Cancer mortality among solid organ transplantation recipients: A systematic review and meta-analysis.

OBJECTIVES: To evaluate the cancer mortality risk among solid organ transplant recipients through a systematic review and meta-analysis. METHODS: Systematic searches were conducted in PubMed (starting from 1965), ISI Web of Science (starting from 1900), MEDLINE (starting from 1976), and Scopus (starting from 1968) from the inception of each database until July 15, 2024. Studies published in English reporting at least one type of cancer mortality risk among recipients of any type of solid organ transplantation were included. The main outcomes were the standardized mortality ratio (SMR) for cancer mortality in transplant recipients compared to the general population, and the hazard ratio (HR) for cancer mortality in transplant recipients versus cancer patients without prior transplantation. RESULTS: Solid organ transplant recipients had a 2.06-fold increased cancer mortality risk (SMR, 2.06 [95 % CI, 1.56-2.71]) than the general population. Risks were higher in kidney (SMR 1.92 [95 % CI: 1.30-2.84]), liver (SMR 3.07 [95 % CI: 1.80-5.24]), and lung/heart (SMR 4.87 [95 % CI: 3.33-7.12]) transplant recipients. Cancer patients with prior transplantation had a 1.47-fold increased cancer mortality risk (HR 1.47 [95 % CI: 1.29-1.68]) than those without. East Asia female transplant recipients exhibited higher mortality risks from breast, ovarian, cervix and uterus cancers than those from other regions (SMR 3.13 [95 % CI: 1.93-5.07] vs. 1.16 [95 % CI: 0.88-1.53], P < 0.01). CONCLUSIONS: Solid organ transplant recipients face significantly higher cancer mortality risks than the general population, highlighting the need for targeted cancer screening and interventions, especially for female solid organ transplant recipients from East Asia.

Association between prescription drugs and all-cause mortality risk in the UK population.

Although most drugs currently approved are meant to treat specific diseases or symptoms, it has been hypothesized that some might bear a beneficial effect on lifespan in healthy older individuals, outside of their specific disease indication. Such drugs include, among others, metformin, SGLT2 inhibitors and rapamycin. Since 2006, the UK biobank has recorded prescription medication and mortality data for over 500'000 participants, aged between 40 and 70 years old. In this work, we examined the impact of the top 406 prescribed medications on overall mortality rates within the general population of the UK. As expected, most drugs were linked to a shorter lifespan, likely due to the life-limiting nature of the diseases they are prescribed to treat. Importantly, a few drugs were associated with increased lifespans, including notably Sildenafil, Atorvastatin, Naproxen and Estradiol. These retrospective results warrant further investigation in randomized controlled trials.

Marital status, educational level, and mid-term mortality risk in 5924 patients after transcatheter aortic valve implantation.

Aims: There is scarce knowledge about the association between social factors and mid-term outcome in older patients undergoing transaortic valve implantation (TAVI). Our aim in this study is to explore associations between marital status, educational level, and mortality risk in patients after TAVI. Methods and results: Patients aged ≥65 who underwent TAVI in Sweden during 2014-2020 were identified from the SWEDEHEART registry. Social factors and comorbidities were collected from mandatory national registries. Cox regression models adjusted for baseline comorbidities, age, sex, year of TAVI, social factors, and smoking were used to estimate mortality risk. Median follow-up was 1.9 years (interquartile range: 0.9-3.3). Overall, 5924 patients were included (47.3% women), with a mean age of 82.1 years (standard deviation: 6.1). Of the 1410 (23.8%) deaths during follow-up, 721 (51.2%) were related to cardiovascular causes. Patients with low education (<10 years) had a higher risk of mortality than patients with the highest education level [>12 years; adjusted hazard ratio (aHR): 1.20, 95% confidence interval (CI): 1.03-1.41]. Never being married/cohabiting was associated with an increased risk of mortality in comparison with being married/cohabiting (aHR: 1.32, 95% CI: 1.05-1.65). A separate analysis of men and women showed an increased risk among never-married men (aHR: 1.63, 95% CI: 1.23-2.14) but not among never-married women (aHR: 0.85, 95% CI: 0.56-1.30). Conclusion: Disadvantage in social factors was associated with an increased mortality risk after TAVI in older patients. These findings emphasize the importance of developing strategies to increase health literacy and social support after TAVI in older patients with unfavourable social factors.

