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Background Previous studies have shown that inflammation plays an important role in atherosclerosis and cardiovascular disease. Platelet to lymphocyte ratio (PLR) has been reported as a novel inflammatory marker. However, it is not clear whether PLR is associated with short‐term all‐cause mortality in critically ill patients with non‐ST‐segment elevation myocardial infarction (NSTEMI). Methods The data for the study is from the Medical Information Mart for Intensive Care III database. The primary outcome in our study was 28‐day mortality. Kapan‐Meier curve, lowess smoother curve, and multivariate Cox regression models were used to determine whether the association between PLR and 28‐day mortality of critically ill patients with NSTEMI. Results A total of 1273 critically ill patients with NSTEMI were included in this analysis. Kapan‐Meier curve and lowess smoother curve show that high PLR is associated with an increased risk of 28‐day all‐cause mortality. The study population is divided into two groups according to the cut‐off value of PLR level. In the Cox model, high PLR levels (PLR≥195.8) were significantly associated with increased 28‐day mortality (HR 1.54; 95%CI 1.09–2.18, p = .013). In quartile analyses, the HR (95% CI) for the third (183 ≤ PLR < 306) and fourth quartile (PLR≥306) was 1.55 (1.05–2.29) and 1.61 (1.03–2.52), respectively, compared to the reference group(111 ≤ PLR < 183). In subgroup analyses, there is no interaction effect in most of the subgroups except for respiratory failure and vasopressor use. Conclusion High PLR is associated with an increased risk of short‐term mortality in critically ill patients with NSTEMI.

Background Risk stratification of patients with acute myocardial infarction (AMI) is of great clinical significance. Hypothesis The present study aimed to establish an optimized risk score to predict short‐term (6‐month) death among rural AMI patients from China. Methods We enrolled 6581 AMI patients and extracted relevant data. Patients were divided chronologically into a derivation cohort (n = 5539), to establish the multivariable risk prediction model, and a validation cohort (n = 1042), to validate the risk score. Results Six variables were identified as independent predictors of short‐term death and were used to establish the risk score: age, Killip class, blood glucose, creatinine, pulmonary artery systolic pressure, and percutaneous coronary intervention treatment. The area under the ROC curve (AUC) of the optimized risk score was 0.82 within the derivation cohort and 0.81 within the validation cohort. The diagnostic performance of the optimized risk score was superior to that of the GRACE risk score (AUC 0.76 and 0.75 in the derivation and validation cohorts, respectively; p < .05). Conclusion These results indicate that the optimized scoring method developed here is a simple and valuable instrument to accurately predict the risk of short‐term mortality in rural patients with AMI.

