Inflammation and malnutrition in inflammatory bowel disease.

Background: We aimed to analyze the prevalence and long-term prognostic impact of non-cardiac comorbidities in patients with reduced and preserved left-ventricular ejection fraction (EF) following ST-elevation myocardial infarction (STEMI). Method: A total of 3033 STEMI patients undergoing primary percutaneous coronary intervention (pPCI) were divided in two groups: reduced EF < 50% and preserved EF ≥ 50%. The follow-up period was 8 years. Results: Preserved EF was present in 1726 (55.4%) patients and reduced EF was present in 1389 (44.5%) patients. Non-cardiac comorbidities were more frequent in patients with reduced EF compared with patients with preserved EF (38.9% vs. 27.4%, respectively, p < 0.001). Lethal outcome was registered in 240 (17.2%) patients with reduced EF and in 40 (2.3%) patients with preserved EF, p < 0.001. Diabetes and chronic kidney disease (CKD) were independent predictors for 8-year mortality in patients with preserved EF. In patients with reduced EF, CKD was independently associated with 8-year mortality. Conclusion: In patients who had reduced EF, the prevalence of non-cardiac comorbidities was higher than in patients who had preserved EF after STEMI. Only diabetes mellitus and CKD were independently associated with 8-year mortality in analyzed patients.

Prognostic Impact of Non-Cardiac Comorbidities on Long-Term Prognosis in Patients with Reduced and Preserved Ejection Fraction following Acute Myocardial Infarction

Abstract Objective: This study was designed to develop a multivariate prediction model using variables obtained at the time of sepsis evaluation to predict necrotizing enterocolitis (NEC) stage III or death within a week with an area under the curve (AUC)&gt;0.90. Study design: This is a retrospective cohort study (n=269) of preterm infants &lt;33 weeks' gestation or &lt;1500 grams birthweight either suspected or with NEC born at Parkland Health between 2009-2021. A multivariate prediction model using the new PACSOFAH score (P neumoperitoneum, A bdominal C ompartment S yndrome, Neonatal Sequential Organ failure Assessment (NSOFA) score, acidemia, hyperkalemia, hyperglycemia), gestational age and use of inotropes for hypotension during the prior week was compared with a similar model using NSOFA score. Results: The PACSOFAH-model had a greater AUC than the NSOFA-model (0.92 vs 0.85, respectively, P =0.0005). Conclusion: A new prediction model for death or NEC stage III was developed with AUC=0.92 at the time of initial sepsis evaluation. 

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Development of a multivariable prediction model for necrotizing enterocolitis stage III or mortality within a week among preterm infants at the time of initial evaluation for necrotizing enterocolitis: A retrospective cohort study

Malnutrition has been associated with inferior outcomes in patients admitted with acute myocardial infarction (AMI). However, there is a lack of data to assess if the degree of malnutrition correlates with outcome severity. We used the Nationwide Readmission Database for 2016 to 2019 in our cross-sectional study. First, we extracted all cases older than 18 years that include a primary diagnosis of AMI. Appropriate survey and domain analyses were applied to obtain the national estimates using Statistical Analysis Software 9.4. We identified 2,280,393 discharges for AMI. Malnutrition was present in 4% of the study cohort (or 89,490 cases). Half of the patients with malnutrition (or 44,919) had moderate-to-severe malnutrition. The other 44,371 (or 50%) had a milder degree of malnutrition. Patients with malnutrition were younger than those without malnutrition (mean age 72 vs 75 years, p <0.001) and were more often women (48% vs 37%, p <0.001). Patients with malnutrition had a higher prevalence of underlying heart failure, dementia, coagulopathy, and chronic (liver, renal, and lung) diseases (p <0.001). Patients with malnutrition also had a significantly higher inpatient mortality (12.5% vs 4.6%, p <0.001), length of stay (mean of 13 vs 7 days, p <0.001), and 30-day all-cause readmission rates (19% vs 13%, p <0.001). Inpatient mortality on readmission was also higher in those with malnutrition (2% vs 0.6%, p <0.001). The univariate analysis showed that the severity of malnutrition also correlated with a higher inpatient mortality (odds ratio [OR] 2.34 [2.24 to 2.46] for mild malnutrition and 3.65 [3.49 to 3.82] for advanced malnutrition). After adjusting for age, gender, heart failure, dementia, coagulopathy, chronic (liver, renal, and lung) diseases, and history of cardiovascular revascularization, the presence of malnutrition and the severity of malnutrition continued to be associated with a higher inpatient mortality than those without malnutrition (OR 1.20 [1.14 to 1.26] for mild malnutrition and OR 1.69 [1.61 to 1.78] for more severe malnutrition). In conclusion, underlying malnutrition is associated with worse outcomes in patients hospitalized with AMI. The severity of malnutrition also correlates with worse outcomes. 

