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Cheng H, Huang X, Yuan S, Song S, Tang Y, Ling Y, Tan S, Wang Z, Zhou F, Lyu J. Can admission Braden skin score predict delirium in older adults in the intensive care unit? Results from a multicenter study. J Clin Nurs 2024; 33:2209-2225. [PMID: 38071493 DOI: 10.1111/jocn.16962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 04/23/2024]
Abstract
AIMS AND OBJECTIVES To investigate whether a low Braden Skin Score (BSS), reflecting an increased risk of pressure injury, could predict the risk of delirium in older patients in the intensive care unit (ICU). BACKGROUND Delirium, a common acute encephalopathy syndrome in older ICU patients, is associated with prolonged hospital stay, long-term cognitive impairment and increased mortality. However, few studies have explored the relationship between BSS and delirium. DESIGN Multicenter cohort study. METHODS The study included 24,123 older adults from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and 1090 older adults from the eICU Collaborative Research Database (eICU-CRD), all of whom had a record of BSS on admission to the ICU. We used structured query language to extract relevant data from the electronic health records. Delirium, the primary outcome, was primarily diagnosed by the Confusion Assessment Method for the ICU or the Intensive Care Delirium Screening Checklist. Logistic regression models were used to validate the association between BSS and outcome. A STROBE checklist was the reporting guide for this study. RESULTS The median age within the MIMIC-IV and eICU-CRD databases was approximately 77 and 75 years, respectively, with 11,195 (46.4%) and 524 (48.1%) being female. The median BSS at enrollment in both databases was 15 (interquartile range: 13, 17). Multivariate logistic regression showed a negative association between BSS on ICU admission and the prevalence of delirium. Similar patterns were found in the eICU-CRD database. CONCLUSIONS This study found a significant negative relationship between ICU admission BSS and the prevalence of delirium in older patients. RELEVANCE TO CLINICAL PRACTICE The BSS, which is simple and accessible, may reflect the health and frailty of older patients. It is recommended that BSS assessment be included as an essential component of delirium management strategies for older patients in the ICU. NO PATIENT OR PUBLIC CONTRIBUTION This is a retrospective cohort study, and no patients or the public were involved in the design and conduct of the study.
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Affiliation(s)
- Hongtao Cheng
- School of Nursing, Jinan University, Guangzhou, China
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaxuan Huang
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shiqi Yuan
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Simeng Song
- School of Nursing, Jinan University, Guangzhou, China
| | - Yonglan Tang
- School of Nursing, Jinan University, Guangzhou, China
| | - Yitong Ling
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shanyuan Tan
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zichen Wang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China
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Xu M, Zeng J. Analysis of factors influencing the risk of secondary infection in patients colonized or infected with multidrug-resistant Gram-negative bacteria following hospitalization. Microb Pathog 2024; 190:106637. [PMID: 38570103 DOI: 10.1016/j.micpath.2024.106637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/20/2024] [Accepted: 03/30/2024] [Indexed: 04/05/2024]
Abstract
We seek to investigate the multifaceted factors influencing secondary infections in patients with multidrug-resistant Gram-negative bacteria (MDR-GNB) colonization or infection post-hospitalization. A total of 100 patients with MDR-GNB colonization or infection were retrospectively reviewed, encompassing those admitted to both the general ward and intensive care unit of our hospital from August 2021 to December 2022. Patients were categorized into the control group (non-nosocomial infection, n = 56) and the observation group (nosocomial infection, n = 44) based on the occurrence of nosocomial infection during hospitalization. Clinical data were compared between the two groups, including the distribution and antibiotic sensitivity of MDR-GNB before nosocomial infection. Significant differences were observed between the two groups in terms of age, underlying diseases, immune status, length of stay, and invasive medical procedures (P < 0.05). The observation group also had fewer patients practicing optimized hygiene, strict isolation, and antibiotic control than the control group (P < 0.05). Factors influencing the risk of secondary infection after hospitalization in patients colonized or infected with MDR-GNB included patient age, underlying diseases, immune status, length of hospitalization, medical invasive procedures, optimized hygiene, strict isolation, and antibiotic control (P < 0.05). The length of hospitalization and treatment cost in the observation group were higher than those in the control group (P < 0.05). This study comprehensively analyzes the intricate mechanisms of secondary infections in patients with MDR-GNB infections post-hospitalization. Key factors influencing infection risk include patient age, underlying diseases, immune status, length of hospitalization, medical invasive procedures, optimized hygiene, strict isolation, and antibiotic control.
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Affiliation(s)
- Min Xu
- Department of Pharmacy, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China.
| | - Jing Zeng
- Department of Pharmacy, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China
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Agoubi LL, Reimel BA, Maine RG, O'Connell KM, Maier RV, McIntyre LK. Intensive care unit readmission in injured older adults: Modifiable risk factors and implications. J Trauma Acute Care Surg 2024; 96:813-819. [PMID: 37926991 DOI: 10.1097/ta.0000000000004203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND Prior evaluations of intensive care unit (ICU) readmission among injured older adults have inconsistently identified risk factors, with findings limited by use of subanalyses and small sample sizes. This study aimed to identify risk factors for and implications of ICU readmission in injured older adults. METHODS This retrospective, single-center cohort study was conducted at a high-volume Level 1 trauma center and included injured older adult patients (65 years or older) requiring at least one ICU admission during hospitalization between 2013 and 2018. Patients who died <48 hours of admission were excluded. Exposures included patient demographics and clinical factors. The primary outcome was ICU readmission. Multivariable regression was used to identify risk factors for ICU readmission. RESULTS A total of 6,691 injured adult trauma patients were admitted from 2013 to 2018, 55.4% (n = 3,709) of whom were admitted to the ICU after excluding early deaths. Of this cohort, 9.1% (n = 339) were readmitted to the ICU during hospitalization. Readmitted ICU patients had a higher median Injury Severity Score (21 [interquartile range, 14-26] vs. 16 [interquartile range, 10-24]), with similar mechanisms of injury between the two groups. Readmitted ICU patients had a significantly higher mortality (19.5%) compared with single ICU admission patients (9.9%) ( p < 0.001) and higher rates of developing any complication, including delirium (61% vs. 30%, p < 0.001). On multivariable analysis, the factors associated with the highest risk of readmission were delirium (Relative Risk, 2.6; 95% confidence interval, 2.07-3.26) and aspiration (Relative Risk, 3.04; 95% confidence interval, 1.67-5.54). More patients in the single ICU admission cohort received comfort-focused care at the time of their death as compared with the ICU readmission cohort (93% vs. 85%, p = 0.035). CONCLUSION Readmission to the ICU is strongly associated with higher mortality for injured older adults. Efforts targeted at preventing respiratory complications and delirium in the geriatric trauma population may decrease the rates of ICU readmission and related mortality risk. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Lauren L Agoubi
- From the Department of Surgery (L.L.A., B.A.R., R.G.M., K.M.O., R.V.M., L.K.M.), University of Washington; and Harborview Injury Prevention and Research Center (L.L.A.), Seattle, Washington
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Zhao W, Zhou Y, Hu Y, Luo W, Wang J, Zhu H, Xu Z. Predictors of mortality and poor outcome for patients with severe infectious encephalitis in the intensive care unit: a cross-sectional study. BMC Infect Dis 2024; 24:421. [PMID: 38644471 PMCID: PMC11034050 DOI: 10.1186/s12879-024-09312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 04/10/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND There are few thorough studies assessing predictors of severe encephalitis, despite the poor prognosis and high mortality associated with severe encephalitis. The study aims to evaluate the clinical predictors of mortality and poor outcomes at hospital discharge in patients with severe infectious encephalitis in intensive care units. METHOD In two Chinese hospitals, a retrospective cohort study comprising 209 patients in intensive care units suffering from severe infectious encephalitis was carried out. Univariate and multivariate logistic regression analyses were used to identify the factors predicting mortality in all patients and poor outcomes in all survivors with severe infectious encephalitis. RESULTS In our cohort of 209 patients with severe encephalitis, 22 patients died, yielding a mortality rate of 10.5%. Cerebrospinal fluid pressure ≥ 400mmH2O (OR = 7.43), abnormal imaging (OR = 3.51), abnormal electroencephalogram (OR = 7.14), and number of rescues (OR = 1.12) were significantly associated with an increased risk of mortality in severe infectious encephalitis patients. Among the 187 survivors, 122 (65.2%) had favorable outcomes, defined as the modified Rankine Scale (mRS) score (0 ~ 3), and 65(34.8%) had poor outcomes (mRS scores 4 ~ 5). Age (OR = 1.02), number of rescues (OR = 1.43), and tubercular infection (OR = 10.77) were independent factors associated with poor outcomes at discharge in all survivors with severe infectious encephalitis. CONCLUSIONS Multiple clinical, radiologic, and electrophysiological variables are independent predictive indicators for mortality and poor outcomes in patients with severe encephalitis in intensive care units. Identifying these outcome predictors early in patients with severe encephalitis may enable the implementation of appropriate medical treatment and help reduce mortality rates.
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Affiliation(s)
- WenYan Zhao
- Department of Neuropsychology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - YuLiang Zhou
- Department of Neuropsychology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - YingYing Hu
- Department of Neuropsychology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - WenJing Luo
- Department of Neurology, General Hospital of Central Theater Command, Wuhan, People's Republic of China
| | - Jing Wang
- Department of Neuropsychology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.
| | - Hong Zhu
- Department of Neuropsychology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - ZhiPeng Xu
- Department of Neuropsychology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.
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Zhao H, Yan X, Guo Z, Li K, Wang Z, Wang J, Lv D, Zhu J, Chen Y. Comparison of outcomes and characteristics of patients admitted to the ICU with COVID-19 and other community-acquired pneumonia based on propensity score matching. BMC Infect Dis 2024; 24:419. [PMID: 38644489 PMCID: PMC11034039 DOI: 10.1186/s12879-024-09306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/09/2024] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE To compare the similarities and differences between patients with Coronavirus Disease 2019 (COVID-19) and those with other community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU), utilizing propensity score matching (PSM), regarding hospitalization expenses, treatment options, and prognostic outcomes, aiming to inform the diagnosis and treatment of COVID-19. METHODS Patients admitted to the ICU of the Third People's Hospital of Datong City, diagnosed with COVID-19 from December 2022 to February 2023, constituted the observation group, while those with other CAP admitted from January to November 2022 formed the control group. Basic information, clinical data at admission, and time from symptom onset to admission were matched using PSM. RESULTS A total of 70 patients were included in the COVID-19 group and 119 in the CAP group. The patients were matched by the propensity matching method, and 37 patients were included in each of the last two groups. After matching, COVID-19 had a higher failure rate than CAP, but the difference was not statistically significant (73% vs. 51%, p = 0.055). The utilization rate of antiviral drugs (40% vs. 11%, p = 0.003), γ-globulin (19% vs. 0%, p = 0.011) and prone position ventilation (PPV) (27% vs. 0%, p < 0.001) in patients with COVID-19 were higher than those in the CAP, and the differences were statistically significant. The total hospitalization cost of COVID-19 patients was lower than that of CAP patients, and the difference was statistically significant (27889.5 vs. 50175.9, p = 0.007). The hospital stay for COVID-19 patients was shorter than for CAP patients, but the difference was not statistically significant (10.9 vs. 16.6, p = 0.071). CONCLUSION Our findings suggest that limited medical resources influenced patient outcomes during the COVID-19 pandemic. Addressing substantial demands for ICU capacity and medications during this period could have potentially reduced the mortality rate among COVID-19 patients.
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Affiliation(s)
- Hongli Zhao
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China
| | - Xiulin Yan
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China.
| | - Ziru Guo
- Science and Education Section, Datong Third People's Hospital, Datong, Shanxi, China
| | - Kaiyu Li
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China
| | - Zhaopeng Wang
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China
| | - Jun Wang
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China
| | - Dong Lv
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China
| | - Jianling Zhu
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China
| | - Ye Chen
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China
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Lin SH, Chen WT, Tsai MH, Liu LT, Kuo WL, Lin YT, Wang SF, Chen BH, Lee CH, Huang CH, Chien RN. A novel prognostic model to predict mortality in patients with acute-on-chronic liver failure in intensive care unit. Intern Emerg Med 2024; 19:721-730. [PMID: 38386096 DOI: 10.1007/s11739-024-03536-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 01/11/2024] [Indexed: 02/23/2024]
Abstract
Acute-on-chronic liver failure (ACLF) implies high short-term mortality rates and usually requires intensive care unit (ICU) admission. Proper prognosis for these patients is crucial for early referral for liver transplantation. The superiority of CLIF-C ACLF score in Asian patients with ACLF admitted to an ICU remains inconclusive when compared to other scoring systems. The purpose of the study is (i) to compare the predictive performance of original MELD, MELD-Lactate, CLIF-C ACLF, CLIF-C ACLF-Lactate, and APACHE-II scores for short-term mortality assessment. (ii) to build and validate a novel scoring system and to compare its predictive performance to that of the original five scores. Two hundred sixty-five consecutive cirrhotic patients with ACLF who were admitted to our ICU were enrolled. The prognostic values for mortality were assessed by ROC analysis. A novel model was developed and internally validated using fivefold cross-validation. Alcohol abuse was identified as the primary etiology of cirrhosis. The AUROC of the five prognostic scores were not significantly superior to each other in predicting 1-month and 3-month mortality. The newly developed prognostic model, incorporating age, alveolar-arterial gradient (A-a gradient), BUN, total bilirubin level, INR, and HE grades, exhibited significantly improved performance in predicting 1-month and 3-month mortality with AUROC of 0.863 and 0.829, respectively, as compared to the original five prognostic scores. The novel ACLF model seems to be superior to the original five scores in predicting short-term mortality in ACLF patients admitted to an ICU. Further rigorous validation is required.
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Affiliation(s)
- Shih-Hua Lin
- Department of Gastroenterology and Hepatology, New Taipei Municipal TuCheng Hospital, Tucheng, New Taipei City, 236, Taiwan
| | - Wei-Ting Chen
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
- College of Medicine, Chang-Gung University, Taoyuan, 333, Taiwan
| | - Ming-Hung Tsai
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
- College of Medicine, Chang-Gung University, Taoyuan, 333, Taiwan
| | - Li-Tong Liu
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Wei-Liang Kuo
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Yan-Ting Lin
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Sheng-Fu Wang
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Bo-Huan Chen
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Cheng-Han Lee
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Chien-Hao Huang
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan.
- College of Medicine, Chang-Gung University, Taoyuan, 333, Taiwan.
| | - Rong-Nan Chien
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
- College of Medicine, Chang-Gung University, Taoyuan, 333, Taiwan
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Lau S, Shum HP, Chan CCY, Man MY, Tang KB, Chan KKC, Leung AKH, Yan WW. Prediction of hospital mortality among critically ill patients in a single centre in Asia: comparison of artificial neural networks and logistic regression-based model. Hong Kong Med J 2024; 30:130-138. [PMID: 38545639 DOI: 10.12809/hkmj2210235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2024] Open
Abstract
INTRODUCTION This study compared the performance of the artificial neural network (ANN) model with the Acute Physiologic and Chronic Health Evaluation (APACHE) II and IV models for predicting hospital mortality among critically ill patients in Hong Kong. METHODS This retrospective analysis included all patients admitted to the intensive care unit of Pamela Youde Nethersole Eastern Hospital from January 2010 to December 2019. The ANN model was constructed using parameters identical to the APACHE IV model. Discrimination performance was assessed using area under the receiver operating characteristic curve (AUROC); calibration performance was evaluated using the Brier score and Hosmer-Lemeshow statistic. RESULTS In total, 14 503 patients were included, with 10% in the validation set and 90% in the ANN model development set. The ANN model (AUROC=0.88, 95% confidence interval [CI]=0.86-0.90, Brier score=0.10; P in Hosmer-Lemeshow test=0.37) outperformed the APACHE II model (AUROC=0.85, 95% CI=0.80-0.85, Brier score=0.14; P<0.001 for both comparisons of AUROCs and Brier scores) but showed performance similar to the APACHE IV model (AUROC=0.87, 95% CI=0.85-0.89, Brier score=0.11; P=0.34 for comparison of AUROCs, and P=0.05 for comparison of Brier scores). The ANN model demonstrated better calibration than the APACHE II and APACHE IV models. CONCLUSION Our ANN model outperformed the APACHE II model but was similar to the APACHE IV model in terms of predicting hospital mortality in Hong Kong. Artificial neural networks are valuable tools that can enhance real-time prognostic prediction.
