Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Mortality Determinants”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed2005

Predictors of mortality in HIV-1 exposed uninfected post-neonatal infants at the Kenyatta National Hospital, Nairobi.

OBJECTIVES: To identify potential predictors of mortality, to determine mortality rate and to identify prevalent causes of death in a cohort of HIV-1 exposed uninfected infants. DESIGN: Prospective cohort study. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: Three hundred and fifty one HIV-1 exposed uninfected post-neonatal infants who survived to one year of age. RESULTS: Sixteen infants died (post-neonatal mortality rate of 47/1000 live births), 14 (88%) before six months of age. The most frequently identified medical conditions at death included bronchopneumonia, diarrhoea and failure to thrive. In multivariate analysis, prematurity (RR=10.5, 95%CI 3.8-29.1, p<0.001), teenage motherhood (RR=3.6, Cl 1.0-13.2, p=0.05) and symptomatic maternal HIV-1 disease (RR=2.7, CI 0.9-7.7, p=0.06) were associated with infant mortality. CONCLUSION: Prematurity, teenage motherhood and symptomatic HIV-1 maternal disease were important predictors for post-neonatal mortality in this cohort of HIV-1 exposed uninfected infants. These factors should be considered in monitoring and follow up in prevention of mother-to-child HIV-1 transmission (PMTCT) programs.

Adolescent↗
PubMed1996

Severe pancreatitis. Determinants of mortality in a tertiary referral center.

OBJECTIVE: To determine factors associated with mortality in patients with severe pancreatitis. DESIGN: Retrospective review. SETTING: University tertiary referral center intensive care unit (ICU). PATIENTS: Thirty patients admitted to the ICU with the primary diagnosis of pancreatitis from 1986 to 1995. MAIN OUTCOME MEASURE: Survival vs nonsurvival. RESULTS: Twenty-seven patients were transferred from another institution. At the time of ICU admission, subsequent death was not associated with the following: systolic blood pressure, pulse rate, hemoglobin level, leukocyte count, platelet count, or serum calcium concentration. The patients who died during the study were older at admission (age [mean+/-SD] of those who lived, 47+/-17 years; age of those who died, 64+/-8 years; P=.01) and their serum creatinine concentrations were higher (creatinine concentrations [mean +/-SD] of those who lived, 150+/-90 micromol/L [1.7+/-1.0 mg/dL]; creatinine concentrations of those who died, 410+/-250 micromol/L [4.6+/-2.8 mg/dL]; P=.001). Clinical events not associated with mortality included respiratory failure, insulin use, positive blood cultures, positive pancreatic cultures, and abdominal surgery for pancreatitis and infected pancreatic necrosis. Death was associated with the use of inotropic and/or vasopressor support (P=.05) and renal failure (creatinine, >170 micromol/L[>2.0 mg/dL]) at any time during the ICU stay (P=.01). Patients with renal failure were no older than the patients without, but were admitted later after the onset of pancreatitis (mean+/-SD, 5.9+/-7.2 days vs 1.5+/-1.1 days; P=.03; median, 2 days vs 1 days). CONCLUSIONS: After hospital transfer to a teritiary referral center, only older age, use of inotropic and/or vasopressor support, and evidence of renal malfunction are associated with death. Prompt recognition of severe pancreatitis, especially in older patients, aggressive hemodynamic management, and/or earlier transfer to a tertiary care center may diminish the incidence of renal failure and mortality in severe pancreatitis.

Adult↗
PubMed1999

Dietary questions as determinants of mortality: the OXCHECK experience.

