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Background: Although sepsis is a well-known cause of in-hospital mortality, data on long term outcomes are scarce. Aim: This study aims to estimate the cumulative 5-year mortality among patients with infection requiring admission. Methods: This was a cohort study done in tertiary care center in South India, with recruitment of those admitted with an infection between January 1st, 2009 and July 31st, 2014 in a medical unit. The patients were followed up by telephonic call or case record review. Kaplan–Meier survival curve was plotted and Cox-proportional hazard model was used as multivariable analysis to identify the independent risk factors of long-term mortality. Results: One thousand four hundred and fifty three patients were followed up in this cohort study. The mean survival by Kaplan–Meier survival analysis was 3.78 years (95% confidence interval [CI] 3.33, 4.22) in quick sepsis-related organ failure assessment (qSOFA) score positive patients and 6.07 years (95% CI 5.73, 6.41) in qSOFA negative patients which was statistically significant by the log-rank test. The cumulative 1-year mortality was 44.9% and 21.8% for qSOFA score of 2 or more and nonsepsis patients, respectively. The median survival of qSOFA score of 2 or more patients was 0.75 years (95% CI 0–2.1 years). The mortality among sepsis patients at discharge, 1 year, 5 and 8 years was 38.2%, 44.9%, 47.4%, and 47.8%, respectively. Cox regression analysis showed age hazard ratio (HR) 1.02 (1.01, 1.04), male gender 1.45 (1.03, 2.04), >qSOFA score HR 1.89 (1.32, 2.72), Charlson Comorbidity Index HR 1.29 (1.14, 1.46), respiratory tract infection HR 1.81 (1.10, 2.95), and inotrope requirement HR 3.24 (1.98, 5.29) were the independent predictors of long-term mortality. Conclusions: The median survival of patients with possible infection with qSOFA score of 2 or more patients was 0.75 years (95% CI 0–2.1 years). Older age, male gender, qSOFA score of 2 or more, Charlson Comorbidity Index, respiratory tract infection, and inotrope requirement HR 3.24 were the independent predictors of long-term mortality.

Introduction: Long-term quality of life, return to work, economic consequences following Acute Respiratory Distress Syndrome (ARDS) are not well described in India. This study was aimed to address the question. Methods: A prospective cohort study of 109 ARDS survivors were followed up for a minimum of 6 months following discharge. Quality of life was assessed using the SF-36 questionnaire. Respiratory quality was assessed using the St Georges Respiratory Questionnaire. Time to return to work was documented. Costs-direct medical, as well as indirect were documented up to 6 months. Results: At 6 months, 6/109 (5.5%) had expired. Low energy/vitality and general heath were noted in the SF-36 scores at 6 months; overall a moderate quality of life. Pulmonary function tests had mostly normalized. Six-min walk distance was 77% of predicted. Respiratory quality of life was good. It took at the median of 111 days to go back Interquartile range (55–193.5) to work with 88% of previously employed going back to work. There were no significant differences in the severity of ARDS and any of these outcomes at 6 months. The average total cost from the societal perspective was ₹ 231,450 (standard deviation 146,430-, 387,300). There was a significant difference between the 3-ARDS severity groups and costs (P < 0.01). There were no independent predictors of return to work. Conclusion: ARDS survivors have low 6-month mortality. Pulmonary physiology and exercise capacity was mostly normal. Overall, quality of life is average was moderate, while respiratory quality of life was good. Return to work was excellent, while cost of care falls under a catastrophic heath expense.

We performed a case control study of 108 patients for the risk of uncontrolled hypertension Housing insecurity, a part of material needs insecurity is an independent predictor of uncontrolled hypertension (adjusted odds ratio 29.9, 1.2-734). Food insecurity, cost related medication underuse and housing instability were seen in 32.4%, 33.3%.and 39.8% of our study subjects respectively. On average patients had 6 stressful life events, which was not different among those with different levels of blood pressure control. We did not find correlation with 24-urine sodium excretion, a reflection of salt intake and hypertension control. The average hypertensive subject was taking more than 10 grams of sodium per day, far higher than recommended.