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Affiliation(s)
- S Lau
- Department of Anaesthesia, Pain and Perioperative Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - H P Shum
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - C C Y Chan
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - M Y Man
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - K B Tang
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - K K C Chan
- Department of Anaesthesia and Intensive Care, Tuen Mun Hospital, Hong Kong SAR, China
| | - A K H Leung
- Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - W W Yan
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
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Martos-Benítez FD, Burgos-Aragüez D, García-Mesa L, Orama-Requejo V, Cárdenas-González RC, Michelena-Piedra JC, Izquierdo-Castañeda J, Sánchez-de-la-Rosa E, Corrales-González O. Fluid balance, biomarkers of renal function and mortality in critically ill patients with AKI diagnosed before, or within 24 h of intensive care unit admission: a prospective study. J Nephrol 2024; 37:439-449. [PMID: 38189864 DOI: 10.1007/s40620-023-01829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/08/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND To evaluate fluid balance, biomarkers of renal function and its relation to mortality in patients with acute kidney injury (AKI) diagnosed before, or within 24 h of intensive care unit admission. METHODS A prospective cohort study considered 773 critically ill patients observed over six years. Pre-intensive care unit-onset AKI was defined as AKI diagnosed before, or within 24 h of intensive care unit admission. Body weight-adjusted fluid balance and fluid balance-adjusted biomarkers of renal function were measured daily for the first three days of intensive care unit admission. Primary outcome was mortality in the intensive care unit. RESULTS Prevalence of pre-intensive care unit-onset AKI was 55.1%, of which 55.6% of cases were hospital-acquired and 44.4% were community-acquired. Fluid balance was higher in AKI patients than in non-AKI patients (p < 0.001) and had a negative correlation with urine output (p < 0.01). Positive fluid balance and biomarkers of renal function were independently related to mortality. Multivariate analysis identified the following AKI-related variables associated with increased mortality: (1) In AKI patients: type 1 cardiorenal syndrome (OR 2.00), intra-abdominal hypertension (OR 1.71), AKI stage 3 (OR 2.15) and increase in AKI stage (OR 4.99); 2) In patients with community-acquired AKI: type 1 cardiorenal syndrome (OR 5.16), AKI stage 2 (OR 2.72), AKI stage 3 (OR 4.95) and renal replacement therapy (OR 3.05); and 3) In patients with hospital-acquired AKI: intra-abdominal hypertension (OR 2.31) and increase in AKI stage (OR 4.51). CONCLUSIONS In patients with pre-intensive care unit-onset AKI, positive fluid balance is associated with worse renal outcomes. Positive fluid balance and decline in biomarkers of renal function are related to increased mortality, thus in this subpopulation of critically ill patients, positive fluid balance is not recommended and renal function must be closely monitored.
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Affiliation(s)
- Frank Daniel Martos-Benítez
- Intensive Care Unit, National Institute of Neurology and Neurosurgery, 29 St. and D St., Vedado, Plaza, 10400, Havana, Cuba.
| | - Dailé Burgos-Aragüez
- Intensive Care Unit-8, Hermanos Ameijeiras Hospital, San Lázaro St., Centro Havana, 10200, Havana, Cuba
| | - Liselotte García-Mesa
- Intensive Care Unit-8, Hermanos Ameijeiras Hospital, San Lázaro St., Centro Havana, 10200, Havana, Cuba
| | | | | | - Juan Carlos Michelena-Piedra
- Intensive Care Unit, National Institute of Neurology and Neurosurgery, 29 St. and D St., Vedado, Plaza, 10400, Havana, Cuba
| | - Judet Izquierdo-Castañeda
- Intensive Care Unit, National Institute of Neurology and Neurosurgery, 29 St. and D St., Vedado, Plaza, 10400, Havana, Cuba
| | - Ernesto Sánchez-de-la-Rosa
- Intensive Care Unit, National Institute of Neurology and Neurosurgery, 29 St. and D St., Vedado, Plaza, 10400, Havana, Cuba
| | - Olivia Corrales-González
- Intensive Care Unit, National Institute of Neurology and Neurosurgery, 29 St. and D St., Vedado, Plaza, 10400, Havana, Cuba
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Merhabene T, Zayet S, Jamoussi A, Ayed S, Mansouri S, Khelil JB, Besbes M. Benefit of intrapleural fibrinolytic therapy in the treatment of complicated parapneumonic effusion and empyema. Pan Afr Med J 2024; 47:54. [PMID: 38646137 PMCID: PMC11032075 DOI: 10.11604/pamj.2024.47.54.15439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 01/24/2024] [Indexed: 04/23/2024] Open
Abstract
Our study aimed to assess the benefit of intrapleural fibrinolysis before resorting to surgery to treat complicated parapneumonic effusion and empyema. We conducted a retrospective and descriptive study, including all patients hospitalized in the intensive care unit (ICU) of the Abderhaman Mami hospital, Tunisia for empyema treated with instillation of intrapleural fibrinolytic therapy between the 1st January 2000 and 31st December 2016. In all patients, empyema was diagnosed on clinical features, imaging findings (chest X-ray, thoracic echography and/or computed tomography (CT), and microbiological data. The fibrinolytic agent used was streptokinase. The efficiency of intrapleural fibrinolytic therapy was judged on clinical and paraclinical results. Among 103 cases of complicated parapneumonic effusion and empyema, 34 patients were included. The mean age was 34 years [15-81] with a male predominance (sex ratio at 2.77). Median APACH II score was 9. Fifty (50%) of the patients (n=17) had no past medical history; addictive behavior was described in 17 patients (50%). All patients were admitted for acute respiratory failure and one patient for septic shock. Pleural effusion was bilateral in 7 patients. Bacteria isolated were Streptococcus pneumonia (6 cases), Staphylococcus aureus (3 cases, including one which methicillin-resistant), Staphylococcus epidermidis (1 case), anaerobes (5 cases), and Klebsiella pneumoniae (1 case). First-line antimicrobial drug therapy was amoxicillin-clavulanate in 20 patients. A chest drain was placed in all cases in the first 38 hours of ICU admission. The median number of fibrinolysis sessions was 4 [2-9] and the median term of drainage was 7 days [3-16]. No side effects were observed. Video-assisted thoracoscopic surgery was proposed in 5 patients. The median length of hospitalization stay was 15 days [6-31]. One patient died due to multi-organ failure.
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Affiliation(s)
- Takoua Merhabene
- Abderrahmen Mami Hospital, Intensive Care Unit, Tunis, Tunisia
- Université Tunis El Manar, Faculté de Médecine, Tunis, Tunisie
| | - Souheil Zayet
- Abderrahmen Mami Hospital, Intensive Care Unit, Tunis, Tunisia
- Université Tunis El Manar, Faculté de Médecine, Tunis, Tunisie
| | - Amira Jamoussi
- Abderrahmen Mami Hospital, Intensive Care Unit, Tunis, Tunisia
- Université Tunis El Manar, Faculté de Médecine, Tunis, Tunisie
| | - Samia Ayed
- Abderrahmen Mami Hospital, Intensive Care Unit, Tunis, Tunisia
- Université Tunis El Manar, Faculté de Médecine, Tunis, Tunisie
| | - Salwa Mansouri
- Abderrahmen Mami Hospital, Intensive Care Unit, Tunis, Tunisia
- Université Tunis El Manar, Faculté de Médecine, Tunis, Tunisie
| | - Jalila Ben Khelil
- Abderrahmen Mami Hospital, Intensive Care Unit, Tunis, Tunisia
- Université Tunis El Manar, Faculté de Médecine, Tunis, Tunisie
| | - Mohamed Besbes
- Abderrahmen Mami Hospital, Intensive Care Unit, Tunis, Tunisia
- Université Tunis El Manar, Faculté de Médecine, Tunis, Tunisie
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10
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Horon I. Characteristics of Mothers Admitted to Intensive Care Units During Hospitalization for Delivery of a Live-born Infant: United States, 2020-2022. NCHS Data Brief 2023:1-7. [PMID: 38085529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Although admission of a mother to an intensive care unit (ICU) during hospitalization for delivery is a relatively rare event, rates of mortality and severe morbidity are high for both mother and child when ICU care is necessary (1-4). Studies on maternal ICU admissions have generally focused on medical diagnoses related to admission, and most have been conducted using international data or data for a hospital or group of hospitals (4-10). Information on demographic characteristics of mothers admitted to ICUs is lacking at the national level. This report describes ICU admissions overall and by race and Hispanic origin, maternal age, live birth order, and plurality for mothers delivering live-born infants in the United States in 2020-2022.
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11
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Raasveld SJ, de Bruin S, Reuland MC, van den Oord C, Schenk J, Aubron C, Bakker J, Cecconi M, Feldheiser A, Meier J, Müller MCA, Scheeren TWL, McQuilten Z, Flint A, Hamid T, Piagnerelli M, Tomić Mahečić T, Benes J, Russell L, Aguirre-Bermeo H, Triantafyllopoulou K, Chantziara V, Gurjar M, Myatra SN, Pota V, Elhadi M, Gawda R, Mourisco M, Lance M, Neskovic V, Podbregar M, Llau JV, Quintana-Diaz M, Cronhjort M, Pfortmueller CA, Yapici N, Nielsen ND, Shah A, de Grooth HJ, Vlaar APJ. Red Blood Cell Transfusion in the Intensive Care Unit. JAMA 2023; 330:1852-1861. [PMID: 37824112 PMCID: PMC10570913 DOI: 10.1001/jama.2023.20737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023]
Abstract
Importance Red blood cell (RBC) transfusion is common among patients admitted to the intensive care unit (ICU). Despite multiple randomized clinical trials of hemoglobin (Hb) thresholds for transfusion, little is known about how these thresholds are incorporated into current practice. Objective To evaluate and describe ICU RBC transfusion practices worldwide. Design, Setting, and Participants International, prospective, cohort study that involved 3643 adult patients from 233 ICUs in 30 countries on 6 continents from March 2019 to October 2022 with data collection in prespecified weeks. Exposure ICU stay. Main Outcomes and Measures The primary outcome was the occurrence of RBC transfusion during ICU stay. Additional outcomes included the indication(s) for RBC transfusion (consisting of clinical reasons and physiological triggers), the stated Hb threshold and actual measured Hb values before and after an RBC transfusion, and the number of units transfused. Results Among 3908 potentially eligible patients, 3643 were included across 233 ICUs (median of 11 patients per ICU [IQR, 5-20]) in 30 countries on 6 continents. Among the participants, the mean (SD) age was 61 (16) years, 62% were male (2267/3643), and the median Sequential Organ Failure Assessment score was 3.2 (IQR, 1.5-6.0). A total of 894 patients (25%) received 1 or more RBC transfusions during their ICU stay, with a median total of 2 units per patient (IQR, 1-4). The proportion of patients who received a transfusion ranged from 0% to 100% across centers, from 0% to 80% across countries, and from 19% to 45% across continents. Among the patients who received a transfusion, a total of 1727 RBC transfusions were administered, wherein the most common clinical indications were low Hb value (n = 1412 [81.8%]; mean [SD] lowest Hb before transfusion, 7.4 [1.2] g/dL), active bleeding (n = 479; 27.7%), and hemodynamic instability (n = 406 [23.5%]). Among the events with a stated physiological trigger, the most frequently stated triggers were hypotension (n = 728 [42.2%]), tachycardia (n = 474 [27.4%]), and increased lactate levels (n = 308 [17.8%]). The median lowest Hb level on days with an RBC transfusion ranged from 5.2 g/dL to 13.1 g/dL across centers, from 5.3 g/dL to 9.1 g/dL across countries, and from 7.2 g/dL to 8.7 g/dL across continents. Approximately 84% of ICUs administered transfusions to patients at a median Hb level greater than 7 g/dL. Conclusions and Relevance RBC transfusion was common in patients admitted to ICUs worldwide between 2019 and 2022, with high variability across centers in transfusion practices.
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Affiliation(s)
- Senta Jorinde Raasveld
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Sanne de Bruin
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Merijn C. Reuland
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Claudia van den Oord
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Jimmy Schenk
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Amsterdam Public Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Cécile Aubron
- Médecine Intensive Réanimation, CHU de Brest, Université de Bretagne Occidentale, Brest, France
| | - Jan Bakker
- Department of Pulmonary and Critical Care, New York University and Columbia University New York
- Department of Intensive Care Adults, Erasmus MC University Medical Centers, Rotterdam, the Netherlands
- Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maurizio Cecconi
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Aarne Feldheiser
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, EvangKliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, Essen, Germany
| | - Jens Meier
- Department of Anesthesiology and Intensive Care, Kepler University Clinic, Kepler University, Linz, Austria
| | - Marcella C. A. Müller
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Thomas W. L. Scheeren
- Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Zoe McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Flint
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tarikul Hamid
- Department of Critical Care, Asgar Ali Hospital, Dhaka, Bangladesh
| | - Michaël Piagnerelli
- Department of Intensive Care, CHU Charleroi Marie Curie, Université Libre de Brussels, Charleroi, Belgium
| | - Tina Tomić Mahečić
- Department of Anesthesiology and Intensive Care, University Clinical Hospital Center Zagreb, Croatia
| | - Jan Benes
- Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine in Plzen–Charles University, Plzen, Czech Republic
| | - Lene Russell
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet Copenhagen, Copenhagen, Denmark
- Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital–Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Vasiliki Chantziara
- Intensive Care Unit, First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, Athens, Greece
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sheila Nainan Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vincenzo Pota
- Department of Child, General and Specialistic Surgery, University of Campania, Luigi Vanvitelli, Naples, Italy
| | | | - Ryszard Gawda
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Mafalda Mourisco
- Department of Intensive Care, Centro Hospitalar de Entro o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Marcus Lance
- Department of Anesthesiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Vojislava Neskovic
- Department of Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia
| | - Matej Podbregar
- Department for Internal Intensive Care, General Hospital Celje, Medical Faculty, University of Ljubljana, Slovenia
| | - Juan V. Llau
- Department of Anesthesiology and Post-surgical Critical Care, University Hospital Doctor Peset, Valencia, Spain
| | | | - Maria Cronhjort
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Carmen A. Pfortmueller
- Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Nihan Yapici
- Department of Anesthesiology and Reanimation, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, University of Health Sciences, Istanbul, Turkey
| | - Nathan D. Nielsen
- Division of Pulmonary, Critical Care and Sleep Medicine, and Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque
| | - Akshay Shah
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Harm-Jan de Grooth
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Alexander P. J. Vlaar
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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12
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Harris E. C difficile Cross-Transmission in US ICUs May Be Rare, Study Suggests. JAMA 2023; 330:1421. [PMID: 37755938 DOI: 10.1001/jama.2023.18740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
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13
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Huang SS, Septimus EJ, Kleinman K, Heim LT, Moody JA, Avery TR, McLean L, Rashid S, Haffenreffer K, Shimelman L, Staub-Juergens W, Spencer-Smith C, Sljivo S, Rosen E, Poland RE, Coady MH, Lee CH, Blanchard EJ, Reddish K, Hayden MK, Weinstein RA, Carver B, Smith K, Hickok J, Lolans K, Khan N, Sturdevant SG, Reddy SC, Jernigan JA, Sands KE, Perlin JB, Platt R. Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs: A Randomized Clinical Trial. JAMA 2023; 330:1337-1347. [PMID: 37815567 PMCID: PMC10565599 DOI: 10.1001/jama.2023.17219] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 08/17/2023] [Indexed: 10/11/2023]
Abstract
Importance Universal nasal mupirocin plus chlorhexidine gluconate (CHG) bathing in intensive care units (ICUs) prevents methicillin-resistant Staphylococcus aureus (MRSA) infections and all-cause bloodstream infections. Antibiotic resistance to mupirocin has raised questions about whether an antiseptic could be advantageous for ICU decolonization. Objective To compare the effectiveness of iodophor vs mupirocin for universal ICU nasal decolonization in combination with CHG bathing. Design, Setting, and Participants Two-group noninferiority, pragmatic, cluster-randomized trial conducted in US community hospitals, all of which used mupirocin-CHG for universal decolonization in ICUs at baseline. Adult ICU patients in 137 randomized hospitals during baseline (May 1, 2015-April 30, 2017) and intervention (November 1, 2017-April 30, 2019) were included. Intervention Universal decolonization involving switching to iodophor-CHG (intervention) or continuing mupirocin-CHG (baseline). Main Outcomes and Measures ICU-attributable S aureus clinical cultures (primary outcome), MRSA clinical cultures, and all-cause bloodstream infections were evaluated using proportional hazard models to assess differences from baseline to intervention periods between the strategies. Results were also compared with a 2009-2011 trial of mupirocin-CHG vs no decolonization in the same hospital network. The prespecified noninferiority margin for the primary outcome was 10%. Results Among the 801 668 admissions in 233 ICUs, the participants' mean (SD) age was 63.4 (17.2) years, 46.3% were female, and the mean (SD) ICU length of stay was 4.8 (4.7) days. Hazard ratios (HRs) for S aureus clinical isolates in the intervention vs baseline periods were 1.17 for iodophor-CHG (raw rate: 5.0 vs 4.3/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 4.1 vs 4.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 18.4% [95% CI, 10.7%-26.6%] for mupirocin-CHG, P < .001). For MRSA clinical cultures, HRs were 1.13 for iodophor-CHG (raw rate: 2.3 vs 2.1/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 2.0 vs 2.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 14.1% [95% CI, 3.7%-25.5%] for mupirocin-CHG, P = .007). For all-pathogen bloodstream infections, HRs were 1.00 (2.7 vs 2.7/1000) for iodophor-CHG and 1.01 (2.6 vs 2.6/1000) for mupirocin-CHG (nonsignificant HR difference in differences, -0.9% [95% CI, -9.0% to 8.0%]; P = .84). Compared with the 2009-2011 trial, the 30-day relative reduction in hazards in the mupirocin-CHG group relative to no decolonization (2009-2011 trial) were as follows: S aureus clinical cultures (current trial: 48.1% [95% CI, 35.6%-60.1%]; 2009-2011 trial: 58.8% [95% CI, 47.5%-70.7%]) and bloodstream infection rates (current trial: 70.4% [95% CI, 62.9%-77.8%]; 2009-2011 trial: 60.1% [95% CI, 49.1%-70.7%]). Conclusions and Relevance Nasal iodophor antiseptic did not meet criteria to be considered noninferior to nasal mupirocin antibiotic for the outcome of S aureus clinical cultures in adult ICU patients in the context of daily CHG bathing. In addition, the results were consistent with nasal iodophor being inferior to nasal mupirocin. Trial Registration ClinicalTrials.gov Identifier: NCT03140423.
