Mortality Rate, Demographics, and Clinical Attributes of Patients Dying in the Intensive Care Unit of a Comprehensive Cancer Center in Jordan: A Descriptive Study.

Very little is known about the provision of or the need for palliative care in the Middle East, including Jordan. This study investigated the mortality rate, demographics, and clinical attributes of patients with cancer who had died in the intensive care unit (ICU) of a national cancer center over a 3-year period in Jordan. We reviewed the records of 661 patients who had died and found that the majority of the people were terminally ill at the time of admission (had metastatic cancer, multisystem organ dysfunction, and seriously ill). This approach differs from the usual practice worldwide in which it is uncommon to admit patients with cancer to the ICU at the end of life. Improving end-of-life care in the ICUs in Jordan requires further exploration of the cultural context in which end-of-life care practice occurs in Jordan and developing a palliative care approach that fit with the Islamic and Arabic culture.

High Dietary Sodium Intake is Associated with Shorter Event-Free Survival in Patients with Heart Failure and Comorbid Diabetes.

The aim was to determine whether 24-hour urine sodium excretion predicted event-free survival of patients with heart failure (HF) and diabetes mellitus (DM). Twenty-four hour urine sodium, as an indicator of dietary sodium, was collected from 107 patients with HF and comorbid DM. Patients were followed for a median period of 337 days to determine time to the first event of either all-cause hospitalization or cardiac-related mortality. There were 44 patients (41%) who had an event of death or hospitalization. Cox regression showed that higher urine sodium (>3.8 gm/day) was associated with 2.8 times greater risk for an event than lower urine sodium after controlling for age, gender, New York Heart Association class (I/II vs. III/IV), left ventricular ejection fraction, and body mass index. These data suggest that dietary sodium restriction may be beneficial for patients with HF and DM.

The health outcomes of inflammation and obesity in patients with heart failure.

BACKGROUND: Although obesity is a risk factor for cardiovascular disease, higher body mass index is related to longer event-free survival in patients with heart failure (HF). While previous research demonstrated that higher levels of inflammatory mediators were associated with shorter event-free survival, the effect of inflammation on the association between obesity and outcomes of HF have not been considered. HYPOTHESIS: Based on the obesity paradox, we hypothesized that patients with higher baseline body mass index (BMI) would experience better event-free survival than those with lower BMI regardless of inflammatory status. METHOD: A sample of 415 patients with HF (age 61 ± 11.5 years; 31% female) provided blood to measure soluble tumor necrosis factor receptor1 (sTNFR1), a biomarker of inflammation. Patients were divided into 4 groups based on BMI and a median split of sTNFR1 levels: (1) high BMI ≥ 30 and sTNFR1 > 1804 pg/ml, (2) high BMI ≥ 30 and low sTNFR1 ≤ 1804 pg/ml, and (3) low BMI < 30 and high sTNFR1 > 1804 pg/ml vs. (4) low BMI < 30 and sTNFR1 ≤ 1804 pg/ml. Patients were followed for an average of 365 days to determine the time to first event of either all-cause hospitalization or death. RESULTS: There were 177 patients (43%) who experienced either an all-cause hospitalization or death. In a Cox regression, high BMI and high sTNFR1 category predicted time to event (hazard ratio = 1.7, 95% confidence interval = 1.01-2.9) with age, gender, race, left ventricular ejection fraction, New York Heart Association functional class (I/II versus III/IV), log-transformed N-terminal Pro-B-type natriuretic peptide levels, prescribed statin (yes/no), and comorbidity as covariates. CONCLUSION: Being in a higher inflammation group was associated with shorter event-free survival regardless of BMI. This study provides evidence that inflammation is an important consideration in the association between obesity and better outcomes in patients with HF.