Risk Factors for COVID-19 Related Death during the First Three Waves of the Pandemic in an Epidemic Treatment Center at Dakar, Senegal

Introduction-Objective: COVID-19 is a highly transmissible but often mild viral infection. However, some patients can present severe COVID-19 and subsequently die. The aim of the present study was to assess the risk factors for COVID-19 related death during the first three waves of the disease at the Epidemic Treatment Center (ETC) of Dakar Principal Hospital (DPH). Method: We conducted a descriptive and analytical perspective survival study from April 4, 2020 to September 25, 2021, including adult patients with COVID-19, hospitalized at the ETC of DPH. Log Rank test and multivariate Cox model were performed to identify risk factors for death. Results: We included 556 COVID-19 patients with mean age of 57 ± 17 years and a male-to-female ratio of 1.26. The number of deaths during one month of follow-up was 41, representing a cumulative risk of 7.4%. The log Rank test showed that being from the third wave (p = 0.0056), advanced age (p = 0.00098), presence of at least one comorbidity (p = 0.034), High blood pressure (p = 0.024), d-dimer level ≥ 1000 IU/L (p Conclusion: Our study showed that elderly and third-wave of COVID-19 patients were more at risk to die. Knowledge of risk factors for COVID-19 related death could improve the prognosis of these patients.

The Impact of Finerenone on Changes in Pulse Wave Velocity, Arterial Pressure and Heart Related Deaths in Hemodialysis Patients—Study Perspective

The description in the abstract lacks clear logic and a comprehensive summary of this study, so please revise and improve it according to the design theme and main content of this study, and describe it in the order of (research background), purpose/aim, method, results and conclusions. The introduction of the abstract and preface is rather lengthy, but the summary of the whole study and the presentation of the research background are not perfect (mainly because the logic of the context is not clear and orderly), so it will appear a bit messy. Hope to be able to modify (this has been mentioned in the preliminary opinion). Cardiovascular events (CVE) pose a significant threat to individuals with end-stage renal disease (ESRD), yet these patients are often excluded from cardiovascular clinical trials, leaving prognostic factors associated with CVE in ESRD patients largely unexplored. Recent human studies have demonstrated elevated circulating aldosterone levels in ESRD patients, correlating with left ventricular hypertrophy. Additionally, animal models have shown improvements in uremic cardiomyopathy with spironolactone therapy, prompting interest in assessing the efficacy of spironolactone or eplerenone in reducing mortality and improving cardiovascular function in dialysis patients. Clinicians have historically been cautious about prescribing mineralocorticoid receptor antagonists (MRAs) to congestive heart failure patients with chronic kidney disease (CKD) due to hyperkalemia risk. However, the emergence of finerenone, a novel MR antagonist with a favorable safety profile and lower hyperkalemia risk, has renewed interest in MRA therapy in this population. Heart disease, including coronary artery disease, hypertension, and left ventricular failure, is alarmingly prevalent in dialysis patients, contributing significantly to elevated mortality rates compared to the general population. Arterial stiffness, as indicated by pulse wave velocity (PWV), progressively worsens with advancing CKD stages, peaking in severity among ESRD patients undergoing dialysis. High PWV serves as a crucial risk stratification tool in ESRD. Elevated NT-proBNP and BNP levels in ESRD patients are well-documented, with significant associations observed between baseline peptide concentrations and cardiovascular morbidity and mortality. By incorporating finerenone into our study, we aim to investigate its potential benefits in reducing arterial stiffness, lowering blood pressure, and ultimately mitigating heart-related mortality among hemodialysis patients. This study holds substantial implications for hypertension and cardiovascular risk management in this vulnerable patient population. Eligible participants must have been on chronic hemodialysis for at least three months, with ACE inhibitors or angiotensin receptor blockers included in their therapy at maximum tolerable doses. Serum potassium levels 5.7 mmol/L, left ventricular ejection fraction 50%, and PWV higher than age-estimated values are also prerequisites for study entry. Randomized allocation will be conducted using a permuted block design, stratified by center, with allocation communicated via signed study forms during initial examinations. All steps of this research will be conducted in accordance with the principles of the Helsinki Declaration.

