The role of serotonin and serotonergic-related metabolites in pathogenesis of vasovagal syncope.

BACKGROUND: Serotonin is an important neurohormone that regulates vascular tone and autonomic reflexes, though its pathophysiological role in vasovagal syncope (VVS) remains uncertain. OBJECTIVE: This study sought to explore the involvement of serotonin and serotonergic-related metabolites in the pathogenesis of VVS. METHODS: Sixty-six patients (age 45.6±17.0 years; 33 females) with recurrent VVS underwent a head-up tilt test (HUTT). Blood samples were collected from all patients in a resting supine position, with an additional sample obtained from HUTT-positive patients during syncope. Plasma and platelet serotonin levels, and plasma concentrations of serotonergic-related metabolites-including serotonin's precursor 5-hydroxytryptophan (5-HTP), major metabolite 5-hydroxyindoleacetic acid (5-HIAA), and synthesis source tryptophan-were measured using the liquid chromatography tandem mass spectrometry (LC-MS/MS) method. RESULTS: HUTT was positive in 45 patients and negative in 21 patients. Significant differences were observed in plasma 5-HTP and 5-HIAA levels between HUTT+ and HUTT- patients (P<0.001 and P=0.040, respectively), as well as before and after syncope (all P<0.001), whereas no significant changes were found in serotonin and tryptophan levels. Notably, plasma serotonin levels significantly increased during syncope in patients with drug-free VVS (P=0.037), and a greater change in serotonin correlated with a shorter time to syncope (R2=0.38, P=0.015). Furthermore, certain serotonergic-related metabolites exhibited significant correlations with hemodynamic changes during VVS episodes, with 5-HTP demonstrating the highest sensitivity. CONCLUSIONS: Despite the unchanged plasma and platelet serotonin levels, certain serotonergic-related metabolites significantly changed and correlated with hemodynamic parameters during VVS episodes, suggesting the potential involvement of an altered serotonergic metabolic pathway in VVS.

Sex differences outcomes in conduction system pacing for patients with typical left bundle branch block.

BACKGROUND: Biventricular pacing (BVP) appears to confer more pronounced advantages in women, yet the impact of conduction system pacing (CSP) remains insufficiently characterized. This investigation seeks to elucidate sex-specific disparities in clinical outcomes among patients with typical left bundle branch block (LBBB) undergoing CSP, with a particular focus on assessing contributory factors. METHODS: Consecutive patients diagnosed with nonischemic cardiomyopathy, exhibiting left ventricular ejection fraction (LVEF) ≤ 40%, and manifesting typical LBBB as Strauss criteria, underwent CSP. Subsequent longitudinal monitoring assessed improvements in LVEF and the composite endpoint of mortality or heart failure hospitalization (HFH). RESULTS: Among the included 176 patients, women (n = 84, mean age: 69.5 ± 8.8 years) displayed smaller heart size (LVEDd, 62.0 ± 8.3 mm vs. 64.8 ± 7.9 mm, P = 0.023) and shorter baseline QRSd (163.5 ± 17.7 ms vs. 169.7 ± 15.1 ms; P = 0.013) than men. Of the 171 patients who completed the follow-up, super-response was observed in 120 (70%), with a higher occurrence in women than men (78.3% vs. 62.5%, P = 0.024). The incidence of death or HFH was numerically lower in women (7.1% Vs 13%, Log-rank P = 0.216). Notably, the super-response showed a significant difference in women compared to men at the same electrocardiography and/or echocardiographic parameters value. Mediation analysis between sex and super-response revealed that LVEDd and pQRSd play an intermediary role, with the mediation proportion of 26.07% and 27.98%, respectively. CONCLUSIONS: Women may derive more benefits from CSP, and pQRSd and LVEDd partly drive this difference.

ABHD12 contributes to tumorigenesis and sorafenib resistance by preventing ferroptosis in hepatocellular carcinoma.