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Affiliation(s)
- Susan S. Huang
- University of California Irvine School of Medicine, Irvine
| | - Edward J. Septimus
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
- Texas A&M College of Medicine and Memorial Hermann Health System, Houston
| | | | - Lauren T. Heim
- University of California Irvine School of Medicine, Irvine
| | | | - Taliser R. Avery
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
| | | | - Syma Rashid
- University of California Irvine School of Medicine, Irvine
| | | | - Lauren Shimelman
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
| | | | | | - Selsebil Sljivo
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
| | - Ed Rosen
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
| | | | - Micaela H. Coady
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
| | | | | | | | | | - Robert A. Weinstein
- Rush Medical College, Chicago, Illinois
- John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | | | | | | | | | | | - S. Gwynn Sturdevant
- University of Massachusetts Amherst
- now with Wharton School of the University of Pennsylvania, Philadelphia
| | - Sujan C. Reddy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Jonathan B. Perlin
- HCA Healthcare, Nashville, Tennessee
- now with The Joint Commission, Oakbrook Terrace, Illinois
| | - Richard Platt
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
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14
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Teixeira RMP, Oliveira JC, de Andrade MAB, Pinheiro FGDMS, Vieira RDCA, Santana-Santos E. Are patient volume and care level in teaching hospitals variables affecting clinical outcomes in adult intensive care units? Einstein (Sao Paulo) 2023; 21:eAO0406. [PMID: 37820201 PMCID: PMC10519666 DOI: 10.31744/einstein_journal/2023ao0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/07/2023] [Indexed: 10/13/2023] Open
Abstract
Teixeira et al. showed that patients admitted to the intensive care unit of a teaching hospital in a non-metropolitan region needed more support, had worse prognostic indices, and had a higher nursing workload in the first 24 hours of admission. In addition, worse outcomes, including mortality, need for dialysis, pressure injury, infection, prolonged mechanical ventilation, and prolonged hospital stay, were observed in the teaching hospital. Worse outcomes were more prevalent in the teaching hospital. Understanding the importance of teaching hospitals to implement well-established care protocols is critical. OBJECTIVE To compare the clinical outcomes of patients admitted to the intensive care unit of teaching (HI) and nonteaching (without an academic affiliation; H2) hospitals. METHODS In this prospective cohort study, adult patients hospitalized between August 2018 and July 2019, with a minimum length of stay of 24 hours in the intensive care unit, were included. Patients with no essential information in their medical records to evaluate the study outcomes were excluded. Resuslts: Overall, 219 patients participated in this study. The clinical and demographic characteristics of patients in H1 and H2 were similar. The most prevalent clinical outcomes were death, need for dialysis, pressure injury, length of hospital stay, mechanical ventilation >48 hours, and infection, all of which were more prevalent in the teaching hospital. CONCLUSION Worse outcomes were more prevalent in the teaching hospital. There was no difference between the institutions concerning the survival rate of patients as a function of length of hospital stay; however, a difference was observed in intensive care unit admissions.
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Affiliation(s)
| | - Jussiely Cunha Oliveira
- Universidade Federal de SergipeSão CristovãoSEBrazil Universidade Federal de Sergipe, São Cristovão, SE, Brazil.
| | | | | | | | - Eduesley Santana-Santos
- Universidade Federal de SergipeSão CristovãoSEBrazil Universidade Federal de Sergipe, São Cristovão, SE, Brazil.
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15
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Ko JY, Pham H, Anglin O, Chai SJ, Alden NB, Meek J, Anderson EJ, Weigel A, Kohrman A, Lynfield R, Rudin D, Barney G, Bennett NM, Billing LM, Sutton M, Talbot HK, Swain A, Havers FP, Taylor CA. Vaccination Status and Trends in Adult Coronavirus Disease 2019-Associated Hospitalizations by Race and Ethnicity: March 2020-August 2022. Clin Infect Dis 2023; 77:827-838. [PMID: 37132204 PMCID: PMC11019819 DOI: 10.1093/cid/ciad266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/14/2023] [Accepted: 04/28/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND We sought to determine whether race/ethnicity disparities in severe coronavirus disease 2019 (COVID-19) outcomes persist in the era of vaccination. METHODS Population-based age-adjusted monthly rate ratios (RRs) of laboratory-confirmed COVID-19-associated hospitalizations were calculated among adult patients from the COVID-19-Associated Hospitalization Surveillance Network, March 2020 - August 2022 by race/ethnicity. Among randomly sampled patients July 2021 - August 2022, RRs for hospitalization, intensive care unit (ICU) admission, and in-hospital mortality were calculated for Hispanic, Black, American Indian/Alaskan Native (AI/AN), and Asian/Pacific Islander (API) persons vs White persons. RESULTS Based on data from 353 807 patients, hospitalization rates were higher among Hispanic, Black, and AI/AN vs White persons March 2020 - August 2022, yet the magnitude declined over time (for Hispanic persons, RR = 6.7; 95% confidence interval [CI], 6.5-7.1 in June 2020 vs RR < 2.0 after July 2021; for AI/AN persons, RR = 8.4; 95% CI, 8.2-8.7 in May 2020 vs RR < 2.0 after March 2022; and for Black persons RR = 5.3; 95% CI, 4.6-4.9 in July 2020 vs RR < 2.0 after February 2022; all P ≤ .001). Among 8706 sampled patients July 2021 - August 2022, hospitalization and ICU admission RRs were higher for Hispanic, Black, and AI/AN patients (range for both, 1.4-2.4) and lower for API (range for both, 0.6-0.9) vs White patients. All other race and ethnicity groups had higher in-hospital mortality rates vs White persons (RR range, 1.4-2.9). CONCLUSIONS Race/ethnicity disparities in COVID-19-associated hospitalizations declined but persist in the era of vaccination. Developing strategies to ensure equitable access to vaccination and treatment remains important.
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Affiliation(s)
- Jean Y Ko
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
- US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Huong Pham
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
| | - Onika Anglin
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
| | - Shua J Chai
- California Emerging Infections Program, Oakland, California, USA
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Evan J Anderson
- Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Department of Public Health, Georgia Emerging Infections Program, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Andy Weigel
- Iowa Department of Public Health, Des Moines, Iowa, USA
| | - Alexander Kohrman
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Dominic Rudin
- New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA
| | - Grant Barney
- New York State Department of Health, Albany, New York, USA
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashley Swain
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Fiona P Havers
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
- US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Christopher A Taylor
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
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16
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Su L, Ma X, Gao S, Yin Z, Chen Y, Wang W, He H, Du W, Hu Y, Ma D, Zhang F, Zhu W, Meng X, Sun G, Ma L, Jiang H, Shan G, Liu D, Zhou X. Evaluation of ICUs and weight of quality control indicators: an exploratory study based on Chinese ICU quality data from 2015 to 2020. Front Med 2023; 17:675-684. [PMID: 37060524 PMCID: PMC10105137 DOI: 10.1007/s11684-022-0970-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/12/2022] [Indexed: 04/16/2023]
Abstract
This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015-2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ⩾15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management + 17.97%xcompliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.
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Affiliation(s)
- Longxiang Su
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xudong Ma
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Sifa Gao
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Zhi Yin
- Intensive Care Unit, The People's Hospital of Zizhong, Neijiang, 641000, China
| | - Yujie Chen
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wenhu Wang
- Intensive Care Unit, The People's Hospital of Zizhong, Neijiang, 641000, China
| | - Huaiwu He
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wei Du
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yaoda Hu
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China
| | - Dandan Ma
- Information Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Feng Zhang
- Information Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Wen Zhu
- Information Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xiaoyang Meng
- Information Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Guoqiang Sun
- Information Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Lian Ma
- Information Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Huizhen Jiang
- Information Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Guangliang Shan
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China.
| | - Dawei Liu
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Xiang Zhou
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
- Information Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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17
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Zhao HM, Wang Y, Li DY, Zhang WY, Dong TR, Wang C. [Emphasis on Post-ICU Syndrome]. Zhonghua Yi Xue Za Zhi 2023; 103:1961-1965. [PMID: 36977560 DOI: 10.3760/cma.j.cn112137-20230320-00446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
With the development of technology and medicine, the mortality rate of intensive care unit (ICU) has declined significantly, and more and more professionals in the medical field are also aware that the disability rate of ICU survivors remains high. More than 70% of ICU survivors have Post-ICU Syndrome (PICS), which is mainly manifested by cognitive, physical, and mental dysfunction, which seriously affects the quality of life of survivors and their caregivers. The COVID-19 pandemic has brought a series of problems such as shortage of medical staff, restricted family visits, and lack of personalized care, which have brought unprecedented challenges to the prevention of PICS and the care of patients with severe COVID-19. In the future, the treatment of ICU patients should change from reducing short-term mortality to improving long-term quality of life of patients, from disease-centered to health-centered, and to practice " the health promotion, the prevention, the diagnosis, the control, the treatment, and the rehabilitation " six-in-one concept to promote comprehensive health care with pulmonary rehabilitation.
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Affiliation(s)
- H M Zhao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital/National Center for Respiratory Medicine/Institute of Respiratory Medicine, Chinese Academy of Medical Sciences/National Clinical Research Center for Respiratory Diseases, Beijing 100029, China
| | - Y Wang
- Beijing University of Traditional Chinese Medicine, School of Clinical Medicine (Sino-Japanese Friendship Hospital), Beijing 100029, China
| | - D Y Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital/National Center for Respiratory Medicine/Institute of Respiratory Medicine, Chinese Academy of Medical Sciences/National Clinical Research Center for Respiratory Diseases, Beijing 100029, China
| | - W Y Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital/National Center for Respiratory Medicine/Institute of Respiratory Medicine, Chinese Academy of Medical Sciences/National Clinical Research Center for Respiratory Diseases, Beijing 100029, China
| | - T R Dong
- Beijing University of Traditional Chinese Medicine, School of Clinical Medicine (Sino-Japanese Friendship Hospital), Beijing 100029, China
| | - C Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital/National Center for Respiratory Medicine/Institute of Respiratory Medicine, Chinese Academy of Medical Sciences/National Clinical Research Center for Respiratory Diseases, Beijing 100029, China Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
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18
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Belfiore A, Mastroianni F, Ventrella F, Errico M, Suppressa P, Tomai M, Sabatino S, De Palma G, Pappagallo F, Erbi A, Simone O, Longo S, Vendemiale G, Balsamo M, Tartaglia I, Guida P. Epidemiology of sepsis in Internal Medicine Units of Apulia: results of SEMINA (SEpsis Management in INternal medicine Apulia) study. Ann Ig 2023; 35:282-296. [PMID: 35861690 DOI: 10.7416/ai.2022.2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Background The prevalence and mortality of sepsis in Internal Medicine Units (IMUs) is poorly understood as most of the data derive from studies conducted in Intensive Care Units. Aim of SEpsis Management in INternal medicine Apulia (SEMINA) study was to determine the prevalence of sepsis and the characteristics and outcomes of patients with Sepsis-3 criteria admitted in Apulia's Internal Medicine Units for over six months. Methods The SEpsis Management in INternal medicine of Apulia study was a prospective, multicentre, observational study. Adult admissions to the 13 Apulia Region's Internal Medicine Units between November 15, 2018 and May 15, 2019 were screened for sepsis according to the Sepsis-3 criteria. Medical data were collected in electronic case report form. Results Out of 7,885 adult patients of the Internal Medicine Units, 359 (4.55%) fulfilled the inclusion criteria, and 65 of them (18.1%) met the septic shock criteria. The patients enrolled were elderly, suffering from chronic poly-pathologies and from cognitive and functional impairment. The respiratory system was the most common site of infection and the most common pathogens isolated from blood cultures were Staphylococcus spp., E. coli, Klebsiella spp., Enterococcus spp. and Acinetobacter spp. The in-hospital fatality rate was 31.2% and was significantly higher for septic shock. Sequential Organ Failure Assessment score, dementia and infections from Acinetobacter spp. were independent risk factors for mortality. Conclusions A high prevalence of sepsis and a high fatality rate were detected in Apulia Region's Internal Medicine Units. The high fatality rate observed in our study could be related to the underlying diseases and to the vulnerability of elderly patients admitted to our Internal Medicine Units.
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Affiliation(s)
- A Belfiore
- Department of Biomedical Science and Human Oncology, Internal Medicine "A. Murri", University "Aldo Moro" of Bari, Italy
| | - F Mastroianni
- University Hospital F. Miulli, Geriatrics Unit, Acquaviva delle Fonti (BA), Italy
| | - F Ventrella
- Division of Internal Medicine, "G.Tatarella" Hospital, Cerignola (FG), Italy
| | - M Errico
- University Hospital F. Miulli, Internal Medicine, Acquaviva delle Fonti (BA), Italy
| | - P Suppressa
- Department of Internal Medicine and Rare Diseases Centre, Internal Medicine "C. Frugoni", University "Aldo Moro" of Bari, Italy
| | - M Tomai
- Division of Internal Medicine, "Di Venere" Hospital, Bari, Italy
| | - S Sabatino
- Division of Internal Medicine, "Di Venere" Hospital, Bari, Italy
| | - G De Palma
- Division of Internal Medicine "Don Tonino Bello" Hospital, Molfetta (BA), Italy
| | - F Pappagallo
- Division of Internal Medicine, "G.Tatarella" Hospital, Cerignola (FG), Italy
| | - A Erbi
- Division of Internal Medicine "SS Annunziata" Hospital, Taranto, Italy
| | - O Simone
- Division of Internal Medicine "San Pio" Hospital, Castellaneta (TA), Italy
| | - S Longo
- Department of Biomedical Science and Human Oncology, Internal Medicine "G. Baccelli", University "Aldo Moro" of Bari, Italy
| | - G Vendemiale
- Internal Medicine Department, University of Foggia, Italy
| | - M Balsamo
- Division of Internal Medicine, "San Camillo De Lellis" Hospital, Manfredonia (FG), Italy
| | - I Tartaglia
- Division of Internal Medicine, "A. Perrino" Hospital, Brindisi, Italy
| | - P Guida
- University Hospital F. Miulli , Clinical Trials Office, Acquaviva delle Fonti (BA), Italy
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19
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Solomon MD, Escobar GJ, Lu Y, Schlessinger D, Steinman JB, Steinman L, Lee C, Liu VX. Risk of severe COVID-19 infection among adults with prior exposure to children. Proc Natl Acad Sci U S A 2022; 119:e2204141119. [PMID: 35895714 PMCID: PMC9388132 DOI: 10.1073/pnas.2204141119] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022] Open
Abstract
Susceptibility and severity of COVID-19 infection vary widely. Prior exposure to endemic coronaviruses, common in young children, may protect against SARS-CoV-2. We evaluated risk of severe COVID-19 among adults with and without exposure to young children in a large, integrated healthcare system. Adults with children 0-5 years were matched 1:1 to adults with children 6-11 years, 12-18 years, and those without children based upon a COVID-19 propensity score and risk factors for severe COVID-19. COVID-19 infections, hospitalizations, and need for intensive care unit (ICU) were assessed in 3,126,427 adults, of whom 24% (N = 743,814) had children 18 years or younger, and 8.8% (N = 274,316) had a youngest child 0-5 years. After 1:1 matching, propensity for COVID-19 infection and risk factors for severe COVID-19 were well balanced between groups. Rates of COVID-19 infection were slightly higher for adults with exposure to older children (incident risk ratio, 1.09, 95% confidence interval, [1.05-1.12] and IRR 1.09 [1.05-1.13] for adults with children 6-11 and 12-18, respectively), compared to those with children 0-5 years, although no difference in rates of COVID-19 illness requiring hospitalization or ICU admission was observed. However, adults without exposure to children had lower rates of COVID-19 infection (IRR 0.85, [0.83-0.87]) but significantly higher rates of COVID-19 hospitalization (IRR 1.49, [1.29-1.73]) and hospitalization requiring ICU admission (IRR 1.76, [1.19-2.58]) compared to those with children aged 0-5. In a large, real-world population, exposure to young children was associated with less severe COVID-19 illness. Endemic coronavirus cross-immunity may play a role in protection against severe COVID-19.
