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Wang X, Guo Z, Chai Y, Wang Z, Liao H, Wang Z, Wang Z. Application Prospect of the SOFA Score and Related Modification Research Progress in Sepsis. J Clin Med 2023; 12:jcm12103493. [PMID: 37240599 DOI: 10.3390/jcm12103493] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
In 2016, the SOFA score was proposed as the main evaluation system for diagnosis in the definition of sepsis 3.0, and the SOFA score has become a new research focus in sepsis. Some people are skeptical about diagnosing sepsis using the SOFA score. Experts and scholars from different regions have proposed different, modified versions of SOFA score to make up for the related problems with the use of the SOFA score in the diagnosis of sepsis. While synthesizing the different improved versions of SOFA proposed by experts and scholars in various regions, this paper also summarizes the relevant definitions of sepsis put forward in recent years to build a clear, improved application framework of SOFA score. In addition, the comparison between machine learning and SOFA scores related to sepsis is described and discussed in the article. Taken together, by summarizing the application of the improved SOFA score proposed in recent years in the related definition of sepsis, we believe that the SOFA score is still an effective means of diagnosing sepsis, but in the process of the continuous refinement and development of sepsis in the future, the SOFA score needs to be further refined and improved to provide more accurate coping strategies for different patient populations or application directions regarding sepsis. Against the big data background, machine learning has immeasurable value and significance, but its future applications should add more humanistic references and assistance.
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Affiliation(s)
- Xuesong Wang
- School of Clinical Medicine, Tsinghua University, Beijing 100190, China
| | - Zhe Guo
- School of Clinical Medicine, Tsinghua University, Beijing 100190, China
| | - Yan Chai
- School of Clinical Medicine, Tsinghua University, Beijing 100190, China
| | - Ziyi Wang
- School of Clinical Medicine, Tsinghua University, Beijing 100190, China
| | - Haiyan Liao
- School of Clinical Medicine, Tsinghua University, Beijing 100190, China
| | - Ziwen Wang
- School of Clinical Medicine, Tsinghua University, Beijing 100190, China
| | - Zhong Wang
- Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 100084, China
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Wick KD, Matthay MA, Ware LB. Pulse oximetry for the diagnosis and management of acute respiratory distress syndrome. THE LANCET. RESPIRATORY MEDICINE 2022; 10:1086-1098. [PMID: 36049490 PMCID: PMC9423770 DOI: 10.1016/s2213-2600(22)00058-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/30/2022] [Accepted: 02/10/2022] [Indexed: 02/07/2023]
Abstract
The diagnosis of acute respiratory distress syndrome (ARDS) traditionally requires calculation of the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) using arterial blood, which can be costly and is not possible in many resource-limited settings. By contrast, pulse oximetry is continuously available, accurate, inexpensive, and non-invasive. Pulse oximetry-based indices, such as the ratio of pulse-oximetric oxygen saturation to FiO2 (SpO2/FiO2), have been validated in clinical studies for the diagnosis and risk stratification of patients with ARDS. Limitations of the SpO2/FiO2 ratio include reduced accuracy in poor perfusion states or above oxygen saturations of 97%, and the potential for reduced accuracy in patients with darker skin pigmentation. Application of pulse oximetry to the diagnosis and management of ARDS, including formal adoption of the SpO2/FiO2 ratio as an alternative to PaO2/FiO2 to meet the diagnostic criterion for hypoxaemia in ARDS, could facilitate increased and earlier recognition of ARDS worldwide to advance both clinical practice and research.
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Affiliation(s)
- Katherine D Wick
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - Lorraine B Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine and Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Rakhit S, Wang L, Lindsell CJ, Hosay MA, Stewart JW, Owen GD, Frutos-Vivar F, Pen Uelas O, Esteban AS, Anzueto AR, Raymondos K, Rios F, Thille AW, Gonza Lez M, Du B, Maggiore SM, Matamis D, Abroug F, Amin P, Zeggwagh AA, Ely EW, Vasilevskis EE, Patel MB. Multicenter International Cohort Validation of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-sedation Scale. Ann Surg 2022; 276:e114-e119. [PMID: 33201122 PMCID: PMC10573707 DOI: 10.1097/sla.0000000000004484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In a multicenter, international cohort, we aimed to validate a modified Sequential Organ Failure Assessment (mSOFA) using the Richmond Agitation-Sedation Scale, hypothesized as comparable to the Glasgow Coma Scale (GCS)-based Sequential Organ Failure Assessment (SOFA). SUMMARY BACKGROUND DATA The SOFA score, whose neurologic component is based on the GCS, can predict intensive care unit (ICU) mortality. But, GCS is often missing in lieu of other assessments, such as the also reliable and validated Richmond Agitation Sedation Scale (RASS). Single-center data suggested an RASS-based SOFA (mSOFA) predicted ICU mortality. METHODS Our nested cohort within the prospective 2016 Fourth International Study of Mechanical Ventilation contains 4120 ventilated patients with daily RASS and GCS assessments (20,023 patient-days, 32 countries). We estimated GCS from RASS via a proportional odds model without adjustment. ICU mortality logistic regression models and c-statistics were constructed using SOFA (measured GCS) and mSOFA (measured RASS-estimated GCS), adjusted for age, sex, body-mass index, region (Europe, USA-Canada, Latin America, Africa, Asia, Australia-New Zealand), and postoperative status (medical/surgical). RESULTS Cohort-wide, the mean SOFA=9.4+/-2.8 and mean mSOFA = 10.0+/-2.3, with ICU mortality = 31%. Mean SOFA and mSOFA similarly predicted ICU mortality (SOFA: AUC = 0.784, 95% CI = 0.769-0.799; mSOFA: AUC = 0.778, 95% CI = 0.763-0.793, P = 0.139). Across models, other predictors of mortality included higher age, female sex, medical patient, and African region (all P < 0.001). CONCLUSIONS We present the first SOFA modification with RASS in a "real-world" international cohort. Estimating GCS from RASS preserves predictive validity of SOFA to predict ICU mortality. Alternative neurologic measurements like RASS can be viably integrated into severity of illness scoring systems like SOFA.
