Analysis of clinical characteristics of early death in adult patients with hemophagocytic syndrome / 白血病·淋巴瘤

Objective:To explore the clinical characteristics of early death in adult patients with hemophagocytic syndrome (HPS).Methods:The clinical data of 53 adult HPS patients in Xianning Central Hospital, Huangshi Central Hospital and Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from September 2016 to November 2021 were retrospectively analyzed, and the patients were grouped according to whether they died within 28 d after diagnosis. The clinical characteristics of the two groups were compared. A multivariate analysis of patients' death within 28 d was performed using logistic regression.Results:In 53 adult HPS patients, the mortality rate within 28 d was 28.3% (15/53). The survival time of patients was related to white blood cell count ( r = 0.324, P = 0.018), total bilirubin level ( r = -0.280, P = 0.042) and albumin level ( r = 0.281, P = 0.042), but there was no linear causality (all P > 0.05). When compared between the death within 28 d group and the non-death within 28 d group, the differences in patients' age, platelet count, albumin level, creatine kinase isoenzyme level, triacylglycerol level, ferritin level, and central nervous system involvement were statistically significant (all P < 0.05). Multivariate logistic regression analysis showed that platelet count <30×10 9/L, albumin <30 g/L, central nervous system involvement, and ferritin ≥10 000 ng/ml were independent risk factors for patients' death within 28 d (all P < 0.05). Conclusions:In adult HPS patients, assessing the risk of early death based on ferritin level, platelet count, albumin level, and neurological symptoms, actively correcting internal environmental disturbances, and enhancing organ support therapy can contribute to survival benefit.

Nomogram for Predicting Early Death in Patients with Metastatic Colon Cancer Based on SEER Database / 肿瘤防治研究

Objective To construct a Nomogram model that can accurately predict early death of metastatic colon cancer (mCC). Methods A total of 6 669 patients from the SEER database were identified using inclusion and exclusion criteria. Multivariate logistic regression was used to identify risk factors for early mortality and to construct a Nomogram. The predictive performance of the Nomogram was evaluated by C-index, calibration curve, and decision curve analysis (DCA). Results Primary tumor location, differentiation grade, T stage, M stage, bone metastases, brain metastases, CEA, tumor size, age and marital status were independent factors for early death in patients with mCC. A Nomogram was constructed based on these variables. The C-index and the calibration curve of the Nomogram showed the good predictive ability of the nomogram. DCA showed that the Nomogram had a superior clinical net benefit in predicting early death compared with TNM stage. Conclusion The developed Nomogram has good predictive ability and can help guide clinicians to identify patients with high-risk mCC for individualized diagnosis and treatment.

Follow-up and outcome of the twelve-year experience in adult patients with acute promyelocytic leukemia

ABSTRACT Acute promyelocytic leukemia is a subtype of acute myeloid leukemia, characterized by the presence of neoplastic promyelocytes, due to the reciprocal balanced translocation between chromosomes 15 and 17. Currently, with the use of agents that act directly on this molecular change, such as all-trans retinoic acid and arsenic trioxide, APL has shifted from a highly mortal to a curable disease. However, some cases are still at high risk of death, especially early death, and acquiring a better understanding of the clinical and biological factors involving APL is needed to correctly identify and treat such cases. The early suspected diagnosis and prompt initiation of the target therapy are important for better response rates. The follow-up and outcomes, using real-life data from 44 consecutive APL patients, were studied between 2001 and 2013. The overall survival rate was 82.7% and early death was 16%. Almost all patient deaths were due to severe bleeding, which was confirmed by multivariate analysis, as the most important prognostic factor leading to death. A better understanding the pathogenesis of the hemorrhagic complications in APL is needed, as well as the risk factors associated with early death in APL patients, as this has become synonymous with overall mortality.

