UNASSIGNED: Patients with acute heart failure (AHF) exacerbation are susceptible to complications in the setting of COVID-19 infection. Data regarding the racial/ethnic and sex disparities in patients with AHF and COVID-19 remains limited.
UNASSIGNED: We aim to evaluate the impact of race, ethnicity, and sex on the in-hospital outcomes of AHF with COVID-19 infection using the data from the National Inpatient Sample (NIS).
UNASSIGNED: We extracted data from the NIS (2020) by using ICD-10-CM to identify all hospitalizations with a diagnosis of AHF and COVID-19 in the year 2020. The associations between sex, race/ethnicity, and outcomes were examined using a multivariable logistic regression model.
UNASSIGNED: We identified a total of 158,530 weighted AHF hospitalizations with COVID-19 infection in 2020. The majority were White (63.9 %), 23.3 % were Black race, and 12.8 % were of Hispanic ethnicity, mostly males (n = 84,870 [53.5 %]). After adjustment, the odds of in-hospital mortality were lowest in White females (aOR 0.83, [0.78-0.98]) and highest in Hispanic males (aOR 1.27 [1.13-1.42]) compared with White males. Overall, the odds of cardiac arrest (aOR 1.54 [1.27-1.85]) and AKI (aOR 1.36 [1.26-1.47] were higher, while odds for procedural interventions such as PCI (aOR 0.23 [0.10-0.55]), and placement on a ventilator (aOR 0.85 [0.75-0.97]) were lower among Black males in comparison to White males.
UNASSIGNED: Male sex was associated with a higher risk of in-hospital mortality in white and black racial groups, while no such association was noted in the Hispanic group. Hispanic males had the highest odds of death compared with White males.

UNASSIGNED: This study aimed to analyze the association between serum osmolality and the risk of in-hospital mortality in intracerebral hemorrhage (ICH) patients.
UNASSIGNED: In this retrospective cohort study, data of a total of 1,837 ICH patients aged ≥18 years were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV). Serum osmolality and blood urea nitrogen (BUN)-to-creatinine (Cr) ratio (BCR) were used as the main variables to assess their association with the risk of in-hospital mortality in ICH patients after first intensive care unit (ICU) admission using a univariable Cox model. Univariable and multivariable Cox regression analyses were applied to explore the associations between serum osmolality, BCR, and in-hospital mortality of ICH patients. Hazard ratio (HR) and 95% confidence intervals (CIs) were calculated.
UNASSIGNED: The median survival duration of all participants was 8.29 (4.61-15.24) days. Serum osmolality of ≥295 mmol/L was correlated with an increased risk of in-hospital mortality in patients with ICH (HR = 1.43, 95%CI: 1.14-1.78). BCR of >20 was not significantly associated with the risk of in-hospital mortality in ICH patients. A subgroup analysis indicated an increased risk of in-hospital mortality among ICH patients who were women, belonged to white or Black race, or had complications with acute kidney injury (AKI).
UNASSIGNED: High serum osmolality was associated with an increased risk of in-hospital mortality among ICH patients.

