bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decreased levels of plasmacytoid dendritic cells predict survival in critically ill patients
Authors: Steinacher E , Lenz M , Krychtiuk K A , Hengstenberg C , Huber K , Wojta J , Heinz G , Niessner A , Speidl W S , Koller L 
Published: November 2023

Abstract

Background
Critically ill patients admitted to intensive care units (ICUs) exhibit high mortality rates and suffer from a broad variety of life-threatening conditions. Irrespective of the initial cause of hospitalization, many of them experience systemic immune dysregulation accompanied by strong inflammatory activation and subsequent anti-inflammatory response resulting in immune paralysis. Dendritic cells (DCs) are the most potent antigen-presenting cells and play a pivotal role in regulating the immune response by linking the innate to the adaptive immune system. Previous studies already highlighted their prognostic value in sepsis and infectious diseases.

Purpose
DCs may be useful as a biomarker in intensive care medicine. Thus, the aim of this study was to analyse whether DCs or their respective subsets are associated with 30-day mortality in a cohort of unselected patients admitted to a medical ICU with cardiovascular focus.

Methods
231 patients admitted to a tertiary care medical ICU were consecutively included in this single-centre prospective observational study. Patient characteristics and vital parameters were assessed within 24 hours following ICU admission and 72 hours thereafter. Additionally, blood was drawn at both time points. Subsequently, flow cytometry was utilized for the analysis of DCs and their respective subsets. Patients were prospectively followed up for 30 days or until the primary study endpoint, defined as mortality, was reached.

Results
In the study cohort, low percentages of total DCs were significantly associated with sepsis, respiratory failure, and the presence of shock. Percentages of plasmacytoid dendritic cells (pDCs) were inversely correlated with routinely assessed markers of inflammation, organ dysfunction and hemodynamic derangement.
In particular, pDCs at admission showed the most robust association with survival in univariate analysis with a hazard ratio (HR) of 6.5 (95% confidence interval [CI]: 2.5 – 17.2, p &lt; 0.001) comparing the first to the third tertile. In multivariate analysis, pDCs remained a strong and independent predictor of 30-day mortality after adjustment for demographic and clinical variables with an adjusted HR of 4.20 (1.3 - 13.3, p = 0.015). Corresponding Kaplan-Meier curves showing survival according to tertiles of pDCs at day 0 are displayed in figure 2 (log-rank test: p &lt; 0.001).

Conclusion
We observed low percentages of DCs in patients admitted to an ICU suffering from sepsis, respiratory failure, and cardiogenic shock, which potentially contributes to the excessive immune response in critically ill patients. In our cohort, pDCs were identified as the most robust subset to predict 30-day mortality.Figure 1Figure 2
Impact on mortality of a cardiogenic shock programme in a non-transplant hospital
Authors: Pascual J , Aboal J , Loma-Osorio P , Nunez M , Badosa E , Martin C , Ferrero M , Moral S , Ballesteros E , Pedraza J , Brugada R 
Published: November 2023

Abstract

Introduction
Cardiogenic shock is associated with high in-hospital morbidity and mortality. Every hospital should take all possible measures to reduce it.

Methods
Quasi-experimental study in patients with cardiogenic shock comparing two periods: A period of a cardiogenic shock programme including the establishment of a multidisciplinary team (shock team), early alert to the transplant hospital, initiation of a VA ECMO programme and extension of continuous care by acute cardiovascular care specialist, and a previous period without the mentioned measures. The primary objective was whether there were differences in in-hospital mortality and mortality at follow-up. Predictors of in-hospital mortality were examined as a secondary objective.

Results
A total of 139 patients were enrolled, including 69 in the previous period and 70 in the cardiogenic shock programme period. There was a significant reduction in-hospital mortality (55.1% vs. 37.1%, p=0-03) and in the follow-up (62.7% vs. 44.6%, p=0.03) in the second period. Diabetes mellitus, ejection fraction, out-of-hospital cardiac arrest and implementation of the cardiogenic shock programme were independent predictors of in-hospital mortality.