The acceptability of the risk of death in the treatment of respiratory diseases in France.

BACKGROUND: The costs associated with respiratory illnesses in the French healthcare budget continue to rise. However, pharmaceutical companies and research centres are continuously developing new treatments. Consequently, accepting these treatments, which necessitates the acceptance of the mortality risk associated with their use, represents a significant economic and public health issue. Our study aims to assess this acceptance. METHODS: The data were obtained from an online questionnaire completed by 315 respondents located in France during June and July 2019. The standard gamble method was employed to ascertain the acceptability of risk. This method quantifies the 'disutility' of a health state by evaluating the extent to which an individual is willing to accept a specific mortality risk in exchange for avoiding the state. RESULTS: The study demonstrated that individuals, irrespective of their personal characteristics, were willing to accept a treatment with an average mortality risk of less than 19%. The findings revealed discrepancies between individuals' perceptions of mortality and actual risks. CONCLUSIONS: In France, it is incumbent upon public decision-makers and research centres to ensure that treatment-related mortality rates remain below 19% so that patients readily accept treatment, irrespective of their personal characteristics. In addition, they should provide further information on the risks associated with treating respiratory diseases to avoid a discrepancy between the mortality risks perceived by individuals and the actual risks.

The neutrophil-lymphocyte ratio predicts all-cause and cardiovascular mortality among United States adults with COPD: results from NHANES 1999-2018.

Background: Neutrophil-to-lymphocyte ratio (NLR) is considered a biomarker of systemic inflammation and immune activation. However, its relationship with the risk of mortality in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to investigate the association between NLR and the risk of all-cause and cardiovascular mortality in patients with COPD. Methods: Data were collected from the National Health and Nutrition Examination Survey (NHANES) from January 1999 to December 2018. The calculation method of NLR involves dividing the neutrophil count by the lymphocyte count in the total blood cell count. The optimal NLR threshold associated with survival outcomes was determined using the maximally selected rank statistics method (MSRSM). The relationship between NLR and the risk of all-cause mortality and cardiovascular mortality in COPD was investigated using a weighted multivariable Cox regression model. Additionally, restricted cubic spline (RCS) was employed to discuss the potential relationship between NLR patients in different groups and the risk of mortality. Results: In this study, 716 adults with COPD were included using the maximally selected rank statistics method, among whom 208 had higher NLR (≥2.56) and 508 had lower NLR (<2.56). During a median follow-up of 111.5 months, 162 COPD patients died from all causes, and 49 patients died from cardiovascular diseases. After adjusting for demographic, socioeconomic status, and lifestyle factors, the risk of all-cause mortality (HR = 2.07, 95%CI: 1.46-2.94) and cardiovascular mortality (HR = 3.03, 95%CI: 1.63-5.65) in patients with higher NLR was increased by 2-3 times compared to those with lower NLR. Kaplan-Meier analysis revealed significantly lower survival rates in patients with higher NLR for all-cause mortality and cardiovascular mortality (p < 0.05). Restricted cubic spline analysis showed a linear correlation between NLR and the risk of all-cause mortality and cardiovascular mortality. Conclusion: NLR has a high value in independently predicting long-term all-cause and cardiovascular mortality risks in community-dwelling COPD patients. Therefore, NLR can serve as a cost-effective and widely available indicator for assessing the prognosis of COPD patients.

Mortality Risk Factors in Appalachian Burn Patients: A 13-Year Retrospective Study.

