Risk of cardiovascular death in patients with hepatocellular carcinoma based on the Fine-Gray model

BACKGROUND Hepatocellular carcinoma(HCC)is one of the most common types of cancers worldwide,ranking fifth among men and seventh among women,resulting in more than 7 million deaths annually.With the development of medical tech-nology,the 5-year survival rate of HCC patients can be increased to 70%.How-ever,HCC patients are often at increased risk of cardiovascular disease(CVD)death due to exposure to potentially cardiotoxic treatments compared with non-HCC patients.Moreover,CVD and cancer have become major disease burdens worldwide.Thus,further research is needed to lessen the risk of CVD death in HCC patient survivors.METHODS This study was conducted on the basis of the Surveillance,Epidemiology,and End Results database and included HCC patients with a diagnosis period from 2010 to 2015.The independent risk factors were identified using the Fine-Gray model.A nomograph was constructed to predict the CVM in HCC patients.The nomograph performance was measured using Harrell’s concordance index(C-index),calibration curve,receiver operating characteristic(ROC)curve,and area under the ROC curve(AUC)value.Moreover,the net benefit was estimated via decision curve analysis(DCA).RESULTS The study included 21545 HCC patients,of whom 619 died of CVD.Age(<60)[1.981(1.573-2.496),P<0.001],marital status(married)[unmarried:1.370(1.076-1.745),P=0.011],alpha fetoprotein(normal)[0.778(0.640-0.946),P=0.012],tumor size(≤2 cm)[(2,5]cm:1.420(1.060-1.903),P=0.019;>5 cm:2.090(1.543-2.830),P<0.001],surgery(no)[0.376(0.297-0.476),P<0.001],and chemotherapy(none/unknown)[0.578(0.472-0.709),P<0.001]were independent risk factors for CVD death in HCC patients.The discrimination and calibration of the nomograph were better.The C-index values for the training and validation sets were 0.736 and 0.665,respectively.The AUC values of the ROC curves at 2,4,and 6 years were 0.702,0.725,0.740 in the training set and 0.697,0.710,0.744 in the validation set,respectively.The calibration curves showed that the predicted probab-ilities of the CVM prediction model in the training set vs the validation set were largely consistent with the actual probabilities.DCA demonstrated that the prediction model has a high net benefit.CONCLUSION Risk factors for CVD death in HCC patients were investigated for the first time.The nomograph served as an important reference tool for relevant clinical management decisions.

Without preprocedural aspirin, PCI carries higher risk of in-hospital death, stroke

Key points： Registry study looks at preprocedural aspirin use in more than 65,000 patients undergoing PCI Aspirin not given to 7%, with only a small minority having a documented contraindication In-hospital death, stroke risk both higher without aspirin

A Study of the Causes of In-Hospital Mortality in Patients with Acute Myocardial Infarction Complicated by Gastrointestinal Haemorrhage

Objective:To analyze the risk factors for death during hospitalization in patients with acute myocardial infarction(AMI)complicated by gastrointestinal bleeding(GIB).Methods:260 patients with AMI complicated by GIB who were admitted to the cardiology department of a hospital from January 2022 to December 2023 were retrospectively analyzed.27 patients who died during hospitalization were designated as the control group and the 233 patients who survived as the observation group.Baseline data and clinical indexes of patients in the two groups were compared,and multifactorial logistic regression was applied to analyze the risk factors for death during hospitalization in patients with AMI complicated by GIB.Results:Univariate analysis showed that the control group had higher proportions of patients with Killip classification III to IV on admission,new arrhythmias,and mechanical complications,as well as higher heart rates,white blood cell counts,urea nitrogen,and creatinine levels.The proportion of patients who received transfusion therapy during hospitalization was also higher in the control group.Conversely,the control group had lower systolic and left ventricular ejection fraction rates compared to the observation group,with statistically significant differences(P<0.05).Multifactorial logistic regression analysis revealed that new-onset arrhythmia(OR=2.724,95%CI 1.289-5.759),heart rate>100 beats/min(OR=3.824,95%CI 1.472-9.927),left ventricular ejection fraction<50%(OR=1.884,95%CI 0.893-3.968),BUN level(OR=1.029,95%CI 1.007-1.052),and blood transfusion(OR=3.774,95%CI 1.124-6.345)were independently associated with an increased risk of death during hospitalization in patients with AMI complicated by GIB.Conclusions:New arrhythmia,heart rate>100 beats/min,left ventricular ejection fraction<50%,elevated BUN levels,and blood transfusion are risk factors for death during hospitalization in patients with AMI complicated by GIB.

