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Hsueh SC, Chen PL, Ho CY, Hong MY, Lee CC, Ko WC. Comparing the Prognostic Impacts of Delayed Administration of Appropriate Antimicrobials in Older Patients with Afebrile and Febrile Community-Onset Bacteremia. Antibiotics (Basel) 2024; 13:465. [PMID: 38786193 PMCID: PMC11117469 DOI: 10.3390/antibiotics13050465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
Although prompt administration of an appropriate antimicrobial therapy (AAT) is crucial for reducing mortality in the general population with community-onset bacteremia, the prognostic effects of delayed AAT in older individuals with febrile and afebrile bacteremia remain unclear. A stepwise and backward logistic regression analysis was used to identify independent predictors of 30-day mortality. In a 7-year multicenter cohort study involving 3424 older patients (≥65 years) with community-onset bacteremia, febrile bacteremia accounted for 27.1% (912 patients). A crucial association of afebrile bacteremia and 30-day mortality (adjusted hazard ratio [AHR], 1.69; p < 0.001) was revealed using Cox regression and Kaplan-Meier curves after adjusting for the independent predictors of mortality. Moreover, each hour of delayed AAT was associated with an average increase of 0.3% (adjusted odds ratio [AOR], 1.003; p < 0.001) and 0.2% (AOR, 1.002; p < 0.001) in the 30-day crude mortality rates among patients with afebrile and febrile bacteremia, respectively, after adjusting for the independent predictors of mortality. Similarly, further analysis based on Cox regression and Kaplan-Meier curves revealed that inappropriate empirical therapy (i.e., delayed AAT administration > 24 h) had a significant prognostic impact, with AHRs of 1.83 (p < 0.001) and 1.76 (p < 0.001) in afebrile and febrile patients, respectively, after adjusting for the independent predictors of mortality. In conclusion, among older individuals with community-onset bacteremia, the dissimilarity of the prognostic impacts of delayed AAT between afebrile and febrile presentation was evident.
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Affiliation(s)
- Shu-Chun Hsueh
- Department of Nursing, Meiho University, Pingtung 912009, Taiwan;
| | - Po-Lin Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (P.-L.C.); (M.-Y.H.)
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Ching-Yu Ho
- Department of Adult Critical Care Medicine, Tainan Sin-Lau Hospital, Tainan 70142, Taiwan;
- Department of Nursing, National Tainan Junior College of Nursing, Tainan 700007, Taiwan
| | - Ming-Yuan Hong
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (P.-L.C.); (M.-Y.H.)
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Ching-Chi Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (P.-L.C.); (M.-Y.H.)
- Clinical Medicine Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (P.-L.C.); (M.-Y.H.)
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
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Ren L, Li Z, Duan L, Gao J, Qi L. Association between white blood cell-to-haemoglobin ratio and 30 day mortality in heart failure in intensive care unit. ESC Heart Fail 2024; 11:400-409. [PMID: 38016675 PMCID: PMC10804145 DOI: 10.1002/ehf2.14592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/10/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023] Open
Abstract
AIMS The short-term mortality of heart failure (HF) patients admitted to the intensive care unit (ICU) is reported to be high. This study aims to explore the association between white blood cell-to-haemoglobin ratio (WHR) and 30 day mortality from the admission to the ICU. METHODS AND RESULTS This retrospective cohort study was performed based on the Medical Information Mart for Intensive Care III (MIMIC-III) database (2001-12) and MIMIC-IV database (2008-19). Covariables were selected using the least absolute shrinkage and selection operator regression. Based on the optimal cutoff point selected using the survminer package, WHR was divided into high-ratio group (≥1.6) and low-ratio group (<1.6). The association between WHR and the risk of 30 day mortality was explored using univariate and multivariable Cox regression models. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the prediction performance of WHR. A total of 13 702 patients were included. After adjusting the potential covariates, high WHR was associated with a greater risk of 30 day mortality compared with low WHR [hazard ratio = 1.16, 95% confidence interval (CI): 1.07-1.27, P < 0.001]. WHR also showed a good performance for the prediction of risk of 30 day mortality (AUC = 0.751, 95% CI: 0.746-0.756). CONCLUSIONS WHR was positively associated with and performed well to predict 30 day mortality, indicating that WHR may be a reliable index to assess the prognosis of HF patients admitted to the ICU.
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Affiliation(s)
- Li Ren
- Cardiovascular Department, Guang'anmen HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Zhaoling Li
- Cardiovascular Department, Guang'anmen HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Lian Duan
- Cardiovascular Department, Guang'anmen HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Jialiang Gao
- Cardiovascular Department, Guang'anmen HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Lianfen Qi
- Cardiovascular Department, Guang'anmen HospitalChina Academy of Chinese Medical SciencesBeijingChina
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Oliveira A, Vieira T, Rodrigues A, Jorge N, Tavares L, Costa L, Paiva JA, Gonçalves Pereira J. Critically ill patients with high predicted mortality: Incidence and outcome. Med Intensiva 2024; 48:85-91. [PMID: 37985339 DOI: 10.1016/j.medine.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/16/2023] [Accepted: 10/08/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE As calculated by the severity scores, an unknown number of patients are admitted to the Intensive Care Unit (ICU) with a very high risk of death. Clinical studies have poorly addressed this population, and their prognosis is largely unknown. DESIGN Post hoc analysis of a multicenter, cohort, longitudinal, observational, retrospective study (CIMbA). SETTING Sixteen Portuguese multipurpose ICUs. PATIENTS Patients with a Simplified Acute Physiology Score II (SAPS II) predicted hospital mortality above 80% on admission to the ICU (high-risk group); A comparison with the remaining patients was obtained. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Hospital, 30 days, 1 year mortality. RESULTS We identified 4546 patients (59.9% male), 12.2% of the whole population. Their SAPS II predicted hospital mortality was 89.0±5.8%, whilst the observed mortality was lower, 61.0%. This group had higher mortality, both during the first 30 days (aHR 3.52 [95% CI 3.34-3.71]) and from day 31 to day 365 after ICU admission (aHR 1.14 [95%CI 1.04-1.26]), respectively. However, their hospital standardized mortality ratio was similar to the other patients (0.69 vs. 0.69, P=.92). At one year of follow-up, 30% of patients in the high-risk group were alive. CONCLUSIONS Roughly 12% of patients admitted to the ICU for more than 24h had a SAPS II score predicted mortality above 80%. Their hospital standardized mortality was similar to the less severe population and 30% were alive after one year of follow-up.
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Affiliation(s)
- André Oliveira
- Intensive Care Medicine Department, Hospital de Vila Franca de Xira, Estrada Carlos Lima Costa Nº2, 2600-009 Vila Franca de Xira, Portugal
| | - Tatiana Vieira
- Intensive Care Medicine Department, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ana Rodrigues
- Intensive Care Medicine Department, Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Núria Jorge
- Intensive Care Medicine Department, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Luís Tavares
- Intensive Care Medicine Department, Hospital Santo Espírito, Av. D. Manuel I, 9500-370 Ponta Delgada, Portugal
| | - Laura Costa
- Intensive Care Medicine Department, Hospital de Braga, R. das Comunidades Lusíadas 133, Braga, Portugal
| | - José Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Grupo de Investigação e Desenvolvimento em Infeção e Sépsis (GISID), Rua Heróis de África, 381, Leça da Palmeira, 4450-681 Matosinhos, Portugal; Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200 - 319 Porto, Portugal
| | - João Gonçalves Pereira
- Intensive Care Medicine Department, Hospital de Vila Franca de Xira, Estrada Carlos Lima Costa Nº2, 2600-009 Vila Franca de Xira, Portugal; Grupo de Investigação e Desenvolvimento em Infeção e Sépsis (GISID), Rua Heróis de África, 381, Leça da Palmeira, 4450-681 Matosinhos, Portugal; Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
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Liu C, Wu X, Deng R, Xu X, Chen C, Wu L, Zhang W, Yang H, Fei Y, Sun Y, Zhou S, Fang B. Systemic immune-inflammation index combined with quick sequential organ failure assessment score for predicting mortality in sepsis patients. Heliyon 2023; 9:e19526. [PMID: 37809490 PMCID: PMC10558729 DOI: 10.1016/j.heliyon.2023.e19526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/03/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Abstract
Objective To evaluate the prognostic ability of systemic immune-inflammation index (SII) combine with quick Sequential Organ Failure Assessment (qSOFA) criteria in predicting the 28-day mortality of sepsis. Methods A retrospective cohort study was conducted, with the population comprised in whom sepsis was confirmed. Clinical and laboratory data recorded were analyzed. The score of Sequential Organ Failure Assessment (SOFA), SII, qSOFA were calculated. Multivariable regression, receiver operating characteristic (ROC) analysis and Kaplan-Meier method were used to identify and compared the predictors of prognosis among SOFA, qSOFA, and the combination of SII with qSOFA. Results A total of 349 patients admitted from December 2020 and December 2022 were included in the cohort. 95 (27.2%) of whom had died by day 28. The SII, SOFA, and qSOFA scores were significant higher in the non-survivors than that of survivors (P < 0.05), and identified as independent predictors of sepsis mortality. The addition of SII to qSOFA shown an area under receiver operator characteristic (AUROC) of 0.840 (95% CI: 0.787-0.884), manifested an effective ability in predicting poor outcome than other scoring systems. The optimum cutoff for SII (>1.7668) and qSOFA (>1) represented a high risk level in 28-day mortality of sepsis, were performed and identified in Kaplan-Meier survival curves (log-rank test, HR: 6.942, 95% CI: 3.976-12.121; P < 0.0001). Conclusion The SII in addition to qSOFA provided an effective prognostic tool for predicting mortality in sepsis.
