Abstract Anemia is common amongst patients undergoing percutaneous coronary intervention (PCI) and current guidelines fail to offer recommendations for its management. This review aims to examine the ...relationship between baseline anemia and mortality, Major Adverse Cardiovascular Events (MACE) and major bleeding in patients undergoing PCI. We searched MEDLINE and EMBASE for studies that evaluated mortality and adverse outcomes in anemic and non-anemic patients who underwent PCI. Data were collected on study design, participant characteristics, definition of anemia, follow up and adverse outcomes. Random effects meta-analysis of risk ratios was performed using inverse variance method. A total of 44 studies were included in the review with 230,795 participants. The prevalence of baseline anemia was 26,514/170,914 (16%). There was an elevated risk of mortality and MACE with anemia compared to no anemia pooled RR 2.39 (2.02-2.83), p<0.001 and RR 1.51 (1.34-1.71), p<0.001, respectively. The risk of myocardial infarction and bleeding with anemia compared to no anemia was elevated, pooled RR 1.33 (1.07-1.65), p=0.01 and RR 1.97 (1.03-3.77), p<0.001, respectively. The risk of mortality per unit incremental decrease in hemoglobin(g/dl) was RR 1.19 (1.09-1.30), p<0.001 and the risk of mortality, MACE and re-infarction per 1 unit incremental decrease in hematocrit(%) was RR 1.07 (1.05-1.10), p=0.04, RR 1.09 (1.08-1.10) and RR 1.06 (1.03-1.10), respectively. The prevalence of anemia in contemporary cohorts of patients undergoing PCI is significant and is associated with significant increases in post procedural mortality, MACE, re-infarction and bleeding. The optimal strategy for the management of anemia in such patients remains uncertain.
Community-acquired pneumonia (CAP) is common and associated with a significant mortality. Currently recommended criteria to assess severity of CAP could be improved.
We derived 2 new criteria CARSI ...confusion, age (<65, ≥65 to <85 or≥ 85), respiratory rate and shock index and CARASI, where shock index is replaced by temperature-adjusted shock index based on previous observations. By using data of a prospective study performed in Norfolk and Suffolk, United Kingdom, we compare these new indices with the CURB-65 criteria.
A total of 190 patients were included (men, 53%). The age range was 18 to 101 years (median, 76 years). There were a total of 54 deaths during a 6-week follow-up, all within 30 days of admission. Sixty-five (34%) had severe pneumonia by CURB-65. Using CARSI and CARASI, 39 (21%) and 36 (19%) had severe pneumonia, respectively. Sensitivity was slightly less, but specificity was higher with CARSI and CARASI indices than that of CURB-65. Positive and negative predictive values in predicting death during 6-week follow-up were comparable among 3 indices examined. The receiver operating characteristic curve values (95% confidence interval) for the criteria were 0.67 (0.60-0.75) for CURB-65, 0.64 (0.60-0.71) for CARSI and 0.64 (0.57-0.71) for CARASI. Comparing receiver operating characteristic curves for CURB-65 versus CARSI, or CURB-65 versus CARASI, there was no evidence of a difference between the tools, P = 0.35 and 0.33, respectively. There was good agreement, which was strongly statistically significant (kappa = 0.56, P < 0.0001 and kappa = 0.54, P < 0.0001, respectively).
Both CARSI and CARASI are useful in predicting deaths associated with CAP, including older patients, and may be particularly useful in the emergency and community settings.
Background Time to computerized tomography (CT) is important to institute appropriate and timely hyperacute management in stroke. We aimed to evaluate mortality outcomes in relation to age and time ...to CT scan. Methods We used routinely collected data in 8 National Health Service trusts in East of England between September 2008 and April 2011. Stroke cases were prospectively identified and confirmed. Odds ratios (ORs) for unadjusted and adjusted models for age categories (<65, 65-74, 75-84, and ≥85 years) as well as time to CT categories (<90 minutes, ≥90 to <180 minutes, ≥180 minutes to 24 hours, and >24 hours) and in-hospital and early (<7 days) mortality outcomes were calculated. Results Of the 7693 patients (mean age 76.1 years, 50% male) included, 1151 (16%) died as inpatients and 336 (4%) died within 7 days. Older patients and those admitted from care home had a significantly longer time from admission until CT ( P < .001). Patients who had earlier CT scans were admitted to stroke units more frequently ( P < .001) but had higher in-patient ( P < .001) and 7-day mortality ( P < .001). Whereas older age was associated with increased odds of mortality outcomes, longer time to CT was associated with significantly reduced mortality within 7 days (corresponding ORs for the above time periods were 1.00, .61 95% confidence interval {CI}: .39-.95, .39 .24-.64, and .16 .08-.33) and in-hospital mortality (ORs 1.00, .86 .64-1.15, .57 .42-.78 and .71 .52-.98). Conclusions Older age was associated with a significantly longer time to CT. However, using CT scan time as a benchmarking tool in stroke may have inherent limitations and does not appear to be a suitable quality marker.
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