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Affiliation(s)
- Matthew D. Solomon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612
- Department of Cardiology, Kaiser Oakland Medical Center, Oakland, CA 94611
| | - Gabriel J. Escobar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612
| | - Yun Lu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612
| | - David Schlessinger
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612
| | | | - Lawrence Steinman
- Department of Pediatrics, Stanford University, Stanford, CA 94305
- Department of Neurology, Stanford University, Stanford, CA 94305
- Department of Neurological Sciences, Stanford University, Stanford, CA 94305
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612
| | - Vincent X. Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612
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20
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Safaei N, Safaei B, Seyedekrami S, Talafidaryani M, Masoud A, Wang S, Li Q, Moqri M. E-CatBoost: An efficient machine learning framework for predicting ICU mortality using the eICU Collaborative Research Database. PLoS One 2022; 17:e0262895. [PMID: 35511882 PMCID: PMC9070907 DOI: 10.1371/journal.pone.0262895] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 01/09/2022] [Indexed: 11/19/2022] Open
Abstract
Improving the Intensive Care Unit (ICU) management network and building cost-effective and well-managed healthcare systems are high priorities for healthcare units. Creating accurate and explainable mortality prediction models helps identify the most critical risk factors in the patients' survival/death status and early detect the most in-need patients. This study proposes a highly accurate and efficient machine learning model for predicting ICU mortality status upon discharge using the information available during the first 24 hours of admission. The most important features in mortality prediction are identified, and the effects of changing each feature on the prediction are studied. We used supervised machine learning models and illness severity scoring systems to benchmark the mortality prediction. We also implemented a combination of SHAP, LIME, partial dependence, and individual conditional expectation plots to explain the predictions made by the best-performing model (CatBoost). We proposed E-CatBoost, an optimized and efficient patient mortality prediction model, which can accurately predict the patients' discharge status using only ten input features. We used eICU-CRD v2.0 to train and validate the models; the dataset contains information on over 200,000 ICU admissions. The patients were divided into twelve disease groups, and models were fitted and tuned for each group. The models' predictive performance was evaluated using the area under a receiver operating curve (AUROC). The AUROC scores were 0.86 [std:0.02] to 0.92 [std:0.02] for CatBoost and 0.83 [std:0.02] to 0.91 [std:0.03] for E-CatBoost models across the defined disease groups; if measured over the entire patient population, their AUROC scores were 7 to 18 and 2 to 12 percent higher than the baseline models, respectively. Based on SHAP explanations, we found age, heart rate, respiratory rate, blood urine nitrogen, and creatinine level as the most critical cross-disease features in mortality predictions.
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Affiliation(s)
- Nima Safaei
- Department of Business Analytics and Information Systems, Tippie College of Business, University of Iowa, Iowa City, IA, United States of America
| | - Babak Safaei
- Civil and Environmental Engineering Department, Michigan State University, East Lansing, MI, United States of America
| | - Seyedhouman Seyedekrami
- Department of Computer Science and Engineering, University of Nevada, Reno, NV, United States of America
| | | | - Arezoo Masoud
- Department of Business Analytics and Information Systems, Tippie College of Business, University of Iowa, Iowa City, IA, United States of America
| | - Shaodong Wang
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, United States of America
| | - Qing Li
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, United States of America
| | - Mahdi Moqri
- Department of Information Systems and Business Analytics, Ivy College of Business, Iowa State University, Ames, IA, United States of America
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21
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Chaiwat O, Sathitkarnmanee B, Dajpratham P, Thanakiattiwibun C, Jarungjitaree S, Rattanamung S. The impact of physical medicine and rehabilitation consultation on clinical outcomes in the surgical intensive care unit: A prospective observational cohort study. Medicine (Baltimore) 2022; 101:e28990. [PMID: 35244073 PMCID: PMC8896451 DOI: 10.1097/md.0000000000028990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 02/14/2022] [Indexed: 01/04/2023] Open
Abstract
The impact of a physical medicine and rehabilitation (PM&R) consultation on clinical outcomes in critically ill surgical patients remains unclear. The aim of this study is to examine whether the patients who received PM&R consultation will demonstrate better clinical outcomes in terms of the differences in clinical outcomes including muscle mass and strength, intensive care unit (ICU) length of stay (LOS) and functional outcomes between the PM&R consultation and no PM&R consultation and between early PM&R consultation and late PM&R consultation in critically ill surgical patients.A prospective observational cohort study was undergone in 65-year-old or older patients who were admitted > 24 hours in the surgical intensive care unit (SICU) in a tertiary care hospital. Data collection included patients' characteristic, muscle mass and muscle strength, and clinical outcomes.Ninety surgical patients were enrolled and PM&R was consulted in 37 patients (36.7%). There was no significant difference in muscle mass and function between consulted and no consulted groups. PM&R consulted group showed worse in clinical outcomes including functional outcomes at hospital discharge, longer duration of mechanical ventilation, ICU, and hospital LOS as compared with no PM&R consulted group. The median time of rehabilitation consultation was 6 days and there were no significant differences in clinical outcomes between early (≤ 6 days) and late (> 6 days) consultation.PM&R consultation did not improve muscle mass, functional outcomes at hospital discharge, and ICU LOS in critically ill surgical patients. The key to success might include the PM&R consultation with both intensified physical therapy and early start of mobilization or the rigid mobilization protocol.
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Affiliation(s)
- Onuma Chaiwat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Benjaporn Sathitkarnmanee
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piyapat Dajpratham
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chayanan Thanakiattiwibun
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sunit Jarungjitaree
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suchera Rattanamung
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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22
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Abstract
We aimed to determine the parameters that affect mortality in pulmonary intensive care units that are faster and inexpensive to determine than existing scoring systems. The relationship between serum osmolarity and prognosis was demonstrated for predialysis patients, in acute pulmonary embolism, heart failure, acute coronary syndrome, myocardial infarction, and acute spontaneous intracerebral hemorrhage in the literature. We hypothesized that serum osmolarity, which is routinely evaluated, may have prognostic significance in patients with respiratory failure.This study comprised 449 patients treated in the Pulmonary Intensive Care Clinic (PICU) of our hospital between January 1, 2020, and December 31, 2020. The modified Charlson Comorbidity Index (mCCI), Acute Physiology and Chronic Health Assessment (APACHE II), Sequential Organ Failure Evaluation Score (SOFA), Nutrition Risk Screening 2002 (NRS-2002), and hospitalization serum osmolarity levels were measured.Of the 449 patients included in the study, 65% (n = 292) were female and the mean age of all patients was 69.86 ± 1.72 years. About 83.1% (n = 373) of the patients included in the study were discharged with good recovery. About 4.9% (n = 22) were transferred to the ward because their intensive care needs were over. About 6.9% (n = 31) were transferred to the tertiary intensive care unit after their status deteriorated. About 5.1% (n = 23) died in the PICU. In the mortality group, APACHE II (P = .005), mCCI (P < .001), NRS-2002 total score (P < .001), and SOFA score (P < .001) were significantly higher. There was no statistically significant difference between the groups in terms of serum osmolarity levels.Although we could not determine serum osmolarity as a practical method to predict patient prognosis in this study, we assume that our results will guide future studies on this subject.
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Affiliation(s)
- Deniz Çelik
- Alanya Alaaddin Keykubat University, Faculty of Medicine, Department of Pulmonology, Alanya, Antalya, Turkey
| | - Murat Yildiz
- University of Health Sciences Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of Pulmonology, Ankara, Turkey
| | - Ayşe Çifci
- University of Health Sciences Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of Pulmonology, Ankara, Turkey
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23
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Shah KB, Saado J, Kerwin M, Mazimba S, Kwon Y, Mangrum JM, Salerno M, Haines DE, Mehta NK. Meta-Analysis of New-Onset Atrial Fibrillation Versus No History of Atrial Fibrillation in Patients With Noncardiac Critical Care Illness. Am J Cardiol 2022; 164:57-63. [PMID: 34815061 DOI: 10.1016/j.amjcard.2021.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022]
Abstract
The incidence of new-onset secondary atrial fibrillation (NOSAF) is as high as 44% in noncardiac critical illness. A systematic review and meta-analysis were performed to evaluate the impact of NOSAF, compared with history of prior atrial fibrillation (AF) and no history of AF in noncardiac critically ill patients. Patients undergoing cardiothoracic surgery were excluded. NOSAF incidence, intensive care unit (ICU)/hospital length of stay (LOS), and mortality outcomes were analyzed. Of 2,360 studies reviewed, 19 studies met inclusion criteria (n = 306,805 patients). NOSAF compared with no history of AF was associated with increased in-hospital mortality (risk ratio [RR] 2.06, 95% confidence interval [CI] 1.76 to 2.41, p <0.001), longer ICU LOS (standardized difference in means [SMD] 0.66, 95% CI 0.41 to 0.91, p <0.001), longer hospital LOS (SMD 0.31, 95% CI 0.07 to 0.56, p = 0.001) and increased risk of long-term (>1 year) mortality (RR 1.76, 95% CI 1.29 to 2.40, p <0.001). NOSAF compared with previous AF was also associated with higher in-hospital mortality (RR 1.29, 95% CI 1.12 to 1.49, p <0.001), longer ICU LOS (SMD 0.37, 95% CI 0.03 to 0.70, p = 0.03) but no difference in-hospital LOS (SMD -0.18, 95% CI -0.66 to 0.31, p = 0.47). In conclusion, NOSAF, in the setting of noncardiac critical illness is associated with increased in-hospital mortality compared with no history of AF and previous AF. NOSAF (vs no history of AF) is also associated with increased long-term mortality.
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Affiliation(s)
- Kuldeep B Shah
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
| | - Jonathan Saado
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia.
| | - Matthew Kerwin
- Department of Internal Medicine, University of Virginia, Charlottesville, Virginia.
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.
| | - Younghoon Kwon
- Division of Cardiovascular Medicine and Critical care medicine, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington.
| | - James Michael Mangrum
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.
| | - Michael Salerno
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.
| | - David E Haines
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
| | - Nishaki K Mehta
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.
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24
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Torres‐Torres J, Espino‐y‐Sosa S, Poon LC, Solis‐Paredes JM, Estrada‐Gutierrez G, Espejel‐Nuñez A, Juarez‐Reyes A, Etchegaray‐Solana A, Alfonso‐Guillen Y, Aguilar‐Andrade L, Hernández‐Pacheco JA, Villafan‐Bernal JR, Martinez‐Portilla RJ. Increased levels of soluble fms-like tyrosine kinase-1 are associated with adverse outcome in pregnant women with COVID-19. Ultrasound Obstet Gynecol 2022; 59:202-208. [PMID: 34664753 PMCID: PMC8661924 DOI: 10.1002/uog.24798] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 06/02/2023]
Abstract
OBJECTIVE In addition to the lungs, the placenta and the endothelium can be affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are markers of endothelial dysfunction and could potentially serve as predictors of severe coronavirus disease 2019 (COVID-19). We aimed to investigate the association of serum concentrations of sFlt-1 and PlGF with the severity of COVID-19 in pregnancy. METHODS This was a prospective cohort study carried out in a tertiary care hospital in Mexico City, Mexico. Symptomatic pregnant women with a positive reverse-transcription quantitative polymerase chain reaction test for SARS-CoV-2 infection who fulfilled the criteria for hospitalization were included. The primary outcome was severe pneumonia due to COVID-19. Secondary outcomes were intensive care unit (ICU) admission, viral sepsis and maternal death. sFlt-1 levels were expressed as multiples of the median (MoM). The association between sFlt-1 and each adverse outcome was explored by logistic regression analysis, adjusted for gestational age for outcomes occurring in more than five patients, and the predictive performance was assessed by receiver-operating-characteristics-curve analysis. RESULTS Among 113 pregnant women with COVID-19, higher sFlt-1 MoM was associated with an increased probability of severe pneumonia (adjusted odds ratio (aOR), 1.817 (95% CI, 1.365-2.418)), ICU admission (aOR, 2.195 (95% CI, 1.582-3.047)), viral sepsis (aOR, 2.318 (95% CI, 1.407-3.820)) and maternal death (unadjusted OR, 5.504 (95% CI, 1.079-28.076)). At a 10% false-positive rate, sFlt-1 MoM had detection rates of 45.2%, 66.7%, 83.3% and 100% for severe COVID-19 pneumonia, ICU admission, viral sepsis and maternal death, respectively. PlGF values were similar between women with severe and those with non-severe COVID-19 pneumonia. CONCLUSION sFlt-1 MoM is higher in pregnant women with severe COVID-19 and has the capability to predict serious adverse pregnancy events, such as severe pneumonia, ICU admission, viral sepsis and maternal death. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J. Torres‐Torres
- Maternal–Fetal Medicine Department, General Hospital of Mexico, ‘Dr Eduardo Liceaga’Mexico CityMexico
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
- ABC Medical Center, Medical AssociationMexico CityMexico
| | - S. Espino‐y‐Sosa
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
- ABC Medical Center, Medical AssociationMexico CityMexico
| | - L. C. Poon
- Chinese University of Hong KongHong Kong SAR
| | | | | | - A. Espejel‐Nuñez
- Immunobiochemistry DepartmentNational Institute of PerinatologyMexico CityMexico
| | - A. Juarez‐Reyes
- Maternal–Fetal Medicine Department, General Hospital of Mexico, ‘Dr Eduardo Liceaga’Mexico CityMexico
| | - A. Etchegaray‐Solana
- Maternal–Fetal Medicine Department, General Hospital of Mexico, ‘Dr Eduardo Liceaga’Mexico CityMexico
| | - Y. Alfonso‐Guillen
- Maternal–Fetal Medicine Department, General Hospital of Mexico, ‘Dr Eduardo Liceaga’Mexico CityMexico
| | - L. Aguilar‐Andrade
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
| | | | | | - R. J. Martinez‐Portilla
- Clinical Research BranchNational Institute of PerinatologyMexico CityMexico
- ABC Medical Center, Medical AssociationMexico CityMexico
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25
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Choi C, Choi DH, Spears GM, Peeraphatdit TB, Serafim LP, Gajic O, Kamath PS, Shah VH, Gallo de Moraes A, Simonetto DA. Relationship Between Etiology of Cirrhosis and Survival Among Patients Hospitalized in Intensive Care Units. Mayo Clin Proc 2022; 97:274-284. [PMID: 35090753 PMCID: PMC8883528 DOI: 10.1016/j.mayocp.2021.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/25/2021] [Accepted: 08/06/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine short-term outcomes of patients with alcohol-associated cirrhosis (ALC) admitted to the intensive care unit (ICU) compared with other etiologies of liver disease. In addition, we investigate whether quick sequential organ failure assessment accurately predicts presence of sepsis and in-hospital mortality in critically ill patients with various etiologies of cirrhosis. METHODS A retrospective cohort of 1174 consecutive patients with cirrhosis admitted to the ICU between January of 2006 and December of 2015 was analyzed. Outcomes of interest included survival rates within the ICU, post-ICU in-hospital, or at 30 days post-ICU discharge. RESULTS Five hundred seventy-eight patients were found to have ALC with 596 in the non-ALC group. There was no significant difference in ICU mortality rates in ALC versus non-ALC cohorts (10.2% vs 11.7%, P=.40). However, patients with ALC had significantly higher post-ICU in-hospital death (10.0% vs 6.5%, P=.04) as well as higher mortality at 30-day post-ICU discharge (18.7% vs 11.2%, P<.001). Sustained alcohol abstinence did not offer survival advantage over nonabstinence. The predictive power for quick sequential organ failure assessment for sepsis and in-hospital mortality for patients with cirrhosis was limited. CONCLUSION Critically ill patients with ALC have decreased survival after ICU discharge compared with patients with other etiologies of cirrhosis, independent of alcohol abstinence.