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Affiliation(s)
- Shayan Rakhit
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Li Wang
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Morgan A Hosay
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
- Baylor University, Waco, TX
| | - James W Stewart
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
- Meharry Medical College, Nashville, TN
| | - Gary D Owen
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN
| | - Fernando Frutos-Vivar
- University Hospital of Getafe, Getafe, Community of Madrid, Spain
- Centro de Investigación Biomédica en red de Enfermedades Respiratorias, Getafe, Comunidad of Madrid, Madrid, Spain
| | - Oscar Pen Uelas
- University Hospital of Getafe, Getafe, Community of Madrid, Spain
- Centro de Investigación Biomédica en red de Enfermedades Respiratorias, Getafe, Comunidad of Madrid, Madrid, Spain
| | - Andre S Esteban
- University Hospital of Getafe, Getafe, Community of Madrid, Spain
- Centro de Investigación Biomédica en red de Enfermedades Respiratorias, Getafe, Comunidad of Madrid, Madrid, Spain
| | - Antonio R Anzueto
- Department of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Science Center, San Antonio, TX
- Pulmonary Section, Audie L Murphy VA Hospital, South Texas Veterans Healthcare System, US Department of Veterans Affairs, San Antonio, TX
| | | | - Fernando Rios
- Alejandro Posadas National Hospital, El Palomar, Buenos Aires, Argentina
| | | | - Marco Gonza Lez
- Medellin Clinic and Pontifical Bolivaran University, Medellin, Colombia
| | - Bin Du
- Peking Union Medical College Hospital, Beijing, China
| | | | | | - Fekri Abroug
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Pravin Amin
- Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | | | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Center (GRECC) Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, TN
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | - Eduard E Vasilevskis
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Geriatric Research, Education, and Clinical Center (GRECC) Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, TN
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Ibn Sina University Hospital Center & Mohammed V University of Rabat, Rabat, Morocco
| | - Mayur B Patel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
- Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
- Surgical Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs Nashville, TN
- Departments of Neurosurgery and Hearing and Speech Sciences, Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN
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Shi QF, Xu Y, Zhang BY, Qu W, Wang SY, Zheng WL, Sheng Y. External validation and comparison of two versions of simplified sequential organ failure assessment scores to predict prognosis of septic patients. Int J Clin Pract 2021; 75:e14865. [PMID: 34523203 DOI: 10.1111/ijcp.14865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 08/20/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Evidence shows that simplified SOFA scoring system has better clinical practice. OBJECTIVE This study aimed to validate and compare the scores acquired with simplified organ dysfunction criteria optimized for electronic health records (eSOFA), and simplified and accurate sequential organ failure assessment (sa-SOFA) for their accuracies in predicting the prognosis of septic patients. METHODS This retrospective observational study was conducted at three major academic hospitals. Clinical data from 574 patients diagnosed with sepsis following the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)were retrospectively retrieved and analysed. Scores from the quick sequential organ failure assessment (qSOFA) and sequential organ failure assessment (SOFA) were used as reference scores. The area under the receiver operating characteristic curve (AUROC) was used to assess the performance of eSOFA and sa-SOFA scores in predicting in-hospital mortality. RESULTS AUROC analysis demonstrated the predictability of the four scoring systems for sepsis surveillance, listed in descending order as: sa-SOFA, 0.790 (95% confidence interval [CI]: 0.754-0.822); SOFA, 0.774 (95% CI: 0.738-0.808); eSOFA, 0.729 (95% CI: 0.691-0.765); and qSOFA, 0.618 (95% CI: 0.577-0.658). Moreover, sa-SOFA and SOFA scores (Z = 1.950, P = .051) did not significantly differ from each other in discriminatory power, but the sa-SOFA score had a higher power than eSOFA score (P values < .001). CONCLUSION sa-SOFA appeared to have performed better than eSOFA score for predicting in-hospital mortality in patients' sepsis. Further large prospective studies are needed to externally validate.
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Affiliation(s)
- Qi-Fang Shi
- Department of Emergency and Critical Care Medicine, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Ying Xu
- Department of Emergency and Critical Care Medicine, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Bing-Yu Zhang
- Department of Critical Care Medicine, Gongli Hospital Affiliated to Naval Medical University, Shanghai, China
| | - Wei Qu
- Deportment of Emergency and Critical Care Medicine, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Shu-Yun Wang
- Department of Emergency and Critical Care Medicine, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Wen-Long Zheng
- Department of Laboratory Medicine, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Ying Sheng
- Department of Emergency and Critical Care Medicine, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
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5
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Evaluating mortality and recovery of extreme hyperbilirubinemia in critically ill patients by phasing the peak bilirubin level: A retrospective cohort study. PLoS One 2021; 16:e0255230. [PMID: 34351969 PMCID: PMC8341602 DOI: 10.1371/journal.pone.0255230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/12/2021] [Indexed: 01/12/2023] Open
Abstract
Background Hyperbilirubinemia is a devastating complication in patients admitted to an intensive care unit (ICU). The sequential organ failure assessment (SOFA) score classifies hyperbilirubinemia without further detailed analyses for bilirubin increase above 12 mg/dL. We evaluated whether the level of bilirubin increase in patients with extreme hyperbilirubinemia (total bilirubin ≥ 12 mg/dL) affects and also helps estimate mortality or recovery. Methods A retrospective cohort analysis comprising 427 patients with extreme hyperbilirubinemia admitted to the ICU of Samsung Medical Center, Seoul, Korea between 2011 and 2015 was conducted. Extreme hyperbilirubinemia was classified into four grades: grade 1 (12–14.9 mg/dL), grade 2 (15–19.9 mg/dL), grade 3 (20–29.9 mg/dL), and grade 4 (≥ 30 mg/dL). These grades were then assessed for their association with hospital mortality and recovery from hyperbilirubinemia to SOFA grade (point) 2 or below (total bilirubin < 6 mg/dL). The influences of various factors, some of which caused extreme hyperbilirubinemia, while others induced bilirubin recovery, were assessed. Results A total of 427 patients (mean age: 59.8 years, male: 67.0%) were evaluated, and the hospital mortality for these patients was very high (76.1%). Extreme hyperbilirubinemia was observed in 111 (grade 1, 26.0%), 99 (grade 2, 23.2%), 131 (grade3, 30.7%), and 86 (grade 4, 20.1%) patients with mortality rates of 62.2%, 71.7%, 81.7%, and 90.7%, respectively (p < 0.001). The peak bilirubin value correlated with the mortality (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.04–1.15, p < 0.001). Compared to those with grade 1 extreme hyperbilirubinemia, the mortality rate gradually increased as the grade increased (OR [95% CI]: 1.92 [0.70–5.28], 3.55 [1.33–9.48], and 12.47 [3.07–50.59] for grades 2, 3 and 4, respectively). The main causes of extreme hyperbilirubinemia were infection including sepsis and hypoxic hepatitis. The recovery from hyperbilirubinemia was observed in 110 (25.8%) patients. Mortality was lower for those who recovered from hyperbilirubinemia than for those who did not (29.1% vs. 92.4%, p < 0.001). The favorable factors of bilirubin recovery were albumin and ursodeoxycholic acid (UDCA). Conclusions This study determined that the level of extreme hyperbilirubinemia is an important prognostic factor in critically ill patients. We expect the results of this study to help predict the clinical course of and determine the optimal treatment for extreme hyperbilirubinemia.
