The early prediction of death is a challenge for medical staff. We evaluated the ability of the heart/breathing rate ratio (HBR) to predict mortality. This was a single-center retrospective observational study of adult patients who had fever with or without respiratory symptoms, who survived at least 2 h after visiting the hospital, and whose lactate levels and vital signs were tested. We evaluated the distribution of mortality at different HBR levels and compared HBR with lactate. A total of 18,872 fever clinic visits were screened, and 183 patients whose lactate levels were tested were recruited. Patients who had HBR values lower than 4·5 or higher than 5·5 had greater mortality than patients who had HBR values between 4·5 and 5·5 (21·3 % vs. 3·4 %, p = 0·003; 28·9 % vs. 3·4 %, p < 0·001, respectively). In patients whose HBR was <5, the AUROC for HBR for mortality was 0·762 (95 % CI: 0.643–0·880), and that for lactate was 0·701 (95 % CI: 0·564–0·837). In patients whose HBR was ≥5, the AUROC for HBR for mortality was 0·721 (95 % CI: 0·584–0·857), and that for lactate was 0·742 (95 % CI: 0·607–0·848). HBR is helpful for stratifying mortality risk among critically ill patients in acute care clinics for infectious diseases.

Objectives: To explore the relationships between the pulse/breathing rate ratio (PBR) and the risk of death and critical illness. Design: This was a retrospective observational study. Setting: This was a single-centre study from a tertiary hospital in Tianjin, China. Participants: The study population consisted of patients aged ≥16 years who underwent consultation and were monitored for medical purposes at the clinic. Interventions: Between April 2021 and December 2021. Before the patients received any medical intervention, vital signs were measured, and the PBR and the National Early Warning Score (NEWS) were calculated on the basis of the above measured indicators. Primary and secondary outcome measures: The associations of PBRs with death and critical illness were evaluated. Results: A total of 1048 outpatients with fever were included. Restricted cubic spline (RCS) bars were used to explore potential nonlinear associations between PBR and mortality and critical illness. The abilities of the PBR and NEWS to predict the risk of death and critical illness were compared through decision curve analysis (DCA). The RCS showed a U-shaped nonlinear distribution of associations between PBRs and death and critical illness (nonlinear p values of p=0.036 and p=0.005, respectively). The risk of mortality was lowest between 4.6 and 6.2 for PBR, with the risk of mortality increasing progressively with decreasing PBR for PBR6.2. The risk of critical illness was lowest when the PBR was between 4.6 and 5.5, and the risk increased gradually with decreasing PBR for PBR5.5. The DCA results revealed that the value of the PBR in predicting death was similar to that of the NEWS. In the DCA, the net benefit achieved by the NEWS ranged from 3% to 10% threshold probability, and the net benefit achieved by the PBR ranged from 4% to 10% threshold probability, with similar net benefits for the NEWS and PBR and 1% for both the PBR and the NEWS when the threshold probability was 7% (equivalent to correctly identifying 10 mortalities per 100 patients). Conclusions: The PBR helps to predict the risk of mortality and critical illness in acutely ill patients, and its value in predicting mortality is similar to that of the NEWS.

Pneumonia remains a major cause of hospitalization and death among older adults worldwide. Simple bedside biomarkers that capture the host response to infe

This report describes a rare case of unilateral absence of the right pulmonary artery (UAPA) with several artery malformations, patent ductus arteriosus (PDA), and an ectopic kidney. A 65-year-old male with arrhythmia underwent chest computed tomographic angiography (CTA), which revealed an absence of the right pulmonary artery with increased tortuous vascular shadows in the right lung hilum. The patient underwent PDA at the age of 13. An ectopic left kidney was detected via urinary ultrasound. This anomaly in adults requires treatment according to symptoms, and there is often no commonly accepted consensus on a particular treatment strategy.