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Affiliation(s)
- Changya Liu
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Xinxin Wu
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 200443, Shanghai, China
| | - Rou Deng
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Xiangru Xu
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Caiyu Chen
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Linguangjin Wu
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Wen Zhang
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Hongqiang Yang
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Yuerong Fei
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Yuting Sun
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Shuang Zhou
- Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Bangjiang Fang
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
- Institute of Emergency and Critical Care Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
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Gao C, Peng L. Association and prediction of red blood cell distribution width to albumin ratio in all-cause mortality of acute kidney injury in critically ill patients. Front Med (Lausanne) 2023; 10:1047933. [PMID: 36968820 PMCID: PMC10034203 DOI: 10.3389/fmed.2023.1047933] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
AimThe progression of acute kidney injury (AKI) might be associated with systemic inflammation. Our study aims to explore the association and predictive value of the red blood cell distribution width (RDW) to human serum albumin (ALB) ratio (RDW/ALB ratio), an inflammation-related indicator, in the risk of all-cause mortality and renal replacement therapy (RRT) in AKI patients admitted in intensive care units (ICU).MethodsA retrospective cohort study was designed, and data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III). The primary outcome was the risk of all-cause mortality (1-month, 3-month, and 12-month), and the secondary outcome was the risk of RRT. The association between the RDW/ALB ratio and the risk of all-cause mortality and RRT was assessed using the Cox regression analysis, with results shown as hazard ratio (HR) and 95% confidence intervals (CIs). The relationship between the RDW/ALB ratio and crude probability of all-cause mortality or RRT was assessed using restricted cubic splines (RCS). The concordance index (C-index) was used to assess the discrimination of the prediction model.ResultsA total of 13,856 patients were included in our study. In the fully adjusted Cox regression model, we found that a high RDW/ALB ratio was associated with an increased risk of 1-month, 3-month, and 12-month all-cause mortality and RRT (all p < 0.05). Moreover, RCS curves showed the linear relationship between the RDW/ALB ratio and the probability of all-cause mortality and RRT, and the probability was elevated with the increase of the ratio. In addition, the RDW/ALB ratio showed a good predictive performance in the risk of 1-month all-cause mortality, 3-month all-cause mortality, 12-month all-cause mortality, and RRT, with a C-index of 0.728 (95%CI: 0.719–0.737), 0.728 (95%CI: 0.721–0.735), 0.719 (95%CI: 0.713–0.725), and 0.883 (95%CI: 0.876–0.890), respectively.ConclusionThe RDW/ALB ratio performed well to predict the risk of all-cause mortality and RRT in critically ill patients with AKI, indicating that this combined inflammatory indicator might be effective in clinical practice.
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Monk M, Torres J, Vickery K, Jayaraman G, Sarva ST, Kesavan R. A Comparison of ICU Mortality Scoring Systems Applied to COVID-19. Cureus 2023; 15:e35423. [PMID: 36987484 PMCID: PMC10040236 DOI: 10.7759/cureus.35423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
Background Over the past three years, COVID-19 has been a major source of mortality in intensive care units around the world. Many scoring systems have been developed to estimate mortality in critically ill patients. Our intent with this study was to compare the efficacy of these systems when applied to COVID-19. Methods The was a multicenter, retrospective cohort study of critically ill patients with COVID-19 admitted to 16 hospitals in Texas from February 2020 to March 2022. The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) score, and 4C Mortality scores were calculated on the initial day of ICU admission. Primary endpoints were all-cause mortality, ICU length of stay, and hospital length of stay. Results Initially, 62,881 patient encounters were assessed, and the cohort of 292 was selected based on the inclusion of the requisite values for each of the scoring systems. The median age was 56 +/- 14.93 years and 61% of patients were male. Mortality was defined as patients who expired or were discharged to hospice and was 78%. The different scoring systems were compared using logistic regression, receiver operating characteristic (ROC) curve, and area under the ROC curve (AUC) analysis to compare the accuracy of prediction of the mortality and length of stay. The multivariate analysis showed that SOFA, APACHE II, SAPS II, and 4C scores were all significant predictors of mortality. The SOFA score had the highest AUC, though the confidence intervals for all of the models overlap therefore one model could not be considered superior to any of the others. Linear regression was performed to evaluate the models' ability to predict ICU and hospital length of stay, and none of the tested systems were found to be significant predictors of length of stay. Conclusion The SOFA, APACHE II, ISARIC 4-C, and SAPS II scores all accurately predicted mortality in critically ill patients with COVID-19. The SOFA score trended to perform the best.
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Affiliation(s)
- Muhammad Monk
- Internal Medicine, HCA Houston Kingwood/University of Houston College of Medicine, Kingwood, USA
| | - Jordan Torres
- Internal Medicine, Univeristy of Houston/HCA Healthcare Kingwood, Houston, USA
| | - Kimberly Vickery
- Medical Education and Simulation, HCA Healthcare, Brentwood, USA
| | | | - Siva T Sarva
- Pulmonary and Critical Care Medicine, HCA Houston Kingwood, Kingwood, USA
| | - Ramesh Kesavan
- Pulmonary and Critical Care Medicine, HCA Houston Kingwood/University of Houston College of Medicine, Houston, USA
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Luedemann WM, Zickler D, Kruse J, Koerner R, Lenk J, Erxleben C, Torsello GF, Fehrenbach U, Jonczyk M, Guenther RW, De Bucourt M, Gebauer B. Percutaneous Large-Bore Pulmonary Thrombectomy with the FlowTriever Device: Initial Experience in Intermediate-High and High-Risk Patients. Cardiovasc Intervent Radiol 2023; 46:35-42. [PMID: 36175655 PMCID: PMC9521880 DOI: 10.1007/s00270-022-03266-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/23/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This retrospective cohort study investigates outcomes of patients with intermediate-high and high-risk pulmonary embolism (PE) who were treated with transfemoral mechanical thrombectomy (MT) using the large-bore Inari FlowTriever aspiration catheter system. MATERIAL AND METHODS Twenty-seven patients (mean age 56.1 ± 15.3 years) treated with MT for PE between 04/2021 and 11/2021 were reviewed. Risk stratification was performed according to European Society of Cardiology (ESC) guidelines. Clinical and hemodynamic characteristics before and after the procedure were compared with the paired Student's t test, and duration of hospital stay was analyzed with the Kaplan-Meier estimator. Procedure-related adverse advents were assessed. RESULTS Of 27 patients treated, 18 were classified as high risk. Mean right-to-left ventricular ratio on baseline CT was 1.7 ± 0.6. After MT, a statistically significant reduction in mean pulmonary artery pressures from 35.9 ± 9.6 to 26.1 ± 9.0 mmHg (p = 0.002) and heart rates from 109.4 ± 22.5 to 82.8 ± 13.8 beats per minute (p < 0.001) was achieved. Two patients died of prolonged cardiogenic shock. Three patients died of post-interventional complications of which a paradoxical embolism can be considered related to MT. One patient needed short cardiopulmonary resuscitation during the procedure due to clot displacement. Patients with PE as primary driver of clinical instability had a median intensive care unit (ICU) stay of 2 days (0.5-3.5 days). Patients who developed PE as a complication of an underlying medical condition spent 11 days (9.5-12.5 days) in the ICU. CONCLUSION In this small study population of predominantly high-risk PE patients, large-bore MT without adjunctive thrombolysis was feasible with an acceptable procedure-related complication rate.
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Affiliation(s)
- W. M. Luedemann
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - D. Zickler
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J. Kruse
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - R. Koerner
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J. Lenk
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C. Erxleben
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - G. F. Torsello
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - U. Fehrenbach
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - M. Jonczyk
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - R. W. Guenther
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - M. De Bucourt
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - B. Gebauer
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Laih CY, Hsiao PJ, Hsieh PF, Wang YD, Lai CM, Yang CT, Lin CH, Huang CP. QSOFA and SOFA scores are valuable tools for predicting postoperative sepsis resulting from ureteroscopic lithotripsy (URSL). Medicine (Baltimore) 2022; 101:e31765. [PMID: 36550908 PMCID: PMC9771339 DOI: 10.1097/md.0000000000031765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The sequential organ failure assessment (SOFA) and quick sequential organ failure assessment (qSOFA) scores are new tools which are used to assess sepsis based on the Third International Consensus Definitions for Sepsis and Septic Shock Task Force. This study aimed to evaluate the feasibility of using the SOFA and qSOFA to predict post-ureteroscopic lithotripsy (URSL) sepsis. Patients who underwent URSL due to ureteral stone obstruction were retrospectively reviewed using SOFA and qSOFA scores. Patient characteristics including age, gender, comorbidities, American Society of Anesthesiologists Classification, stone burden, stone location, hydronephrosis status, infectious status, preoperative SOFA and qSOFA score were collected. Preoperative factors were analyzed to determine if they were correlated with postoperative sepsis. A total of 830 patients were included in this study, of whom 32 (3.9%) had postoperative sepsis. Multivariate analysis revealed that older age, proximal ureteral stones, severe hydronephrosis, and high preoperative qSOFA or SOFA score were significantly associated with postoperative sepsis. The areas under the curves of a qSOFA score ≥ 1 and SOFA score ≥ 2 for predicting postoperative sepsis were 0.754 and 0.823, respectively. Preoperative qSOFA and SOFA scores are convenient and effective for predicting post-URSL sepsis. Further preventive strategies should be performed in these high-risk patients.
