospital mortality (Quartile 4 vs Quartile 1: OR, 95% CI: 1.99, 1.46-2.71, P<0.001, P for trend <0.001). The Lowess curves showed a positive relationship between PLR and in-hospital mortality. The subgroup analysis revealed that patients with low Acute Physiology and Chronic Health Evaluation IV (APACHE IV) or with less comorbidities had higher risk of mortality for PLR. Further, PLR quartiles had positive relation with length of CICU stay (Quartile 4 vs Quartile 1: 2.7, 1.6-5.2 vs 2.1, 1.3-3.9, P<0.001), and the length of hospital stay (Quartile 4 vs Quartile 1: 7.9, 4.6-13.1 vs 5.8, 3.3-9.8, P<0.001). Conclusion: PLR was independently associated with in-hospital mortality in CICU patients.

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