The impact of complete atrioventricular block on in-hospital and long-term mortality in patients treated with primary percutaneous coronary intervention

Objective: To analyze the incidence and the prognostic impact of complete AV block on in-hospital and 6-year mortality in STEMI patients treated with pPCI. Method: Study included 3044 consecutive STEMI patients. Results: Complete AV block was registered only at admission in 144 (4.73%) patients; 125 (86.8%) patients with complete AV block had inferior infarction. Temporary pacemaker was implanted in 72 (50%) patients with complete AV block. No patient underwent permanent pacemaker implantation. In-hospital mortality was significantly higher in patients with complete AV block than in patients without complete AV block: 17.9%vs3.6%, respectively, p<0.001. In patients with heart block and inferior infarction inhospital mortality was 13%, whereas in patients with heart block and anterior infarction inhospital mortality was 53%. When we analyzed patients who were discharged alive from the hospital, we also found significantly higher long-term (6-year) mortality rate in those with complete AV block vs patients without AV block: 7.8%v 3.4% respectively, p<0.001. Complete AV block was an independent predictor for in-hospital and 6-year mortality: inhospital mortality OR 2.94 95%CI 1.23-5.22; six year mortality HR 1.61, 95%CI 1.10- 2.37. When subanalysis was performed, in patients with inferior STEMI, complete AV block was an independent predictor of in-hospital and 6-year mortality, while in patients with anterior STEMI, complete AV block was an independent predictor of in-hospital mortality. Conclusion: In analyzed STEMI patients complete AV block was transitory and was registered only at hospital admission. Although transitory, complete AV block remained a strong independent predictor of in-hospital and long-term mortality.

D-DIMER AS A POTENTIAL BIOMARKER OF COVID-19 DISEASE SEVERITY

Было продемонстрировано, что аномальная функция коагуляции участвует в прогрессировании COVID-19. Однако связь между уровнем D-димера и тяжестью COVID-19 не ясна. Исследование было направлено на изучение связи между уровнями D-димера и тяжестью COVID-19 на основе литературного обзора. Мы провели поиск в базах данных PubMed, Embase, Cochrane Library и Scopus до октября 2021 года. Изменения в уровнях D-димера и тенденции после антикоагуляции являются высокопрогнозирующими факторами внутрибольничной смертности и могут помочь в распределении ресурсов и будущих исследованиях новых методов лечения тяжелой формы COVID-19. It has been demonstrated that abnormal coagulation function is involved in the progression of COVID-19. However, the relationship between D-dimer levels and the severity of COVID-19 is not clear. The study aimed to investigate the relationship between D-dimer levels and the severity of COVID-19 based on a literature review. We searched PubMed, Embase, Cochrane Library and Scopus until October 2021. Changes in D-dimer levels and trends after anticoagulation are highly predictive factors for inhospital mortality and may aid resource allocation and future research into new treatments for severe COVID-19.

Effect of Colostomy on Treatment Outcome in Fournier Gangrene: A Prospective Comparative Study

Background and Aim: Value of colostomy in management of Fournier gangrene (FG) is a debatable issue. Almost all relevant studies are retrospective and included heterogeneous patients’ groups. The present prospective study aimed to evaluate the role of colostomy in management of FG affecting the perianal region in 2 well-matched FG groups. Patients and Methods: The present prospective comparative study included 30 patients with FG associated with extensive involvement of the perianal region. They comprised 15 patients subjected to colostomy and other 15 patients who refused to perform the procedure. Colostomy was performed after the first debridement. Outcome parameters in the present study included time to wound healing, length of hospital stay, and inhospital mortality. Results: Comparison between the studied groups regarding the preoperative characteristics revealed no statistically significant differences. Postoperatively, patients in the colostomy group had significantly fewer number of debridements (1.3 ± 0.5 vs 2.7 ± 1.2, P < .001), shorter hospital stay (9.5 ± 3.3 vs 29.9 ± 6.2 days, P < .001), and significantly shorter time to wound healing (16.5 ± 3.9 vs 42.9 ± 6.9 days, P < .001). Also, patients in the colostomy group had significantly lower rate of wound dehiscence, wound infection, and flap ischemia. However, the difference wasn’t statistically significant. Conclusions: Aggressive treatment of FG aided by colostomy after first debridement would result in better clinical outcome.