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Affiliation(s)
- Chun-Yo Laih
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Po-Jen Hsiao
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu City, Taiwan
| | - Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-De Wang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Ming Lai
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Chao-Tung Yang
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Chu-Hsing Lin
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- * Correspondence: Chi-Ping Huang, Department of Urology, China Medical University Hospital, Taichung, TaiwanSchool of Medicine, China Medical University, Taichung, Taiwan (e-mail: )
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Ho CY, Hung YP, Chen PL, Hsieh CC, Lee CH, Lee CC, Ko WC. Prognostic Effects of Delayed Administration of Appropriate Antimicrobials in Bacteraemic Adults Initially Presenting with Various Body Temperatures. Infect Drug Resist 2022; 15:3149-3160. [PMID: 35747335 PMCID: PMC9211744 DOI: 10.2147/idr.s357183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the different impact of delayed administration of appropriate antimicrobial therapy (AAT) on short-term mortality of bacteraemia patients initially presenting with various body temperatures (BTs). Materials and Methods A six-year, two-center cohort consisting of adults with community-onset bacteraemia in emergency departments (EDs) was retrospectively collected. Through the multivariable analyses, clinical impacts of delayed AAT, assessed by the time gap between the first dose of AAT and ED arrival, on 30-day mortality (primary outcomes) were respectively examined in the different groups of initial BTs (iBTs). Results Of the 3171 adults, despite the similarities of delayed AAT in six iBT categories, hourly AAT delay was associated with an average increase in 30-day mortality rates of 0.24% in the group of iBT <36.0℃, 0.40% in the 36.0℃–36.9℃ group, 0.48% in the 37.0℃–37.9℃ group, 0.59% in the 38.0℃–38.9℃ group, 0.58% in the 39.0℃–39.9℃ group, and 0.71% in the ≥40.0℃ group, after respective adjusting independent predictors of mortality. Furthermore, for 589 patients who inappropriately received empirical antimicrobial treatment (ie, delayed AAT ≥ 24 hours), with a cutoff of 34.0℃, each 1℃ increase in iBTs was independently associated with an average increase in 30-day mortality rates of 42%. Conclusion For adults with community-onset bacteraemia, the iBT-related differences in the prognostic impacts of delayed administration of appropriate antimicrobials might be evident.
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Affiliation(s)
- Ching-Yu Ho
- Department of Adult Critical Care Medicine, Tainan Sin-Lau Hospital, Tainan, 70142, Taiwan.,Department of Nursing, National Tainan Junior College of Nursing, Tainan, 700007, Taiwan
| | - Yuan-Pin Hung
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan.,Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, 70043, Taiwan.,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Po-Lin Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan.,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Chih-Chia Hsieh
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan.,Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Chung-Hsun Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan.,Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Ching-Chi Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan.,Clinical Medicine Research Centre, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan.,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan
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10
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Kammar-García A, Castillo-Martínez L, Mancilla-Galindo J, Villanueva-Juárez JL, Pérez-Pérez A, Rocha-González HI, Arrieta-Valencia J, Remolina-Schlig M, Hernández-Gilsoul T. SOFA Score Plus Impedance Ratio Predicts Mortality in Critically Ill Patients Admitted to the Emergency Department: Retrospective Observational Study. Healthcare (Basel) 2022; 10:healthcare10050810. [PMID: 35627947 PMCID: PMC9140899 DOI: 10.3390/healthcare10050810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The Sequential Organ Failure Assessment (SOFA) is a scoring system used for the evaluation of disease severity and prognosis of critically ill patients. The impedance ratio (Imp-R) is a novel mortality predictor. Aims: This study aimed to evaluate the combination of the SOFA + Imp-R in the prediction of mortality in critically ill patients admitted to the Emergency Department (ED). Methods: A retrospective cohort study was performed in adult patients with acute illness admitted to the ED of a tertiary-care referral center. Baseline SOFA score and bioelectrical impedance analysis to obtain the Imp-R were performed within the first 24 h after admission to the ED. A Cox regression analysis was performed to evaluate the mortality risk of the initial SOFA score plus the Imp-R. Harrell’s C-statistic and decision curve analyses (DCA) were performed. Results: Out of 325 patients, 240 were included for analysis. Overall mortality was 31.3%. Only 21.3% of non-surviving patients died after hospital discharge, and 78.4% died during their hospital stay. Of the latter, 40.6% died in the ED. The SOFA and Imp-R values were higher in non-survivors and were significantly associated with mortality in all models. The combination of the SOFA + Imp-R significantly predicted 30-day mortality, in-hospital mortality, and ED mortality with an area under the curve (AUC) of 0.80 (95% CI: 74–0.86), 0.79 (95% CI: 0.74–0.86) and 0.75 (95% CI: 0.66–0.84), respectively. The DCA showed that combining the SOFA + Imp-R improved the prediction of mortality through the lower risk thresholds. Conclusions: The addition of the Imp-R to the baseline SOFA score on admission to the ED improves mortality prediction in severely acutely ill patients admitted to the ED.
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Affiliation(s)
- Ashuin Kammar-García
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City 10200, Mexico;
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (H.I.R.-G.); (J.A.-V.)
| | - Lilia Castillo-Martínez
- Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (L.C.-M.); (J.L.V.-J.)
| | - Javier Mancilla-Galindo
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04360, Mexico;
- Licenciatura en Nutrición, Facultad de Ciencias de la Salud, Universidad Autónoma de Tlaxcala, Tlaxcala 90750, Mexico
| | - José Luis Villanueva-Juárez
- Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (L.C.-M.); (J.L.V.-J.)
| | - Anayeli Pérez-Pérez
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (A.P.-P.); (M.R.-S.)
| | - Héctor Isaac Rocha-González
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (H.I.R.-G.); (J.A.-V.)
| | - Jesús Arrieta-Valencia
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (H.I.R.-G.); (J.A.-V.)
| | - Miguel Remolina-Schlig
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (A.P.-P.); (M.R.-S.)
| | - Thierry Hernández-Gilsoul
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (A.P.-P.); (M.R.-S.)
- Correspondence: ; Tel.: +52-555-4870-900 (ext. 5010)
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11
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Singh H, Mhasawade V, Chunara R. Generalizability challenges of mortality risk prediction models: A retrospective analysis on a multi-center database. PLOS DIGITAL HEALTH 2022; 1:e0000023. [PMID: 36812510 PMCID: PMC9931319 DOI: 10.1371/journal.pdig.0000023] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/17/2022] [Indexed: 12/23/2022]
Abstract
Modern predictive models require large amounts of data for training and evaluation, absence of which may result in models that are specific to certain locations, populations in them and clinical practices. Yet, best practices for clinical risk prediction models have not yet considered such challenges to generalizability. Here we ask whether population- and group-level performance of mortality prediction models vary significantly when applied to hospitals or geographies different from the ones in which they are developed. Further, what characteristics of the datasets explain the performance variation? In this multi-center cross-sectional study, we analyzed electronic health records from 179 hospitals across the US with 70,126 hospitalizations from 2014 to 2015. Generalization gap, defined as difference between model performance metrics across hospitals, is computed for area under the receiver operating characteristic curve (AUC) and calibration slope. To assess model performance by the race variable, we report differences in false negative rates across groups. Data were also analyzed using a causal discovery algorithm "Fast Causal Inference" that infers paths of causal influence while identifying potential influences associated with unmeasured variables. When transferring models across hospitals, AUC at the test hospital ranged from 0.777 to 0.832 (1st-3rd quartile or IQR; median 0.801); calibration slope from 0.725 to 0.983 (IQR; median 0.853); and disparity in false negative rates from 0.046 to 0.168 (IQR; median 0.092). Distribution of all variable types (demography, vitals, and labs) differed significantly across hospitals and regions. The race variable also mediated differences in the relationship between clinical variables and mortality, by hospital/region. In conclusion, group-level performance should be assessed during generalizability checks to identify potential harms to the groups. Moreover, for developing methods to improve model performance in new environments, a better understanding and documentation of provenance of data and health processes are needed to identify and mitigate sources of variation.