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Affiliation(s)
- Chansong Choi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Dae Hee Choi
- Department of Internal Medicine, School of Medicine, Kangwon National University, Republic of Korea
| | - Grant M Spears
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Thoetchai Bee Peeraphatdit
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Laura Piccolo Serafim
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN
| | - Ognjen Gajic
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Vijay H Shah
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Alice Gallo de Moraes
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN
| | - Douglas A Simonetto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
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Ludbrook GL, Leaman E. Cost-Effectiveness in Perioperative Care: Application of Markov Modeling to Pathways of Perioperative Care. Value Health 2022; 25:215-221. [PMID: 35094794 DOI: 10.1016/j.jval.2021.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/23/2021] [Accepted: 07/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to evaluate the application of cost-effectiveness modeling to redesign of perioperative care pathways, from a hospital perspective. METHODS A Markov cost-effectiveness model of patient transition between care locations, each with different characteristics and cost, was developed. Inputs were derived from clinical trials piloting a preoperative call center and a postoperative medium-acuity care unit. The effect chosen was days at home (DAH) after surgery, reflecting quality of in-hospital care, acknowledged financially by fundholders, and relevant to consumers. Cost was from the hospital's perspective. A model cycle time of 4 hours for 30 days reflected relevant timelines and costs. RESULTS A Markov model was successfully created, accounting for the care locations in the 2 pathways as model states and accounting for consequences and costs. Cost-effectiveness analysis allowed the calculation of an incremental cost-effectiveness ratio comparing these pathways, providing a mean incremental cost-effectiveness ratio of -$427 per additional DAH, where incremental costs and DAH were -$644 and +1.51, respectively. Probabilistic sensitivity analysis suggested the new pathway had a 61% probability of reduced costs and a 74% probability of increased DAH and a 58% probability this pathway was dominant. Tornado analysis revealed the major contributor to increased costs as intensive care unit stay and the major contributor to decreased costs as ward stay. For the new pathway, the probability of transfer from ward to home and the probability of staying at home had the greatest impact on DAH. CONCLUSIONS These data suggest Markov modeling may be a useful tool for the cost-effectiveness analysis of initiatives in perioperative care.
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Affiliation(s)
- Guy L Ludbrook
- Department of Anaesthesia, Royal Adelaide Hospital and Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia.
| | - Esrom Leaman
- Department of Anaesthesia, Royal Adelaide Hospital and Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Juschten J, Bos LDJ, de Grooth HJ, Beuers U, Girbes ARJ, Juffermans NP, Loer SA, van der Poll T, Cremer OL, Bonten MJM, Schultz MJ, Tuinman PR. Incidence, Clinical Characteristics and Outcomes of Early Hyperbilirubinemia in Critically Ill Patients: Insights From the MARS Study. Shock 2022; 57:161-167. [PMID: 34238904 PMCID: PMC8757589 DOI: 10.1097/shk.0000000000001836] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/19/2021] [Accepted: 06/29/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the incidence, clinical characteristics and outcomes of early hyperbilirubinemia in critically ill patients. DESIGN AND SETTING This is a post hoc analysis of a prospective multicenter cohort study. PATIENTS Patients with measured bilirubin levels within the first 2 days after ICU admission were eligible. Patients with liver cirrhosis were excluded. ENDPOINTS The primary endpoint was the incidence of early hyperbilirubinemia, defined as bilirubin ≥33 μmol/L within 2 days after ICU admission. Secondary endpoints included clinical characteristics of patients with versus patients without early hyperbilirubinemia, and outcomes up to day 30. RESULTS Of 4,836 patients, 559 (11.6%) patients had early hyperbilirubinemia. Compared to patients without early hyperbilirubinemia, patients with early hyperbilirubinemia presented with higher severity of illness scores, and higher incidences of sepsis and organ failure. After adjustment for confounding variables, early hyperbilirubinemia remained associated with mortality at day 30 (odds ratio, 1.31 [95%-confidence interval 1.06-1.60]; P = 0.018). Patients with early hyperbilirubinemia and thrombocytopenia (interaction P-value = 0.005) had a higher likelihood of death within 30 days (odds ratio, 2.61 [95%-confidence interval 2.08-3.27]; P < 0.001) than patients with early hyperbilirubinemia and a normal platelet count (odds ratio, 1.09 [95%-confidence interval 0.75-1.55]; P = 0.655). CONCLUSIONS Early hyperbilirubinemia occurs frequently in the critically ill, and these patients present with higher disease severity and more often with sepsis and organ failures. Early hyperbilirubinemia has an association with mortality, albeit this association was only found in patients with concomitant thrombocytopenia.
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Affiliation(s)
- Jenny Juschten
- Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Intensive Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe D. J. Bos
- Department of Intensive Care, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Department of Pulmonology, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Harm-Jan de Grooth
- Department of Intensive Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Armand R. J. Girbes
- Department of Intensive Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nicole P. Juffermans
- Department of Intensive Care Medicine, OLVG Hospital, Amsterdam, The Netherlands
| | - Stephan A. Loer
- Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tom van der Poll
- Division of Infectious Diseases, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Olaf L. Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc J. M. Bonten
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Pieter Roel Tuinman
- Department of Intensive Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Prescott BR, Saglam H, Duskin JA, Miller MI, Thakur AS, Gholap EA, Hutch MR, Smirnakis SM, Zafar SF, Dupuis J, Benjamin EJ, Greer DM, Ong CJ. Anisocoria and Poor Pupil Reactivity by Quantitative Pupillometry in Patients With Intracranial Pathology. Crit Care Med 2022; 50:e143-e153. [PMID: 34637415 PMCID: PMC8810747 DOI: 10.1097/ccm.0000000000005272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To describe the prevalence and associated risk factors of new onset anisocoria (new pupil size difference of at least 1 mm) and its subtypes: new onset anisocoria accompanied by abnormal and normal pupil reactivities in patients with acute neurologic injuries. DESIGN We tested the association of patients who experienced new onset anisocoria subtypes with degree of midline shift using linear regression. We further explored differences between quantitative pupil characteristics associated with first-time new onset anisocoria and nonnew onset anisocoria at preceding observations using mixed effects logistic regression, adjusting for possible confounders. SETTING All quantitative pupil observations were collected at two neuro-ICUs by nursing staff as standard of care. PATIENTS We conducted a retrospective two-center study of adult patients with intracranial pathology in the ICU with at least a 24-hour stay and three or more quantitative pupil measurements between 2016 and 2018. MEASUREMENTS AND MAIN RESULTS We studied 221 patients (mean age 58, 41% women). Sixty-three percent experienced new onset anisocoria. New onset anisocoria accompanied by objective evidence of abnormal pupil reactivity occurring at any point during hospitalization was significantly associated with maximum midline shift (β = 2.27 per mm; p = 0.01). The occurrence of new onset anisocoria accompanied by objective evidence of normal pupil reactivity was inversely associated with death (odds ratio, 0.34; 95% CI, 0.16-0.71; p = 0.01) in adjusted analyses. Subclinical continuous pupil size difference distinguished first-time new onset anisocoria from nonnew onset anisocoria in up to four preceding pupil observations (or up to 8 hr prior). Minimum pupil reactivity between eyes also distinguished new onset anisocoria accompanied by objective evidence of abnormal pupil reactivity from new onset anisocoria accompanied by objective evidence of normal pupil reactivity prior to first-time new onset anisocoria occurrence. CONCLUSIONS New onset anisocoria occurs in over 60% of patients with neurologic emergencies. Pupil reactivity may be an important distinguishing characteristic of clinically relevant new onset anisocoria phenotypes. New onset anisocoria accompanied by objective evidence of abnormal pupil reactivity was associated with midline shift, and new onset anisocoria accompanied by objective evidence of normal pupil reactivity had an inverse relationship with death. Distinct quantitative pupil characteristics precede new onset anisocoria occurrence and may allow for earlier prediction of neurologic decline. Further work is needed to determine whether quantitative pupillometry sensitively/specifically predicts clinically relevant anisocoria, enabling possible earlier treatments.
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Affiliation(s)
- Brenton R. Prescott
- Boston Medical Center, 1 Boston Medical Center Pl, Boston, MA 02118
- Boston University School of Medicine, 72 E Concord St, Boston, MA 02118
- Brigham & Women’s Hospital, 75 Francis St, Boston, MA 02115
| | - Hanife Saglam
- Brigham & Women’s Hospital, 75 Francis St, Boston, MA 02115
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115
| | - Jonathan A. Duskin
- Brigham & Women’s Hospital, 75 Francis St, Boston, MA 02115
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Matthew I. Miller
- Boston University School of Medicine, 72 E Concord St, Boston, MA 02118
| | - Arnav S. Thakur
- Boston Medical Center, 1 Boston Medical Center Pl, Boston, MA 02118
| | - Eesha A. Gholap
- Boston University School of Medicine, 72 E Concord St, Boston, MA 02118
| | | | - Stelios M. Smirnakis
- Brigham & Women’s Hospital, 75 Francis St, Boston, MA 02115
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115
| | - Sahar F. Zafar
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Josée Dupuis
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118
| | - Emelia J. Benjamin
- Boston Medical Center, 1 Boston Medical Center Pl, Boston, MA 02118
- Boston University School of Medicine, 72 E Concord St, Boston, MA 02118
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118
| | - David M. Greer
- Boston Medical Center, 1 Boston Medical Center Pl, Boston, MA 02118
- Boston University School of Medicine, 72 E Concord St, Boston, MA 02118
| | - Charlene J. Ong
- Boston Medical Center, 1 Boston Medical Center Pl, Boston, MA 02118
- Boston University School of Medicine, 72 E Concord St, Boston, MA 02118
- Brigham & Women’s Hospital, 75 Francis St, Boston, MA 02115
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115
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Paetzold J, Kimpel J, Bates K, Hummer M, Krammer F, von Laer D, Winner H. Impacts of rapid mass vaccination against SARS-CoV2 in an early variant of concern hotspot. Nat Commun 2022; 13:612. [PMID: 35105889 PMCID: PMC8807735 DOI: 10.1038/s41467-022-28233-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022] Open
Abstract
We study the real-life effect of an unprecedented rapid mass vaccination campaign. Following a large outbreak of the Beta variant in the district of Schwaz/Austria, 100,000 doses of BNT162b2 (Pfizer/BioNTech) were procured to mass vaccinate the entire adult population of the district between the 11th and 16th of March 2021. This made the district the first widely inoculated region in Europe. We examine the effect of this campaign on the number of infections, cases of variants of concern, hospital and ICU admissions. We compare Schwaz with (i) a control group of highly similar districts, and (ii) with populations residing in municipalities along the border of Schwaz which were just excluded from the campaign. We find large and significant decreases for all outcomes after the campaign. Our results suggest that rapid mass vaccination is an effective tool to curb the spread of SARS-CoV-2.
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Affiliation(s)
- Jörg Paetzold
- University of Salzburg, Department of Economics, Residenzplatz 9, A-5010, Salzburg, Austria.
| | - Janine Kimpel
- Institute of Virology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Peter-Mayr-Str. 4b, 6020, Innsbruck, Austria
| | - Katie Bates
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Hummer
- The Austrian National Public Health Institute (Gesundheit Österreich GmbH, GÖG), Stubenring 6, 1010, Vienna, Austria
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1124, New York, NY, 10029, USA
| | - Dorothee von Laer
- Institute of Virology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Peter-Mayr-Str. 4b, 6020, Innsbruck, Austria
| | - Hannes Winner
- University of Salzburg, Department of Economics, Residenzplatz 9, A-5010, Salzburg, Austria
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Hobohm L, Sagoschen I, Barco S, Schmidtmann I, Espinola-Klein C, Konstantinides S, Münzel T, Keller K. Trends and Risk Factors of In-Hospital Mortality of Patients with COVID-19 in Germany: Results of a Large Nationwide Inpatient Sample. Viruses 2022; 14:v14020275. [PMID: 35215869 PMCID: PMC8880622 DOI: 10.3390/v14020275] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 01/27/2023] Open
Abstract
Unselected data of nationwide studies of hospitalized patients with COVID-19 are still sparse, but these data are of outstanding interest to avoid exceeding hospital capacities and overloading national healthcare systems. Thus, we sought to analyze seasonal/regional trends, predictors of in-hospital case-fatality, and mechanical ventilation (MV) in patients with COVID-19 in Germany. We used the German nationwide inpatient samples to analyze all hospitalized patients with a confirmed COVID-19 diagnosis in Germany between 1 January and 31 December in 2020. We analyzed data of 176,137 hospitalizations of patients with confirmed COVID-19-infection. Among those, 31,607 (17.9%) died, whereby in-hospital case-fatality grew exponentially with age. Overall, age ≥ 70 years (OR 5.91, 95%CI 5.70–6.13, p < 0.001), pneumonia (OR 4.58, 95%CI 4.42–4.74, p < 0.001) and acute respiratory distress syndrome (OR 8.51, 95%CI 8.12–8.92, p < 0.001) were strong predictors of in-hospital death. Most COVID-19 patients were treated in hospitals in urban areas (n = 92,971) associated with the lowest case-fatality (17.5%), as compared to hospitals in suburban (18.3%) or rural areas (18.8%). MV demand was highest in November/December 2020 (32.3%, 20.3%) in patients between the 6th and 8th age decade. In the first age decade, 78 of 1861 children (4.2%) with COVID-19-infection were treated with MV, and five of them died (0.3%). The results of our study indicate seasonal and regional variations concerning the number of COVID-19 patients, necessity of MV, and case fatality in Germany. These findings may help to ensure the flexible allocation of intensive care (human) resources, which is essential for managing enormous societal challenges worldwide to avoid overloaded regional healthcare systems.
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Affiliation(s)
- Lukas Hobohm
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
| | - Ingo Sagoschen
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
| | - Stefano Barco
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
- Department of Angiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, 67100 Alexandroupolis, Greece
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Karsten Keller
- Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
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Oh S, Kim JH, Cho KH, Kim MC, Sim DS, Hong YJ, Ahn Y, Jeong MH. Clinical impact of pulmonary hypertension on the outcomes of acute myocardial infarction patients with or without chronic obstructive pulmonary disease. Medicine (Baltimore) 2022; 101:e28627. [PMID: 35060541 PMCID: PMC8772642 DOI: 10.1097/md.0000000000028627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/02/2022] [Indexed: 01/05/2023] Open
Abstract
Acute myocardial infarction (AMI) and chronic obstructive pulmonary disease (COPD) are leading global causes of morbidity and mortality. In patients with both of these conditions, the presence of pulmonary hypertension (PH) can further worsen their prognosis. We examined the outcomes of AMI patients with COPD (AMI+COPD) and without COPD (AMI-COPD), depending on the presence or absence of PH.A total of 318 AMI patients with COPD (AMI+COPD cohort) (n = 109) or without COPD (AMI-COPD cohort) (n = 209) were included in this study and were subdivided into 2 groups according to right ventricular systolic pressure (RVSP) level (PH group [RVSP ≥35 mm Hg] and no PH group [RVSP <35 mm Hg]).We investigated characteristics and clinical outcomes in both the AMI-COPD and AMI+COPD cohorts. When investigating in-hospital clinical outcomes, the PH group had a higher proportion of new-onset heart failure (HF) in both cohorts. In the AMI+COPD cohort, however, the PH group had a higher incidence of cardiogenic shock than the no PH group, which was consistent with the result of the post-inverse probability of treatment weighting (IPTW) analysis. When investigating 1-year clinical outcomes, the PH group had higher incidences of a major adverse cardiac event and all-cause mortality in both cohorts. This finding was mainly driven by cardiac death in the AMI-COPD cohort, whereas it was mainly driven by non-cardiac death in the AMI+COPD cohort. After IPTW adjustment, these differences were statistically attenuated such that all variables were similar between both groups.PH may be associated with the development of new-onset HF (in all patients) and cardiogenic shock (in the AMI+COPD cohort). In addition, PH may be also associated with all-cause mortality, although it was statistically attenuated after IPTW adjustment.
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Osuagwu UL, Xu M, Piya MK, Agho KE, Simmons D. Factors associated with long intensive care unit (ICU) admission among inpatients with and without diabetes in South Western Sydney public hospitals using the New South Wales admission patient data collection (2014-2017). BMC Endocr Disord 2022; 22:27. [PMID: 35057791 PMCID: PMC8781508 DOI: 10.1186/s12902-022-00933-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Long stay in intensive care unit (ICU) is associated with poor outcomes, particularly in people with diabetes. It increases the financial burden of care and this is a challenge to the South Western Sydney region, which is already a hotspot for diabetes in Australia. This study compared ICU admission characteristics of people with and without diabetes and the factors associated with long ICU stay among patients admitted to public hospitals in this metropolitan health district from 2014 to 2017. METHODS Cross-sectional datasets on 187,660, including all ICU admissions in the New South Wales Admitted Patient Data Collection (APDC) from June 2014 - July 2017 in public hospital were extracted. Data on demographic and health insurance status, primary admission diagnosis using ICD-10, comorbidities including death among hospital inpatients aged ≥18 years residing in SWS were analysed. The ICU length of stay was the outcome variable and were classified into short stay (≤48 h) and long stay (> 48 h), and were examined against potential confounding factors using bivariate and multiple logistic regression analyses. RESULTS Our results showed higher ICU admissions in patients with diabetes than in those without diabetes (5% vs. 3.3%, P < 0.001) over three years. The median and interquartile range (IQR) of length of the ICU stay were similar in both groups [diabetes: 40 h, IQR = 16-88 h vs. non-diabetes: 43 h, IQR = 19-79 h]. The prevalence of long ICU stays among people with and without diabetes were 44.9% [95% CI 42.1, 47.7%] and 43.6% [95% CI 42.2, 44.9%], respectively. For both groups, increased odds of long ICU stay were associated with death and circulatory system disease admissions, while musculoskeletal disease admissions were associated with lower risk of long ICU stay. In the non-diabetes group, male sex, nervous system disease admissions and living in peri-urban areas were associated with higher odds of long ICU stay. CONCLUSIONS The rate of ICU admissions among inpatients remain higher in people with diabetes. One in every two admissions to ICU had a long stay. Additional care for those admitted with circulatory system diseases are needed to reduce long ICU stay related deaths in SWS.