OBJECTIVE: To determine whether responses to simple dietary questions are associated with specific causes of death. DESIGN: Self-reported frequency intakes of various classes of foods and data on confounding factors were collected at the baseline survey. Death notifications up to 31 December 1997 were ascertained from the Office for National Statistics. Relative risk (RR) of death and 95% confidence intervals (CI) associated with baseline dietary factors were calculated by Cox regression. SETTING: Prospective follow-up study based on five UK general practices. SUBJECTS: Data were used from 11,090 men and women aged 35-64 years (81% of the eligible patient population) who responded to a postal questionnaire in 1989. RESULTS: After 9 years of follow-up, 598 deaths were recorded, 514 of these among the 10,522 subjects with no previous history of angina. All-cause mortality was positively associated with age, smoking and low social class, as expected. Among the dietary variables, all-cause mortality was significantly reduced in participants who reported relatively high consumption of vegetables, puddings, cakes, biscuits and sweets, fresh or frozen red meat (but not processed meat), among those who reported using polyunsaturated spreads and among moderate alcohol drinkers. These associations were broadly similar for deaths from ischaemic heart disease (IHD), cancer and all other causes combined, and were not greatly attenuated by adjusting for potential confounding factors including social class. CONCLUSIONS: Responses to simple questions about nutrition were associated with mortality. These findings must be interpreted with caution since residual confounding by dietary and lifestyle factors may underlie the associations.

Adult↗
PubMedDate not supplied

A theoretical model of the determinants of mortality.

Outcome research in nursing has been criticized for being atheoretical. Although there has been research investigating patient mortality as an outcome, there has been little discussion about models or theories of nursing-related determinants of mortality for hospitalized patients. Yet, unnecessary patient mortality is an important patient safety outcome. This article describes development of beginning theory of determinants of patient mortality culminating with a revised mortality model. Conclusions are made related to plans for further testing and refinement of the revised mortality model. Further, the utility of the proposed model in practice is discussed.

Acute Disease↗
PubMed2003

Determinants of child mortality in LDCs: empirical findings from demographic and health surveys.

Empirical studies on child mortality at the disaggregated level-by social-economic group or geographic location-are more informative for designing health polices. Using Demographic and Health Survey data from over 60 low-income countries, this study (1) presents global patterns of the level and inequality in child mortality and (2) investigates the determinants of child mortality, both at the national level and separately for urban and rural areas. The global patterns of health outcomes reveal two interesting observations. First, as child mortality declines, the gap in mortality between the poor and the better-off widens. Second, while child mortality in rural areas is substantially higher than in urban areas, the reduction in child mortality is much slower in rural areas where the poor are concentrated. This suggests that health interventions implemented in the past decade may not have been as effective as intended in reaching the poor. The analysis on mortality determination shows that at the national level access to electricity, incomes, vaccination in the first year of birth, and public health expenditure significantly reduce child mortality. The electricity effect is large and independent of the income effect. While in urban areas, access to electricity is the only significant mortality determinant, in rural areas, vaccination in the first year of birth is the only significant factor.

Child, Preschool↗
PubMed1997

Clinical determinants of mortality in patients with angiographically diagnosed ischemic or nonischemic cardiomyopathy.

OBJECTIVES: We sought to characterize the clinical determinants of mortality in patients with angiographically diagnosed ischemic or nonischemic cardiomyopathy. BACKGROUND: Patients with ischemic cardiomyopathy may have a worse prognosis than patients with nonischemic cardiomyopathy. Few studies have assessed the effect of ischemic versus nonischemic etiology on outcomes. METHODS: We analyzed prospectively collected data on 3,787 patients with a left ventricular ejection fraction < or = 40% who underwent coronary angiography. Patients were considered to have ischemic cardiomyopathy (n = 3,112) if they had a history of myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery or at least one major epicardial coronary artery with > or = 75% stenosis; all others were considered to have nonischemic cardiomyopathy (n = 675). RESULTS: The median age, ejection fraction and proportion of patients with New York Heart Association functional class III or IV symptoms for the nonischemic and ischemic groups were 55 years versus 63 years, 27% versus 32% and 57% versus 25%, respectively. After adjustment for baseline clinical risk factors and presenting characteristics, ischemic etiology remained an important independent predictor of 5-year mortality (p < 0.0001). The extent of coronary artery disease was a better predictor of survival than ischemic or nonischemic etiology (log likelihood chi-square 700 vs. 675, respectively). CONCLUSIONS: Ischemic etiology is a significant independent predictor of mortality in patients with cardiomyopathy. However, the extent of coronary artery disease contributes more prognostic information than the clinical diagnosis of ischemic or nonischemic cardiomyopathy. Further research is needed to refine the clinical definition of ischemic cardiomyopathy so that physicians can appropriately prescribe treatment and accurately predict outcome.

Adult↗
PubMed2000

Factors determining operative mortality of grade V blunt hepatic trauma.