The impact of social participation on older people’s death risk:an analysis from CLHLS

This study uses nested Cox proportional hazard models to analyze data from five waves(2002,2005,2008,2011,2014)of the Chinese Longitudinal Healthy Longevity Survey.We found that secular social participation and religious participation both contributed to statistically lower death risk among older respondents.These associations still held after controlling for a wide range of covariates.In particular,secular social participation predicted a greater decrease in death risk and had interactive effects with gender and age-group.Female and young-old adults enjoyed more health benefits from participating in secular social activities than their male or old-old counterparts,respectively.This interactive effect was not observed regarding the impact of religious participation on death hazard.

Risk Factors for SARS-Related Deaths in 2003, Beijing

Objective To study the potential risk factors for severe acute respiratory syndromes （SARS）-related deaths in Beijing. Methods Epidemiological data were collected among the confirmed SARS patients officially reported by Beijing Centers for Disease Control and Prevention （BCDC）, and information was also supplemented by a follow-up case survey, Chi-square test and multivariate stepwise logistic regression analysis were performed. Results Old age （over 60 years） was found to be significantly associated with SARS-related deaths in the univariate analysis. Also, history of contacting SARS patients within 2 weeks prior to the onset of illness, health occupation, and inferior hospital ranking as well as longer interval of clinic consulting （longer than 1 day） were the risk factors for SARS-related deaths. Multivariate stepwise logistic regression analysis found four risk factors for SARS-related deaths. Conclusion Old age （over 60 years） is the major risk factor for SARS-related deaths. Moreover, hospital health workers, the designated hospitals for SARS clinical services and the interval of consulting doctors （less than 1 day） are protective factors for surviving from SARS.

Risk factors of intrapartal fetal death in a low-resource setting

Objective: To identify the risk factors of intrapartal fetal death in a tertiary hospital in Yaoundé. Methods: It was a case-control study comparing 53 women who delivered with intrapartal fetal death to 106 women who delivered without intrapartal fetal death, carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon. Results: The risk factors of intrapartal fetal death identified at bivariate analysis were: maternal age <20 years (OR = 3.1;CI = 1.1 - 8.3), absence of regular income (OR = 2.4;CI = 1.2 - 4.7), single motherhood (OR = 2.9;CI = 1.5 - 5.7), illiteracy and primary level of education (OR = 4.7;CI = 1.9 - 11.5), referral (OR = 5.0;CI = 2.5 - 9.9), parity 0 and 1 (OR = 2.3;CI = 1.1 - 4.5), no antenatal care (OR = 9.2;CI = 2.4 - 35.6), number of antenatal visits <4 (OR = 4.2;CI = 2.1 - 8.6), antenatal care in a health center (OR = 3.8;CI = 1.9 - 7.5), antenatal care by a midwife (OR = 2.5;CI = 1.3 - 4.9) or a nurse (OR = 5.2;CI = 1.4 - 18.7), absence of malaria prophylaxis (OR = 10.6;CI = 2.9 - 39.5), absence of obstetrical ultrasound (OR = 4.7;CI = 1.9 - 10.9), prematurity (OR = 3.4;CI = 1.5 - 7.3), abnormal presentation (OR = 2.6;CI = 1.1 - 5.9), ruptured membranes at admission (OR = 2.7;CI = 1.3 - 5.4), ruptured membranes >12 hours at admission (OR = 5.1;CI = 2.5 - 10.3), stained amniotic fluid (OR = 4.8;CI = 2.4 - 9.7), labor lasting more than 12 hours (OR = 18.1;CI = 8.0 - 41.0), presence of maternal complications (OR = 4.7;CI = 2.2 - 10.3), and presence of fetal complications (OR = 48.6;CI = 18.3 - 129), particularly acute fetal distress (OR = 52.3;CI = (14.6 - 186), cord prolapse (OR = 12.1;CI = 3.3 - 43.4), and birth weight <2500 g (OR = 2.8;CI = 1.2 - 6.6). Conclusion: Close attention should be offered to pregnant women, so as to identify these risk factors and promptly provide an appropriate management.

Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction

Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators(ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.

Population attributable risks of cigarette smoking for deaths of all causes, all cancers and other chronic diseases among adults aged 40-74 years in urban Shanghai, China

Objective： To evaluate the population attributable risks （PARs） between cigarette smoking and deaths of all causes, all cancers, lung cancer and other chronic diseases in urban Shanghai. Methods： In total, 61,480 men aged 40-74 years from 2002 to 2006 and 74,941 women aged 40-70 years from 1997 to 2000 were recruited to undergo baseline surveys in urban Shanghai, with response rates of 74.0% and 92.3%, respectively. A Cox proportional hazards regression model was used to estimate relative risks （RRs） and 95% confidence intervals （95% CIs） of deaths associated with cigarette smoking. PARs and 95 % CIs for deaths were estimated from smoking exposure rates and the estimated RRs. Results： Cigarette smoking was responsible for 23.9% （95% CI： 19.4-28.3%） and 2.4% （95% Ch 1.6- 3.2%） of all deaths in men and women, respectively, in our study population. Respiratory disease had the highest PAR in men [37.5% （95% CI： 21.5-51.6%）], followed by cancer [31.3% （95% Ch 24.6-37.7%）] and cardiovascular disease （CVD） [24.1% （95% CI： 16.7-31.2%）]. While the top three PARs were 12.7% （95% CI： 6.1-19.3%）, 4.0% （95% CI： 2.4-5.6%）, and 1.1% （95% CI： 0.0-2.3%）, for respiratory disease, CVD, and cancer, respectively in women. For deaths of lung cancer, the PAR of smoking was 68.4% （95% CI： 58.2- 76.5%） in men. Conclusions： In urban Shanghai, 23.9% and 2.4% of all deaths in men and women could have been prevented if no people had smoked in the area. Effective control programs against cigarette smoking should be strongly advocated to reduce the increasing smoking-related death burden.

亚砷酸诱导的老年急性早幼粒细胞白血病早期死亡分析

目的分析经单药亚砷酸(arsenic trioxide,ATO)诱导治疗的老年(年龄≥60岁)初发急性早幼粒细胞白血病(acute promyelocytic leukemia,APL)的早期死亡(early death,ED)发生情况及预测因素。方法收集连续收治的71例老年APL患者和456例年轻APL患者的临床资料。选取临床上可以快速获取的10个临床及实验室检测参数,采用χ^(2)检验及Logistic回归模型进行统计学分析。结果老年患者的ED率(22.5%,16/71)高于年轻患者(15.1%,69/456),但差异无统计学意义(P=0.115)。老年感染相关ED(8.5%)和血栓相关ED(2.3%)的发生率均显著高于年轻患者(分别为2.0%和0.3%),差异有统计学意义(P<0.01)。男性和白细胞计数>10×10^(9)/L是两组患者ED的共同独立风险因素,低白蛋白血症(P<0.001)和血清纤维蛋白原<1g/L(P=0.001)还是年轻患者ED的独立风险因素。结论单药ATO诱导治疗的老年APL患者的入院临床特征、ED发生情况及风险因素与年轻患者明显不同。因此,有必要对APL患者的ED情况进行年龄分层研究。