Background: Tuberculosis (TB) is still a significant health problem worldwide. Central nervous system TB amounts to 10% of all cases of TB. Despite advances in the pharmacological management of TB, the overall outcomes remain poor with significant mortality and morbidity. There are no predictors for neurological outcomes in tuberculosis meningitis (TBM). In this study, we aimed to evaluate the role of cerebrospinal fluid (CSF) C-reactive protein (CRP) in predicting mortality and neurological outcome in TBM. Method: In this observational study, all patients with TBM were recruited prospectively over a 12-month duration. Baseline demographic data, laboratory parameters, and Imaging findings were collected. CSF CRP was obtained on the CSF sample collected at the time of diagnosis. Patients were followed up at 3 months to assess neurological status and mortality. Results: Seventy-one patients with TBM were recruited in this study. The overall mortality in this study was 22.5% of patients. The primary composite outcome of mortality and adverse neurological outcome occurred in 40.8%. The CSF CRP levels ranged between 0.1 and 4.8 mg/dl, and the mean CSF CRP level was 1.11 mg/dl. The Relative risk for a patient with high CSF CRP to develop adverse outcome was 1.84 (P = 0.038). CSF CRP was a good predictor of mortality with a relative risk of 2.92 (P = 0.027). Stroke in TBM had a high incidence of 47.9% and a relative risk of 3.42 for an adverse neurological outcome. CSF CRP did not predict the occurrence of stroke. Hydrocephalus and elevated intracranial pressure were good predictors of stroke. Conclusion: TBM is a disease with significant mortality and morbidity. CRP level in the CSF can be measured, but a highly sensitive scale may be needed as the mean values were much lower compared to the serum values. CSF CRP Levels showed significant associations with adverse outcomes and mortality.

Aim: Heart failure is a global problem that is increasing in prevalence. We undertook the initiative to compile the Vellore Heart Failure Registry (VHFR) to assess the clinical profile, mortality, risk factors and economic burden of heart failure by conducting a prospective, observational, hospital-based cohort study in Vellore, Tamil Nadu. Methods and results: This study was a prospective observational cohort study conducted at the Christian Medical College and Hospital, Vellore, between January 2014 and December 2016. A total of 572 patients who satisfied the Boston criteria for “definite heart failure” were included and the primary outcome was all-cause mortality. The median duration of hospital stay was eight days and the in-hospital, one, three and six month mortalities were 13.25%, 27.3%, 32.53% and 38.15%, respectively. The median duration of survival was 921 days. Readmission for heart failure constituted 42%, and the most common cause of decompensation was an infection(31.5%). The presence of cyanosis at admission, history of previous stroke or transient ischemic attack, and American College of Cardiology (ACC)/American Heart Association (AHA) stage D at the time of discharge were independently associated with mortality at six months. The median total direct cost of admission was INR 84,881.00 ($ 1232.34) Conclusion: The VHFR cohort had younger, more diabetic, and fewer hypertensive subjects than most cohorts. Admission for heart failure is a catastrophic health expenditure. Attempts should be made to ensure a reduction in readmission rates by targeting goal-directed therapy. As the most common cause of acute decompensation is pneumonia, vaccinating all patients before discharge may also help in this regard.

Objectives: Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect every organ system. The study aimed to analyze the clinical manifestations, laboratory findings, antibody associations, and clinical outcomes of patients with cardiac lupus. Materials and Methods: Biomedical records of patients admitted during 2014–2017 who had a diagnosis of SLE were reviewed. Using predetermined inclusion criteria patients with cardiac lupus were identified. Disease manifestations, antibody associations, and clinical outcomes were studied. The Cox proportional hazards model was used to study factors associated with mortality. Results: Over a 3-year period, a total of 372 were admitted with a diagnosis of SLE, out of which 59 patients with cardiac lupus were identified. The patients were predominantly female (86.4%), fever and breathlessness were most common symptoms and the median SLE disease activity index score was 18. Myocardial disease (66.1%), pericardial disease (30.5%), and pulmonary artery hypertension (23.7%) were the most common cardiac manifestations. The mean ejection fraction was 46% ±11.4% with left ventricular systolic dysfunction present in 65.5% (n = 36). The inpatient mortality rate was 22% (n = 13). An elevated serum creatinine, elevated creatine Kinase–muscle/brain, neutrophilic leukocytosis, left ventricular systolic dysfunction, noninitiation of hydroxychloroquine, and the presence of neuropsychiatric lupus predicted mortality. On follow-up, 12 of the 13 echocardiograms demonstrated normal findings. Conclusion: Cardiac disease affects a significant proportion of patients with lupus. A high mortality rate as evident from this study, highlights the importance of recognizing the cardiac complications of SLE. Clinicians should diligently search for the same, as early interventions could reduce mortality and morbidity.