BACKGROUND: Despite recent advances in the management of severe hepatic injuries, the operative mortality rate of grade V hepatic injuries still ranges from 67% to 80%. Grade V hepatic injuries involving the retrohepatic cava or main hepatic veins are almost always lethal, especially those from blunt trauma. The purpose of this study is to understand the risk factors determining operative mortality in grade V blunt hepatic trauma, and to try to improve the surgical management of these injuries. METHODS: A retrospective study was conducted at a medical center that offers services including primary, secondary, and tertiary care. Forty-four patients with grade V blunt hepatic injuries were treated during a 6-year period from January 1, 1991, to December 31, 1996. The operative mortality was compared by a multivariate analysis. RESULTS: Forty-four patients with grade V blunt hepatic injuries were identified. Seven patients had only parenchymal injuries, and the others had vascular and associated parenchymal injuries. Venorrhaphy was used in 37 patients; 29 were treated using a nonshunting approach, and 8 with an atriocaval shunt. The overall mortality rate was 68% (30 of 44), and liver-related mortality was 50% (22 of 44). Univariate analysis revealed that the significant variables affecting operative mortality were initial systolic blood pressure, initial base deficit, the Glasgow Coma Scale, injury type, number of resected segments, and total intraoperative blood loss. Based on forward stepping logistic regression analysis, patients with an initial base deficit of -6 mmol/L or less (relative risk = 17.3), and a total intraoperative blood loss of 5,000 mL or more (relative risk = 23.5) would, significantly, encounter a worsening prognosis. CONCLUSIONS: Initial base deficit and total intraoperative blood loss were the significant factors that determined operative mortality after grade V blunt hepatic trauma. We suggest that prompt resuscitation and expeditious and appropriate surgical management, to control operative blood loss, is the only way to reduce operative mortality in patients with grade V blunt hepatic trauma.

Adolescent↗
PubMed1998

Outcome of patients with cirrhosis requiring intensive care unit support: prospective assessment of predictors of mortality.

Determinants of outcome and the utility of the Child-Pugh score and the acute physiology and chronic health evaluation (APACHE) II score as predictors of outcome were prospectively assessed in 54 consecutive patients with cirrhosis requiring intensive care unit (ICU) management. Overall mortality in the ICU was 43% (23/54). Child-Pugh scores did not differ between survivors or nonsurvivors (12.8 versus 12.3, P = 0.26), however APACHE II scores (P = 0.007), acute physiology scores (P = 0.006), and Karnofsky scores (P = 0.001) were significant predictors of outcome. By univariate analysis, requirement of mechanical ventilation analysis (P = 0.001), duration of mechanical ventilation (P = 0.001), pulmonary infiltrates (P = 0.0001), infections (P = 0.047), gastrointestinal bleeding (P = 0.005), and serum creatinine >1.5mg/dl (P = 0.0005) were significantly associated with mortality. By logistic regression analysis only pulmonary infiltrates (P = 0.0001) and renal dysfunction (P = 0.041) were independent predictors of mortality. When controlled for the severity of illness (APACHE II scores), the mortality in patients with cirrhosis caused by alcohol was significantly lower than that in patients with liver disease not caused by alcohol (P = 0.01). Our study not only identified predictors of poor outcome in patients with cirrhosis requiring ICU care but also provided data that may have implications for optimal timing for transplantation.

APACHE↗
PubMed1984

Postoperative pneumonia. Determinants of mortality.

Postoperative pneumonia continues to be a major cause of mortality on surgical services. The determinants that affect survival in patients in whom postoperative pneumonia develops are not clearly defined. We completed a retrospective analysis of 136 patients in whom postoperative pneumonia developed after they had major operative procedures between 1974 and 1980. These patients represented 1.3% of all operative cases, yet comprised 10% of the total 614 patients who died during the study period. The average age of the patients in whom pneumonia developed was 66 years. Significant determinants of death by chi 2 analysis included gram-negative pneumonitis, emergent operation, respirator-acquired pneumonia, postoperative peritonitis, and several factors that suggested that host defenses were overwhelmed (remote organ failure, positive blood cultures, or spread of infection to the second lung). We concluded that postoperative pneumonia is a disease of elderly patients and that survival depends on the ability of the surgeon to help the patient localize and resist the challenge presented by virulent gram-negative organisms.

