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Bredin S, Decroocq J, Devautour C, Charpentier J, Vigneron C, Pène F. Impact of critical illness on continuation of anticancer treatment and prognosis of patients with aggressive hematological malignancies. Ann Intensive Care 2024; 14:143. [PMID: 39259434 DOI: 10.1186/s13613-024-01372-5] [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: 05/31/2024] [Accepted: 08/23/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Maintaining the dose-intensity of cancer treatment is an important prognostic factor of aggressive hematological malignancies. The objective of this study was to assess the long-term outcomes of intensive care unit (ICU) survivors with acute myeloid leukemia (AML) or aggressive B-cell non-Hodgkin lymphoma (B-NHL) with emphasis on the resumption of the intended optimal regimen of cancer treatment. PATIENTS AND METHODS We conducted a retrospective (2013-2021) single-center observational study where we included patients with AML and B-NHL discharged alive from the ICU after an unplanned admission. The primary endpoint was the change in the intended optimal cancer treatment following ICU discharge. Secondary endpoints were 1-year progression-free survival and overall survival rates. Determinants associated with modifications in cancer treatment were assessed through multivariate logistic regression. RESULTS Over the study period, 366 patients with AML or B-NHL were admitted to the ICU, of whom 170 survivors with AML (n = 92) and B-NHL (n = 78) formed the cohort of interest. The hematological malignancy was recently diagnosed in 68% of patients. The admission Sequential Organ Failure Assessment (SOFA) score was 5 (interquartile range 4-8). During the ICU stay, 30 patients (17.6%) required invasive mechanical ventilation, 29 (17.0%) vasopressor support, and 16 (9.4%) renal replacement therapy. The one-year survival rate following ICU discharge was 59.5%. Further modifications in hematologic treatment regimens were required in 72 patients (42%). In multivariate analysis, age > 65 years (odds ratio (OR) 3.54 [95%-confidence interval 1.67-7.50], p < 0.001), ICU-discharge hyperbilirubinemia > 20 µmol/L (OR 3.01 [1.10-8.15], p = 0.031), and therapeutic limitations (OR 16.5 [1.83-149.7], p = 0.012) were independently associated with modifications in cancer treatment. Post-ICU modifications of cancer treatment had significant impact on in-hospital, 1-year overall survival and progression-free survival. CONCLUSION The intended cancer treatment could be resumed in 58% of ICU survivors with aggressive hematological malignancies. At the time of ICU discharge, advanced age, persistent liver dysfunction and decisions to limit further life-support therapies were independent determinants of cancer treatment modifications. These modifications were associated with worsened one-year outcomes.
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Affiliation(s)
- Swann Bredin
- Service de médecine intensive-réanimation, hôpital Cochin, Assistance Publique-Hôpitaux de Paris. Centre, Université Paris-Cité, Paris, France
| | - Justine Decroocq
- Service d'hématologie clinique, hôpital Cochin, Assistance Publique-Hôpitaux de Paris. Centre, Université Paris-Cité, Paris, France
| | - Clément Devautour
- Service de médecine intensive-réanimation, hôpital Cochin, Assistance Publique-Hôpitaux de Paris. Centre, Université Paris-Cité, Paris, France
| | - Julien Charpentier
- Service de médecine intensive-réanimation, hôpital Cochin, Assistance Publique-Hôpitaux de Paris. Centre, Université Paris-Cité, Paris, France
| | - Clara Vigneron
- Service de médecine intensive-réanimation, hôpital Cochin, Assistance Publique-Hôpitaux de Paris. Centre, Université Paris-Cité, Paris, France
| | - Frédéric Pène
- Service de médecine intensive-réanimation, hôpital Cochin, Assistance Publique-Hôpitaux de Paris. Centre, Université Paris-Cité, Paris, France.
- Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris-Cité, Paris, France.