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Affiliation(s)
- Uchechukwu L Osuagwu
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa.
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Matthew Xu
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Milan K Piya
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Macarthur Diabetes Service, Camden and Campbelltown Hospital, Campbelltown, NSW, 2560, Australia
| | - Kingsley E Agho
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - David Simmons
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Macarthur Diabetes Service, Camden and Campbelltown Hospital, Campbelltown, NSW, 2560, Australia
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Tsiklidis EJ, Sinno T, Diamond SL. Predicting risk for trauma patients using static and dynamic information from the MIMIC III database. PLoS One 2022; 17:e0262523. [PMID: 35045100 PMCID: PMC8769353 DOI: 10.1371/journal.pone.0262523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/28/2021] [Indexed: 11/19/2022] Open
Abstract
Risk quantification algorithms in the ICU can provide (1) an early alert to the clinician that a patient is at extreme risk and (2) help manage limited resources efficiently or remotely. With electronic health records, large data sets allow the training of predictive models to quantify patient risk. A gradient boosting classifier was trained to predict high-risk and low-risk trauma patients, where patients were labeled high-risk if they expired within the next 10 hours or within the last 10% of their ICU stay duration. The MIMIC-III database was filtered to extract 5,400 trauma patient records (526 non-survivors) each of which contained 5 static variables (age, gender, etc.) and 28 dynamic variables (e.g., vital signs and metabolic panel). Training data was also extracted from the dynamic variables using a 3-hour moving time window whereby each window was treated as a unique patient-time fragment. We extracted the mean, standard deviation, and skew from each of these 3-hour fragments and included them as inputs for training. Additionally, a survival metric upon admission was calculated for each patient using a previously developed National Trauma Data Bank (NTDB)-trained gradient booster model. The final model was able to distinguish between high-risk and low-risk patients to an AUROC of 92.9%, defined as the area under the receiver operator characteristic curve. Importantly, the dynamic survival probability plots for patients who die appear considerably different from those who survive, an example of reducing the high dimensionality of the patient record to a single trauma trajectory.
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Affiliation(s)
- Evan J. Tsiklidis
- Department of Chemical and Biomolecular Engineering, Institute for Medicine and Engineering, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Talid Sinno
- Department of Chemical and Biomolecular Engineering, Institute for Medicine and Engineering, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Scott L. Diamond
- Department of Chemical and Biomolecular Engineering, Institute for Medicine and Engineering, University of Pennsylvania, Philadelphia, PA, United States of America
- * E-mail:
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Saad Menezes MC, Santinelli Pestana DV, Ferreira JC, Ribeiro de Carvalho CR, Felix MC, Marcilio IO, da Silva KR, Junior VC, Marchini JF, Alencar JC, Gomez LMG, Mauá DD, Souza HP. Distinct Outcomes in COVID-19 Patients with Positive or Negative RT-PCR Test. Viruses 2022; 14:v14020175. [PMID: 35215772 PMCID: PMC8874612 DOI: 10.3390/v14020175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/08/2022] [Accepted: 01/15/2022] [Indexed: 02/01/2023] Open
Abstract
Identification of the SARS-CoV-2 virus by RT-PCR from a nasopharyngeal swab sample is a common test for diagnosing COVID-19. However, some patients present clinical, laboratorial, and radiological evidence of COVID-19 infection with negative RT-PCR result(s). Thus, we assessed whether positive results were associated with intubation and mortality. This study was conducted in a Brazilian tertiary hospital from March to August of 2020. All patients had clinical, laboratory, and radiological diagnosis of COVID-19. They were divided into two groups: positive (+) RT-PCR group, with 2292 participants, and negative (−) RT-PCR group, with 706 participants. Patients with negative RT-PCR testing and an alternative most probable diagnosis were excluded from the study. The RT-PCR(+) group presented increased risk of intensive care unit (ICU) admission, mechanical ventilation, length of hospital stay, and 28-day mortality, when compared to the RT-PCR(−) group. A positive SARS-CoV-2 RT-PCR result was independently associated with intubation and 28 day in-hospital mortality. Accordingly, we concluded that patients with a COVID-19 diagnosis based on clinical data, despite a negative RT-PCR test from nasopharyngeal samples, presented more favorable outcomes than patients with positive RT-PCR test(s).
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Affiliation(s)
- Maria Clara Saad Menezes
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
- Correspondence:
| | - Diego Vinicius Santinelli Pestana
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
| | - Juliana Carvalho Ferreira
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Carlos Roberto Ribeiro de Carvalho
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Marcelo Consorti Felix
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Izabel Oliva Marcilio
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Katia Regina da Silva
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Vilson Cobello Junior
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Julio Flavio Marchini
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Julio Cesar Alencar
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Luz Marina Gomez Gomez
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
| | - Denis Deratani Mauá
- Institute of Mathematics and Statistics, Universidade de São Paulo, São Paulo 05508-090, Brazil;
| | - Heraldo Possolo Souza
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
| | - Emergency USP COVID-19 Group
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
| | - HCFMUSP COVID-19 Study Group
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
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Hupert N, Marín-Hernández D, Gao B, Águas R, Nixon DF. Heterologous vaccination interventions to reduce pandemic morbidity and mortality: Modeling the US winter 2020 COVID-19 wave. Proc Natl Acad Sci U S A 2022; 119:e2025448119. [PMID: 35012976 PMCID: PMC8784160 DOI: 10.1073/pnas.2025448119] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/02/2021] [Indexed: 12/12/2022] Open
Abstract
COVID-19 remains a stark health threat worldwide, in part because of minimal levels of targeted vaccination outside high-income countries and highly transmissible variants causing infection in vaccinated individuals. Decades of theoretical and experimental data suggest that nonspecific effects of non-COVID-19 vaccines may help bolster population immunological resilience to new pathogens. These routine vaccinations can stimulate heterologous cross-protective effects, which modulate nontargeted infections. For example, immunization with Bacillus Calmette-Guérin, inactivated influenza vaccine, oral polio vaccine, and other vaccines have been associated with some protection from SARS-CoV-2 infection and amelioration of COVID-19 disease. If heterologous vaccine interventions (HVIs) are to be seriously considered by policy makers as bridging or boosting interventions in pandemic settings to augment nonpharmaceutical interventions and specific vaccination efforts, evidence is needed to determine their optimal implementation. Using the COVID-19 International Modeling Consortium mathematical model, we show that logistically realistic HVIs with low (5 to 15%) effectiveness could have reduced COVID-19 cases, hospitalization, and mortality in the United States fall/winter 2020 wave. Similar to other mass drug administration campaigns (e.g., for malaria), HVI impact is highly dependent on both age targeting and intervention timing in relation to incidence, with maximal benefit accruing from implementation across the widest age cohort when the pandemic reproduction number is >1.0. Optimal HVI logistics therefore differ from optimal rollout parameters for specific COVID-19 immunizations. These results may be generalizable beyond COVID-19 and the US to indicate how even minimally effective heterologous immunization campaigns could reduce the burden of future viral pandemics.
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Affiliation(s)
- Nathaniel Hupert
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065;
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY 10065
- Cornell Institute for Disease and Disaster Preparedness, Cornell University, New York, NY 10065
| | - Daniela Marín-Hernández
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY 10065
| | - Bo Gao
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Ricardo Águas
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Douglas F Nixon
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY 10065
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El Nekidy WS, Almuti K, ElRefaei H, Atallah B, Mohammad LM, AlMahmeed W, Badr M, Abdallah K, Hamed F, Mallat J. QT Prolongation in Critically Ill Patients With SARS-CoV-2 Infection. J Cardiovasc Pharmacol Ther 2022; 27:10742484211069479. [PMID: 35006023 DOI: 10.1177/10742484211069479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several reports linked the use of repurposed drugs such as hydroxychloroquine (HCQ), azithromycin, lopinavir/ritonavir, and favipiravir with QT interval prolongation in patients with SARS-CoV2 infection. Little is known about the risk factors for QT interval prolongation in this population. We sought to describe the prevalence and identify the main risk factors associated with clinically significant corrected QT (QTc) prolongation in this population. METHODS We conducted a retrospective analysis of critically ill patients who were admitted to our intensive care unit (ICU), had at least one electrocardiogram performed during their ICU stay, and tested positive for SARs-CoV-2. Clinically significant QTc interval prolongation was defined as QTc >500 milliseconds (ms). RESULTS Out of the 111 critically ill patients with SARS-CoV-2 infection, QTc was significantly prolonged in 47 cases (42.3%). Patients with a clinically significant QTc prolongation had significantly higher proportions of history of cardiac diseases/surgery (22 [46.8%] vs. 10 [15.6%], P < .001), hypokalemia (10 [21.3] vs. 5 [7.8%], P = .04), and male gender (95% vs. 82.8%, P = .036) than patients with QTc ≤500 ms, respectively. A total of 46 patients (41.4%) received HCQ, 28 (25.2%) received lopinavir/ritonavir, and 5 (4.5%) received azithromycin. Multivariate logistic regression analysis showed that a history of cardiac disease was the only independent factor associated with clinically significant QTc prolongation (P = .004 for the likelihood-ratio test). CONCLUSION The prevalence of clinically significant QTc prolongation in critically ill patients with SARS-CoV-2 infection was high and independent of drugs used. Larger prospective observational studies are warranted to elucidate independent risk factors associated with clinically significant QTc prolongation in this study population.
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Affiliation(s)
- Wasim S El Nekidy
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Khalid Almuti
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Hazem ElRefaei
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Bassam Atallah
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Lana M Mohammad
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Gulf Medical University, Ajman, United Arab Emirates
| | - Wael AlMahmeed
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mohamed Badr
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697West Hertfordshire NHS Trust, Watford, United Kingdom
| | - Khaled Abdallah
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - Fadi Hamed
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Jihad Mallat
- 284697Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- 284697Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Normandy University, Caen, France
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Barnato AE, Birkmeyer JD, Skinner JS, O'Malley AJ, Birkmeyer NJO. Treatment intensity and mortality among COVID-19 patients with dementia: A retrospective observational study. J Am Geriatr Soc 2022; 70:40-48. [PMID: 34480354 PMCID: PMC8742761 DOI: 10.1111/jgs.17463] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/26/2021] [Accepted: 08/15/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND We sought to determine whether dementia is associated with treatment intensity and mortality in patients hospitalized with COVID-19. METHODS This study includes review of the medical records for patients >60 years of age (n = 5394) hospitalized with COVID-19 from 132 community hospitals between March and June 2020. We examined the relationships between dementia and treatment intensity (including intensive care unit [ICU] admission and mechanical ventilation [MV] and care processes that may influence them, including advance care planning [ACP] billing and do-not-resuscitate [DNR] orders) and in-hospital mortality adjusting for age, sex, race/ethnicity, comorbidity, month of hospitalization, and clustering within hospital. We further explored the effect of ACP conversations on the relationship between dementia and outcomes, both at the individual patient level (effect of having ACP) and at the hospital level (effect of being treated at a hospital with low: <10%, medium 10%-20%, or high >20% ACP rates). RESULTS Ten percent (n = 522) of the patients had documented dementia. Dementia patients were older (>80 years: 60% vs. 27%, p < 0.0001), had a lower burden of comorbidity (3+ comorbidities: 31% vs. 38%, p = 0.003), were more likely to have ACP (28% vs. 17%, p < 0.0001) and a DNR order (52% vs. 22%, p < 0.0001), had similar rates of ICU admission (26% vs. 28%, p = 0.258), were less likely to receive MV (11% vs. 16%, p = 0.001), and more likely to die (22% vs. 14%, p < 0.0001). Differential treatment intensity among patients with dementia was concentrated in hospitals with low, dementia-biased ACP billing practices (risk-adjusted ICU use: 21% vs. 30%, odds ratio [OR] = 0.6, p = 0.016; risk-adjusted MV use: 6% vs. 16%, OR = 0.3, p < 0.001). CONCLUSIONS Dementia was associated with lower treatment intensity and higher mortality in patients hospitalized with COVID-19. Differential treatment intensity was concentrated in low ACP billing hospitals suggesting an interplay between provider bias and "preference-sensitive" care for COVID-19.
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Affiliation(s)
- Amber E Barnato
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - John D Birkmeyer
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Sound Physicians, Tacoma, Washington, USA
| | - Jonathan S Skinner
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Economics, Dartmouth College, Hanover, New Hampshire, USA
| | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Nancy J O Birkmeyer
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Saunders R, Davis JA, Bosma KJ. Proportional-assist ventilation with load-adjustable gain factors for mechanical ventilation: a cost-utility analysis. CMAJ Open 2022; 10:E126-E135. [PMID: 35168935 PMCID: PMC9259387 DOI: 10.9778/cmajo.20210078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mechanical ventilation is an important component of patient critical care, but it adds expense to an already high-cost setting. This study evaluates the cost-utility of 2 modes of ventilation: proportional-assist ventilation with load-adjustable gain factors (PAV+ mode) versus pressure-support ventilation (PSV). METHODS We adapted a published Markov model to the Canadian hospital-payer perspective with a 1-year time horizon. The patient population modelled includes all patients receiving invasive mechanical ventilation who have completed the acute phase of ventilatory support and have entered the recovery phase. Clinical and cost inputs were informed by a structured literature review, with the comparative effectiveness of PAV+ mode estimated via pragmatic meta-analysis. Primary outcomes of interest were costs, quality-adjusted life years (QALYs) and the (incremental) cost per QALY for patients receiving mechanical ventilation. Results were reported in 2017 Canadian dollars. We conducted probabilistic and scenario analyses to assess model uncertainty. RESULTS Over 1 year, PSV had costs of $50 951 and accrued 0.25 QALYs. Use of PAV+ mode was associated with care costs of $43 309 and 0.29 QALYs. Compared to PSV, PAV+ mode was considered likely to be cost-effective, having lower costs (-$7642) and increased QALYs (+0.04) after 1 year. In cost-effectiveness acceptability analysis, 100% of simulations would be cost-effective at a willingness-to-pay threshold of $50 000 per QALY gained. INTERPRETATION Use of PAV+ mode is expected to benefit patient care in the intensive care unit (ICU) and be a cost-effective alternative to PSV in the Canadian setting. Canadian hospital payers may therefore consider how best to optimally deliver mechanical ventilation in the ICU as they expand ICU capacity.
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Affiliation(s)
- Rhodri Saunders
- Coreva Scientific & Co (Saunders, Davis), KÖnigswinter, Germany; University of Western Ontario (Bosma); London Health Sciences Centre (Bosma), University Hospital, London, Ont
| | - Jason A Davis
- Coreva Scientific & Co (Saunders, Davis), KÖnigswinter, Germany; University of Western Ontario (Bosma); London Health Sciences Centre (Bosma), University Hospital, London, Ont
| | - Karen J Bosma
- Coreva Scientific & Co (Saunders, Davis), KÖnigswinter, Germany; University of Western Ontario (Bosma); London Health Sciences Centre (Bosma), University Hospital, London, Ont.
