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Journal of Diabetes Jun 2024Reportedly, the stress-hyperglycemia ratio (SHR) is closely associated with poor prognosis in patients with severe acute disease. However, the community-dwelling may...
Association between the stress-hyperglycemia ratio and all-cause mortality in community-dwelling populations: An analysis of the National Health and Nutrition Examination Survey (NHANES) 1999-2014.
BACKGROUND
Reportedly, the stress-hyperglycemia ratio (SHR) is closely associated with poor prognosis in patients with severe acute disease. However, the community-dwelling may also be in a state of stress due to environmental exposure. Our study aimed to explore the association between SHR and all-cause mortality in the community-dwelling population.
METHODS
A total of 18 480 participants were included out of 82 091 from the NHANES 1999-2014 survey. The Kaplan-Meier survival analyses were used to assess the disparities in survival rates based on SHR, and the log-rank test was employed to investigate the distinctions between groups. The multivariate Cox regression analysis and restricted cubic spline (RCS) analysis were performed to assess the association of SHR with all-cause mortality. A subgroup analysis was also conducted.
RESULTS
A total of 3188 deaths occurred during a median follow-up period of 11.0 (7.7; 15.4) years. The highest risk for all-cause mortality was observed when SHR≤ 0.843 or SHR ≥0.986 (log-rank p < .001). After adjusting for the confounding factors, compared with subjects in the second SHR quartile (Q2), participants in the highest (Q4, adjusted hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.28-1.73) and lowest quartiles (Q1, adjusted HR 1.37, 95% CI 1.16-1.60) have a higher probability of all-cause death. The RCS observed a dose-response U-shaped association between SHR and all-cause mortality. The U-shaped association between SHR and all-cause mortality was similar across subgroup analysis.
CONCLUSIONS
The SHR was significantly associated with all-cause mortality in the community-dwelling population, and the relationship was U-shaped.
Topics: Humans; Male; Female; Nutrition Surveys; Middle Aged; Independent Living; Hyperglycemia; Adult; Aged; Cause of Death; Risk Factors; Mortality; Stress, Physiological; United States; Prognosis; Kaplan-Meier Estimate
PubMed: 38769875
DOI: 10.1111/1753-0407.13567 -
Clinical and Applied... 2024Several risk stratification systems aid clinicians in classifying pulmonary embolism (PE) severity and prognosis. We compared 2 clinical PE scoring systems, the PESI and...
Several risk stratification systems aid clinicians in classifying pulmonary embolism (PE) severity and prognosis. We compared 2 clinical PE scoring systems, the PESI and sPESI scores, with 2 comorbidity indices, the Charlson Comorbidity Index (CCI) and the val Walraven Elixhauser Comorbidity Index (ECI), to determine the utility of each in predicting mortality and hospital readmission. Information was collected from 436 patients presenting with PE via retrospective chart review. The PESI, sPESI, CCI, and ECI scores were calculated for each patient. Multivariate analysis was used to determine each system's ability to predict in-hospital mortality, 90-day mortality, overall mortality, and all-cause hospital readmission. The impact of various demographic and clinical characteristics of each patient on these outcomes was also assessed. The PESI score was found to be an independent predictor of in-hospital mortality and 90-day mortality. The PESI score and the CCI were able to independently predict overall mortality. None of the 4 risk scores independently predicted hospital readmission. Other factors including hypoalbuminemia, serum BNP, coagulopathy, anemia, and diabetes were associated with increased mortality and readmission at various endpoints. The PESI score was the best tool for predicting mortality at any endpoint. The CCI may have utility in predicting long-term outcomes. Further work is needed to better determine the roles of the CCI and ECI in predicting patient outcomes in PE. The potential prognostic implications of low serum albumin and anemia at the time of PE also warrant further investigation.
Topics: Humans; Pulmonary Embolism; Patient Readmission; Female; Male; Aged; Middle Aged; Retrospective Studies; Hospital Mortality; Comorbidity; Acute Disease; Aged, 80 and over; Prognosis
PubMed: 38755956
DOI: 10.1177/10760296241253844 -
Sex differences in cause-specific mortality: regional trends in seven European countries, 1996-2019.European Journal of Public Health Dec 2023Male excess mortality is mostly related to non-biological factors, and is thus of high social- and health-policy concern. Previous research has mainly focused on...
BACKGROUND
Male excess mortality is mostly related to non-biological factors, and is thus of high social- and health-policy concern. Previous research has mainly focused on national patterns, while subnational disparities have been less in the focus. This study takes a spatial perspective on subnational patterns, covering seven European countries at the crossroad between Eastern and Western Europe.
METHODS
We analyze a newly gathered spatially detailed data resource comprising 228 regions with well-established demographic methods to assess the contribution of specific causes of death to the evolution of sex mortality differentials (SMDs) since the mid-1990s.