Analysis of early death in children with neuroblastoma / 中华实用儿科临床杂志

Objective:To summarize the causes of death and severe complication in the early diagnosis of children with neuroblastoma (NB), and to analyze the relative factors of early death of children with NB, so as to raise awareness and reduce early mortality by early detection and early intervention.Methods:Patients with newly diagnosed NB in the Hematology Oncology Center of Beijing Children′s Hospital from April 2007 to December 2017 were included consecutively, and those died within 1 month after diagnosis were retrospectively analyzed.The general data of patients, immediate causes of death, complications, time elapsed between death and diagnosis, whether to receive chemotherapy and other information were collected.Results:A total of 654 cases were included for diagnosis, treatment and follow-up, 31 cases of which died in early stage, accounting for 4.7% of the total.The major complication were pulmonary infection in 18 cases (58.1%) and bone marrow suppression after chemotherapy in 17 cases (54.8%), tumor rupture hemorrhage in 16 cases (51.6%), multiple organ failure in 8 cases (25.8%). Risk factor analysis of the 31 early death cases with NB was conducted.Single factor analysis: there were statistical differences between early death group and non-early death group in risk grouping ( P=0.006 6), bone marrow invasion ( P=0.020 7), site of primary tumor ( P=0.016 7), age ( P=0.003 3), lactate dehydrogenase (LDH) level ( P<0.000 1), neuron-specific enolase (NSE) level ( P<0.000 1), serum ferritin level ( P=0.016 0), D dimer level ( P<0.000 1), fibrinogen level ( P=0.002 7), diameter of tumor ( P<0.000 1), hemoglobin ( P<0.000 1), platelet level ( P<0.000 1), serum albumin level ( P<0.000 1). Multiple-factor analysis: age younger than 30 months, OR=2.824 (95% CI: 1.084-7.359), LDH level greater than 1 004 IU/L, OR=6.991 (95% CI: 2.135-22.887), albumin level less than 36 g/L, OR= 65.237 (95% CI: 2.024-13.545), hemoglobin level less than 92 g/L, OR=5.358 (95% CI: 2.024-13.545), platelet level less than 192×10 9/L, OR=3.554 (95% CI: 1.267-9.965). Conclusions:Strengthening vital signs detection after admission, identifying severe life-threatening complications such as rupture of tumors as early as possible, implementing symptomatic interventions such as appropriate sedation and active transfusion of blood products as early as possible after invasive operation, and transferring to intensive care unit for respiratory support when necessary are important means to avoid early death.

Trend analysis of mortality and early death burden of cardiovascular diseases from 2009 to 2018 in Ningbo / 预防医学

Objective@#To understand the trend of cardiovascular diseases death and disease burden caused by early death from 2009 to 2018 in Ningbo, so as to provide evidence for the prevention and control of cardiovascular disease.@*Methods@#The monitoring data of cardiovascular diseases death from 2009 to 2018 was collected from Ningbo death cause surveillance system. The mortality rate, early death probability, years of life lost ( YLL ) and working years of potential life lost ( WYPLL ) were calculated, and the mortality rate and YLL rate were standardized by 2010 national standard population. The annual percentage change ( APC ) was used to measure the time trend. @*Results@#From 2009 to 2018, there were 42 961 deaths from cardiovascular diseases in Ningbo, with a mortality rate of 7.35/104, a standardized mortality rate of 4.25/104, and an early death probability of 0.84%. The APC of cardiovascular disease mortality and standardized mortality were 57.488% and 6.004%, both showing an upward trend ( P<0.05 ); the APC of the probability of early death was -1.253%, showing a downward trend ( P<0.05 ). The male mortality rate was 4.16×104, which was lower than the female's 4.36/104 ( P<0.05 ). The YLL, standardized YLL rate, and WYPLL for cardiovascular diseases were 329 266.65 person-years, 3.82‰, and 18 355.63 person-years, respectively. The overall APC of YLL is 1.700%, showing an upward trend ( P<0.05 ). The standardized YLL rate of cardiovascular diseases increased with age ( P<0.05 ). with the APC of 1.503%. Ischemic heart disease and hypertensive heart disease were dominant, their YLLs were 105 949.75 and 46 015.68 person-years, respectively. @*Conclusion@#From 2009 to 2018, the mortality of cardiovascular diseases show an increasing trend, while the burden caused by early death in Ningbo reverses. Women and the elderly are high-risk groups, and ischemic heart disease and hypertensive heart disease are high-risk diseases.

