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Association between ICU quality and in-hospital mortality of V-V ECMO-supported patients—the ECMO quality improvement action(EQIA)study:a national cohort study in China from 2017 to 2019

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Frontiers of Medicine 2024年第2期18卷 315-326页

作者： Wei Cheng Jieqing Chen Xudong Ma Jialu Sun Sifa Gao Ye Wang Longxiang Su Lu Wang Wei Du Huaiwu He Yujie Chen Zunzhu Li Qi Li Jianhua Sun Hongbo Luo Jinbang Liu Guangliang Shan Bing Du Yanhong Guo Dawei Liu Chang Yin Xiang Zhou on behalf of the China National Critical Care Quality Control Center-the ECMO quality improvement action(EQIA)study Department of Critical Care Medicine State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing100730China Information Center Department/Department of Information Management State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalPeking Union Medical College&Chinese Academy of Medical SciencesBeijing100730China Department of Medical Administration National Health Commission of the People’s Republic of ChinaBeijing100044China School of Population Medicine and Public Health Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730China Department of Epidemiology and Biostatistics Institute of Basic Medicine SciencesChinese Academy of Medical Sciences(CAMS)&School of Basic MedicinePeking Union Medical CollegeBeijing100730China National Institute of hospital Administration National Health Commission of the People’s Republic of ChinaBeijing100044China 不详

This cohort study was performed to explore the influence of intensive care unit(ICU)quality on in-hospital mortality of veno-venous(V-V)extracorporeal membrane oxygenation(ECMO)-supported patients in China.The study involved all V-V ECMO-supported patients in 318 of 1700 tertiary hospitals from 2017 to 2019,using data from the National Clinical Improvement System and China National Critical Care Quality Control Center.ICU quality was assessed by quality control indicators and capacity parameters.Among the 2563 V-V ECMO-supported patients in 318 hospitals,a significant correlation was found between ECMO-related complications and prognosis.The reintubation rate within 48 hours after extubation and the total ICU mortality rate were independent risk factors for higher in-hospital mortality of V-V ECMO-supported patients(cutoff:1.5%and 7.0%;95%confidence interval:1.05–1.48 and 1.04–1.45;odds ratios:1.25 and 1.23;P=0.012 and P=0.015,respectively).Meanwhile,the V-V ECMO center volume was a protective factor(cutoff of≥50 cases within the 3-year study period;95%confidence interval:0.57–0.83,odds ratio:0.69,P=0.0001).The subgroup analysis of 864 patients in 11 high-volume centers further strengthened these findings.Thus,ICU quality may play an important role in improving the prognosis of V-V ECMO-supported patients.

关键词： veno-venous extracorporeal membrane oxygenation in-hospital mortality high-volume centers quality control intensive care unit capacity parameters

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Development and validation of an emergency bloodstream infection score for predicting in-hospital mortality in patients with community-acquired bloodstream infections

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World Journal of Emergency Medicine 2023年第4期14卷 280-286页

作者： Xinlei Wang Yao Sun Xiaoyu Ni Shu Zhang Department of Emergency West China HospitalSichuan UniversityChengdu 610041Chiha

BACKGROUND:Community-acquired bloodstream infections(CABSIs)are common in the emergency departments,and some progress to sepsis and even lead to death.However,limited information is available regarding the prediction of patients with high risk of death.METHODS:The Emergency Bloodstream Infection Score(EBS)for CABSIs was developed to visualize the output of a logistic regression model and was validated by the area under the curve(AUC).The mortality in Emergency Department Sepsis(MEDS),Pitt Bacteremia Score(PBS),Sequential Organ Failure Assessment(SOFA),quick Sequential Organ Failure Assessment(qSOFA),Charlson Comorbidity Index(CCI),and McCabe–Jackson Comorbid Classification(MJCC)for patients with CABSIs were computed to compare them with EBS in terms of the AUC and decision curve analysis(DCA).The net reclassification improvement(NRI)index and integrated discrimination improvement(IDI)index were compared between the SOFA and EBS.RESULTS:A total of 547 patients with CABSIs were included.The AUC(0.853)of the EBS was larger than those of the MEDS,PBS,SOFA,and qSOFA(all Pin-hospital mortality of CABSIs patients was 0.368(P=0.04),and the IDI index was 0.079(P=0.03).DCA showed that when the threshold probability wasin-hospital mortality of patients with CABSIs.