Sorafenib induces ferroptosis, making it a useful treatment against advanced liver hepatocellular carcinoma (LIHC). However, sorafenib resistance is extremely common among LIHC patients. Here, we used a comprehensive approach to investigate the effects of ABHD12, which regulates tumorigenesis and sorafenib resistance in LIHC. We validated ABHD12 expression was upregulated in LIHC tissue, which correlated with worse overall survival and related to tumor size or stage. ABHD12 facilitated a pro-tumorigenic phenotype involving increased cell proliferation, migration, and clonogenicity as well as sorafenib resistance. Knockout of ABHD12 sensitized liver cancer cells to sorafenib-induced ferroptosis. Co-delivery of sorafenib and ABHD12 inhibitor into a nude mouse model enhanced therapeutic efficacy for LIHC. Our study demonstrates that ABHD12 contributes to tumor growth and sorafenib resistance in liver cancer, which indicate the promising potential of ABHD12 in diagnosis and prognosis as well as highlight the potential therapeutic applications for co-delivery of sorafenib and ABHD12 inhibitor.

Left Bundle Branch Pacing Postatrioventricular Junction Ablation for Atrial Fibrillation: Propensity Score Matching With His Bundle Pacing.

BACKGROUND: Left bundle branch pacing (LBBP) has emerged as a promising pacing modality to preserve physiological left ventricular activation; however, prospective data evaluating its long-term safety and efficacy in pacemaker-dependent patients following atrioventricular junction (AVJ) ablation are lacking. This study aimed to examine the feasibility, safety, and efficacy of LBBP in patients with atrial fibrillation and heart failure (HF) after AVJ ablation and compare LBBP with His bundle pacing (HBP) through a propensity score (PS) matching analysis. METHODS: We prospectively enrolled patients with atrial fibrillation and HF referred for AVJ ablation and LBBP between July 2017 and December 2019. The control group was patients selected from HBP implants performed from 2012 to 2019 using PS matching with a 1:1 ratio. RESULTS: A total of 99 patients were enrolled in the study. The LBBP implant success rate was 100%. Left ventricular ejection fraction improved from baseline 30.3±4.9 to 1-year 47.3±14.5 in HF patients with reduced ejection fraction and from baseline 56.3±12.1 to 1-year 62.3±9.1 in HF patients with preserved ejection fraction (both P<0.001), and left ventricular ejection fraction in both groups remained stable for up to 3 years of follow-up. A threshold increase >2 V at 0.5 ms occurred in only one patient. Of 176 (81.9%) of 215 patients who received permanent HBP post-AVJ ablation, 86 were matched to the LBBP group by 1:1 PS (propensity score matched His bundle pacing, N=86; propensity score matched left bundle branch pacing, N=86). No significant differences in echocardiographic or clinical outcomes were observed between the 2 groups (P>0.05), whereas lower thresholds, greater sensed R-wave amplitudes, and fewer complications were observed in the propensity score matched left bundle branch pacing group (P<0.05). CONCLUSIONS: LBBP is feasible, safe, and effective in patients with atrial fibrillation and HF post-AVJ ablation and has similar clinical benefits, a higher implant success rate, better pacing parameters, and fewer complications compared with HBP.

Impact of Pre-Revascularization and Post-Revascularization Cardiac Arrest on Survival Prognosis in Patients With Acute Myocardial Infarction and Following Emergency Percutaneous Coronary Intervention.

Objectives: To evaluate the effects of occurrence and timing of sudden cardiac arrest (SCA) on survival in patients with acute myocardial infarction (AMI) who underwent emergency percutaneous coronary intervention (PCI). Methods: We analyzed 1,956 consecutive patients with AMI with emergency PCI from 2014 to 2018. Patients with cardiac arrest events were identified, and their medical records were reviewed. Results: Patients were divided into non-cardiac arrest group (NCA group, n = 1,724), pre-revascularization cardiac arrest (PRCA group, n = 175), and post-revascularization SCA (POCA group, n = 57) according to SCA timing. Compared to NCA group, PRCA group and POCA group presented with higher brain natriuretic polypeptide (BNP), more often Killip class 3/4, atrial fibrillation, and less often completed recovery of coronary artery perfusion (all p < 0.05). Both patients with PRCA and POCA showed increased 30-day all-cause mortality when compared to patients with NCA (8.0 and 70.2% vs. 2.9%, both p < 0.001). However, when compared to patients with NCA, patients with PRCA did not lead to higher mortality during long-term follow-up (median time 917 days) (16.3 vs. 18.6%, p = 0.441), whereas patients with POCA were associated with increased all-cause mortality (36.3 vs. 18.6%, p < 0.001). Multivariate analysis identified Killip class 3/4, atrial fibrillation, high maximum MB isoenzyme of creatine kianse, and high creatinine as predictive factors for POCA. In Cox regression analysis, POCA was found as a strong mortality-increase predictor (HR, 8.87; 95% CI, 2.26-34.72; p = 0.002) for long-term all-cause death. Conclusions: POCA appeared to be a strong life-threatening factor for 30-day and long-term all-cause mortality among patients with AMI who admitted alive and underwent emergency PCI. However, PRCA experience did not lead to a poorer long-term survival in patients with AMI surviving the first 30 days.