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Affiliation(s)
| | | | - Rumi Chunara
- New York University, Tandon School of Engineering,New York University, School of Global Public Health
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12
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Mølgaard Nielsen F, Lass Klitgaard T, Granholm A, Lange T, Perner A, Lilleholt Schjørring O, Steen Rasmussen B. Higher versus lower oxygenation targets in COVID-19 patients with severe hypoxaemia (HOT-COVID) trial: Protocol for a secondary Bayesian analysis. Acta Anaesthesiol Scand 2022; 66:408-414. [PMID: 34951717 DOI: 10.1111/aas.14023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/27/2021] [Accepted: 12/17/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Respiratory failure is the main cause of mortality and morbidity among ICU patients with coronavirus disease 2019 (COVID-19). In these patients, supplemental oxygen therapy is essential, but there is limited evidence the optimal target. To address this, the ongoing handling oxygenation targets in COVID-19 (HOT-COVID) trial was initiated to investigate the effect of a lower oxygenation target (partial pressure of arterial oxygen (PaO2 ) of 8 kPa) versus a higher oxygenation target (PaO2 of 12 kPa) in the ICU on clinical outcome in patients with COVID-19 and hypoxaemia. METHODS The HOT-COVID is planned to enrol 780 patients. This paper presents the protocol and statistical analysis plan for the conduct of a secondary Bayesian analysis of the primary outcome of HOT-COVID being days alive without life-support at 90 days and the secondary outcome 90-day all-cause mortality. Furthermore, both outcomes will be investigated for the presence heterogeneity of treatment effects based on four baseline parameters being sequential organ failure assessment score, PaO2 /fraction of inspired oxygen ratio, highest dose of norepinephrine during the 24 h before randomisation, and plasma concentration of lactate at randomisation. CONCLUSION The results of this pre-planned secondary Bayesian analysis will complement the primary frequentist analysis of the HOT-COVID trial and may facilitate a more nuanced interpretation of the trial results.
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Affiliation(s)
- Frederik Mølgaard Nielsen
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Thomas Lass Klitgaard
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Anders Granholm
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Theis Lange
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Anders Perner
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Olav Lilleholt Schjørring
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Bodil Steen Rasmussen
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
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13
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Jung HY, Jeon Y, Jeon S, Lim JH, Kim YL. Superiority of Simplified Acute Physiologic Score II Compared with Acute Physiologic and Chronic Health Evaluation II and Sequential Organ Failure Assessment Scores for Predicting 48-Hour Mortality in Patients Receiving Continuous Kidney Replacement Therapy. Nephron Clin Pract 2022; 146:369-376. [PMID: 35100603 DOI: 10.1159/000521495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Predicting early mortality is important in patients undergoing continuous kidney replacement therapy (CKRT), especially in the first 48 h. This study aimed to determine the predictive performance of the Simplified Acute Physiologic Score (SAPS) II, the Acute Physiologic and Chronic Health Evaluation (APACHE) II, and the Sequential Organ Failure Assessment (SOFA) scores for early mortality in patients receiving CKRT. METHODS Data from patients with acute kidney injury receiving CKRT were consecutively and retrospectively obtained at a tertiary medical center between August 2017 and March 2021. The outcomes included 48-h and 7-day mortality. The scoring systems were evaluated via discrimination at the time of CKRT initiation (using area under the receiver operating characteristics curve [AUROC]) and calibration (via Hosmer-Lemeshow goodness-of-fit C statistics). RESULTS Among eligible 652 patients, 95 (14.6%) and 212 (32.5%) died within 48 h and within 7 days, respectively. The AUROC for SAPS II (0.71, 95% confidence interval [CI]: 0.65-0.77, p = 0.016 vs. APACHE II score, p = 0.044 vs. SOFA score) was significantly higher than that of the APACHE II (0.66, 95% CI: 0.60-0.72) and SOFA scores (0.66, 95% CI: 0.60-0.72) for 48-h mortality. However, no significant differences in the AUROCs for SAPS II, APACHE II, and SOFA scores for 7-day mortality were observed. The calibration of the SAPS II for 48-h and 7-day mortality was adequate (p = 0.507 and p = 0.141, respectively). CONCLUSIONS The predictive performance of SAPS II for mortality within the first 48 h was superior to that of the APACHE II and SOFA scores in patients with acute kidney injury receiving CKRT.
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Affiliation(s)
- Hee-Yeon Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yena Jeon
- Department of Statistics, Kyungpook National University, Daegu, Republic of Korea
| | - Soojee Jeon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jeong-Hoon Lim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
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14
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Lu T, Tan L, Xu K, Liu J, Liu C, Zhang G, Shi R, Huang Z. Outcomes of hyperlactatemia on admission in critically ill patients with acute myocardial infarction: A retrospective study from MIMIC-IV. Front Endocrinol (Lausanne) 2022; 13:1015298. [PMID: 36213274 PMCID: PMC9538672 DOI: 10.3389/fendo.2022.1015298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It has not been verified whether there is a correlation between admission hyperlactatemia and outcomes in critically ill patients with acute myocardial infarction (AMI), especially in large data studies, which we aimed to do in this study. METHODS For this retrospective study, we extracted analysis data from a famous online intensive care unit database, the Medical Information Mart for Intensive Care (MIMIC)-IV. Included patients were divided into four groups according to the serum lactate level on admission. Hospital mortality and mortality over time were the main outcomes. To explore the relationship between admission hyperlactatemia and outcomes in critically ill patients with AMI, logistic regression, Cox regression, Kaplan-Meier curves, and subgroup analyses were used. RESULTS 2171 patients matching the selection criteria were enrolled in this study. After adjusting for potential confounding factors, hyperlactatemia on admission contributed to increased short-term mortality in critically ill patients with AMI. The adjusted odds ratio for hospital mortality were 1.62, 3.46 and 5.28 in the mild, moderate, and severe hyperlactatemia groups (95% CI: 1.20-2.18, 2.15-5.58, and 2.20-12.70, respectively). The adjusted hazard ratio for 7-day and 30-day mortality were 1.99 and 1.35 (95% CI: 1.45-2.73 and 1.09-1.67) in the mild hyperlactatemia group, 3.33 and 2.31 (95% CI: 2.22-4.99 and 1.72-3.10) in the moderate hyperlactatemia group, 4.81 and 2.91 (95% CI: 2.86-8.08 and 1.88-4.50) in the severe hyperlactatemia group. The adjusted hazard ratio for 1-year and 5-year mortality were 2.03 and 1.93 (95% CI: 1.58-2.62 and 1.52-2.47) in the moderate hyperlactatemia group, 1.92 and 1.74 (95% CI: 1.28-2.89 and 1.17-2.59) in the severe hyperlactatemia group. Subgroup analyses indicated that the positive correlation between serum lactate level on admission and short-term mortality of critically ill patients with AMI was similar in the subgroups of cardiogenic shock and acute heart failure (P for interaction > 0.05). CONCLUSION Hyperlactatemia, especially moderate and severe hyperlactatemia, on admission is closely related to higher short-term mortality incidence in critically ill patients with AMI. The relationship between serum lactate level on admission and short-term mortality of critical AMI patients is stable in subgroups of cardiogenic shock and acute heart failure.
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Affiliation(s)
- Ting Lu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
- Department of Critical Care, Changsha Hospital of Traditional Chinese Medicine, Changsha, China
| | - Liao Tan
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Kai Xu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jia Liu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Chong Liu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Guogang Zhang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ruizheng Shi
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Ruizheng Shi, ; Zheng Huang,
| | - Zheng Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Ruizheng Shi, ; Zheng Huang,
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15
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Klitgaard TL, Schjørring OL, Lange T, Møller MH, Perner A, Rasmussen BS, Granholm A. Lower versus higher oxygenation targets in critically ill patients with severe hypoxaemia: secondary Bayesian analysis to explore heterogeneous treatment effects in the Handling Oxygenation Targets in the Intensive Care Unit (HOT-ICU) trial. Br J Anaesth 2022; 128:55-64. [PMID: 34674834 PMCID: PMC8787771 DOI: 10.1016/j.bja.2021.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In the Handling Oxygenation Targets in the Intensive Care Unit (HOT-ICU) trial, a lower (8 kPa) vs a higher (12 kPa) PaO2 target did not affect mortality amongst critically ill adult patients. We used Bayesian statistics to evaluate any heterogeneity in the effect of oxygenation targets on mortality between different patient groups within the HOT-ICU trial. METHODS We analysed 90-day all-cause mortality using adjusted Bayesian logistic regression models, and assessed heterogeneous treatment effects according to four selected baseline variables using both hierarchical models of subgroups and models with interactions on the continuous scales. Results are presented as mortality probability (%) and relative risk (RR) with 95% credibility intervals (CrI). RESULTS All 2888 patients in the intention-to-treat cohort of the HOT-ICU trial were included. The adjusted 90-day mortality rates were 43.0% (CrI: 38.3-47.8%) and 42.3% (CrI: 37.7-47.1%) in the lower and higher oxygenation groups, respectively (RR 1.02 [CrI: 0.93-1.11]), with 36.5% probability of an RR <1.00. Analyses of heterogeneous treatment effects suggested a dose-response relationship between baseline norepinephrine dose and increased mortality with the lower oxygenation target, with 95% probability of increased mortality associated with the lower oxygenation target as norepinephrine doses increased. CONCLUSIONS A lower oxygenation target was unlikely to affect overall mortality amongst critically ill adult patients with acute hypoxaemic respiratory failure. However, our results suggest an increasing mortality risk for patients with a lower oxygen target as the baseline norepinephrine dose increases. These findings warrant additional investigation. CLINICAL TRIAL REGISTRATION NCT03174002.