Aim The study aimed to investigate the short‐term outcomes of hospitalized patients with chronic liver disease (CLDs) and assess the prognostic impact of predisposition and precipitants, which currently remains unclear. Methods The study included 3970 hospitalized patients with CLDs from two prospective longitudinal multicenter studies (NCT02457637 and NCT03641872) conducted in highly endemic hepatitis B virus (HBV) areas. Competing risk analysis was used to evaluate the effect of predispositions, including the etiology and severity of CLDs and precipitants; on sequential 28, 90, and 365‐day liver transplantation (LT)‐free mortality. Results Among all enrolled patients, 76.8% of adverse outcomes (including death and LT) within one year occurred within 90 days. Compared with alcoholic etiology, the association of HBV etiology with poorer outcomes was remarkably on the 28th day (hazard ratio [HR], 1.81; 95% confidence interval [CI], 1.07–3.06; p = 0.026); however, and diminished or became insignificant at 90 days and 365 days. Cirrhosis increased the adjusted risk for 365‐day (HR, 1.50; CI, 1.13–1.99; p = 0.004) LT‐free mortality when compared with noncirrhosis. In patients with cirrhosis, prior decompensation (PD) independently increased the adjusted risk of 365‐day LT‐free mortality by 1.25‐fold (p = 0.021); however, it did not increase the risk for 90‐day mortality. Neither the category nor the number of precipitants influenced the adjusted risk of 28 or 90‐day LT‐free mortality. Conclusions The 90‐day outcome should be considered a significant endpoint for evaluating the short‐term prognosis of hospitalized patients with CLD. Predisposing factors, other than etiology, mainly affected the delayed (365‐day) outcome. Timely effective therapy for CLD etiology, especially antiviral treatments for HBV, and post‐discharge long‐term surveillance monitoring in cirrhotic patients undergoing PD are suggested to enhance disease management and reduce mortality. This study revealed the predisposition and precipitant factors that affect short‐term outcomes in hospitalized patients with chronic liver diseases (CLDs). Numerous 1‐year adverse outcomes (death and liver transplantation) occurred within 90 days in CLDs. The 90‐day outcome should be considered a major endpoint for evaluating the short‐term prognosis of hospitalized patients with CLDs. Predisposing factors, other than etiology, mainly impacted the delayed short‐term outcome. Compared to alcoholic etiology, hepatitis B virus (HBV) had a significantly poorer 28‐day outcome. Timely antiviral therapy for HBV and post‐discharge long‐term surveillance monitoring in patients with cirrhosis with prior decompensation are suggested to enhance disease management. Key points Significant findings of the study Numerous 1‐year adverse outcomes (death and liver transplantation) occurred within 90 days in chronic liver diseases (CLDs). Predisposing factors, other than etiology, mainly impacted the delayed short‐term outcome. Compared to alcoholic etiology, hepatitis B virus (HBV) had a significantly poorer 28‐day outcome. What this study adds The 90‐day outcome should be considered a major endpoint for evaluating the short‐term prognosis of hospitalized patients with CLDs. Timely antiviral therapy for HBV and postdischarge long‐term surveillance monitoring in patients with cirrhosis with prior decompensation are suggested to enhance disease management.

SummaryThe aim of this study was to investigate the association of surgical delay and comorbidities with the risk of mortality after hip fracture surgeries. We found that CCI was the dominant factor in predicting both short- and long-term mortality, and its effect is vital in the prognostication of survivorship.IntroductionHip fracture is a growing concern and a delay in surgery is often associated with a poorer outcome. We hypothesized that a higher Charlson Comorbidity Index (CCI) portends greater risk of mortality than a delay in surgery. Our aim was to investigate the associations of surgical delay and CCI with risk of mortality and to determine the dominant predictor.MethodsThis retrospective study examines hip fracture data from a large tertiary hospital in Singapore over the period January 2013 through December 2015. Data collected included age, gender, CCI, delay of surgery, fracture patterns, and the American Society of Anaesthesiologist (ASA) score. Post-operative outcomes analyzed included mortality at inpatient, at 30 and 90 days, and at 2 years.ResultsA total of 1004 patients with hip fractures were included in this study. Study mortality rates were 1.1% (n = 11) during in-hospital admission, 1.8% (n = 18) at 30 days, 2.7% (n = 27) at 90 days, and 13.3% (n = 129) at 2 years. Lost to follow-up rate at 2 years was 3.3%. We found that CCI was consistently the dominant factor in predicting both short- and long-term mortality. A CCI score of 5 was identified as the inflection point above which comorbidity at baseline presented a greater risk of mortality than a delay in surgery.ConclusionOur analysis showed that CCI is the dominant predictor of both short- and long-term mortality compared with delay in surgery. The effect of CCI is vital in the prognostication of mortality in patients surgically treated for hip fractures.