Introduction Burn injuries pose a significant public health challenge globally, with Appalachia facing unique obstacles due to its rugged terrain, economic disparities, and limited access to healthcare. Understanding mortality risk factors specific to Appalachian burn patients is crucial for optimizing treatment approaches in this underserved population. Materials and methods A retrospective analysis of burn patient data from Cabell Huntington Hospital's burn intensive care unit (BICU) over 13 years was conducted. Patient records were reviewed, and demographic and clinical variables were analyzed using descriptive statistics and logistic regression models. Results Among 1,104 Appalachian burn patients treated at Cabell Huntington Hospital's BICU between January 2010 and June 2023, advanced age, larger total body surface area (TBSA) burned, inhalation injuries, chronic obstructive pulmonary disease (COPD), and third-degree burns were significant predictors of mortality. Advanced age (p < 0.001, OR: 1.07), larger TBSA burned (p < 0.001, OR: 1.1), inhalation injuries (p < 0.001, OR: 8.34), COPD (p < 0.001, OR: 2.64), and third-degree burns (p < 0.001, OR: 6.45) were significant predictors of mortality. Gender, smoking history, diabetes mellitus (DM), and body mass index did not significantly differ between survivors and deceased patients. Discussion/conclusion Our findings underscore the importance of tailored interventions for Appalachian burn patients. Advanced age, pre-existing comorbidities, and burn severity significantly impact mortality risk, emphasizing the need for comprehensive care strategies. Specialized burn centers play a critical role in managing complex burn injuries in underserved regions. Addressing mortality risk factors identified in this study is essential for optimizing burn care outcomes in Appalachia. Tailored interventions and collaborative efforts are needed to improve survival rates and promote health equity for burn patients in underserved regions. Future research should explore additional factors influencing burn outcomes and assess disparities in access to specialized care services.

Trimethylamine-N-oxide and 5-year mortality: the role of gut microbiota-generated metabolite from the CORE-Thailand cohort.

The gut microbiota metabolite trimethylamine-N-oxide (TMAO)-derived from dietary phosphatidylcholine-is mechanistically linked to cardiovascular disease (CVD) and increased cardiovascular risk. This study examined the relationship between fasting plasma TMAO levels and 5-year all-cause mortality in a cohort of patients at high risk of cardiovascular events (CORE-Thailand Registry). Of the 134 patients, 123 (92%) had established cardiovascular disease, and 11 (8%) had multiple risk factors. Fasting plasma TMAO levels were measured using nuclear magnetic resonance spectroscopy. Within this prospective cohort study, the median TMAO was 3.81 µM [interquartile range (IQR) 2.89-5.50 µM], with a mean age of 65 ± 11 years; 61% were men, and 39.6% had type II diabetes. Among 134 patients, 65 (49%) were identified as the high-TMAO group (≥ 3.8 µM), and 69 (51%) were identified as the low-TMAO group (< 3.8 µM). After a median follow-up of 58.8 months, the high-TMAO group was associated with a 2.88-fold increased mortality risk. Following adjustment for traditional risk factors, high-sensitivity cardiac troponin-T, estimated glomerular filtration rate, angiotensin-converting enzyme (ACEI), or angiotensin-receptor blocker (ARB) use, the high-TMAO group remained predictive of 5-year all-cause mortality risk (the high-TMAO vs. the low-TMAO group, adjusted hazard ratio 2.73, 95% CI 1.13-6.54; P = 0.025). Among Thai patients at high risk of cardiovascular events, increased plasma TMAO levels portended greater long-term mortality risk.

Serum Erythritol and Risk of Overall and Cause-Specific Mortality in a Cohort of Men.

Erythritol occurs naturally in some fruits and fermented foods, and has also been used as an artificial sweetener since the 1990s. Although there have been questions and some studies regarding its potential adverse health effects, the association between serum erythritol and long-term mortality has not been evaluated. To examine the association between serum erythritol's biochemical status and risk of overall and cause-specific mortality, a prospective cohort analysis was conducted using participants in the ATBC Study (1985-1993) previously selected for metabolomic sub-studies. The analysis included 4468 participants, among whom 3377 deaths occurred during an average of 19.1 years of follow-up. Serum erythritol was assayed using an untargeted, global, high-resolution, accurate-mass platform of ultra-high-performance liquid and gas chromatography. Cause-specific deaths were identified through Statistics Finland and defined by the International Classification of Diseases. After adjustment for potential confounders, serum erythritol was associated with increased risk of overall mortality (HR = 1.50 [95% CI = 1.17-1.92]). We found a positive association between serum erythritol and cardiovascular disease mortality risk (HR = 1.86 [95% CI = 1.18-2.94]), which was stronger for heart disease mortality than for stroke mortality risk (HR = 3.03 [95% CI = 1.00-9.17] and HR = 2.06 [95% CI = 0.72-5.90], respectively). Cancer mortality risk was also positively associated with erythritol (HR = 1.54 [95% CI = 1.09-2.19]). The serum erythritol-overall mortality risk association was stronger in men ≥ 55 years of age and those with diastolic blood pressure ≥ 88 mm Hg (p for interactions 0.045 and 0.01, respectively). Our study suggests that elevated serum erythritol is associated with increased risk of overall, cardiovascular disease, and cancer mortality. Additional studies clarifying the role of endogenous production and dietary/beverage intake of erythritol in human health and mortality are warranted.