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Affiliation(s)
- Thomas L Klitgaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Collaboration for Research in Intensive Care, Copenhagen, Denmark.
| | - Olav L Schjørring
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Collaboration for Research in Intensive Care, Copenhagen, Denmark
| | - Theis Lange
- Collaboration for Research in Intensive Care, Copenhagen, Denmark; Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Morten H Møller
- Collaboration for Research in Intensive Care, Copenhagen, Denmark; Department of Intensive Care 4131, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Collaboration for Research in Intensive Care, Copenhagen, Denmark; Department of Intensive Care 4131, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bodil S Rasmussen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Collaboration for Research in Intensive Care, Copenhagen, Denmark
| | - Anders Granholm
- Collaboration for Research in Intensive Care, Copenhagen, Denmark; Department of Intensive Care 4131, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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16
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The Use of Different Sepsis Risk Stratification Tools on the Wards and in Emergency Departments Uncovers Different Mortality Risks: Results of the Three Welsh National Multicenter Point-Prevalence Studies. Crit Care Explor 2021; 3:e0558. [PMID: 34704060 PMCID: PMC8542169 DOI: 10.1097/cce.0000000000000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Supplemental Digital Content is available in the text. To compare the performance of Sequential Organ Failure Assessment, systemic inflammatory response syndrome, Red Flag Sepsis, and National Institute of Clinical Excellence sepsis risk stratification tools in the identification of patients at greatest risk of mortality from sepsis in nonintensive care environments.
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17
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Li Q, Yang W, Zhao K, Sun X, Bao L. Thrombomodulin gene polymorphism and the occurrence and prognostic value of sepsis acute kidney injury. Medicine (Baltimore) 2021; 100:e26293. [PMID: 34190147 PMCID: PMC8257907 DOI: 10.1097/md.0000000000026293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 04/20/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT To investigate the relationship between thrombomodulin (THBD) gene single nucleotide polymorphisms (SNPs) and susceptibility to sepsis and the occurrence and prognosis of acute kidney injury (AKI) in sepsis patients.The genotypes of THBD gene rs1962, rs3176123, and rs1042580 in 178 sepsis patients with AKI, 243 sepsis patients without AKI (No AKI), and 103 healthy controls were analyzed by direct sequencing. Enzyme-linked immunosorbent assay (ELISA) was used to detect the plasma THBD protein levels. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic value of plasma THBD levels in sepsis, AKI, and death of sepsis patients.The C allele carriers of THBD gene rs1962 were more likely to develop AKI and sepsis than the T allele carriers (OR = 1.61, 95% CI: 1.18-2.19, P < .01; OR = 2.16, 95% CI: 1.42-3.29, P < .01). The rs3176123 G allele was associated with an increased risk of AKI in sepsis patients (OR = 1.41, 95% CI: 1.06-1.88, P = .02), the G allele had a significant association with a higher risk of sepsis susceptibility (OR = 1.91, 95% CI: 1.33-2.75, P < .01). Sepsis patients of rs1042580 C allele had a lower risk of AKI than those of T allele (OR = 0.58, 95% CI: 0.37-0.91, P = .02), the C allele was related to a reduced risk of sepsis susceptibility (OR = 0.38, 95% CI: 0.26-0.55, P < .01). The THBD gene rs1962, rs3176123, and rs1042580 TGT haplotype was linked to higher risk of AKI in patients with sepsis (OR = 1.96, 95%CI: 1.14-3.38, P = .02). Sepsis patients with the THBD gene rs1962 TC + CC genotype had a higher risk of death than those with TT genotype (OR = 10.93, 95%CI: 5.05-26.96, P < .01), but there was no significant difference in the risk of death in sepsis patients with different genotypes at rs3176123 and rs1042580 (P > .05).The THBD gene rs1962, rs3176123, and rs1042580 SNPs are significantly associated with sepsis susceptibility and the risk of AKI. The rs1962 SNP is related to the risk of death in sepsis patients.
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Affiliation(s)
- Qin Li
- Department of Nephrology Ward, Zibo Central Hospital, Zhangdian, Zibo, Shandong
| | - Wenjuan Yang
- Department of Nephrology Ward, Zibo Central Hospital, Zhangdian, Zibo, Shandong
| | - Keming Zhao
- Department of Nephrology Ward, Zibo Central Hospital, Zhangdian, Zibo, Shandong
| | - Xifeng Sun
- Department of Nephrology Ward, Zibo Central Hospital, Zhangdian, Zibo, Shandong
| | - Liuqian Bao
- Department of Emergency Medicine Department, People's Hospital of Tiantai County, Tiantai County, Taizhou City, Zhejiang, China
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Zanuto ACD, Larangeira AS, Tanita MT, Ishioka HK, Grion CMC, Delfino VDA. SOFAMONIA: Comparison of the original SOFA score with the proposed new score including serum ammonia. HONG KONG J EMERG ME 2021. [DOI: 10.1177/1024907920928690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Introduction: Hyperammonemia can represent organic dysfunction of the brain, kidney, or liver. Evaluation of serum ammonia concentrations as a parameter for organ dysfunction may be justified. Objective: To evaluate the performance of serum ammonia as an additional or substitute variable for organ systems in the Sequential Organ Failure Assessment (SOFA) score. Methods: A prospective cohort study including 173 patients admitted to the intensive care unit between March 2015 and February 2016. SOFAMONIA scores were defined as follows: SOFAMONIA1 (Glasgow coma scale replaced by serum ammonia), SOFAMONIA2 (serum bilirubin replaced by serum ammonia), SOFAMONIA3 (renal system score replaced by serum ammonia), and SOFAMONIA4 (addition of serum ammonia to the original SOFA as the seventh variable, changing the maximum score from 24 to 28). Results: The original SOFA presented an area under the curve–receiver operating characteristic of 0.697 to predict hospital mortality. There was a positive correlation between SOFA and SOFAMONIA scores. SOFAMONIA1 presented a cut-off point of 5 for area under the curve 0.684 (0.610–0.753, 95% confidence interval), SOFAMONIA2 presented a cut-off point of 9 for area under the curve 0.701 (0.626–0.768, 95% confidence interval), SOFAMONIA3 presented a cut-off point of 8 for area under the curve 0.674 (0.598–0.743, 95% confidence interval), and SOFAMONIA4 presented a cut-off point of 8 for area under the curve 0.702 (0.628–0.769, 95% confidence interval). Conclusions: The addition of ammonia as the seventh parameter of the SOFA score showed the best performance to predict hospital mortality. The addition of ammonia as a representative of metabolic dysfunction may be useful in the follow-up of critically ill patients.
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Survival in the Intensive Care Unit: A prognosis model based on Bayesian classifiers. Artif Intell Med 2021; 115:102054. [PMID: 34001314 DOI: 10.1016/j.artmed.2021.102054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/01/2021] [Accepted: 03/17/2021] [Indexed: 12/15/2022]
Abstract
We develop a predictive prognosis model to support medical experts in their clinical decision-making process in Intensive Care Units (ICUs) (a) to enhance early mortality prediction, (b) to make more efficient medical decisions about patients at higher risk, and (c) to evaluate the effectiveness of new treatments or detect changes in clinical practice. It is a machine learning hierarchical model based on Bayesian classifiers built from some recorded features of a real-world ICU cohort, to bring about the assessment of the risk of mortality, also predicting destination at ICU discharge if the patient survives, or the cause of death otherwise, constructed as an ensemble of five base Bayesian classifiers by using the average ensemble criterion with weights, and we name it the Ensemble Weighted Average (EWA). We compare EWA against other state-of-the-art machine learning predictive models. Our results show that EWA outperforms its competitors, presenting in addition the advantage over the ensemble using the majority vote criterion of allowing to associate a confidence level to the provided predictions. We also prove the convenience of locally recalibrate from data the standard model used to predict the mortality risk based on the APACHE II score, although as a predictive model it is weaker than the other.
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Severity-Adjusted ICU Mortality Only Tells Half the Truth—The Impact of Treatment Limitation in a Nationwide Database. Crit Care Med 2020; 48:e1242-e1250. [DOI: 10.1097/ccm.0000000000004658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Klitgaard TL, Schjørring OL, Lange T, Møller MH, Perner A, Rasmussen BS, Granholm A. Bayesian and heterogeneity of treatment effect analyses of the HOT-ICU trial-A secondary analysis protocol. Acta Anaesthesiol Scand 2020; 64:1376-1381. [PMID: 32659856 DOI: 10.1111/aas.13669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Handling Oxygenation Targets in the Intensive Care Unit (HOT-ICU) trial is an ongoing randomised clinical trial exploring the benefits and harms of targeting a lower (8 kPa) versus a higher (12 kPa) arterial oxygenation target in adult patients acutely admitted to the intensive care unit (ICU) with hypoxaemic respiratory failure. METHODS This protocol describes a secondary analysis of the primary trial outcome, 90-day all-cause mortality. We will analyse the primary outcome using Bayesian methods, which allows quantification of probabilities of all effect sizes. We will explore the presence of heterogeneity of treatment effects (HTE) using Bayesian hierarchical models in subgroups based on baseline parameters: (a) severity of illness (Sequential Organ Failure Assessment (SOFA) score), (b) severity of hypoxaemic respiratory failure (partial pressure of arterial oxygen (PaO2 )/fraction of inspired oxygen (FiO2 ) ratio), (c) vasopressor requirement (highest noradrenaline dose in the 24 hours prior to randomisation), and (d) plasma lactate concentration (latest prior to randomisation). Additionally, we will perform separate assessments of the treatment effect interaction with each of the baseline parameters above on the continuous scale and present these using conditional effects plots. CONCLUSIONS This secondary analysis will aid the interpretation of the HOT-ICU trial by evaluating probabilities of all effect sizes. In addition, we will evaluate whether HTE is present, thus, further evaluating benefits and harms of a lower versus a higher oxygenation target in adult ICU patients with acute hypoxaemic respiratory failure.