RESULTS
Our results show that declines in SMDs were mostly driven by a reduction of male excess mortality from cardiovascular diseases and neoplasms (about 50-60% and 20-30%, respectively). In Western Europe, trends in deaths from neoplasms contributed more to the reduction of SMDs, while among regions located in Eastern-Central Europe narrowing SMDs were mostly driven by changes in cardiovascular disease-related deaths. Moreover, men show up to three times higher mortality levels from external causes as compared to women in several analyzed regions. But in absolute terms, external deaths play only a minor role in explaining SMDs due to their small contribution to overall mortality.
CONCLUSIONS
We conclude that examining the regional development of SMDs is useful for introducing targeted social and health policies in order to reduce and prevent mortality inequalities between women and men.
Topics: Humans; Male; Female; Cause of Death; Sex Characteristics; Cardiovascular Diseases; Neoplasms; Europe; Mortality
PubMed: 37507140
DOI: 10.1093/eurpub/ckad111 -
Journal of Dairy Science Mar 2024Abortions and perinatal mortalities (APM) substantially affect cattle industry efficiency. Various infectious and noninfectious factors have been associated with bovine...
Abortions and perinatal mortalities (APM) substantially affect cattle industry efficiency. Various infectious and noninfectious factors have been associated with bovine APM worldwide. Infections are often considered pivotal due to their abortifacient potential, leading laboratories to primarily investigate relevant infectious agents for APM cases. Some infectious causes, such as Brucella abortus, have also a zoonotic impact, necessitating monitoring for both animal and human health. However, underreporting of bovine APM is a global issue, affecting early detection of infectious and zoonotic causes. Previous studies identified factors influencing case submission, but regional characteristics may affect results. In Belgium, farmers are obliged to report cases of APM within the context of a national brucellosis monitoring program. The inclusion criteria for this monitoring program cover abortions (gestation length of 42-260 d) and perinatal mortalities of (pre)mature calves following a gestation length of more than 260 d, which were stillborn or died within 48 h after birth. The objective of the present study was to describe the evolution in submission of APM cases within a mandatory abortion monitoring program in relation to subsidized initiatives in the northern part of Belgium. Based on the proportion of APM submissions versus the proportion of bovine reproductive females, an APM proportion (APM) was calculated, and factors at both animal and herd level that may influence this APM were explored by using linear models. This evaluation revealed that the APM increased with the introduction of an extensive analytical panel of abortifacient agents and a free on-farm sample collection from 0.44% to 0.94%. Additionally, an increase of the APM was associated with an outbreak of an emerging abortifacient pathogen (Schmallenberg virus; 1.23%), and the introduction of a mandatory eradication program for bovine viral diarrhea virus (BVDv; 1.20%). The APM was higher in beef compared with dairy cattle, and it was higher in winter compared with fall, spring, and summer. Smaller herds categorized in the first quartile had a higher APM compared with larger herds. Herds that submitted an APM in the previous year had a higher APM in the next year compared with herds without an APM submission. Finally, herds for which there was evidence of the presence of BVDv had a higher APM compared with herds without evidence of the presence of BVDv. In conclusion, the number of APM submissions increased after the introduction of a free on-farm sample collection and an extensive pathogen screening panel. Production type (beef), season (winter), smaller herd size, previous APM, and presence of BVDv seemed to have a positive effect on APM. However, even under mandatory circumstances, APM still seems to be underreported, since the APM was lower than the expected minimal rate of 2%. Therefore, further research is necessary to identify the drivers that convince farmers to submit APM cases to improve submission rates and ensure an efficient monitoring program for APM and eventually associated zoonotic pathogens.
Topics: Female; Pregnancy; Humans; Animals; Cattle; Learning; Abortifacient Agents; Stillbirth; Perinatal Mortality; Belgium
PubMed: 37806630
DOI: 10.3168/jds.2023-23823 -
Frontiers in Immunology 2023Acute respiratory distress syndrome (ARDS) is an acute inflammatory lung injury characterized by diffuse alveolar damage. The period prevalence of ARDS was 10.4% of ICU... (Review)
Review
Acute respiratory distress syndrome (ARDS) is an acute inflammatory lung injury characterized by diffuse alveolar damage. The period prevalence of ARDS was 10.4% of ICU admissions in 50 countries. Although great progress has been made in supportive care, the hospital mortality rate of severe ARDS is still up to 46.1%. Moreover, up to now, there is no effective pharmacotherapy for ARDS and most clinical trials focusing on consistently effective drugs have met disappointing results. Mesenchymal stem cells (MSCs) and their derived extracellular vesicles (EVs) have spawned intense interest of a wide range of researchers and clinicians due to their robust anti-inflammatory, anti-apoptotic and tissue regeneration properties. A growing body of evidence from preclinical studies confirmed the promising therapeutic potential of MSCs and their EVs in the treatment of ARDS. Based on the inspiring experimental results, clinical trials have been designed to evaluate safety and efficacy of MSCs and their EVs in ARDS patients. Moreover, trials exploring their optimal time window and regimen of drug administration are ongoing. Therefore, this review aims to present an overview of the characteristics of mesenchymal stem cells and their derived EVs, therapeutic mechanisms for ARDS and research progress that has been made over the past 5 years.