UNASSIGNED: To construct and evaluate a predictive model for in-hospital mortality among critically ill patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT), based on nine machine learning (ML) algorithm.
UNASSIGNED: The study retrospectively included patients with AKI who underwent CRRT during their initial hospitalization in the United States using the medical information mart for intensive care (MIMIC) database IV (version 2.0), as well as in the intensive care unit (ICU) of Huzhou Central Hospital. Patients from the MIMIC database were used as the training cohort to construct the models (from 2008 to 2019, n = 1068). Patients from Huzhou Central Hospital were utilized as the external validation cohort to evaluate the models (from June 2019 to December 2022, n = 327). In the training cohort, least absolute shrinkage and selection operator (LASSO) regression with cross-validation was employed to select features for constructing the model and subsequently established nine ML predictive models. The performance of these nine models on the external validation cohort dataset was comprehensively evaluated based on the area under the receiver operating characteristic curve (AUROC) and the optimal model was selected. A static nomogram and a web-based dynamic nomogram were presented, with a comprehensive evaluation from the perspectives of discrimination (AUROC), calibration (calibration curve) and clinical practicability (DCA curves).
UNASSIGNED: Finally, 1395 eligible patients were enrolled, including 1068 patients in the training cohort and 327 patients in the external validation cohort. In the training cohort, LASSO regression with cross-validation was employed to select features and nine models were individually constructed. Compared to the other eight models, the Lasso regularized logistic regression (Lasso-LR) model exhibited the highest AUROC (0.756) and the optimal calibration curve. The DCA curve suggested a certain clinical utility in predicting in-hospital mortality among critically ill patients with AKI undergoing CRRT. Consequently, the Lasso-LR model was the optimal model and it was visualized as a common nomogram (static nomogram) and a web-based dynamic nomogram (https://chsyh2006.shinyapps.io/dynnomapp/). Discrimination, calibration and DCA curves were employed to assess the performance of the nomogram. The AUROC for the training and external validation cohorts in the nomogram model was 0.771 (95%CI: 0.743, 0.799) and 0.756 (95%CI: 0.702, 0.809), respectively. The calibration slope and Brier score for the training cohort were 1.000 and 0.195, while for the external validation cohort, they were 0.849 and 0.197, respectively. The DCA indicated that the model had a certain clinical application value.
UNASSIGNED: Our study selected the optimal model and visualized it as a static and dynamic nomogram integrating clinical predictors, so that clinicians can personalized predict the in-hospital outcome of critically ill patients with AKI undergoing CRRT upon ICU admission.

BACKGROUND: Severe aortic stenosis (AS) is the most common valvular disease in the USA. Patients undergoing urgent or emergent transcatheter aortic valve replacement (TAVR) have worse clinical outcomes than those undergoing non-urgent procedures. No studies have examined the impact of procedural TAVR timing on outcomes in AS complicated by acute heart failure (AHF).
OBJECTIVE: We aimed to evaluate differences in in-hospital mortality and clinical outcomes between early (<48 hours) vs. late (≥48 hours) TAVR in patients hospitalized with AHF using a real-world US database.
METHODS: We queried the National Inpatient Sample database to identify hospitalizations with a diagnosis of AHF, aortic valve disease, and a TAVR procedure (2015-2020). The associations between TAVR timing and clinical outcomes were examined using logistic regression model.
RESULTS: A total of 25,290 weighted AHF hospitalizations were identified, of which 6,855 patients (27.1%) underwent early TAVR, and 18,435 (72.9%) late TAVR. Late TAVR patients had higher in-hospital mortality rate (2.2% vs. 2.8%, p<0.01) on unadjusted analysis but no significant difference following adjustment for demographic, clinical, and hospital characteristics [aOR 1.00 (0.82-1.23)]. Late TAVR was associated with higher odds of cardiac arrest (aOR 1.50, 95% CI: 1.18-1.90) and use of mechanical circulatory support (aOR 2.05, 95% CI: 1.68-2.51). Late TAVR was associated with longer hospital stay (11 days vs. 4 days, p<0.01) and higher costs ($72,851 vs. $53,209, p<0.01).
CONCLUSIONS: Early TAVR was conducted in approximately 25% of the AS patients admitted with AHF, showing improved in-hospital outcomes before adjustment, with no significant differences observed after adjustment.

UNASSIGNED: This study examines serum calcium levels and in-hospital mortality in patients with sepsis, a subject with contradictory findings in the existing literature.
UNASSIGNED: This retrospective cohort study utilized data from the MIMIC-IV database, focusing on adult patients diagnosed with sepsis between 2008 and 2019. The serum calcium levels were taken as the highest value within the first 24 h of Intensive Care Unit (ICU) admission. We performed Cox proportional hazards regression analyses in multivariable-adjusted models to investigate the association between serum calcium levels and in-hospital mortality. Restricted cubic spline functions were used to assess the nonlinear relationship, and threshold effect analysis was conducted to identify potential inflection points.
UNASSIGNED: A total of 18,546 patients with sepsis were included in the study, and an in-hospital mortality rate of 16.9 % (3,126 out of 18,546) was obtained. Furthermore, a U-shaped relationship was observed between serum calcium concentrations and in-hospital mortality, with the lowest point at approximately 8.23 mg/dL. Hazard ratios were calculated as 0.75 (95 % CI: 0.67-0.85, P < 0.001) on the left side and 1.10 (95 % CI: 1.04-1.16, P < 0.001) on the right side of the inflection point. Sensitivity analyses corroborated these results.
UNASSIGNED: The research identified a U-shaped correlation between serum calcium concentrations and in-hospital mortality rates among patients with sepsis, underscoring the importance of serum calcium monitoring in this patient population upon hospital admission.