2016—2021年合肥市极端气温与循环系统疾病死亡的时间序列分析

目的探讨合肥市极端气温对居民循环系统疾病死亡的影响及不同人群的敏感性分析。方法收集合肥市2016—2021年逐日气象资料、大气污染物监测资料及循环系统疾病死亡数据。采用基于广义相加模型的分布滞后非线性模型(distributed lag non-linear model,DLNM),评估极端气温对不同性别、年龄人群循环系统疾病死亡影响以及对循环系统主要疾病死亡的滞后效应和累积效应。以日均气温中位数(17.7℃)为对照,计算极端气温的相对危险度(RR)。结果合肥市极端气温对居民循环系统疾病死亡具有显著影响。极端低温对循环系统疾病死亡影响滞后时间长,lag4时达到最大,RR(95%CI)为1.067(1.039,1.095),且不同人群的死亡风险均明显增加。极端高温对循环系统疾病死亡的影响在当天达到最大,RR(95%CI)为1.088(1.020,1.160),持续时间短;≥65岁、女性和脑血管病患者也均在当日效应最大,且效应具有统计学意义,而对其他人群无明显影响。极端气温对不同人群的冷效应均高于热效应,低温对<65岁人群的死亡风险明显高于≥65岁人群,热效应则相反;女性冷效应和热效应均高于男性;脑血管病人群冷效应和热效应也均高于缺血性心脏病人群。结论合肥市极端气温可能增加居民循环系统疾病死亡风险,冷效应影响更大,不同人群对冷热效应的敏感性有差别。

Risk Factors for Severity and Mortality of Patients Hospitalized for COVID-19 during the 3rd Wave of the Epidemic-Sao Tome and Principe

Rationale: In the literature, some risk factors for severity and mortality from COVID-19 have been indicated. However, these factors can change, depending on the characteristics of the population and health services. In this sense, longitudinal studies can be useful for understanding local realities and subsidizing health actions based on these realities. Objective: To analyze the risk factors for severity and death in hospitalized patients with COVID-19. Methods: A retrospective cohort of patients with COVID-19 hospitalized from August 1 to October 16, 2021 (3rd wave of the pandemic), notified by the Department of Epidemiological Surveillance of Sao Tome and Principe. We employed measures of strength of associations for the analysis of exposure risk factors. Results: We analyzed 110 hospitalized patients (31.8% severe-critical and 68.2% non-severe). The risk factors for severe forms of COVID-19 were: being aged ≥60 years (RR = 3.3), being male (RR = 2), having comorbidities (RR = 2) and the risk increases to 10-fold for multicomorbidities, with emphasis on obesity, neoplasia, skin-muscle-surgical infection, dementia and to some degree CVD. 62.9% of patients with severe forms of the disease were not vaccinated. Risk factors for death among hospitalized and severe/critical cases, respectively, were having comorbidities (RR = 8 and 2.4) multicomorbidities (RR = 10 and 2.8 for those with 2 comorbidities and RR = 33.3 and 4 for those with 3 or 4 comorbidities), especially diabetes, dementia, neoplasia, cutaneous-muscular infection, and obesity. Although CVD was not associated with risk factors for death, these were the most frequently found among the severely hospitalized and deaths. In addition, important risk factors associated with death were not using corticoids (RR = 3.3, 230-fold risk) and not using anticoagulants-heparin (RR = 1.3, 30% risk) more compared to the severe cases that did use them. Most of the patients who died (63.2%) were not vaccinated. Moreover, having only 1 dose of the vaccine was a risk factor 1.9 times more for death among all hospitalized patients, but in the severe cases, there was no association between the variable vaccination and death. Among those hospitalized with 2 doses, it was a 0.5-fold protective factor among those hospitalized. The Delta variant of Sarscov-2 was the one found among severe cases and deaths investigated by genetic sequencing, with more exuberant clinical features compared to the other 2 previous vaccinations. Conclusion: Being elderly, male and presenting comorbidities, mainly multicomorbidities were the main characteristics associated with severity of COVID-19. On the other hand, comorbidities, and even worse, multicomorbidities, hospitalization for respiratory failure, lowered level of consciousness, no use of corticoid and no use of anticoagulation in critically ill patients, and not having at least 2 doses of vaccine for covid-19, were characteristics associated with death by COVID-19. These results will help inform healthcare providers so that the best interventions can be implemented to improve outcomes for patients with COVID-19. Public health interventions must be carefully tailored and implemented in these susceptible groups to reduce the risk of mortality in patients with COVID-19 and then the risk of major complications. Intensive and regular follow-up is needed to detect early occurrences of clinical conditions.

