Does admission via an Acute Medical Unit influence hospital mortality? 12 years’ experience in a large Dublin Hospital

Background: Following an emergency medical admission, patients may be admitted an acute medical assessment unit (AMAU) or directly into a ward. An AMAU provides a structured environment for their initial assessment and treatment. Methods: All emergency admissions (66,933 episodes in 36,271 patients) to an Irish hospital over an 12-year period (2002-2013) were studied with 30-day in-hospital mortality as the outcome measure. Univariate Odds Ratios, by initial patient allocation, and the fully adjusted Odds Ratios were calculated, using a validated logistic regression model. Results: Patients, by design, were intended to be admitted initially to the AMAU (<= 5 day stay). Capacity constraints dictated that only 39.8% of patients were so admitted; the remainder bypassed the AMAU to a ward (60.2%). All patients remained under the care of the admitting consultant/team. We computed the risk profile for each group, using a multiple variable validated model of 30-day in-hospital mortality; the model indicated the same risk profile between these groups. The univariate OR of an in-hospital death by day 30 for a patient initially allocated to the AMAU, compared with an initial ward allocation was 0.76 (95% CI: 0.71, 0.82- p<0.001). The fully adjusted risk for patients was 0.67 (95% CI: 0.62, 0.73- p<0.001). Conclusion: Patients, with equivalent mortality risk, allocated initially to AMAU or a more traditional ward, appeared to have substantially different outcomes.

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Early Prediction of In-Hospital Death of COVID-19 Patients: A Machine-Learning Model Based on Age, Blood Analyses, and Chest X-Ray Score

10.1101/2021.06.10.21258721 ◽

2021 ◽

Author(s):

Emirena Garrafa ◽

Marika Vezzoli ◽

Marco Ravanelli ◽

Davide Farina ◽

Andrea Borghesi ◽

...

Keyword(s):

Hospital Mortality ◽

Characteristic Curve ◽

Hospital Death ◽

Web Based ◽

X Ray ◽

Neutrophil Lymphocyte Ratio ◽

Patient Allocation ◽

Chest X Ray ◽

Blood Analytes ◽

Second Wave

Background: To develop and validate an early-warning model to predict in-hospital mortality on admission of COVID-19 patients at an emergency department (ED).<br /> Methods: In total, 2782 patients were enrolled between March 2020 and December 2020, including 2106 patients (first wave) and 676 patients (second wave) in the COVID-19 outbreak in Italy. The first wave patients were divided into two groups with 1474 patients used to train the model, and 632 to validate it. The 676 patients in the second wave were used to test the model. Age, 17 blood analytes and Brescia chest X-ray score were the variables processed using a Random Forests classification algorithm to build and validate the model. ROC analysis was used to assess the model performances. A web-based death-risk calculator was implemented and integrated within the Laboratory Information System of the hospital. Results: The final score was constructed by age (the most powerful predictor), blood analytes (the strongest predictors were lactate dehydrogenase, D-dimer, Neutrophil/Lymphocyte ratio, C-reactive protein, Lymphocyte %, Ferritin std and Monocyte %), and Brescia chest X-ray score. The areas under the receiver operating characteristic curve obtained for the three groups (training, validating and testing) were 0.98, 0.83 and 0.78, respectively.<br />Conclusions: The model predicts in-hospital mortality on the basis of data that can be obtained in a short time, directly at the ED on admission. It functions as a web-based calculator, providing a risk score which is easy to interpret. It can be used in the triage process to support the decision on patient allocation.

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Mortality and high risk of major adverse events in patients with COVID-19 and history of cardiovascular disease

Open Heart ◽

10.1136/openhrt-2020-001526 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001526

Author(s):

Elena Tessitore ◽

David Carballo ◽

Antoine Poncet ◽

Nils Perrin ◽

Cedric Follonier ◽

...

Keyword(s):