A Retrospective Analysis of Early Death after Admission in Advanced Cancer Patients at the End-of-life in Single-institution

<p>Little is known about early death after admission during the terminal phase in advanced cancer patients. We retrospectively analyzed data from 510 advanced cancer patients who were at the end-of-life between August 2011 and August 2016, and found that 83 patients (16.3%) died within 3 days after admission to our institute. We divided the deceased patients into those who died within 3 days (early death group) and those who died after more than 4 days (non-early death group) after admission. Prevalence of delirium, cancer pain, dyspnea, nausea and vomiting, and fatigue patients showed no significant differences. Mean hydration at the end of life was significantly more per infusion for early death group than non-early death group. Continuous sedation and mean opioid use was significantly less for early death group than non-early death group. The risk factor of age, sex, clinical stage, histological state, overtreatment of chemotherapy, comorbidity had no significant associated with early death. The primary site of cancer, the number of metastatic sites, the consciousness level, and the performance status might be predictors for early death after admission in advanced cancer patients at the end-of-life.</p>

Causes of early death in elderly patients undergoing maintenance hemodialysis / 军事医学

Objective To analyze the causes of early death in elderly patients undergoing maintenance hemodialysis ( MHD) and major risk factors.Methods A retrospective study was conducted.Fourty-three patients who had undergone MHD between January 2005 and December 2015 and died within 3 -12 months after hemodialysis in the Hemodialysis Center of China Aerospace Center Hospital were included in Group A while 106 patients who had undergone hemodialysis in the same period but survived for over 12 months were selected as control group(Group B).Results The main causes of early death of 43 elderly patients with MHD were cardiovascular ( 46.5%) and cerebrovascular diseases ( 25.6%) (CCVD), and infections(14.0%).The age,proportion of patients with diabetes and CVD,and the proportion of patients using the central venous catheter( CVC) as vascular access were higher in Group A,but the level of hemoglobin and serum albumin was lower.Indicators of cardiac structure and function showed that the left ventricular end-diastolic diameter (LVDd),left ventricular posterior wall thickness(LVPWT),and left ventricular myocardial quality index(LVMI)in Group A were well above those in Group B, but EF and E/A ratio were significantly lower(P<0.05 and P<0.01).COX regression analysis indicated that the comorbidity with CVD, a lower level of serum albumin and EF were the main risk factors for early mortality in elderly patients under MHD.Conclusion The main cause of early death in elderly MHD patients is CCVD.The comorbidity of CVD, malnutrition and decreased left ventricular systolic function might be the main risk factors for early mortality in elderly MHD patients.Early and adequate dialysis,active treatment of underlying diseases, and the correction of hypoalbuminemia can decrease complications,prolong life and improve the quality of life.

Clinical analysis of early death in multiple myeloma / 中国肿瘤临床

Objective:This study investigated the clinical characteristics of multiple myeloma with early death in the era of novel drugs. Methods:Medical records from 188 patients diagnosed from January 2009 to December 2015 were retrospectively reviewed, showing that early death occurred in 19 patients. Early death was defined as death by any cause within the first year after diagnosis. Results:(1) Early mortality was 10.1%, and the median age was 67 years old (range:40-84 years). Eight cases presented IgG type, and 11 cases were non-IgG type. All 19 patients were diagnosed to be at stageⅢin accordance with the Durie–Salmon staging system, and renal insufficiency occurred in 10 patients. In accordance with the International Staging System (ISS), four patients were diagnosed to be at stageⅡ, whereas 15 other patients were at stageⅢ. Extramedullary plasmacytoma (EMP) occurred in six cases, whereas 10 cases pre-sented high-risk patients with cytogenetic abnormalities. Elevated lactate dehydrogenase (LDH) was found in five cases, amyloidosis was detected in three patients, and secondary plasma cell leukemia was observed in two cases. The median score of performance sta-tus (KPS) was 70 (range: 20-80). A total of 16 patients were treated with bortezomib, and 3 patients were treated with CADT. (2) Among the 13 patients who were evaluated, the overall response rate was 46.2%(6/13), and the complete response (CR) and near-CR rate was 7.7%(1/13). (3) The median overall survival was 3 (1-11.5) months, although the two patients with secondary plasma cell leu-kemia survived for less than 2 months. (4) Eight patients died of disease progression (42.1%), eight patients died of severe infections (42.1%), and three patients died of thrombotic events. Conclusion:The important causes of early death include the following:high-risk cytogenetics, elevated LDH, EMP, amyloidosis, advanced age, poor performance status, and serious complications during treat-ment. In the era of novel drugs, we should improve early diagnosis rates and explore individualized treatment for high-risk multiple my-eloma for the benefit of a wide range of patients.

