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1.

Background

We have a limited understanding of the biological underpinnings of symptoms in heart failure (HF).

Objectives

The purpose of this paper was to compare relationships between peripheral biomarkers of HF pathogenesis and physical symptoms between patients with advanced versus moderate HF.

Methods

This was a two-stage phenotype sampling cohort study wherein we examined patients with advanced HF undergoing ventricular assist device implantation in the first stage, and then patients with moderate HF (matched adults with HF not requiring device implantation) in the second stage. Linear modeling was used to compare relationships among biomarkers and physical symptoms between cohorts.

Results

Worse myocardial stress, systemic inflammation and endothelial dysfunction were associated with worse physical symptoms in moderate HF (n=48), but less physical symptom burden in advanced HF (n=48).

Conclusions

Where patients are in the HF trajectory needs to be taken into consideration when exploring biological underpinnings of physical HF symptoms.  相似文献   

2.

Background

Little has been reported about protocol-driven outpatient palliative care consultation (OPCC) for advanced heart failure (HF).

Objectives

To describe evaluation practices and treatment recommendations made during protocol-driven OPCCs for advanced HF.

Methods

We performed content analysis of OPCCs completed as part of ENABLE CHF-PC, an early palliative care HF intervention, conducted at sites in the Northeast and Southeast. T-tests, Fisher's exact, and Chi-square tests were used to evaluate sociodemographic, outcome measures, and site content differences.

Results

Of 61 ENABLE CHF-PC participants, 39 (64%) had an OPCC (Northeast, n=27; Southeast, n=12). Social and medical history assessed most were close relationships (n=35, 90%), family support (n=33, 85%), advance directive status (n=33, 85%), functional status (n=30, 77%); and symptoms were mood (n= 35, 90%), breathlessness (n=28, 72%), and chest pain (n=24, 62%). Treatment recommendations focused on care coordination (n=13, 33%) and specialty referrals (n=12, 31%). Between-site OPCC differences included assessment of family support (Northeast vs. Southeast: 100% vs. 50%), code status (96% vs. 58%), goals of care discussions (89% vs. 41.7%), and prognosis understanding (85% vs. 33%).

Conclusion

OPCCs for HF focused on evaluating medical and social history, along with goals of care and code status discussions. Symptom evaluation commonly included mood disorders, pain, dyspnea, and fatigue. Notable regional differences were found in topics evaluated and OPCC completion rates.  相似文献   

3.

Background

Long-term data on outcomes of participants hospitalized with heart failure (HF) from low- and middle-income countries are limited.

Methods and Results

In the Trivandrum Heart Failure Registry (THFR) in 2013, 1205 participants from 18 hospitals in Trivandrum, India, were enrolled. Data were collected on demographics, clinical presentation, treatment, and outcomes. We performed survival analyses, compared groups and evaluated the association between heart failure (HF) type and mortality, adjusting for covariates that predicted mortality in a global HF risk score. The mean (standard deviation) age of participants was 61.2 (13.7) years. Ischemic heart disease was the most common cause (72%). The in-hospital mortality rate was higher for participants with HF with reduced ejection fraction (HFrEF; 9.7%) compared with those with HF with preserved ejection fraction (HFpEF; 4.8%; P?=?.003). After 3 years, 540 (44.8%) participants had died. The all-cause mortality rate was lower for participants with HFpEF (40.8%) compared with HFrEF (46.2%; P?=?.049). In multivariable models, older age (hazard ratio [HR] 1.24 per decade, 95% confidence interval [CI] 1.15-1.33), New York Heart Association functional class IV symptoms (HR 2.80, 95% CI 1.43-5.48), and higher serum creatinine (HR 1.12 per mg/dL, 95% CI 1.04-1.22) were associated with all-cause mortality.