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

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 P<0.001).The NRI index of EBS in predicting the in-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 was<0.1,the net benefit of the EBS model was higher than those of the other models.CONCLUSION:The EBS prognostic models were better than the SOFA,qSOFA,MEDS,and PBS models in predicting the in-hospital mortality of patients with CABSIs.

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.

Survival and risk analysis of patients with COVID-19 in Iran

Objective:To evaluate the risk factors of death caused by COVID-19 in Iran.Methods:This study was a retrospective cohort study from February 20,2020,to August 22,2022,in the hospitals in Isfahan,Iran.The data were collected through a researcher-made checklist.To determine the risk factors of the death,logistic regression and Cox regression models were used.For each variable,the odds ratio and 95%confidence interval were also reported.Results:1885 Patients were included.The age of deceased persons was significantly higher than that of the surviving persons.The risk of death for the age group above 60 years was about 14 times higher than that of people aged 19-35 years[95%CI:14.41(2.02-102.99),P<0.01].Hypertension[95%CI:1.92(1.47-2.5),P<0.01],diabetes[95%CI:1.62(1.23-2.13),P<0.001],and chronic obstructive pulmonary disease[95%CI:1.92(1.47-2.50),P<0.01]were also risk factors of mortality.Conclusions:This study reveals that the mortality rate due to COVID-19 is associated with old age,longer hospitalization in the ICU,increased length of stay,and comorbidities of high blood pressure,diabetes,and chronic pulmonary disease.

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.

Risk Factors Associated with In-Hospital Post-Chemotherapy Mortality in Patients with Malignant Musculoskeletal Tumors

Introduction: Reducing the in-hospital post-chemotherapy mortality rate in patients with malignant musculoskeletal tumors is important for improving treatment outcome. This study aimed to investigate the risk factors associated with in-hospital post-chemotherapy mortality in patients with primary malignant musculoskeletal tumors. Methods: Using a Japanese national inpatient database, we retrospectively identified 5039 patients (2920 men and 2131 women;mean age, 39 years) who underwent curative chemotherapy for malignant musculoskeletal tumors between 2007 and 2010. We extracted data on the patients’ characteristics, complications, chemotherapeutic agent use, comorbidities, and in-hospital death. Logistic regression analyses were performed to analyze factors affecting in-hospital post-chemotherapy death in these patients. Results: The overall in-hospital mortality rate was 1.1%. Higher in-hospital mortality rates were significantly associated with a greater volume of blood transfusion (>2500 mL) (odds ratio [OR], 49.71;95% confidence interval [CI], 22.24 - 111.12;p < 0.001), diabetes mellitus (OR, 3.05;95% CI: 1.21 - 7.70;p = 0.019), and older age (OR, 3.05;95% CI, 1.11 - 8.37;p = 0.031). Conclusions: Higher in-hospital post-chemotherapy mortality rates were associated with massive blood transfusion, which was associated with a 16-fold higher risk of in-hospital mortality compared with other risk factors. Blood transfusion volume should be considered an important indicator for deciding whether the next cycle of chemotherapy is administered continuously or not.