The study of cause of early death and a matched study for the risk factors in patients undergoing maintenance hemodialysis / 中华危重病急救医学

ObjectiveTo explore the cause of early death (death within 3-12 months after hemodialysis) and the related influencing factors patients undergoing maintenance hemodialysis (MHD) as to provide a scientific basis for the prevention of early death.Methods A retrospective matched controlled study was conducted. Fifty-one patients who underwent MHD from January 2004 to April 2014 and died within 3-12 months after hemodialysis in hemodialysis center of the 174th Chinese People's Liberation Army Hospital were included in the case group by retrospective analysis method. According to 1∶2 matched controls, 102 patients underwent hemodialysis in the same period (±2 months) and survived over 12 months were selected as control group. All patients received regular hemodialysis (dialysis 2-3 times per week), with conventional limitation of water and sodium intake, routine treatments such as control of blood pressure, treatment of anemia and disorders of calcium and phosphorus contents. Causes of short-term death were analyzed. Clinical and biochemical parameters of two groups were collected when dialysis was started, and the single factor and multiple factors logistic regression was used to analyze the related risk factors when dialysis was started. Receiver operating characteristic curve (ROC) was plotted to evaluate the value of above parameters in predicting the early death in patents with MHD.Results The main causes of early death of 51 patients with MHD were mainly cardiovascular and cerebrovascular diseases (27 cases, 52.9%), and infections (15 cases, 29.4%). It was shown by single factor analysis that the age [odds ratio (OR) = 6.625, 95% confidence interval (95%CI) = 3.232-13.580,P = 0.000], diabetes (OR = 3.875, 95%CI = 0.654 - 10.622,P = 0.031), specialist intervention time before dialysis (OR = 0.349, 95%CI =0.287 - 0.572,P = 0.004), the emergence of cardiovascular and cerebrovascular events before dialysis (OR = 9.667, 95%CI = 4.632 - 20.174,P = 0.000), the first dialysis for emergency dialysis (OR = 3.875, 95%CI = 1.713 - 8.765, P = 0.005), blood albumin level (OR = 0.294, 95%CI = 0.068 - 0.550,P = 0.008), leukocyte count (OR = 6.286, 95%CI = 1.648 - 23.982,P = 0.026), neutrophil count (OR = 2.833, 95%CI = 1.630 - 4.923,P = 0.001) might be the factors correlating with early death. Eight independent factors were statistically significant, and their effect on the MHD patients was analyzed by logistic regression analysis inα = 0.05 level. The results showed that patients with old age (OR = 1.054, 95%CI = 1.019-1.090,P = 0.002), and the emergence of cardio-cerebrovascular events (OR = 7.469, 95%CI = 2.474 - 22.545,P = 0.000)were early death risk factors of MHD patients, and early specialist intervention before dialysis was a protective factor (OR = 0.286, 95%CI = 0.113-0.722,P = 0.008). ROC curve showed that age had moderate diagnostic value for early death of MHD [area under ROC curve (AUC) = 0.756], the cut-off value was 59.0 years old, the sensitivity was 66.7%, and the specificity was 77.5%. The diagnostic value of early specialist intervention before dialysis was relatively low (AUC = 0.367), the cut-off value was 0.875 years, the sensitivity was 39.2%, and the specificity was 33.3%.Conclusion Old age, the emergency of cardiovascular and cerebrovascular events before dialysis is associated with early death, and specialist intervention ahead of dialysis can reduce the risk of early death.

Establishment of risk prediction model and risk score for in-hospital mortality after adult rheumatic heart valve surgery / 中华胸心血管外科杂志