急性A型主动脉夹层患者发生院内死亡的危险因素分析

目的:探讨急性A型主动脉夹层(ATAAD)患者发生院内死亡的危险因素。方法:选取2018年1月—2022年12月于宜昌市中心人民医院就诊的288例ATAAD患者,根据患者预后情况分为院内死亡组(n=30)和生存组(n=258),将单因素分析中P<0.05的指标作为自变量,将患者院内死亡作为因变量,进行多因素Logistic回归分析,探讨ATAAD患者发生院内死亡的危险因素。结果:单因素分析结果显示,两组患者的年龄、心率、白细胞计数(WBC)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、肌酸激酶同工酶(CK-MB)、促甲状腺素(TSH)水平差异有统计学意义(均P<0.05);多因素Logistic回归分析结果显示,年龄≥60岁(OR=2.807,95%CI:2.341,3.365)、WBC>10×10^(9)/L(OR=2.837,95%CI:2.360,3.410)、ALT≥40 U/L(OR=3.081,95%CI:2.525,3.760)均为ATAAD院内死亡的独立危险因素(均P<0.05)。结论:年龄≥60岁、WBC>10×10^(9)/L、ALT≥40 U/L均为ATAAD患者发生院内死亡的独立危险因素。

基于CHARLS数据库肌酐水平与心脏病患者死亡的相关性分析

目的基于中国健康与养老追踪调查(CHARLS)大型社区研究数据库,探究中国中老年人群肌酐水平预期心脏病发生死亡的相关性。方法收集CHARLS数据库中心脏病患者的2011年血液学检查结果及2018年生存情况数据,将患者按2018年生存情况分为死亡组和存活组,共纳入死亡组133例,存活组982例。比较两组一般人口学、血液学检查结果、疾病史的差异,并通过线性回归方法分析与心脏病死亡有关的因素。结果与存活组相比,死亡组的平均年龄更高、男性比例更多,差异有统计学意义(P<0.05);与存活组相比,死亡组心脏病有关的风险指标(如慢性肺部疾病、胃部疾病或消化系统疾病)患者比例更高(P<0.05),死亡组有哮喘、吸烟史的比例更高(P<0.05)。两组在有无高血压、血脂异常、糖尿病或血糖升高、肝脏疾病、卒中、情感及精神方面问题、与记忆相关的疾病、关节炎或风湿病方面比较,差异无统计学意义(P>0.05)。血液学检查结果显示,两组肌酐、血小板计数、尿素氮、血糖、C反应蛋白、尿酸、血红蛋白水平比较,差异有统计学意义(P<0.05);而白细胞计数、平均红细胞体积、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、糖化血红蛋白、红细胞比容比较,差异无统计学意义(P>0.05)。多因素Logistic线性回归分析结果显示,除胃部疾病或消化系统疾病、哮喘、吸烟史、血糖、C反应蛋白、年龄是心脏病患者死亡的高风险因素外,2011年心脏病患者的肌酐水平和长期死亡风险增加有关[比值比(OR)=3.068,95%CI:1.193~7.894,P=0.020]。结论高肌酐水平可能预示着心脏病患者死亡风险增加,胃部疾病或消化系统疾病、哮喘、吸烟史、血糖、肌酐、C反应蛋白、年龄可能是中老年心脏病患者长期死亡风险的危险因素。