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6
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Kashyap R, Sherani KM, Dutt T, Gnanapandithan K, Sagar M, Vallabhajosyula S, Vakil AP, Surani S. Current Utility of Sequential Organ Failure Assessment Score: A Literature Review and Future Directions. Open Respir Med J 2021; 15:1-6. [PMID: 34249175 PMCID: PMC8227444 DOI: 10.2174/1874306402115010001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/13/2020] [Accepted: 01/13/2021] [Indexed: 02/08/2023] Open
Abstract
The Sequential Organ Failure Assessment (SOFA) score is commonly used in the Intensive Care Unit (ICU) to evaluate, prognosticate and assess patients. Since its validation, the SOFA score has served in various settings, including medical, trauma, surgical, cardiac, and neurological ICUs. It has been a strong mortality predictor and literature over the years has documented the ability of the SOFA score to accurately distinguish survivors from non-survivors on admission. Over the years, multiple variations have been proposed to the SOFA score, which have led to the evolution of alternate validated scoring models replacing one or more components of the SOFA scoring system. Various SOFA based models have been used to evaluate specific clinical populations, such as patients with cardiac dysfunction, hepatic failure, renal failure, different races and public health illnesses, etc. This study is aimed to conduct a review of modifications in SOFA score in the past several years. We review the literature evaluating various modifications to the SOFA score such as modified SOFA, Modified SOFA, modified Cardiovascular SOFA, Extra-renal SOFA, Chronic Liver Failure SOFA, Mexican SOFA, quick SOFA, Lactic acid quick SOFA (LqSOFA), SOFA in hematological malignancies, SOFA with Richmond Agitation-Sedation scale and Pediatric SOFA. Various organ systems, their relevant scoring and the proposed modifications in each of these systems are presented in detail. There is a need to incorporate the most recent literature into the SOFA scoring system to make it more relevant and accurate in this rapidly evolving critical care environment. For future directions, we plan to put together most if not all updates in SOFA score and probably validate it in a large database a single institution and validate it in multisite data base.
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Affiliation(s)
- Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Khalid M Sherani
- Department of Internal Medicine, Jamaica Hospital Medical Center, Jamaica, NY 11418, USA.,Corpus Christi Medical Center, Corpus Christi, TX 78411, USA
| | - Taru Dutt
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester MN, USA and Hennepin County Medical Center, Minneapolis, MN 55905, USA
| | - Karthik Gnanapandithan
- Department of Internal Medicine, Yale-New Haven Hospital and Yale University School of Medicine, New Haven, CT 06510, USA
| | - Malvika Sagar
- Department of Pediatrics, McLane Children's Hospital, Baylor Scott and White Health, Temple, TX 76502, USA
| | | | - Abhay P Vakil
- Department of Pediatrics, McLane Children's Hospital, Baylor Scott and White Health, Temple, TX 76502, USA.,Critical Care Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Salim Surani
- Corpus Christi Medical Center, Corpus Christi, TX 78411, USA.,Texas A&M University System Health Science Center, Bryan, TX 77807, USA
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Mulatu HA, Bayisa T, Worku Y, Lazarus JJ, Woldeyes E, Bacha D, Taye B, Nigussie M, Gebeyehu H, Kebede A. Prevalence and outcome of sepsis and septic shock in intensive care units in Addis Ababa, Ethiopia: A prospective observational study. Afr J Emerg Med 2021; 11:188-195. [PMID: 33680740 PMCID: PMC7910175 DOI: 10.1016/j.afjem.2020.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/23/2020] [Accepted: 10/02/2020] [Indexed: 12/29/2022] Open
Abstract
Background Sepsis and septic shock are the major causes of morbidity and mortality in Intensive care Units (ICUs) in low and middle-income countries. However, little is known about their prevalence and outcome in these settings. The study aimed to assess the prevalence and outcome of sepsis and septic shock in ICUs in Addis Ababa, Ethiopia. Methods A prospective observational study was conducted from March 2017 to February 2018 in four selected ICUs in Addis Ababa from a total of twelve hospitals having ICU services. There were 1145 total ICU admissions during the study period. All admissions into those ICUs with sepsis, severe sepsis, and septic shock using the Systemic Inflammatory Response Syndrome (SIRS) criteria (SEPSIS-2) during the study period were screened for sepsis or septic shock based on the new sepsis definition (SEPSIS-3). All patients with sepsis and septic shock during ICU admission were included and followed for 28 days of ICU admission. Data analysis was done using the Statistical Package for Social Sciences (SPSS) software version 20.0. Results A total of 275 patients were diagnosed with sepsis and septic shock. The overall prevalence of sepsis and septic shock was 26.5 per 100 ICU admissions. The most frequent source of sepsis was respiratory infection (53.1%). The median length of stay in the ICUs was 5 (IQR, 2–8) days. The most common bacterium isolate was Pseudomonas aeroginosa (34.5%). The ICU and 28-day mortality rate was 41.8% and 50.9% respectively. Male sex, modified Sequential Organ Failure Assessment score ≥10 on day 1 of ICU admission, and comorbidity of HIV or malignancy were the independent predictors of 28-day mortality. Conclusion Sepsis and septic shock are common among our ICU admissions, and are associated with a high mortality rate.