Conclusions
Implementing a comprehensive cardiogenic shock programme in a non-transplanting hospital improved in-hospital and follow-up mortality of patients in cardiogenic shock.
Full percutaneous angio-guided ECLS implantation reduces major vascular complications as compared to surgical implantation
Authors: Asslo G , Truong T , Gall E , Boukantar M , Folliguet T , Teiger E , Gallet R 
Published: November 2023

Abstract

Background
Veno-arterial extracardiac life support (VA-ECLS) has become the current practice for managing severe refractory cardiogenic shock and cardiac arrest. Both surgical and percutaneous approaches can be used for VA-ECLS implantation, with the latter seeming to be associated with fewer complications. A full percutaneous approach using pre-closing enables percutaneous implantation but also explantation and may further decrease vascular complication. We aimed to address the incidence of vascular complications and 30-day mortality using full percutaneous ECLS implantation as compared to surgical implantation.

Methods
We included all patients who received VA-ECLS in a single center between January 2017 and December 2022. All patients had VA-ECLS implantation for severe cardiogenic shock or cardiac arrest, and post-operative patients were excluded. We compared 30-day survival and major vascular complications incidence (major bleeding, groin infection, limb ischemia) between the percutaneous and surgical groups.

Results
A total of 221 patients (mean of 53 years old, 71% men) received VA-ECLS, 115 using full percutaneous approach and 106 using surgical approach. ECLS was implanted in the setting of eCPR in 83 patients (37.7%). Baseline characteristics and clinical severity were comparable between the two groups. In the angio-guided group, there were significantly fewer major bleeding events (7% versus 27%, p&lt;0.01) and groin infection (3.5% versus 12%, p=0.018) compared with the surgical group, but no difference in the incidence of limb ischemia (8.8% versus 10.1%, p=0.74) was observed. Thirty day mortality tended to be lower in the percutaneous group (69.6%) than in the surgical group (79.2%), but this difference did not reach statistical significance (p=0.076). Predictive factors of mortality at 30 days were BMI, SOFA score at implantation, age, and refractory arrest.

Conclusion
Full percutaneous ECLS implantation dramatically reduces major vascular complications as compared to surgical implantation. Larger studies are needed to determine if this benefit may increase survival.
Real world impact of added FFR-CT to coronary CT angiography on clinical decision-making and patient prognosis
Authors: Becker L , Peper J , Verhappen B , Swart L A , Dedic A , Van Dockum W G , Van Der Ent M , Royaards C J , Niezen A , Hensen J H , Van Kuijk J P , Mohamed Hoesein F A A , Leiner T , Bruning T A , Swaans M J 
Published: November 2023

Abstract

Objectives
The addition of CT-derived fractional flow reserve (FFR-CT) increases the diagnostic accuracy of Coronary CT Angiography (CCTA). We assessed the impact of FFR-CT in routine clinical practice on clinical decision-making and patient prognosis in patients suspected of stable coronary artery disease (CAD).

Methods
This retrospective, single-center study compared a cohort that received CCTA with FFR-CT to a historical cohort that received CCTA before FFR-CT was available. We assessed the clinical management decisions after FFR-CT and CCTA and the rate of major adverse cardiac events (MACE) during the one-year follow-up using chi-square tests for independence. Kaplan-Meier curves were used to visualize the occurrence of safety outcomes over time.

Results
360 patients at low to intermediate risk of CAD were included, 224 in the CCTA only group and 136 in the FFR-CT group. During follow-up, 13 MACE occurred in 12 patients, 9 (4.0%) in the CCTA-group and three (2.2%) in the FFR-CT group. Clinical management decisions differed significantly between both groups. After CCTA, 60 patients (26.5%) received optimal medical therapy (OMT) only, 115 (51.3%) invasive coronary angiography (ICA) and 49 (21.9%) single positron emission CT (SPECT). After FFR-CT, 106 patients (77.9%) received OMT only, 27 (19.9%) ICA and three (2.2%) SPECT (p&lt;0.001 for all three options). The revascularization rate after ICA was similar between groups (p=0.15). However, patients in the CCTA-group more often underwent revascularization (p=0.007).

