Plasma adiponectin levels and five-year survival after first-ever ischemic stroke

Background and Purpose - This study aimed to investigate the association between plasma adiponectin levels and 5-year survival after first-ever ischemic stroke. Methods - Plasma adiponectin measured within 24 hours after first-ever ischemic stroke was related to 5-year outcome. The Kaplan-Meier technique was applied in survival analysis, and the Cox proportional hazards model was used to evaluate the relationship between risk factors and prognosis. Results - The probabilities of death were 92.8%, 52.5%, and 10.5% (P < 0.001) for patients stratified according to tertiles of adiponectin (< 4 mu g/mL, 4 to 7 mu g/mL, and > 7 mu g/mL, respectively). The relative risk of death was 8.1 (95% CI, 3.1, 24.5; P < 0.001) for individuals with adiponectin levels in the lowest tertile compared with the upper tertile. Adiponectin < 4 mu g/mL (hazard ratio [HR], 5.2; 95% CI, 2.1, 18.4; P < 0.001), score > 15 in the National Institutes of Health Stroke Scale (HR, 3.6; 95% CI, 1.7, 15.9; P < 0.001), and coronary heart disease (HR, 2.9; 95% CI, 1.5, 12.3; P < 0.001) were independently associated with mortality. Conclusions - Low plasma adiponectin is related to an increased risk of 5-year mortality after first-ever ischemic stroke, independently of other adverse predictors

A mortality prediction model in diabetic ketoacidosis

AIM To assess the value of clinical and laboratory parameters in predicting mortality in patients presenting with diabetic ketoacidosis (DKA). METHODS The records of all DKA admissions within 10 years were reviewed. Eighteen variables were evaluated at initial presentation and 20 variables at 4, 12 and 24 h from admission. A scoring system derived from these variables was compared to the APACHE III scoring system. RESULTS Among 154 patients (52 males, mean age 58 +/- 12 years), 20 (13%) died in hospital. Multivariate analysis yielded six variables as significant independent predictors ( P < 0.05) of mortality: severe coexisting diseases (SCD) and pH < 7.0, at presentation; units of regular insulin required in the first 12 h > 50 and serum glucose > 16.7 mmo/l, after 12 h; depressed mental state and fever, after 24 h. An integer-based scoring system was derived, as follows: number of points = 6 (SCD at presentation) + 4 (pH < 7.0 at presentation) + 4 (regular insulin required > 50 IU after 12 h) + 4 (serum glucose > 16.7 mmo/l after 12 h) + 4 (depressed mental state after 24 h) + 3 (fever after 24 h). Patients with 0-14 points had 0.86% risk of death, whereas for those with 19-25 points the risk was 93.3%. Median APACHE III scores differed significantly ( P < 0.001) among groups of patients stratified according to the above scoring system. CONCLUSIONS Risk stratification of patients with diabetic ketoacidosis is possible from simple clinical and laboratory variables available during the first day of hospitalization

Acute pyelonephritis in adults - Prediction of mortality and failure of treatment

Background: To formulate a classification tool for early recognition of patients admitted with acute pyelonephritis (AP) who are at high risk for failure of treatment or for death. Methods: A retrospective chart review of 225 patients (102 men) admitted with AP. We considered 13 potential risk factors in a multivariate analysis. Results: Recent hospitalization, previous use of antibiotics, and immunosuppression were found to be independent correlates of the prevalence of resistant pathogens in both sexes. Additional predictors included nephrolithiasis in women and a history of recurrent AP in men. Prolonged hospitalization should be expected for a man with diabetes and long-term catheterization who is older than 65 years or for a woman of any age with the same characteristics, when the initial treatment was changed according to the results of urine culture. For mortality prediction, we derived an integer-based scoring system with 6 points for shock, 4 for bedridden status, 4 for age greater than 65 years, and 3 for previous antibiotic treatment for men and 6 points for shock, 4 for bedridden status, 4 for age greater than 65 years, and 3 for immunosuppression for women. Among patients with at least 11 points, the risk for in-hospital death was 100% for men and 91% for women. Conclusions: Simple variables available at presentation can be used for risk stratification of patients with AP. The additional identification of certain risk factors by means of a carefully obtained history could contribute to early recognition of patients infected by resistant bacteria and optimize the selection of antimicrobial agents