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Nicholson CJ, Wooster L, Sigurslid HH, Li RH, Jiang W, Tian W, Lino Cardenas CL, Malhotra R. Estimating risk of mechanical ventilation and in-hospital mortality among adult COVID-19 patients admitted to Mass General Brigham: The VICE and DICE scores. EClinicalMedicine 2021; 33:100765. [PMID: 33655204 PMCID: PMC7906522 DOI: 10.1016/j.eclinm.2021.100765] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/22/2021] [Accepted: 02/04/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Risk stratification of COVID-19 patients upon hospital admission is key for their successful treatment and efficient utilization of hospital resources. We sought to evaluate the risk factors on admission (including comorbidities, vital signs, and initial laboratory assessment) associated with ventilation need and in-hospital mortality in COVID-19. METHODS We established a retrospective cohort of COVID-19 patients from Mass General Brigham hospitals. Demographic, clinical, and admission laboratory data were obtained from electronic medical records of patients admitted to the hospital with laboratory-confirmed COVID-19 before May 19, 2020. Multivariable logistic regression analyses were used to construct and validate the Ventilation in COVID Estimator (VICE) and Death in COVID Estimator (DICE) risk scores. FINDINGS The entire cohort included 1042 patients (median age, 64 years; 56.8% male). The derivation and validation cohorts for the risk scores included 578 and 464 patients, respectively. We found four factors to be independently predictive for mechanical ventilation requirement (diabetes mellitus, SpO2:FiO2 ratio, C-reactive protein, and lactate dehydrogenase), and 10 factors to be predictors of in-hospital mortality (age, male sex, coronary artery disease, diabetes mellitus, chronic statin use, SpO2:FiO2 ratio, body mass index, neutrophil to lymphocyte ratio, platelet count, and procalcitonin). Using these factors, we constructed the VICE and DICE risk scores, which performed with C-statistics of 0.84 and 0.91, respectively. Importantly, the chronic use of a statin was associated with protection against death due to COVID-19. The VICE and DICE score calculators have been placed on an interactive website freely available to healthcare providers and researchers (https://covid-calculator.com/). INTERPRETATION The risk scores developed in this study may help clinicians more appropriately determine which COVID-19 patients will need to be managed with greater intensity. FUNDING COVID-19 Fast Grant (fastgrants.org).
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Affiliation(s)
- Christopher J. Nicholson
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States
| | - Luke Wooster
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Haakon H. Sigurslid
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States
| | - Rebecca H. Li
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States
| | - Wanlin Jiang
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States
| | - Wenjie Tian
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States
- Department of Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Christian L. Lino Cardenas
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States
| | - Rajeev Malhotra
- Cardiovascular Research Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Yawkey 5700; 55 Fruit Street, Boston, MA 02114, United States
- Corresponding author.
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Ñamendys-Silva SA, Alvarado-Ávila PE, Domínguez-Cherit G, Rivero-Sigarroa E, Sánchez-Hurtado LA, Gutiérrez-Villaseñor A, Romero-González JP, Rodríguez-Bautista H, García-Briones A, Garnica-Camacho CE, Cruz-Ruiz NG, González-Herrera MO, García-Guillén FJ, Guerrero-Gutiérrez MA, Salmerón-González JD, Romero-Gutiérrez L, Canto-Castro JL, Cervantes VH. Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study. Heart Lung 2021; 50:28-32. [PMID: 33138974 PMCID: PMC7577687 DOI: 10.1016/j.hrtlng.2020.10.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND As of June 15, 2020, a cumulative total of 7,823,289 confirmed cases of COVID-19 have been reported across 216 countries and territories worldwide. However, there is little information on the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to intensive care units (ICUs) in Latin America. The present study evaluated the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to ICUs in Mexico. METHODS This was a multicenter observational study that included 164 critically ill patients with laboratory-confirmed COVID-19 who were admitted to 10 ICUs in Mexico, from April 1 to April 30, 2020. Demographic data, comorbid conditions, clinical presentation, treatment, and outcomes were collected and analyzed. The date of final follow-up was June 4, 2020. RESULTS A total of 164 patients with severe COVID-19 were included in this study. The mean age of patients was 57.3 years (SD 13.7), 114 (69.5%) were men, and 6.0% were healthcare workers. Comorbid conditions were common in patients with critical COVID-19: 38.4% of patients had hypertension and 32.3% had diabetes. Compared to survivors, nonsurvivors were older and more likely to have diabetes, hypertension or other conditions. Patients presented to the hospital a median of 7 days (IQR 4.5-9) after symptom onset. The most common presenting symptoms were shortness of breath, fever, dry cough, and myalgias. One hundred percent of patients received invasive mechanical ventilation for a median time of 11 days (IQR 6-14). A total of 139 of 164 patients (89.4%) received vasopressors, and 24 patients (14.6%) received renal replacement therapy during hospitalization. Eighty-five (51.8%) patients died at or before 30 days, with a median survival of 25 days. Age (OR, 1.05; 95% CI, 1.02-1.08; p<0.001) and C-reactive protein levels upon ICU admission (1.008; 95% CI, 1.003-1.012; p<0.001) were associated with a higher risk of in-hospital death. ICU length of stay was associated with reduced in-hospital mortality risk (OR, 0.89; 95% CI, 0.84-0.94; p<0.001). CONCLUSIONS This observational study of critically ill patients with laboratory-confirmed COVID-19 who were admitted to the ICU in Mexico demonstrated that age and C-reactive protein level upon ICU admission were associated with in-hospital mortality, and the overall hospital mortality rate was high. TRIAL REGISTRATION ClinicalTrials.gov, NCT04336345.