Topics: Humans; Mesenchymal Stem Cells; Acute Lung Injury; Extracellular Vesicles; Hospital Mortality; Respiratory Distress Syndrome
PubMed: 37711624
DOI: 10.3389/fimmu.2023.1244930 -
Revista Brasileira de Epidemiologia =... 2024To assess the magnitude, trend, and spatial patterns of childhood and adolescent cancer mortality between 1996 and 2017 in 133 Brazilian intermediate regions by using...
OBJECTIVE
To assess the magnitude, trend, and spatial patterns of childhood and adolescent cancer mortality between 1996 and 2017 in 133 Brazilian intermediate regions by using socioeconomic and healthcare services indicators.
METHODS
This is an ecological study for analyzing the trend of mortality from cancer in childhood and adolescence through time series. Data on deaths were extracted from the Brazilian Mortality Information System. Data on population were extracted from the 1991, 2000, and 2010 demographic censuses of the Brazilian Institute of Geography and Statistics, with interpolation for intercensal years. Time series were delineated for mortality by type of cancer in each intermediate region. Such regions were grouped by macroregions to present the results. The calculation and interpretation of mortality trends use the Prais-Winsten autoregression procedure.
RESULTS
Mortality rates for all neoplasms were higher in the Northern region (7.79 deaths per 100 thousand population), while for leukemias, they were higher in the Southern region (1.61 deaths per 100 thousand population). In both regions, mortality was higher in boys and in the 0-4 age group. The trend was decreasing (annual percent change [APC] - -2.11 [95%CI: -3.14; - 1.30]) for all neoplasms in the Brazilian regions and stationary (APC - -0.43 [95%CI: -1.61; 2.12]) for leukemias in the analyzed period.
CONCLUSION
The mortality rate for all neoplasms showed higher values in regions with smaller numbers of ICU beds in the public healthcare system.
Topics: Adolescent; Humans; Male; Brazil; Delivery of Health Care; Geography; Leukemia; Mortality; Neoplasms
PubMed: 38294061
DOI: 10.1590/1980-549720240003 -
The Clinical Respiratory Journal Aug 2023The prognosis for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is not optimistic, and severe AECOPD leads to an increased risk of mortality.... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The prognosis for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is not optimistic, and severe AECOPD leads to an increased risk of mortality. Prediction models help distinguish between high- and low-risk groups. At present, many prediction models have been established and validated, which need to be systematically reviewed to screen out more suitable models that can be used in the clinic and provide evidence for future research.
METHODS
We searched PubMed, EMBASE, Cochrane Library and Web of Science databases for studies on risk models for AECOPD mortality from their inception to 10 April 2022. The risk of bias was assessed using the prediction model risk of bias assessment tool (PROBAST). Stata software (version 16) was used to synthesize the C-statistics for each model.
RESULTS
A total of 37 studies were included. The development of risk prediction models for mortality in patients with AECOPD was described in 26 articles, in which the most common predictors were age (n = 17), dyspnea grade (n = 11), altered mental status (n = 8), pneumonia (n = 6) and blood urea nitrogen (BUN, n = 6). The remaining 11 articles only externally validated existing models. All 37 studies were evaluated at a high risk of bias using PROBAST. We performed a meta-analysis of five models included in 15 studies. DECAF (dyspnoea, eosinopenia, consolidation, acidemia and atrial fibrillation) performed well in predicting in-hospital death [C-statistic = 0.91, 95% confidence interval (CI): 0.83, 0.98] and 90-day death [C-statistic = 0.76, 95% CI: 0.69, 0.82] and CURB-65 (confusion, urea, respiratory rate, blood pressure and age) performed well in predicting 30-day death [C-statistic = 0.74, 95% CI: 0.70, 0.77].
CONCLUSIONS
This study provides information on the characteristics, performance and risk of bias of a risk model for AECOPD mortality. This pooled analysis of the present study suggests that the DECAF performs well in predicting in-hospital and 90-day deaths. Yet, external validation in different populations is still needed to prove this performance.
Topics: Humans; Hospital Mortality; Prognosis; Dyspnea; Pulmonary Disease, Chronic Obstructive; Risk Assessment; Disease Progression
PubMed: 36945821
DOI: 10.1111/crj.13606 -
Respiratory Medicine 2023Reduced lung function is associated with increased mortality, but it is unclear how different spirometric patterns are related to specific deaths. Aim of this study was...
