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Bosch NA, Law AC, Vail EA, Gillmeyer KR, Gershengorn HB, Wunsch H, Walkey AJ. Inhaled Nitric Oxide vs Epoprostenol During Acute Respiratory Failure: An Observational Target Trial Emulation. Chest 2022; 162:1287-1296. [PMID: 35952768 PMCID: PMC9899639 DOI: 10.1016/j.chest.2022.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/14/2022] [Accepted: 08/01/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The inhaled vasodilators nitric oxide and epoprostenol may be initiated to improve oxygenation in mechanically ventilated patients with severe acute respiratory failure (ARF); however, practice patterns and head-to-head comparisons of effectiveness are unclear. RESEARCH QUESTION What are the practice patterns and comparative effectiveness for inhaled nitric oxide and epoprostenol in severe ARF? STUDY DESIGN AND METHODS Using a large US database (Premier Healthcare Database), we identified adult patients with ARF or ARDS who were mechanically ventilated and started on inhaled nitric oxide, epoprostenol, or both. Leveraging large hospital variation in the choice of initial inhaled vasodilator, we compared the effectiveness of inhaled nitric oxide with that of epoprostenol by limiting analysis to patients admitted to hospitals that exclusively used either inhaled nitric oxide or epoprostenol. The primary outcome of successful extubation was modeled using multivariate Fine-Grey competing risk (death or hospice discharge) time-to-event models. RESULTS Among 11,200 patients (303 hospitals), 6,366 patients (56.8%) received inhaled nitric oxide first, 4,720 patients (42.1%) received inhaled epoprostenol first, and 114 patients (1.0%) received both therapies on the same day. One hundred four hospitals (34.3%; 1,666 patients) exclusively used nitric oxide and 118 hospitals (38.9%; 1,812 patients) exclusively used epoprostenol. No differences were found in the likelihood of successful extubation between patients admitted to nitric oxide-only hospitals vs those admitted to epoprostenol-only hospitals (subdistribution hazard ratio, 0.97; 95% CI, 0.80-1.18). Also no differences were found in total hospital costs or death. Results were robust to multiple sensitivity analyses. INTERPRETATION Large variation exists in the use of initial inhaled vasodilator for respiratory failure across US hospitals. Comparative effectiveness analyses identified no differences in outcomes based on inhaled vasodilator type.
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Affiliation(s)
- Nicholas A Bosch
- Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, MA.
| | - Anica C Law
- Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Emily A Vail
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Kari R Gillmeyer
- Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Hayley B Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL; Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Hannah Wunsch
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Allan J Walkey
- Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, MA; Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston, MA
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Rakhit S, Wang L, Lindsell CJ, Hosay MA, Stewart JW, Owen GD, Frutos-Vivar F, Pen Uelas O, Esteban AS, Anzueto AR, Raymondos K, Rios F, Thille AW, Gonza Lez M, Du B, Maggiore SM, Matamis D, Abroug F, Amin P, Zeggwagh AA, Ely EW, Vasilevskis EE, Patel MB. Multicenter International Cohort Validation of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-sedation Scale. Ann Surg 2022; 276:e114-e119. [PMID: 33201122 PMCID: PMC10573707 DOI: 10.1097/sla.0000000000004484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In a multicenter, international cohort, we aimed to validate a modified Sequential Organ Failure Assessment (mSOFA) using the Richmond Agitation-Sedation Scale, hypothesized as comparable to the Glasgow Coma Scale (GCS)-based Sequential Organ Failure Assessment (SOFA). SUMMARY BACKGROUND DATA The SOFA score, whose neurologic component is based on the GCS, can predict intensive care unit (ICU) mortality. But, GCS is often missing in lieu of other assessments, such as the also reliable and validated Richmond Agitation Sedation Scale (RASS). Single-center data suggested an RASS-based SOFA (mSOFA) predicted ICU mortality. METHODS Our nested cohort within the prospective 2016 Fourth International Study of Mechanical Ventilation contains 4120 ventilated patients with daily RASS and GCS assessments (20,023 patient-days, 32 countries). We estimated GCS from RASS via a proportional odds model without adjustment. ICU mortality logistic regression models and c-statistics were constructed using SOFA (measured GCS) and mSOFA (measured RASS-estimated GCS), adjusted for age, sex, body-mass index, region (Europe, USA-Canada, Latin America, Africa, Asia, Australia-New Zealand), and postoperative status (medical/surgical). RESULTS Cohort-wide, the mean SOFA=9.4+/-2.8 and mean mSOFA = 10.0+/-2.3, with ICU mortality = 31%. Mean SOFA and mSOFA similarly predicted ICU mortality (SOFA: AUC = 0.784, 95% CI = 0.769-0.799; mSOFA: AUC = 0.778, 95% CI = 0.763-0.793, P = 0.139). Across models, other predictors of mortality included higher age, female sex, medical patient, and African region (all P < 0.001). CONCLUSIONS We present the first SOFA modification with RASS in a "real-world" international cohort. Estimating GCS from RASS preserves predictive validity of SOFA to predict ICU mortality. Alternative neurologic measurements like RASS can be viably integrated into severity of illness scoring systems like SOFA.