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Affiliation(s)
- Silvio A Ñamendys-Silva
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14000, Mexico; Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
| | - Pedro E Alvarado-Ávila
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14000, Mexico
| | - Guillermo Domínguez-Cherit
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14000, Mexico; Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Eduardo Rivero-Sigarroa
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14000, Mexico
| | - Luis A Sánchez-Hurtado
- Hospital de Especialidades del Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | | | | | | | | | - César E Garnica-Camacho
- Hospital General de Zona No.1 "Dr. Enrique Von Borstel Labastida", IMSS, La Paz, Baja California Sur, Mexico
| | - Néstor G Cruz-Ruiz
- Hospital General de Zona No. 1, "Dr. Demetrio Mayoral Pardo", IMSS, Oaxaca, Mexico
| | | | | | | | | | - Laura Romero-Gutiérrez
- Hospital de Especialidades del Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - José L Canto-Castro
- Unidad Médica de Alta Especialidad "Ignacio García Téllez", IMSS, Mérida, Yucatán, Mexico
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Guarino M, Gambuti E, Alfano F, De Giorgi A, Maietti E, Strada A, Ursini F, Volpato S, Caio G, Contini C, De Giorgio R. Predicting in-hospital mortality for sepsis: a comparison between qSOFA and modified qSOFA in a 2-year single-centre retrospective analysis. Eur J Clin Microbiol Infect Dis 2020; 40:825-831. [PMID: 33118057 PMCID: PMC7979592 DOI: 10.1007/s10096-020-04086-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/23/2020] [Indexed: 12/27/2022]
Abstract
Sepsis is a life-threating organ dysfunction caused by a dysregulated host response to infection. This study proposed a new tool, i.e. modified qSOFA, for the early prognostic assessment of septic patients. All cases of sepsis/septic shock consecutively observed in 2 years (January 2017–December 2018), at St. Anna University Hospital of Ferrara, Italy, were included. Each patient was evaluated with qSOFA and a modified qSOFA (MqSOFA), i.e. adding a SpO2/FiO2 ratio to qSOFA. Logistic regression and survival analyses were applied to compare the two scores. A total number of 1137 consecutive cases of sepsis and septic shock were considered. Among them 136 were excluded for incomplete report of vital parameters. A total number of 668 patients (66.7%) were discharged, whereas 333 (33.3%) died because of sepsis-related complications. Data analysis showed that MqSOFA (AUC 0.805, 95% C.I. 0.776–0.833) had a greater ability to detect in-hospital mortality than qSOFA (AUC 0.712, 95% C.I. 0.678–0.746) (p < 0.001). Eighty-five patients (8.5%) were reclassified as high-risk (qSOFA< 2 and MqSOFA≥ 2) resulting in an improvement of sensitivity with a minor reduction in specificity. A significant difference of in-hospital mortality was observed between low-risk and reclassified high-risk (p < 0.001) and low-risk vs. high-risk groups (p < 0.001). We demonstrated that MqSOFA provided a better predictive score than qSOFA regarding patient’s outcome. Since sepsis is an underhanded and time-dependent disease, physicians may rely upon the herein proposed simple score, i.e. MqSOFA, to establish patients’ severity and outcome.
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Affiliation(s)
- Matteo Guarino
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Edoardo Gambuti
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Franco Alfano
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Alfredo De Giorgi
- Department of Internal Medicine, St. Anna University Hospital, University of Ferrara, Cona, Ferrara, Italy
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Centre of Clinical Epidemiology, Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Andrea Strada
- Department of Emergency Medicine, St. Anna University Hospital, University of Ferrara, Cona, Ferrara, Italy
| | - Francesco Ursini
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Stefano Volpato
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Giacomo Caio
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Carlo Contini
- Department of Infectious and Dermatology Diseases, St. Anna University Hospital, University of Ferrara, Cona, Ferrara, Italy
| | - Roberto De Giorgio
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy.
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11
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Incidence of Delirium in Critically Ill Cancer Patients. Pain Res Manag 2018; 2018:4193275. [PMID: 30073040 PMCID: PMC6057317 DOI: 10.1155/2018/4193275] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/13/2018] [Accepted: 06/25/2018] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to estimate the incidence of delirium and its risk factors among critically ill cancer patients in an intensive care unit (ICU). Materials and Methods This is a prospective cohort study. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was measured daily at morning to diagnose delirium by a physician. Delirium was diagnosed when the daily was positive during a patient's ICU stay. All patients were followed until they were discharged from the ICU. Using logistic regression, we estimated potential risk factors for developing delirium. The primary outcome was the development of ICU delirium. Results There were 109 patients included in the study. Patients had a mean age of 48.6 ± 18.07 years, and the main reason for admission to the ICU was septic shock (40.4%). The incidence of delirium was 22.9%. The mortality among all subjects was 15.6%; the mortality rate in patients who developed delirium was 12%. The only variable that had an association with the development of delirium in the ICU was the days of use of mechanical ventilation (OR: 1.06; CI 95%: 0.99–1.13;p=0.07). Conclusion Delirium is a frequent condition in critically ill cancer patients admitted to the ICU. The duration in days of mechanical ventilation is potential risk factors for developing delirium during an ICU stay. Delirium was not associated with a higher rate of mortality in this group of patients.