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Affiliation(s)
- Thomas L. Klitgaard
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Olav L. Schjørring
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Theis Lange
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Public Health, Section of Biostatistics University of Copenhagen Copenhagen Denmark
| | - Morten Hylander Møller
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Intensive Care 4131 Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Anders Perner
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Intensive Care 4131 Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Bodil S. Rasmussen
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Anders Granholm
- Department of Intensive Care 4131 Rigshospitalet, University of Copenhagen Copenhagen Denmark
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Cardiovascular Safety of Clonidine and Dexmedetomidine in Critically Ill Patients after Cardiac Surgery. Crit Care Res Pract 2020; 2020:4750615. [PMID: 32455009 PMCID: PMC7229561 DOI: 10.1155/2020/4750615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 02/26/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of this retrospective study was to assess the haemodynamic adverse effects of clonidine and dexmedetomidine in critically ill patients after cardiac surgery. Methods 2769 patients were screened during the 30-month study period. Heart rate (HR), mean arterial pressure (MAP), and norepinephrine requirements were assessed 3-hourly during the first 12 hours of the continuous drug infusion. Results are given as median (interquartile range) or numbers (percentages). Results Patients receiving clonidine (n = 193) were younger (66 (57-73) vs 70 (63-77) years, p=0.003) and had a lower SAPS II (35 (27-48) vs 41 (31-54), p=0.008) compared with patients receiving dexmedetomidine (n = 141). At the start of the drug infusion, HR (90 (75-100) vs 90 (80-105) bpm, p=0.028), MAP (70 (65-80) vs 70 (65-75) mmHg, p=0.093), and norepinephrine (0.05 (0.00-0.11) vs 0.12 (0.03-0.19) mcg/kg/min, p < 0.001) were recorded in patients with clonidine and dexmedetomidine. Bradycardia (HR < 60 bpm) developed in 7.8% with clonidine and 5.7% with dexmedetomidine (p=0.51). Between baseline and 12 hours, norepinephrine remained stable in the clonidine group (0.00 (-0.04-0.02) mcg/kg/min) and decreased in the dexmedetomidine group (-0.03 (-0.10-0.02) mcg/kg/min, p=0.007). Conclusions Dexmedetomidine and the low-cost drug clonidine can both be used safely in selected patients after cardiac surgery.
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Wang XL, Ma LJ, Hu XG, Wang K, Cheng JJ. Application of the respiratory "critical care-sub-critical care-rehabilitation integrated management model" in severe stroke associated pneumonia. BMC Pulm Med 2020; 20:61. [PMID: 32138782 PMCID: PMC7059713 DOI: 10.1186/s12890-020-1100-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/24/2020] [Indexed: 12/20/2022] Open
Abstract
Background This study aimed to explore the feasibility of applying the respiratory “critical care-sub-critical care-rehabilitation integrated management model” in severe stroke-associated pneumonia and evaluate its effect. Methods From January to September 2018, 24 patients with severe stroke-associated pneumonia, who were admitted to the Respiratory Intensive Care Unit of the Respiratory and Critical Care Medicine Department of Henan Provincial People’s Hospital, were randomly divided into two groups: integrated management group and control group. According to the admission criteria of the respiratory “critical care-sub-critical care-rehabilitation integrated model” prescribed by the above-mentioned hospital, patients were grouped. The professional respiratory therapy team participated in the whole treatment. The acute physiology and chronic health evaluation II (APACHE II) score, clinical pulmonary infection score (CPIS) and oxygenation index of these two groups were dynamically observed, and the average hospital stay, 28-day mortality and patient satisfaction were investigated. Results Patients in the integrated management group and control group were similar before treatment (P > 0.05). After treatment, the main indicators, the APACHE II score, CPIS score and oxygenation index, were significantly different between the integration group and control group (P < 0.05). The secondary indicators, the average hospitalization days and patient/family member satisfaction scores, were also significantly different between the integration group and control group (P < 0.05). However, the 28-day mortality wasn’t significantly different (P > 0.05). Conclusions For patients with severe stroke-associated pneumonia, it was feasible to implement the respiratory “critical care-sub-critical care-rehabilitation integrated management model”, which could significantly improve the treatment effect, shorten average hospitalization days and improve patient/family satisfaction.
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Affiliation(s)
- Xue-Lin Wang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, No. 7 of Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Li-Jun Ma
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, No. 7 of Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Xin-Gang Hu
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, No. 7 of Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Kai Wang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, No. 7 of Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Jian-Jian Cheng
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, No. 7 of Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.
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Zang H, Shen X, Wang S, He Z, Cheng H. Evaluation and prognostic value of Cv-aCO 2/Da-vO 2 in patients with septic shock receiving fluid resuscitation Cv-aCO 2/Ca-vO 2. Exp Ther Med 2019; 18:3631-3635. [PMID: 31602240 DOI: 10.3892/etm.2019.7956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 07/16/2019] [Indexed: 12/21/2022] Open
Abstract
The present study aimed to evaluate the prognostic value of venous-arterial CO2 to arterial-venous O2 (Cv-aCO2/Da-vO2) for patients with septic shock treated by fluid resuscitation. A total of 108 cases who received fluid resuscitation for septic shock at the Intensive Care Unit were retrospectively screened according to the 2012 surviving sepsis campaign guidelines. Patients were divided into 2 groups according to the Cv-aCO2/Da-vO2 ratio at 6 h after fluid resuscitation: Group A, Cv-aCO2/Da-vO2 >1; group B, Cv-aCO2/Da-vO2 ≤1. The resuscitation target rate and transfused resuscitation volume at 6 h exhibited no significant difference between the 2 groups. The cardiac output at 6 and 24 h, as well as the ratio of patients who reached the target of resuscitation within 24 h, the 24-h lactic acid clearance rate and the number of cases with central venous oxygen saturation >70% were significantly decreased in group A compared with those in group B (all P<0.05). The Sequential Organ Failure Assessment score at day 3 in group A was higher compared with that in group B (7.94±1.6 vs. 6.82±1.9; P=0.0013). The mortality rate at day 7 and 35 was higher in group A compared with that in group B (29/52 vs. 6/56, P<0.001; 48/52 vs. 36/56; P<0.001). In conclusion, the Cv-aCO2/Da-vO2 was able to effectively evaluate the success rate of resuscitation and, regarding prognosis, it was able to identify patients at high risk of adverse outcomes.
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Affiliation(s)
- Huiling Zang
- Department of Intensive Care Unit, The First Hospital of Shijiazhuang, Shijiazhuang, Hebei 050000, P.R. China
| | - Xiaohui Shen
- Department of Intensive Care Unit, The First Hospital of Shijiazhuang, Shijiazhuang, Hebei 050000, P.R. China
| | - Shengchi Wang
- Department of Intensive Care Unit, The First Hospital of Shijiazhuang, Shijiazhuang, Hebei 050000, P.R. China
| | - Zhihong He
- Department of Intensive Care Unit, The First Hospital of Shijiazhuang, Shijiazhuang, Hebei 050000, P.R. China
| | - Hui Cheng
- Department of Intensive Care Unit, The First Hospital of Shijiazhuang, Shijiazhuang, Hebei 050000, P.R. China
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Granholm A, Perner A, Krag M, Marker S, Hjortrup PB, Haase N, Holst LB, Collet MO, Jensen AKG, Møller MH. External validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). Acta Anaesthesiol Scand 2019; 63:1216-1224. [PMID: 31273763 DOI: 10.1111/aas.13422] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/26/2019] [Accepted: 05/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Simplified Mortality Score for the Intensive Care Unit (SMS-ICU) is a clinical prediction model, which estimates the risk of 90-day mortality in acutely ill adult ICU patients using 7 readily available variables. We aimed to externally validate the SMS-ICU and compare its discrimination with existing prediction models used with 90-day mortality as the outcome. METHODS We externally validated the SMS-ICU using data from 3282 patients included in the Stress Ulcer Prophylaxis in the Intensive Care Unit trial, which randomised acutely ill adult ICU patients with risk factors for gastrointestinal bleeding to prophylactic pantoprazole or placebo in 33 ICUs in Europe. We assessed discrimination, calibration and overall performance of the SMS-ICU and compared discrimination with the commonly used and more complex SAPS II and SOFA scores. RESULTS Mortality at day 90 was 30.7%. The discrimination (area under the receiver operating characteristic curve) for the SMS-ICU was 0.67 (95% CI: 0.65-0.69), as compared with 0.68 (95% CI: 0.66-0.70, P = 0.35) for SAPS II and 0.63 (95% CI: 0.61-0.65, P < 0.001) for the SOFA score. Calibration (intercept and slope) was 0.001 and 0.786, respectively, and Nagelkerke's R2 (overall performance) was 0.06. The proportions of missing data for the SMS-ICU, SAPS II and SOFA scores were 0.2%, 8.5% and 6.8%, respectively. CONCLUSIONS Discrimination for 90-day mortality of the SMS-ICU in this cohort was poor, but similar to SAPS II and better than that of the SOFA score with markedly less missing data.