艾滋病患者血流感染病原菌特点及死亡危险因素分析

目的探讨艾滋病患者血流感染病原菌分布特点及患者死亡的危险因素,为提高临床诊治水平、降低病死率提供有效依据。方法回顾性分析南宁市第四人民医院急诊科2022年1月—2022年12月收治的艾滋病合并血流感染患者的临床资料,分析病原菌分布情况。根据住院期间患者存活或死亡,分为生存组及死亡组,用Logistic回归分析筛选患者死亡的独立危险因素。结果艾滋病合并血流感染200例患者中,检出致病菌232株:其中真菌144株(62.07%),以马尔尼菲蓝状菌(55.60%)为主;革兰阴性菌35株(15.09%),以肠沙门氏菌(3.88%)和大肠埃希菌(3.88%)为主;分枝杆菌16株(6.90%);革兰阳性菌37株(15.95%),以人葡萄球菌(3.45%)和表皮葡萄球菌(3.45%)为主。200例患者中,死亡49例(24.5%),生存151例(75.5%),2组性别、年龄、白细胞计数、C-反应蛋白、血清淀粉样蛋白、红细胞压积、CD4^(+)T细胞计数差异均无统计学意义(P均>0.05);单因素分析显示,死亡组血小板计数、白蛋白水平、内生肌酐清除率低于生存组,而降钙素原水平、复数菌感染率、脓毒性休克发生率、急性生理与慢性健康Ⅱ评分、序贯器官衰竭评分高于生存组,差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,内生肌酐清除率下降(OR=1.035)、发生脓毒性休克(OR=10.443)、急性生理与慢性健康Ⅱ评分>25(OR=7.708)是患者死亡的独立危险因素。结论艾滋病患者血流感染率高,病原菌以真菌为主,患者病死率高。内生肌酐清除率下降、发生脓毒性休克、急性生理与慢性健康Ⅱ评分>25是患者死亡的独立危险因素。

Risk factors of clinical birth asphyxia and subsequent newborn death following nuchal cord in a low-resource setting

Introduction: Our aim was to identify the risk factors of clinical birth asphyxia and subsequent newborn death in the presence of nuchal cord in a sub-Saharan Africa setting. Methodology: It was a six-months’ case-control study involving 117 parturients whose babies presented with a nuchal cord at delivery. The study was carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon, from January 1st to June 30th 2013. Results: The risk factors of clinical birth asphyxia identified were: first delivery, absence of obstetrical ultrasound during pregnancy, nuchal cord with more than one loop, duration of second stage of labor more than 30 minutes during vaginal delivery. The risk factors for newborn death from clinical birth asphyxia in the presence of nuchal cord were: maternal age Conclusion: We recommend a systematic obstetrical ultrasound before labor, so as to detect the presence of a nuchal cord, its tightness and the number of loops. Also, cesarean section should be considered when a nuchal cord is associated with first delivery, tightness or multiple looping.

血清OPN、sPD-L1、miR-370在急性髓系白血病中的表达及与危险分层的关系

目的:分析血清骨桥蛋白(OPN)、可溶性程序性死亡因子配体-1(sPD-L1)、微小RNA-370(miR-370)在急性髓系白血病(AML)中的表达及与危险分层的关系。方法:选取2021年11月—2023年2月本院诊治的79例AML患者作为研究对象,根据相关标准分为低危组(n=26)、中危组(n=39)及高危组(n=14)。比较3组治疗前后血清OPN、sPD-L1、miR-370、白细胞计数(WBC)、血红蛋白(Hb)水平,采用Pearson分析血清OPN、sPD-L1、miR-370水平与WBC、Hb水平相关性,采用受试者工作特征曲线(ROC)分析治疗前血清OPN、sPD-L1、miR-370水平联合检测对AML患者危险分层情况的诊断价值。结果:3组治疗前后血清OPN、sPD-L1、miR-370、WBC水平比较:低危组<中危组<高危组(P<0.05);血清Hb水平比较:低危组>中危组>高危组(P<0.05);治疗前后血清OPN、sPD-L1、miR-370水平与WBC水平呈正相关(治疗前:r=0.637、0.629、0.661,治疗后:r=0.432、0.422、0.544,P<0.05),与Hb水平呈负相关(治疗前:r=-0.655、-0.648、-0.646,治疗后:r=-0.519、-0.507、-0.438,P<0.05);治疗前血清OPN、sPD-L1、miR-370联合检测诊断AUC为0.942,高于单一检测(P<0.05)。结论:血清OPN、sPD-L1、miR-370水平与AML患者病情程度、分层情况密切相关,可为临床诊疗提供参考。