Aged↗
PubMed1987

Failure of passive immunoglobulin transfer: a major determinant of mortality in newborn alpacas (Lama pacos).

Failure of passive transfer (FPT) of immunoglobulin from colostrum was demonstrated as a major determinant of mortality in newborn alpacas (Lama pacos; crias). Serum IgG concentrations of dying crias were significantly (P less than 0.0001) lower than were serum IgG concentrations of crias that lived. Of 82 crias, 10 (12%) died within 1 month of age, and 7 of these had 0 to 9 mg of IgG/ml of serum at 48 hours after birth; 5 of the 7 had evidence of infectious diseases. The serum IgG concentrations of the remaining dead crias were 12, 13, and 20 mg/ml. On the basis of serum IgG concentrations of crias that died in the first month, FPT was defined as a 48-hour serum IgG concentration less than 9 mg/ml, which was greater than 2 SD below the 48-hour mean of clinically normal crias. Using this definition, the prevalence of FPT in the 82 crias studied was 9%. Corroborative evidence of the relationship between FPT and mortality was obtained from a retrospective study of 21 dead crias. The postmortem serum IgG concentration of 5 crias that died 2 to 10 days after birth ranged from less than 1 to 3 mg/ml; all were greater than 2 SD below the mean of age matched clinically normal crias. The range of serum IgG concentration was 2.2 to 21 mg/ml in 8 crias that died 11 to 20 days after birth; serum IgG concentration in 1 cria was greater than 2 SD below the normal mean, and 6 were greater than 1 SD below the normal mean.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Determinants of mortality for necrotizing soft-tissue infections.

OBJECTIVE: The authors determined the risk factors of mortality in patients with necrotizing soft-tissue infections (NSTIs) and examined the incidence and mortality from NSTI secondary to Streptococcus pyogenes. METHODS: All patients with NSTIs who were treated between January 1989 and June 1994 were analyzed for presentation, etiology, factors important in pathogenesis and treatment, and mortality. RESULTS: Sixty-five patients were identified with NSTIs secondary to postoperative wound complications (18), trauma (15), cutaneous disease (15), idiopathic causes (10), perirectal abscesses (3), strangulated hernias (2), and subcutaneous injections (2). Necrotizing soft-tissue infections were polymicrobial in 45 patients (69%). S. pyogenes was isolated in only 17% of the NSTIs, but accounted for 53% of monomicrobial infections. Eight of ten idiopathic infections were caused by a single bacterium (p = 0.0005), whereas 82% of postoperative infections were polymicrobial. An average of 3.3 operative debridements per patient and amputation in 12 patients were necessary to control infection. The overall mortality was 29%; mortality from S. pyogenes infection was only 18%. The average time from admission to operation was 90 hours in nonsurvivors versus 25 hours in survivors (p = 0.0002). Other risk factors previously associated with the development of NSTIs did not affect mortality. CONCLUSIONS: Early debridement of NSTI was associated with a significant decrease in mortality. S. pyogenes infection was the most common cause of monomicrobial NSTI, but was not associated with an increased mortality.

Debridement↗
PubMed2001

Long-term results and determinants of mortality after surgery for native and prosthetic valve endocarditis.

BACKGROUND AND AIM OF THE STUDY: The study aim was to describe the long-term results and determinants of mortality after operative treatment of native and prosthetic valve endocarditis at a single institution. METHODS: Between March 1985 and October 1999, 171 patients underwent surgery for native (NVE) or prosthetic valve endocarditis (PVE). NVE was present in 98 patients (57%), and PVE in 73 patients (43%). Mean follow up was 5.6+/-3.9 years (range: 0 to 15 years). RESULTS: Overall hospital mortality was 9.9% (n = 17). Hospital mortality was higher among patients with PVE (15.1%) than those with NVE (6.1%; p = 0.05). Overall survival at 10 years was 46+/-5%. Patients with NVE had a higher 10-year survival rate (53+/-7%) than those with PVE (37+/-7%; p = 0.02). At 10 years, overall freedom from any late complication was 47+/-6% and from residual or recurrent endocarditis was 78+/-5%. Predictors of hospital death were emergency surgery (p <0.003) and preoperative renal insufficiency (p <0.008). Predictors of late death were age >70 years (p <0.002), renal failure (p <0.03) and fungal endocarditis (p <0.04). CONCLUSION: These findings demonstrate the increased perioperative, as well as postoperative, risks associated with PVE versus NVE. Cardiac and extracardiac manifestations of the disease, as well as fungal organisms, but not the activity of the endocarditis, were significant adverse determinants of late outcome.

