Approaching adverse event detection utilizing transformers on clinical time-series

Patients being admitted to a hospital will most often be associated with a certain clinical development during their stay. However, there is always a risk of patients being subject to the wrong diagnosis or to a certain treatment not pertaining to the desired effect, potentially leading to adverse events. Our research aims to develop an anomaly detection system for identifying deviations from expected clinical trajectories. To address this goal we analyzed 16 months of vital sign recordings obtained from the Nordland Hospital Trust (NHT). We employed an self-supervised framework based on the STraTS transformer architecture to represent the time series data in a latent space. These representations were then subjected to various clustering techniques to explore potential patient phenotypes based on their clinical progress. While our preliminary results from this ongoing research are promising, they underscore the importance of enhancing the dataset with additional demographic information from patients. This additional data will be crucial for a more comprehensive evaluation of the method's performance.Comment: 10 pages, 6 figure

Low YKL-40 in Chronic Heart Failure may predict beneficial effects of statins: Analysis from the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA)

Context and objective: To evaluate if YKL-40 can provide prognostic information in patients with ischemic heart failure (HF) and identify patients who may benefit from statin therapy. Materials and Methods: The association between serum YKL-40 and predefined outcome was evaluated in 1344 HF patients assigned to rosuvastatin or placebo. Results: YKL-40 was not associated with outcome in adjusted analysis. In YKL-40 tertile 1, an effect on the primary outcome (HR 0.50, p = 0.006) and CV death (HR 0.54 p = 0.040) was seen by rosuvastatin in adjusted analysis. Conclusions: A beneficial modification of outcome was observed with statin therapy in patients with low YKL-40 levels

Fatty Acid Binding Protein 4 Is Associated with Carotid Atherosclerosis and Outcome in Patients with Acute Ischemic Stroke

BACKGROUND AND PURPOSE: Fatty acid binding protein 4 (FABP4) has been shown to play an important role in macrophage cholesterol trafficking and associated inflammation. To further elucidate the role of FABP4 in atherogenesis in humans, we examined the regulation of FABP4 in carotid atherosclerosis and ischemic stroke. METHODS: We examined plasma FABP4 levels in asymptomatic (n = 28) and symptomatic (n = 31) patients with carotid atherosclerosis, as well as in 202 subjects with acute ischemic stroke. In a subgroup of patients we also analysed the expression of FABP4 within the atherosclerotic lesion. In addition, we investigated the ability of different stimuli with relevance to atherosclerosis to regulate FABP4 expression in monocytes/macrophages. RESULTS: FABP4 levels were higher in patients with carotid atherosclerosis, both systemically and within the atherosclerotic lesion, with particular high mRNA levels in carotid plaques from patients with the most recent symptoms. Immunostaining of carotid plaques localized FABP4 to macrophages, while activated platelets and oxidized LDL were potent stimuli for FABP4 expression in monocytes/macrophages in vitro. When measured at the time of acute ischemic stroke, high plasma levels of FABP4 were significantly associated with total and cardiovascular mortality during follow-up, although we did not find that addition of FABP4 to the fully adjusted multivariate model had an effect on the prognostic discrimination for all-cause mortality as assessed by c-statistics. CONCLUSIONS: FABP4 is linked to atherogenesis, plaque instability and adverse outcome in patients with carotid atherosclerosis and acute ischemic stroke

Inflammatory Biomarkers in Cardiovascular diseases

Kardiovaskulær sykdom rammer mange i løpet av livet, og selv om mange overlever den akutte sykdommen, har kardiovaskulær sykdom høy mortalitet og morbiditet også etter debuten. Særlig hjertesvikt er forbundet med mange sykehusinnleggelser, og lav 5-års overlevelse. Mange studier har vist at pasienter med hjertesvikt eller akutt koronarsykdom viser tegn på aktivering av immunsystemet. Det har også vært spekulert i om denne immunaktiviteten kan være noe av årsaken til den dårlige prognosen til mange av disse pasientene. I denne avhandlingen har vi sett sett nærmere på molekyler som vanligvis er assosiert med immunsystemet, og om konsentrasjonen av disse i blod kan si noe om langtidsoverlevelse. Våre funn viser tydelig at nivåer av mange kjente mediatorer i immunsystemet er økt hos pasienter med hjertesvikt, men at disse i liten grad egner seg til å si noe om prognosen. Heller ikke når man kombinerer flere av disse biomarkørene i paneler som beskriver ulike deler av den tenkte sykdomsutviklingen, øker den prognostiske styrken til modellene nevneverdig

Patient characteristics in sepsis-related deaths: prevalence of advanced frailty, comorbidity, and age in a Norwegian hospital trust