Hospital Mortality ◽

Male Gender ◽

Hospital Death ◽

Chronic Obstructive ◽

University Hospitals ◽

Adverse Cardiovascular Event ◽

Risk Of Death ◽

Hospitalised Patients ◽

Increased Risk ◽

History Of

ObjectiveHistory of cardiovascular diseases (CVDs) may influence the prognosis of patients hospitalised for COVID-19. We investigated whether patients with previous CVD have increased risk of death and major adverse cardiovascular event (MACE) when hospitalised for COVID-19.MethodsWe included 839 patients with COVID-19 hospitalised at the University Hospitals of Geneva. Demographic characteristics, medical history, laboratory values, ECG at admission and medications at admission were collected based on electronic medical records. The primary outcome was a composite of in-hospital mortality or MACE.ResultsMedian age was 67 years, 453 (54%) were males and 277 (33%) had history of CVD. In total, 152 (18%) died and 687 (82%) were discharged, including 72 (9%) who survived a MACE. Patients with previous CVD were more at risk of composite outcomes 141/277 (51%) compared with those without CVD 83/562 (15%) (OR=6.0 (95% CI 4.3 to 8.4), p<0.001). Multivariate analyses showed that history of CVD remained an independent risk factor of in-hospital death or MACE (OR=2.4; (95% CI 1.6 to 3.5)), as did age (OR for a 10-year increase=2.2 (95% CI 1.9 to 2.6)), male gender (OR=1.6 (95% CI 1.1 to 2.3)), chronic obstructive pulmonary disease (OR=2.1 (95% CI 1.0 to 4.2)) and lung infiltration associated with COVID-19 at CT scan (OR=1.9 (95% CI 1.2 to 3.0)). History of CVD (OR=2.9 (95% CI 1.7 to 5)), age (OR=2.5 (95% CI 2.0 to 3.2)), male gender (OR=1.6 (95% CI 0.98 to 2.6)) and elevated C reactive protein (CRP) levels on admission (OR for a 10 mg/L increase=1.1 (95% CI 1.1 to 1.2)) were independent risk factors for mortality.ConclusionHistory of CVD is associated with higher in-hospital mortality and MACE in hospitalised patients with COVID-19. Other factors associated with higher in-hospital mortality are older age, male sex and elevated CRP on admission.

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Hyperglycemia at admission, comorbidities, and in-hospital mortality in elderly patients hospitalized in internal medicine wards: data from the RePoSI Registry

Acta Diabetologica ◽

10.1007/s00592-021-01716-8 ◽

2021 ◽

Author(s):

Salvatore Corrao ◽

Alessandro Nobili ◽

Giuseppe Natoli ◽

Pier Mannuccio Mannucci ◽

Francesco Perticone ◽

...

Keyword(s):

Internal Medicine ◽

Elderly Patients ◽

Hospital Mortality ◽

Barthel Index ◽

Rating Scale ◽

Depression Scale ◽

Cognitive Status ◽

Hospital Death ◽

Glycemia Level ◽

Male Sex

Abstract Aims The association between hyperglycemia at hospital admission and relevant short- and long-term outcomes in elderly population is known. We assessed the effects on mortality of hyperglycemia, disability, and multimorbidity at admission in internal medicine ward in patients aged ≥ 65 years. Methods Data were collected from an active register of 102 internal medicine and geriatric wards in Italy (RePoSi project). Patients were recruited during four index weeks of a year. Socio-demographic data, reason for hospitalization, diagnoses, treatment, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), renal function, functional (Barthel Index), and cognitive status (Short Blessed Test) and mood disorders (Geriatric Depression Scale) were recorded. Mortality rates were assessed in hospital 3 and 12 months after discharge. Results Of the 4714 elderly patients hospitalized, 361 had a glycemia level ≥ 250 mg/dL at admission. Compared to subjects with lower glycemia level, patients with glycemia ≥ 250 mg/dL showed higher rates of male sex, smoke and class III obesity. These patients had a significantly lower Barthel Index (p = 0.0249), higher CIRS-SI and CIRS-CI scores (p = 0.0025 and p = 0.0013, respectively), and took more drugs. In-hospital mortality rate was 9.2% and 5.1% in subjects with glycemia ≥ 250 and < 250 mg/dL, respectively (p = 0.0010). Regression analysis showed a strong association between in-hospital death and glycemia ≥ 250 mg/dL (OR 2.07; [95% CI 1.34–3.19]), Barthel Index ≤ 40 (3.28[2.44–4.42]), CIRS-SI (1.87[1.27–2.77]), and male sex (1.54[1.16–2.03]). Conclusions The stronger predictors of in-hospital mortality for older patients admitted in general wards were glycemia level ≥ 250 mg/dL, Barthel Index ≤ 40, CIRS-SI, and male sex.

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Hemogram as marker of in-hospital mortality in COVID-19

Journal of Investigative Medicine ◽

10.1136/jim-2021-001810 ◽

2021 ◽

pp. jim-2021-001810

Author(s):

Alejandro López-Escobar ◽

Rodrigo Madurga ◽

José María Castellano ◽

Santiago Ruiz de Aguiar ◽

Sara Velázquez ◽

...