Endocarditis↗
PubMed2004

Perioperative determinants of mortality and morbidity in distal arch and proximal descending aortic aneurysm surgery.

BACKGROUND: The purpose of this article is to describe our experience on distal arch and proximal descending aortic aneurysm repair, and to evaluate retrospectively the determinants of mortality and morbidity. MATERIAL/METHODS: Between 1994 and 2002, 30 patients (mean age 53.4 years) underwent repair of distal arch or proximal descending aortic aneurysm approached through left thoracotomy with deep hypothermic circulatory arrest. Femoro-femoral bypass was used in all patients except for four, in whom the left subclavian artery was cannulated. Retrograde cerebral perfusion was performed in 16 patients. The mean circulatory arrest time was 30.7 min. RESULTS: Overall hospital mortality was 13.3%. Excessive blood (p=0.008) and plasma (p=0.009) transfusions, and coronary artery disease (p=0.012) were correlated with mortality. The overall rate of postoperative complications was 30%. Renal failure and respiratory failure were the most frequent complications (16.7%), while the rates of stroke and transient neurological dysfunction were 6.7% and 3.3%, respectively. Age >70 years, bypass time >140 min, distal ischemia time >55 min, and excessive blood or plasma transfusions were determinants of postoperative complications. CONCLUSIONS: Deep hypothermic circulatory arrest with left thoracotomy is a valid procedure with acceptable mortality rates in the management of aneurysms of distal arch and proximal descending aorta. Prolonged bypass and distal ischemia times and excessive blood transfusions are associated with increased postoperative morbidity.

Adult↗
PubMed2003

Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality.

BACKGROUND: Necrotizing fasciitis is a life-threatening soft-tissue infection primarily involving the superficial fascia. The present report describes the clinical presentation and microbiological characteristics of this condition as well as the determinants of mortality associated with this uncommon surgical emergency. METHODS: The medical records of eighty-nine consecutive patients who had been admitted to our institution for necrotizing fasciitis from January 1997 to August 2002 were reviewed retrospectively. RESULTS: The paucity of cutaneous findings early in the course of the disease makes the diagnosis difficult, and only thirteen of the eighty-nine patients had a diagnosis of necrotizing fasciitis at the time of admission. Preadmission treatment with antibiotics modified the initial clinical picture and often masked the severity of the underlying infection. Polymicrobial synergistic infection was the most common cause (forty-eight patients; 53.9%), with streptococci and enterobacteriaceae being the most common isolates. Group-A streptococcus was the most common cause of monomicrobial necrotizing fasciitis. The most common associated comorbidity was diabetes mellitus (sixty-three patients; 70.8%). Advanced age, two or more associated comorbidities, and a delay in surgery of more than twenty-four hours adversely affected the outcome. Multivariate analysis showed that only a delay in surgery of more than twenty-four hours was correlated with increased mortality (p < 0.05; relative risk = 9.4). CONCLUSIONS: Early operative débridement was demonstrated to reduce mortality among patients with this condition. A high index of suspicion is important in view of the paucity of specific cutaneous findings early in the course of the disease.

Adult↗
PubMedDate not supplied

[Unequal conditions for longevity--determinants of mortality from the longitudinal perspective].

Longitudinal data of the German Socioeconomic Panel (GSOEP) offer new possibilities to identify the determinants for longevity respective the mortality risk. A panel probit model shows that beyond the cohort effects a low income position and a low educational level are determinants which increase the mortality risk dramatically. Widowhood and small family size also have increasing effect on mortality for men while marital status of single (unmarried, separated, divorced) has shortening effect on a woman's life expectancy. Reduced societal participation creates conditions which increase the mortality risk.

Aged↗