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You SB. Ethical considerations in evaluating discharge readiness from the intensive care unit. Nurs Ethics 2024; 31:896-906. [PMID: 37950598 PMCID: PMC11370158 DOI: 10.1177/09697330231212338] [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] [Indexed: 11/12/2023]
Abstract
Evaluating readiness for discharge from the intensive care unit (ICU) is a critical aspect of patient care. Whereas evidence-based criteria for ICU admission have been established, practical criteria for discharge from the ICU are lacking. Often discharge guidelines simply state that a patient no longer meets ICU admission criteria. Such discharge criteria can be interpreted differently by different healthcare providers, leaving a clinical void where misunderstandings of patients' readiness can conflict with perceptions of what readiness means for patients, families, and healthcare providers. In considering ICU discharge readiness, the use and application of ethical principles may be helpful in mitigating such conflicts and achieving desired patient outcomes. Ethical principles propose different ways of understanding what readiness might mean and how clinicians might weigh these principles in their decision-making process. This article examines the concept of discharge readiness through the lens of the most widely cited ethical principles (autonomy [respect for persons], nonmaleficence/beneficence, and justice) and provides a discussion of their application in the critical care environment. Ongoing bioethics discourse and empirical research are needed to identify factors that help determine discharge readiness within critical care environments that will ultimately promote safe and effective ICU discharges for patients and their families.
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Affiliation(s)
- Sang Bin You
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Lee J, Im C. Time-to-surgery paradigms: wait time and surgical outcomes in critically Ill patients who underwent emergency surgery for gastrointestinal perforation. BMC Surg 2024; 24:159. [PMID: 38760752 PMCID: PMC11100233 DOI: 10.1186/s12893-024-02452-w] [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: 02/28/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Waiting time for emergency abdominal surgery have been known to be linked to mortality. However, there is no clear consensus on the appropriated timing of surgery for gastrointestinal perforation. We investigated association between wait time and surgical outcomes in emergency abdominal surgery. METHODS This single-center retrospective cohort study evaluated adult patients who underwent emergency surgery for gastrointestinal perforations between January 2003 and September 2021. Risk-adjusted restricted cubic splines modeled the probability of each mortality according to wait time. The inflection point when mortality began to increase was used to define early and late surgery. Outcomes among propensity-score matched early and late surgical patients were compared using percent absolute risk differences (RDs, with 95% CIs). RESULTS Mortality rates began to rise after 16 h of waiting. However, early and late surgery groups showed no significant differences in 30-day mortality (11.4% vs. 5.7%), ICU stay duration (4.3 ± 7.5 vs. 4.3 ± 5.2 days), or total hospital stay (17.4 ± 17.0 vs. 24.7 ± 23.4 days). Notably, patients waiting over 16 h had a significantly higher ICU readmission rate (8.6% vs. 31.4%). The APACHE II score was a significant predictor of 30-day mortality. CONCLUSIONS Although we were unable to reveal significant differences in mortality in the subgroup analysis, we were able to find an inflection point of 16 h through the RCS curve technique. TRIAL REGISTRATION Formal consent was waived due to the retrospective nature of the study, and ethical approval was obtained from the institutional research committee of our institution (B-2110-714-107) on 6 October 2021.
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Affiliation(s)
- Junghyun Lee
- Department of Surgery, Yongin Severance Hostpital, Yongin, Korea
- Yonsei University College of Medicine, Seoul, Korea
| | - Chami Im
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
- Seoul National University College of Medicine, Seoul, Korea.
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Kang J, Lee KM. Three-year mortality, readmission, and medical expenses in critical care survivors: A population-based cohort study. Aust Crit Care 2024; 37:251-257. [PMID: 37574386 DOI: 10.1016/j.aucc.2023.07.036] [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: 10/10/2022] [Revised: 07/10/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Due to the increasing number of critical care survivors, population-based studies on the long-term outcomes after discharge are necessary to inform local decision-making. OBJECTIVES This study aimed to investigate mortality and its risk factors, readmissions, and medical expenses of intensive care unit survivors for 3 years after hospital discharge. METHODS This retrospective study analysed data from the National Health Insurance Service-National Sample Cohort in Korea. Of the 195,702 patients who survived and were discharged from hospital in 2012, 2693 intensive care unit patients were assigned to the case group for the study, and the remaining 193,009 were assigned to the comparison group. The primary outcome was all-cause mortality for 3 years after discharge. Secondary outcomes were all-cause hospital readmission and medical expenses in 3 years. We analysed risk factors for mortality using the Cox proportional hazard regression. The differences in hospital readmission and medical expenses between the case and comparison groups were analysed by multivariate logistic regression and independent t-tests. RESULTS The 1-year, 2-year, and 3-year cumulative mortality rates in the case group were 15.9%, 20.5%, and 24.4%, respectively, and older age, disability, medical admission, and longer hospital stay increased mortality. Almost 40% of intensive care unit survivors were readmitted to hospital within 6 months of discharge, and their odds of being readmitted were significantly higher than those of the comparison group. Medical expenses were also significantly higher in the case group, with the highest paid within 6 months. CONCLUSIONS Mortality, hospital readmission, and medical expenses for intensive care unit survivors were the worst within 6 months of discharge. In light of the long-term recovery trajectory of critical illness, it is necessary to investigate what factors may have contributed to the negative outcome during this period. Further research is needed to determine which services primarily contributed to the increase in medical expenses.