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Affiliation(s)
- Shayan Rakhit
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Li Wang
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Morgan A Hosay
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
- Baylor University, Waco, TX
| | - James W Stewart
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
- Meharry Medical College, Nashville, TN
| | - Gary D Owen
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN
| | - Fernando Frutos-Vivar
- University Hospital of Getafe, Getafe, Community of Madrid, Spain
- Centro de Investigación Biomédica en red de Enfermedades Respiratorias, Getafe, Comunidad of Madrid, Madrid, Spain
| | - Oscar Pen Uelas
- University Hospital of Getafe, Getafe, Community of Madrid, Spain
- Centro de Investigación Biomédica en red de Enfermedades Respiratorias, Getafe, Comunidad of Madrid, Madrid, Spain
| | - Andre S Esteban
- University Hospital of Getafe, Getafe, Community of Madrid, Spain
- Centro de Investigación Biomédica en red de Enfermedades Respiratorias, Getafe, Comunidad of Madrid, Madrid, Spain
| | - Antonio R Anzueto
- Department of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Science Center, San Antonio, TX
- Pulmonary Section, Audie L Murphy VA Hospital, South Texas Veterans Healthcare System, US Department of Veterans Affairs, San Antonio, TX
| | | | - Fernando Rios
- Alejandro Posadas National Hospital, El Palomar, Buenos Aires, Argentina
| | | | - Marco Gonza Lez
- Medellin Clinic and Pontifical Bolivaran University, Medellin, Colombia
| | - Bin Du
- Peking Union Medical College Hospital, Beijing, China
| | | | | | - Fekri Abroug
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Pravin Amin
- Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | | | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Center (GRECC) Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, TN
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | - Eduard E Vasilevskis
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Geriatric Research, Education, and Clinical Center (GRECC) Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, TN
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Ibn Sina University Hospital Center & Mohammed V University of Rabat, Rabat, Morocco
| | - Mayur B Patel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
- Surgical Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs Nashville, TN
- Departments of Neurosurgery and Hearing and Speech Sciences, Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN
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Blank SP, Blank RM, Campbell L. What Is the Optimal Speed of correction of the Hyperosmolar Hyperglycemic State in Diabetic Ketoacidosis? An Observational Cohort Study of U.S. Intensive Care Patients. Endocr Pract 2022; 28:875-883. [PMID: 35688365 DOI: 10.1016/j.eprac.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The international guidelines for the treatment of diabetic ketoacidosis (DKA) advise against rapid changes in osmolarity and glucose; however, the optimal rates of correction are unknown. We aimed to evaluate the rates of change in tonicity and glucose level in intensive care patients with DKA and their relationship with mortality and altered mental status. METHODS This is an observational cohort study using 2 publicly available databases of U.S. intensive care patients (Medical Information Mart for Intensive Care-IV and Electronic Intensive Care Unit), evaluating adults with DKA and associated hyperosmolarity (baseline Osm ≥300 mOsm/L). The primary outcome was hospital mortality. The secondary neurologic outcome used a composite of diagnosed cerebral edema or Glasgow Coma Scale score of ≤12. Multivariable regression models were used to control for confounding factors. RESULTS On adjusted analysis, patients who underwent the most rapid correction of up to approximately 3 mmol/L/hour in tonicity had reduced mortality (n = 2307; odds ratio [OR], 0.21; overall P < .001) and adverse neurologic outcomes (OR, 0.44; P < .001). Faster correction of glucose levels up to 5 mmol/L/hour (90 mg/dL/hour) was associated with improvements in mortality (n = 2361; OR, 0.24; P = .020) and adverse neurologic events (OR, 0.52; P = .046). The number of patients corrected significantly faster than these rates was low. A maximal hourly rate of correction between 2 and 5 mmol/L for tonicity was associated with the lowest mortality rate on adjusted analysis. CONCLUSION Based on large-volume observational data, relatively rapid correction of tonicity and glucose level was associated with lower mortality and more favorable neurologic outcomes. Avoiding a maximum hourly rate of correction of tonicity >5 mmol/L may be advisable.
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Affiliation(s)
- Sebastiaan P Blank
- Intensive Care Unit, Royal Darwin Hospital, Tiwi, Northern Territory, Australia.
| | - Ruth M Blank
- Royal Darwin Hospital, Tiwi, Darwin, Northern Territory, Australia
| | - Lewis Campbell
- Intensive Care Unit, Royal Darwin Hospital, Tiwi, Northern Territory, Australia; Flinders University, Adelaide, Australia; Menzies School of Health Research, Royal Darwin Hospital Campus, Tiwi, Northern Territory, Australia
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Predictive Validity of the Sequential Organ Failure Assessment Score versus Claims-based Scores among Critically Ill Patients. Ann Am Thorac Soc 2022; 19:1072-1076. [PMID: 35266866 PMCID: PMC9797032 DOI: 10.1513/annalsats.202111-1251rl] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Kashyap R, Sherani KM, Dutt T, Gnanapandithan K, Sagar M, Vallabhajosyula S, Vakil AP, Surani S. Current Utility of Sequential Organ Failure Assessment Score: A Literature Review and Future Directions. Open Respir Med J 2021; 15:1-6. [PMID: 34249175 PMCID: PMC8227444 DOI: 10.2174/1874306402115010001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/13/2020] [Accepted: 01/13/2021] [Indexed: 02/08/2023] Open
Abstract
The Sequential Organ Failure Assessment (SOFA) score is commonly used in the Intensive Care Unit (ICU) to evaluate, prognosticate and assess patients. Since its validation, the SOFA score has served in various settings, including medical, trauma, surgical, cardiac, and neurological ICUs. It has been a strong mortality predictor and literature over the years has documented the ability of the SOFA score to accurately distinguish survivors from non-survivors on admission. Over the years, multiple variations have been proposed to the SOFA score, which have led to the evolution of alternate validated scoring models replacing one or more components of the SOFA scoring system. Various SOFA based models have been used to evaluate specific clinical populations, such as patients with cardiac dysfunction, hepatic failure, renal failure, different races and public health illnesses, etc. This study is aimed to conduct a review of modifications in SOFA score in the past several years. We review the literature evaluating various modifications to the SOFA score such as modified SOFA, Modified SOFA, modified Cardiovascular SOFA, Extra-renal SOFA, Chronic Liver Failure SOFA, Mexican SOFA, quick SOFA, Lactic acid quick SOFA (LqSOFA), SOFA in hematological malignancies, SOFA with Richmond Agitation-Sedation scale and Pediatric SOFA. Various organ systems, their relevant scoring and the proposed modifications in each of these systems are presented in detail. There is a need to incorporate the most recent literature into the SOFA scoring system to make it more relevant and accurate in this rapidly evolving critical care environment. For future directions, we plan to put together most if not all updates in SOFA score and probably validate it in a large database a single institution and validate it in multisite data base.