Conclusions

Participants with HF in the THFR have high 3-year all-cause mortality. Targeted hospital-based quality improvement initiatives are needed to improve survival during and after hospitalization for HF.  相似文献   

4.
Background: Low resectability and poor survival outcome are common for hilar cholangiocarcinoma(HCCA), especially in advanced stages. The present study was to assess the clinical outcome of advanced HCCA, focusing on therapeutic modalities, survival analysis and prognostic assessment.Methods: Clinical data of 176 advanced HCCA patients who had been treated in our hospital between January 2013 and December 2015 were analyzed retrospectively. Prognostic effects of clinicopathological factors were explored by univariate and multivariate analysis. Survival predictors were evaluated by the receiver operating characteristic(ROC) curve.Results: The 3-year overall survival rate was 13% for patients with advanced HCCA. Preoperative total bilirubin(P = 0.009), hepatic artery invasion(P = 0.014) and treatment modalities(P = 0.020) were independent prognostic factors on overall survival. A model combining these independent prognostic factors(area under ROC curve: 0.748; 95% CI: 0.678–0.811; sensitivity: 82.3%, specificity: 53.5%) was highly predictive of tumor death. After R0 resection, the 3-year overall survival was up to 38%. Preoperative total bilirubin was still an independent negative factor, but not for hepatic artery invasion.Conclusions: Surgery is still the best treatment for advanced HCCA. Preoperative biliary drainage should be performed in highly-jaundiced patients to improve survival. Prediction of survival is improved significantly by a model that incorporates preoperative total bilirubin, hepatic artery invasion and treatment modalities.  相似文献   

5.

Background

Guyana is a small developing country with a high burden of cardiovascular disease and extensive barriers to optimal care delivery. We investigated the effectiveness of a newly established multidisciplinary inpatient cardiology service in this setting.

Methods

We performed an interrupted time-series cohort study of heart failure (HF) patients admitted to the Georgetown Public Hospital Corporation from January to December 2015 and July 2016 to December 2017. The primary outcome was discharge on guideline-directed medical therapy (GDMT). Secondary outcomes included length of hospitalization and all-cause mortality.

Results

We identified 740 patients, 347 (46.9%) of whom were admitted after service implementation. The postimplementation cohort was more likely to be discharged on a beta-blocker (66.6% vs 41.7%; P < .01) and mineralocorticoid receptor antagonist (31.7% vs 15.3%; P?=?.01). They were also more likely to undergo echocardiography (60.8% vs 40.5%; P < .01) and chest x-rays (70.6% vs 46.6%; P < .01). Hospitalization length (10.0 ± 13.1 vs 9.8 ± 10.1 days) and readmissions within 90 days (19.0% vs 19.1%) were not significantly different. There were fewer deaths in the postimplementation cohort compared with the preimplementation cohort (12/347 vs 28/393).

Conclusions

Establishment of a multidisciplinary inpatient cardiology service demonstrated increased adherence to GDMT without extending length of hospitalization.  相似文献   

6.
Background: Plasmapheresis is a desensitization method used prior to ABO-incompatible(ABO-I) living donor liver transplantation. However, studies on its usefulness in the rituximab era are lacking.Methods: Fifty-six adult patients underwent ABO-I living donor liver transplantation between January2012 and October 2015. A single dose of rituximab(300 mg/m~2) was administered 2 weeks before surgery with plasmapheresis in all patients until February 2014(RP group, n = 26). Patients were administered rituximab only, without plasmapheresis between March 2014 and October 2015(RO group, n = 30).Results: The 6-, 12-and 18-month overall survival rates were 92.3%, 80.8% and 76.9% in the RP group and 96.6%, 85.4% and 85.4% in the RO group, respectively(P = 0.574). When the initial isoagglutinin titers 16, neither group showed a rebound rise of isoagglutinin titers. For patients with initial isoagglutinin titers ≥ 16, the rebound rise of isoagglutinin titers was more prominent in the RP group. There was no difference in time-dependent changes in B cell subpopulations and ABO-I-related complications.Conclusions: Sufficient desensitization for ABO-I living donor liver transplantation can be achieved using rituximab alone. This desensitization strategy does not affect the isoagglutinin titers, ABO-I-related complications and patient survival.  相似文献   

7.