Associations of prognostic nutritional index with risk of all-cause and cardiovascular disease mortalities in persons with gestational diabetes mellitus: A NHANES-based analysis.

OBJECTIVE: To investigate relationships between prognostic nutritional index (PNI) during pregnancy and risk of all-cause mortality (ACM) and cardiovascular disease (CVD) mortality in persons with gestational diabetes mellitus (GDM). METHODS: A cross-sectional study was conducted using NHANES data from 2007 to 2018, and weighted Cox regression models were established. Restricted cubic spline analysis was used to unveil associations of PNI with risk of ACM and CVD mortalities in individuals with GDM. Receiver operating characteristic curve was employed for determination of threshold value for association of PNI with mortality. Sensitivity analysis was performed to verify the stability of the results. RESULTS: 734 GDM individuals and 7987 non-GDM individuals were included in this study. In GDM population, after adjusting for different categorical variables, PNI was significantly negatively correlated with ACM risk. Subgroup analysis showed that among GDM populations with no physical activity, moderate physical activity, parity of 1 or 2, negative correlation between PNI and risk of ACM was stronger than other subgroups. Sensitivity analysis results showed stable negative correlations between PNI and ACM and CVD mortality of total population, and between PNI and ACM of GDM. CONCLUSION: In individuals with GDM, PNI was negatively correlated with ACM risk, especially in populations with no physical activity, moderate physical activity, and parity of 1 or 2. PNI = 50.75 may be an effective threshold affecting ACM risk in GDM, which may help in risk assessment and timely intervention for individuals with GDM.

Criticality of Nursing Care for Patients With Alzheimer's Disease in the ICU: Insights From MIMIC III Dataset.

Alzheimer's disease (AD) patients admitted to intensive care units (ICUs) exhibit varying survival outcomes due to the unique challenges in managing AD patients. Stratifying patient mortality risk and understanding the criticality of nursing care are important to improve the clinical outcomes of AD patients. This study aimed to leverage machine learning (ML) and electronic health records (EHRs) only consisting of demographics, disease history, and routine lab tests, with a focus on nursing care, to facilitate the optimization of nursing practices for AD patients. We utilized Medical Information Mart for Intensive Care III, an open-source EHR dataset, and AD patients were identified based on the International Classification of Diseases, Ninth Revision codes. From a cohort of 453 patients, a total of 60 features, encompassing demographics, laboratory tests, disease history, and number of nursing events, were extracted. ML models, including XGBoost, random forest, logistic regression, and multi-layer perceptron, were trained to predict the 30-day mortality risk. In addition, the influence of nursing care was analyzed in terms of feature importance using values calculated from both the inherent XGBoost module and the SHapley Additive exPlanations (SHAP) library. XGBoost emerged as the lead model with a high accuracy of 0.730, area under the curve (AUC) of 0.750, sensitivity of 0.688, and specificity of 0.740. Feature importance analyses using inherent XGBoost module or SHAP both indicated the number of nursing care within 14 days post-admission as an important denominator for 30-day mortality risk. When nursing care events were excluded as a feature, stratifying patient mortality risk was also possible but the model's AUC of receiver operating characteristic curve was reduced to 0.68. Nursing care plays a pivotal role in the survival outcomes of AD patients in ICUs. ML models can be effectively employed to predict mortality risks and underscore the importance of specific features, including nursing care, in patient outcomes. Early identification of high-risk AD patients can aid in prioritizing intensive nursing care, potentially improving survival rates.