Conclusion
Addition of FFR-CT to CCTA led to a reduction in (invasive) diagnostic testing and less revascularizations without observed difference in outcomes after one year.Clinical decisions and follow upSignificant LAD lesion, negative FFRCT
Survival disparities for in-hospital cardiac arrests occurring during nights and weekends
Authors: Yonis H , Dillon J W , Qvortrup M , Svenstrup Moeller D , Meaidi A , Torp-Pedersen C , Kragholm K 
Published: November 2023

Abstract

Background
In-hospital cardiac arrest is a life-threatening event, often leading to poor outcomes and high mortality rates. There is limited research investigating how the time and day of arrest might impact long-term outcomes, such as mortality and functional status.

Purpose
To investigate the relationship between time and day of arrest and long-term outcomes in patients who experience in-hospital cardiac arrest.

Methods
This study included all patients who experienced an in-hospital cardiac arrest between January 1st, 2013 and December 31st, 2019, and who had a clinical indication for resuscitation. Data was obtained from the Danish in-hospital cardiac arrest registry, which was linked to other national registries to gather information on patient characteristics, such as survival, anoxic brain damage, and nursing home admission.
The patients were stratified into three groups (A-C) based on time and day of the week: Group A included patients who were resuscitated during regular working hours (Monday to Friday from 08:00 to 15:59), Group B included patients who were resuscitated during off-hours (Monday to Sunday from 16:00 to 23:59 and Saturday to Sunday from 08:00 to 15:59), and Group C included patients who were resuscitated during off-hours at night (Monday to Sunday from 00:00 to 07:59).
Standardized average probability of outcomes was estimated using logistic regression.

Results
The study population consisted of 9,225 patients, median age was 74 (1st-3rd quartile [Q1-Q3] 65-81 years) and 63.3% were men. In total, 53.6% (n = 4,909) of the patients achieved return of spontaneous circulation (ROSC). The standardized absolute chance of 30-day survival was 32.7% (95% CI 30.9%-34.5%) for group A, 27.2% (95% CI 25.7%-28.7%) for group B, and 23.6% (95% CI 22.0%-25.3%) for group C. Similarly, the chance of 1-year survival was highest for group A (27.6%; 95% CI 25.9%-29.3%) gradually decreasing to 18.9% (95% CI 17.4%-20.4%) in group C (Fig. 1).
For patients who survived at least 30 days following an in-hospital cardiac arrest, the standardized absolute chance of surviving without anoxic brain damage or admission to a nursing home within one year was greatest among those in group A (81.1%; 95% CI 78.3%-83.8%), but decreased to 75.1% (95% CI 72.2%-78.1%) for those in group B, and 72.2% (95% CI 68.3%-76.1%) for those in group C (Fig. 1D).

Conclusion
In conclusion, this study found that patients who experience in-hospital cardiac arrest during off-hours at night have significantly lower chances of survival at both 30 days and 1 year compared to those experiencing an arrest during on-hours or off-hours. Additionally, among patients who survive the initial 30 days, those resuscitated during off-hours at night have the poorest outcomes, with lower chances of 1-year survival without anoxic brain damage or nursing home admission.Figure 1
Meta-analysis depicting the outcomes of hypothermia versus normothermia post cardiac arrest
Authors: Duhan S , Keisham B , Singh S , Taha A , Sandhyavenu H , Rout A 
Published: November 2023

Abstract

Background
The current American Heart Association (AHA) 2020 guidelines recommend targeted temperature monitoring (TTM) for cardiac arrest patients. However, more recently published trials intrigued us to review the therapeutic benefit of TTM.

Objective
To assess the usefulness of recommended TTM temperature (&lt; 36° C), we performed this updated meta-analysis of randomized controlled trials (RCTs), including the latest Targeted Hypothermia Versus Targeted Normothermia After Out-of-hospital Cardiac Arrest-2 (TTM2) trial and trial conducted by Wolfrum S., comparing neurological and mortality outcomes in targeted hypothermia (TH) (&lt; 36° C) with normothermia group (&gt; 36° C).

