Objectives: Systemic immune-inflammation index (SII) is a biomarker of inflammatory conditions; however, no scoring system has been evaluated for predicting mortality in patients with renal failure in intensive care unit (ICU). This study aimed to determine associations between SII level and mortality in patients with renal failure. Design: Using the Medical Information Mart for Intensive Care IV (V.2.0) database (USA), this retrospective study included 837 patients who were admitted to ICU with end-stage renal disease (ESRD), between 2008 and 2019. Primary and secondary outcome measures: Cox proportional-hazards models were used to evaluate correlations between SII and outcomes, expressing results as hazard ratios (HRs) with 95% confidence intervals (95% CIs). Regression analysis was used to determine associations between variables and SII. Results: In total, 837 adult patients from a total of 76 943 patients admitted to ICU were included, comprising 59.60% males with mean age 62.27±14.9 years and mean BMI 28.36±7.43 Kg/m². Using median SII (1628 X 10⁹ /L) as cut-off value, high (≥ 1628X10⁹ /L) SII was also associated with an increased risk of ICU mortality (HR 1.97 (95% CI 1.15 to 3.35), p=0.034), in-hospital mortality (HR 1.95 (95% CI 1.23 to 3.09), p=0.017) and total mortality (HR 1.30 (95% CI 1.07 to 1.58), p=0.024). Conclusions: SII may predict mortality in critically ill patients admitted to ICU with ESRD. SII ≥ 1628×10⁹ /L correlates significantly with increased ICU mortality, in-hospital mortality and total mortality.

The current treatment paradigm for atrial fibrillation (AF) prioritizes rate control over rhythm control; however, rhythm control has shown benefits over other AF strategies. This study compares the outcomes of rivaroxaban with and without concomitant antiarrhythmic drugs (AADs), using propensity score matching to correct for statistical effects of baseline discrepancies. This multi-center retrospective study included 1,477 patients with non-permanent AF who took rivaroxaban for at least one month between 2011 and 2016 and had not received catheter ablation. Concomitant AAD use was compared against clinical outcome endpoints for effectiveness, safety, and major adverse cardiac events (MACE). Associations with concomitant AAD use were evaluated using multivariate Cox proportional hazard analyses. Patients were divided into two matched groups: rivaroxaban alone (n = 739) and with concomitant AADs (n = 738). The cumulative incidences of safety (p = 0.308), effectiveness (p = 0.583), and MACE (p = 0.754) were similar between the two groups, and multivariate analysis showed no significant differences. The new thromboembolism and all-cause death rates were higher in rivaroxaban alone (2.7% vs 0.8%, p = 0.005; and 10% vs. 6.9%, p = 0.032, respectively). The heart failure readmission rate was higher in the concomitant-AAD group (8.4% vs. 13.3%, p = 0.003). The concomitant use of rivaroxaban with AADs appears to be well-tolerated, with lower rates of thromboembolism and all-cause death, but is associated with more occurrences of congestive heart failure.

Aim: Changes in QRS duration in patients with heart failure with reduced ejection fraction (HFrEF) after sacubitril/valsartan therapy is not fully understood. This study aimed to assess the association of duration of HFrEF diagnosis with electrocardiographic and echocardiographic outcomes between before and after sacubitril/valsartan. Methods: We included HFrEF patients who received naïve sacubitril/valsartan therapy for ≥3 months, between January 2016 and March 2018. All patients were divided into 2 groups based on their duration of HFrEF. Generalized linear models were analyzed the cardiac outcomes after sacubitril/valsartan therapy by HFrEF duration. Results: Among these, 42 patients were HFrEF duration of <1 year and 47 patients were ≥1 year. The mean difference of QRS duration was lesser in the <1-year group than in the ≥1-year group (−2.3 msec vs 6.3 msec; P = .029). However, the mean difference of left ventricular ejection fraction (LVEF) was higher in the ≥1-year group (13.8% vs 5.8%; P = .008). After adjusting for patient demographics and clinical characteristics, the ≥1-year group had a significantly prolonged QRS duration (coefficient = 11; 95% confidence interval [CI], 0.3-21.7) and an unfavorable LVEF recovery (coefficient = −10.3; 95% CI −14.5 to −6.1) compared with the <1-year group. Conclusion: Prolonged QRS durations and unfavorable LVEF recoveries after sacubitril/valsartan therapy were observed in patients with HFrEF duration of ≥1 year. Earlier diagnosis of HFrEF and appropriate medication treatment may be beneficial in the improvement of QRS duration and LVEF recovery.

