Underweight and hypoalbuminemia as risk indicators for mortality among psychiatric patients with medical comorbidities.

AIM: Medical comorbidities are a major cause of death among patients with mental illness. The purpose of this study was to clarify the risk factors for mortality among psychiatric patients with medical comorbidities. METHODS: We retrospectively reviewed the clinical files of patients transferred to Tokyo Metropolitan Matsuzawa Hospital from a psychiatric hospital to treat medical comorbidities during the 3-year period from January 2014 to December 2016. We analyzed the clinical differences between the expired and alive patients. RESULTS: Of the 287 patients included, 29 (10.1%) had expired at the time of hospital discharge, while 258 (89.9%) were living. A multivariable analysis to determine the prognostic factors related to mortality from medical comorbidities showed that body mass index <18.5 had the highest odds ratio among the predictive factors (5.1; 95% confidence interval, 1.5-17.1; P < 0.05), followed by a serum albumin level < 3.0 mg/dL (3.0; 95% confidence interval, 1.1-8.1; P < 0.05). CONCLUSION: We found that underweight and hypoalbuminemia were risk factors for mortality among psychiatric patients with medical comorbidities. Physicians at psychiatric hospitals should consider transferring patients with medical comorbidities to a general medical hospital in the presence of underweight and/or hypoalbuminemia.

Severe cell fragmentation in the endothelial cell apoptosis induced by snake apoptosis toxin VAP1 is an apoptotic characteristic controlled by caspases.

Hemorrhagic snake venom induces apoptosis in vascular endothelial cells (VEC). Vascular apoptosis-inducing protein 1 (VAP1), which is identified as an apoptosis toxin against vascular endothelial cells, induces apoptosis accompanied by severe cell fragmentation compared with that of apoptosis due to other inducers. The mechanism of this morphologic feature is not known. In this report, we examine the roles of the caspases in the apoptosis induced by VAP1. Measurement of the caspase activities shows that activation of caspases occurred in this type of cell death. In the presence of certain caspase inhibitors, the severe cell fragmentation was strongly inhibited. The other hand, cell death induced by VAP1 was not affected by caspase inhibitors. These data suggest that the severe cell fragmentation induced by the snake toxin is a special characteristic of this apoptosis. Apoptosis with severe cell fragmentation may be regarded as a new category of endothelial cell apoptosis.