Keyword(s):

Hospital Mortality ◽

Hospital Admission ◽

White Blood Cells ◽

Rate Of Change ◽

Hospital Death ◽

Direct Role ◽

Lymphocyte Ratio ◽

Risk Of Death ◽

Rate Of Increase ◽

Increased Risk

The clinical impact of COVID-19 disease calls for the identification of routine variables to identify patients at increased risk of death. Current understanding of moderate-to-severe COVID-19 pathophysiology points toward an underlying cytokine release driving a hyperinflammatory and procoagulant state. In this scenario, white blood cells and platelets play a direct role as effectors of such inflammation and thrombotic response. We investigate whether hemogram-derived ratios such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio and the systemic immune-inflammation index may help to identify patients at risk of fatal outcomes. Activated platelets and neutrophils may be playing a decisive role during the thromboinflammatory phase of COVID-19 so, in addition, we introduce and validate a novel marker, the neutrophil-to-platelet ratio (NPR).Two thousand and eighty-eight hospitalized patients with COVID-19 admitted at any of the hospitals of HM Hospitales group in Spain, from March 1 to June 10, 2020, were categorized according to the primary outcome of in-hospital death.Baseline values, as well as the rate of increase of the four ratios analyzed were significantly higher at hospital admission in patients who died than in those who were discharged (p<0.0001). In multivariable logistic regression models, NLR (OR 1.05; 95% CI 1.02 to 1.08, p=0.00035) and NPR (OR 1.23; 95% CI 1.12 to 1.36, p<0.0001) were significantly and independently associated with in-hospital mortality.According to our results, hemogram-derived ratios obtained at hospital admission, as well as the rate of change during hospitalization, may easily detect, primarily using NLR and the novel NPR, patients with COVID-19 at high risk of in-hospital mortality.

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Abstract 50: Atrial Fibrillation is Associated with Higher Stroke Rates in Takotsubo Cardiomyopathy

Circulation Research ◽

10.1161/res.121.suppl_1.50 ◽

2017 ◽

Vol 121 (suppl_1) ◽

Author(s):

Akintunde M Akinjero ◽

Oluwole Adegbala ◽

Nike E Akinjero ◽

Eseosa Edo-Osagie ◽

Tomi Akinyemiju

Keyword(s):

Atrial Fibrillation ◽

Hospital Mortality ◽

Takotsubo Cardiomyopathy ◽

Nationwide Inpatient Sample ◽

Coronary Intervention ◽

Independent Effect ◽

Adjusted Risk ◽

Representative Study ◽

Percutaneous Coronary ◽

Nationally Representative

Background: The prognosis of Takotsubo Cardiomyopathy (TTCM) is worse than in the general population. It is unclear how atrial fibrillation (AF) impacts this prognosis. We sought to evaluate the effect of concurrent AF on outcomes in patients with TTCM. Methods: We used the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to extract all hospitalizations between 2007 and 2011 with concurrent diagnosis of AF and TTCM. The ICD-9 CM codes for AF and TTCM were used. We compared patients admitted for TTCM who had coexisting AF to those without. We excluded patients below the age of 18 as well as those diagnosed with TTCM who later underwent percutaneous coronary intervention (PCI). Multivariate regression was used to assess the independent effect of coexisting AF on clinical outcomes (length of stay (LOS), stroke, and in-hospital mortality). Results: A total of 13,136 TTCM patients were studied. Of these, 2,083 (15.86%) had coexisting AF. Compared with those without, TTCM patients with coexisting AF had a greater multivariate-adjusted risk for increased stroke rate (aOR=1.66, 95% CI=1.27-2.18, Table 1). We found no significant association with in-hospital mortality (aOR=1.21, 95% CI=0.96-1.52) or LOS (aOR=1.21, 95% CI= 0.83-1.58). Conclusions: In this large, nationally representative study, we found higher stroke rates in patients with coexisting AF and TTCM. Our findings suggest the need for closer monitoring during hospitalization.

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Abstract 17075: Impact of Peripheral Artery Disease on Outcomes Following Admission for Cardiogenic Shock

Circulation ◽

10.1161/circ.142.suppl_3.17075 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Nino Mihatov ◽

Robert W Yeh ◽

Eunhee Choi ◽

Changyu Shen ◽

Sahil A Parikh ◽

...