中国成人肥厚型心肌病患者的猝死风险评估与预防

肥厚型心肌病(HCM)是一种以心肌肥厚为特征的基因遗传病,其中心源性猝死(SCD)是该疾病主要的死亡原因之一,评估HCM患者发生SCD的风险并早期识别和预防对于该疾病的预后至关重要,现结合目前关于HCM的最新相关研究及指南,对于HCM所致的猝死风险评估及预防进行简要阐述,以期对HCM引发SCD有更加深刻的认识。

运动后心率恢复与心源性猝死风险的相关性:一项队列研究的Meta分析

目的通过Meta分析,综合分析运动后心率恢复(HRR)与心源性猝死(SCD)之间的关系。方法基于PubMed、Embase和Web of Science数据库,进行截至2024年1月2日的文献检索。队列研究关注于HRR和SCD间的风险关系,通过风险比(HR)及95%可信区间(CI)进行评估。统计学分析采用Stata 12.0软件。结果纳入6项研究。固定效应模型(I^(2)=41.8%,P=0.112)的汇总结果显示:与心率恢复慢相比,心率恢复快人群发生SCD风险更低(HR=0.74,95%CI:0.64~0.86,P<0.001)。大多数亚组分析中都观察到了持续结果。排除一项研究并不影响总体结果[HR(95%CI):0.66(0.55,0.79)~0.76(0.65,0.88)]。Egger检验未发现明显的发表偏倚(P=0.059)。结论心率恢复较慢会增加普通人群发生SCD的风险。因此,HRR可能是临床实践中预防SCD的一个潜在靶点。

急性主动脉夹层患者急诊救治期间夹层破裂死亡风险预测模型的构建与验证

目的:探讨急性主动脉夹层患者急诊救治期间发生夹层破裂死亡的危险因素,构建风险预测模型并对其进行验证,检验其预测效能。方法:选取2018年1月至2021年8月中国医学科学院阜外医院急诊室收治的符合标准的301例急性主动脉夹层患者(模型组),根据患者是否于急诊救治期间发生夹层破裂死亡,分为生存亚组(n=239)和死亡亚组(n=62),对两亚组患者资料进行单因素和多因素分析,采用Logistic回归分析建立风险预测模型,采用Hosmer-Lemeshow检验判断模型的拟合优度,采用ROC曲线检验模型的预测效果。纳入2021年9月至2022年9月同一家医院急诊室收治的129例急性主动脉夹层患者对模型进行验证(验证组)。结果:301例急性主动脉夹层患者中,62例(20.6%)发生夹层破裂死亡。多因素分析结果显示,年龄(OR=1.066,95%CI:1.034~1.099)、高血压史(OR=0.377,95%CI:0.167~0.850)、夹层分型(OR=0.045,95%CI:0.006~0.364)、合并低血压(OR=4.424,95%CI:1.467~13.340)是夹层破裂死亡的危险因素;模型公式Z=-5.624+0.064×年龄-0.976×高血压史(是=1,否=0)-3.104×夹层分型(A型=0,B型=1)+1.487×合并低血压(是=1,否=0)。Hosmer-Lemeshow检验结果显示χ^(2)=9.328,df=8,P=0.315,AUC为0.874,灵敏度为79.0%,特异度为81.6%,最大约登指数为0.606。模型验证结果显示,AUC为0.722,灵敏度为73.7%,特异度为69.1%,准确度为89.9%。结论:年龄、高血压史、夹层分型、合并低血压是急性主动脉夹层患者急诊救治期间夹层破裂死亡的预测因子。本研究构建的模型预测效果较好,可为医护人员快速识别急性主动脉夹层破裂死亡高危患者,为采取预防性措施提供参考。