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12
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Haniffa R, Isaam I, De Silva AP, Dondorp AM, De Keizer NF. Performance of critical care prognostic scoring systems in low and middle-income countries: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:18. [PMID: 29373996 PMCID: PMC5787236 DOI: 10.1186/s13054-017-1930-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/21/2017] [Indexed: 12/15/2022]
Abstract
Background Prognostic models—used in critical care medicine for mortality predictions, for benchmarking and for illness stratification in clinical trials—have been validated predominantly in high-income countries. These results may not be reproducible in low or middle-income countries (LMICs), not only because of different case-mix characteristics but also because of missing predictor variables. The study objective was to systematically review literature on the use of critical care prognostic models in LMICs and assess their ability to discriminate between survivors and non-survivors at hospital discharge of those admitted to intensive care units (ICUs), their calibration, their accuracy, and the manner in which missing values were handled. Methods The PubMed database was searched in March 2017 to identify research articles reporting the use and performance of prognostic models in the evaluation of mortality in ICUs in LMICs. Studies carried out in ICUs in high-income countries or paediatric ICUs and studies that evaluated disease-specific scoring systems, were limited to a specific disease or single prognostic factor, were published only as abstracts, editorials, letters and systematic and narrative reviews or were not in English were excluded. Results Of the 2233 studies retrieved, 473 were searched and 50 articles reporting 119 models were included. Five articles described the development and evaluation of new models, whereas 114 articles externally validated Acute Physiology and Chronic Health Evaluation, the Simplified Acute Physiology Score and Mortality Probability Models or versions thereof. Missing values were only described in 34% of studies; exclusion and or imputation by normal values were used. Discrimination, calibration and accuracy were reported in 94.0%, 72.4% and 25% respectively. Good discrimination and calibration were reported in 88.9% and 58.3% respectively. However, only 10 evaluations that reported excellent discrimination also reported good calibration. Generalisability of the findings was limited by variability of inclusion and exclusion criteria, unavailability of post-ICU outcomes and missing value handling. Conclusions Robust interpretations regarding the applicability of prognostic models are currently hampered by poor adherence to reporting guidelines, especially when reporting missing value handling. Performance of mortality risk prediction models in LMIC ICUs is at best moderate, especially with limitations in calibration. This necessitates continued efforts to develop and validate LMIC models with readily available prognostic variables, perhaps aided by medical registries. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1930-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rashan Haniffa
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka. .,AA (Ltd), London, UK. .,National Intensive Care Surveillance, Ministry of Health, Amsterdam, Netherlands.
| | - Ilhaam Isaam
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,AA (Ltd), London, UK
| | - A Pubudu De Silva
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,National Intensive Care Surveillance, Ministry of Health, Amsterdam, Netherlands
| | - Arjen M Dondorp
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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13
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Ñamendys-Silva SA, Arredondo-Armenta JM, Guevara-García H, Barragán-Dessavre M, García-Guillén FJ, Sánchez-Hurtado LA, Córdova-Sánchez B, Bautista-Ocampo AR, Herrera-Gómez A, Meneses-García A. Usefulness of ultrasonographic measurement of the diameter of the inferior vena cava to predict responsiveness to intravascular fluid administration in patients with cancer. Proc (Bayl Univ Med Cent) 2017; 29:374-377. [PMID: 27695165 DOI: 10.1080/08998280.2016.11929474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We conducted an observational, longitudinal prospective study in which we measured the diameters of the inferior vena cava (IVC) of 47 patients using ultrasonography. The aim of our study was to assess the state of blood volume and to determine the percentage of patients who responded to intravascular volume expansion. Only 17 patients (36%) responded to fluid management. A higher number of responding patients had cardiovascular failure compared with nonresponders (82% vs. 50%, P = 0.03). Among the patients with cardiovascular failure, the probability of finding responders was 4.6 times higher than that of not finding responders (odds ratio, 4.66; 95% confidence interval, 1.10-19.6; P = 0.04). No significant difference was observed in the mortality rate between the two groups (11% vs. 23%, P = 0.46). In conclusion, responding to intravascular volume expansion had no impact on patient survival in the intensive care unit.
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Affiliation(s)
- Silvio A Ñamendys-Silva
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, México (Ñamendys-Silva, Arredondo-Armenta, Guevara-García, Barragán-Dessavre, García-Guillén, Sánchez-Hurtado, Córdova-Sánchez, Bautista-Ocampo, Herrera-Gómez, Meneses-García); Department of Critical Care Medicine, Fundación Clínica Médica Sur, Ciudad de México (Ñamendys-Silva, Arredondo-Armenta, Barragán-Dessavre); and Department of Critical Care Medicine, Hospital de Especialidades Centro Médico Nacional La Raza, Mexican Institute of Social Security, Mexico City, Mexico (Sánchez-Hurtado)
| | - Juan M Arredondo-Armenta
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, México (Ñamendys-Silva, Arredondo-Armenta, Guevara-García, Barragán-Dessavre, García-Guillén, Sánchez-Hurtado, Córdova-Sánchez, Bautista-Ocampo, Herrera-Gómez, Meneses-García); Department of Critical Care Medicine, Fundación Clínica Médica Sur, Ciudad de México (Ñamendys-Silva, Arredondo-Armenta, Barragán-Dessavre); and Department of Critical Care Medicine, Hospital de Especialidades Centro Médico Nacional La Raza, Mexican Institute of Social Security, Mexico City, Mexico (Sánchez-Hurtado)