Poststroke Cognitive Impairment and the Risk of Recurrent Stroke and Mortality: Systematic Review and Meta-Analysis.

BACKGROUND: Poststroke cognitive impairment (PSCI) occurs in about 60% of patients with stroke in the first year after stroke. However, the question regarding risks of recurrent stroke and mortality in patients with PSCI remains controversial. The goal of this study was to conduct a meta-analysis of published literature to estimate the risks of stroke recurrence and mortality associated with PSCI. METHODS AND RESULTS: Electronic databases were screened for eligible studies published from 1990 to 2023. The primary end points of this study were recurrent stroke and mortality. Pooled estimates were calculated as hazard ratios (HR) with 95% CIs. Meta-regression analyses evaluated moderating effects of PSCI severity, study design, and study period on recurrent stroke and mortality. Pooled data from 27 studies comprised 39 412 patients with ischemic stroke. Nine studies evaluated the association between PSCI and risk of stroke recurrence that showed the hazard of recurrent stroke risk was significantly higher in patients with PSCI compared with those without it (HR, 1.59 [95% CI, 1.29-1.94]; I2=52.2%). Eighteen studies examined the impact of PSCI on mortality risk. The pooled hazard of mortality was significantly higher in the group with PSCI relative to the non-PSCI group (HR, 2.07 [95% CI, 1.65 -2.59]; I2=89.3%). Meta-regressions showed that the average effect of PSCI on mortality risk differed across study period and study design. CONCLUSIONS: Based on this meta-analysis PSCI was statistically significantly associated with increased risks of recurrent stroke and all-cause mortality. Poststroke neurocognitive assessment may identify patients at a higher risk who may require more aggressive interventions for secondary prevention.

Mortality Risk and Antibiotic Therapy for Patients with Infections Caused by Elizabethkingia Species-A Meta-Analysis.

Background and Objectives: Patients with infections caused by Elizabethkingia species require prompt identification and effective antibiotic treatment since these spp. are typically resistant to multiple antibiotics and variable susceptibility patterns. Understanding the mortality risk of this disease is difficult because of the relatively low incidence of infections caused by Elizabethkingia spp. and the lack of published systematic evaluations of the risk factors for mortality. The aim of the present study was to investigate risk factors for mortality in patients with infections caused by Elizabethkingia spp. by conducting a meta-analysis of existing studies on these infections. Materials and Methods: Studies comparing patients who died from infections caused by Elizabethkingia spp. with patients who survived were considered for inclusion. Studies that reported one or more risk factors for mortality were considered. Clinical predisposing variables, predisposing comorbidities, and clinical outcomes of antibiotic treatment were among the risk factors for mortality. Results: The meta-analysis included twenty studies with 990 patients, and 298 patients (30.1%) died. The following risk factors for mortality were identified: intensive care unit admission, the need for mechanical ventilation, immunosuppressive or steroid therapy use, pneumonia, comorbid liver disease, and the use of inappropriate antimicrobial therapy. Conclusions: The use of appropriate antimicrobial therapy is critical for the effective management of infections caused by Elizabethkingia spp. Antimicrobial susceptibility testing would be a more reliable means of guiding treatment. The identification of the best antimicrobial drugs is needed to ensure optimal treatment recommendations for treating Elizabethkingia-related infections.

Impact of comorbidities on COVID-19 mortality in hospitalized women: Insights from the metropolitan area of the Valley of Mexico from 2020 to 2022.