关键词： Community-acquired bloodstream infection Risk factors in-hospital mortality Emergency department

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Comparison of different versions of the quick sequential organ failure assessment for predicting in-hospital mortality of sepsis patients:A retrospective observational study

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World Journal of Emergency Medicine 2022年第2期13卷 114-119页

作者： Hai Hu Jing-yuan Jiang Ni Yao Emergency Office of West China hospital Sichuan UniversityChengdu 610041China China International Emergency Medical Team Chengdu 610041China Emergency Department West China HospitalSichuan UniversityChengdu 610041China West China School of Nursing Sichuan UniversityChengdu 610041China Department of Critical Care Medicine West China HospitalSichuan UniversityChengdu 610041China

BACKGROUND:The quick sequential organ failure assessment(qSOFA)is recommended to identify sepsis and predict sepsis mortality.However,some studies have recently shown its poor performance in sepsis mortality prediction.To enhance its effectiveness,researchers have developed various revised versions of the qSOFA by adding other parameters,such as the lactate-enhanced qSOFA(LqSOFA),the procalcitonin-enhanced qSOFA(PqSOFA),and the modified qSOFA(MqSOFA).This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department(ED).METHODS:This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31,2019.Receiver operating characteristic(ROC)curve analyses were performed to determine the area under the curve(AUC),with sensitivity,specificity,and positive and negative predictive values calculated for the various scores.RESULTS:Among the 936 enrolled cases,there were 835 survivors and 101 deaths.The AUCs of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 0.740,0.731,0.712,and 0.705,respectively.The sensitivity of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 64.36%,51.40%,71.29%,and 39.60%,respectively.The specificity of the four scores were 70.78%,80.96%,61.68%,and 91.62%,respectively.The LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital mortality.CONCLUSIONS:Among patients with sepsis in the ED,the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to qSOFA.As the added parameter of the MqSOFA was more convenient compared to the LqSOFA,the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality.

关键词： Quick sequential organ failure assessment in-hospital mortality Sepsis Lactate-enhanced qSOFA Modified qSOFA

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Regional heterogeneity of in-hospital mortality of COVID-19 in Brazil

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Infectious Disease Modelling 2022年第3期7卷 364-373页

作者： Yuan Liu Kexin Wang Lin Yang Daihai He Department of Applied Mathematics Hong Kong Polytechnic UniversityHong KongChina School of Nursing Hong Kong Polytechnic UniversityHong KongChina

Background The ongoing Coronavirus disease of 2019(COVID-19)pandemic has hit Brazil hard in period of different dominant variants.Different COIVD-19 variants have swept through the region,resulting that the total number of cases in Brazil is the third highest in the world.This study is aimed at investigating the regional heterogeneity of in-hospital mortality of COVID-19 in Brazil and the effects of vaccination and social inequality.Methods We fitted a multivariate mixed-effects Cox model to a national database of inpatient data in Brazil who were admitted for COVID-19 from February 27,2020 to March 15,2022.The in-hospital mortality risks of vaccinated and unvaccinated patients were compared,with adjustment for age,state,ethnicity,education and comorbidities.And the effects of variables to in-hospital mortality were also compared.Stratified analysis was conducted across different age groups and vaccine types.Results By fitting the multivariate mixed-effects Cox model,we concluded that age was the most important risk factor for death.With regards to educational level,illiterate patients(hazard ratio:1.63,95%CI:1.56–1.70)had a higher risk than those with a university or college degree.Some common comorbidities were more dangerous for hospitalized patients,such as liver disease(HR:1.46,95%CI:1.34–1.59)and immunosuppression(HR:1.32,95%CI:1.26–1.40).In addition,the states involving Sergipe(HR:1.75,95%CI:1.46–2.11),Roraima(HR:1.65,95%CI:1.43–1.92),Maranhão(HR:1.57,95%CI:1.38–1.79),Acre(HR:1.44,95%CI:1.12–1.86),and Rondônia(HR:1.26,95%CI:1.10–1.44)in the north and the northeast region tended to have higher hazard ratios than other area.In terms of vaccine protection,vaccination did not significantly reduce mortality among hospitalized patients.Sinovac and AstraZeneca offered different protection in different regions,and no vaccine provided high protection in all regions.Conclusion The study revealed the regional heterogeneity of in-hospital mortality of Covid-19 in Brazil and the effects of vaccination and social inequa

关键词： COVID-19 in-hospital mortality Vaccine Brazil

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A Multicentre Prospective Evaluation of the Impact of Renal Insufficiency on In-hospital and Long-term mortality of Patients with Acute ST-elevation Myocardial Infarction

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Chinese Medical Journal 2015年第1期128卷 1-6页