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Reppucci ML, Acker SN, Cooper E, Meier M, Stevens J, Phillips R, Moulton SL, Bensard DD. Improved identification of severely injured pediatric trauma patients using reverse shock index multiplied by Glasgow Coma Scale. J Trauma Acute Care Surg 2022; 92:69-73. [PMID: 34932042 DOI: 10.1097/ta.0000000000003432] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The shock index pediatric age-adjusted (SIPA) predicts the need for increased resources and mortality among pediatric trauma patients without incorporating neurological status. A new scoring tool, rSIG, which is the reverse shock index (rSI) multiplied by the Glasgow Coma Scale (GCS), has been proven superior at predicting outcomes in adult trauma patients and mortality in pediatric patients compared with traditional scoring systems. We sought to compare the accuracy of rSIG to Shock Index (SI) and SIPA in predicting the need for early interventions in civilian pediatric trauma patients. METHODS Patients (aged 1-18 years) in the 2014 to 2018 Pediatric Trauma Quality Improvement Program database with complete heart rate, systolic blood pressure, and total GCS were included. Optimal cut points of rSIG were calculated for predicting blood transfusion within 4 hours, intubation, intracranial pressure monitoring, and intensive care unit admission. From the optimal thresholds, sensitivity, specificity, and area under the curve were calculated from receiver operating characteristics analyses to predict each outcome and compared with SI and SIPA. RESULTS A total of 604,931 patients with a mean age of 11.1 years old were included. A minority of patients had a penetrating injury mechanism (5.6%) and the mean Injury Severity Score was 7.6. The mean SI and rSIG scores were 0.85 and 18.6, respectively. Reverse shock index multiplied by Glasgow Coma Scale performed better than SI and SIPA at predicting early trauma outcomes for the overall population, regardless of age. CONCLUSION Reverse shock index multiplied by Glasgow Coma Scale outperformed SI and SIPA in the early identification of traumatically injured children at risk for early interventions, such as blood transfusion within 4 hours, intubation, intracranial pressure monitoring, and intensive care unit admission. Reverse shock index multiplied by Glasgow Coma Scale adds neurological status in initial patient assessment and may be used as a bedside triage tool to rapidly identify pediatric patients who will likely require early intervention and higher levels of care. LEVEL OF EVIDENCE Prognostic, level III.
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Affiliation(s)
- Marina L Reppucci
- From the Pediatric Surgery (M.L.R., S.N.A., J.S., R.P., S.L.M., D.D.B.), Children's Hospital Colorado, Aurora, Colorado; Division of Pediatric Surgery, Department of Surgery (M.L.R., S.N.A., J.S., R.P., S.L.M., D.D.B.), University of Colorado School of Medicine, Aurora, CO; The Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery (E.C., M.M.), University of Colorado School of Medicine, Aurora, CO; and Department of Surgery (D.D.B.), Denver Health Medical Center, Denver, CO
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Alvikas J, Zenati M, Campwala I, Jansen JO, Hassoune A, Phelos H, Okonkwo DO, Neal MD. Rapid detection of platelet inhibition and dysfunction in traumatic brain injury: A prospective observational study. J Trauma Acute Care Surg 2022; 92:167-176. [PMID: 34629458 PMCID: PMC8677601 DOI: 10.1097/ta.0000000000003427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rapid platelet function testing is frequently used to determine platelet function in patients with traumatic intracranial hemorrhage (tICH). Accuracy and clinical significance of decreased platelet response detected by these tests is not well understood. We sought to determine whether VerifyNow and whole blood aggregometry (WBA) can detect poor platelet response and to elucidate its clinical significance for tICH patients. METHODS We prospectively enrolled patients with isolated tICH between 2018 and 2020. Demographics, medical history, injury characteristics, and patient outcomes were recorded. Platelet function was determined by VerifyNow and WBA testing at the time of arrival to the trauma bay and 6 hours later. RESULTS A total of 221 patients were enrolled, including 111 patients on no antiplatelet medication, 78 on aspirin, 6 on clopidogrel, and 26 on aspirin and clopidogrel. In the trauma bay, 29.7% and 67.7% of patients on no antiplatelet medication had poor platelet response on VerifyNow and WBA, respectively. Among patients on aspirin, 72.2% and 82.2% had platelet dysfunction on VerifyNow and WBA. Among patients on clopidogrel, 67.9% and 88.9% had platelet dysfunction on VerifyNow and WBA. Patients with nonresponsive platelets had similar in-hospital mortality (3 [3.0%] vs. 6 [6.3%], p = 0.324), tICH progression (26 [27.1%] vs. 24 [26.1%], p = 0.877), intensive care unit admission rates (34 [34.3%] vs. 38 [40.0%), p = 0.415), and length of stay (3 [interquartile range, 2-8] vs. 3.2 [interquartile range, 2-7], p = 0.818) to those with responsive platelets. Platelet transfusion did not improve platelet response or patient outcomes. CONCLUSION Rapid platelet function testing detects a highly prevalent poor platelet response among patients with tICH, irrespective of antiplatelet medication use. VerifyNow correlated fairly with whole blood aggregometry among patients with tICH and platelet responsiveness detectable by these tests did not correlate with clinical outcomes. In addition, our results suggest that platelet transfusion may not improve clinical outcomes in patients with tICH. LEVEL OF EVIDENCE Diagnostic tests, level II.
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Trentini F, Marziano V, Guzzetta G, Tirani M, Cereda D, Poletti P, Piccarreta R, Barone A, Preziosi G, Arduini F, Valle PGD, Zanella A, Grosso F, Castillo G, Castrofino A, Grasselli G, Melegaro A, Piatti A, Andreassi A, Gramegna M, Ajelli M, Merler S. Pressure on the Health-Care System and Intensive Care Utilization During the COVID-19 Outbreak in the Lombardy Region of Italy: A Retrospective Observational Study in 43,538 Hospitalized Patients. Am J Epidemiol 2022; 191:137-146. [PMID: 34652416 PMCID: PMC8549288 DOI: 10.1093/aje/kwab252] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 08/19/2021] [Accepted: 10/08/2021] [Indexed: 12/30/2022] Open
Abstract
During the spring of 2020, the COVID-19 epidemic caused an unprecedented demand for intensive care resources in Lombardy, Italy. Using data on 43,538 hospitalized patients admitted between February 21 and July 12, 2020, we evaluated variations in intensive care unit (ICU) admissions and mortality over three periods: the early phase (February 20-March 13), the period of highest pressure on healthcare (March 14-April 25, when COVID-19 patients exceeded the ICU pre-pandemic bed capacity), and the declining phase (April 26-July 12). Compared to the early phase, patients above 70 years of age were admitted less often to an ICU during highest pressure on healthcare (odds ratio OR 0.47, 95%CI: 0.41-0.54) with longer delays (incidence rate ratio IRR 1.82, 95%CI: 1.52-2.18), and lower chances of death in ICU (OR 0.47, 95%CI: 0.34-0.64). Patients under 56 years of age reported more limited changes in the probability (OR 0.65, 95%CI: 0.56-0.76) and delay to ICU admission (IRR 1.16, 95%CI: 0.95-1.42) and an increased mortality (OR 1.43, 95%CI: 1.00-2.07). In the declining phase, all quantities decreased for all age groups. These patterns may suggest that limited healthcare resources during the peak epidemic phase in Lombardy forced a shift in ICU admission criteria to prioritize patients with higher chances of survival.
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Affiliation(s)
- Filippo Trentini
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
- Correspondence to Dr. Filippo Trentini, Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Via Roentgen 1, 20141 Milan, Italy ()
| | | | - Giorgio Guzzetta
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | - Marcello Tirani
- Directorate General for Health, Lombardy Region, Milan, Italy
- Health Protection Agency of Milan, Milan, Italy
| | - Danilo Cereda
- Directorate General for Health, Lombardy Region, Milan, Italy
| | - Piero Poletti
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | - Raffaella Piccarreta
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
- Department of Decision Sciences, Bocconi University, Milan, Italy
| | - Antonio Barone
- Regional Agency for Innovation and Procurement, Milan, Italy
| | | | - Fabio Arduini
- Regional Agency for Innovation and Procurement, Milan, Italy
| | - Petra Giulia Della Valle
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Alberto Zanella
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | | | | | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessia Melegaro
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | | | - Aida Andreassi
- Directorate General for Health, Lombardy Region, Milan, Italy
| | - Maria Gramegna
- Directorate General for Health, Lombardy Region, Milan, Italy
| | - Marco Ajelli
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA, USA
| | - Stefano Merler
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
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Abstract
OBJECTIVES We investigated whether the risk of death among noncoronavirus disease 2019 critically ill patients increased when numerous coronavirus disease 2019 cases were admitted concomitantly to the same hospital units. DESIGN We performed a nationwide observational study based on the medical information system from all public and private hospitals in France. SETTING Information pertaining to every adult admitted to ICUs or intermediate care units from 641 hospitals between January 1, 2020, and June 30, 2020 was analyzed. PATIENTS A total of 454,502 patients (428,687 noncoronavirus disease 2019 and 25,815 coronavirus disease 2019 patients) were included. INTERVENTIONS For each noncoronavirus disease 2019 patient, pandemic exposure during their stay was calculated per day using the proportion of coronavirus disease 2019 patients among all patients treated in ICU. MEASUREMENTS AND MAIN RESULTS We computed a multivariable logistic regression model to estimate the influence of pandemic exposure (low, moderate, and high exposure) on noncoronavirus disease 2019 patient mortality during ICU stay. We adjusted on patient and hospital confounders. The risk of death among noncoronavirus disease 2019 critically ill patients increased in case of moderate (adjusted odds ratio, 1.12; 95% CI, 1.05-1.19; p < 0.001) and high pandemic exposures (1.52; 95% CI, 1.33-1.74; p < 0.001). CONCLUSIONS In hospital units with moderate or high levels of coronavirus disease 2019 critically ill patients, noncoronavirus disease deaths were at higher levels.
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Affiliation(s)
- Cécile Payet
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Lyon University Hospital, Lyon, France
| | - Stéphanie Polazzi
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Lyon University Hospital, Lyon, France
| | - Thomas Rimmelé
- Department of Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Pathophysiology of Injury-Induced Immunosuppression (Pi3, EA 7426), Université Claude Bernard Lyon 1, Lyon, France
| | - Antoine Duclos
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Lyon University Hospital, Lyon, France
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Zebrowski AM, Hsu JY, Holena DN, Wiebe DJ, Carr BG. Developing a measure of overall intensity of injury care: A latent class analysis. J Trauma Acute Care Surg 2022; 92:193-200. [PMID: 34225349 PMCID: PMC8692337 DOI: 10.1097/ta.0000000000003321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND While injury is a leading cause of death and debility in older adults, the relationship between intensity of care and trauma remains unknown. The focus of this analysis is to measure the overall intensity of care delivered to injured older adults during hospitalization. METHODS We used Centers for Medicare and Medicaid Services Medicare fee-for-service claims data (2013-2014), to identify emergency department-based claims for moderate and severe blunt trauma in age-eligible beneficiaries. Medical procedures associated with care intensity were identified using a modified Delphi method. A latent class model was estimated using the identified procedures, intensive care unit length of stay, demographics, and injury characteristics. Clinical phenotypes for each class were explored. RESULTS A total of 683,398 cases were classified as low- (73%), moderate- (23%), and high-intensity care (4%). Greater age and reduced injury severity were indicators of lower intensity, while males, non-Whites, and nonfall mechanisms were more common with high intensity. Intubation/mechanical ventilation was an indicator of high intensity and often occurred with at least one other procedure or an extended intensive care unit stay. CONCLUSION This work demonstrates that, although heterogeneous, care for blunt trauma can be evaluated using a single novel measure. LEVEL OF EVIDENCE For prognostic/epidemiological studies, level III.
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Affiliation(s)
- Alexis M. Zebrowski
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jesse Y. Hsu
- Department of Epidemiology, Biostatistics, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daniel N. Holena
- Department of Epidemiology, Biostatistics, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Surgery, Division of Traumatology, Perelman School of Medicine, University of Pennsylvania
| | - Douglas J. Wiebe
- Department of Epidemiology, Biostatistics, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Brendan G. Carr
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Rosen JE, Bulger EM, Cuschieri J. Respiratory events after intensive care unit discharge in trauma patients: Epidemiology, outcomes, and risk factors. J Trauma Acute Care Surg 2022; 92:28-37. [PMID: 34284468 PMCID: PMC8692327 DOI: 10.1097/ta.0000000000003362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Respiratory complications are associated with significant morbidity and mortality in trauma patients. The care transition from the intensive care unit (ICU) to the acute care ward is a vulnerable time for injured patients. There is a lack of knowledge about the epidemiology of respiratory events and their outcomes during this transition. METHODS Retrospective cohort study in a single Level I trauma center of injured patients 18 years and older initially admitted to the ICU from 2015 to 2019 who survived initial transfer to the acute care ward. The primary outcome was occurrence of a respiratory event, defined as escalation in oxygen therapy beyond nasal cannula or facemask for three or more consecutive hours. Secondary outcomes included unplanned intubation for a primary pulmonary cause, adjudicated via manual chart review, as well as in-hospital mortality and length of stay. Multivariable logistic regression was used to examine patient characteristics associated with posttransfer respiratory events. RESULTS There were 6,561 patients that met the inclusion criteria with a mean age of 52.3 years and median Injury Severity Score of 18 (interquartile range, 13-26). Two hundred and sixty-two patients (4.0%) experienced a respiratory event. Respiratory events occurred early after transfer (median, 2 days, interquartile range, 1-5 days), and were associated with high mortality (16% vs. 1.8%, p < 0.001), and ICU readmission rates (52.6% vs. 4.7%, p < 0.001). Increasing age, male sex, severe chest injury, and comorbidities, including preexisting alcohol use disorder, congestive heart failure, and chronic obstructive pulmonary disease, were associated with increased odds of a respiratory event. Fifty-eight patients experienced an unplanned intubation for a primary pulmonary cause, which was associated with an in-hospital mortality of 39.7%. CONCLUSION Respiratory events after transfer to the acute care ward occur close to the time of transfer and are associated with high mortality. Interventions targeted at this critical time are warranted to improve patient outcomes. LEVEL OF EVIDENCE Prognostic and Epidemiological study, level III.
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Affiliation(s)
- Joshua E Rosen
- From the Surgical Outcomes Research Center, Department of Surgery (J.E.R.), University of Washington; Department of Surgery (J.E.R., E.M.B.), Harborview Medical Center, Seattle, Washington; and Department of Surgery (J.C.), University of California San Francisco, San Francisco, California
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Melançon E, Brosseau M, Bartoli A, Labbé AC, Lavallée C, Marchand-Senécal X, Wang HT. Outcomes of hospital-acquired SARS-CoV-2 infection in the Canadian first wave epicentre: a retrospective cohort study. CMAJ Open 2022; 10:E74-E81. [PMID: 35105684 PMCID: PMC8812720 DOI: 10.9778/cmajo.20210055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND During the first wave of the COVID-19 pandemic, a substantial number of Quebec hospitals were hit by hospital-acquired (HA) SARS-CoV-2 infections. Our objective was to assess whether mortality is higher in HA cases than in non-hospital-acquired (NHA) cases and determine the prevalence of HA-SARS-CoV-2 infection in our hospital. METHODS This retrospective single-centre cohort study included all adults (≥ 18 yr) who had COVID-19, admitted to Hôpital Maisonneuve-Rosemont (Montréal, Canada) from Mar. 1 to June 30, 2020. We collected data on demographic characteristics, comorbidities, treatment, admission to the intensive care unit (ICU) and mechanical ventilation requirements from electronic health records. We adjudicated hospital acquisition based on the timing of symptom onset, and polymerase chain reaction testing for and exposures to SARS-CoV-2. To evaluate the association between HA-SARS-CoV-2 infection and in-hospital mortality, we computed a multivariable logistic regression analysis including known risk factors for death in patients with COVID-19 as covariates. RESULTS Among 697 patients with SARS-CoV-2 infection, 253 (36.3%) were classified as HA. The mortality rate was higher in the HA group than in the NHA group (38.2% v. 26.4%, p = 0.001), while the rates of ICU admission (8.3% v. 19.1%, p = 0.001) and requirement for mechanical ventilation (3.6% v. 13.0%, p = 0.001) were lower. Multivariable logistic regression analysis showed that HA-SARS-CoV-2 infection in patients younger than 75 years is an independent risk factor for death (odds ratio 2.78, 95% confidence interval 1.44-5.38). INTERPRETATION Our results show that HA-SARS-CoV-2 infection in younger patients was associated with higher mortality. Future studies need to evaluate relevant patient-centred long-term outcomes in this population.