Undernutrition Severity Is Associated With Worse Outcomes in Patients With Acute Myocardial Infarction.

(1) Birth asphyxia is a major cause of delivery room resuscitation. Subsequent organ failure and hypoxic–ischemic encephalopathy (HIE) account for 25% of all early postnatal deaths. The neonatal sequential organ failure assessment (nSOFA) considers platelet count and respiratory and cardiovascular dysfunction in neonates with sepsis. To evaluate whether nSOFA is also a useful predictor for in-hospital mortality in neonates (≥36 + 0 weeks of gestation (GA)) following asphyxia with HIE and therapeutic hypothermia (TH), (2) nSOFA was documented at ≤6 h of life. (3) A total of 65 infants fulfilled inclusion criteria for TH. All but one infant received cardiopulmonary resuscitation and/or respiratory support at birth. nSOFA was lower in survivors (median 0 [IQR 0–2]; n = 56, median GA 39 + 3, female n = 28 (50%)) than in non-survivors (median 10 [4–12], p < 0.001; n = 9, median GA 38 + 6, n = 4 (44.4%)). This was also observed for the respiratory (p < 0.001), cardiovascular (p < 0.001), and hematologic sub-scores (p = 0.003). The odds ratio for mortality was 1.6 [95% CI = 1.2–2.1] per one-point increase in nSOFA. The optimal cut-off value of nSOFA to predict mortality was 3.5 (sensitivity 100.0%, specificity 83.9%). (4) Since early accurate prognosis following asphyxia with HIE and TH is essential to guide decision making, nSOFA (≤6 h of life) offers the possibility of identifying infants at risk of mortality.

https://www.mdpi.com/2077-0383/12/13/4322/pdf?version=1687930567

Early Prediction of Mortality after Birth Asphyxia with the nSOFA

Background Respiratory distress syndrome (RDS) is one of the leading causes of neonatal death in the neonatal intensive care unit (NICU). Previous studies have suggested that the development of neonatal RDS may be associated with inflammation and lead to organ dysfunction. The neonatal sequential organ failure assessment (nSOFA) scoring system is an operational definition of organ dysfunction, but whether it can be used to predict mortality in neonates RDS is unknown. The aim of this study was to clarify the performance of the nSOFA score in predicting mortality in patients with neonatal RDS, with the aim of broadening the clinical application of the nSOFA score. Methods Neonates with RDS were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Cox proportional hazards model were used to assess the association between nSOFA score and mortality. Propensity score matched analysis were used to assess the robustness of the analytical results. Results In this study of 1,281 patients with RDS of which 57.2% were male, death occurred in 40 cases (3.1%). Patients with high nSOFA scores had a higher mortality rate of 10.7% compared with low nSOFA scores at 0.3%. After adjusting for confounding, multivariate Cox proportional risk analysis showed that an increase in nSOFA score was significantly associated with increased mortality in patients with RDS [adjusted Hazards Ratio (aHR): 1.48, 95% Confidence Interval (CI): 1.32–1.67; p < 0.001]. Similarly, the High nSOFA group was significantly associated with higher mortality in RDS patients (aHR: 19.35, 95% CI: 4.41–84.95; p < 0.001) compared with the low nSOFA group. Conclusion The nSOFA score was positively associated with the risk of mortality in cases of neonatal RDS in the NICU, where its use may help clinicians to quickly and accurately identify high risk neonates and implement more aggressive intervention.

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Evaluation of the neonatal sequential organ failure assessment and mortality risk in neonates with respiratory distress syndrome: A retrospective cohort study

Background Although inflammation is a known predictor for poor prognosis in patients with diabetics, few data report the synergistic association between inflammation, malnutrition, and mortality in patients with diabetics. We aim to explore whether malnutrition modifies the predictor of inflammation on prognosis. Methods Nutritional status and inflammation were measured in 6,682 patients with diabetics undergoing coronary angiography or percutaneous coronary intervention between January 2007 to December 2018 from Cardiorenal Improvement Registry. Malnutrition was defined as Controlling Nutritional Status (CONUT) score, which was more than 1. High-sensitivity C-reactive protein (hs-CRP) exceeding the median was assessed as a high-risk inflammation. Cox regression models were used to estimate hazard ratios (HR) for mortality across combined hs-CRP and CONUT score categories. Results During a median follow-up of 5.0 years (interquartile range: 3.0–7.6 years), 759 (11.36%) patients died. The mortality of the four groups (normal nutrition and low hs-CRP level; normal nutrition and high hs-CRP level; malnutrition and low hs-CRP level; and malnutrition and high hs-CRP level) were 7.29, 7.12, 10.71, and 17.31%, respectively. Compared with normal nutrition and low hs-CRP level, an isolated condition of either malnutrition or high hs-CRP level was not associated with any significant risk for all-cause mortality. However, concomitant presence of both high hs-CRP level and malnutrition condition was associated with a significantly increased risk of all-cause mortality (HR: 1.51; 95% CI: 1.20–1.89; p < 0.001). The p-value for interaction between nutritional status and hs-CRP level on all-cause mortality was 0.03. Conclusion The interplay of inflammation and malnutrition in patients with diabetics significantly amplifies the deleterious effects of each as distinct disease entities. A prospective randomized clinical trial is needed in the future to verify the results.