HCM Risk-SCD评分单独及联合LVEF对中青年肥厚型心肌病患者长期预后的预测价值

目的:探讨HCM Risk-SCD评分及其联合左心室射血分数(LVEF)预测中青年肥厚型心肌病(HCM)长期预后的价值。方法:收集2014年1月至2022年6月共224例确诊为HCM的中青年患者临床资料。通过Cox回归确定患者发生心源性猝死(SCD)的危险因素,ROC曲线分析LVEF联合HCM Risk-SCD评分对SCD的预测价值。结果:随访期间共发生SCD 17例。在调整了BMI、血小板计数等混杂因素后,HCM Risk-SCD评分对于患者生存结局的评估仍具有统计学意义(HR=1.321,95%CI为1.155~1.510,P<0.001)。HCM Risk-SCD评分与LVEF联合后AUC(95%CI)可达0.901(0.878~0.924),而HCM Risk-SCD评分AUC(95%CI)为0.776(0.762~0.790),LVEF AUC(95%CI)为0.683(0.665~0.701),联合后对HCM患者发生SCD的预测价值上升(P<0.05)。结论:HCM Risk-SCD评分联合LVEF可预测中青年HCM患者发生SCD。

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.

Predictors of rebleeding and in-hospital mortality in patients with nonvariceal upper digestive bleeding

BACKGROUND Nonvariceal upper digestive bleeding (NVUDB) represents a severe emergency condition and is associated with significant morbidity and mortality. Despite a decrease in the incidence due to the widespread use of potent therapy with proton pump inhibitors as well as the implementation of modern endoscopic techniques, the mortality rate associated with NVUDB is still high. AIM To identify the clinical, biological, and endoscopic parameters associated with a poor outcome in patients with NVUDB to allow the stratification of risk, which will lead to the implementation of the most accurate management. METHODS We performed a retrospective study including patients who were admitted to the Gastroenterology Department of Clinical Emergency County Hospital Timisoara, Romania, with a diagnosis of NVUDB between 1 January 2008 and 31 December 2016. All the data were collected from the patient’s records, including demographic data, medication history, hemodynamic status, paraclinical tests, and endoscopic features as well as the methods of hemostasis, rate of rebleeding, need for surgery and death;we also assessed the Rockall score of the patients, length of hospitalization and associated comorbidities. All these parameters were evaluated as potential risk factors associated with rebleeding and death in patients with NVUDB.RESULTS We included a batch of 1581 patients with NVUDB, including 523 (33%) females and 1058 (67%) males with a median age of 66 years. The main cause of NVUDB was peptic ulcer (73% of patients). More than one-third of the patients needed endoscopic treatment. Rebleeding rate was 7.72%;surgery due to failure of endoscopic hemostasis was needed in 3.22% of cases;the in-hospital mortality rate was 8.09%, and the bleeding-episode-related mortality rate was 2.97%. Although our predictive models for rebleeding and death had a low sensitivity, the specificity was very high, suggesting a better discriminative capacity for identifying patients with better outcomes. Our results showed that the Rockall score was associated with both rebleeding and death;comorbidities such as respiratory conditions, liver cirrhosis and sepsis increased significantly the risk of in-hospital mortality (OR of 3.29, 2.91 and 8.03). CONCLUSION Our study revealed that the Rockall score, need for endoscopic therapy, necessity of transfusion and sepsis were risk factors for rebleeding. Moreover, an increased Rockall score and the presence of comorbidities were predictive factors for inhospital mortality.

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.

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.

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 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.

Risk factor of sudden death in dilated cardiomyopathy patients:A retrospective follow-up study

Objective: To discuss the related risk factors of sudden death in dilated cardiomyopathy (DCM)patients. Methods: A retrospective survey of DCM patients was conducted, all patients were chosen at random from Xi’an city and 8 adjacent counties. One hundred and fifty patients were reinvestigated after 3.1±1.5 years. Binary multivariate logistic regression analyses and one way analysis of variance (ANOVA) were used to identify risk factors of the sudden death in DCM patients. Results: Risk factors of sudden death in 150 DCM patients were frequently ventricular premature beats (OR=11.617), paroxysmal ventricular tachycardia (OR=6.305), hypertension (OR=5.689), EF (OR=0.977). The serum sodium concentration (P=0.023) and left ventricular diastolic dimension (LVDD)(P=0.039) were significant difference between the sudden death group and the survival group in one way ANOVA, LVDD was not a risk factor in multivariate analysis controlling for possible confounding. Conclusion: The present study identified some risk factors of sudden death in DCM patients, including frequently ventricular premature beats, paroxysmal ventricular tachycardia, hypertension and low EF value.

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.

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。

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。

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。