Introduction: The elderly population is unique and the prognostic scoring systems developed for the adult population need to be validated. We evaluated the predictive value of frequently used scoring systems on mortality in critically ill elderly sepsis patients. Methodology: In this single-center, observational, prospective study, critically ill elderly sepsis patients were evaluated. Sequential organ failure evaluation score (SOFA), acute physiology and chronic health evaluation score-II (APACHE-II), logistic organ dysfunction score (LODS), multiple organ dysfunction score (MODS), and simplified acute physiology score-II (SAPS-II) were calculated. The participants were followed up for 28 days for in-hospital mortality. Prognostic scoring systems, demographic characteristics, comorbid conditions, and baseline laboratory findings were compared between “survivor” and “non-survivor” groups. Results: 202 patients with a mean age of 79 (interquartile range, IQR: 11) years were included, and 51% (n = 103) were female. The overall mortality was 41% (n = 83). SOFA, APACHE-II, LODS, MODS, and SAPS-II scores were significantly higher in the non-survivor group (p < 0.001), and higher scores were correlated with higher mortality. The receiver operator characteristics (ROC) - area under curve (AUC) values were 0.802, 0.784, 0.735, 0.702 and 0.780 for SOFA, APACHE-II, LODS, MODS, and SAPS-II, respectively. All prognostic scoring models had a significant discriminative ability on the prediction of mortality among critically ill elderly sepsis patients (p < 0.001). Conclusions: This study showed that SOFA, APACHE-II, LODS, MODS, and SAPS-II scores are significantly associated with 28-day mortality in critically ill elderly sepsis patients, and can be successfully used for predicting mortality.

Gastrointestinal bleeding is a significant cause of morbidity and mortality among emergency unit patients. Several scoring systems are verified for predicting hospitalization and mortality such as Glasgow Blatchford Bleeding Score (GBS), AIMS65 score, Rockall score (RS), and International Bleeding Risk Score (INBS; ABC score). The aim of this study is to evaluate the efficacy and predictive value of these scoring systems. Adult emergency unit patients with gastrointestinal bleeding were retrospectively enrolled. The age, gender, complaints at admission, vitals and examination results, laboratory findings, outcomes, blood transfusion status, and endoscopic interventions were all reported, and GBS, AIMS65, RS, and INBS (ABC) scores were calculated individually for all enrollies. A total of 311 patients were included. The median age of participants was 70 years (IQR (25–75%): 59–81), and 202 (65%) of them were male. The efficacy of all four scoring systems (GBS, AIMS65, RS, and INBS (ABC)) in predicting hospitalization, need of blood transfusion, determination of high- and low-risk patients, and mortality was found to be statistically significant (p < 0.05 for all). ROC-AUC analysis was revealed that while GBS is the most beneficial in predicting hospitalization, INBS (ABC) has the best predictive value on mortality. Besides, the only scoring model with predictive value in determining the need for endoscopic intervention was RS (p < 0.05). The present study showed that, among adult emergency unit patients with gastrointestinal bleeding, GBS, AIMS65, RS, and INBS (ABC) scores could successfully predict hospitalization, need of blood transfusion, determination of high- and low-risk patients, and mortality. However, the only scoring system that could be used to determine the need of endoscopic intervention is RS. Finally, we believe further studies with prospective enrollment would be beneficial for more accurate conclusions.

Introduction: Arrhythmias are one of the most common causes of mortality in patients with acute ischemic stroke (AIS). This study aimed to investigate the relationships of arrhythmia susceptibility markers (QT, QTc, Tpe, Tpe-D, Tpe/QT, and Tpe/QTc) with the localization and volume of the ischemic area, the National Institutes of Health Stroke Scale (NIHSS) scores, and troponin levels in AIS. Methods: Patients diagnosed with AIS in the emergency department in the period from 01 November 2016 to 31 March 2019 were retrospectively reviewed. Patients admitted to the emergency department with no pathological ECG findings were included. The measurements of QT, QTc, Tpe, Tpe-D, Tpe/QTc, and Tpe/QT were performed under a digital microscope. The NIHSS scores, troponin values, and the ischemic area volume based on the diffusion-weighted magnetic resonance imaging findings at the time of admission were found. Results: A total of 135 patients, comprising 70 AIS patients and 65 individuals as controls, were included in the study. The male/female ratio was 73/62 and the mean age was 68.51 +/- 10.80 years. All of the ECG parameters in the AIS group and the control group were statistically significantly different between the groups except Tpe-D (p=0.454) (For QT, QTc, Tpe, Tpe/QTc, and Tpe/QT; p=0.003, 0.022, <0.001, 0.001, 0.001; respectively). QT, QTc, Tpe, Tpe/QTc, and Tpe/QT values were not significantly different between the groups with a NIHSS score of <= 5 and >5 (p=0.480, 0.688, 0.663, 0.512, 0.333, respectively). Conclusions: Arrhythmia susceptibility markers including QT, QTc, Tpe, the values of Tpe-D, Tpe/QT, and Tpe/QTc are different in AIS patients compared to the individuals in the control group; therefore, these parameters can be included among the other parameters of close cardiac monitoring.

Background Early prediction of return of spontaneous circulation (ROSC) for cardiac arrest (CA) patients is a major challenge. Different biomarkers have been studied as an early predictor for ROSC, but a consensus has not been achieved in this regard. This study’s goal was to investigate the value of the carboxyhemoglobin (COHb) and methemoglobin (MetHb) levels as a predictive marker for ROSC and prognostic marker for patients who achieve ROSC. Methods A total of 241 adult patients (109 female, 132 male) diagnosed as non-traumatic CA were included in the study. The patients were divided into two groups based on whether they achieved ROSC. The ROSC group was divided into two sub-groups, survivors and non-survivors. Complete blood count parameters, routine biochemistry measurements, coagulation parameters, and blood gas analysis, and cardiac markers values were compared between the groups. Results COHb levels were significantly lower in the non-ROSC group than in the ROSC group (p = 0.002). Urea, creatinine, potassium, and cTn (cardiac troponin) levels in the non-ROSC group were significantly higher than in the ROSC group (p < 0.001, 0.001, 0.014, and 0.005, respectively). COHb levels were significantly lower in the non-survivor group than in the survivor group (p = 0.022). Urea, creatinine, potassium, lactate dehydrogenase, and cTn levels were significantly higher in the non-survivor group than the survivor group (p = 0.001, 0.005, 0.001, 0.010, and 0.008, respectively). There was no significant difference between the ROSC and non-ROSC groups and survivor group and non-survivor groups in terms of MetHb levels (p = 0.769 and 0.668, respectively). Moreover, CPR duration is significantly shorter in the survivor group than the non-survivor group (p ˂ 0.001). Conclusion COHb levels in the blood gas analysis at the time of admission could be used as a predictive marker for ROSC and prognostic marker for the patients who achieved ROSC.

Cardiopulmonary resuscitation is more effective for in-hospital cardiac arrest when performed on a stretcher. A manikin study