Objective To establish a surgical risk prediction model for in-hospital mortality of adult rheumatic heart disease.Methods The study sample comprised of 3 889 patients with adult (is, or older than 18 years) rheumatic heart valve surgery only.All patients were divided into three subgroups according to the surgery site of left atrioventricular valve: mitral valve surgery group;aortic valve surgery group;and mitral and aortic valve surgery group.The data was splited into development(60％) and validation(40％) data sets, and then the risk model was developed by using a logistic regression model according to the data in development data set.Model calibration was analyzed by Hosmer-Lemeshow goodness-of-fit statistic, and model discrimination was tested by calculating the area under the receiver operating characteristic(ROC) curve.Risk score was finally set up according to the coefficient β and rank of variables in logistic regression model.Results The general in-hospital mortality of the whole group is 4.2％ (165/3 889).We established a risk prediction model and found seven risk factors: heart function in NYHA functional class ≥ Ⅱ grade (OR =3.36, 95％ CI: 2.42-4.67) , preoperative creatinine ＞ 110 mmoL/L (OR =2.69, 95％ CI: 1.51-4.79) , history of previous chest pain(OR =2.33, 95％ CI: 1.07-5.11) , surgical status(OR =2.32, 95 ％ CI: 0.94-5.73) , previous history of hypertension (OR =2.24, 95 ％ CI: 1.19-4.23), preoperative critical state (OR =2.14, 95％ CI: 1.27-3.60) and age ＞ 50 years (OR =1.57, 95 ％ CI: 1.18-2.09).Our risk model showed good calibration and discriminative power for the development data set, validation data set, and three subgroup in which Hosmer-Leme-show test' s P value were greater than 0.05 and the area under the ROC curve were greater than 0.70.Scoring methods: age 51-60years: 1 point, age 61-70 yeas: 2 points, age ＞70 years: 3 points;history of hypertension: 1 point;creatinine ＞ 110 umol/L: 4 points;NYHA class stage Ⅱ : 2 points, NYHA class stage Ⅲ: 4 points;NYHA class stage Ⅳ: 6 points;history of previous chest pain: 1point;preoperative critical condition: 2 points;urgent surgery: 2 points: emergency surgery: 4 points.Conclusion We have created a new risk prediction model and risk score, which can accurately predicts outcomes in patients undergoing heart valve surgery for our center.Furthermore, our risk model can also enable benchmarking and comparisons between multicenter in a meaningful way in the future.

An analysis of relevant factors of early death in acute paraquat poisoning / 中华危重病急救医学

Objective To determine the clinical indicators of early death (within 72 hours) in patients with acute paraquat poisoning.Methods The data of 93 acute paraquat poisoning patients admitted to emergency intensive care unit (EICU) of the First Hospital of China Medical University were retrospectively analyzed.The patients were divided into two groups according to whether they died within 72 hours or not.The gender,age,poison dose,paraquat concentration in urine,reduction of paraquat amount in urine after each hemoperfusion,and the worst value of white blood cell (WBC) count,lymphocytes count,arterial blood gas analysis,blood K +,Na+,Cl-,and serum amylase,serum lipase,serum total bilirubin,troponin Ⅰ,creatine kinase (CK),blood urea nitrogen,serum creatinine within 24 hours after poisoning were compared.Spearman correlation analysis was used to analyze the correlation between paraquat concentration in urine and the dose of paraquat.The predictive value of each indicator at death in early stage of poisoning was analyzed with receiver operating characteristic curve (ROC curve).Results Nineteen patients in the group of those died in early stage of poisoning (within 72 hours) resulted in a mortality rate of 20.4％.Compared with non-early death group,in early death group,the value of poison dose (mL:133.4 ± 108.8 vs.58.6 ± 40.0,t=3.145,P=0.002),paraquat concentration in urine [mg/L:16.34 (11.87,96.76) vs.4.46 (1.21,12.78),Z=-3.422,P=0.001],WBC (× 109/L:22.63 ±9.72 vs.14.95 ±8.39,t=3.446,P=0.001),blood lactate [Lac (mmol/L):6.7 (2.2,12.1) vs.1.9 (1.1,3.4),Z=-3.294,P=0.001] were significantly higher,and the reduction rate of paraquat concentration in urine after first perfusion [(38.4 ± 15.63)％ vs.(67.59 ± 27.87)％,t=2.945,P=0.004] and arterial partial pressure of carbon dioxide [PaCO2 (mmHg,1 mmHg=0.133 kPa):28.7 ± 9.3 vs.34.8 ± 6.7,t=-3.245,P=0.002] were significantly lowered.There was no significant difference between two groups in other indexes.Poison dose and paraquat concentration in urine showed significantly positive correlation (r=0.450,P＜0.001).ROC curve showed that the predictive value of paraquat concentration in urine,WBC,and Lac in early death were significant [area under the ROC curve (AUC) of paraquat concentrations in urine was 0.806,95％ confidence interval (95％CI) 0.699-0.913,the cut-off value was 11.64 mg/L,with sensitivity 84.6％,specificity 71.4％; AUC of WBC was 0.734,95％CI 0.569-0.899,the cut-off value was 15.94 × 109/L with sensitivity 69.2％,specificity 76.8％ ; AUC of Lac was 0.729,95％CI 0.568-0.891,the cut-off value was 1.95 mmol/L with sensitivity 84.6％,specificity 42.9％].Conclusions Paraquat concentrations in urine,WBC,Lac,poison dose and PaCO2 were the risk factors of the early death of the acute paraquat poisoning.The research suggests that paraquat concentration in urine,WBC and Lac are valuable in predicting early death of the patients.