老年患者耐碳青霉烯类鲍曼不动杆菌血流感染的危险因素和病死率:一项为期十年的回顾性研究

目的 评估老年患者发生耐碳青霉烯类鲍曼不动杆菌(CRAB)血流感染和28天短期死亡相关的危险因素,为预防和治疗CRAB血流感染提供依据。方法 回顾性分析玉林市某医院2013年1月—2022年12月确诊为鲍曼不动杆菌血流感染且年龄≥60岁的老年患者临床资料,包括患者人口统计学、微生物学相关特征及临床结局等数据。选取单变量分析有意义的变量进行二元logistic回归模型和Cox比例风险模型多变量分析,进一步确定感染的独立危险因素,采用Kaplan-Meier曲线进行生存分析。结果 共150例患者纳入研究,其中CRAB血流感染16例,占10.7%,碳青霉烯类敏感鲍曼不动杆菌(CSAB)血流感染134例。老年患者鲍曼不动杆菌血流感染28天短期病死率为15.3%(23/150,95%CI:9.6%~21.1%),其中CRAB血流感染短期病死率(56.3%,9/16)高于CSAB(10.4%,14/134)。深静脉置管(OR:15.598,95%CI:1.831~132.910)和合并其他部位感染(OR:15.449,95%CI:1.497~159.489)与老年患者发生CRAB血流感染相关。老年患者鲍曼不动杆菌血流感染28天死亡的独立危险因素为血液透析(OR:11.856,95%CI:2.924~48.076)、入住重症监护病房(OR:9.387,95%CI:1.941~45.385)和肺部感染为菌血症可疑来源(OR:7.019,95%CI:1.345~36.635)。结论 老年患者合并其他部位感染和深静脉置管与CRAB血流感染的发生相关。血液透析、入住重症监护病房和肺部感染为菌血症可疑来源是影响老年患者鲍曼不动杆菌血流感染预后的独立危险因素。

急性缺血性脑卒中患者行血管内治疗后严重预后不良的预测模型建立及验证

目的探讨急性缺血性脑卒中患者行血管内治疗后严重预后不良(SDD)的相关危险因素,建立并验证SDD的列线图风险预测模型。方法回顾性分析2017年11月至2019年3月在急性缺血性脑卒中血管内治疗关键技术及急救流程改进(ANGEL-ACT)登记研究数据库中的患者1677例,男1111例,女566例,年龄≥18岁。根据是否发生SDD(术后90 d mRS 5~6分)为将患者分为两组:SDD组(n=478)和非SDD组(n=1199)。采用多因素分析、LASSO回归及RF-RFE方法筛选急性缺血性脑卒中患者SDD的危险因素,建立列线图模型并进行性能检测及内部验证。结果训练集中有380例(28.1%)患者发生SDD,验证集中有98例(30.2%)患者发生SDD。综合三种变量筛选方法,最终选择10个SDD的危险因素纳入模型,分别为年龄、入院NIHSS评分、是否成功再通、入院血糖浓度、血红蛋白浓度、血细胞比容、发病到穿刺时间、入院收缩压、ASPECT评分和有无与治疗相关的严重不良事件。模型1包含治疗前7个变量,模型2包含治疗前和治疗后共10个变量。训练集中模型1的曲线下面积(AUC)为0.705(95%CI 0.674~0.736),模型2的AUC为0.731(95%CI 0.701~0.760)。两个模型的校准斜率均为1.000,具有良好的校准度,决策曲线分析显示两个模型具有良好的临床适用度。结论年龄、入院NIHSS评分、是否成功再通、入院血糖浓度、血红蛋白浓度、红细胞压积、发病到穿刺时间、入院收缩压、ASPECT评分和有无与治疗相关的严重不良事件是急性缺血性脑卒中患者发生SDD的危险因素,基于以上因素构建的两种风险预测模型可分别在血管内治疗前和治疗后使用,以较好地预测SDD的发生。