作者： Chao Li Dayi Hu Xubo Shi Li Li Jingang Yang Li Song Changsheng Ma Department of Cardiology Beijing Anzhen Hospital Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China Cardiovascular Center Beijing Tongren Hospital Capital Medical University Beijing 100730 China Heart Center The People's Hospital of Peking University Beijing 100044 China Cardiovascular Center Beijing United Family Hospital Beijing 100016 China Department of Cardiology Cardiovascular Institute and Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background：Numerous previous studies have shown that renal insufficiency （RI） in patients with acute coronary syndrome is associated with poor cardiovascular outcomes.These studies do not well address the impact of RI on the long-term outcome of patients with acute ST-elevation myocardial infarction （STEMI） in China.The aim of this study was to investigate the association of admission RI and inhospital and long-term mortality of patients with acute STEMI.Methods：This was a multicenter,observational,prospective-cohort study.718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI,between January 1,2006 and December 31,2006.Estimation of glomerular filtration rate （eGFR） was calculated using the modified abbreviated modification of diet in renal disease equation-based on the Chinese chronic kidney disease patients.The patients were categorized according to eGFR,as normal renal dysfunction （eGFR ≥ 90 ml·min^-1·1.73 m^-2）,mild RI （60 ml·min^-1· 1.73 m^-2 〈 eGFR 〈 90 ml·min^-1· 1.73 m^2） and moderate or severe RI （eGFR 〈 60 ml·min^-1· 1.73 m^2）.The association between RI and inhospital and 6-year mortality of was evaluated.Results：Seven hundred and eighteen patients with STEMI were evaluated.There were 551 men and 167 women with a mean age of 61.0 ＆#177; 13.0 years.Two hundred and eighty patients （39.0%） had RI,in which 61 patients （8.5%） reached the level of moderate or severe RI.Patients with RI were more often female,elderly,hypertensive,and more patients had heart failure and stroke with higher killip class.Patients with RI were less likely to present with chest pain.The inhospital mortality （1.4% vs.5.9% vs.22.9%,P 〈 0.001）,6-year all-cause mortality （9.5% vs.19.8 vs.45.2%,P 〈 0.001） and 6-year cardiac mortality （2.9% vs.12.2% vs.23.8%,P 〈 0.001） were markedly increased in patients with RI.After adjusting for other confounding factors,classification of admission renal function was an independent predictor of inhospital mortality （Odd ratio,1.966; 95% confidence inter

关键词： in-hospital mortality Long-term mortality Myocardial Infarction Renal Insufficiency

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A Risk Prediction Model for in-hospital mortality in Patients with Suspected Myocarditis

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Chinese Medical Journal 2017年第7期130卷 782-790页

作者： Duo Xu Ruo-Chi Zhao Wen-Hui Gao Han-Bin Cui Department of Cardiology Ningbo First Hospital Ningbo Zhejiang 315010 China Department of Cardiology CHC International Hospital Cixi Zhejiang 315310 China Department of Cardiology Ningbo First Hospital Ningbo Zhejiang 315010 China Department of Cardiology Ningbo Yinzhou No.2 Hospital Ningbo Zhejiang 315100 China

Background：Myocarditis is an inflammatory disease of the myocardium that may lead to cardiac death in some patients.However,little is known about the predictors of in-hospital mortality in patients with suspected myocarditis.Thus,the aim of this study was to identify the independent risk factors for in-hospital mortality in patients with suspected myocarditis by establishing a risk prediction model.Methods：A retrospective study was performed to analyze the clinical medical records of 403 consecutive patients with suspected myocarditis who were admitted to Ningbo First hospital between January 2003 and December 2013.A total of 238 males （59%） and 165 females （41%） were enrolled in this study.We divided the above patients into two subgroups （survival and nonsurvival）,according to their clinical in-hospital outcomes.To maximize the effectiveness of the prediction model,we first identified the potential risk factors for in-hospital mortality among patients with suspected myocarditis,based on data pertaining to previously established risk factors and basic patient characteristics.We subsequently established a regression model for predicting in-hospital mortality using univariate and multivariate logistic regression analyses.Finally,we identified the independent risk factors for in-hospital mortality using our risk prediction model.Results：The following prediction model for in-hospital mortality in patients with suspected myocarditis,including creatinine clearance rate （Ccr）,age,ventricular tachycardia （VT）,New York Heart Association （NYHA） classification,gender and cardiac troponin T （cTnT）,was established in the study：P =ea/（1 ＋ ea）（where e is the exponential function,P is the probability of in-hospital death,and a =-7.34 ＋ 2.99× [Ccr 〈60 ml/min =1,Ccr ≥60 ml/min =0] ＋ 2.01 × [age ≥50 years =1,age 〈50 years =0] ＋ 1.93 × [VT =1,no VT =0] ＋ 1.39 × [NYHA ≥3 =1,NYHA 〈3 =0] ＋ 1.25 × [male =1,female =0] ＋ 1.13 × [cTnT ≥50 μg/L 1,cTnT 〈50 μg/L =0]）.The area under the receiver operating characteristic curve was 0.96 （standa