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Affiliation(s)
- Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Khalid M Sherani
- Department of Internal Medicine, Jamaica Hospital Medical Center, Jamaica, NY 11418, USA.,Corpus Christi Medical Center, Corpus Christi, TX 78411, USA
| | - Taru Dutt
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester MN, USA and Hennepin County Medical Center, Minneapolis, MN 55905, USA
| | - Karthik Gnanapandithan
- Department of Internal Medicine, Yale-New Haven Hospital and Yale University School of Medicine, New Haven, CT 06510, USA
| | - Malvika Sagar
- Department of Pediatrics, McLane Children's Hospital, Baylor Scott and White Health, Temple, TX 76502, USA
| | | | - Abhay P Vakil
- Department of Pediatrics, McLane Children's Hospital, Baylor Scott and White Health, Temple, TX 76502, USA.,Critical Care Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Salim Surani
- Corpus Christi Medical Center, Corpus Christi, TX 78411, USA.,Texas A&M University System Health Science Center, Bryan, TX 77807, USA
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Nicholson CJ, Wooster L, Sigurslid HH, Li RH, Jiang W, Tian W, Lino Cardenas CL, Malhotra R. Estimating risk of mechanical ventilation and in-hospital mortality among adult COVID-19 patients admitted to Mass General Brigham: The VICE and DICE scores. EClinicalMedicine 2021; 33:100765. [PMID: 33655204 PMCID: PMC7906522 DOI: 10.1016/j.eclinm.2021.100765] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/22/2021] [Accepted: 02/04/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Risk stratification of COVID-19 patients upon hospital admission is key for their successful treatment and efficient utilization of hospital resources. We sought to evaluate the risk factors on admission (including comorbidities, vital signs, and initial laboratory assessment) associated with ventilation need and in-hospital mortality in COVID-19. METHODS We established a retrospective cohort of COVID-19 patients from Mass General Brigham hospitals. Demographic, clinical, and admission laboratory data were obtained from electronic medical records of patients admitted to the hospital with laboratory-confirmed COVID-19 before May 19, 2020. Multivariable logistic regression analyses were used to construct and validate the Ventilation in COVID Estimator (VICE) and Death in COVID Estimator (DICE) risk scores. FINDINGS The entire cohort included 1042 patients (median age, 64 years; 56.8% male). The derivation and validation cohorts for the risk scores included 578 and 464 patients, respectively. We found four factors to be independently predictive for mechanical ventilation requirement (diabetes mellitus, SpO2:FiO2 ratio, C-reactive protein, and lactate dehydrogenase), and 10 factors to be predictors of in-hospital mortality (age, male sex, coronary artery disease, diabetes mellitus, chronic statin use, SpO2:FiO2 ratio, body mass index, neutrophil to lymphocyte ratio, platelet count, and procalcitonin). Using these factors, we constructed the VICE and DICE risk scores, which performed with C-statistics of 0.84 and 0.91, respectively. Importantly, the chronic use of a statin was associated with protection against death due to COVID-19. The VICE and DICE score calculators have been placed on an interactive website freely available to healthcare providers and researchers (https://covid-calculator.com/). INTERPRETATION The risk scores developed in this study may help clinicians more appropriately determine which COVID-19 patients will need to be managed with greater intensity. FUNDING COVID-19 Fast Grant (fastgrants.org).
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Affiliation(s)
- Christopher J. Nicholson
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States
| | - Luke Wooster
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Haakon H. Sigurslid
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States
| | - Rebecca H. Li
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States
| | - Wanlin Jiang
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States
| | - Wenjie Tian
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States
- Department of Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Christian L. Lino Cardenas
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States
| | - Rajeev Malhotra
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States
- Corresponding author.
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Ko H, Yan M, Gupta R, Kebbel K, Maiti A, Song J, Nates J, Overman MJ. Predictors of Survival in Patients with Advanced Gastrointestinal Malignancies Admitted to the Intensive Care Unit. Oncologist 2018; 24:483-490. [PMID: 30518614 DOI: 10.1634/theoncologist.2018-0328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/28/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Patients with cancer have a high use of health care utilization at the end of life, which can frequently involve admissions to the intensive care unit (ICU). We sought to evaluate the predictors for outcome in patients with gastrointestinal (GI) cancer admitted to the ICU for nonsurgical conditions. PATIENTS AND METHODS The primary objective was to determine the predictors of hospital mortality. Secondary objectives included investigating the predictors of ICU mortality and hospital overall survival (OS). All patients with GI cancer admitted to the ICU at the University of Texas MD Anderson Cancer Center between November 2012 and February 2015 were retrospectively analyzed. Cancer characteristics, treatment characteristics, and Sequential Organ Failure Assessment (SOFA) scores were analyzed for their effects on survival. RESULTS The characteristics of the 200 patients were as follows: 64.5% male, mean age of 60 years, median SOFA score of 6.7, and tumor types of intestinal (37.5%), hepatobiliary/pancreatic (36%), and gastroesophageal (24%). The hospital mortality was 41%, and overall 6-month mortality was 75%. In multivariate analysis, high admission SOFA score > 5, poor tumor differentiation, and duration of metastatic disease ≤7 months were associated with increased hospital mortality. For OS, high admission SOFA score > 5, poor tumor differentiation, and patients who were not on active chemotherapy because of poor performance had worse outcome. In multivariate analysis, SOFA score remained significant for OS even after excluding patients who died in the ICU. CONCLUSION For patients with metastatic GI cancer admitted to the ICU, SOFA score was predictive for both acute and long-term survival. A patient's chemotherapy treatment status was not predictive for hospital mortality but was for OS. The SOFA score should be utilized in all patients with GI cancer upon ICU admission for prognostication. IMPLICATIONS FOR PRACTICE Patients with cancer have a high use of health care utilization at the end of life, which can frequently involve admissions to the intensive care unit (ICU). Although there have been substantial increases in duration of survival for patients with advanced metastatic cancer, their mortality after an ICU admission remains high. GI malignancy is considered one of the top three lethal cancers estimated in 2017. Survival of critically ill patients with advanced GI cancer should be evaluated to help guide treatment planning.
