Browsing by Subject "hospital mortality"

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    Analysis of the Impact of Early Surgery on In-Hospital Mortality of Native Valve Endocarditis
    (2010-03) Lalani, Tahaniyat; Cabell, Christopher H; Benjamin, Daniel K; Lasca, Ovidiu; Naber, Christoph; Fowler, Vance G; Corey, G Ralph; Chu, Vivian H; Fenely, Michael; Pachirat, Orathai; Tan, Ru-San; Watkin, Richard; Ionac, Adina; Moreno, Asuncion; Mestres, Carlos A; Casabé, José; Chipigina, Natalia; Eisen, Damon P; Spelman, Denis; Delahaye, Francois; Peterson, Gail; Olaison, Lars; Wang, Andrew; International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators
    Background— The impact of early surgery on mortality in patients with native valve endocarditis (NVE) is unresolved. This study sought to evaluate valve surgery compared with medical therapy for NVE and to identify characteristics of patients who are most likely to benefit from early surgery. Methods and Results— Using a prospective, multinational cohort of patients with definite NVE, the effect of early surgery on in-hospital mortality was assessed by propensity-based matching adjustment for survivor bias and by instrumental variable analysis. Patients were stratified by propensity quintile, paravalvular complications, valve perforation, systemic embolization, stroke, Staphylococcus aureus infection, and congestive heart failure. Of the 1552 patients with NVE, 720 (46%) underwent early surgery and 832 (54%) were treated with medical therapy. Compared with medical therapy, early surgery was associated with a significant reduction in mortality in the overall cohort (12.1% [87/720] versus 20.7% [172/832]) and after propensity-based matching and adjustment for survivor bias (absolute risk reduction [ARR] −5.9%, P<0.001). With a combined instrument, the instrumental-variable–adjusted ARR in mortality associated with early surgery was −11.2% (P<0.001). In subgroup analysis, surgery was found to confer a survival benefit compared with medical therapy among patients with a higher propensity for surgery (ARR −10.9% for quintiles 4 and 5, P=0.002) and those with paravalvular complications (ARR −17.3%, P<0.001), systemic embolization (ARR −12.9%, P=0.002), S aureus NVE (ARR −20.1%, P<0.001), and stroke (ARR −13%, P=0.02) but not those with valve perforation or congestive heart failure. Conclusions— Early surgery for NVE is associated with an in-hospital mortality benefit compared with medical therapy alone.
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    Sepsis in sub-Saharan Africa: a prospective observational study of clinical characteristics, management, and outcomes for adolescents and adults with sepsis in northern Tanzania
    (2020) Bonnewell, John

    Background: Sepsis is a leading cause of death and disability globally. Despite a high burden of sepsis in sub-Saharan Africa, clinical data for sepsis in that setting are limited. We sought to describe the clinical characteristics, management, and outcomes in a cohort of adults and adolescents with sepsis in northern Tanzania. We also assessed for associations between clinical factors and in-hospital mortality.

    Methods: We carried out a prospective observational cohort study at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. We collected data on demographics, baseline clinical characteristics, and management, with an emphasis on hours 0-6 after arrival to the Emergency Department. Log risk regression was carried out to assess for associations between demographic and clinical factors and our primary outcome of in-hospital death. Separate multivariable regression analyses were conducted for both antimicrobial administration by hour 6 and administration of intravenous (IV) fluids >1L by hour 6 and the outcome of in-hospital mortality.

    Results: Fifty-eight participants were included in our analysis. Seventeen (29.3%) participants died in-hospital. Baseline characteristics associated with inpatient mortality included inability to drink unassisted, respiratory rate >30 breaths per minute, hypoxia, and altered mentation. Less than half of participants received any antimicrobial by hour 6, and most participants received <1L of IV fluids. HIV antibody testing was performed for only one participant in the first 6 hours. On multivariable analysis, neither antimicrobial administration nor IV fluids >1L by hour 6 was associated with inpatient mortality.

    Conclusion: Sepsis in northern Tanzania carries a high risk of in-hospital mortality. Further research is urgently needed to establish the highest-yield interventions suited to the unique characteristics of sepsis in sSA.