Methods
We searched Cochrane, MEDLINE, and EMBASE from inception to December 2022. Only trials with patients randomized for TTM and reported neurological and mortality outcomes were included. Non-randomized design, retrospective cohorts, and non-English abstracts were excluded. The data was extracted using full text for all RCTs except two where abstract and previous meta-analysis was used. Statistical analysis was performed using Cochrane Review Manager using the random effects model and calculated pooled risk ratios of outcomes using the Mantel-Haenszel method.

Results
A total of 12 RCTs and 4,262 patients were included in the review (Table 1). Almost 80% weight was carried by four trials (Lascarrou JB, Dankiewicz J, Nielsen N, and Wolfrum S). The neurological outcomes were mainly measured using the cerebral performance category (CPC) scoring in the RCTs. Patients had significantly improved neurological outcomes [Risk Ratio (RR) 0.90, 95% Confidence Interval (CI): 0.83, 0.98, p = 0.02, I² = 61%] in the TH group (Figure 1). However, no significant difference in mortality was observed [RR 0.97, 95% CI: 0.90, 1.06, p = 0.55, I² = 38%]. In patients with an initial shockable rhythm, no significant difference in the neurological [RR 0.82 (95% CI: 0.67, 1.00), p = 0.05, I² = 82] and mortality outcomes [RR 0.82, 95% CI: 0.57,1.18, p=0.29, I²=94%] was seen between the two groups.

Conclusion
Our meta-analysis indicates a therapeutic benefit in neurological outcomes of patients undergoing TH post-cardiac arrest. Our findings align with the current AHA guidelines and demonstrate the utility of TH irrespective of the initial rhythm.Table 1Figure 1
CT FFR in stable heart disease and Coronary Computed Tomographic Angiography helps improve patient care and societal costs
Authors: Fairbairn T 
Published: November 2023

Abstract

Background
NHS England (NHSE) has advocated Coronary Computed Tomographic Angiography (CCTA) as the first line diagnostic test for suspected symptomatic coronary artery disease (CAD) since NICE Guidance in 2016 and CT Fractional Flow Reserve (CT FFR) as a second line test since 2017. In 2018 a national health technology programme funded CT FFR utilisation with the aim of improving patient pathways and reducing costs.

Purpose
To determine whether the introduction of a new technology (CT FFR) into the national health system improved patient care.

Methods
A multi-centre, observational analytic cohort study of all patients that underwent CCTA at 25 NHSE sites for the assessment of CAD over a 3-year period (April 2017- March 2020). Sites and patients were categorised as pre or post CT FFR health technology introduction. Clinical outcomes (all-cause death, myocardial infarction, cardiovascular death, revascularization) and resource utilization (downstream cardiac tests) were assessed at 2 years from NHS digital health records.

Results
90,573 patients (Age 58.1±13.2, 51.9% male, 48.1% female), received 96,353 CCTA and 8,831 CT FFR as a second line test. Clinical characteristics were well matched between the 2 study groups (Figure 1).
Results are presented as pre-CT FFR vs post-CT FFR with Odds Ratio (95% CI) for Post-CT FFR.
No difference was observed for all-cause mortality (n=1135 (3.2%) vs 1627 (3.0%); OR 0.93 (0.86, 1.01), p=0.07) or Myocardial infarction events (n=348 (1.0%) vs 597 (1.1%); OR 1.12 (0.98, 1.28), p=0.10). Cardiovascular mortality was lower in the post CT FFR population (n=466 (1.3%) vs 628 (1.1%); OR 0.88 (0.78, 0.99), p=0.03) with higher rates of percutaneous intervention (PCI) (n=1866 (5.2%) vs 3069 (5.6%); OR 1.07 (1.01, 1.14), p=0.02 but not CABG (n=669 (1.9%) vs 993 (1.8%); OR 0.97 (0.87, 1.07), p=0.48). Figure 2. Fewer cardiac downstream tests were performed post CT-FFR (n=6356 (17.8%) vs 8073 (14.7%), p&lt;0.001) including fewer invasive coronary angiograms (ICA) (n=4128 (11.6%) vs 5437 (9.9%); OR 0.84 (0.81, 0.88), p&lt;0.001).