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Affiliation(s)
- Heidi Ko
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Melissa Yan
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rohan Gupta
- Department of Hematology and Medical Oncology, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Kayla Kebbel
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Abhishek Maiti
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juhee Song
- Department of Biostatistics, Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joseph Nates
- Department of Critical Care Medicine, Division of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Huerta LE, Wanderer JP, Ehrenfeld JM, Freundlich RE, Rice TW, Semler MW. Validation of a Sequential Organ Failure Assessment Score using Electronic Health Record Data. J Med Syst 2018; 42:199. [PMID: 30218383 PMCID: PMC6261278 DOI: 10.1007/s10916-018-1060-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/06/2018] [Indexed: 01/31/2023]
Abstract
The sequential organ failure assessment (SOFA) score is a scoring system commonly used in critical care to assess severity of illness. Automated calculation of the SOFA score using existing electronic health record data would broaden its applicability. We performed a manual validation of an automated SOFA score previously developed at our institution. A retrospective analysis of a random subset of 300 patients from a previously published randomized trial of critically ill adults was performed, with manual validation of SOFA scores from the date of initial intensive care unit admission. Spearman's rank correlation coefficient, weighted Cohen's kappa, and Bland-Altman plots were used to assess agreement between manual and electronic versions of SOFA scores and between manual and electronic versions of their individual components. There was high agreement between manual and electronic SOFA scores (Spearman's rank correlation coefficient = 0.90, 95% CI 0.87-0.93). Renal and respiratory components had lower agreement (weighted Cohen's kappa = 0.63, 95% CI 0.53-0.73 for renal; weighted Cohen's kappa = 0.77, 95% CI 0.70-0.84 for respiratory). The area under the receiver operating characteristic curve (AUC) for 30-day in-hospital mortality was 0.77 (95% CI 0.68-0.84) for manual SOFA scores and 0.75 (95% CI 0.66-0.83) for automated SOFA scores. Automatic calculation of SOFA scores from the electronic health record is feasible and correlates highly with manually calculated SOFA scores. Both have similar predictive value for 30-day in-hospital mortality.
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Affiliation(s)
- Luis E Huerta
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Ave S., T-1218 MCN, Nashville, TN, 37232-2650, USA.
| | - Jonathan P Wanderer
- Department of Anesthesiology, Vanderbilt University Medical Center, 1161 21st Ave S., T-1218 MCN, Nashville, TN, 37232-2650, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 1161 21st Ave S., T-1218 MCN, Nashville, TN, 37232-2650, USA
| | - Jesse M Ehrenfeld
- Department of Anesthesiology, Vanderbilt University Medical Center, 1161 21st Ave S., T-1218 MCN, Nashville, TN, 37232-2650, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 1161 21st Ave S., T-1218 MCN, Nashville, TN, 37232-2650, USA
- Department of Surgery, Vanderbilt University Medical Center, 1161 21st Ave S., T-1218 MCN, Nashville, TN, 37232-2650, USA
- Department of Health Policy, Vanderbilt University Medical Center, 1161 21st Ave S., T-1218 MCN, Nashville, TN, 37232-2650, USA
| | - Robert E Freundlich
- Department of Anesthesiology, Vanderbilt University Medical Center, 1161 21st Ave S., T-1218 MCN, Nashville, TN, 37232-2650, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 1161 21st Ave S., T-1218 MCN, Nashville, TN, 37232-2650, USA
| | - Todd W Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Ave S., T-1218 MCN, Nashville, TN, 37232-2650, USA
| | - Matthew W Semler
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Ave S., T-1218 MCN, Nashville, TN, 37232-2650, USA
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10
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Sepsis and Acute Myeloid Leukemia: A Population-Level Study of Comparative Outcomes of Patients Discharged From Texas Hospitals. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:e27-e32. [PMID: 28844403 DOI: 10.1016/j.clml.2017.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND In the United States, approximately 750,000 cases of sepsis occur annually, and 28% to 50% of affected people die. Treatment is costly, often involving admission to the intensive care unit and prolonged hospitalization. We evaluated outcomes of patients with acute myeloid leukemia (AML) and sepsis in Texas. PATIENTS AND METHODS We conducted a population-based cohort study of adults discharged from Texas hospitals during 2011, using ICD-9-CM codes and the Texas Inpatient Data Collection. RESULTS A total of 2,173,776 adults were discharged from hospitals in Texas, and 5501 (0.25%) had a diagnosis of AML. Among patients with AML, 40% were ≥ 65 years old, and 52% were men. The rate of sepsis for AML patients was 16% compared to 4% for non-AML patients. Among patients with AML, sepsis was associated with pneumonia, acute renal failure, and hematologic dysfunctions in 34%, 32%, and 29% of discharges, respectively. Median length of stay, intensive care unit admission rate, and median hospital charges per stay for patients with AML and sepsis were 13 days (range, 1-133 days), 72%, and $122,333, respectively. Among in-hospital deaths due to sepsis, mortality was 30% in AML patients compared to 21% in non-AML patients. CONCLUSION Patients with AML had a higher sepsis incidence and higher mortality rates overall, especially in relation to stem-cell transplant recipients and those with other types of cancer. Clinical trials are needed to determine whether early intervention or treatment in specialized centers could improve outcomes and reduce costs of care, particularly in the management of serious complications such as sepsis.