| | - Humberto Guevara-García
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, México (Ñamendys-Silva, Arredondo-Armenta, Guevara-García, Barragán-Dessavre, García-Guillén, Sánchez-Hurtado, Córdova-Sánchez, Bautista-Ocampo, Herrera-Gómez, Meneses-García); Department of Critical Care Medicine, Fundación Clínica Médica Sur, Ciudad de México (Ñamendys-Silva, Arredondo-Armenta, Barragán-Dessavre); and Department of Critical Care Medicine, Hospital de Especialidades Centro Médico Nacional La Raza, Mexican Institute of Social Security, Mexico City, Mexico (Sánchez-Hurtado)
| | - Mireya Barragán-Dessavre
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, México (Ñamendys-Silva, Arredondo-Armenta, Guevara-García, Barragán-Dessavre, García-Guillén, Sánchez-Hurtado, Córdova-Sánchez, Bautista-Ocampo, Herrera-Gómez, Meneses-García); Department of Critical Care Medicine, Fundación Clínica Médica Sur, Ciudad de México (Ñamendys-Silva, Arredondo-Armenta, Barragán-Dessavre); and Department of Critical Care Medicine, Hospital de Especialidades Centro Médico Nacional La Raza, Mexican Institute of Social Security, Mexico City, Mexico (Sánchez-Hurtado)
| | - Francisco J García-Guillén
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, México (Ñamendys-Silva, Arredondo-Armenta, Guevara-García, Barragán-Dessavre, García-Guillén, Sánchez-Hurtado, Córdova-Sánchez, Bautista-Ocampo, Herrera-Gómez, Meneses-García); Department of Critical Care Medicine, Fundación Clínica Médica Sur, Ciudad de México (Ñamendys-Silva, Arredondo-Armenta, Barragán-Dessavre); and Department of Critical Care Medicine, Hospital de Especialidades Centro Médico Nacional La Raza, Mexican Institute of Social Security, Mexico City, Mexico (Sánchez-Hurtado)
| | - Luis A Sánchez-Hurtado
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, México (Ñamendys-Silva, Arredondo-Armenta, Guevara-García, Barragán-Dessavre, García-Guillén, Sánchez-Hurtado, Córdova-Sánchez, Bautista-Ocampo, Herrera-Gómez, Meneses-García); Department of Critical Care Medicine, Fundación Clínica Médica Sur, Ciudad de México (Ñamendys-Silva, Arredondo-Armenta, Barragán-Dessavre); and Department of Critical Care Medicine, Hospital de Especialidades Centro Médico Nacional La Raza, Mexican Institute of Social Security, Mexico City, Mexico (Sánchez-Hurtado)
| | - Bertha Córdova-Sánchez
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, México (Ñamendys-Silva, Arredondo-Armenta, Guevara-García, Barragán-Dessavre, García-Guillén, Sánchez-Hurtado, Córdova-Sánchez, Bautista-Ocampo, Herrera-Gómez, Meneses-García); Department of Critical Care Medicine, Fundación Clínica Médica Sur, Ciudad de México (Ñamendys-Silva, Arredondo-Armenta, Barragán-Dessavre); and Department of Critical Care Medicine, Hospital de Especialidades Centro Médico Nacional La Raza, Mexican Institute of Social Security, Mexico City, Mexico (Sánchez-Hurtado)
| | - Andoreni R Bautista-Ocampo
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, México (Ñamendys-Silva, Arredondo-Armenta, Guevara-García, Barragán-Dessavre, García-Guillén, Sánchez-Hurtado, Córdova-Sánchez, Bautista-Ocampo, Herrera-Gómez, Meneses-García); Department of Critical Care Medicine, Fundación Clínica Médica Sur, Ciudad de México (Ñamendys-Silva, Arredondo-Armenta, Barragán-Dessavre); and Department of Critical Care Medicine, Hospital de Especialidades Centro Médico Nacional La Raza, Mexican Institute of Social Security, Mexico City, Mexico (Sánchez-Hurtado)
| | - Angel Herrera-Gómez
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, México (Ñamendys-Silva, Arredondo-Armenta, Guevara-García, Barragán-Dessavre, García-Guillén, Sánchez-Hurtado, Córdova-Sánchez, Bautista-Ocampo, Herrera-Gómez, Meneses-García); Department of Critical Care Medicine, Fundación Clínica Médica Sur, Ciudad de México (Ñamendys-Silva, Arredondo-Armenta, Barragán-Dessavre); and Department of Critical Care Medicine, Hospital de Especialidades Centro Médico Nacional La Raza, Mexican Institute of Social Security, Mexico City, Mexico (Sánchez-Hurtado)
| | - Abelardo Meneses-García
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, México (Ñamendys-Silva, Arredondo-Armenta, Guevara-García, Barragán-Dessavre, García-Guillén, Sánchez-Hurtado, Córdova-Sánchez, Bautista-Ocampo, Herrera-Gómez, Meneses-García); Department of Critical Care Medicine, Fundación Clínica Médica Sur, Ciudad de México (Ñamendys-Silva, Arredondo-Armenta, Barragán-Dessavre); and Department of Critical Care Medicine, Hospital de Especialidades Centro Médico Nacional La Raza, Mexican Institute of Social Security, Mexico City, Mexico (Sánchez-Hurtado)
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Outcome of Critically Ill Patients with Testicular Cancer. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3702605. [PMID: 29214164 PMCID: PMC5682042 DOI: 10.1155/2017/3702605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/19/2017] [Indexed: 12/03/2022]
Abstract
Purpose To evaluate the clinical characteristics and outcomes of critically ill patients with testicular cancer (TC) admitted to an oncological intensive care unit (ICU). Methods This was a prospective observational study. There were no interventions. Results During the study period, 1,402 patients with TC were admitted to the Department of Oncology, and 60 patients (4.3%) were admitted to the ICU. The most common histologic type was nonseminomatous germ cell tumors (55/91.7%). The ICU, hospital, and 6-month mortality rates were 38.3%, 45%, and 63.3%, respectively. The Cox multivariate analysis identified the white blood cells count (HR = 1.06, 95% CI = 1.01–1.11, and P = 0.005), ionized calcium (iCa) level (HR = 1.23, 95% CI = 1.01–1.50, and P = 0.037), and 2 or more organ failures during the first 24 hours after ICU admission (HR = 3.86, 95% CI = 1.96–7.59, and P < 0.001) as independent predictors of death for up to 6 months. Conclusion The ICU, hospital, and 6-month mortality rates were 38.3%, 45%, and 63.3%, respectively. The factors associated with an increased 6-month mortality rate were white blood cells count, iCa level, and 2 or more organ failures during the first 24 hours after ICU admission.