Objective - To examine the prevalence of advanced frailty, comorbidity, and age among sepsis-related deaths in an adult hospital population. Methods - Retrospective chart reviews of deceased adults within a Norwegian hospital trust, with a diagnosis of infection, over 2 years (2018–2019). The likelihood of sepsis-related death was evaluated by clinicians as sepsis-related, possibly sepsis-related, or not sepsis-related. Results - Of 633 hospital deaths, 179 (28%) were sepsis-related, and 136 (21%) were possibly sepsis-related. Among these 315 patients whose deaths were sepsis-related or possibly sepsis-related, close to three in four patients (73%) were either 85 years or older, living with severe frailty (Clinical Frailty Scale, CFS, score of 7 or more), or an end-stage condition prior to the admission. Among the remaining 27%, 15% were either 80–84 years old, living with frailty corresponding to a CFS score of 6, or severe comorbidity, defined as 5 points or more on the Charlson Comorbidity Index (CCI). The last 12% constituted the presumably healthiest cluster, but in this group as well, the majority died with limitations of care due to their premorbid functional status and/ or comorbidity. Findings remained stable if the population was limited to sepsis-related deaths on clinicians’ reviews or those fulfilling the Sepsis-3 criteria. Conclusions - Advanced frailty, comorbidity, and age were predominant in hospital fatalities where infection contributed to death, with or without sepsis. This is of importance when considering sepsis-related mortality in similar populations, the applicability of study results to everyday clinical work, and future study designs

Data from: Electrolyte imbalances in an unselected population in an emergency department: a retrospective cohort study

Background: Although electrolyte imbalances (EIs) are common in the emergency department (ED), few studies have examined the occurrence of such conditions in an unselected population. Objectives: To investigate the frequency of EI among adult patients who present to the ED, with regards to type and severity, and the association with age and sex of the patient, hospital length of stay (LOS), readmission, and mortality. Methods: A retrospective cohort study. All patients ≥18 years referred for any reason to the ED between January 1, 2010, and December 31, 2015, who had measured blood electrolytes were included. In total, 62 991 visits involving 31 966 patients were registered. Results: EIs were mostly mild, and the most common EI was hyponatremia (glucose-corrected) (24.6%). Patients with increasing severity of EI had longer LOS compared with patients with normal electrolyte measurements. Among all admitted patients, there were 12928 (20.5%) readmissions within 30 days from discharge during the study period. Hyponatremia (glucose-corrected) was associated with readmission, with an adjusted odds ratio (OR) of 1.25 (95% CI, 1.18–1.32). Hypomagnesemia and hypocalcemia (albumin-corrected) were also associated with readmission, with ORs of 1.25 (95% CI, 1.07–1.45) and 1.22 (95% CI, 1.02–1.46), respectively. Dysnatremia, dyskalemia, hypercalcemia, hypermagnesemia, and hyperphosphatemia were associated with increased in-hospital mortality, whereas all EIs except hypophosphatemia were associated with increased 30-day and 1-year mortality. Conclusions: EIs were common and increasing severity of EIs was associated with longer LOS and increased in-hospital, 30-days and 1-year mortality. EI monitoring is crucial for newly admitted patients, and up-to-date training in EI diagnosis and treatment is essential for ED physicians

Electrolyte imbalances in an ED-datafile-Tazmini-032019

Datafile for the article as Excelfile. The varibles are described in the README file

Potassium infusion increases the likelihood of conversion of recent-onset atrial fibrillation- A single-blinded, randomized clinical trial

Background The optimal antiarrhythmic management of recent-onset atrial fibrillation (ROAF) or atrial flutter is controversial and there is a considerable variability in clinical treatment strategies. It is not known if potassium infusion has the potential to convert ROAF or atrial flutter to sinus rhythm (SR). Therefore, we aimed to investigate if patients with ROAF or atrial flutter and plasma-potassium levels ≤4.0 mmol/L have increased probability to convert to SR if the plasma-potassium level is increased towards the upper reference range (4.1-5.0 mmol/L). Methods In a placebo-controlled, single-blinded trial, patients with ROAF or atrial flutter and plasma-potassium ≤4.0 mmol/L presenting between April 2013 and November 2017 were randomized to receive potassium chloride (KCl) infusion (n = 60) or placebo (n = 53). Patients in the KCl group received infusions at one of three different rates: 9.4 mmol/h (n = 11), 12 mmol/h (n = 19), or 15 mmol/h (n = 30). Results There was no statistical difference in the number of conversions to SR between the KCl group and placebo [logrank test, P = .29; hazard ratio (HR) 1.20 (CI 0.72-1.98)]. However, KCl-infused patients who achieved an above-median hourly increase in plasma-potassium (>0.047 mmol/h) exhibited a significantly higher conversion rate compared with placebo [logrank P = .002; HR 2.40 (CI 1.36-4.21)] and KCl patients with below-median change in plasma-potassium [logrank P < .001; HR 4.41 (CI 2.07-9.40)]. Due to pain at the infusion site, the infusion was prematurely terminated in 10 patients (17%). Conclusions Although increasing plasma-potassium levels did not significantly augment conversion of ROAF or atrial flutter to SR in patients with potassium levels in the lower-normal range, our results indicate that this treatment may be effective when a rapid increase in potassium concentration is tolerated and achieved

Vertraeglichkeitsrechnung Theorie und Anwendung

TIB: RN 5905 (1824) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman