Project description:BackgroundIt is commonly observed that a higher target of mean arterial pressure (MAP) is in previous studies. This study assessed the association of MAP with short-term mortality in heart failure (HF) patients.MethodsA retrospective cohort study was conducted by using data from Hospitalized patients with heart failure: integrating electronic healthcare records and external outcome database (v1.2 ). The characteristic of patients was described by 3 groups of MAP: below 80 mmHg, 80-100 mmHg, and above 100 mmHg. Univariate and multivariate logistic regression analyses were used to assess the relevance between MAP and all-cause mortality within 28 days and 6 months. For assessing the effect of multiple variables on patient survival time, 28-day and 6-month, Kaplan-Meier survival analysis and Forest plot were performed.ResultsThe overall cohort comprised 2008 patients divided by MAP into 3 groups, each group had 344 (17.1%), 938 (46.7%), and 726 (36.2%) patients. Patients in MAP < 80 mmHg group had higher mortality than MAP 80-100 mmHg and MAP ≥ 100 mmHg in 28 days(3.8% versus 1.6% versus 1.2%) and in 6 months (4.9% versus 2.5% versus 2.3%). Univariate analysis showed that MAP as a continuous variate was associated with 28-day (OR was 0.98, 95% CIs: 0.96-0.99, P = 0.011) and 6-month mortality (OR was 0.98, 95% CIs: 0.97-1, P = 0.021) in HF patients. Model 4 put into multivariate logistic regression analyses showed MAP 80-100 mmHg (OR was 0.13, 95% CIs: 0.02-0.8, P = 0.027) stably associated with 28-day and 6-month mortality after adjusted covariable. Kaplan-Meier survival curves revealed a higher survival rate in the MAP ≥ 80 mmHg group than in the MAP < 80 mmHg group. The forest plot showed the stable effect of MAP ≥ 80 mmHg compared with MAP < 80 mmHg, the interaction analysis had no statistical significance effect between the two groups of MAP and multi-variable.ConclusionIt is indicated that MAP was independently associated with 28-day, 6-month all-cause mortality of HF patients, and compared with MAP < 80 mmHg, MAP ≥ 80 mmHg had a lower risk of 28-day, 6-month all-cause mortality of patients with HF.

Project description:Age is an important risk factor for mortality among patients with cardiogenic shock and heart failure (HF). We sought to assess the extent to which age modified the performance of the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage for in-hospital and 1 year mortality in cardiac intensive care unit (CICU) patients with and without HF. We retrospectively reviewed unique admissions to the Mayo Clinic CICU during 2007-2015 and stratified patients by age and SCAI shock stage. The association between age and in-hospital mortality was analysed using multivariable logistic regression, and 1 year mortality was analysed using Cox proportional hazards analysis, both in the entire cohort and among patients with an admission diagnosis of HF or acute coronary syndrome (ACS). The final study population included 10 004 unique patients with a mean age of 67 ± 15 years, including 46.1% with HF and 43.1% with ACS. Older patients more frequently had HF and had more extensive co-morbidities, higher illness severity, more organ failure, and differential use of critical care therapies. The percentage of patients with SCAI shock stages A, B, C, D, and E were 46%, 30%, 16%, 7%, and 1%, respectively. Patients with HF were older, had greater severity of illness and higher SCAI shock stage, and had higher rates of death at all time points. In-hospital mortality occurred in 908 (9%) patients, including 549 (12%) patients with HF (61% of all hospital deaths). Age was independently associated with hospital mortality (adjusted odds ratio per 10 years 1.3, 95% confidence interval 1.2-1.4, P < 0.001) and 1 year mortality (adjusted hazard ratio per 10 years 1.2, 95% confidence interval 1.2-1.3, P < 0.001) in the overall cohort. The associations of age with both hospital mortality (adjusted odds ratio 1.6 vs. 1.3 per 10 years older) and 1 year mortality (adjusted hazard ratio 1.5 vs. 1.3 per 10 years older) were higher for patients with ACS compared with patients with HF. Older age was associated with higher adjusted hospital mortality and 1 year mortality in each SCAI shock stage (all P < 0.05). Additive increases in both hospital mortality and 1 year mortality were observed with increasing age and SCAI shock stage. Age is an independent risk factor for mortality that modifies the relationship between the SCAI shock stage and mortality risk in CICU patients, providing robust risk stratification for in-hospital and 1 year mortality. Although patients with HF had a higher risk of dying, age was more strongly associated with mortality among patients with ACS.