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Affiliation(s)
- Jiyeon Kang
- College of Nursing, Dong-A University, Busan, South Korea.
| | - Kwang Min Lee
- Industry-Academy Cooperation, Dong-A University, Busan, South Korea
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Schweppe JA, Potthoff AL, Heimann M, Ehrentraut SF, Borger V, Lehmann F, Schaub C, Bode C, Putensen C, Herrlinger U, Vatter H, Schäfer N, Schuss P, Schneider M. Incurring detriments of unplanned readmission to the intensive care unit following surgery for brain metastasis. Neurosurg Rev 2023; 46:155. [PMID: 37382699 PMCID: PMC10310600 DOI: 10.1007/s10143-023-02066-5] [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: 01/14/2023] [Revised: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
OBJECT Postoperative intensive care unit (ICU) monitoring is a common regime after neurosurgical resection of brain metastasis (BM). In comparison, unplanned secondary readmission to the ICU after initial postoperative treatment course occurs in response to adverse events and might significantly impact patient prognosis. In the present study, we analyzed the potential prognostic implications of unplanned readmission to the ICU and aimed at identifying preoperatively collectable risk factors for the development of such adverse events. METHODS Between 2013 and 2018, 353 patients with BM had undergone BM resection at the authors' institution. Secondary ICU admission was defined as any unplanned admission to the ICU during the initial hospital stay. A multivariable logistic regression analysis was performed to identify preoperatively identifiable risk factors for unplanned ICU readmission. RESULTS A total of 19 patients (5%) were readmitted to the ICU. Median overall survival (mOS) of patients with unplanned ICU readmission was 2 months (mo) compared to 13 mo for patients without secondary ICU admission (p<0.0001). Multivariable analysis identified "multiple BM" (p=0.02) and "preoperative CRP levels > 10 mg/dl" (p=0.01) as significant and independent predictors of secondary ICU admission. CONCLUSIONS Unplanned ICU readmission following surgical therapy for BM is significantly related to poor OS. Furthermore, the present study identifies routinely collectable risk factors indicating patients that are at a high risk for unplanned ICU readmission after BM surgery.
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Affiliation(s)
- Justus August Schweppe
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Anna-Laura Potthoff
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Muriel Heimann
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Stefan Felix Ehrentraut
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Felix Lehmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Current address: Department of Neurosurgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Mady AF, Al-Odat MA, Alshaya R, Hussien S, Aletreby A, Hamido HM, Aletreby WT. Mortality Rates in Early versus Late Intensive Care Unit Readmission. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:143-149. [PMID: 37252017 PMCID: PMC10211416 DOI: 10.4103/sjmms.sjmms_634_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/21/2023] [Accepted: 03/16/2023] [Indexed: 05/31/2023]
Abstract
Background ICU readmission is associated with poor outcomes. Few studies have directly compared the outcomes of early versus late readmissions, especially in Saudi Arabia. Objective To compare the outcomes between early and late ICU readmissions, mainly with regards to hospital mortality. Methods This retrospective study included unique patients who, within the same hospitalization, were admitted to the ICU, discharged to the general wards, and then readmitted to the ICU of King Saud Medical City, Riyadh, Saudi Arabia, between January 01, 2015, and June 30, 2022. Patients readmitted within 2 calendar days were grouped into the Early readmission group, while those readmitted after 2 calendar days were in the Late readmission group. Results A total of 997 patients were included, of which 753 (75.5%) belonged to the Late group. The mortality rate in the Late group was significantly higher than that in the Early group (37.6% vs. 29.5%, respectively; 95% CI: 1%-14.8%; P = 0.03). The readmission length of stay (LOS) and severity score of both groups were similar. The odds ratio of mortality for the Early group was 0.71 (95% CI: 0.51-0.98, P = 0.04); other significant risk factors were age (OR = 1.023, 95% CI: 1.016-1.03; P < 0.001) and readmission LOS (OR = 1.017, 95% CI: 1.009-1.026; P < 0.001). The most common reason for readmission in the Early group was high Modified Early Warning Score, while in the Late group, it was respiratory failure followed by sepsis or septic shock. Conclusion Compared with late readmission, early readmission was associated with lower mortality, but not with lower LOS or severity score.
