Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe

BackgroundMultimorbidity poses a global challenge to healthcare delivery. This study aimed to describe the prevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort of patients undergoing major abdominal surgery.MethodsThis was a pre-planned analysis of a prospective, multicentre, international study investigating cardiovascular complications after major abdominal surgery conducted in 446 hospitals in 29 countries across Europe. The primary outcome was 30-day postoperative mortality. The secondary outcome measure was the incidence of complications within 30 days of surgery.ResultsOf 24,227 patients, 7006 (28.9%) had one long-term condition and 10,486 (43.9%) had multimorbidity (two or more long-term health conditions). The most common conditions were primary cancer (39.6%); hypertension (37.9%); chronic kidney disease (17.4%); and diabetes (15.4%). Patients with multimorbidity had a higher incidence of frailty compared with patients <= 1 long-term health condition. Mortality was higher in patients with one long-term health condition (adjusted odds ratio 1.93 (95%CI 1.16-3.23)) and multimorbidity (adjusted odds ratio 2.22 (95%CI 1.35-3.64)). Frailty and ASA physical status 3-5 mediated an estimated 31.7% of the 30-day mortality in patients with one long-term health condition (adjusted odds ratio 1.30 (95%CI 1.12-1.51)) and an estimated 36.9% of the 30-day mortality in patients with multimorbidity (adjusted odds ratio 1.61 (95%CI 1.36-1.91)). There was no improvement in 30-day mortality in patients with multimorbidity who received pre-operative medical assessment.ConclusionsMultimorbidity is common and outcomes are poor among surgical patients across Europe. Addressing multimorbidity in elective and emergency patients requires innovative strategies to account for frailty and disease control. The development of such strategies, that integrate care targeting whole surgical pathways to strengthen current systems, is urgently needed for multimorbid patients. Interventional trials are warranted to determine the effectiveness of targeted management for surgical patients with multimorbidity

Amniotic fluid thyrotropin (TSH) following maternal administration of thyrotropin releasing hormone

Peer Reviewe

Influence of dipyridamole stress echocardiography on galectin-3, amino-terminal B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T.

Non-invasive assessment using a pharmacological provocative test is an essential part of the workup of patients admitted to the emergency department with chest pain. Some doubts, however, remain about the safety of dipyridamole stress echocardiography in patients with non-diagnostic troponin and ECG. Methods and results: Twenty-nine consecutive patients admitted to the emergency department with chest pain and no evidence of acute coronary syndrome were subjected to standard dipyridamole stress echocardiography. Blood samples for measurement of galectin-3, NT-proBNP and high-sensitivity troponin T (HS-TnT) were collected at the baseline and after provocative testing. The provocative test was positive in 7/29 patients. As compared with baseline measurements, no significant differences were observed in 1-h values of HS-TnT (10.7 versus 10.5 ng/L; P = 0.085) and galectin-3 (14.3 versus 13.7 ng/mL; P = 0.128), whereas values of NT-proBNP were slightly higher (126 versus 111 ng/L; P = 0.002). The 1-h delta variation of patients with a positive provocative test was significantly higher than that of patients with negative provocative testing for galectin-3 (1.12 versus 1.00; P 1 in all patients with a positive provocative test as compared with 50% of patients with a negative provocative test (P = 0.018). Conclusions: Dipyridamole stress testing did not trigger clinically meaningful injuries to the myocardium. Galectin-3 testing may hence be preliminarily regarded as a complementary means for enhancing the diagnostic value of provocative testing. It is also worthwhile investigating whether patients with abnormal response to a provocative test and increased galectin-3 values may be targeted with specific therapy

Full interferometric map of the L1157 southern outflow: Formamide (NH2CHO) can form in the gas, after all

International audienceContext. The formation mechanism of interstellar formamide (NH2CHO), a key prebiotic precursor, is currently a matter of hot debate within the astrochemistry community, with both gas-phase and grain-surface chemical pathways having been proposed as its dominant formation route.Aims. The aim of the present study is to place firm observational constraints on the formation pathways leading to formamide thanks to new interferometric observations of the molecular outflow driven by the protostellar binary L1157.Methods. We employed the IRAM NOEMA interferometer to map the entire southern outflow of L1157, which contains three main shocked regions with increasing post-shock age: B0, B1, and B2. This allowed us to measure how the abundance of formamide, that of acetaldehyde (CH3CHO), and the ratio of the two, vary with time in this region. In order to gain a greater understanding of the most likely formation routes of formamide, we ran a grid of astrochemical models and compared these to our observations.Results. A comparison between observations and astrochemical modelling indicates that there are two possible scenarios: one in which the amount of formamide observed can be explained by gas-phase-only chemistry, and more specifically via the reaction H2CO + NH2 → NH2CHO + H2 , and another in which part of the observed formamide originates from surface chemistry and part from gas-phase chemistry. Surface chemistry alone cannot account for the abundance of formamide that we measure.Conclusions. While grain-surface chemistry cannot be ruled out, the present study brings definitive proof that gas-phase chemistry does work in L1157-B and acts efficiently in the production of this molecular species