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Affiliation(s)
- Anders Granholm
- Department of Intensive Care 4131 Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Anders Perner
- Department of Intensive Care 4131 Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
- Centre for Research in Intensive Care Copenhagen Denmark
| | - Mette Krag
- Department of Intensive Care 4131 Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
- Centre for Research in Intensive Care Copenhagen Denmark
| | - Søren Marker
- Department of Intensive Care 4131 Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
- Centre for Research in Intensive Care Copenhagen Denmark
| | - Peter Buhl Hjortrup
- Centre for Research in Intensive Care Copenhagen Denmark
- Department of Anaesthesia and Intensive Care Zealand University Hospital Køge Denmark
| | - Nicolai Haase
- Department of Intensive Care 4131 Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Lars Broksø Holst
- Department of Intensive Care 4131 Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Marie Oxenbøll Collet
- Department of Intensive Care 4131 Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
- Centre for Research in Intensive Care Copenhagen Denmark
| | - Aksel Karl Georg Jensen
- Centre for Research in Intensive Care Copenhagen Denmark
- Section of Biostatistics University of Copenhagen Copenhagen Denmark
| | - Morten Hylander Møller
- Department of Intensive Care 4131 Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
- Centre for Research in Intensive Care Copenhagen Denmark
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Bateman M, Alkhatib A, John T, Parikh M, Kheir F. Pleural Effusion Outcomes in Intensive Care: Analysis of a Large Clinical Database. J Intensive Care Med 2019; 35:48-54. [PMID: 31640451 DOI: 10.1177/0885066619872449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pleural effusions are common in critically ill patients. However, the management of pleural fluid on relevant clinical outcomes is poorly studied. We evaluated the impact of pleural effusion in the intensive care unit (ICU). METHODS A large observational ICU database Multiparameter Intelligent Monitoring in Intensive Care III was utilized. Analyses used matched patients with the same admission diagnosis, age, gender, and disease severity. RESULTS Of 50 765, 3897 (7.7%) of critically ill adult patients had pleural effusions. Compared to patients without effusion, patients with effusion had higher in-hospital (38.7% vs 31.3%, P < .0001), 1-month (43.1% vs 36.1%, P < .0001), 6-month (63.6% vs 55.7%, P < .0001), and 1-year mortality (73.8% vs 66.1%, P < .0001), as well as increased length of hospital stay (17.6 vs 12.7 days, P < .0001), ICU stay (7.3 vs 5.1 days, P < .0001), need for mechanical ventilation (63.1% vs 55.7%, P < .0001), and duration of mechanical ventilation (8.7 vs 6.3 days, P < .0001). A total of 1503 patients (38.6%) underwent pleural fluid drainage. Patients in the drainage group had higher in-hospital (43.9% vs 35.4%, P = .0002), 1-month (47.7% vs 39.7%, P = .0005), 6-month (67.1% vs 61.8%, P = .0161), and 1-year mortality (77.1% vs 72.1%, P = .0147), as well as increased lengths of hospital stay (22.1 vs 16.0 days, P < .0001), ICU stay (9.2d vs 6.4 days, P < .0001), and duration of mechanical ventilation (11.7 vs 7.1 days, P < .0001). CONCLUSIONS The presence of a pleural effusion was associated with increased mortality in critically ill patients regardless of disease severity. Drainage of pleural effusion was associated with worse outcomes in a large, heterogeneous cohort of ICU patients.
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Affiliation(s)
- Marjorie Bateman
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ala Alkhatib
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Thomas John
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Malhar Parikh
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Fayez Kheir
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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Abstract
OBJECTIVE Severity of illness scores rest on the assumption that patients have normal physiologic values at baseline and that patients with similar severity of illness scores have the same degree of deviation from their usual state. Prior studies have reported differences in baseline physiology, including laboratory markers, between obese and normal weight individuals, but these differences have not been analyzed in the ICU. We compared deviation from baseline of pertinent ICU laboratory test results between obese and normal weight patients, adjusted for the severity of illness. DESIGN Retrospective cohort study in a large ICU database. SETTING Tertiary teaching hospital. PATIENTS Obese and normal weight patients who had laboratory results documented between 3 days and 1 year prior to hospital admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Seven hundred sixty-nine normal weight patients were compared with 1,258 obese patients. After adjusting for the severity of illness score, age, comorbidity index, baseline laboratory result, and ICU type, the following deviations were found to be statistically significant: WBC 0.80 (95% CI, 0.27-1.33) × 10/L; p = 0.003; log (blood urea nitrogen) 0.01 (95% CI, 0.00-0.02); p = 0.014; log (creatinine) 0.03 (95% CI, 0.02-0.05), p < 0.001; with all deviations higher in obese patients. A logistic regression analysis suggested that after adjusting for age and severity of illness at least one of these deviations had a statistically significant effect on hospital mortality (p = 0.009). CONCLUSIONS Among patients with the same severity of illness score, we detected clinically small but significant deviations in WBC, creatinine, and blood urea nitrogen from baseline in obese compared with normal weight patients. These small deviations are likely to be increasingly important as bigger data are analyzed in increasingly precise ways. Recognition of the extent to which all critically ill patients may deviate from their own baseline may improve the objectivity, precision, and generalizability of ICU mortality prediction and severity adjustment models.
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Chen Q, Zhang L, Ge S, He W, Zeng M. Prognosis predictive value of the Oxford Acute Severity of Illness Score for sepsis: a retrospective cohort study. PeerJ 2019; 7:e7083. [PMID: 31218129 PMCID: PMC6563807 DOI: 10.7717/peerj.7083] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/06/2019] [Indexed: 01/15/2023] Open
Abstract
Background The Oxford Acute Severity of Illness Score (OASIS) has shown fair prognosis predictive value in critically ill patients, but its predictive value has not been assessed in septic patients. Objective The aim of this study was to evaluate the performance of the OASIS for the assessment of mortality in septic patients, especially when compared with the Sepsis-related Organ Failure Assessment (SOFA) score. Methods A retrospective cohort study was conducted using data from a public database and septic patients were identified using the Sepsis-3 criteria. The primary outcome was hospital mortality. Data were mainly analyzed using multivariable logistic regression and receiver operating characteristic (ROC) curves. Sensitive analyses were performed in patients with an ICD-9-CM code for sepsis and ROC curves analyses were also conducted in septic patients stratified by the Simplified Acute Physiology Score (SAPS) II as subgroup analyses. Results A total of 10,305 septic patients were included. The OASIS was found to be significantly associated with hospital mortality (odds ratio 1.07 per one-point increase, 95% confidence interval [1.06–1.08]), while ROC curves analyses showed the discriminatory power of the OASIS for hospital mortality was statistically significantly lower than that of the SOFA score (area under the ROC curve: 0.652 vs 0.682, p < 0.001). Results of sensitive analyses were consistent, but the significant difference existed only when the SAPS II was higher than 50 according to results of the subgroup analyses. Conclusions The OASIS might serve as an initial predictor of clinical outcomes for septic patients, but one should be circumspect when it is applied to severer patients.
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Affiliation(s)
- Qingui Chen
- Department of Medical Intensive Care Unit, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lishan Zhang
- Department of Medical Intensive Care Unit, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shanhui Ge
- Department of Medical Intensive Care Unit, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wanmei He
- Department of Medical Intensive Care Unit, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Mian Zeng
- Department of Medical Intensive Care Unit, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Pantoprazole prophylaxis in ICU patients with high severity of disease: a post hoc analysis of the placebo-controlled SUP-ICU trial. Intensive Care Med 2019; 45:609-618. [DOI: 10.1007/s00134-019-05589-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
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Buck DL, Christiansen CF, Christensen S, Møller MH. Out-of-hours intensive care unit admission and 90-day mortality: a Danish nationwide cohort study. Acta Anaesthesiol Scand 2018; 62:974-982. [PMID: 29602190 DOI: 10.1111/aas.13119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 02/25/2018] [Accepted: 02/28/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Mortality rates in critically ill adult patients admitted to the intensive care unit (ICU) remains high, and numerous patient- and disease-related adverse prognostic factors have been identified. In recent years, studies in a variety of emergency conditions suggested that outcome is dependent on the time of hospital admission. The importance of out-of-hours admission to the ICU has been sparsely evaluated and with ambiguous findings. We assessed the association between out-of-hours (16:00 to 07:00) and weekend admission to the ICU, respectively, and 90-day mortality in a nationwide cohort. METHODS We included all Danish adult patients admitted to the ICU between 1 January 2011 and 30 June 2014, with an ICU stay > 24 h. The crude and adjusted association between out-of-hours and weekend admission and 90-day mortality was assessed (odds ratio (ORs) with 95% confidence intervals (CI)). RESULTS A total of 44,797 patients were included, 53.3% were admitted out-of-hours, and 22.6% during weekends. Median age was 67 years (interquartile range (IQR) 55-76), and median SAPS II was 42 (IQR 30-54). Patients admitted in-hours vs. out-of-hours displayed a 90-day mortality rate of 41.0% vs. 44.2%. The adjusted association (OR with 95% CI) between out-of-hours admission and 90-day mortality was 1.07 (1.02-1.11), and the adjusted association (OR with 95% CI) between weekend admission and 90-day mortality was 1.10 (1.05-1.15). CONCLUSION This nationwide study suggests that critically ill adult patients admitted to the ICU during weekends and out-of-hours, and with an ICU stay > 24 h are at slightly increased risk of mortality.