Background

The impact of frailty on long-term prognosis in patients with heart failure (HF) remains unclear, and there is no simple and objective assessment for it. This study was performed to examine the association between frailty score and clinical outcome in elderly patients hospitalized for HF.

Methods and Results

A retrospective cohort study was performed with 603 elderly patients with HF (mean age 75 ± 6 years, 378 [62.7%] men). Frailty was measured by a composite of 4 markers combined into a frailty score (possible range 0–12): gait speed, handgrip strength, serum albumin, and activities of daily living status. The patient population was divided into 2 groups with frailty score <5 (non-frail) or ≥5 (frail). The end point was all-cause mortality. Over a mean follow-up period of 1.7 ± 0.5 years, 89 patients died. After adjustment for several preexisting factors associated with prognosis, the frailty score (hazard ratio [HR] 1.11; P?=?.014) and frailty (HR 1.75; P?=?.036) were independently associated with all-cause mortality. The inclusion of frailty score significantly increased both continuous net reclassification improvement (0.341; P?=?.002) and integrated discrimination improvement (0.016; P?=?.039) for all-cause mortality.

Conclusions

A simple and objective frailty score was associated with health outcome in elderly patients hospitalized for HF.  相似文献   

8.

Introduction

Practice guidelines recommend that patients with peripheral artery disease receive antiplatelets, statins, and angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). We sought to quantify the rates of prescribing these therapies in patients with peripheral artery disease in the literature.

Methods

We performed a systematic review and meta-analysis of treatment prescribing rates in observational studies containing peripheral artery disease patients published on or after the year 2000. We also assessed whether prescribing rates are increasing over time.

Results

A total of 86 studies were available for analysis. The aggregate sample size across all studies was 332,555. The pooled estimates for utilization of antiplatelets, statins, and ACE inhibitors or ARBs were 75% (95% confidence interval [CI], 71%-79%), 56% (95% CI, 52%-60%), and 53% (95% CI, 49%-58%), respectively. Statin use was directly related to publication year (+2.0% per year, P < .001), but this was not the case for antiplatelets (P?=?.68) or ACE inhibitors or ARBs (P?=?.066).

Conclusions

Although some improvement in statin prescribing has occurred in recent years, major practice gaps exist in the treatment of peripheral artery disease. Effective measures to close these gaps should be implemented.  相似文献   

9.

Background

Differences in outcomes have previously been reported between urban and rural settings across a multitude of chronic diseases. Whether these discrepancies have changed over time, and how sex may influence these findings is unknown for patients with ambulatory heart failure (HF). We examined the temporal incidence and mortality trends by geography in these patients.

Methods and Results

We conducted a retrospective cohort study of 36,175 eastern Ontario residents who were diagnosed with HF in an outpatient setting from 1994 to 2013. The primary outcome was 1-year mortality. We examined temporal changes in mortality risk factors with the use of multivariable Cox proportional hazard models. The incidence of HF decreased in women and men across both rural and urban settings. Age-standardized mortality rates also decreased over time in both sexes but remained greater in rural men compared with rural women.

Conclusions

The incidence of HF in the ambulatory setting was greater for men than women and greater in rural than urban areas, but mortality rates remained higher in rural men compared with rural women. Further research should focus on ways to reduce this gap in the outcomes of men and women with HF.  相似文献   

10.

Background

Calculated estimates of plasma volume (PV) have been developed with the use of hemoglobin/hematocrit-body weight–based methods. The accuracy of such formula-derived values has not been thoroughly evaluated. The objective of this analysis was to compare the calculated estimate and a quantitative measure of PV in patients with chronic heart failure (HF).