Keyword(s):

Hospital Mortality ◽

Cardiogenic Shock ◽

Peripheral Artery Disease ◽

Circulatory Support ◽

Complication Rates ◽

Medicare Beneficiaries ◽

Peripheral Artery ◽

Adjusted Risk ◽

Artery Disease ◽

The Impact

Introduction: Contemporary in-hospital mortality rates for patients presenting with acute myocardial infarction (AMI) and cardiogenic shock (CS) remain as high as 50%. The impact of comorbid lower extremity peripheral artery disease (LE-PAD) is unknown. Hypothesis: LE-PAD is associated with higher morbidity and mortality in patients presenting with CS and AMI. Methods: Medicare beneficiaries hospitalized with CS related to AMI from 10/2015-6/2017 were identified. PAD status was defined by the inpatient billing codes present in the year prior to presentation. Outcomes included in-hospital mortality, amputation, peripheral revascularization, and 6-month mortality. Adjusted regression models were used to evaluate outcomes. A subgroup analysis included patients requiring mechanical circulatory support (MCS). Results: Among 45,144 patients, 5.9% (N=2,651) had LE-PAD. The average age was 77.8±7.9, 59.8% were male and 83.0% were white. Cumulative in-hospital mortality was 46.8%, with greater risk among LE-PAD patients (55.2% vs 46.3%; adjusted OR 1.52, 95% CI 1.39-1.65). LE-PAD patients also had greater adjusted risk of in-hospital amputation (1.5% vs 0.2%; OR 3.23, 95% CI: 2.16-4.83), peripheral revascularization rates (1.4% vs 0.4%; OR 1.54, 95% CI: 1.06-2.23), and 6-month mortality (43.2% vs 23.7%; HR 2.06, 95% CI: 1.80-2.35). MCS was less frequently utilized in LE-PAD (20.1% vs. 38.1%, p<0.01). Adjusted in-hospital mortality, amputation and peripheral revascularization rates were comparable between LE-PAD and non-LE-PAD patients who received MCS. Non-MCS LE-PAD patients had a 2.28 fold higher adjusted 6-month mortality compared with MCS LE-PAD patients (95% CI 1.60-3.11; Figure). Conclusions: Comorbid PAD is associated with worse limb outcomes and mortality among patients with AMI and CS. Although MCS was less likely to be used in LE-PAD patients, in-hospital mortality and limb complication rates were comparable to non-LE-PAD MCS patients.

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Impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular infarction

Sao Paulo Medical Journal ◽

10.1590/s1516-31802006000400003 ◽

2006 ◽

Vol 124 (4) ◽

pp. 186-191 ◽

Cited By ~ 6

Author(s):

Afonso Celso Pereira ◽

Roberto Alexandre Franken ◽

Sandra Regina Schwarzwälder Sprovieri ◽

Valdir Golin

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Right Ventricular ◽

Left Ventricular ◽

Hospital Death ◽

Inferior Wall ◽

Mortality And Morbidity ◽

Killip Class ◽

Increased Risk ◽

The Impact

CONTEXT AND OBJECTIVE: There is uncertainty regarding the risk of major complications in patients with left ventricular (LV) infarction complicated by right ventricular (RV) involvement. The aim of this study was to evaluate the impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular myocardial infarction. DESIGN AND SETTING: Prospective cohort study, at Emergency Care Unit of Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. METHODS: 183 patients with acute myocardial infarction participated in this study: 145 with LV infarction alone and 38 with both LV and RV infarction. The presence of complications and hospital death were compared between groups. RESULTS: 21% of the patients studied had LV + RV infarction. In this group, involvement of the dorsal and/or inferior wall was predominant on electrocardiogram (p < 0.0001). The frequencies of Killip class IV upon admission and 24 hours later were greater in the LV + RV group, along with electrical and hemodynamic complications, among others, and death. The probability of complications among the LV + RV patients was 9.7 times greater (odds ratio, OR = 9.7468; 95% confidence interval, CI: 2.8673 to 33.1325; p < 0.0001) and probability of death was 5.1 times greater (OR = 5.13; 95% CI: 2.2795 to 11.5510; p = 0.0001), in relation to patients with LV infarction alone. CONCLUSIONS: Patients with LV infarction with RV involvement present increased risk of early morbidity and mortality.

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Blood Glucose Control Among Critically Ill Patients with Brain Injury

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100007757 ◽

2009 ◽

Vol 36 (4) ◽

pp. 436-442 ◽

Cited By ~ 19

Author(s):

Michael J. Jacka ◽

Clinton J. Torok-Both ◽

Sean M. Bagshaw

Keyword(s):

