The association between angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphisms and plasma ACE levels may allow for the optimization of a preventive intervention to reduce cardiovascular morbidity and mortality in the chronic kidney disease (CKD) population. In this study, we aimed to analyze the association between ACE I/D polymorphism and cardiovascular mortality risk among non-hemodialyzed chronic kidney disease patients. This cross-sectional study examined 70 patients of Javanese ethnic origin with stable CKD who did not receive hemodialysis. ACE I/D polymorphisms, plasma ACE levels, atherosclerotic cardiovascular disease (ASCVD) risk, and cardiovascular mortality risk were investigated. As per our findings, the I allele was found to be more frequent (78.6) than the D allele (21.4), and the DD genotype was less frequent than the II genotype (4.3 vs. 61.4). The ACE I/D polymorphism had a significant direct positive effect on plasma ACE levels (path coefficient = 0.302, p = 0.021). Similarly, plasma ACE levels had a direct and significant positive effect on the risk of atherosclerotic cardiovascular disease (path coefficient = 0.410, p = 0.000). Moreover, atherosclerotic cardiovascular disease risk had a significant positive effect on cardiovascular mortality risk (path coefficient = 0.918, p = 0.000). The ACE I/D polymorphism had no direct effect on ASCVD and cardiovascular mortality risk. However, our findings show that the indirect effects of high plasma ACE levels may be a factor in the increased risk of ASCVD and cardiovascular mortality in Javanese CKD patients.

Background: Electrocardiogram (ECG) is a widely accessible diagnostic tool that can easily be obtained on admission and can reduce excessive contact with coronavirus disease 2019 (COVID‐19) patients. A systematic review and meta‐analysis were performed to evaluate the latest evidence on the association of ECG on admission and the poor outcomes in COVID‐19.Methods: A literature search was conducted on online databases for observational studies evaluating ECG parameters and composite poor outcomes comprising ICU admission, severe illness, and mortality in COVID‐19 patients.Results: A total of 2,539 patients from seven studies were included in this analysis. Pooled analysis showed that a longer corrected QT (QTc) interval and more frequent prolonged QTc interval were associated with composite poor outcome ([WMD 6.04 [2.62‐9.45], P = .001; I²:0%] and [RR 1.89 [1.52‐2.36], P < .001; I²:17%], respectively). Patients with poor outcome had a longer QRS duration and a faster heart rate compared with patients with good outcome ([WMD 2.03 [0.20‐3.87], P = .030; I²:46.1%] and [WMD 5.96 [0.96‐10.95], P = .019; I²:55.9%], respectively). The incidence of left bundle branch block (LBBB), premature atrial contraction (PAC), and premature ventricular contraction (PVC) were higher in patients with poor outcome ([RR 2.55 [1.19‐5.47], P = .016; I²:65.9%]; [RR 1.94 [1.32‐2.86], P = .001; I²:62.8%]; and [RR 1.84 [1.075‐3.17], P = .026; I²:70.6%], respectively). T‐wave inversion and ST‐depression were more frequent in patients with poor outcome ([RR 1.68 [1.31‐2.15], P < .001; I²:14.3%] and [RR 1.61 [1.31‐2.00], P < .001; I²:49.5%], respectively).Conclusion: Most ECG abnormalities on admission are significantly associated with an increased composite poor outcome in patients with COVID‐19.

The shock index (SI) ratio serves as a straightforward predictor to identify patients who are either at risk of or experiencing shock. COVID-19 patients with shock face increased mortality risk and reduced chances of recovery. This review aims to determine the role of SI in the emergency department (ED) to predict COVID-19 patient outcomes. The systematic search was conducted in PubMed, ProQuest, Scopus, and ScienceDirect on June 16, 2023. We included observational studies evaluating SI in ED and COVID-19 patient outcomes. Random-effect meta-analysis was done to generate odds ratios of SI as the predictor of intensive care unit (ICU) admission and mortality. The sensitivity and specificity of SI in predicting these outcomes were also pooled, and a summary receiver operating characteristics (sROC) curve was generated. A total of eight studies involving 4557 participants were included in the pooled analysis. High SI was found to be associated with an increased risk of ICU admission (OR 5.81 [95%CI: 1.18–28.58], p = 0.03). Regarding mortality, high SI was linked to higher rates of in-hospital (OR 7.45 [95%CI: 2.44–22.74], p = 0.0004), within 30-day (OR 7.34 [95%CI: 5.27–10.21], p < 0.00001), and overall (OR 7.52 [95%CI: 3.72–15.19], p < 0.00001) mortality. The sensitivity and specificity of SI for predicting ICU admission were 76.2% [95%CI: 54.6%–89.5%] and 64.3% [95%CI: 19.6%–93.0%], respectively. In terms of overall mortality, the sensitivity and specificity were 54.0% (95%CI: 34.3%–72.6%) and 85.9% (95%CI: 75.8%–92.3%), respectively, with only subtle changes for in-hospital and within 30-day mortality. Adjustment of SI cut-off to >0.7 yielded improved sensitivity (95%CI: 78.0% [59.7%–89.4%]) and specificity (95%CI: 76.8% [41.7%–93.9%]) in predicting overall mortality. SI in emergency room may be a simple and useful triage instrument for predicting ICU admission and mortality in COVID-19 patients. Future well-conducted studies are still needed to corroborate the findings of this study.

Cardiogenic shock (CS) is a critical condition with high mortality rate, as the current management of CS presents significant challenges. Exploration of more effective therapies is necessitated. This review article comprehensively examines the efficacy and safety of levosimendan in the management of CS. By synthesising evidence from numerous studies, a comparison of levosimendan over traditional inotropic agents, such as enoximone, dobutamine, dopamine and norepinephrine, is highlighted. The unique mechanism of action of levosimendan enhances myocardial contractility without increasing oxygen demand, offering a promising alternative for patients with CS. This review also delves into comparative studies that demonstrate the superiority of levosimendan in improving survival rates, haemodynamic parameters, and reducing the incidence of CS complications. Safety profiles and adverse effects are critically assessed to provide a balanced view of the therapeutic window provided by levosimendan. The review concludes that levosimendan is a valuable addition to the therapeutic strategy against CS, with the potential to improve patient outcomes.

Interleukin-6 (IL-6) has been identified as an important pro-inflammatory factor involved in mediating the severity of chronic kidney disease (CKD). This study sought to determine the effect of plasma IL-6 levels on atherosclerotic cardiovascular disease (ASCVD) and cardiovascular mortality risk scores in Javanese CKD patients. We also analyzed the frequency of IL-6 G174C single nucleotide polymorphism (SNP) in the population. This study was a cross-sectional study involving seventy-three patients of Javanese ethnic origin with stable chronic kidney disease. We assessed the ASCVD risk score, cardiovascular mortality score, genotyping of IL-6 G174C SNP, and plasma IL-6 levels in these patients. The genotype distribution and allele frequencies of the IL-6 G174C SNP were predominated by the G genotype/allele (GG: 97.26%, GC: 1.37%, CC: 1.37%, G-allele: 97.95%, and C-allele: 2.05%). Despite the fact that plasma IL-6 levels did not directly affect cardiovascular mortality risk, further analysis revealed its direct effect on the ASCVD risk score (path coefficient = 0.184, p = 0.043, 95% CI = 0.018–0.380), which in turn affected cardiovascular mortality risk (path coefficient = 0.851, p = <0.01, 95% CI = 0.714–0.925). In conclusion, plasma IL-6 levels play important roles on ASCVD risk and cardiovascular mortality risk in Javanese patients with CKD.