Impact of QRS morphology on response to conduction system pacing after atrioventricular junction ablation.

AIMS: His-Purkinje conduction system pacing (HPCSP) utilizing His (HBP) or left bundle branch pacing (LBBP) in patients with atrial fibrillation (AF) and wide QRS duration has not been well studied. We assessed the benefit of left bundle branch block (LBBB) correction during HPCSP in AF patients undergoing atrioventricular junction (AVJ) ablation with LBBB, compared with those with narrow QRS duration. METHODS AND RESULTS: This is an observational study in consecutive patients with typical LBBB or narrow QRS duration in whom we attempted HPCSP after AVJ ablation for refractory AF with a left ventricular ejection fraction (LVEF) ≤ 50%. Echocardiographic responses and clinical outcomes were assessed at baseline and during 1 year of follow-up. A total of 178 patients were enrolled, of which 170 achieved AVJ ablation + permanent HPCSP (age 69.3 ± 10.1 years; LVEF 34.3 ± 7.7%), 133 (78.2%) patients had a narrow QRS duration, and 37 (21.2%) had an LBBB. The QRS duration changed from a baseline of 159.7 ± 16.6 ms to a paced QRS duration of 110.4 ± 12.7 ms in the LBBB cohort and from 95.6 ± 10.4 to 100.8 ± 14.5 ms (both P < 0.001) in the narrow QRS cohort after AVJ ablation and pacing. Compared with the narrow QRS cohort, the LBBB cohort showed a greater absolute increase in LVEF (+22.3% vs. +14.2%, P < 0.001), higher super responder rate (71.4% vs. 49.2%, P = 0.011), and greater New York Heart Association (NYHA) class improvement (-1.9 vs. -1.4, P < 0.001) at 1 year. CONCLUSION: Patients with LBBB have greater improvement in LVEF and NYHA class function than patients with narrow QRS from HPCSP after AVJ ablation.

Left Bundle Branch Pacing for Cardiac Resynchronization Therapy: Nonrandomized On-Treatment Comparison With His Bundle Pacing and Biventricular Pacing.

BACKGROUND: Left bundle branch pacing (LBBP) is a novel method for delivering cardiac resynchronization therapy (CRT). We compared on-treatment outcomes with His bundle pacing (HBP) and biventricular pacing (BVP) in this nonrandomized observational study. METHODS: Consecutive patients with left-ventricular ejection fraction (LVEF) ≤ 40% and typical left bundle branch block (LBBB) referred for CRT received BVP, HBP, or LBBP. QRS duration, pacing threshold, LVEF, and New York Heart Association (NYHA) class were assessed. RESULTS: One hundred thirty-seven patients were recruited: 49 HBP, 32 LBBP, and 54 BVP; 2 did not receive CRT. The majority of patients had nonischemic cardiomyopathy. Mean paced QRS duration was 100.7 ± 15.3 ms, 110.8 ± 11.1 ms, and 135.4 ± 20.2 ms during HBP, LBBP, and BVP, respectively. HBP and LBBP demonstrated a similar absolute increase (Δ) in LVEF (+23.9% vs +24%, P = 0.977) and rate of normalized final LVEF (74.4% vs 70.0%, P = 0.881) at 1-year follow-up. This was significantly higher than in the BVP group (Δ LVEF +16.7% and 44.9% rate of normalized final LVEF, P < 0.005). HBP and LBBP also demonstrated greater improvements in NYHA class compared with BVP. LBBP was associated with higher R-wave amplitude (11.2 ± 5.1 mV vs 3.8 ± 1.9 mV, P < 0.001) and lower pacing threshold (0.49 ± 0.13 V/0.5 ms vs 1.35 ± 0.73 V/0.5 ms, P < 0.001) compared with HBP. CONCLUSION: LBBP appears to be a promising method for delivering CRT. We observed similar improvements in symptoms and LV function with LBBP and HBP. These improvements were significantly greater than those seen in patients treated with BVP in this nonrandomized study. These promising findings justify further investigation with randomized trials.

Long-term performance and risk factors analysis after permanent His-bundle pacing and atrioventricular node ablation in patients with atrial fibrillation and heart failure.

AIMS: His-bundle pacing (HBP) combined with atrioventricular node (AVN) ablation has been demonstrated to be effective in patients with atrial fibrillation (AF) and heart failure (HF) during medium-term follow-up and there are limited data on the risk analysis of adverse prognosis in this population. In this study, we aimed to evaluate the long-term performance of HBP following AVN ablation in AF and HF. METHODS AND RESULTS: From August 2012 to December 2017, consecutive AF patients with HF and narrow QRS who underwent AVN ablation and HBP were enrolled. The clinical and echocardiographic data, pacing parameters, all-cause mortality, and heart failure hospitalization (HFH) were tracked. A total of 94 patients were enrolled (age 70.1 ± 10.5 years; male 57.4%). Acute HBP were achieved in 89 (94.7%) patients with successful permanent HBP combined with AVN ablation in 81 (86.2%) patients. Left ventricular ejection fraction (LVEF) improved from 44.9 ± 14.9% at baseline to 57.6 ± 12.5% during a median follow-up of 3.0 (IQR: 2.0-4.4) years (P < 0.001). Heart failure hospitalization or all-cause mortality occurred in 21 (25.9%) patients. The LVEF ≤ 40%, pulmonary artery systolic pressure (PASP) ≥40 mmHg, or serum creatinine (Scr) ≥97 µmol/L at baseline was significantly associated with higher composite endpoint of HFH or death (P < 0.05). The His capture threshold was 1.0 ± 0.7 V/0.5 ms at implant and remained stable during follow-up. CONCLUSION: His-bundle pacing combined with AVN ablation was effective in patients with AF and drug-refectory HF. High PASP, high Scr, or low LVEF at baseline was independent predictors of composite endpoint of all-cause mortality or HFH.

Electrophysiological characteristics and clinical values of left bundle branch current of injury in left bundle branch pacing.

BACKGROUND: Left bundle branch pacing (LBBP) is emerging as a novel option for physiological ventricular pacing. The impact of current of injury (COI) at left bundle branch (LBB) has not been previously evaluated. METHODS: Consecutive patients with QRS duration less than 120 milliseconds referred for LBBP in whom LBB potentials were recorded were included from August 2018 to March 2019. We recorded LBB COI during LBBP and assessed its impact on the pacing parameters and complications during implantation and at short term follow-up. RESULTS: A total of 115 patients with an identifiable LBB potential at implant were included. LBB COI was confirmed in 77 (67.0%) of these patients. Three types of LBB COI were observed. LBB was captured in all patients at a pacing threshold less than 1.5 V/0.5 ms in COI(+) patients, while present in only 29 patients without an LBB COI(-) (100% vs 76.3%; P < .001). There was no significant difference between COI(+) and COI(-) patients in LBB bundle capture threshold (0.64 ± 0.24 vs 0.74 ± 0.26 V/0.5 ms). Selective LBBP was more common in COI(+) group than COI(-) group (54.5% vs 0%; P < .001). Pacing parameters were stable and no lead perforation or dislodgements were observed during follow-up. CONCLUSIONS: LBB COI is commonly observed during LBBP in cases with an identifiable LBB potential and can be associated with a low LBB capture threshold and demonstrable selective capture of the LBB acutely and during follow-up. A COI does not preclude safe and stable LBBP pacing.

Association of lymphocyte-to-monocyte ratio with the long-term outcome after hospital discharge in patients with ST-elevation myocardial infarction: a retrospective cohort study.