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Aakre C, Franco PM, Ferreyra M, Kitson J, Li M, Herasevich V. Prospective validation of a near real-time EHR-integrated automated SOFA score calculator. Int J Med Inform 2017; 103:1-6. [PMID: 28550994 DOI: 10.1016/j.ijmedinf.2017.04.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/27/2017] [Accepted: 04/01/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES We created an algorithm for automated Sequential Organ Failure Assessment (SOFA) score calculation within the Electronic Health Record (EHR) to facilitate detection of sepsis based on the Third International Consensus Definitions for Sepsis and Septic Shock (SEPSIS-3) clinical definition. We evaluated the accuracy of near real-time and daily automated SOFA score calculation compared with manual score calculation. METHODS Automated SOFA scoring computer programs were developed using available EHR data sources and integrated into a critical care focused patient care dashboard at Mayo Clinic in Rochester, Minnesota. We prospectively compared the accuracy of automated versus manual calculation for a sample of patients admitted to the medical intensive care unit at Mayo Clinic Hospitals in Rochester, Minnesota and Jacksonville, Florida. Agreement was calculated with Cohen's kappa statistic. Reason for discrepancy was tabulated during manual review. RESULTS Random spot check comparisons were performed 134 times on 27 unique patients, and daily SOFA score comparisons were performed for 215 patients over a total of 1206 patient days. Agreement between automatically scored and manually scored SOFA components for both random spot checks (696 pairs, κ=0.89) and daily calculation (5972 pairs, κ=0.89) was high. The most common discrepancies were in the respiratory component (inaccurate fraction of inspired oxygen retrieval; 200/1206) and creatinine (normal creatinine in patients with no urine output on dialysis; 128/1094). 147 patients were at risk of developing sepsis after intensive care unit admission, 10 later developed sepsis confirmed by chart review. All were identified before onset of sepsis with the ΔSOFA≥2 point criterion and 46 patients were false-positives. CONCLUSIONS Near real-time automated SOFA scoring was found to have strong agreement with manual score calculation and may be useful for the detection of sepsis utilizing the new SEPSIS-3 definition.
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Affiliation(s)
- Christopher Aakre
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Pablo Moreno Franco
- Department of Critical Care, Mayo Clinic,4500 San Pablo Rd S, Jacksonville, FL 32224, USA; Department of Transplant, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Micaela Ferreyra
- Department of Transplant, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Jaben Kitson
- Department of Information Technology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; Multidisciplinary Epidemiology and Translation Research in Intensive Care (METRIC), Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Man Li
- Department of Information Technology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; Multidisciplinary Epidemiology and Translation Research in Intensive Care (METRIC), Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Vitaly Herasevich
- Multidisciplinary Epidemiology and Translation Research in Intensive Care (METRIC), Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Gutierrez C, Cárdenas YR, Bratcher K, Melancon J, Myers J, Campbell JY, Feng L, Price KJ, Nates JL. Out-of-Hospital ICU Transfers to an Oncological Referral Center: Characteristics, Resource Utilization, and Patient Outcomes. J Intensive Care Med 2016; 34:55-61. [PMID: 28030995 DOI: 10.1177/0885066616686536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE: To determine resource utilization and outcomes of out-of-hospital transfer patients admitted to the intensive care unit (ICU) of a cancer referral center. DESIGN: Single-center cohort. SETTING: A tertiary oncological center. PATIENTS: Patients older than 18 years transferred to our ICU from an outside hospital between January 2013 and December 2015. MEASUREMENTS AND MAIN RESULTS: A total of 2127 (90.3%) were emergency department (ED) ICU admissions and 228 (9.7%) out-of-hospital transfers. The ICU length of stay (LOS) was longer in the out-of-hospital transfers when compared to all other ED ICU admissions ( P = .001); however, ICU and hospital mortality were similar between both groups. The majority of patients were transferred for a higher level of care (77.2%); there was no difference in the amount of interventions performed, ICU LOS, and ICU mortality between nonhigher level-of-care and higher level-of-care patients. Factors associated with an ICU LOS ≥10days were a higher Sequential Organ Failure Assessment (SOFA) score, weekend admissions, presence of shock, need for mechanical ventilation, and acute kidney injury on admission or during ICU stay ( P < .008). The ICU mortality of transferred patients was 17.5% and associated risk factors were older age, higher SOFA score on admission, use of mechanical ventilation and vasopressors during ICU stay, and renal failure on admission ( P < .0001). Data related to the transfer such as LOS at the outside facility, time of transfer, delay in transfer, and longer distance traveled were not associated with increased LOS or mortality in our study. CONCLUSION: Organ failure severity on admission, and not transfer-related factors, continues to be the best predictor of outcomes of critically ill patients with cancer when transferred from other facilities to the ICU. Our data suggest that transferring critically ill patients with cancer to a specialized center does not lead to worse outcomes or increased resource utilization when compared to patients admitted from the ED.