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Affiliation(s)
- Ahmed Fouad Mady
- Department of Critical Care, King Saud Medical City, Riyadh, Saudi Arabia
- Department of Anesthesia, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Rayan Alshaya
- Department of Critical Care, King Saud Medical City, Riyadh, Saudi Arabia
| | - Sahar Hussien
- Department of Internal Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed Aletreby
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hend Mohammed Hamido
- Department of Obstetrics and Gynecology, King Saud Medical City, Riyadh, Saudi Arabia
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Elsayed HH, Ahmed MH, El Ghanam M, Hikal T, Abdel-Gayed M, Moharram AA. Patients after lung resection heading to the high-dependency unit: a cost-effectiveness study for managing lung cancer patients. THE CARDIOTHORACIC SURGEON 2022. [DOI: 10.1186/s43057-022-00078-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Recently, most thoracic surgery units allocate patients post lung resection to high-dependency units (HDU) rather than the old trend of intensive care units (ITU). The aim of the study is to assess the safety and efficacy of such a policy. We compared a single group of patients who underwent lobectomies who were admitted to ITU before March 2011 and patients whom their destination was to HDU after that date. Preoperative factors and postoperative outcomes were compared.
Results
A total of 408 patients were studied, 203 post-lobectomy patients were admitted routinely to ITU before March 2011, while 205 patients were admitted to HDU after that date. The mean postoperative length of stay in ITU was 1.2 days while in HDU was 1.1 days. In-hospital mortality for the ITU group was 2.5% (n = 5) while in the HDU group was 1.4% (n = 3) (p = 0.43). ITU readmission was observed in 6.5% (n = 13) in the ITU group and 4.3% (n = 9) in the HDU group (p = 0.31). Total complications were present in 39% in the ITU group and 33% in the HDU group (p = 0.16). The total estimated cost of one ITU day per patient is 850 GBP in comparison with 430 GBP for the HDU group (p = 0.007). The incremental cost-effectiveness ratio of the HDU stay per year was US $32.130/QALY.
Conclusion
The high-dependency unit is a safe destination for post-lobectomy patients. The same concept may apply to all thoracotomy patients. Hospitals could adopt such a policy which offers a better financial option without jeopardizing the level of patient care or outcome.
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Haruna J, Masuda Y, Tatsumi H, Sonoda T. Nursing Activities Score at Discharge from the Intensive Care Unit Is Associated with Unplanned Readmission to the Intensive Care Unit. J Clin Med 2022; 11:jcm11175203. [PMID: 36079134 PMCID: PMC9457354 DOI: 10.3390/jcm11175203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
This study evaluated the accuracy of predicting unplanned the intensive care unit (ICU) readmission using the Nursing Activities Score (NAS) at ICU discharge based on nursing workloads, and compared it to the accuracy of the prediction made using the Stability and Workload Index for Transfer (SWIFT) score. Patients admitted to the ICU of Sapporo Medical University Hospital between April 2014 and December 2017 were included, and unplanned ICU readmissions were retrospectively evaluated using the SWIFT score and the NAS. Patient characteristics, such as age, sex, the Charlson Comorbidity Index, and sequential organ failure assessment score at ICU admission, were used as covariates, and logistic regression analysis was performed to calculate the odds ratios for the SWIFT score and NAS. Among 599 patients, 58 (9.7%) were unexpectedly readmitted to the ICU. The area under the receiver operating characteristic curve of NAS (0.78) was higher than that of the SWIFT score (0.68), and cutoff values were 21 for the SWIFT and 53 for the NAS. Multivariate analysis showed that the NAS was an independent predictor of unplanned ICU readmission. The NAS was superior to the SWIFT in predicting unplanned ICU readmission. NAS may be an adjunctive tool to predict unplanned ICU readmission.