Methods and Results

PV was measured with the use of a standardized computer-based indicator-dilution–labeled albumin technique in 110 patients with clinically stable chronic HF and correlated with paired Kaplan-Hakim (K-H) and Strauss formula estimates of PV. The K-H formula underestimated (3.4 ± 0.7 L) and the Strauss formula overestimated (5.3 ± 1.5 L) PV relative to the measured volume (4.3 ± 1.1 L). Calculated PV was only moderately correlated with measured PV by the K-H formula (r?=?0.64; P < .001) and weakly by the Strauss formula (r?=?0.285; P?=?.003). Strauss formula estimates of change (%) in PV were also poorly correlated with paired measured changes in PV (r?=?0.162; P?=?.999; n?=?40).

Conclusions

Calculated estimates of PV demonstrate limited association with measured volumes. These findings indicate that although formula-based estimates of PV have been shown to have prognostic value, they are limited in their reliability for volume management in patients with chronic HF.  相似文献   

11.
Background: Early detection of small solid pancreatic lesions is increasingly common. To date, few and contradictory data have been published about the relationship between lesion size and endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) diagnostic yield. The aim of this study was to assess the relation between the size of solid pancreatic lesions and the diagnostic yield of EUS-FNA using a 25-gauge needle in a center without available rapid on-site evaluation.Methods: In the retrospective cohort study, we selected patients who underwent EUS-FNA for solid pancreatic lesions with a 25-gauge needle from October 2014 to October 2015. Patients were divided into three groups(≤15 mm, 16–25 mm and 25 mm), and the outcomes were compared.Results: We analyzed 163 patients. Overall adequacy, sensitivity, specificity and accuracy were 85.2%,81.8%, 93.7%, and 80.4%, respectively. When stratified by size, the sensitivity and accuracy correlated with size(P = 0.016 and P = 0.042, respectively). Multivariate analysis showed that lesion size was the only independent factor(P = 0.019, OR = 4.76) affecting accuracy. The role of size as an independent factor affecting accuracy was confirmed in a separate multivariate analysis, where size was included in the model as a covariate(P = 0.018, OR = 1.08).Conclusion: Our study demonstrates that, in the absence of rapid on-site evaluation, mass size affects the accuracy of EUS-FNA of solid pancreatic lesions.  相似文献   

12.

Background

We lack recent data on the incidence, correlates, and prognosis associated with heart failure (HF) development in patients with stable coronary artery disease (CAD). Here, we analyzed HF development in a contemporary population of outpatients with stable CAD.

Methods and Results

Of 4184 unselected outpatients with stable CAD (ie, myocardial infarction [MI] and/or coronary revascularization >1 year earlier) included in the multicenter CORONOR registry, we identified 3871 patients with no history of hospitalization for HF at inclusion and followed 3785 (98%) of them for 5 years. During follow-up, 211 patients were hospitalized for HF (5-year cumulative incidence 5.7%) and 163 patients had incident MIs. Independent predictors of hospitalization for HF were older age, lower left ventricular ejection fraction (LVEF), atrial fibrillation, higher body mass index, diabetes mellitus, history of hypertension, angina at inclusion, and multivessel CAD. Most hospitalizations for HF (62.6%) occurred in patients with LVEF ≥50% at inclusion, and most (92.4%) were not preceded by an incident MI. Hospitalization for HF was a powerful predictor of mortality (adjusted hazard ratio 5.97, 95% confidence interval 4.55–7.83; P < .0001). After hospitalization for HF, mortality rates were similar in patients with LVEFs ≥50% and <50% at hospitalization.

Conclusions

Outpatients with stable CAD were frequently hospitalized for HF, and HF was associated with high mortality. Most HF hospitalizations were associated with preserved LVEF at inclusion and were not preceded by an incident MI.  相似文献   

13.