D-dimer Levels as Novel Biomarker Predictor for All-cause In-hospital Mortality Risk in COVID-19 Patients

Background : Coronavirus disease 2019 (COVID-19) has affected people all around the world in varying degrees of severity, causing death. The global case fatality rate (CFR) due to COVID-19 was 2.2 % as of January 1st, 2021. The CFR in the Kediri district is 7.7%, which is higher than the Nasional CFR of 3%. In COVID-19, we looked at high D-dimer as one of the predictors of in-hospital mortality. Objectives : The goal of this study was to find a link between D-dimer levels and all-cause in-hospital mortality in COVID-19 patients, as well as to define the best cut-off point. Methods : A single-center cross-sectional study was conducted. From March to December 2020, 185 COVID-19 patients treated at Kediri General Hospital who were confirmed positive by RT-PCR matched the eligibility criteria. The levels of D-dimer were divided into two groups: those above and those below the cutoff point. We 􏰏􏰚􏰏􏰦􏰗􏰱􏰋􏰕 􏰲 􏰩􏰞􏰊 􏰓􏰒 􏰐􏰓􏰝􏰚􏰊􏰌􏰳 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰢􏰣􏰤 􏰶􏰟􏰷􏰔􏰦􏰳 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰧 􏰶􏰟􏰷􏰔􏰦􏰳 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰸 􏰶􏰟􏰷􏰔􏰦􏰳 􏰏􏰚􏰕 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰲 􏰶􏰟􏰷􏰔􏰦􏰣 The primary endpoint was all-cause in-hospital mortality. Data were collected retrospectively and processed using SPSS version 25.0. Results : 􏰴􏰞􏰑􏰝􏰚􏰟 􏰜􏰓􏰌􏰐􏰝􏰊􏰏􏰦􏰝􏰱􏰏􏰊􏰝􏰓􏰚􏰳 􏰲􏰤 􏰐􏰏􏰊􏰝􏰋􏰚􏰊􏰌 􏰪􏰧􏰲􏰣􏰸􏰹􏰮 􏰎􏰋􏰑􏰋 􏰕􏰝􏰋􏰕􏰣 􏰺􏰦􏰋􏰻􏰏􏰊􏰋􏰕 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰵 􏰲 􏰶􏰟􏰷􏰔􏰦 􏰎􏰏􏰌 􏰌􏰊􏰏􏰊􏰝􏰌􏰊􏰝􏰩􏰏􏰦􏰦􏰗 significant associated with all-cause inhospital mortality (adjusted odds ratio [OR] 3.46; 95% confidence interval [CI] = 1.41 – 8.49, p = 0.007), with a sensitivity of 82.1% and a specificity of 42.2% ( area under curve [AUC] = 0.628; 95% CI = 0.527 – 0.728; p = 0.012). Conclusion : Elevated D-dimer levels were associated with all-cause in-hospital mortality. In our study, the 􏰓􏰐􏰊􏰝􏰔􏰏􏰦 􏰩􏰞􏰊 􏰓􏰒 􏰐􏰓􏰝􏰚􏰊 􏰴􏰘􏰕􏰝􏰔􏰋􏰑 􏰻􏰏􏰦􏰞􏰋 􏰎􏰏􏰌 􏰲 􏰶􏰟􏰷􏰔􏰦􏰣

Cystatin C-based estimated glomerular filtration rate after percutaneous coronary intervention in the prediction of inhospital mortality in acute myocardial infarction