Blood Glucose ◽

Hospital Mortality ◽

Retrospective Cohort ◽

Blood Glucose Control ◽

Median Number ◽

Hospital Death ◽

Lengths Of Stay ◽

Brain Injured ◽

Prolonged Duration ◽

Injured Patients

Objective:To evaluate the incidence of hypoglycemia, hyperglycemia and blood glucose (BG) variability in brain-injured patients and their association with clinical outcomes.Methods:Retrospective cohort study of brain-injured patients admitted to an 11- bed neurosciences intensive care unit (ICU) from January 1 to December 31, 2003.Results:We included 606 patients. Mean age was 52.3 years, 60.6% were male, 11.9% had diabetes mellitus, and 64% were post-operative. Seventy-five (12.4%) received intensive insulin therapy (IIT) for a median (IQR) 72 (24-154) hours. Hypoglycemia and hyperglycemia occurred in 4.6% (96.4% receiving IIT) and 9.6% (77.6% receiving IIT). Median number of episodes per patient was 3 (75% with ≥2) and 4 (81% with ≥2) for hypoglycemia and hyperglycemia. Variable glycemic control occurred in 3.8% (100% receiving IIT) with median number of 13 episodes per patient. In-hospital mortality was 16.7%, median (IQR) ICU and hospital lengths of stay were 2 (1-5) and 8 (3-19) days. Hypoglycemia, hyperglycemia and BG variability showed non-significant but consistent associations with hospital mortality and prolonged lengths of ICU and hospital stay. The rate of recurrence of episodes showed stronger and significant associations with outcome, in particular for BG variability and hyperglycemia.Conclusions:Hypoglycemia, hyperglycemia and BG variability are relatively common in brain-injured patients and are associated with IIT. An increased frequency of episodes, in particular for BG variability and hyperglycemia, was associated with greater risk of both hospital death and prolonged duration of stay.

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Newly Diagnosed Infection After Admission for Acute Heart Failure: From the KCHF Registry

Journal of the American Heart Association ◽

10.1161/jaha.121.023256 ◽

2021 ◽

Author(s):

Yuta Seko ◽

Takao Kato ◽

Takeshi Morimoto ◽

Hidenori Yaku ◽

Yasutaka Inuzuka ◽

...

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

Clinical Outcomes ◽

Acute Heart Failure ◽

Newly Diagnosed ◽

Post Discharge ◽

Infection Group ◽

Unique Identifier ◽

Adjusted Risk ◽

Coronary Syndrome

Background No studies have explored the association between newly diagnosed infections after admission and clinical outcomes in patients with acute heart failure. We aimed to explore the factors associated with newly diagnosed infection after admission for acute heart failure, and its association with in‐hospital and post‐discharge clinical outcomes. Methods and Results Among 4056 patients enrolled in the Kyoto Congestive Heart Failure registry, 2399 patients without any obvious infectious disease upon admission were analyzed. The major in‐hospital and post‐discharge outcome measures were all‐cause deaths. There were 215 patients (9.0%) with newly diagnosed infections during hospitalization, and 2184 patients (91.0%) without infection during hospitalization. The factors independently associated with a newly diagnosed infection were age ≥80 years, acute coronary syndrome, non‐ambulatory status, hyponatremia, anemia, intubation, and patients who were not on loop diuretics as outpatients. The newly diagnosed infection group was associated with a higher incidence of in‐hospital mortality (16.3% and 3.2%, P <0.001) and excess adjusted risk of in‐hospital mortality (odds ratio, 6.07 [95% CI, 3.61–10.19], P <0.001) compared with the non‐infection group. The newly diagnosed infection group was also associated with a higher 1‐year incidence of post‐discharge mortality (19.3% in the newly diagnosed infection group and 13.6% in the non‐infection group, P <0.001) and excess adjusted risk of post‐discharge mortality (hazard ratio, 1.49 [95% CI, 1.08–2.07], P =0.02) compared with the non‐infection group. Conclusions Elderly patients with multiple comorbidities were associated with the development of newly diagnosed infections after admission for acute heart failure. Newly diagnosed infections after admission were associated with higher in‐hospital and post‐discharge mortality in patients with acute heart failure. Registration URL: https://clinicaltrials.gov ; Unique identifier: NCT02334891.

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Association between active cooling and lower mortality among patients with heat stroke and heat exhaustion

PLoS ONE ◽

10.1371/journal.pone.0259441 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259441

Author(s):

Jun Kanda ◽

Shinji Nakahara ◽

Shunsuke Nakamura ◽

Yasufumi Miyake ◽

Keiki Shimizu ◽

...

Keyword(s):

Hospital Mortality ◽

Core Body Temperature ◽

Heat Stroke ◽

Case Series ◽

Clinical Findings ◽

Hospital Death ◽

Heat Illness ◽

Heat Exhaustion ◽

Active Cooling ◽

Severe Group

Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the “severe” group or the “mild-to-moderate” group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received “active cooling + rehydration” and patients who received “rehydration only,” with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio [aOR], 3.29; 95% confidence interval [CI], 1.21–8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92–5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness.

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