Background:

We studied the relationship between resting heart rate (HR), chronotropic response to exercise, and clinical outcomes in patients with heart failure (HF) across the spectrum of left ventricle ejection fraction (LVEF).

Methods and Results:

Resting HR and chronotropic index (CIx) were assessed in 718 patients with HF (53 ± 14 years of age, 66% male) referred for exercise testing. Associations with the composite outcome of left ventricular assist device implantation, transplantation, or death (151 events, 4.4 [range 3.0–5.8] years of follow-up) were assessed with the use of Cox models adjusted for age, sex, HF etiology, diabetes, LVEF, beta-blocker use, device therapy, estimated glomerular filtration rate, and peak oxygen uptake. Resting HR was 73 ± 15 beats/min, CIx was 0.60 ± 0.26, LVEF was 34% ± 15%, and 39% had an LVEF ≥40%. Resting HR correlated poorly with CIx (r?=?0.08; P?=?.04) and did not predict (P?=?.84) chronotropic incompetence (CIx <0.60). Both higher resting HR (per 5 beats/min increase: adjusted hazard ratio [HR] ?1.05, 95% confidence interval [CI] 1.00–1.11) and CIx (per SD change: adjusted HR ?0.77, 95% CI 0.62–0.94) were independent prognostic markers. No heterogeneity of effect was noted based on LVEF (P >.05).

Conclusion:

Higher resting HR and lower CIx are both associated with more severe HF, but correlated poorly with each other. They provide independent and additive prognostic information in HF across the LVEF spectrum.  相似文献   

14.

Background

The high prevalence of heart failure (HF) in developed countries imposes a substantial burden on health care resources. Depression is widely recognized as a risk factor associated with HF. This study examined the relationship between suicide and HF after controlling for depression and other comorbidities.

Methods and Results

The population comprised 52,749 adult patients who died from suicide from 2000 to 2012 and 210,996 living control subjects matched by age, sex, and residence area. Data were obtained from the Health and Welfare Data Science Center, Taiwan. Multivariable models were constructed to evaluate the relationship between HF and suicide. In the case and control groups 1624 (3.08%) and 4053 (1.92%) patients had HF, respectively, indicating that HF was associated with an increased risk of suicide (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.59–1.79). The risk of suicide was highest during the initial 6 months after HF (adjusted OR 7.04, 95% CI 5.37–9.22) and subsequently declined gradually. Among psychiatric disorders, mood disorders (adjusted OR 7.42, 95% CI 7.06–7.79) yielded the highest odds of suicide.

Conclusions

The risk of suicide is higher for patients with HF than for healthy individuals without HF. This risk is particularly high during the first 6 months after HF diagnosis. This study provides strong evidence that depression is a negative prognostic factor for patients with HF and increases the risk of suicide. The results suggest that early screening and treatment for depression and suicide risk should be conducted for patients with HF.  相似文献   

15.

Background

Transfemoral percutaneous coronary intervention (PCI) requires strict bed rest, causing pain and discomfort in patients. However, no studies have investigated this issue.

Objectives

To investigate the predictors of discomfort in transfemoral PCI patients.

Methods

A cross-sectional sample of 110 patients from two coronary care units completed questionnaires on demographic and clinical characteristics, visual analogue pain scale, and discomfort.

Results

Eight factors predicted overall discomfort: physiologic pain, physiological discomfort, psychological discomfort, analgesic use after sheath removal, hemostasis method, and bed rest duration. Psychological discomfort was associated with age, chronic obstructive pulmonary disease, analgesic use after sheath removal, successful hemostasis, and hematoma >5 cm. A hierarchical regression model explained 70.5% of the variance in overall discomfort.