Aim. To assess the significance of changes cystatin C-based estimated glomerular filtration rate (eGFRcys) in predicting inhospital mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).Material and methods. In 133 patients with STEMI, serum creatinine and cystatin C were determined. Creatinine clearance (CrCl) was estimated according to Cockcroft-Gault equation. Creatinine-based estimated glomerular filtration rate (eGFRcr) was assessed using the MDRD (eGFRcr_MDRD) and CKD-EPI 2009 (eGFRcr_CKD-EPI). In addition, eGFRcys and a combination of serum creatinine and cystatin C (eGFRcr-cys) was assessed using the CKD-EPI 2012 equation at admission and 24-48 hours after PCI. In the groups of deceased patients and survivors, the studied parameters were compared. Their relationship with imhospital mortality was assessed by logistic regression adjusted for acute kidney injury (AKI) and GRACE risk. To assess the informativeness of identified independent predictors, an ROC analysis was performed.Results. After PCI, serum creatinine level increased by 9,8%, cystatin C — by 38,2%. CrCl decreased by 9,0%, eGFRcr_MDRD — by 10,2%, eGFRcr_CKD-EPI — by 5,2%, eGFRcys — by 29,5%, eGFRcr-cys — by 19,3%. AKI was diagnosed in 21 people (15,8%). Among the deceased patients (n=12), compared with the survivors, serum creatinine level was higher at baseline and after PCI, cystatin C — after PCI, eGFR of any calculation method was lower, while AKI developed more often. According to multivariate regression analysis, the eGFRcr-cys after PCI and the GRACE risk score were independent predictors of the endpoint. The area under the ROC curve for eGFRcr-cys after PCI was 0,835 [0,712-0,958], while the cut-off point was 38 ml/min/1,73 m2, below which the odds ratio of developing a fatal outcome was 22,2 with a 95% confidence interval of 5,7- 86,8.Conclusion. Estimated GFR determined 24-48 h after PCI based on the combination of serum creatinine and cystatin C using the CKD-EPI 2012 equation was an independent predictor of inhospital mortality in STEMI. The cut-off point of this parameter was 38 ml/min/1,73 m2, below which the death risk increases significantly. The results indicate the viability of introducing novel methods for assessing renal function based on cystatin C to improve the quality of prediction in STEMI.

Prognostic Association Between Perioperative Red Blood Cell Transfusion and Postoperative Cardiac Surgery Outcomes

Objective: To investigate the correlation between red blood cell transfusion and clinical outcome in patients after cardiac surgery.Methods: Demographic, clinical characteristics, treatment with/without transfusion, and outcomes of patients after cardiac surgery from the Medical Information Mart for Intensive Care—III database were collected. Patients were divided into two groups according to perioperative transfusion. A multivariable logistic regression analysis was utilized to adjust for the effect of red blood cell transfusion on outcomes for baseline and covariates and to determine its association with outcomes.Results: In total, 6,752 patients who underwent cardiac surgery were enrolled for the analysis. Among them, 2,760 (40.9%) patients received a perioperative transfusion. Compared with patients without red blood cell transfusion, transfused patients demonstrated worse outcomes in inhospital mortality, 1-year mortality, and all-cause mortality. Adjusting odds ratios (ORs) for the significant characteristic, patients with perioperative transfusion remained significantly associated with an increased risk of inhospital mortality [OR = 2.8, 95% confidence interval (CI) 1.5–5.1, P = 0.001], 1-year mortality (OR = 2.0, 95% CI 1.4–2.7, P &lt; 0.001), and long-term mortality (OR = 2.2, 95% CI 1.8–2.8, P &lt; 0.001).Conclusion: Perioperative red blood cell transfusion is associated with a worse prognosis of cardiac surgery patients. Optimal perioperative management and restricted transfusion strategy might be considered in selected patients.