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Affiliation(s)
- Cristina Gutierrez
- 1 Division of Anesthesia and Critical Care, Critical Care Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yenny R Cárdenas
- 2 Critical Care Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Kristie Bratcher
- 1 Division of Anesthesia and Critical Care, Critical Care Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Judd Melancon
- 1 Division of Anesthesia and Critical Care, Critical Care Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason Myers
- 1 Division of Anesthesia and Critical Care, Critical Care Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeannee Y Campbell
- 1 Division of Anesthesia and Critical Care, Critical Care Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Feng
- 3 Division of Quantitative Sciences, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston TX, USA
| | - Kristen J Price
- 1 Division of Anesthesia and Critical Care, Critical Care Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph L Nates
- 1 Division of Anesthesia and Critical Care, Critical Care Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abstract
OBJECTIVE To investigate ICU utilization and hospital outcomes of oncological patients admitted to a comprehensive cancer center. DESIGN Observational cohort study. SETTING The University of Texas MD Anderson Cancer Center. PATIENTS Consecutive adults with cancer discharged over a 20-year period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The Cochran-Armitage test for trend was used to evaluate ICU utilization and hospital mortality rates by primary service over time. A negative binomial log linear regression model was fitted to the data to investigate length of stay over time. Among 387,306 adult hospitalized patients, the ICU utilization rate was 12.9%. The overall hospital mortality rate was 3.6%: 16.2% among patients with an ICU stay and 1.8% among non-ICU patients. Among those admitted to the ICU, the mean (SD) admission Sequential Organ Failure Assessment score was 6.1 (3.8) for all ICU patients: 7.3 (4.4) for medical ICU patients and 4.9 (2.8) for surgical ICU patients. Hematologic disorders were associated with the highest hospital mortality rate in ICU patients (42.8%); metastatic disease had the highest mortality rate in non-ICU patients (4.2%); sepsis, pneumonia, and other infections had the highest mortality rate for all inpatients (8.5%). CONCLUSIONS This study provides a longitudinal view of ICU utilization rates, hospital and ICU length of stay, and severity-adjusted mortality rates. Although the data arise from a single institution, it encompasses a large number of hospital admissions over two decades and can serve as a point of comparison for future oncological studies at similar institutions. More studies of this nature are needed to determine whether consolidation of cancer care into specialized large-volume facilities may improve outcomes, while simultaneously sustaining appropriate resource utilization and reducing unnecessary healthcare costs.
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Validity of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-Sedation Scale. Crit Care Med 2016; 44:138-46. [PMID: 26457749 DOI: 10.1097/ccm.0000000000001375] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The Sequential Organ Failure Assessment and other severity of illness scales rely on the Glasgow Coma Scale to measure acute neurologic dysfunction, but the Glasgow Coma Scale is unavailable or inconsistently applied in some institutions. The objective of this study was to assess the validity of a modified Sequential Organ Failure Assessment that uses the Richmond Agitation-Sedation Scale instead of Glasgow Coma Scale. DESIGN Prospective cohort study. SETTING Medical and surgical ICUs within a large, tertiary care hospital. PATIENTS Critically ill medical/surgical ICU patients. INTERVENTIONS We calculated daily Sequential Organ Failure Assessment scores by using electronic medical record-derived data. By using bedside nurse-recorded Glasgow Coma Scale and Richmond Agitation-Sedation Scale measures, we calculated neurologic Sequential Organ Failure Assessment scores using the original Glasgow Coma Scale-based approach and a novel Richmond Agitation-Sedation Scale-based approach, converting the 10-point Richmond Agitation-Sedation Scale to a 4-point neurologic Sequential Organ Failure Assessment score. We assessed construct validity of Richmond Agitation-Sedation Scale-based Sequential Organ Failure Assessment by analyzing correlations with established severity of illness constructs (Acute Physiology and Chronic Health Evaluation II and Glasgow Coma Scale-based Sequential Organ Failure Assessment) and predictive validity by using logistic regression to determine whether Richmond Agitation-Sedation Scale-based Sequential Organ Failure Assessment predicts ICU, hospital, and 1-year mortality. We assessed discriminative performance with c-statistics. MEASUREMENTS AND MAIN RESULTS Among 513 patients (5,199 patient-days), Richmond Agitation-Sedation Scale-based Sequential Organ Failure Assessment was strongly correlated with Acute Physiology and Chronic Health Evaluation II acute physiology score at enrollment (r = 0.583; 95% CI, 0.518-0.642) and daily Glasgow Coma Scale-based Sequential Organ Failure Assessment scores (r = 0.963; 95% CI, 0.956-0.968). Mean Richmond Agitation-Sedation Scale-based Sequential Organ Failure Assessment scores predicted ICU mortality (areas under the curve = 0.814)-as did mean Glasgow Coma Scale-based Sequential Organ Failure Assessment (0.799)-as well as hospital and 1-year mortality. Admission Sequential Organ Failure Assessment scores, whether using Richmond Agitation-Sedation Scale or Glasgow Coma Scale, were less accurate predictors of mortality; areas under the curves for ICU mortality for Richmond Agitation-Sedation Scale-based and Glasgow Coma Scale-based Sequential Organ Failure Assessment, for example, were 0.622 and 0.608, respectively. CONCLUSION A modified Sequential Organ Failure Assessment score that uses bedside Richmond Agitation-Sedation Scale when Glasgow Coma Scale data are not available is a valid means of assessing daily severity of illness in the ICU and may be valuable for risk-adjustment and benchmarking purposes.