A Synergistic Association Between Inflammation, Malnutrition, and Mortality in Patients With Diabetics

Background Malnutrition is associated with poor prognosis in patients with acute myocardial infarction (AMI). However, the prognostic impact of malnutrition in critical patients with AMI has not been well addressed. Methods We analyzed two critical AMI cohorts from Cardiorenal ImprovemeNt (CIN) in China and Medical Information Mark for Intensive Care-III (MIMIC-III) in the United States. The primary outcome was all-cause mortality. Cox proportional hazards models were constructed to examine the risk of malnutrition for mortality in critical patients with AMI. Results There were 2,075 critical patients with AMI (mean age, 62.5 ± 12.3 years, 20.00% were female) from the CIN cohort and 887 critical patients with AMI (mean age, 70.1 ± 12.9 years, 37.43% were female) from MIMIC-III included in this study. Based on the Controlling Nutritional Status (CONUT) score, of the Chinese patients with AMI, the prevalence was 47.5, 28.3, and 3.5% for mild, moderate, and severe malnutrition, respectively. The percentage of mild, moderate, and severe malnutrition was 41.60, 30.55, and 7.32% in the MIMIC-III cohort, respectively. Controlling for confounders, worse nutritional state was significantly associated with increased risk for all-cause mortality [an adjusted hazard ratio for mild, moderate, and severe malnutrition, respectively, 1.10 (95% confidence interval (CI): 0.76–1.59), 1.49 (95% CI: 1.02–2.19), and 1.70 (95% CI: 1.00–2.88) in the CIN cohort and 1.41 (95% CI: 0.95–2.09), 1.97 (95% CI: 1.32–2.95), and 2.70 (95% CI: 1.67–4.37) in the MIMIC-III cohort]. Conclusion Malnutrition was independently associated with an increased risk of all-cause mortality in critical patients with AMI after full adjustments. Further trials are needed to prospectively evaluate the efficacy of nutritional interventions in critical patients with AMI.

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Prevalence and Prognostic Impact of Malnutrition in Critical Patients With Acute Myocardial Infarction: Results From Chinese CIN Cohort and American MIMIC-III Database

Objective Inflammation plays an important role in the pathophysiology of hypertension (HTN). Aggregate index of systemic inflammation (AISI), as a new inflammatory and prognostic marker has emerged recently. Our goal was to determine whether there was a relationship between HTN and AISI. Methods We analyzed patients with HTN from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. The primary end point was cardiovascular mortality. A total of 23,765 participants were divided into four groups according to the AISI quartile level. The association between AISI and cardiovascular mortality in patients with HTN was assessed by survival curves and Cox regression analyses based on NHANES recommended weights. Results High levels of AISI were significantly associated with cardiovascular mortality in patients with HTN. After full adjustment for confounders, there was no significant difference in the risk of cardiovascular mortality in Q2 and Q3 compared to Q1, while Q4 (HR: 1.91, 95% CI: 1.42–2.58; P < 0.001) had a higher risk of cardiovascular mortality compared to Q1. Results remained similar in subgroup analyses stratified by age (P for interaction = 0.568), gender (P for interaction = 0.059), and obesity (P for interaction = 0.289). Conclusions In adults with HTN, elevated AISI levels are significantly associated with an increased risk of cardiovascular mortality and may serve as an early warning parameter for poor prognosis.

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Jiabin Tu

Papers

Evaluation of the neonatal sequential organ failure assessment and mortality risk in neonates with respiratory distress syndrome: A retrospective cohort study

A Synergistic Association Between Inflammation, Malnutrition, and Mortality in Patients With Diabetics

Prevalence and Prognostic Impact of Malnutrition in Critical Patients With Acute Myocardial Infarction: Results From Chinese CIN Cohort and American MIMIC-III Database

The aggregate index of systemic inflammation (AISI): a novel predictor for hypertension

Predictors of mortality in heart failure with reduced ejection fraction: interaction between diabetes mellitus and impaired renal function