Project description:BackgroundThe effects of diastolic arterial pressure (DAP) and heart rate (HR) on the prognosis of patients with septic shock are unclear, and whether these effects persist over time is unknown. We aimed to investigate the relationship between exposure to different intensities of DAP and HR over time and mortality at 28 days in patients with septic shock.MethodsIn this cohort study, we obtained data from the Medical Information Mart for Intensive Care IV, which includes the data of adult patients (≥ 18 years) with septic shock who underwent invasive blood pressure monitoring. We excluded patients who received extracorporeal membrane oxygenation (ECMO) or glucocorticoids within 48 h of ICU admission. The primary outcome was mortality at 28 days. Piece-wise exponential additive mixed models were used to estimate the strength of the associations over time.ResultsIn total, 4959 patients were finally included. The median length of stay in the ICU was 3.2 days (IQR: 1.5-7.1 days), and the mortality in the ICU was 12.9%, with a total mortality at 28 days of 15.9%. After adjustment for baseline and time-dependent confounders, both daily time-weighted average (TWA) DAP and HR were associated with increased mortality at 28 days and strong association, mainly in the early to mid-stages of the disease. The results showed that mortality in patients with septic shock was lowest at a DAP of 50-70 mm Hg and an HR of 60-90 beats per minute (bpm). Throughout, a significant increase in the risk of death was found with daily exposure to TWA-DAP ≤ 40 mmHg (hazard ratio 0.99, 95% confidence interval (CI) 0.94-1.03) or TWA-HR ≥ 100 bpm (hazard ratio 1.16, 95% CI 1.1-1.21). Cumulative and interactive effects of harmful exposure (TWA-DAP ≤ 40 mmHg and TWA-HR ≥ 100 bpm) were also observed.ConclusionThe optimal ranges for DAP and HR in patients with septic shock are 50-70 mmHg and 60-90 bpm, respectively. The cumulative and interactive effects of exposure to low DAP (≤ 40 mmHg) and tachycardia (≥ 100 bpm) were associated with an increased risk of death.

Project description:IntroductionCancer patients are at high risk of developing septic shock (SSh) and are increasingly admitted to ICU given their improved long-term prognosis. We, therefore, compared the prognosis of cancer and non-cancer patients with SSh.MethodsWe conducted a monocentric, retrospective cohort study (2013-2019) on patients admitted to ICU for SSh. We compared the clinical characteristics and management and studied short- and long-term mortality with ICU and in-hospital mortality and 1-year survival according to cancer status.ResultsWe analyzed 239 ICU stays in 210 patients, 59.5% of whom were men (n = 125), with a median age of 66.5 (IQR 56.3-77.0). Of the 121 cancer patients (57.6% of all patients), 70 had solid tumors (33.3%), and 51 had hematological malignancies (24.3%). When comparing ICU stays of patients with versus without cancer (n = 148 vs. n = 91 stays, respectively), mortality reached 30.4% (n = 45) vs. 30.0% (n = 27) in the ICU (p = 0.95), and 41.6% (n = 59) vs. 35.6% (n = 32) in hospital (p = 0.36), respectively. ICU length of stay (LOS) was 5.0 (2.0-11.3) vs. 6.0 (3.0-15.0) days (p = 0.27), whereas in-hospital LOS was 25.5 (13.8-42.0) vs. 19.5 (10.8-41.0) days (p = 0.33). Upon multivariate analysis, renal replacement therapy (OR = 2.29, CI95%: 1.06-4.93, p = 0.03), disseminated intravascular coagulation (OR = 5.89, CI95%: 2.49-13.92, p < 0.01), and mechanical ventilation (OR = 7.85, CI95%: 2.90-21.20, p < 0.01) were associated with ICU mortality, whereas malignancy, hematological, or solid tumors were not (OR = 1.41, CI95%: 0.65-3.04; p = 0.38). Similarly, overall cancer status was not associated with in-hospital mortality (OR = 1.99, CI95%: 0.98-4.03, p = 0.06); however, solid cancers were associated with increased in-hospital mortality (OR = 2.52, CI95%: 1.12-5.67, p = 0.03). Lastly, mortality was not significantly different at 365-day follow-up between patients with and without cancer.ConclusionsIn-hospital and ICU mortality, as well as LOS, were not different in SSh patients with and without cancer, suggesting that malignancies should no longer be considered a barrier to ICU admission.