关键词： in-hospital mortality Logistic Model Myocarditis Risk Factors

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Influence of preoperative coronary collateral circulation on in-hospital mortality in patients undergoing coronary artery bypass graft surgery with intra-aortic balloon pump support

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Chinese Medical Journal 2014年第17期127卷 3077-3081页

作者： Hasan Gungor Cemil Zencir Abraham Samuel Babu Cagdas Akgullu Ufuk Eryilmaz All Zorlu Mithat Selvi Sevil Onay Tunay Kurtoglu Department of Cardiology Adnan Menderes University Aydin Turkey Department of Physiotherapy School of Allied Health Sciences Manipal University Karnataka India Department of Cardiology Cumhuriyet University Sivas Turkey Department of Cardiovascular Surgery Adnan Menderes University Aydin Turkey

Background Outcomes in patients requiring coronary artery bypass graft （CABG） surgery have been improved with devices such as the intra-aortic balloon pump （IABP）.Good coronary collateral circulation （CCC） has been shown to reduce mortality in patients with coronary artery disease （CAD）.We aimed to investigate whether poor preoperative CCC grade is a predictor of in-hospital mortality in CABG surgery requiring IABP support.Methods Fifty-five consecutive patients who were undergoing isolated first time on-pump CABG surgery with IABP support were enrolled into this study and CCC of those patients was evaluated.Results Twenty-seven patients had poor CCC and 28 patients had good CCC.in-hospital mortality rate in poor CCC group was significantly higher than good CCC group （14 （50％） vs.4 （13％）,P=0.013）.Preoperative hemoglobin level （OR：0.752; 95％ CI,0.571-0.991,P=0.043）,chronic obstructive pulmonary disease （OR：6.731; 95％ CI,1.159-39.085,P=0.034） and poor CCC grade （OR：5.750; 95％ CI,1.575-20.986,P=0.008） were associated with post-CABG in-hospital mortality.Poor CCC grade （OR：4.853; 95％ CI,1.124-20.952,P=0.034） and preoperative hemoglobin level （OR：0.624; 95％ CI,0.476-0.954,P=0.026） were independent predictors of in-hospital mortality after CABG.Conclusion Preoperative poor CCC and hemoglobin are predictors of in-hospital mortality after CABG with IABP support.

关键词： coronary collateral circulation coronary artery bypass graft surgery intra-aortic balloon pump in-hospital mortality

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SinoSCORE:a logistically derived additive prediction model for post-coronary artery bypass grafting in-hospital mortality in a Chinese population

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Frontiers of Medicine 2013年第4期7卷 477-485页

作者： Zhe Zheng Lu Zhang Xi Li Shengshou Hu behalf of the Chinese CABG Registry Study Department of Cardiovascular Surgery and State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China 不详

This study aims to construct a logistically derived additive score for predicting in-hospital mortality risk in Chinese patients undergoing coronary artery bypass surgery(CABG).Data from 9839 consecutive CABG patients in 43 Chinese centers were collected between 2007 and 2008 from the Chinese Coronary Artery Bypass Grafting Registry.This database was randomly divided into developmental and validation subsets(9:1).The data in the developmental dataset were used to develop the model using logistic regression.Calibration and discrimination characteristics were assessed using the validation dataset.Thresholds were defined for each model to distinguish different risk groups.After excluding 275 patients with incomplete information,the overall mortality rate of the remaining 9564 patients was 2.5%.The SinoSCORE model was constructed based on 11 variables:age,preoperative NYHA stageⅢorⅣ,chronic renal failure,extracardiac arteriopathy,chronic obstructive pulmonary disease,preoperative atrial fibrillation or flutter(within 2 weeks),left ventricular ejection fraction,other elective surgery,combined valve procedures,preoperative critical state,and BMI.In the developmental dataset,calibration using a Hosmer-Lemeshow(HL)test was at P=0.44 and discrimination based on the area under the receiver operating characteristic curve(ROC)was 0.80.In the validation dataset,the HL test was at P=0.34 and the area under the ROC(AUC)was 0.78.A logistically derived additive model for predicting in-hospital mortality among Chinese patients undergoing CABG was developed based on the most up-to-date multi-center data from China.