Conclusion
The introduction of CT FFR as a new technology on a national scale as part of a health intervention programme resulted in fewer cardiac downstream tests including fewer ICA. There was an associated increase in PCI but not CABG rates. All-cause mortality rates did not differ over time but CV mortality was significantly lower in the post-CT FFR population at 2 years.
Neurofilament Light Chain levels during admission after out-of-hospital cardiac arrest is associated with cognitive performance at 3-months follow-up
Authors: Abdi Isse Y , Wiberg S , Grand J , Obling L , Frikke-Schmidt R , Kjaergaard J , Hassager C , Meyer M A S 
Published: November 2023

Abstract

Background
Patients who are resuscitated from out-of-hospital cardiac arrest (OHCA) and hospitalized in coma are at high risk of mortality or brain injury with consequent cognitive impairment, and new therapy are wanted. Biomarkers of brain injury, including Neuron-specific enolase (NSE) and Neurofilament light chain (NfL), predict mortality from cerebral injury. However, prognostication of cognitive dysfunction after discharge in OHCA survivors is challenging. Montreal Cognitive Assessment (MoCA) is a recommended standardized cognitive function testing which is used in the months following OHCA. Nevertheless, prognostic methods assessed in the initial phase of admittance which identify patients at risk of developing cognitive impairment are needed.

Purpose
To investigate the effect of tocilizumab administered at admission after OHCA on cognitive performance assessed by MoCA at 3-month follow-up, and to investigate the association to time-to-ROSC, and NSE as well as NfL levels during index admission with MoCA at follow-up.

Methods
The IMICA trial evaluated tocilizumab for reducing systemic inflammation after OHCA and randomized 80 comatose adult patients at admission to an infusion of either tocilizumab (8mg/kg, maximum 800mg) or placebo. NSE at 48 hours was measured as part of routine biochemistry based on serum samples, and NFL at 48 hours was measured in serum samples from the biobank. Time-to-ROSC was reported from pre-hospital data and cognitive performance at 3 months follow-up were assessed by the MoCA test. The association between MoCA and time-to-ROSC, NSE and NfL was assessed by Spearman’s correlation analyses.

Results
At follow-up, 35 patients had a MoCA test performed, while 28 patients were deceased, and 17 were alive without having an available MoCA score. There was no difference in MoCA scores at follow-up in the tocilizumab group compared to placebo group (p=0.72), and therefore results for both groups were pooled for analyses. NfL was found to be inversely correlated with MoCA score, r = -0.49, p = 0.003 (Figure), while there were no correlations with MoCA for time-to-ROSC or NSE (p = 0.46 and p = 0.34).

Conclusions
NfL measured at 48 hours after admission was inversely correlated with cognitive performance at 3 months for survivors of OHCA.
Extracorporeal CPR versus conventional CPR for refractory out-of-hospital cardiac arrest: a meta-analysis of randomised clinical trials
Authors: Goel S , Greenstein S G , Park W J P , Hooda A H , Krishnamoorthy P M K , Kini A K , Sharma S S 
Published: November 2023

Abstract

Background
Refractory out of hospital cardiac arrest carry poor outcomes. Extracorporeal cardiopulmonary resuscitation (CPR) help restore perfusion and oxygenation in a patient who does not have spontaneous circulation. Recently published randomized clinical trials (RCT) have conflicting evidence supporting use of early extracorporeal CPR and have small sample size.

Purpose
To compare Extracorporeal CPR versus conventional CPR in improving neurologically favorable survival.

Methods
We conducted an electronic database search of all published data for all RCT that compared Extracorporeal CPR versus conventional CPR for refractory out of hospital cardiac arrest and reported on neurologically favorable survival rates. Event rates were compared using a forest plot of odds ratios using a fixed-effects model assuming interstudy heterogeneity.

Results
Three RCT (n= 428; Extracorporeal CPR = 208, conventional CPR = 210) were included in the final analysis. Mean follow-up period 6 months. In our analysis, extracorporeal CPR compared with conventional CPR had favorable effect on survival with a favorable neurologic outcome (OR = 1.71, 95% CI = 1.08-2.71, P = 0.02, I2= 28).

Conclusions
In patients with refractory out-of-hospital cardiac arrest, extracorporeal CPR compared with conventional CPR had favorable effect on survival with a favorable neurologic outcome