OBJECTIVE: Lymphocyte-to-monocyte ratio (LMR), a novel systemic inflammatory factor, correlates with adverse outcomes in patients with cardiovascular disease. However, data are limited regarding the prognostic value of LMR in patients with ST-elevation myocardial infarction (STEMI) after hospital discharge. Therefore, the aim of our study was to evaluate the prognostic impact of admission LMR in hospital survivors of STEMI. METHODS: This retrospective observational study enrolled 1369 STEMI patients between 2014 and 2017. The study population was divided into three groups according to tertiles (T) of LMR (T1: ≥2.84; T2: 1.85-2.83; T3: <1.85). The primary outcomes were long-term outcomes after discharge including major adverse cardiac events (MACE) and all-cause mortality. The associations between LMR and long-term outcomes were assessed using Cox regression analysis. RESULTS: The median follow-up period was 556 days (interquartile range, 342-864 days). Independent correlations were observed between LMR and both long-term MACE and all-cause mortality. For long-term MACE, the T3 (adjusted hazard ratio [HR], 1.74; 95% confidence interval [CI]: 1.12-2.70; P = 0.013) and T2 groups (adjusted HR, 1.65; CI: 1.07-2.54; P = 0.024) showed significantly higher risk of MACE than did the T1 group. For long-term all-cause mortality, the adjusted HR was 3.07 (CI: 1.10-8.54; P = 0.032) in the T3 group and 2.35 (CI: 0.82-6.76; P = 0.112) in the T2 group compared with that of the T1 group. CONCLUSION: Decreased admission LMR was independently associated with long-term all-cause mortality and MACE after discharge in patients with STEMI.

Metabolic acidosis in critically ill patients with cirrhosis: Epidemiology and short-term mortality risk factors.

BACKGROUND/AIMS: Metabolic acidosis is a common complication in patients with cirrhosis at the intensive care units (ICUs) and associated with increased mortality. The aim of our research was to explore the epidemiology and risk factors of metabolic acidosis in critically ill patients with cirrhosis. MATERIALS AND METHODS: A total of 975 patients with cirrhosis were selected into our study, and all participants were followed up for at least 28 days. Cox regression model and machine-learning algorithm were used to identify the importance of different risk factors, respectively. Finally, an improved prognostic model as Model for End-stage Liver Disease and metabolic acidosis (MELD-MA) was developed. RESULTS: Among the 975 patients with liver cirrhosis, 506 had metabolic acidosis, including 257 patients who had decompensated metabolic acidosis at ICU admission. The 28-day mortality was 41% (206/506) in patients with metabolic acidosis. Bilirubin (hazard ratio (HR): 1.023, 95% confidence interval (CI): 1.011-1.036), international normalized ratio (HR: 1.527, 95% CI: 1.332-1.750), pH (HR: 0.173, 95% CI: 0.047-0.640), BE-Lac (HR: 0.907, 95% CI: 0.868-0.948), and BE-Na (HR: 0.923, 95% CI: 0.859-0.991) were considered as independent prognostic parameters for 28-day mortality. MELD-NA had significantly higher discrimination (area under the receiver operating characteristic curve 0.79) than MELD and Child-Pugh score. CONCLUSION: Critically ill patients with cirrhosis have a high mortality rate and poor prognosis because of the high prevalence of metabolic acidosis. Lactic acidosis is the worst prognosis of all types of metabolic acidosis. MELD-MA performs well on the short-term mortality assessment in critically ill patients with cirrhosis and metabolic acidosis.

Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: a multicenter study.

Lactate clearance (Δ24Lac) was reported to be inversely associated with mortality in critically ill patients. The aim of our study was to assess the value of Δ24Lac for the prognosis of critically ill patients with cirrhosis and acute-on-chronic liver failure (ACLF). We analysed 954 cirrhotic patients with hyperlactatemia admitted to intensive care units (ICUs) in the United States and eastern China. The patients were followed up for at least 1 year. In the unadjusted model, we observed a 15% decrease in hospital mortality with each 10% increase in Δ24Lac. In the fully adjusted model, the relationship between the risk of death and Δ24Lac remained statistically significant (hospital mortality: odds ratio [OR] 0.84, 95% confidence interval [CI]: 0.78- 0.90, p < 0.001; 90-day mortality: hazard ratio [HR] 0.94, 95%CI 0.92- 0.97, p < 0.001; for Δ24Lac per 10% increase). Similar results were found in patients with ACLF. We developed a Δ24Lac-adjusted score (LiFe-Δ24Lac), which performed significantly better in the area under the receiver operating characteristic curves (AUROCs) than the original LiFe score for predicting mortality. Lactate clearance is an independent predictor of death, and the LiFe-Δ24Lac score is a practical tool for stratifying the risk of death.

Age shock index and age-modified shock index are strong predictors of outcomes in ST-segment elevation myocardial infarction patients undergoing emergency percutaneous coronary intervention.

