Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy

Supplemental oxygen is often administered liberally to acutely ill adults, but the credibility of the evidence for this practise is unclear. In this paper the authors systematically reviewed the efficacy and safety of liberal versus conservative oxygen therapy in acutely ill adults.

Data from 25 randomised trials involving over 16,000 appropriate patients was reviewed. The liberal oxygen strategy was found to be associated with an increased in-hospital mortality (relative risk 1.21) and also an increased mortality risk at 30 days and at longest follow-up. Morbidity outcomes were similar in the two groups.

The authors conclude that “in acutely ill adults, high-quality evidence shows that liberal oxygen therapy increases mortality without improving other patient-important outcomes. Supplemental oxygen might become unfavourable above an Sp02 range of 94–96%. These results support the conservative administration of oxygen therapy”.

Lancet 2018; 391:1693–705

MRI-targeted or standard biopsy for prostate cancer diagnosis

Men with a clinical suspicion of prostate cancer on the basis of an elevated prostate-specific antigen (PSA) level or an abnormal digital rectal examination are typically offered a standard transrectal ultrasonography-guided biopsy of the prostate.

An MRI-targeted biopsy is a possible alternative and this is explored in this report. Five hundred men suspected to have prostate cancer were randomised to have MRI-targeted biopsy or standard transrectal ultrasonography-guided biopsy. Clinically significant cancer was detected in 38% of the MRI cohort compared with 26% in the standard group.

The researchers concluded that MRI-targeted biopsy was superior to standard transrectal ultrasonography-guided biopsy in men at clinical risk for prostate cancer who had not undergone biopsy previously.

N Engl J Med 2018; 378:1767–77

Urolithiasis is associated with an increased risk of stroke

Epidemiological studies have reported an association between urolithiasis and cardiovascular disease. However, studies examining the risks of ischaemic and haemorrhagic stroke in patients with urolithiasis are limited.

This issue is evaluated in this report. Using information obtained from a nationwide population database in Taiwan, the investigators have been able to confirm the hypothesis. Both ischaemic and haemorrhagic strokes were found to be significantly more common at five-year follow-up in the urolithiasis cohort. The findings were consistent in both men and women.

The present study detected an increased risk of both ischaemic and haemorrhagic stroke in patients with urolithiasis, particularly in those older than 40 years.

Internal Medicine Journal 2018; 48:445–450

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