Several studies have shown that elevated serum ferritin level is associated with a higher risk of coronary artery disease. Recently, it has been shown that high serum ferritin levels in men are independently correlated with an increased risk of cardiovascular mortality. This study aimed to investigate the possible correlation between the initial serum ferritin level and in-hospital mortality in patients presenting with ST-elevation myocardial infarction (STEMI). This retrospective cohort study included 890 patients who presented with acute STEMI and underwent successful primary percutaneous coronary intervention (PPCI) according to the standard techniques during the period from 1 May 2020 to 1 May 2021. At the time of admission, an initial serum ferritin level was measured in all patients. Comparison between initial ferritin levels was made between two groups: died and survived. Propensity matching was performed to exclude confounding factors effect. Forty-one patients had in-hospital mortality. There was no significant difference between both groups regarding baseline clinical characteristics. Initial serum ferritin levels were higher in deceased patients, even after propensity matching. In conclusion, even after propensity matching, initial ferritin levels were significantly higher in patients who died after being admitted for STEMI.

BACKGROUND: Fasudil and ozagrel are drugs with the same indications for the treatment of cerebral vasospasm in Japan. However, there have been no definitive conclusions on the clinical efficacy of fasudil hydrochloride and ozagrel sodium monotherapy or their combination. Therefore, we aimed to investigate the effectiveness of the combined administration of fasudil hydrochloride and ozagrel sodium in Japanese patients with subarachnoid hemorrhage (SAH).
METHODS: This cross-sectional study used Diagnosis Procedure Combination data to assess patients who were hospitalized with SAH and received fasudil hydrochloride or ozagrel sodium between April 2016 and March 2020 (n = 17,346). The participants were divided into three groups based on the treatment received: fasudil hydrochloride monotherapy (F group, n = 10,484), ozagrel sodium monotherapy (O group, n = 465), and fasudil hydrochloride and ozagrel sodium combination therapy (FO group, n = 6,397). The primary outcome was in-hospital mortality. Multivariable adjusted logistic regression analysis (significance level, 5%) was used for data analyses.
RESULTS: The results of the multivariable analysis, adjusted for factors considered to impact prognosis, showed that the adjusted odds ratio (OR) with the F group as the reference for in-hospital mortality was 0.94 in the FO group (95% confidence interval [CI]: 0.81-1.08, p = 0.355), with no differences compared to the F group.
CONCLUSIONS: Fasudil hydrochloride and ozagrel sodium had different mechanisms of action, suggesting a synergistic effect of combination therapy. However, a comparison of fasudil hydrochloride monotherapy and combination therapy of fasudil hydrochloride and ozagrel sodium showed no difference in the prognostic effect. Therefore, it was suggested that fasudil hydrochloride monotherapy may be sufficient.

UNASSIGNED: Patients admitted with decompensated cirrhosis who develop acute kidney injury (AKI) tend to experience poor outcomes, even if provided with increased organ support such as renal replacement therapies. We assessed the association of albumin administered ≤24 hours of admission with hospital length of stay (LOS) and in-hospital mortality.
UNASSIGNED: The Cerner Health Facts Database was queried for hospitalized patients with cirrhosis who had >0.3 mg/dL increase in serum creatinine within 48 hours and received diuretics following admission between January 2009 and April 2018. This study received institutional review board exemption through federal regulation 45CFR46. Albumin infusion was \"timely\" if administered ≤24 hours after admission and \"nontimely\" if administered >24 hours after admission or not at all. Two subgroups were assessed: the AKILOS subgroup (patients who survived to discharge) and the AKIMORTALITY RISK subgroup (patients with the highest risk of mortality, ie, AKI stage 3).
UNASSIGNED: A total of 4135 hospitalizations with cirrhosis and AKI were grouped into AKILOS (n = 3321) and AKIMORTALITY RISK (n = 609) subgroups. Albumin administration occurred in 59.7% of the AKILOS subgroup and 77.8% of the AKIMORTALITY RISK subgroup, but timely treatment only occurred in 25.9% and 35.8% of encounters within these subgroups, respectively. Risk-adjusted analysis showed timely albumin administration to be associated with a 15.5% reduction (P < .01) in LOS in the AKILOS subgroup and a 49% reduction in the odds of death (adjusted odds ratio: 0.51; P < .01) in the AKIMORTALITY RISK subgroup, when compared to the nontimely group.
UNASSIGNED: Among patients with cirrhosis and AKI, treatment with albumin ≤24 hours after admission was associated with a shorter LOS and lower risk of death in patients with stage 3 AKI.