BACKGROUND: Early identification of high-risk patients provides clinicians with greater decision-making time and better informs strategies to cope with disease. The predictive values of age shock index (age SI) and age-modified shock index (age MSI) in ST-segment elevation myocardial infarction (STEMI) patients undergoing emergency percutaneous coronary intervention (PCI) have rarely been reported, especially compared with those for SI, MSI, and the Global Registry of Acute Coronary Events (GRACE) risk score. PATIENTS AND METHODS: Nine hundred and eighty-three STEMI patients undergoing emergency PCI between January 2014 and September 2017 were analyzed in a retrospective cohort study. The primary outcomes were rates of in-hospital cardiovascular events, and 6-month and long-term all-cause mortality. RESULTS: In multivariate analyses, the predictive values of age SI and age MSI were comparable to that of the GRACE score, but superior to those of SI and MSI for in-hospital cardiac mortality [age SI: odds ratio (OR) = 1.05, P < 0.001, area under the receiver operating characteristic (ROC-AUC) = 0.805, P < 0.001; age MSI: OR = 1.04, P < 0.001, ROC-AUC = 0.813, P < 0.001; GRACE score: OR = 1.03, P < 0.001, ROC-AUC = 0.827, P < 0.001], 6-month all-cause mortality (age SI: OR = 1.04, P < 0.001, ROC-AUC = 0.791, P < 0.001; age MSI: OR = 1.03, P < 0.001, ROC-AUC = 0.801, P < 0.001; GRACE score: ROC-AUC = 0.828, P < 0.001), long-term all-cause mortality [age SI: hazard ratio (HR) = 1.06, P < 0.001, ROC-AUC = 0.798, P < 0.001; age MSI: HR = 1.04, P < 0.001, ROC-AUC = 0.84, P < 0.001; GRACE score: ROC-AUC = 0.822, P < 0.001] and post-discharge all-cause mortality (age SI: HR = 1.05, P < 0.001, ROC-AUC = 0.78, P = 0.001; age MSI: HR = 1.05, P < 0.001, ROC-AUC = 0.789, P < 0.001; GRACE score: ROC-AUC = 0.812, P < 0.001). CONCLUSION: Age SI and age MSI are stronger predictors than SI and MSI for in-hospital cardiovascular events, and 6-month and long-term all-cause mortality in STEMI patients undergoing emergency PCI. Age SI and age MSI appear to be convenient and simpler indicators than the GRACE score.

Model for end-stage liver disease and pneumonia: An improved scoring model for critically ill cirrhotic patients with pneumonia.

BACKGROUND/AIMS: Critically ill patients with cirrhosis with pneumonia are at an increased risk for mortality. Only a few accurate predictive models are existing specific to these patients. The aim of the present study was to compare the existing prognostic models and to develop an improved mortality risk model for patients with cirrhosis and pneumonia. MATERIALS AND METHODS: A total of 231 patients were enrolled in our study (70% training and 30% validation cohorts). All participants were followed up for at least 21 days. Model for End-stage Liver Disease and Pneumonia (MELD-P) was derived by the Cox proportional hazards model. The performances of prognostic scoring systems were compared by calculation of the area under the receiver operating characteristic (AUROC) curve. RESULTS: MELD-P showed better discriminative capabilities than existing scoring systems. Four clinical variables, including loge bilirubin (hazard ratio (HR) 1.29, 95% confidence interval (CI) 1.01-1.73), loge international normalized ratio (HR 3.57, 95% CI 1.30-9.78), loge pulse oxygen saturation/fraction of inspired oxygen (HR 0.38, 95% CI 0.14-0.99), and vasopressors used (HR 3.72, 95% CI 1.85-7.49), were considered as independent prognostic values associated with 21-day mortality. MELD-P had AUROC curve values of 0.78 (95% CI 0.71-0.84) in predicting in-hospital mortality, 0.78 (95% CI 0.70-0.84) at 21-day, 0.88 (95% CI 0.82-0.93) at 14-day, and 0.87 (95% CI 0.81-0.92) at 7-day. A similar result was obtained in validation cohort. CONCLUSION: MELD-P, as the first model specifically designed to evaluate the risk of mortality in critically ill patients with cirrhosis and pneumonia, performs well on the mortality assessment of short-term mortality.

Prognostic value of international normalized ratio to albumin ratio among critically ill patients with cirrhosis.