Risk models and risk scores derived from those models require periodic updating to account for changes in procedural performance, patient mix, and new risk factors added to existing systems. No risk model or risk score exists for predicting in-hospital/30-day mortality for percutaneous coronary interventions (PCIs) using contemporary data. This study develops an updated risk model and simplified risk score for in-hospital/30-day mortality following PCI. To accomplish this, New York's Percutaneous Coronary Intervention Reporting System was used to develop a logistic regression model and a simplified risk score model for predicting in-hospital/30-day mortality and to validate both models based on New York data from the previous year. A total of 54,770 PCI patients from 2019 were used to develop the models. Twelve different risk factors and 27 risk factor categories were used in the models. Both models displayed excellent discrimination for the development and validation samples (range from 0.894 to 0.896) and acceptable calibration, but the full logistic model had superior calibration, particularly among higher-risk patients. In conclusion, both the PCI risk model and its simplified risk score model provide excellent discrimination and although the full risk model requires the use of a hand-held device for estimating individual patient risk, it provides somewhat better calibration, especially among higher-risk patients.

Purpose Many apparent differences exist in aetiology, genetics, anatomy and treatment response between colon cancer (CC) and rectal cancer (RC). This study examines the differences in patient characteristics, prevalence of complications and their effect on short-term survival, long-term survival and the rate of recurrence between RC and CC. Methods For all stage II–III CC and RC patients who underwent resection with curative intent (2006–2008) in five hospitals in the Netherlands, occurrence of complications, crude survival, relative survival and recurrence rates were compared. Results A total of 767 CC and 272 RC patients underwent resection. Significant differences were found for age, gender, emergency surgery, T-stage and grade. CC patients experienced fewer complications compared to RC ( p  = 0.019), but CC patients had worse short-term mortality rates (1.5 versus 6.7 % for 30-day mortality, p  = 0.001 and 5.2 versus 9.5 % for 90-day mortality, p  = 0.032). The adjusted HR (overall survival) for CC patients with complications was 1.57 (1.23–2.01; p  < 0.001) as compared to patients without complications; for RC, the HR was 1.79 (1.12–2.87; p  = 0.015). Relative survival analyses showed high excess mortality in the first months after surgery and a sustained, prolonged negative effect on both CC and RC. Complications were associated with a higher recurrence rate for both CC and RC; adjusted analyses showed a trend towards a significant association. Conclusion Large differences exist in patient characteristics and clinical outcomes between CC and RC. CC patients have a significantly higher short-term mortality compared to RC patients due to a more severe effect of complications.

BackgroundEarly mobilization and weight-bearing have been proposed to improve hip fracture outcomes. This study aimed to compare early postoperative complications and outcomes of patients who underwent weight-bearing as tolerated (WBAT) on postoperative day one (POD1) with those that did not on: (1) 30-day mortality; (2) 30-day postoperative major and minor complications; (3) length of stay (LOS); and (4) discharge disposition after hip fracture management.MethodsThe NSQIP database was used to identify 7947 hip fracture patients managed with a hemiarthroplasty and internal fixation, sliding hip screw, or cephalomedullary nail, for a total of 5845 patients were allowed to WBAT on POD1. They were compared to patients who were non-WBAT using adjusted multivariate regression models to evaluate the effect of WBAT status on the outcomes above.ResultsAmong the cephalomedullary nail patients, WBAT on POD1 was associated with a decreased likelihood of mortality. In the cephalomedullary nail and sliding hip screw treatment groups, patients were less likely to experience major and minor complications if they were WBAT on POD1. WBAT patients had shorter LOS in the sliding hip screw and cephalomedullary nail treatment groups. Patients were less likely to be discharged to a non-home facility when WBAT on POD1 regardless of treatment.ConclusionEarly weight-bearing after surgical care of hip fracture seems to decrease morbidity and mortality; however, this effect is treatment dependent. These findings further support the need for early mobilization and rapid recovery programs in the care of hip fracture patients.Level of evidenceLevel III.