UNASSIGNED: The inflammatory response of the body is intimately linked to the quick onset and high in-hospital mortality of Acute Type A Aortic Dissection (ATAAD). The purpose of the study was to examine the connection between in-hospital mortality in patients with ATAAD upon admission and the Pan-Immune-Inflammation Value (PIV).
UNASSIGNED: 308 patients who were diagnosed with ATAAD between September 2018 and October 2021 at Fujian Provincial Center for Cardiovascular Medicine had their clinical data retrospectively examined. PIV was assessed at the time of study population admission, with in-hospital mortality serving as the main outcome measure. Patients were divided into two groups, the high PIV group (PIV > 1807.704) and the low PIV group (PIV < 1807.704), based on the PIV ROC curve and the best threshold of the Youden index. The clinical results of the two groups were then compared.
UNASSIGNED: Among ATAAD patients, postoperative in-hospital mortality was higher in the high PIV group (54.7% vs 10.6%, P < 0.001), and the high PIV group had significantly higher rates of postoperative acute kidney injury, acute liver insufficiency, and gastrointestinal hemorrhage (P < 0.05). Additionally, the high PIV group\'s ICU stays lasted longer than the low PIV group\'s (P < 0.05). The results of multifactorial logistic regression analysis, which controlled for other variables, indicated that the mechanical ventilation time (OR = 1.860, 95% CI: 1.437, 2.408; P < 0.001), the high PIV group (> 1807.704) (OR = 1.939, 95% CI: 1.257, 2.990; P = 0.003), the cardiopulmonary bypass time (OR = 1.011, 95% CI: 1.004, 1.018; P = 0.002), and the white blood cell count (OR = 1.188, 95% CI: 1.054, 1.340; P = 0.005) were independent risk factors for postoperative in-hospital mortality in ATAAD patients.
UNASSIGNED: Postoperative death in ATAAD patients was independently predicted by high PIV levels at admission. Patients should be informed about their preoperative inflammatory status and actively participate in prompt clinical decision-making and treatment.

UNASSIGNED: Carotid-femoral pulse wave velocity has been identified as an autonomous predictor of cardiovascular mortality and kidney injury. This important clinical parameter can be non-invasively estimated using the calculated pulse wave velocity (ePWV). The objective of this study was to examine the correlation between ePWV and in-hospital as well as one-year mortality among critically ill patients with chronic kidney disease (CKD) and atherosclerotic heart disease (ASHD).
UNASSIGNED: This study included a cohort of 1173 patients diagnosed with both CKD and ASHD, sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The four groups divided into quartiles according to ePWV were compared using a Kaplan-Meier survival curve to assess variations in survival rates. Cox proportional hazards models were employed to analyze the correlation between ePWV and in-hospital as well as one-year mortality among critically ill patients with both CKD and ASHD. To further investigate the dose-response relationship, a restricted cubic splines (RCS) model was utilized. Additionally, stratification analyses were performed to examine the impact of ePWV on hospital and one-year mortality across different subgroups.
UNASSIGNED: The survival analysis results revealed a negative correlation between higher ePWV and survival rate. After adjusting for confounding factors, higher ePWV level (ePWV > 11.90 m/s) exhibited a statistically significant association with an increased risk of both in-hospital and one-year mortality among patients diagnosed with both CKD and ASHD (HR = 4.72, 95% CI = 3.01-7.39, p < 0.001; HR = 2.04, 95% CI = 1.31-3.19, p = 0.002). The analysis incorporating an RCS model confirmed a linear escalation in the risk of both in-hospital and one-year mortality with rising ePWV values (P for nonlinearity = 0.619; P for nonlinearity = 0.267).
UNASSIGNED: The ePWV may be a potential marker for the in-hospital and one-year mortality assessment of CKD with ASHD, and elevated ePWV was strongly correlated with an elevated mortality risk in patients diagnosed with both CKD and ASHD.