Risk factors for early death in patients with cervical spinal cord injury / 中华创伤杂志

Objective To explore the causes and risk factors affecting early death in patients with traumatic cervical spinal cord injury (SCI). Methods Clinical data of 553 patients with traumatic cervical SCI were analyzed retrospectively to discuss the related factors affecting early death of patients with traumatic cervical SCI by using univariate analysis and multivariate logistic regression analysis. Results The early mortality of the patients with traumatic cervical SCI was 4.0% ( 22/553 ). The main causes of the early death were respiratory failure in nine patients (40.9%) and electrolyte disorders in five (22.7%). Univariate analysis showed that age, cervical spinal cord injury severity, complications in respiratory, cardiovascular, digestive systems and electrolyte disturbance as well as tracheotomy were considered statistically significant for early death in patients with traumatic cervical SCI ( P < 0, 05 ). Multivariate logistic regression analysis showed that age, cervical SCI severity, complications in respiratory,cardiovascular system and electrolyte disturbance as well as tracheotomy. Conclusion Severe cervical SCI, combined respiratory, cardiovascular system and electrolyte disorder complications as well as tracheotomy are high risk factors for the early death in patients with traumatic cervical SCI.

Primary Study of the Factors Causing Early Death in Patients with Acute Severe Cervical Spinal Cord Injury / 中国微创外科杂志

Objective To study the causes of early death of patients with acute severe cervical spinal cord injury.Methods A retrospective analysis was done on 78 cases of acute severe cervical spinal cord injury,who were treated in our hospital between January 2003 and December 2007.The patients were divided into death group and survival group(survived more than 30 days after the injury).The clinical data including age,level of spinal cord injury,time of injury and admission,surgical treatment,duration between injury and surgery,neurogenic shock,central hyperthermia,hyponatremia,serum level of albumin,percentage of lymphocytes in serum,tracheotomy,and pulmonary infection,were recorded and analyzed. Results The proportion of high-level spinal cord injures(C1-C4) in death group(8/9) was significantly higher than that in the survival group(49/69,?2=18.086,P=0.000).Whereas the duration between injury and surgery in the death group was significantly shorter than that in the survival group(1-12 d,median 2 d vs 1-39 d,median 3 d;Z=-2.664,P=0.008).In the death group,4 of the 9 patients had neurogenic shock,and 4 developed hyponatremia,which were significantly more than those in the survival group(6/69,?2=12.392,P=0.000;19/69,?2=4.526,P=0.033).The percentage of peripheral lymphocyte on admission was(11.84?5.80)% in the death group,which was significantly lower than that of the survival group(19.17?16.64)%(t=-4.006,P=0.000).In the death group,7 patients received tracheotomy,and 8 patients showed pulmonary infection,the proportions were significantly higher than those in the survival group(10/69,?2=29.749,P=0.000;and 15/69,?2=17.266,P=0.000).Conclusions Several factors,including high-level injury(C1-C4),neurogenic shock,pulmonary shock,and tracheotomy,may cause the death of patients with acute severe cervical spinal cord injury in an early stage.

Evaluating early death rate with years of potential life lost (YPLL) in Ba Vi district, Ha Tay province in 2002-2003

Researching 485 cases of death in two years (2002-2003) at Bavi district, the findings showed that: The crude death rate in the whole of district is 5.20%o in the year 2002 and 4.68%o in the year 2003. The death rate is higher in men than women (5.66%o) compared to 4.77%o and compared to 3.62%o). YPLL in the years of 2002-2003: The burden of mortality is higher in men than women (2002: men/women = 1.24/1; 2003: men/women: 2.6/1).The burden of mortality focused on groups of under 5, over 60 and 20-60 years old. The burden of mortality in group of school ages is lowest. By group of disease, YPLL is highest at external causes (death from drowning, injury, accident).