Fulminant myocarditis (FM) may lead to cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Results of effectiveness studies of VA-ECMO have been contradictory. We evaluated the aggregate short-term mortality after VA-ECMO and predictive factors in patients with FM. We systematically searched in electronic databases (February 2022) to identify studies evaluating short-term mortality (defined as mortality at 30 days or in-hospital) after VA-ECMO support for FM. We included studies with 5 or more patients published after 2009. We assessed the quality of the evidence using the QUIPS and GRADE tools. Mortality was pooled using random effect models. We performed meta-regression to explore heterogeneity based on a priori defined factors. We included 54 observational studies encompassing 2388 FM patients supported with VA-ECMO. Median age was 41 years (25th to 75th percentile 37–47), and 50% were female. The pooled short-term mortality was 35% (95% CI 29–40%, I2 = 69%; moderate certainty). By meta-regression, studies with younger populations showed lower mortality. Female sex, receiving a biopsy, cardiac arrest, left ventricular unloading, and earlier recruitment time frame, did not explain heterogeneity. These results remained consistent regardless of continent and the risk of bias category. In individual studies, low pH value, high lactate, absence of functional cardiac recovery on ECMO, increased burden of malignant arrhythmia, high peak coronary markers, and IVIG use were identified as independent predictors of mortality. When conventional therapies have failed, especially in younger patients, cardiopulmonary support with VA-ECMO should be considered in the treatment of severe FM.

To adapt the Sequential Organ Failure Assessment (SOFA) score to fit the prehospital care needs; to do that, the SOFA was modified by replacing platelets and bilirubin, by lactate, and tested this modified SOFA (mSOFA) score in its prognostic capacity to assess the mortality-risk at 2 days since the first Emergency Medical Service (EMS) contact. Prospective, multicentric, EMS-delivery, ambulance-based, pragmatic cohort study of adults with acute diseases, referred to two tertiary care hospitals (Spain), between January 1st and December 31st, 2020. The discriminative power of the predictive variable was assessed through a prediction model trained using the derivation cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) on the validation cohort. A total of 1114 participants comprised two separated cohorts recruited from 15 ambulance stations. The 2-day mortality rate (from any cause) was 5.9% (66 cases). The predictive validity of the mSOFA score was assessed by the calculation of the AUC of ROC in the validation cohort, resulting in an AUC of 0.946 (95% CI, 0.913–0.978, p < .001), with a positive likelihood ratio was 23.3 (95% CI, 0.32–46.2). Scoring systems are now a reality in prehospital care, and the mSOFA score assesses multiorgan dysfunction in a simple and agile manner either bedside or en route. Patients with acute disease and an mSOFA score greater than 6 points transferred with high priority by EMS represent a high early mortality group. Trial registration: ISRCTN48326533, Registered Octuber 312,019, Prospectively registered (doi:https://doi.org/10.1186/ISRCTN48326533).

Objective To study the relationship between red blood cell distribution width (RDW) and short-term mortality of hip fracture in middle-aged and older adults. Methods A retrospective cohort of electronic medical records at a single hospital over a 2-year period between 2020 and 2021. We received the records of 233 patients aged > 50 years who suffered from hip fracture. the clinical data including patients demographics, comorbidities at the time of admission, type of surgery, blood examination, 3-months mortality, 6-months mortality and 1-year mortality. the relationship between RDW and short-term mortality of hip fracture were analyzed. the cohort was then divided into two groups based on their RDW levels at the time of admission: low (RDW < 13.6%) and high (RDW ≥ 13.6%). Results Results the mean age was 78.03 ± 12.09 years; 64.81% were woman. At admission, 80 patients (34.33%) had high RDW levels and 153 patients (65.67%) had low RDW levels. there were no statistically significant differences between the groups with regard to sex, type of operation, duration of surgery and hospitalization length. Patients with high RDW had more comorbidities when compared to patients with low RDW levels ( p  < 0.05). All-cause mortality was higher for patients with high RDW levels, at 3 months ( p  < 0.05), 6 months ( p  < 0.05), and 12 months ( p  < 0.05). Conclusion RDW is significantly related with short-term mortality in hip fracture. The higher RDW, the higher risk of mortality.