Conclusions

Age and physiologic pain are major predictors of overall discomfort, especially in patients aged <60 years having high pain sensitivity. Critical care providers should note patients’ physiological and psychological issues throughout the PCI process.  相似文献   

16.
Background: Immunotherapy has shown promise against solid tumors. However, the clinical significance of programmed cell death 1(PD-1) and programmed cell death ligand 1(PD-L1) in pancreatic ductal adenocarcinoma(PDAC) remains unclear. This meta-analysis aimed to analyze the prognostic effect of PD-L1 in PDAC.Data sources: Electronic search of the Pub Med, Cochrane Library and Web of Science was performed until December 2016. Through database searches, we identified articles describing the relationship between PD-L1 status and PDAC patient prognosis. Meta-analysis was performed to investigate the relationship between PD-1 and overall survival(OS).Results: Nine studies with 989 PDAC patients were included for PD-L1 expression analysis. And 5 studies with 688 PDAC patients were included in the prognostic analysis. The PD-L1 positive rate measured by immunohistochemistry(IHC) was higher than that measured by polymerase chain reaction(PCR)(P 0.001). PDAC patients with high expression levels of PD-L1 had significantly reduced OS(HR = 2.34;95% CI: 1.78–3.08). Subgroup analysis showed that the prognostic effect of PD-L1 levels was similar between the IHC and PCR methods. The PD-L1 positive rate was associated with PDAC T stages; the PD-L1 positive rate in the T3–4 group was higher than that in the T1-2 group(OR = 0.37; P = 0.001).Conclusions: High PD-L1 expression levels predicted a poor prognosis in PDAC patients. Thus, PD-L1 status helps determine treatment in PDAC patients.  相似文献   

17.

Background

Circulating cardiac troponin levels (cTn), representative of myocardial injury, are commonly elevated in heart failure (HF) and related to adverse clinical events. However, whether cTn represents a spectrum of risk in HF is unclear.

Methods

Baseline, 48–72-hour, and 30-day plasma cTnI was measured with the use of a new highly sensitive assay in 900 subjects with acute decompensated HF (ADHF) in ASCEND-HF. Multivariable models determined the relationship between cTnI and outcomes.

Results

The median (interquartile range) cTnI was 16.4 (9.3–31.6) ng/L at baseline, 14.1 (7.8–29.7) ng/L at 48–72 hours, and 11.6 (6.8–22.5) ng/L at 30 days. After additional adjustment for N-terminal pro–B-type natriuretic peptide (NT-proBNP) to established risk predictors, both baseline (odds ratio [OR] 1.25; P?=?.03) and 48–72-hour (OR 1.43; P?=?.001) cTnI were associated with higher risk for death or worsening HF before discharge. However, only cTnI at 30 days was associated with 180-day death (hazard ratio 1.25; P?=?.007). There were no curvilinear associations between changing cTnI and clinical outcomes.

Conclusions

Circulating cTnI level was associated with clinical outcomes in ADHF, but these observations diminished with additional adjustment for NT-proBNP. Although they likely represent a spectrum of risk in ADHF, these findings question the implications of changing cTnI levels during treatment.  相似文献   

18.
Background: Major morbidity in pancreatic surgery remains high. Different scores for predicting complications have been described. Preoperative pancreatic resection(PREPARE) score is based on objective preoperative variables and offers good predictive accuracy for Clavien ≥ III complications. This study aimed to validate this score and analyze other preoperative variables in a prospective study performed in a medium-volume center. Methods: A total of 50 pancreatic resections were included. Preoperative variables were registered and PREPARE was calculated. The main outcome was severe morbidity(Clavien ≥ III) up to 30 days after discharge. The secondary outcomes were length of stay(LOS) and readmission. Statistical validation was performed to compare severe morbidity rate among the scores categories. Association with other preoperative variables(not included in PREPARE) was also tested. Results: Of the 50 pancreatic resections, the severe morbidity was 34.0%, with median LOS of 11 days. Readmission rate was 25.5%. Severe morbidity rates according to PREPARE categories were 18.5% in lowrisk group, 41.7% in intermediate-risk group, and 63.6% in high-risk group, respectively( P = 0.023). The accuracy was 72%(Hosmer–Lemeshow, P = 0.86). ROC curve was obtained both for PREPARE score expressed as incremental values and categorized as the three risk groups, showing an area under curve(AUC) of 0.736(95% CI: 0.586–0.887; P = 0.007) and 0.712(95% CI: 0.555–0.869; P = 0.015), respectively. PREPARE was significant in multivariate analysis. Median LOS was statistically higher as PREPARE category increases(9, 11 and 15 days in low-, intermediate-and high-risk groups, respectively; P = 0.009). Readmission was not associated with any variables. Conclusions: PREPARE behaves as an independent risk factor for severe morbidity after pancreatic surgery. Score validation shows good accuracy prediction. Increasing PREPARE category is also associated with longer LOS.  相似文献   