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Affiliation(s)
- Junpei Haruna
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
- Correspondence:
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Hiroomi Tatsumi
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Tomoko Sonoda
- Department of Nursing, Tensei University, Sapporo 065-0013, Japan
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Fernández Ros N, Alegre F, Rodríguez Rodriguez J, Landecho MF, Sunsundegui P, Gúrpide A, Lecumberri R, Sanz E, García N, Quiroga J, Lucena JF. Long-Term Outcome of Critically Ill Advanced Cancer Patients Managed in an Intermediate Care Unit. J Clin Med 2022; 11:jcm11123472. [PMID: 35743544 PMCID: PMC9225024 DOI: 10.3390/jcm11123472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/01/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023] Open
Abstract
Background: To analyze the long-term outcomes for advanced cancer patients admitted to an intermediate care unit (ImCU), an analysis of a do not resuscitate orders (DNR) subgroup was made. Methods: A retrospective observational study was conducted from 2006 to January 2019 in a single academic medical center of cancer patients with stage IV disease who suffered acute severe complications. The Simplified Acute Physiology Score 3 (SAPS 3) was used as a prognostic and severity score. In-hospital mortality, 30-day mortality and survival after hospital discharge were calculated. Results: Two hundred and forty patients with stage IV cancer who attended at an ImCU were included. In total, 47.5% of the cohort had DNR orders. The two most frequent reasons for admission were sepsis (32.1%) and acute respiratory failure (excluding sepsis) (38.7%). Mortality in the ImCU was 10.8%. The mean predicted in-hospital mortality according to SAPS 3 was 51.9%. The observed in-hospital mortality was 37.5% (standard mortality ratio of 0.72). Patients discharged from hospital had a median survival of 81 (30.75−391.25) days (patients with DNR orders 46 days (19.5−92.25), patients without DNR orders 162 days (39.5−632)). The observed mortality was higher in patients with DNR orders: 52.6% vs. 23.8%, p 0 < 0.001. By multivariate logistic regression, a worse ECOG performance status (3−4 vs. 0−2), a higher SAPS 3 Score and DNR orders were associated with a higher in-hospital mortality. By multivariate analysis, non-invasive mechanical ventilation, higher bilirubin levels and DNR orders were significantly associated with 30-day mortality. Conclusion: For patients with advanced cancer disease, even those with DNR orders, who suffer from acute complications or require continuous monitoring, an ImCU-centered multidisciplinary management shows encouraging results in terms of observed-to-expected mortality ratios.
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Affiliation(s)
- Nerea Fernández Ros
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
- Correspondence: ; Tel.: +34-948-296635; Fax: +34-948-296500
| | - Félix Alegre
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
| | | | - Manuel F. Landecho
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Patricia Sunsundegui
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
| | - Alfonso Gúrpide
- Department of Oncology, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (J.R.R.); (A.G.)
| | - Ramón Lecumberri
- Hematology Service, Clinica Universidad de Navarra, 31008 Pamplona, Spain;
| | - Eva Sanz
- Faculty of Medicine, European University of Madrid, 28670 Madrid, Spain;
| | - Nicolás García
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Jorge Quiroga
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), 28801 Madrid, Spain
| | - Juan Felipe Lucena
- Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain; (F.A.); (M.F.L.); (P.S.); (N.G.); (J.Q.); (J.F.L.)
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Xia W, Li C, Yao X, Chen Y, Zhang Y, Hu H. Prognostic value of fibrinogen to albumin ratios among critically ill patients with acute kidney injury. Intern Emerg Med 2022; 17:1023-1031. [PMID: 34850361 PMCID: PMC9135817 DOI: 10.1007/s11739-021-02898-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/17/2021] [Indexed: 12/14/2022]
Abstract
Fibrinogen to albumin ratios (FAR) have shown to be a promising prognostic factor for improving the predictive accuracy in various diseases. This study explores FAR's prognostic significance in critically ill patients with acute kidney injury (AKI). All clinical data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.4. All patients were divided into four groups based on FAR quartiles. The primary endpoint was in-hospital mortality. A generalized additive model was applied to explore a nonlinear association between FAR and in-hospital mortality. The Cox proportional hazards models were used to determine the association between FAR and in-hospital mortality. A total of 5001 eligible subjects were enrolled. Multivariate analysis demonstrated that higher FAR was an independent predictor of in-hospital mortality after adjusting for potential confounders (HR, 95% CI 1.23, 1.03-1.48, P = 0.025). A nonlinear relationship between FAR and in-hospital mortality was observed. FAR may serve as a potential prognostic biomarker in critically patients with AKI and higher FAR was associated with increased risk of in-hospital mortality among these patients.