Objective Heart rate serves as a critical prognostic factor in heart failure (HF) patients. We hypothesise that elevated heart rate in critically ill HF patients on discharge from the intensive care unit (ICU) could be linked to adverse outcomes. Design A single-centre retrospective cohort study. Setting This study used data collected between 2008 and 2019 from the Medical Information Mart for Intensive Care IV (V.2.0) Database. Participants From the 76 943 ICU stays, we enrolled 2365 patients in this study. Primary and secondary outcome measures We observed correlations between in-hospital mortality and ICU discharge heart rate of 83.56±15.81 beats per minute (bpm) (survivors) vs 93.84±17.28 bpm (non-survivors, p<0.001). Total mortality showed similar trends, with 83.67±15.36 bpm (survivors) vs 85.23±17.25 bpm (non-survivors, p=0.027), as did ICU readmissions at 83.55±15.77 bpm (non-readmitted) vs 88.64±17.49 bpm (readmitted, p<0.001). Results Given multivariate analysis, the ICU discharge heart rate strongly predicted in-hospital mortality (HR 1.032 (95% CI 1.022 to 1.041), p<0.001), total mortality (HR 1.008 (95% CI 1.004 to 1.013), p<0.001) and ICU readmission (HR 1.018 (95% CI 1.010 to 1.025), p90 bpm demonstrated significantly higher in-hospital mortality (HR 2.639 (95% CI 1.898 to 3.669), p<0.001), total mortality (HR 1.342 (95% CI 1.163 to 1.550), p<0.001) and ICU readmission rates (HR 1.781 (95% CI 1.413 to 2.243), p90 bpm) at ICU discharge are more likely to experience increased in-hospital mortality, total mortality and ICU readmissions, indicating potential negative outcomes.

Background: Reduced-dose rivaroxaban (10 mg) was used in the J-ROCKET AF trial, demonstrating safety in the Asian population. It remains unclear whether treatment with reduced-dose versus full-dose rivaroxaban (20 mg/15 mg) is associated with all-cause mortality in older patients with nonvalvular atrial fibrillation. Proposed: To evaluate the effects of reduced-dose rivaroxaban on all-cause mortality in patients over 85. Methods: We retrospectively enrolled medical records representing the period from October 2012 to November 2016. The 2 × 2 factorial design incorporated age (≥85 vs. <85) and rivaroxaban use (reduced vs. full dose). The primary study outcomes were all-cause and cardiac-related mortality. Results: The study enrolled 2386 patients with a mean age of 76.6 ± 10.4 years; 51.8% were male. In the ≥85 group (n = 593), the reduced-dose subgroup had lower all-cause (5.3% vs. 10.6%, p = 0.02) and cardiac-related mortality (1.9% vs. 5.1%, p = 0.04), whereas the younger patients receiving reduced-dose rivaroxaban had higher all-cause mortality (3.7% vs. 1.8%, p = 0.01) but no difference in cardiac-related mortality (1.2% vs. 0.7%, p = 0.33). The rate of hospitalization for heart failure was significantly lower in the elderly group with reduced-dose rivaroxaban (7.2% vs. 15.7%, p < 0.01) but not in the younger group. After adjusting for confounders in the older group, treatment with reduced-dose rivaroxaban was associated with lower risk of all-cause mortality (adjusted HR (aHR): 0.40, 95% CI: 0.21–0.74, p < 0.01) and hospitalization for heart failure (aHR: 0.54, 95% CI: 0.29–0.99, p = 0.05). No associations were found between rivaroxaban dose and cardiac-related mortality in either group, nor between younger age and any outcome. Conclusions: Reduced-dose rivaroxaban was associated with lower risks of all-cause mortality and hospitalization for heart failure in older patients with nonvalvular atrial fibrillation. Future studies can investigate the effect of reduced-dose rivaroxaban on prognoses in elderly individuals ≥85 years in the west.