19.

Background

The Systolic Blood Pressure Intervention Trial (SPRINT) was a randomized controlled trial that studied 9361 adults ≥50 years of age with systolic blood pressure >130 mm Hg and ≥1 cardiovascular risk factors. Patients were randomized to intensive (≤120 mm Hg) or standard (≤140 mm Hg) systolic targets. In August 2016, a limited dataset was released for secondary analysis. We hypothesized that excessive lowering of diastolic blood pressure could cause harm. Using the data from SPRINT, we sought to determine whether the development of diastolic hypotension during treatment was associated with adverse outcomes.

Methods

We included 8046 patients from SPRINT with a baseline diastolic blood pressure ≥65 mm Hg at study enrollment (4041 intensive target; 4005 standard target). Using Cox proportional hazards models, we evaluated the association between the development of diastolic hypotension (defined as ≤55 mm Hg and modeled as a time-dependent covariate) and the combined outcome of cardiovascular morbidity (myocardial infarction, other acute coronary syndromes, stroke, heart failure) and all-cause death.

Results

In multivariable analyses, patients who developed diastolic hypotension had an increased risk for our primary outcome (hazard ratio [HR] 1.67; 95% confidence interval [CI] 1.24-2.26). This was true in both the intensive (HR 1.53; 95% CI, 1.04-2.26) and standard (HR 2.23; 95% CI, 1.40-3.54; P for interaction?=?.09) treatment arms.

Conclusions

We found an association between diastolic hypotension and the combined endpoint of cardiovascular events and all-cause mortality among SPRINT participants with normal to high diastolic blood pressure at entry. Attention to diastolic blood pressure may be important for optimizing outcomes when targeting systolic blood pressure reduction.  相似文献   

20.
Background: The reported mortality rate of mushroom-induced acute liver failure with conventional treatment is 1.4%–16.9%. Emergency liver transplantation may be indicated and can be the only curative treatment option. This study aimed to assess the prognostic value of criteria for emergency liver transplantation in predicting 28-day mortality in patients with mushroom-induced acute liver injury.Methods: A retrospective cohort study was performed between January 2005 and December 2015. All adult patients aged≥18 years admitted with mushroom intoxication at our emergency department were evaluated. All patients with acute liver injury, defined as elevation of serum liver enzymes(5 times the upper limit of normal, ULN) or moderate coagulopathy(INR 2.0) were included. The ability of the King's College, Ganzert's, and Escudié's criteria to predict 28-day mortality was evaluated.Results: Of the 23 patients with acute liver injury following mushroom intoxication, 10(43.5%) developed acute liver failure and subsequently died. The mean time interval from ingestion to death was 11.3 ± 6.6 days. Eight patients fulfilled Ganzert's criteria, while 10 patients fulfilled the King's College and Escudié's criteria for emergency liver transplantation. King's College and Escudié's criteria had 100% accuracy in predicting 28-day mortality; however, Escudié's criteria were able to identify fatal cases earlier.Conclusions: Escudié's criteria demonstrated the best performance with 100% accuracy and the ability to promptly identify fatal cases of mushroom-induced acute liver failure.  相似文献   

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