The Causes of Early Death in End-stage Renal Disease Patients / 대한신장학회잡지

BACKGROUND: Despite improvements in dialysis care, the mortality of patients with end-stage renal disease(ESRD) remains high. Patients who die within the first 90 days after beginning dialysis are not included in mortality rates and may be absent from incidence count. Therefore, the identification of modifiable characteristics associated with the risk of death during the first 90 days of treatment could lead to improved survival during this interval. METHODS: We performed a retrospective analysis in 986 patients(at least 1 year survival from initiating dialysis were 920 patients, and 66 patients died within 90 days after dialysis) who were initiated renal replacement therapy first at Yonsei Medical Center from Jan 1994 to Jun 1999. RESULTS: The 1 year mortality rate of total patients was 10.4%, and early death rate was 6.9%. The mean survival duration was 28.9+/-23.0 days. Characteristics independently associated with increased risk of early death included older age, inflammation, nutritional impairment, more comorbid condition and previous history of cardiovascular disease at starting dialysis. But Diabetes was not increased early death rate. By multivariate logistic regression analysis, old age, combined comorbid conditions, especially malignancy and congestive heart failure, low serum album and elevated C-reactive protein level were the independent risk factors affecting early death. Other variables such as sex, dyslipidemia, hypertension and diabetes mellitus were not significant risk factors. The leading cause of death in early death group was infection rather than cardiovascular accidents. CONCLUSION: Proper treatment of infection and improved nutritional status by adequate predialytic managements may contribute to their prolonged survival on dialysis patients.

Initial CT Findings of the Early Death after Head Injury

We examined the initial CT findings of the early(within on week) death after head injury, retrospectively. The patient population consisted of 182 patients who were admitted to the Soonchunhyand University Chonan Hospital, and were examined by CT, from August 1986 to May 1990 after head injury. We compared clinical features and radiological findings between the group of focal lesion and the group of diffuse lesion. The focal lesion was found in 47.8%, while the diffuse lesion was found in 45.6%. Statistically significant differences were found in the age, Glasgow Coma Score(GCS) on admission, injury Severity Score(ISS), hypotension, and hypoxia. The focal lesion was more common in the aged, while the diffuse lesion was common in the young(less than 40 years of age). Patients with high GCS(more than 8) constitued 25.3% of the focal lesion, while only 6.0% of the duffuse lesion had the high GCS. ISS was higher than 30 in 67.5% of the diffuse lesion, while 32.2% of the focal lesion had ISS of 30 or more. The causes of injury was pedestrian traffic accident in 46.5% and passanger's traffic accident in 31.8%. Midline shift(more than 3mm), compressed ventricles, and obliteration of the suprasellar cistern and quadrigeminal cistern were observed in 34.1%, 82.4%, 67.6%, and 58.2%, respectively. Lesions with severe midline shift were focal in 93.1% and lesions without midline shift were diffuse in 88.4%(P<0.005). Cranial vault fracture was noticed in 68.2%, and basal skull fracture was found in 28.8%. The frequency of basal skull fracture was high in the diffuse lesion(P<0.005). In this study, we could presumed that 17.2% to 25.3% of the patients with focal lesions could be saved, if proper treatment was given. Since the diffuse lesion was responsible for nearly half of the early death after head injury, proper treatment or prevention should be made. Prevention of the diffuse lesion seems to be possible by correction of hypotension and hypoxia for the diffuse lesions were intimately related to them. At any event, further studies on the diffuse brain injury are required.

Systemic Insults in the Early Death after Head Injury

We present a study on the systemic insults in the early death(within one week) after head injury. The patient population consisted of 192 patients who were admitted to the Soonchunhyang University Chonan Hospital from August 1986 to May 1990 after head injury. We collected clinical features and systemic insults including blood pressure, arterial pH, PaO2, PaCO2, hematocrit, and serum concentration of Na, retrospectively. The most common cause of injury was road traffic accident(77.6%). More than half(57.8%) were under the age of 40 years. The interval from injury to admission was within one hour in 63.2%, and within four hours in 91.4%. The mean interval was 1.8 hours. However, in 154(80.2%) patients, we found the evidence of systemic insults on admission. We found hypotension(ststolic less than 90mmHg) in 22.9%, acidemia(pH45mmHg) in 28.7%, anemia(hematocrit145mEq/L) in 11.2%. These results imply that the prehospital emergency care system useful at the scene of accident and during the transportation is more important than the simple quick-transport-system.