Prestroke Metformin Use on the 1-Year Prognosis of Intracerebral Hemorrhage Patients with Type 2 Diabetes

Background. Although recent studies have focused on the use of metformin in treating ischemic stroke, there is little literature to support whether it can treat intracerebral hemorrhage (ICH). Therefore, this study is aimed at evaluating the possible effects of prestroke metformin (MET) on ICH patients with type 2 diabetes. Methods. From January 2010 to December 2019, all first-ever ICH patients with type 2 diabetes from our hospitals were included. All discharged patients would receive a one-time follow-up at 1 year after admission. Death, disability, and recurrence events were recorded. Results. We included 730 patients for analysis (the median age: 65 [IQR, 56-72] years and 57.7% was men). Of those patients, 281 (38.5%) had received MET before ICH (MET+), whereas 449 (61.5%) had not (MET−). MET (+) patients had a lower median baseline hematoma volume than did MET (-) patients (9.6 ml [IQR, 5.3-22.4 ml] vs. 14.7 ml [IQR, 7.9-28.6 ml]; P < 0.001 ). The inhospital mortality events were not significantly reduced in the MET (+) group compared with the MET (-) group (6.4% vs 8.9%, respectively; absolute difference, −2.5% [95% CI, −3.9% to −0.7%]; OR, 0.70 [95% CI, 0.39 to 1.27]; P = 0.22 ). The 1-year mortality events were not significantly reduced in the MET (+) group compared with the MET (-) group (14.1% vs 17.4%, respectively; absolute difference, −3.3% [95% CI, −5.1% to −1.8%]; OR, 0.73 [95% CI, 0.47 to 1.14]; P = 0.16 ). The 1-year disability events were not significantly reduced in the MET (+) group compared with the MET (-) group (28.4% vs 34.1%, respectively; absolute difference, −5.7% [95% CI, −8.2% to −3.3%]; OR, 0.77 [95% CI, 0.52 to 1.13]; P = 0.18 ). Finally, the recurrence rates in those two groups were not significantly different (MET [+] vs. MET [-]: 6.4% vs. 5.9%; absolute difference, 0.5% [95% CI, 0.2% to 1.3%]; OR, 1.08 [95% CI, 0.51 to 2.28]; P = 0.84 ). Conclusions. Pre-ICH metformin use was not associated with inhospital mortality and 1-year prognosis in diabetic ICH patients.

Low Eosinophil Count : A Predictor of Inhospital Mortality in a Cohort of Cirrhosis Patients With Sepsis

Background and Aims:Eosinopenia has recently been associated with sepsis. Thus, eosinopenia can be used as a marker of the severity of sepsis and high mortality, which helps in early identification of high risk patients, so better management can be offered to such patients. Aim of the study was to assess whether Absolute Esoinophil Count (AEC) at the time of ICU admission can be used as a predictor of inhospital mortality in cirrhotics.Materials and Methods:This study was a retrospective cohort study. The study population included cirrhosis patients admitted in ICU and High Dependency Unit with sepsis and their absolute eosinophil counts were assessed on the day of hospital admission.Results: A total of 105 patients were enrolled in the study. Among the various parameters analyzed, MELD score, CTP score, Albumin levels, Total count, CRP, ESR, ALT, Bilirubin, Creatinine, Urea, SIRS and Absolute Eosinophil Count(AEC) were statistically significant in predicting the mortality. AUROC of AEC for predicting mortality was 0.881. Cutoff of AEC by Youden’s index was 110 cells/cumm (sensitivity 91.3%, specificity 89%, positive predictive value 87.5% and negative predictive value 93%) in predicting inhospital mortality. MELD AUROC was 0.78 with cut off of > 24 (sensitivity 89%, specificity 74.6%, positive predictive value 73% and negative predictive value 89%) to predict mortality. Conclusion:In critically ill cirrhosis patients, absolute eosinophil count less than 110 cells/cumm can predict inhospital mortality.