Objectives: This research summarizes the impact of the major comorbidities impacting hospitalized women with COVID-19 and their relation to death. Methods: Public data from national databases (2020-2022) for hospitalized women, including identification data, hospitalization time, comorbidities, and intensive care unit (ICU) admissions, were analyzed. Women were stratified by age (split at 50 years). Binary regression models determined the correlation between comorbidities and COVID-19 with mortality, expressed as odds ratios. Results: A total of 46,492 women were hospitalized, with 70.1% aged above 50 years. A total of 17,728 fatalities occurred, with 86.5% in the older age group. A total of 5.82% women required intensive care. The common comorbidities were pneumonia, hypertension, diabetes, obesity, and intubation. A total of 56.6% died within the 1st week; in the ICU, 65.7% died by week 2. In the logistic regression, diabetes and chronic kidney disease (CKD) were initially significant, followed by pneumonia and CKD (days 8-14), intubation and, ICU stay (beyond the 15th day). In the ICU, intubation impact worsened over time. Conclusions: Our study highlights the significant impact of comorbidities on COVID-19 mortality in women in the Valley of Mexico. Pneumonia, diabetes, CKD, and intubation were notably prevalent and correlated strongly with death in older women. Timely intubation improves survival, whereas delayed intubation increases mortality risk, particularly, in the ICU. Urgent targeted interventions are required, especially for older hospitalized women.

Patient- vs organ-based prognostic tools for older patients in critical care units : An observational study with a 3-month follow-up.

BACKGROUND: Anticipating a doubling of older adults in Europe by 2050, healthcare systems face substantial challenges, particularly in critical care units. However, there is still a lack of evidence-based knowledge for treating and assessing mortality risk in older patients. This study compared the predictive accuracy of two assessment tools for long-term outcomes among older patients: the Multidimensional Prognostic Index (MPI) and the Sequential Organ Failure Assessment (SOFA). As the MPI is based on a more holistic assessment, it may provide a more accurate prediction than the organ-based SOFA. OBJECTIVE: Does the MPI provide a more accurate prediction of mortality risk and quality of life for older patients in critical care units than the organ-based SOFA score? METHODS: In a 6-month study, 96 patients aged 65 and older admitted to intensive (ICU) or intermediate care units (IMC) were enrolled to assess 90-day mortality using a comprehensive geriatric assessment-based MPI and the SOFA score. The follow-up (FU) involved telephone assessments 30 and 90 days after admission, focusing on posthospitalization health and quality of life. RESULTS: Both MPI (p = 0.039) and SOFA score (p = 0.014) successfully predicted mortality among older IMC and ICU patients in logistic regressions. Receiver operating characteristic (ROC) analyses demonstrated comparable areas under the curve (AUCs) for MPI (0.618) and SOFA score (0.621), as well as a similar sensitivity and specificity (MPI 61.0% and 52.9%; SOFA score: 68.9% and 45.1%, respectively). The MPI at admission moreover correlated significantly with quality of life (p < 0.001, r = -0.631 at discharge; p = 0.005, r = -0.377 at 30-day FU; p = 0.004, r = -0.409 at 90-day FU) and nursing needs (Mann-Whitney U­test, p = 0.002 at 30-day FU; p = 0.011 at 90-day FU) at FU, while the SOFA score did not show significant associations with respect to these parameters. CONCLUSIONS: In geriatric critical care, both the MPI and the SOFA score effectively predict mortality risk. While the SOFA score may appear more practical due to its simpler and faster implementation, only the MPI demonstrated significant correlations with quality of life and nursing needs in the FU after 30 and 90 days.

Do greenspaces really reduce heat health impacts? Evidence for different vegetation types and distance-based greenspace exposure.

BACKGROUND: While vegetation type, population density and proximity to greenspaces have been linked to human health, what type and location of greenspace matter most have remained unclear. In this context, there are question marks over investment-style metrics. OBJECTIVES: This paper aims at establishing what vegetation type may matter most in modifying heat-mortality associations, and what the optimal buffer distances of total and specific types of greenspace exposure associated with reduced heat-related mortality risks are. METHODS: We conducted small-area analyses using daily mortality data for 286 Territory Planning Units (TPUs) across Hong Kong and 1 × 1 km gridded air temperature data for the summer months (2005-2018). Using a case time series design, we examined effect modifications of total and specific types of greenspaces, as well as population-weighted exposure at varying buffer distances (200-4000 m). We tested the significance of effect modifications by comparing relative risks (RRs) between the lowest and highest quartiles of each greenspace exposure metric; and explored the strength of effect modifications by calculating the ratio of RRs. RESULTS: Forests, unlike grasslands, showed significant effect modifications on heat-mortality associations, with RRs rising from 0.98 (95 %CI: 0.92,1.05) to 1.06 (1.03, 1.10) for the highest to lowest quartiles (p-value = 0.037) The optimal distances associated with the most apparent effects were around 1 km for population-weighted exposure, with the ratio of RRs being 1.424 (1.038,1.954) for NDVI, 1.191 (1.004,1.413) for total greenspace, and 1.227 (1.024,1.470) for forests. A marked difference was observed in terms of the paired area-level and optimal distance-based exposure to total greenspace and forests under extreme heat (p-values < 0.05). DISCUSSION: Our findings suggest that greenspace, particularly nearby forests, may significantly mitigate heat-related mortality risks.