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Affiliation(s)
- Eve Melançon
- Pulmonary Division (Melançon, Brosseau), Department of Medicine, Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Department of Medicine (Melançon, Brosseau, Bartoli, Wang), Faculty of Medicine, Université de Montréal; Critical Care Division (Brosseau, Wang), Internal Medicine Division (Bartoli), and Microbiology and Infectious Disease Division (Labbé, Lavallée, Marchand-Senécal), Department of Medicine, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal; Department of Microbiology, Infectious Diseases and Immunology (Labbé, Lavallée, Marchand-Senécal), Faculty of Medicine, Université de Montréal, Montréal, Que
| | - Marc Brosseau
- Pulmonary Division (Melançon, Brosseau), Department of Medicine, Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Department of Medicine (Melançon, Brosseau, Bartoli, Wang), Faculty of Medicine, Université de Montréal; Critical Care Division (Brosseau, Wang), Internal Medicine Division (Bartoli), and Microbiology and Infectious Disease Division (Labbé, Lavallée, Marchand-Senécal), Department of Medicine, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal; Department of Microbiology, Infectious Diseases and Immunology (Labbé, Lavallée, Marchand-Senécal), Faculty of Medicine, Université de Montréal, Montréal, Que
| | - Anthony Bartoli
- Pulmonary Division (Melançon, Brosseau), Department of Medicine, Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Department of Medicine (Melançon, Brosseau, Bartoli, Wang), Faculty of Medicine, Université de Montréal; Critical Care Division (Brosseau, Wang), Internal Medicine Division (Bartoli), and Microbiology and Infectious Disease Division (Labbé, Lavallée, Marchand-Senécal), Department of Medicine, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal; Department of Microbiology, Infectious Diseases and Immunology (Labbé, Lavallée, Marchand-Senécal), Faculty of Medicine, Université de Montréal, Montréal, Que
| | - Annie-Claude Labbé
- Pulmonary Division (Melançon, Brosseau), Department of Medicine, Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Department of Medicine (Melançon, Brosseau, Bartoli, Wang), Faculty of Medicine, Université de Montréal; Critical Care Division (Brosseau, Wang), Internal Medicine Division (Bartoli), and Microbiology and Infectious Disease Division (Labbé, Lavallée, Marchand-Senécal), Department of Medicine, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal; Department of Microbiology, Infectious Diseases and Immunology (Labbé, Lavallée, Marchand-Senécal), Faculty of Medicine, Université de Montréal, Montréal, Que
| | - Christian Lavallée
- Pulmonary Division (Melançon, Brosseau), Department of Medicine, Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Department of Medicine (Melançon, Brosseau, Bartoli, Wang), Faculty of Medicine, Université de Montréal; Critical Care Division (Brosseau, Wang), Internal Medicine Division (Bartoli), and Microbiology and Infectious Disease Division (Labbé, Lavallée, Marchand-Senécal), Department of Medicine, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal; Department of Microbiology, Infectious Diseases and Immunology (Labbé, Lavallée, Marchand-Senécal), Faculty of Medicine, Université de Montréal, Montréal, Que
| | - Xavier Marchand-Senécal
- Pulmonary Division (Melançon, Brosseau), Department of Medicine, Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Department of Medicine (Melançon, Brosseau, Bartoli, Wang), Faculty of Medicine, Université de Montréal; Critical Care Division (Brosseau, Wang), Internal Medicine Division (Bartoli), and Microbiology and Infectious Disease Division (Labbé, Lavallée, Marchand-Senécal), Department of Medicine, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal; Department of Microbiology, Infectious Diseases and Immunology (Labbé, Lavallée, Marchand-Senécal), Faculty of Medicine, Université de Montréal, Montréal, Que
| | - Han Ting Wang
- Pulmonary Division (Melançon, Brosseau), Department of Medicine, Hôpital Maisonneuve-Rosemont, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Department of Medicine (Melançon, Brosseau, Bartoli, Wang), Faculty of Medicine, Université de Montréal; Critical Care Division (Brosseau, Wang), Internal Medicine Division (Bartoli), and Microbiology and Infectious Disease Division (Labbé, Lavallée, Marchand-Senécal), Department of Medicine, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal; Department of Microbiology, Infectious Diseases and Immunology (Labbé, Lavallée, Marchand-Senécal), Faculty of Medicine, Université de Montréal, Montréal, Que.
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Schork A, Moll K, Haap M, Riessen R, Wagner R. Course of lactate, pH and base excess for prediction of mortality in medical intensive care patients. PLoS One 2021; 16:e0261564. [PMID: 34929006 PMCID: PMC8687550 DOI: 10.1371/journal.pone.0261564] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/04/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction As base excess had shown superiority over lactate as a prognostic parameter in intensive care unit (ICU) surgical patients we aimed to evaluate course of lactate, base excess and pH for prediction of mortality of medical ICU patients. Materials and methods For lactate, pH and base excess, values at the admission to ICU, at 24 ± 4 hours, maximum or minimum in the first 24 hours and in 24–48 hours after admission were collected from all patients admitted to the Medical ICU of the University Hospital Tübingen between January 2016 until December 2018 (N = 4067 at admission, N = 1715 with ICU treatment > 48 h) and investigated for prediction of in-hospital-mortality. Results Mortality was 22% and significantly correlated with all evaluated parameters. Strongest predictors of mortality determined by ROC were maximum lactate in 24 h (AUROC 0.74, cut off 2.7 mmol/L, hazard ratio of risk group with value > cut off 3.20) and minimum pH in 24 h (AUROC 0.71, cut off 7.31, hazard ratio for risk group 2.94). Kaplan Meier Curves stratified across these cut offs showed early and clear separation. Hazard ratios per standard deviation increase were highest for maximum lactate in 24 h (HR 1.65), minimum base excess in 24 h (HR 1.56) and minimum pH in 24 h (HR 0.75). Conclusion Lactate, pH and base excess were all suitable predictors of mortality in internal ICU patients, with maximum / minimum values in 24 and 24–48 h after admission altogether stronger predictors than values at admission. Base excess and pH were not superior to lactate for prediction of mortality.
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Affiliation(s)
- Anja Schork
- Division of Endocrinology, Diabetology, and Nephrology, Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- Department of Internal Medicine, Medical Intensive Care Unit, University Hospital Tübingen, Tübingen, Germany
- * E-mail:
| | - Kathrin Moll
- Department of Internal Medicine, Medical Intensive Care Unit, University Hospital Tübingen, Tübingen, Germany
| | - Michael Haap
- Department of Internal Medicine, Medical Intensive Care Unit, University Hospital Tübingen, Tübingen, Germany
| | - Reimer Riessen
- Department of Internal Medicine, Medical Intensive Care Unit, University Hospital Tübingen, Tübingen, Germany
| | - Robert Wagner
- Division of Endocrinology, Diabetology, and Nephrology, Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
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Tsunemitsu T, Kataoka Y, Matsumoto M, Hashimoto T, Suzuki T. Effect of enterally administered sleep-promoting medication on the intravenous sedative dose and its safety and cost profile in mechanically ventilated patients: A retrospective cohort study. PLoS One 2021; 16:e0261305. [PMID: 34928967 PMCID: PMC8687529 DOI: 10.1371/journal.pone.0261305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical effect of enteral administration of sleep-promoting medication (SPM) in mechanically ventilated patients remains unclear. This study aimed to investigate the relationship between enteral SPM administration and the intravenous sedative dose and examine the safety and cost of enteral SPM administration. METHODS This single-center retrospective cohort study was conducted in a Japanese tertiary hospital intensive care unit (ICU). The exposure was enteral SPM administration during mechanical ventilation. The outcome was the average daily propofol dose per body weight administered as a continuous sedative during mechanical ventilation. Patients were divided into three groups based on the timing of SPM administration at ICU admission: "administration within 48 hours (early administration [EA])," "administration after 48 hours (late administration [LA])," and "no administration (NA)." We used multiple linear regression models. RESULTS Of 123 included patients, 37, 50, and 36 patients were assigned to the EA, LA, and NA groups, respectively. The average daily propofol dose per body weight was significantly lower in the EA group than in the LA and NA groups (β -5.13 [95% confidence interval (CI) -8.93 to -1.33] and β -4.51 [95% CI -8.59 to -0.43], respectively). Regarding safety, enteral SPM administration did not increase adverse events, including self-extubation. The total cost of neuroactive drugs tended to be lower in the EA group than in the LA and NA groups. CONCLUSIONS Early enteral SPM administration reduced the average daily propofol dose per body weight without increasing adverse events.
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Affiliation(s)
- Takefumi Tsunemitsu
- Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Yuki Kataoka
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Masaru Matsumoto
- Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Takashi Hashimoto
- Department of Pharmacy, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Takao Suzuki
- Department of Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
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KASAPOĞLU US, KAÇMAZ O, GÖK A, YILDIZ EGLEN M, ŞAYAN H, ÇOLAK F. Prognostic factors for 30-days mortality in eighty years aged and older critically ill patients: a single center retrospective cohort study. Turk J Med Sci 2021; 51:2968-2977. [PMID: 34482680 PMCID: PMC10734822 DOI: 10.3906/sag-2104-359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 12/13/2021] [Accepted: 09/04/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Nowadays, with the rise in average life expectancy, the rate of hospitalization of the older population in intensive care unit (ICU) is gradually increasing. Unfortunately, there are no ideal combination of prognostic factors predicting the mortality in older patients admitted to the ICU. In the present study, we aim to determine the prognostic factors and their impacts on short-time mortality in older critically ill patients. Materials and methods This retrospective cohort study was performed between January 2019 and February 2020. We included 133 patients aged ≥80 years and hospitalized ≥24 h in the ICU. Results A total of 133 critically ill patients enrolled in the present study. And, the median age of the patients was 85 (80–106) years. 30-days and overall ICU mortality rates were found 30.1% and 34.6%, respectively. The patients were grouped as survivors (n = 94) and nonsurvivors (n = 39). Hospital length of stay before the ICU admission was found significantly longer in nonsurvivors (p = 0.001). Sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation-II (APACHE-II) score were significantly higher in nonsurvivors (p < 0.001, p < 0.001). Also, blood lactate level and glucose level were respectively significantly higher in nonsurvivors (p < 0.001, p = 0.006). We found that modified nutrition risk in critically ill (mNUTRIC) score and prehospital clinical frailty scale (CFS) were independent prognostic factors for the older critically ill patients (HR = 9.19, 95% CI=1.47–57.32, p = 0.018, HR = 20.16, 95% CI = 2.63–54.07, p =0.004). Conclusion mNUTRIC score and prehospital CFS score were the most important prognostic factors in the admission of older patients to intensive care units.
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Affiliation(s)
- Umut Sabri KASAPOĞLU
- Department of Pulmonary and Critical Care Medicine, Malatya Training and Research Hospital, Malatya,
Turkey
| | - Osman KAÇMAZ
- Department of Anesthesiology and Reanimation, Malatya Training and Research Hospital, Malatya,
Turkey
| | - Abdullah GÖK
- Department of Anesthesiology and Reanimation, Malatya Training and Research Hospital, Malatya,
Turkey
| | - Merih YILDIZ EGLEN
- Department of Anesthesiology and Reanimation, Malatya Training and Research Hospital, Malatya,
Turkey
| | - Hasan ŞAYAN
- Department of Anesthesiology and Reanimation, Malatya Training and Research Hospital, Malatya,
Turkey
| | - Fatih ÇOLAK
- Department of Anesthesiology and Reanimation, Malatya Training and Research Hospital, Malatya,
Turkey
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49
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Kisat MT, Odenheimer-Bergman A, Markus H, Joseph B, Srivatsan SN, Contente-Cuomo T, Khalpey Z, Keim P, O'Keeffe T, Askari R, Salim A, Rhee P, Murtaza M. Plasma metagenomic sequencing to detect and quantify bacterial DNA in ICU patients suspected of sepsis: A proof-of-principle study. J Trauma Acute Care Surg 2021; 91:988-994. [PMID: 34510074 DOI: 10.1097/ta.0000000000003396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Timely recognition of sepsis and identification of pathogens can improve outcomes in critical care patients but microbial cultures have low accuracy and long turnaround times. In this proof-of-principle study, we describe metagenomic sequencing and analysis of nonhuman DNA in plasma. We hypothesized that quantitative analysis of bacterial DNA (bDNA) levels in plasma can enable detection and monitoring of pathogens. METHODS We enrolled 30 patients suspected of sepsis in the surgical trauma intensive care unit and collected plasma samples at the time of diagnostic workup for sepsis (baseline), and 7 days and 14 days later. We performed metagenomic sequencing of plasma DNA and used computational classification of sequencing reads to detect and quantify total and pathogen-specific bDNA fraction. To improve assay sensitivity, we developed an enrichment method for bDNA based on size selection for shorter fragment lengths. Differences in bDNA fractions between samples were evaluated using t test and linear mixed-effects model, following log transformation. RESULTS We analyzed 72 plasma samples from 30 patients. Twenty-seven samples (37.5%) were collected at the time of infection. Median total bDNA fraction was 1.6 times higher in these samples compared with samples with no infection (0.011% and 0.0068%, respectively, p < 0.001). In 17 patients who had active infection at enrollment and at least one follow-up sample collected, total bDNA fractions were higher at baseline compared with the next sample (p < 0.001). Following enrichment, bDNA fractions increased in paired samples by a mean of 16.9-fold. Of 17 samples collected at the time when bacterial pathogens were identified, we detected pathogen-specific DNA in 13 plasma samples (76.5%). CONCLUSION Bacterial DNA levels in plasma are elevated in critically ill patients with active infection. Pathogen-specific DNA is detectable in plasma, particularly after enrichment using selection for shorter fragments. Serial changes in bDNA levels may be informative of treatment response. LEVEL OF EVIDENCE Epidemiologic/Prognostic, Level V.
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Affiliation(s)
- Mehreen T Kisat
- From the Center for Noninvasive Diagnostics (M.T.K., A.O.-B., H.M., S.N.S., T.C.-C., M.M.), Translational Genomics Research Institute, Phoenix; Department of Surgery (M.T.K., B.J., Z.K., T.O., P.R.), University of Arizona, Tucson, Arizona; Department of Surgery (M.T.K., R.A., A.S.), Brigham and Women's Hospital, Boston, Massachusetts; and Pathogen and Microbiome Institute, Northern Arizona University (P.K.), Flagstaff, Arizona
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50
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Li L, Zhou J, Huang L, Zhen J, Yao L, Xu L, Zhang W, Zhang G, Chen Q, Cheng B, Gong S, Cai G, Jiang R, Yan J. Prevention, treatment, and risk factors of deep vein thrombosis in critically ill patients in Zhejiang province, China: a multicenter, prospective, observational study. Ann Med 2021; 53:2234-2245. [PMID: 34797177 PMCID: PMC8805816 DOI: 10.1080/07853890.2021.2005822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/08/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the prevention and treatment patterns of deep vein thrombosis (DVT) in critically ill patients and to explore the risk factors for DVT in people from Zhejiang Province, China. MATERIALS AND METHODS This study prospectively enrolled patients admitted in intensive care units (ICUs) of 54 hospitals from 09/16/2019 to 01/16/2020. The risk of developing DVT and subsequent prophylaxis was evaluated. The primary outcome was DVT occurrence during ICU hospitalisation. Univariate and multivariate logistic regression were performed to determine the risk factors for DVT. RESULTS A total of 940 patients were included in the study. Among 847 patients who received prophylaxis, 635 (75.0%) patients received physical prophylaxis and 199 (23.5%) patients received drug prophylaxis. Fifty-eight (6.2%) patients were diagnosed with DVT after admission to the ICU, and 36 patients were treated with anticoagulants (all patients received low molecular weight heparin [LMWH]). D-dimer levels (OR = 1.256, 95% CI: 1.132-1.990), basic prophylaxis (OR = 0.092, 95% CI: 0.016-0.536), and physical prophylaxis (OR = 0.159, 95% CI: 0.038-0.674) were independently associated with DVT in ICU patients. The short-term survival was similar between DVT and non-DVT patients. CONCLUSIONS DVT prophylaxis is widely performed in ICU patients. Prophylaxis is an independent protective factor for DVT occurrence. The most common treatment of DVT patients is LMWH, although it might increase the rate of bleeding.Key messagesThis is the only multicenter and prospective study of DVT in ICUs in China.d-dimer levels were independently associated with DVT in ICU patients.Prophylaxis was an independent protective factor for DVT occurrence in ICU.
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Affiliation(s)
- Li Li
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Jia Zhou
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Liquan Huang
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China
| | - Junhai Zhen
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Lina Yao
- Department of Critical Care Medicine, Ningbo Yinzhou People’s Hospital, Yinzhou, Zhejiang, China
| | - Lingen Xu
- Department of Critical Care Medicine, Xinchang Hospital of Traditional Chinese Medicine, Xinchang, Zhejiang, China
| | - Weimin Zhang
- Department of Critical Care Medicine, Dongyang People's Hospital, Dongyang, Zhejiang, China
| | - Gensheng Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qijiang Chen
- Department of Critical Care Medicine, Ninghai First Hospital, Ninghai, Zhejiang, China
| | - Bihuan Cheng
- Department of Critical Care Medicine, The 2 School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shijin Gong
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Guolong Cai
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Ronglin Jiang
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China
| | - Jing Yan
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - (Zhejiang Provincial Critical Care Clinical Research Group)
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, Zhejiang, China
- Department of Critical Care Medicine, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China
- Department of Critical Care Medicine, Ningbo Yinzhou People’s Hospital, Yinzhou, Zhejiang, China
- Department of Critical Care Medicine, Xinchang Hospital of Traditional Chinese Medicine, Xinchang, Zhejiang, China
- Department of Critical Care Medicine, Dongyang People's Hospital, Dongyang, Zhejiang, China
- Department of Critical Care Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Critical Care Medicine, Ninghai First Hospital, Ninghai, Zhejiang, China
- Department of Critical Care Medicine, The 2 School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
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