BACKGROUND AND AIM
Reduced lung function is associated with increased mortality, but it is unclear how different spirometric patterns are related to specific deaths. Aim of this study was to investigate these associations in a large general population cohort.
METHODS
The study population consisted of 26,091 men aged 30-46 years from the Pneumoconiosis Survey of Western Norway conducted in 1988-1990 with follow-up on date and cause of death for 26 years. Cox proportional hazard models were used to estimate the association between baseline FEV, FVC, obstructive (OSP) and restrictive spirometric pattern (RSP) (z-scores calculated according to GLI-2012 equations) and mortality (European 2012 shortlist classification (E-2012)), after adjustment for age, body mass index, smoking habits, and education.
RESULTS
In total, 2462 (9%) subjects died. A predominant reduction of FEV (and OSP) were associated with respiratory non-cancer (E-8) (HR for one unit FEV z-score decrease 2.29 (95% CI 1.90, 2.77) and lung cancer mortality (E-2.1.8) (1.27(1.12, 1.44)). A similar reduction of FEV and FVC (and RSP) were associated with diabetes (E-4.1) (FEV 2.21(1.67, 2.92), FVC 2.41(1.75, 3.32)), cerebrovascular (E-7.3) (1.52(1.21, 1.91), 1.54(1.19, 1.98)), ischemic heart disease (E-7.1) (1.22(1.10, 1.35), 1.21(1.08, 1.36)), neurological (E-6.3) (1.56(1.21, 2.01), 1.61(1.22, 2.13)), suicide (E-17.2) (1.37(1.13, 1.65), 1.29(1.04, 1.59)) and hematological cancer mortality (E-2.1.19-21) (1.29(1.05, 1.58), (1.26(1.00, 1.58)). No association was found between reduced lung function and mortality due to accidents, alcohol abuse, digestive and genitourinary cancer.
CONCLUSIONS
Spirometric obstruction was mainly related to pulmonary mortality. Spirometric restriction was mainly related to extra-pulmonary mortality.
Topics: Male; Humans; Pulmonary Disease, Chronic Obstructive; Cause of Death; Forced Expiratory Volume; Lung; Spirometry; Vital Capacity
PubMed: 37776914
DOI: 10.1016/j.rmed.2023.107421 -
Nursing Open Sep 2023
Topics: Pregnancy; Humans; Female; Bias, Implicit; Maternal Mortality; Reproductive Health; Parturition; Physicians
PubMed: 37327404
DOI: 10.1002/nop2.1759 -
BMC Pulmonary Medicine Aug 2023A high mortality rate has always been observed in patients with severe community-acquired pneumonia (SCAP) admitted to the intensive care unit (ICU); however, there are...
BACKGROUND
A high mortality rate has always been observed in patients with severe community-acquired pneumonia (SCAP) admitted to the intensive care unit (ICU); however, there are few reported predictive models regarding the prognosis of this group of patients. This study aimed to screen for risk factors and assign a useful nomogram to predict mortality in these patients.
METHODS
As a developmental cohort, we used 455 patients with SCAP admitted to ICU. Logistic regression analyses were used to identify independent risk factors for death. A mortality prediction model was built based on statistically significant risk factors. Furthermore, the model was visualized using a nomogram. As a validation cohort, we used 88 patients with SCAP admitted to ICU of another hospital. The performance of the nomogram was evaluated by analysis of the area under the receiver operating characteristic (ROC) curve (AUC), calibration curve analysis, and decision curve analysis (DCA).
RESULTS
Lymphocytes, PaO2/FiO2, shock, and APACHE II score were independent risk factors for in-hospital mortality in the development cohort. External validation results showed a C-index of 0.903 (95% CI 0.838-0.968). The AUC of model for the development cohort was 0.85, which was better than APACHE II score 0.795 and SOFA score 0.69. The AUC for the validation cohort was 0.893, which was better than APACHE II score 0.746 and SOFA score 0.742. Calibration curves for both cohorts showed agreement between predicted and actual probabilities. The results of the DCA curves for both cohorts indicated that the model had a high clinical application in comparison to APACHE II and SOFA scoring systems.
CONCLUSIONS
We developed a predictive model based on lymphocytes, PaO2/FiO2, shock, and APACHE II scores to predict in-hospital mortality in patients with SCAP admitted to the ICU. The model has the potential to help physicians assess the prognosis of this group of patients.
Topics: Humans; Hospital Mortality; Hospitals; Intensive Care Units; Community-Acquired Infections; Pneumonia; Risk Factors; Respiratory Distress Syndrome
PubMed: 37592285
DOI: 10.1186/s12890-023-02567-5