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Affiliation(s)
- D. L. Buck
- Department of Intensive Care, 4131; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - C. F. Christiansen
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
| | - S. Christensen
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
| | - M. H. Møller
- Department of Intensive Care, 4131; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
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Granholm A, Perner A, Krag M, Hjortrup PB, Haase N, Holst LB, Marker S, Collet MO, Jensen AKG, Møller MH. Development and internal validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). Acta Anaesthesiol Scand 2018; 62:336-346. [PMID: 29210058 DOI: 10.1111/aas.13048] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/18/2017] [Accepted: 11/17/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Intensive care unit (ICU) mortality prediction scores deteriorate over time, and their complexity decreases clinical applicability and commonly causes problems with missing data. We aimed to develop and internally validate a new and simple score that predicts 90-day mortality in adults upon acute admission to the ICU: the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). METHODS We used data from an international cohort of 2139 patients acutely admitted to the ICU and 1947 ICU patients with severe sepsis/septic shock from 2009 to 2016. We performed multiple imputations for missing data and used binary logistic regression analysis with variable selection by backward elimination, followed by conversion to a simple point-based score. We assessed the apparent performance and validated the score internally using bootstrapping to present optimism-corrected performance estimates. RESULTS The SMS-ICU comprises seven variables available in 99.5% of the patients: two numeric variables: age and lowest systolic blood pressure, and five dichotomous variables: haematologic malignancy/metastatic cancer, acute surgical admission and use of vasopressors/inotropes, respiratory support and renal replacement therapy. Discrimination (area under the receiver operating characteristic curve) was 0.72 (95% CI: 0.71-0.74), overall performance (Nagelkerke's R2 ) was 0.19 and calibration (intercept and slope) was 0.00 and 0.99, respectively. Optimism-corrected performance was similar to apparent performance. CONCLUSIONS The SMS-ICU predicted 90-day mortality with reasonable and stable performance. If performance remains adequate after external validation, the SMS-ICU could prove a valuable tool for ICU clinicians and researchers because of its simplicity and expected very low number of missing values.
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Affiliation(s)
- A. Granholm
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
| | - A. Perner
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
- Centre for Research in Intensive Care; Copenhagen Denmark
| | - M. Krag
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
- Centre for Research in Intensive Care; Copenhagen Denmark
| | - P. B. Hjortrup
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
| | - N. Haase
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
| | - L. B. Holst
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
| | - S. Marker
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
- Centre for Research in Intensive Care; Copenhagen Denmark
| | - M. O. Collet
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
- Centre for Research in Intensive Care; Copenhagen Denmark
| | - A. K. G. Jensen
- Centre for Research in Intensive Care; Copenhagen Denmark
- Section of Biostatistics; University of Copenhagen; Copenhagen Denmark
| | - M. H. Møller
- Department of Intensive Care 4131; Copenhagen University Hospital - Rigshospitalet; Copenhagen Denmark
- Centre for Research in Intensive Care; Copenhagen Denmark
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Khwannimit B, Bhurayanontachai R, Vattanavanit V. Comparison of the performance of SOFA, qSOFA and SIRS for predicting mortality and organ failure among sepsis patients admitted to the intensive care unit in a middle-income country. J Crit Care 2017; 44:156-160. [PMID: 29127841 DOI: 10.1016/j.jcrc.2017.10.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/06/2017] [Accepted: 10/17/2017] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The Sepsis-3 definition provides a change of two or more scores from zero or a known baseline of the Sequential Organ Failure Assessment (SOFA) as criteria of sepsis. The aim of this study was to compare the SOFA score and the quick SOFA (qSOFA) to Systemic Inflammatory Response Syndrome (SIRS) criteria in predictive ability of mortality and organ failure. METHODS A-10year retrospective cohort study was conducted in a teaching hospital in Thailand. RESULTS A total of 2350 of mixed sepsis patients by Sepsis-2 definition were included. The all-cause hospital mortality rate was 44.5%. Of the total sample, 95.6% (n=2247) of patients met criteria for sepsis under the Sepsis-3 definition. The SOFA score presented the best discrimination with an area under the receiver operating characteristic curve (AUC) of 0.839. The AUC of SOFA score for hospital mortality was significantly higher than qSOFA (AUC 0.814, P=0.003) and SIRS (AUC 0.587, P<0.0001). Also, the SOFA score had superior performance than other scores for predicting intensive care unit (ICU) mortality and organ failure. CONCLUSIONS The SOFA is a superior prognostic tool for predicting mortality and organ failure than qSOFA and SIRS criteria among sepsis patients admitted to the ICU.
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Affiliation(s)
- Bodin Khwannimit
- Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
| | - Rungsun Bhurayanontachai
- Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Veerapong Vattanavanit
- Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Comorbidities impact on the prognosis of severe acute community-acquired pneumonia. Porto Biomed J 2017; 2:265-272. [PMID: 32289091 PMCID: PMC6806761 DOI: 10.1016/j.pbj.2017.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/12/2017] [Indexed: 02/08/2023] Open
Abstract
Highlights Abstract Community-acquired pneumonia (CAP) is a frequent cause of admission to hospital worldwide with high mortality rates. Host comorbidities may be associated not just with a greater risk of developing the disease but also with worse outcomes. In this work, the evaluation of the impact of host comorbidities on the prognosis of severe CAP patients admitted to an Intensive Care Unit (ICU) was proposed. Severity indexes, some clinical and analytic parameters at admission in ICU as well as patient comorbidities were analyzed and statistically compared with mortality. In this study, although there was no clear link between comorbidities and mortality, factors such as smoking, obesity and previous renal disease impairment seem to have an impact on the prognosis of severe CAP.
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Granholm A, Perner A, Krag M, Hjortrup PB, Haase N, Holst LB, Marker S, Collet MO, Jensen AKG, Møller MH. Simplified Mortality Score for the Intensive Care Unit (SMS-ICU): protocol for the development and validation of a bedside clinical prediction rule. BMJ Open 2017; 7:e015339. [PMID: 28279999 PMCID: PMC5353313 DOI: 10.1136/bmjopen-2016-015339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Mortality prediction scores are widely used in intensive care units (ICUs) and in research, but their predictive value deteriorates as scores age. Existing mortality prediction scores are imprecise and complex, which increases the risk of missing data and decreases the applicability bedside in daily clinical practice. We propose the development and validation of a new, simple and updated clinical prediction rule: the Simplified Mortality Score for use in the Intensive Care Unit (SMS-ICU). METHODS AND ANALYSIS During the first phase of the study, we will develop and internally validate a clinical prediction rule that predicts 90-day mortality on ICU admission. The development sample will comprise 4247 adult critically ill patients acutely admitted to the ICU, enrolled in 5 contemporary high-quality ICU studies/trials. The score will be developed using binary logistic regression analysis with backward stepwise elimination of candidate variables, and subsequently be converted into a point-based clinical prediction rule. The general performance, discrimination and calibration of the score will be evaluated, and the score will be internally validated using bootstrapping. During the second phase of the study, the score will be externally validated in a fully independent sample consisting of 3350 patients included in the ongoing Stress Ulcer Prophylaxis in the Intensive Care Unit trial. We will compare the performance of the SMS-ICU to that of existing scores. ETHICS AND DISSEMINATION We will use data from patients enrolled in studies/trials already approved by the relevant ethical committees and this study requires no further permissions. The results will be reported in accordance with the Transparent Reporting of multivariate prediction models for Individual Prognosis Or Diagnosis (TRIPOD) statement, and submitted to a peer-reviewed journal.
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Affiliation(s)
- Anders Granholm
- Department of Intensive Care 4131, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care 4131, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
- Centre for Research in Intensive Care, Copenhagen, Denmark
| | - Mette Krag
- Department of Intensive Care 4131, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Peter Buhl Hjortrup
- Department of Intensive Care 4131, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Nicolai Haase
- Department of Intensive Care 4131, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Lars Broksø Holst
- Department of Intensive Care 4131, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Søren Marker
- Department of Intensive Care 4131, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - Marie Oxenbøll Collet
- Department of Intensive Care 4131, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | | | - Morten Hylander Møller
- Department of Intensive Care 4131, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
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