关键词： coronary artery bypass grafting risk stratification in-hospital mortality

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Prognostic Value of Neutrophil to Lymphocyte Ratio for in-hospital mortality in Elderly Patients with Acute Myocardial Infarction

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Current Medical Science 2018年第2期38卷 354-359页

作者： Tang-meng GUO Bei CHENG Li KE Si-ming GUAN Ben-ling QI Wen-zhu LI Bin YANG Department of Geriatrics Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China Institute of Geriatrics Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China

Coronary artery disease （CAD） is a multifactorial disease in which inflammation plays a central role. This study aimed to investigate the association of inflammatory markers such as the neutrophil to lymphocyte ratio （NLR）, the Global Registry of Acute Coronary Events （GRACE） score with in-hospital mortality of elderly patients with acute myocardial infarction （AMI） in an attempt to explore the prognostic value of these indices for elderly AMI patients. One thousand consecutive CAD patients were divided into two groups based on age 60. The laboratory and clinical characteristics were assessed retrospectively by reviewing the medical records. The NLR and GRACE score were calculated. In the elderly （〉60 years）, patients with non-ST-elevation myocardial infarction （NSTEMI） and ST-elevation myocardial infarction （STEMI） had significantly higher NLR than did those with unstable angina （UA） and stable angina pectoris （SAP）（P〈0.01）. The NLR was considerably elevated in older AMI patients compared with their younger counterparts （〈60 years）（P〈0.05）. In elderly AMI patients, the NLR was considerably higher in the high-risk group than in both the low-risk and mediumrisk groups based on the GRACE score （P〈0.05 and P〈0.01, respectively）, and the NLR was positively correlated with the GRACE score （r=0.322, P〈0.001）. Either the NLR level or the GRACE score was significantly higher in the death group than in the surviving group （P〈0.05）. By curve receiver operator characteristic curve （ROC） analysis, the optimal cut-off levels of 9.41 for NLR and 174 for GRACE score predicted in-hospital death [ROC area under the curve （AUC） 0.771 and 0.787, respectively, P〈0.001]. It was concluded that an elevated NLR is a potential predictor of in-hospital mortality in elderly patients with AMI.

关键词： neutrophil to lymphocyte ratio in-hospital mortality coronary artery disease elderly patients

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Comparison of Child-Pugh, MELD, MELD-Na, and ALBI Scores in Predicting in-hospital mortality in Patients with HCC

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International Journal of Clinical Medicine 2023年第3期14卷 148-162页

作者： Yun Liu Lijian Ran Hongjia Zhang Heling Ren Xin Jiang Pinliang Liao Min Ou Department of Gastroenterology Southwest Hospital The First Affiliated Hospital of Army Medical University Chongqing China Department of Cardiovascular Medicine Southwest Hospital The First Affiliated Hospital of Army Medical University Chongqing China

Background & Objectives: Hepatocellular carcinoma (HCC) leads to high morbidity and mortality. Various models have been proposed for predicting the outcome of patients with HCC. We aim to compare the prognostic abilities of Child-Pugh, MELD, MELD-Na, and ALBI scores for predicting in-hospital mortality of HCC. Methods: We enrolled patients diagnosed with liver cirrhosis and HCC from May 2017 through May 2018. We further divided eligible patients into hepatitis B virus (HBV), patients without ascites, and patients with ascites subgroups. Areas under the characteristic curves (AUCs) were analyzed. Results: A total of 495 patients were included in the study. We collected data on patients at admission. A majority of patients were infected with HBV (91.5%). None of them were complicated with hepatic encephalopathy. Only 14.9% of patients presented with ascites. In the whole population, AUCs with 95% confidence interval (CI) of Child-Pugh, ALBI, MELD, and MELD-Na scores in predicting in-hospital mortality were 0.889 (95% CI: 0.858 - 0.915), 0.849 (95% CI: 0.814 - 0.879), 0.669 (95% CI: 0.626 - 0.711), and 0.721 (95% CI: 0.679 - 0.760), respectively. In the patients without ascites subgroup, Child-Pugh showed better discriminatory ability than ALBI score in predicting in-hospital mortality (P = 0.0002), while there were no significant differences among other comparisons. Conclusions: Child-Pugh and ALBI may be useful predictors for predicting in-hospital mortality in whole patients, in patients with HBV infection, and in patients without ascites. In HCC patients with ascites, MELD-Na may be effective for predicting in-hospital mortality.

关键词： Hepatocellular Carcinoma Child-Pugh Score MELD Score MELD-Na Score ALBI Score in-hospital mortality

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