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Thromboelastography in patients with severe sepsis: a prospective cohort study. Intensive Care Med 2014; 41:77-85. [PMID: 25413378 DOI: 10.1007/s00134-014-3552-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/07/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the association between consecutively measured thromboelastographic (TEG) tracings and outcome in patients with severe sepsis. METHODS Multicentre prospective observational study in a subgroup of the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) Trial (NCT00962156) comparing hydroxyethyl starch (HES) 130/0.42 vs. Ringer's acetate for fluid resuscitation in severe sepsis. TEG (standard and functional fibrinogen) was measured consecutively for 5 days, and clinical data including bleeding and death was retrieved from the trial database. Statistical analyses included Cox regression with time-dependent covariates and joint modelling techniques. RESULTS Of 267 eligible patients, we analysed 260 patients with TEG data. At 90 days, 68 (26 %) had bled and 139 (53 %) had died. For all TEG variables, hypocoagulability according to the reference range was significantly associated with increased risk of death. In a linear model, hazard ratios for death were 6.03 (95 % confidence interval, 1.64-22.17) for increased clot formation speed, 1.10 (1.04-1.16) for decreased angle, 1.09 (1.05-1.14) for decreased clot strength and 1.12 (1.06-1.18) for decreased fibrinogen contribution to clot strength (functional fibrinogen MA), showing that deterioration towards hypocoagulability in any TEG variable significantly increased the risk of death. Patients treated with HES had lower functional fibrinogen MA than those treated Ringer's acetate, which significantly increased the risk of subsequent bleeding [HR 2.43 (1.16-5.07)] and possibly explained the excess bleeding with HES in the 6S trial. CONCLUSIONS In our cohort of patients with severe sepsis, progressive hypocoagulability defined by TEG variables was associated with increased risk of death and increased risk of bleeding.
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Glasgow Coma Scale score dominates the association between admission Sequential Organ Failure Assessment score and 30-day mortality in a mixed intensive care unit population. J Crit Care 2014; 29:780-5. [PMID: 25012961 DOI: 10.1016/j.jcrc.2014.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/25/2014] [Accepted: 05/22/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The Sequential Organ Failure Assessment (SOFA) score, a measure of multiple-organ dysfunction syndrome, is used to predict mortality in critically ill patients by assigning equally weighted scores across 6 different organ systems. We hypothesized that specific organ systems would have a greater association with mortality than others. DESIGN We retrospectively studied patients admitted over a period of 4.2 years to a mixed-profile intensive care unit (ICU). We recorded age and comorbidities, and calculated SOFA organ scores. The primary outcome was 30-day all-cause mortality. We determined which organ subscores of the SOFA score were most associated with mortality using multiple analytic methods: random forests, conditional inference trees, distanced-based clustering techniques, and logistic regression. SETTING A 24-bed mixed-profile adult ICU that cares for medical, surgical, and trauma (level 1) patients at an academic referral center. PATIENTS All patients' first admission to the study ICU during the study period. MEASUREMENTS AND MAIN RESULTS We identified 9120 first admissions during the study period. Overall 30-day mortality was 12%. Multiple analytical methods all demonstrated that the best initial prediction variables were age and the central nervous system SOFA subscore, which is determined solely by Glasgow Coma Scale score. CONCLUSIONS In a mixed population of critically ill patients, the Glasgow Coma Scale score dominates the association between admission SOFA score and 30-day mortality. Future research into outcomes from multiple-organ dysfunction may benefit from new models for measuring organ dysfunction with special attention to neurologic dysfunction.
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Egashira R, Kobayashi T. Lactate clearance as a predictor of mortality in colonic perforation. Crit Care 2014. [PMCID: PMC4068876 DOI: 10.1186/cc13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Validation of computerized automatic calculation of the sequential organ failure assessment score. Crit Care Res Pract 2013; 2013:975672. [PMID: 23936639 PMCID: PMC3722890 DOI: 10.1155/2013/975672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/12/2013] [Accepted: 06/18/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose. To validate the use of a computer program for the automatic calculation of the sequential organ failure assessment (SOFA) score, as compared to the gold standard of manual chart review. Materials and Methods. Adult admissions (age > 18 years) to the medical ICU with a length of stay greater than 24 hours were studied in the setting of an academic tertiary referral center. A retrospective cross-sectional analysis was performed using a derivation cohort to compare automatic calculation of the SOFA score to the gold standard of manual chart review. After critical appraisal of sources of disagreement, another analysis was performed using an independent validation cohort. Then, a prospective observational analysis was performed using an implementation of this computer program in AWARE Dashboard, which is an existing real-time patient EMR system for use in the ICU. Results. Good agreement between the manual and automatic SOFA calculations was observed for both the derivation (N=94) and validation (N=268) cohorts: 0.02 ± 2.33 and 0.29 ± 1.75 points, respectively. These results were validated in AWARE (N=60). Conclusion. This EMR-based automatic tool accurately calculates SOFA scores and can facilitate ICU decisions without the need for manual data collection. This tool can also be employed in a real-time electronic environment.