Project description:IntroductionParoxetine is a GRK2 inhibitor that has been widely used to treat depression and anxiety over the last few decades. The inhibition of GRK2 has been studied extensively in vivo; however, evidence of its impact on heart failure remains scarce.MethodsTo assess the association between paroxetine use and mortality in patients with heart failure. We conducted a retrospective longitudinal cohort study from 2008 to 2019, with a follow-up time of 28 days for all groups. This is a single-center study using the Medical Information Mart for Intensive Care IV database with 11,657 heart failure patients identified. We performed genetic matching to adjust for the covariates. Heart failure patients prescribed paroxetine for >24 h after hospital admission were categorized into the paroxetine group (77 patients), with remaining heart failure patients making up the matched control group (231 patients). The primary outcome was 28-day all-cause mortality from the date of hospital admission. Secondary outcomes included length of intensive care unit stay, length of hospital stay, and in-hospital mortality. The Kaplan-Meier survival estimator, logistic regression, Cox regression, and restricted mean survival time were used to detect the association between paroxetine therapy and outcomes.ResultsPatients who received paroxetine during one hospital admission lived, on average, 0.7 lesser days (95% CI -2.53 to 1.1, p = 0.46) than patients who did not use it in a 28-day truncation time point. Multivariable logistic regression, including all matched covariates, demonstrated that the adjusted odds ratio of 28-day mortality of the paroxetine administration group was 1.1 (95% CI 0.37-2.9, p = 0.90). Multivariable Cox regression of 28-day mortality presented an adjusted hazard ratio of 1.00 (95% CI 0.42-2.62, p = 0.92). Paroxetine was associated with an increased survival time at a 3,000-day truncation time point (203 days, 95% CI -305.69 to 817.8, p = 0.37).ConclusionsIn patients with heart failure, treatment with paroxetine did not significantly reduce 28-day all-cause mortality.

Project description:AimsThe initial bundle of cares strongly affects haemodynamics and outcomes in acute decompensated heart failure cardiogenic shock (ADHF-CS). We sought to characterize whether 24 h haemodynamic profiling provides superior prognostic information as compared with admission assessment and which haemodynamic parameters best predict in-hospital death.Methods and resultsAll patients with ADHF-CS and with available admission and 24 h invasive haemodynamic assessment from two academic institutions were considered for this study. The primary endpoint was in-hospital death. Regression analyses were run to identify relevant predictors of study outcome. We included 127 ADHF-CS patients [65 (inter-quartile range 52-72) years, 25.2% female]. Overall, in-hospital mortality occurred in 26.8%. Non-survivors were older, with greater CS severity. Among admission variables, age [odds ratio (OR) = 1.06; 95% confidence interval (CI): 1.02-1.11; Padj = 0.005] and CPIRAP (OR = 0.62 for 0.1 increment; 95% CI: 0.39-0.95; Padj = 0.034) were found significantly associated with in-hospital death. Among 24 h haemodynamic univariate predictors of in-hospital death, pulmonary elastance (PaE) was the strongest (area under the curve of 0.77; 95% CI: 0.68-0.86). PaE (OR = 5.98; 95% CI: 2.29-17.48; Padj < 0.001), pulmonary artery pulsatility index (PAPi, OR = 0.77; 95% CI: 0.62-0.92; Padj = 0.013) and age (OR = 1.06; 95% CI: 1.02-1.11; Padj = 0.010) were independently associated with in-hospital death. Best cut-off for PaE was 0.85 mmHg/mL and for PAPi was 2.95; cohort phenotyping based on these PaE and PAPi thresholds further increased in-hospital death risk stratification; patients with 24 h high PaE and low PAPi exhibited the highest in-hospital mortality (56.2%).ConclusionsPulmonary artery elastance has been found to be the most powerful 24 h haemodynamic predictor of in-hospital death in patients with ADHF-CS. Age, 24 h PaE, and PAPi are independently associated with hospital mortality. PaE captures ventricular (RV) afterload mismatch and PAPi provides a metric of RV adaptation, thus their combination generates four distinct haemodynamic phenotypes, enhancing in-hospital death risk stratification.

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Association between intra-arterial catheterization and mortality of acute heart failure patients without shock in ICU: A retrospective study

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