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15
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Ñamendys-Silva SA, Ruiz-Beltran AM, Barragán-Dessavre M, Bautista-Ocampo AR, Meneses-García A, González-Chon O, Herrera-Gómez A. Clinical characteristics of critically ill cancer patients who are undergoing isolated limb perfusion. Mol Clin Oncol 2017; 7:747-750. [PMID: 29142747 PMCID: PMC5666660 DOI: 10.3892/mco.2017.1401] [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: 02/16/2017] [Accepted: 05/22/2017] [Indexed: 11/13/2022] Open
Abstract
The aim of the present study was to investigate the incidence of organ dysfunction, and to describe the clinical characteristics and intensive care unit (ICU) outcomes of critically ill cancer patients who were admitted to an oncological ICU during the isolated limb perfusion post-operative period. The present study was an observational investigation of 42 critically ill cancer patients who were admitted to the ICU of the Instituto Nacional de Cancerología, during the isolated limb perfusion post-operative period, between July 2010 and February 2016. The mean age of the patients was 45.7±16.9 years, and 45.2% (19 cases) were female. Soft tissue sarcoma was the most common pre-operative diagnosis (38.1%), and the mean duration of surgery was 267.6±50.1 min. Furthermore, a mean blood loss volume of 732.3±526.1 ml during the procedure was recorded, and the patients received a mean volume of 3.88±1.28 l crystalloid fluid during the surgical procedure, subsequently requiring an additional 2.95±6.28 l on the first post-operative day. The incidence of organ dysfunction was 90.5% and was most frequently noted in the respiratory (81%), hepatic (33%), hematologic (31%) and renal (11.9%) systems. No patients succumbed to the disease during the ICU and hospital stay. Nevertheless, <10% of the patients required vasopressors. Additionally, <5% of the patients required invasive mechanical ventilation. Therefore, ICU admission directly following isolated limb perfusion should not be standardized.
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Affiliation(s)
- Silvio A Ñamendys-Silva
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico.,Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.,Department of Critical Care Medicine, Fundación Clínica Médica Sur, Mexico City 14050, Mexico
| | - Arturo M Ruiz-Beltran
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Mireya Barragán-Dessavre
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico.,Department of Critical Care Medicine, Fundación Clínica Médica Sur, Mexico City 14050, Mexico
| | | | - Abelardo Meneses-García
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Octavio González-Chon
- Department of Critical Care Medicine, Fundación Clínica Médica Sur, Mexico City 14050, Mexico
| | - Angel Herrera-Gómez
- Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
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16
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Demandt AMP, Geerse DA, Janssen BJP, Winkens B, Schouten HC, van Mook WNKA. The prognostic value of a trend in modified SOFA score for patients with hematological malignancies in the intensive care unit. Eur J Haematol 2017; 99:315-322. [PMID: 28656589 DOI: 10.1111/ejh.12919] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Patients with hematological malignancies admitted to an intensive care unit (ICU) have a poor prognosis. The Sequential Organ Failure Assessment (SOFA) score is used to monitor patients on the ICU. Little is known about the value of this score in hematology patients. Therefore, the prognostic value of the SOFA score and a modified hematological SOFA score (SOFAhem) was studied. METHODS Patients with hematological malignancies admitted to the ICU between 1999 and 2009 were analyzed in a retrospective cohort study. The SOFAhem score was defined as the original SOFA score omitting the coagulation and neurological parameters. RESULTS In 149 admissions, ICU mortality was 52%. Mortality was significantly associated with higher SOFA and SOFAhem scores on admission, and trend in SOFAhem scores. An unchanged and increased SOFAhem score compared to decreasing SOFAhem scores was associated with a higher mortality rate (53% resp 67% resp 25%). CONCLUSIONS Trends in SOFA or SOFAhem score are both suitable as prognostic parameter. The trend in SOFAhem score seems to be independently related to mortality in hematological patients admitted to the ICU, and because of the higher odds ratios and lower P-values compared to the SOFA score, it is probably stronger related to mortality than the classical score, but its prognostic value should be tested in a larger cohort.
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Affiliation(s)
- Astrid M P Demandt
- Division of Hematology, Department of Internal Medicine, GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daniël A Geerse
- Division of Nephrology, Department of Internal Medicine, Bravis Hospital, Roosendaal, The Netherlands
| | - Bram J P Janssen
- Department of Anaesthesiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Harry C Schouten
- Division of Hematology, Department of Internal Medicine, GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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17
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Sánchez-Hurtado L, Terán-Godínez C, Herrera-Gómez A, Arredondo-Armenta J, Guevara-García H, García-Guillén F, Meneses-García A, Juárez-Cedillo T, Ñamendys-Silva S. Outcomes of elderly patients admitted to an oncological intensive care unit: A retrospective analysis. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Arvizu-Tachiquín PC, Baltazar-Torres JA, Cano-Oviedo AA, Esquivel-Chávez A, Zamora-Varela S, Canedo-Castillo NA. Relationship between ΔSOFA and mortality in patients admitted to the intensive care unit. Intensive Care Med Exp 2015. [PMCID: PMC4796104 DOI: 10.1186/2197-425x-3-s1-a339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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19
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Ñamendys-Silva SA, Plata-Menchaca EP, Rivero-Sigarroa E, Herrera-Gómez A. Opening the doors of the intensive care unit to cancer patients: A current perspective. World J Crit Care Med 2015; 4:159-162. [PMID: 26261768 PMCID: PMC4524813 DOI: 10.5492/wjccm.v4.i3.159] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/12/2015] [Accepted: 07/17/2015] [Indexed: 02/06/2023] Open
Abstract
The introduction of new treatments for cancer and advances in the intensive care of critically ill cancer patients has improved the prognosis and survival. In recent years, the classical intensive care unit (ICU) admission comorbidity criteria used for this group of patients have been discouraged since the risk factors for death that have been studied, mainly the number and severity of organic failures, allow us to understand the determinants of the prognosis inside the ICU. However, the availability of intensive care resources is dissimilar by country, and these differences are known to alter the indications for admission to critical care setting. Three to five days of ICU management is warranted before making a final decision (ICU trial) to consider keep down intensive management of critically ill cancer patients. Nowadays, taking into account only the diagnosis of cancer to consider ICU admission of patients who need full-supporting management is no longer justified.
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