The correlation between frailty index and incidence, mortality in obstructive sleep apnea: Evidence from NHANES.

Background: The emergence of obstructive sleep apnea (OSA) is marked by a growing trend towards younger individuals, while its developmental trajectory remains shrouded in uncertainty, accompanied by intricate prognostic implications. While frailty and sleep problems often coexist, the relationship between them remains unclear. Hence, this study aims to utilize the National Health and Nutrition Examination Survey (NHANES) database from 2005 to 2008 to analyze and explore the relationship between the level of frailty index (FI) and the risk of OSA incidence and survival outcomes. Materials and methods: Specialized weighted complex survey design analysis software was employed for data analysis. Multivariate logistic regression models and restricted cubic splines (RCS) were utilized to assess the association between FI and OSA incidence in all participants. Additionally, a Cox proportional hazards model was established to estimate the association between FI and the hazard ratios (HRs) for all-cause mortality and cardiovascular disease (CVD) mortality. Results: A total of 8524 participants were included in this study. Compared to the Non-frail group (FI ≤ 0.1), OSA risk increased with higher FI levels. In Model 3, adjusted for multiple covariates, the Pro-frail group (0.1 0.3) [OR = 2.32, 95 % CI (1.55, 3.48)] exhibited an average 31 %, 62 %, and 132 % increase in OSA risk, respectively. RCS results demonstrated a nonlinear dose-response relationship between OSA risk and FI levels, with an increasing trend (P = 0.004). The Cox model indicated that, except for the Pro-frail group, OSA-related mortality risk also increased with higher FI levels, with a more pronounced effect on CVD-related mortality. Conclusion: This study supports the hypothesis that FI may be associated with an increased risk of OSA, with a higher emphasis on OSA-related mortality risk in Mildly frail and Moderately/Severely frail populations.

Predicting the Risk of In-Hospital Mortality in Traumatic Brain Injury Patients on Invasive Mechanical Ventilation in the Intensive Care Unit: Construction and Validation of an Online Nomogram.

OBJECTIVE: To explore mortality risk factors and to construct an online nomogram for predicting in-hospital mortality in traumatic brain injury (TBI) patients receiving invasive mechanical ventilation (IMV) in intensive care unit (ICU). METHODS: We retrospectively analyzed TBI patients on IMV in ICU from Medical Information Mart for Intensive Care IV database and 2 hospitals. Least absolute shrinkage and selection operation regression and multiple logistic regression were used to detect predictors of in-hospital mortality and to construct an online nomogram. The predictive performance of nomogram was evaluated using area under the receiver operating characteristic curves (AUC), calibration curves, decision curve analysis, and clinical impact curves. RESULTS: Five hundred ten from Medical Information Mart for Intensive Care IV database were enrolled for nomogram construction (80%, n = 408) and internal validation (20%, n = 102). One hundred eighty-five from 2 hospitals were enrolled for external validation. Least absolute shrinkage and selection operation-logistic regression revealed predictors of in-hospital mortality among TBI patients on IMV in ICU included Glasgow Coma Scale (GCS) after ICU admission, Acute Physiology Score III (APS III) after ICU admission, neutrophil and lymphocyte ratio after IMV, blood urea nitrogen after IMV, arterial serum lactate after IMV, and in-hospital tracheotomy. The AUC, calibration curves, decision curve analysis, and clinical impact curves indicated the nomogram had good discrimination, calibration, clinical benefit, and applicability. The multimodel comparisons revealed the nomogram had higher AUC than GCS, APS III, and Simplified Acute Physiology Score II. CONCLUSIONS: We constructed and validated an online nomogram based on routinely recorded factors at admission to ICU and at the beginning of IMV to target prediction of in-hospital mortality among TBI patients on IMV in ICU.