BACKGROUND AND AIM: Critically ill patients with cirrhosis are at an increased risk of mortality. Our study aimed to externally validate the ability of the prothrombin time-international normalized ratio to albumin ratio (PTAR), an objective and simple scoring system, to predict 90-day mortality in critically ill patients with cirrhosis. PATIENTS AND METHODS: A total of 865 patients were entered into the study, and all the participants were followed up for at least 90 days. Clinical parameters on the first day of intensive care unit admission were included to compare survivors with nonsurvivors. RESULTS: After multivariable adjustment, the association between the risk of 90-day mortality and PTAR remained statistically significant with a hazard ratio of 2.71 (95% confidence interval: 1.99-3.68). The PTAR score showed good discrimination ability for predicting 90-day mortality with an area under receiver operating characteristic curve of 0.72 (95% confidence interval: 0.68-0.75). To improve its feasibility, we regrouped the PTAR scores into three levels of risk (low risk: <0.55, intermediate risk: 0.55-1.00, and high risk: ≥1.00); the 90-day mortality rates were 20.1% (74/368), 41.7% (168/403), and 73.4% (69/94), respectively. CONCLUSION: The PTAR score system is a convenient and practical tool for predicting the prognosis of critically ill patients with cirrhosis.

Risk scores for predicting dysphagia in critically ill patients after cardiac surgery.

BACKGROUND: This study aimed at developing and validating a scoring model to stratify critically ill patients after cardiac surgery based on risk for dysphagia, a common but often neglected complication. METHODS: Data were prospectively collected and analyzed from January 2016 to June 2017 from 395 consecutive post cardiac surgery patients at the cardiac care unit (CCU) at a single center; 103 (26.1%) developed dysphagia. Univariate and multivariate logistic analyses were used to identify independent predictors for dysphagia. The survival nomogram was developed on the basis of a multivariable Cox model, which allowed us to obtain survival probability estimations. The predictive performance of the nomogram was verified for discrimination and calibration. Areas under receiver operating characteristic curve analysis were used to illustrate and evaluate the diagnostic performance of the novel model. RESULTS: The final novel scoring model, named SSG-OD, consists of three independent factors: gastric intubation (OR = 1.024, 95% CI 1.015-1.033), sedative drug use duration (OR = 1.031, 95% CI 1.001-1.063) and stroke or not (OR = 6.182, 95% CI 3.028-12.617). SSG-OD identified patients at risk for dysphagia with sensitivity of 68.5% and specificity of 89.0% (OR = 0.833, 95% CI: 0.782-0.884). The positive and negative likelihood ratios were 6.22 and 0.35. CONCLUSIONS: The novel SSG-OD scoring system to risk stratify CCU patients for dysphagia is an easy-to-use bedside prognostication aid with good predictive performance and the potential to reduce aspiration incidence and accelerate recovery.

Association between admission lactate levels and mortality in patients with acute coronary syndrome: a retrospective cohort study.

OBJECTIVE: Hyperlactatemia at admission is associated with poor outcome in critically ill patients. However, data on the prognostic value of blood lactate level in patients with acute coronary syndrome (ACS) are limited. The present study assessed the prognostic effect of admission lactate level in a large population of patients with ACS. MATERIALS AND METHODS: This was a retrospective observational study including patients with ACS who were admitted to the Coronary Care Unit of the First Affiliated Hospital of Wenzhou Medical University between 2014 and 2017. Patients were divided into tertiles of lactate level (T1: <1.8; T2: 1.8-2.6; T3: ≥2.7 mmol/l). The clinical outcomes were 30-day and 180-day mortality from hospital admission. Cox proportional hazards models were used to evaluate the association between lactate level and survival. RESULTS: A total of 1865 consecutive patients with ACS were enrolled. Significant positive associations were observed between admission lactate level and both 180-day and 30-day mortality, with highest risk for lactate greater than or equal to 2.7 mmol/l. The adjusted hazard ratio for 180-day mortality was 2.09 [95% confidence interval (CI): 1.18-3.71, P=0.011] for T3 and 1.53 (95% CI: 0.86-2.72, P=0.147) for T2 compared with T1 (P for trend=0.006), and 1.10 (95% CI: 1.02-1.18, P=0.010) for each unit increase in lactate level. Similar trends were observed for 30-day mortality. The association was highly consistent across all subgroups studied (all P for interaction >0.05). CONCLUSION: In patients with ACS, elevated admission lactate level is an independent predictor of 30-day and 180-day all-cause mortality.