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Affiliation(s)
- Wenkai Xia
- Department of Nephrology, The Affiliated Jiangyin Hospital of Southeast University Medical College, 3 Yinrui Road, Jiangsu, 214400, Jiangyin, China
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Chenyu Li
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Xiajuan Yao
- Department of Nephrology, The Affiliated Jiangyin Hospital of Southeast University Medical College, 3 Yinrui Road, Jiangsu, 214400, Jiangyin, China
| | - Yan Chen
- Department of Nephrology, The Affiliated Jiangyin Hospital of Southeast University Medical College, 3 Yinrui Road, Jiangsu, 214400, Jiangyin, China
| | - Yaoquan Zhang
- Department of Nephrology, The Affiliated Jiangyin Hospital of Southeast University Medical College, 3 Yinrui Road, Jiangsu, 214400, Jiangyin, China
| | - Hong Hu
- Department of Nephrology, The Affiliated Jiangyin Hospital of Southeast University Medical College, 3 Yinrui Road, Jiangsu, 214400, Jiangyin, China.
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Xia W, Zhao D, Li C, Xu L, Yao X, Hu H. Prognostic significance of albumin to alkaline phosphatase ratio in critically ill patients with acute kidney injury. Clin Exp Nephrol 2022; 26:917-924. [PMID: 35579723 DOI: 10.1007/s10157-022-02234-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE No epidemiological evidence has investigated the effect of albumin to alkaline phosphatase ratio (AAPR) on the prognosis among critically ill patients with acute kidney injury (AKI). We aimed to explore the prognostic value of AAPR in these patients. METHODS We extracted all clinical data from MIMIC III. ROC curve analysis was used to evaluate the discrimination of AAPR for predicting in-hospital mortality. A generalized additive model was applied to identify a nonlinear association between AAPR and in-hospital mortality. The Cox proportional hazards models were used to determine the association between AAPR and in-hospital and 30-day mortality. RESULTS A total of 6894 eligible subjects were enrolled in this study. The relationship between AAPR and in-hospital mortality was nonlinear. Multivariate analysis demonstrated that lower AAPR (AAPR < 0.35) was an independent predictor of in-hospital and 30-day mortality after adjusting for potential confounders (HR 1.74, 95% CI 1.72-2.20, P < 0.001; HR 1.89, 95% CI 1.66-2.14, P < 0.001, respectively). CONCLUSIONS AAPR may serve as a potential prognostic biomarker in critically ill patients with AKI and lower AAPR was associated with increased risk of in-hospital and 30-day mortality among these patients.
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Affiliation(s)
- Wenkai Xia
- Department of Nephrology, Jiangyin People's Hospital Affiliated to Nantong University, 3 Yinrui Road, Jiangyin, 214400, Jiangsu, China
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Danyang Zhao
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Chenyu Li
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lingyu Xu
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiajuan Yao
- Department of Nephrology, Jiangyin People's Hospital Affiliated to Nantong University, 3 Yinrui Road, Jiangyin, 214400, Jiangsu, China
| | - Hong Hu
- Department of Nephrology, Jiangyin People's Hospital Affiliated to Nantong University, 3 Yinrui Road, Jiangyin, 214400, Jiangsu, China.