Context: Tuberculosis (TB) has become the most common opportunistic infection among individuals with human immunodeficiency virus (HIV) infection worldwide and continues to be a major killer resulting in 0.4 million deaths every year. While some of the risk factors for developing TB in HIV-infected individuals are known, identifying other risk factors will help in screening strategies to pick out those at higher risk for closer follow-up. Aims: The aim of this study was to identify the risk factors related to the development of active TB in HIV-infected individuals. Settings and Design: This case–control study among the HIV-infected individuals was carried out at a HIV clinic in a large tertiary care hospital in South India. Methods: HIV-infected individuals >18 years of age with confirmed TB were chosen as cases. For each case, two age- and sex-matched controls, diagnosed to have HIV infection without active TB or history of TB, were included. The potential risk factors for the development of active TB were evaluated using the odds ratios (ORs) and logistic regression analysis. Results: A total of 150 patients, 50 cases (mean age: 39.3 ± 7.2 years) and 100 controls (mean age: 40.2 ± 7.1 years) were included. On univariate analysis, smoking (OR 8.14, 95% confidence interval [CI]: 3.13–21.21; P < 0.001), low body mass index (OR 6.31, 95% CI: 2.75–14.48; P < 0.001), chronic obstructive pulmonary disease (P = 0.013), ethanol consumption (OR 8.61, 95% CI: 3.57–20.81; P < 0.001), CD4 cell count < 200 cells/μL (OR 13.12, 95% CI: 5.64–30.50; P < 0.001), and not on antiretroviral treatment (ART) (13.34, 95% CI: 5.85–30.41; P < 0.001) were associated with active TB. The risk factors found to be independently associated were CD4 counts < 200 cells/μL (OR 5.75, 95% CI: 1.81–18.20; P = 0003), smoking (OR 7.40, 95% CI: 1.47–37.15; P = 0.015), and not being on ART (OR 13.94, 95% CI: 3.84–50.61; P < 0.001). Conclusion: Initiating ART as soon as possible and patient education on modifiable risk factors including counseling for smoking cessation for HIV-infected individuals are warranted.

Objectives: Mycobacterium tuberculosis produces high-affinity siderophores that play essential roles in iron acquisition and tuberculosis (TB) pathogenesis. In response, host cells secrete a siderophore-binding protein, siderocalin, to limit the bacteria’s access to iron. The objective of the present study was to evaluate the levels of siderocalin in patients with TB with or without HIV infection compared to controls. Methods: Siderocalin levels were tested using a neutrophil gelatinase-associated lipocalin (NGAL) ELISA kit in four populations: HIV-infected patients with TB (HIVpos, TBpos), non-HIV-infected patients with TB (HIVneg, TBpos), HIV-infected patients without TB (HIVpos, TBneg), and healthy controls (HIVneg, TBneg). Results: Serum siderocalin levels were significantly elevated in patients with TB regardless of their HIV status (HIVneg, TBpos 920 (480–1050) pg/ml; HIVpos, TBpos 494 (166–1050) pg/ml), whereas lower levels of siderocalin were seen in HIV-positive patients (HIVpos, TBneg 268 (77–937) pg/ml; HIVneg, TBneg 453 (193–994) pg/ml). Conclusions: The results indicate that active TB leads to an up-regulation of serum siderocalin regardless of HIV status, whereas HIV infection leads to a down-regulation of serum siderocalin levels in both TB-negative and TB-positive individuals. Further studies are needed to evaluate siderocalin as a potential marker of active TB and to clarify its role in the pathogenesis of HIV-associated TB. Keywords: Tuberculosis, Mycobacterium tuberculosis, HIV, Siderophore, Siderocalin, Iron