Iron therapy effect on chronic heart failure and iron-deficiency anemia: a systematic review and meta-analysis.

BACKGROUND: Heart failure complicated with iron deficiency is associated with impaired functional capacity, poor quality of life, increased hospitalization, and mortality. This systematic review and meta-analysis were conducted to assess the effect of oral and intravenous iron therapy on functional capacity, hospitalization risk, and mortality risk in patients with chronic heart failure and iron-deficiency anemia. METHODS: Search for published scientific articles using the PRISMA (Preferred Reporting, Items for Systematic Reviews and Meta-Analysis) method conducted on Cochrane Library, PubMed Central, and Medline databases published in the last 20 years. Further systematic review and meta-analysis using RevMan version 5.4 were performed based on the included published scientific articles. RESULTS: Based on the meta-analysis of included studies, the analytical results of intravenous iron therapy in patient with chronic heart failure and iron-deficiency anemia showed there is 30.82 (MD = 30.82: 95% CI 18.23-43.40) meter change in patient 6MWT, there is likelihood of 0.55 times (55%) (RR = 0.45: 95% CI 0.30-0.68) lower risk of hospitalization and lower risk of mortality (RR = 0.18: 95% CI 0.04-0.78), because heart failure worsening both with statistically significant overall effect compared with placebo. CONCLUSIONS: There is statistically significant effect of intravenous iron therapy to improve patient functional capacity and reduce likelihood of hospitalization risk of 0.55 times (55%) in patient with chronic heart failure and iron-deficiency anemia.

Proenkephalin Improves Cardio-Renal Risk Prediction in Acute Coronary Syndromes: The KID-ACS Score.

BACKGROUND AND AIMS: Circulating proenkephalin (PENK) is a stable endogenous polypeptide with fast response to glomerular dysfunction and tubular damage. This study examined the predictive value of PENK for renal outcomes and mortality in patients with acute coronary syndromes (ACS). METHODS: Proenkephalin was measured in plasma in a prospective multicentre ACS cohort from Switzerland (n=4787) and in validation cohorts from the UK (n=1141), Czechia (n=927), and Germany (n=220). A biomarker-enhanced risk score (KID-ACS score) for simultaneous prediction of in-hospital acute kidney injury (AKI) and 30-day mortality was derived and externally validated. RESULTS: On multivariable adjustment for established risk factors, circulating PENK remained associated with in-hospital AKI (per log2 increase: adjusted odds ratio [OR] 1.53, 95% confidence interval [CI] 1.13-2.09, P=0.007) and 30-day mortality (adjusted hazard ratio [HR] 2.73, 95% CI 1.85-4.02, P<0.001). The KID-ACS score integrates PENK and showed an area under the receiver operating characteristic curve (AUC) of 0.72 (95% CI 0.68-0.76) for in-hospital AKI, and of 0.91 (95% CI 0.87-0.95) for 30-day mortality in the derivation cohort. Upon external validation, KID-ACS achieved similarly high performance for in-hospital AKI (Zurich: AUC 0.73, 95% CI 0.70-0.77; Czechia: AUC 0.75, 95% CI 0.68-0.81; Germany: AUC 0.71, 95% CI 0.55-0.87) and 30-day mortality (UK: AUC 0.87, 95% CI 0.83-0.91; Czechia: AUC 0.91, 95% CI 0.87-0.94; Germany: AUC 0.96, 95% CI 0.92-1.00) outperforming the CA-AKI score and the GRACE 2.0 score, respectively. CONCLUSIONS: Circulating PENK offers incremental value for predicting in-hospital AKI and mortality in ACS. The simple 6-item KID-ACS risk score integrates PENK and provides a novel tool for simultaneous assessment of renal and mortality risk in patients with ACS.