Association between endothelial activation and stress index and mortality in critically ill patients with atrial fibrillation: In MIMIC database: A Retrospective Cohort Study

by Peiling Zuo, Huanhuan Zhu, Chunying Sun, Xiaohan Ma, Sheng Chen, Rong Tang, Tong Wu, Ding Zhang, Xiao Tang, Wenquan Lv, Wenzhong Chen, Xiawei Wei, Encun Hou, Minsheng Wu, Minghe Jiang

Evidence indicates that the Endothelial Activation and Stress Index (EASIX) is a predictor of mortality in endothelium-related conditions; however, its association with mortality risk in atrial fibrillation (AF) remains uncertain. Accordingly, this study examines the relationship between EASIX and mortality risk among patients with AF.

This retrospective analysis utilized data from the Medical Information Marketplace in Intensive Care IV (MIMIC-IV) database, which includes critically ill patients diagnosed with AF. To examine the association between EASIX scores and mortality, Kaplan–Meier survival analysis, Cox proportional hazards models, and restricted cubic spline regression were applied to evaluate the relationship between EASIX and all-cause mortality. Subgroup analyses were conducted to explore potential interactions with key patient characteristics, and sensitivity analyses were performed to further confirm the robustness of the results.

A total of 3,193 patients were included in the analysis. KM survival analysis showed that elevated EASIX levels were associated with a higher risk of both in-hospital and ICU mortality. After adjusting for potential confounders, increased EASIX levels remained significantly associated with in-hospital mortality [HR, 1.09 (95% CI 1.03, 1.15), P = 0.0002] and ICU mortality [HR, 1.10 (95% CI 1.04, 1.17), P = 0.0002]. Stratified analyses revealed a significant interaction between sepsis, respiratory failure, and EASIX in relation to both in-hospital and ICU mortality. To evaluate the robustness of the findings, a sensitivity analysis was performed. After additionally adjusting for metoprolol and heparin as covariates, patients in the highest EASIX group continued to demonstrate the greatest mortality risk: the HR for in-hospital death was 2.08 (95% CI: 1.51–2.85), and the HR for ICU death was 1.83 (95% CI: 1.21–2.65).

Elevated EASIX levels correlate with higher mortality rates, underscoring its potential as an accessible tool for identifying high-risk patients and informing clinical decisions. However, further studies are needed to explore the underlying mechanisms and validate its applicability across diverse patient populations.

Applications, Challenges and Strategies of Patient Journey Maps in Care Transitions: A Scoping Review

ABSTRACT

Aim

To synthesise the application, construction methods, challenges, and optimisation strategies of Patient Journey Maps (PJMs) in care transitions.

Design

A scoping review guided by Arksey and O'Malley's framework and PRISMA-ScR.

Data Sources

Nine databases, including PubMed, Embase, CINAHL, Cochrane Library, Web of Science, CNKI, etc., searched from January 2015 to March 2025.

Methods

Two reviewers independently screened studies, extracting data from 23 studies across 12 countries, synthesised via descriptive and thematic analyses informed by nursing theories.

Results

PJMs targeted elderly, children/adolescents, and special-needs populations across in-hospital referrals, inter-hospital transitions, and community adaptation. PJMs development integrated qualitative (interviews, co-design) and quantitative (process mining, EHR analysis) methods to map stages, touchpoints, and emotional curves. Challenges included collaboration breakdowns (78.3%), information fragmentation (74.0%), and psychosocial barriers (47.8%). Optimization strategies emphasised interdisciplinary collaboration, standardised processes, technology enablement, and patient-centred interventions.

Conclusion

PJMs enhance care transitions by visualising patient experiences and systemic gaps, improving continuity and safety. Scalability requires addressing technological adaptation, policy alignment and resource equity. Future research should prioritise dynamic, digitally driven PJM tools and cross-regional collaboration for health equity.

Impact

This review informs clinical practice and policy by bridging theoretical and practical gaps in transitional care via interdisciplinary strategies and technology integration.

Contribution to the Field

Advances global nursing practice with patient-centered strategies, promotes health equity through collaboration, and informs policy and digital innovation for dynamic care transitions.

Patient or Public Contribution

None.

Protocol Registration

Not registered.