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Son YJ, Kim GO, Lee YM, Oh M, Choi J. Predictors of Early and Late Unplanned Intensive Care Unit Readmission: A Retrospective Cohort Study. J Nurs Scholarsh 2021; 53:400-407. [PMID: 33783100 DOI: 10.1111/jnu.12657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Intensive care unit (ICU) readmission is considered one of the major quality indicators of critical care. Reducing ICU readmission can improve patients' outcomes and optimize health resources, but there are limited data on the predictors of unplanned ICU readmission. This study aimed to identify the risk factors associated with unplanned ICU readmission within 48 hr (early) and after 48 hr (late) from ICU discharge. DESIGN Retrospective cohort study. METHODS Data were collected from patients' electronic medical records in a 24-bed medical ICU at a tertiary academic medical center in Busan, South Korea. Among all the patients admitted to the medical ICU (n = 1,033) between January 2015 and December 2017, 739 eligible patients were analyzed. A multivariable multinomial logistic regression model was conducted to identify predictors of ICU readmission. FINDINGS Out of the 739 patients analyzed, 66 (8.9%) were readmitted to the medical ICU: 13 (1.8%) as early readmission and 53 (7.1%) as late readmission. Two significant predictors were identified for early readmission: ICU admission from the ward (odds ratio [OR] = 4.14; 95% confidence interval [CI] 1.25, 13.67) and mechanical ventilation support >14 days (OR = 13.25; 95% CI 1.78, 98.89). For late ICU admission, there were four risk factors: ICU admission from the ward (OR = 2.69; 95% CI 1.44, 5.05), tracheostomy placement (OR = 3.58; 95% CI 1.49, 8.59), mechanical ventilation support >14 days (OR = 4.77; 95% CI 1.67, 13.63), and continuous renal replacement therapy (OR = 4.57; 95% CI 2.42, 8.63). CONCLUSIONS To prevent unplanned ICU readmission in patients at high risk, it is necessary to investigate further the role of clinical judgment and communication within the ICU clinical team and institutional-level support regarding ICU readmission events. CLINICAL RELEVANCE Both ICU nurses and nurses in post-ICU settings should be aware of the potential risk factors associated with early and late ICU readmission. Predictors and readmission strategies may be different for early and late readmissions. Prospective multicenter studies are needed to examine how these factors influence post-ICU outcomes.
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Affiliation(s)
- Youn-Jung Son
- Lambda Alpha-at-Large, Professor, Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Gi-Ock Kim
- Charge Nurse, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Yun Mi Lee
- Professor, College of Nursing, Institute of Health Science Research, Inje University, Busan, Republic of Korea
| | - Minkyung Oh
- Associate Professor, Department of Pharmacology, Inje University College of Medicine, Busan, Republic of Korea
| | - JiYeon Choi
- Lambda Alpha-at-Large, Assistant Professor, Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
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Oh TK, Song IA, Jeon YT. Impact of Glasgow Coma Scale scores on unplanned intensive care unit readmissions among surgical patients. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:520. [PMID: 31807502 DOI: 10.21037/atm.2019.10.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Physiological instability at discharge from intensive care units (ICU) is known to increase readmission rates among critically ill patients. However, associations between consciousness levels at discharge and readmission rates remain unclear. This study aimed to investigate the association between the Glasgow Coma Scale (GCS) score at discharge and unplanned ICU readmissions in surgical patients. Methods This retrospective cohort study in a single tertiary academic hospital analyzed the electronic health records of adults aged 18 years or older, who were discharged from the ICU between January 2012 and December 2018. The primary endpoint was unplanned readmission within 48 hours after discharge. Multivariable logistic regression analysis was performed. Results Among 9,512 patients, unplanned readmissions occurred in 161 (1.7%). At discharge, GCS and verbal response scores of ≤13 (vs. ≥14) were associated with 2.28-fold higher unplanned readmissions within 48 hours [odds ratio (OR): 2.35, 95% confidence interval (CI): 1.51-3.65, P<0.001]. Sensitivity analysis showed that verbal response scores of ≤4 (vs. 5) at ICU discharge were associated with 2.21-fold higher unplanned readmissions within 48 hours (OR: 2.21, 95% CI: 1.49-3.29, P<0.001), whereas eye or motor responses at time of ICU discharge were not significantly associated with unplanned readmissions (P>0.05). Conclusions In this surgical ICU population cohort, GCS scores at ICU discharge were significantly associated with unplanned readmissions within 48 hours. This association was stronger with GCS scores of ≤13 and with verbal response scores of ≤4 at time of discharge. These findings suggest that surgical ICU patients with GCS scores of ≤13 or verbal response scores of ≤4 should be monitored carefully for discharge in order to avoid unplanned ICU readmissions.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul, South Korea
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Jeong BH, Na SJ, Lee DS, Chung CR, Suh GY, Jeon K. Correction: Readmission and hospital mortality after ICU discharge of critically ill cancer patients. PLoS One 2019; 14:e0218196. [PMID: 31167000 PMCID: PMC6550420 DOI: 10.1371/journal.pone.0218196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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AbuSara AK, Nazer LH, Hawari FI. Intensive Care Unit readmissions- separate entity or a disease continuum. J Crit Care 2019; 54:278-279. [PMID: 31128965 DOI: 10.1016/j.jcrc.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/06/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Aseel K AbuSara
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Lama H Nazer
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Feras I Hawari
- Department of Medicine, Section of Pulmonary and Critical Care, King Hussein Cancer Center, Jordan.
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