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Namendys-Silva SA, Silva-Medina MA, Vásquez-Barahona GM, Baltazar-Torres JA, Rivero-Sigarroa E, Fonseca-Lazcano JA, Domínguez-Cherit G. Application of a modified sequential organ failure assessment score to critically ill patients. Braz J Med Biol Res 2013; 46:186-93. [PMID: 23369978 PMCID: PMC3854366 DOI: 10.1590/1414-431x20122308] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 09/04/2012] [Indexed: 01/31/2023] Open
Abstract
The purpose of the present study was to explore the usefulness of the Mexican
sequential organ failure assessment (MEXSOFA) score for assessing the risk of
mortality for critically ill patients in the ICU. A total of 232 consecutive
patients admitted to an ICU were included in the study. The MEXSOFA was
calculated using the original SOFA scoring system with two modifications: the
PaO2/FiO2 ratio was replaced with the
SpO2/FiO2 ratio, and the evaluation of neurologic
dysfunction was excluded. The ICU mortality rate was 20.2%. Patients with an
initial MEXSOFA score of 9 points or less calculated during the first 24 h after
admission to the ICU had a mortality rate of 14.8%, while those with an initial
MEXSOFA score of 10 points or more had a mortality rate of 40%. The MEXSOFA
score at 48 h was also associated with mortality: patients with a score of
9 points or less had a mortality rate of 14.1%, while those with a score of
10 points or more had a mortality rate of 50%. In a multivariate analysis, only
the MEXSOFA score at 48 h was an independent predictor for in-ICU death with an
OR = 1.35 (95%CI = 1.14-1.59, P < 0.001). The SOFA and MEXSOFA scores
calculated 24 h after admission to the ICU demonstrated a good level of
discrimination for predicting the in-ICU mortality risk in critically ill
patients. The MEXSOFA score at 48 h was an independent predictor of death; with
each 1-point increase, the odds of death increased by 35%.
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Affiliation(s)
- S A Namendys-Silva
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Terapia Intensiva, Mexico City, Mexico.
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Cross-validation of a Sequential Organ Failure Assessment score-based model to predict mortality in patients with cancer admitted to the intensive care unit. J Crit Care 2012; 27:673-80. [PMID: 22762932 DOI: 10.1016/j.jcrc.2012.04.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 04/16/2012] [Accepted: 04/22/2012] [Indexed: 12/27/2022]
Abstract
PURPOSE This study aims to validate the performance of the Sequential Organ Failure Assessment (SOFA) score to predict death of critically ill patients with cancer. MATERIAL AND METHODS We conducted a retrospective observational study including adults admitted to the intensive care unit (ICU) between January 1, 2006, and December 31, 2008. We randomly selected training and validation samples in medical and surgical admissions to predict ICU and in-hospital mortality. By using logistic regression, we calculated the probabilities of death in the training samples and applied them to the validation samples to test the goodness-of-fit of the models, construct receiver operator characteristics curves, and calculate the areas under the curve (AUCs). RESULTS In predicting mortality at discharge from the unit, the AUC from the validation group of medical admissions was 0.7851 (95% confidence interval [CI], 0.7437-0.8264), and the AUC from the surgical admissions was 0.7847 (95% CI, 0.6319-0.937). The AUCs of the SOFA score to predict mortality in the hospital after ICU admission were 0.7789 (95% CI, 0.74-0.8177) and 0.7572 (95% CI, 0.6719-0.8424) for the medical and surgical validations groups, respectively. CONCLUSIONS The SOFA score had good discrimination to predict ICU and hospital mortality. However, the observed underestimation of ICU deaths and unsatisfactory goodness-of-fit test of the model in surgical patients to indicate calibration of the score to predict ICU mortality is advised in this group.
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Nates JL, Cárdenas-Turanzas M, Ensor J, Wakefield C, Wallace SK, Price KJ. Cross-validation of a modified score to predict mortality in cancer patients admitted to the intensive care unit. J Crit Care 2011; 26:388-94. [DOI: 10.1016/j.jcrc.2010.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 10/25/2010] [Accepted: 10/26/2010] [Indexed: 01/27/2023]
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Samuels J, Ng CS, Nates J, Price K, Finkel K, Salahudeen A, Shaw A. Small increases in serum creatinine are associated with prolonged ICU stay and increased hospital mortality in critically ill patients with cancer. Support Care Cancer 2010; 19:1527-32. [PMID: 20711842 DOI: 10.1007/s00520-010-0978-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 08/05/2010] [Indexed: 01/31/2023]
Abstract
PURPOSE Declining kidney function has been associated with adverse hospital outcome in cancer patients. ICU literature suggests that small changes in serum creatinine are associated with poor outcome. We hypothesized that reductions in renal function previously considered trivial would predict a poor outcome in critically ill patients with malignant disease. We evaluated the effects on hospital mortality and ICU length of stay of small changes in creatinine following admission to the intensive care unit. METHODS We conducted a retrospective cohort study utilizing clinical, laboratory and pharmacy data collected from 3,795 patients admitted to the University of Texas M.D. Anderson Cancer Center's Intensive Care Unit. We conducted univariate and multivariate regression analysis to determine those factors associated with adverse ICU and hospital outcome. RESULTS Increases in creatinine as small as 10% (0.2 mg/dl) were associated with prolonged ICU stay (5 days vs 6.6 days, p < 0.001) and increased mortality (14.6% vs 25.5%, p < 0.0001). Patients with a 25% rise in creatinine during the first 72 h of ICU admission were twice as likely to die in the hospital (14.3% vs 30.1%, p < 0.001). RIFLE criteria were accurate predictors of outcome, though they missed much of the risk of even smaller increases in creatinine. CONCLUSIONS Even small rises in serum creatinine following admission to the ICU are associated with increased morbidity and mortality in oncologic patients. The poor outcome in those with rising creatinine could not be explained by severity of illness or other risk factors. These small changes in creatinine may not be trivial, and should be regarded as evidence of a decline in an individual patient's condition.
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Affiliation(s)
- Joshua Samuels
- Division of Renal Diseases and Hypertension, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 5-134, Houston, TX 77030, USA.
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Effect of IV Contrast Medium on Renal Function in Oncologic Patients Undergoing CT in ICU. AJR Am J Roentgenol 2010; 195:414-22. [DOI: 10.2214/ajr.09.4150] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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