scholarly journals Fibrinogen Level Predicts Outcomes in Critically Ill Patients with Acute Exacerbation of Chronic Heart Failure

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Zhongyuan Meng ◽  
Yaxin Zhao ◽  
Yan He
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Acute Exacerbation ◽  
Critically Ill ◽  
Roc Curve ◽  
Critically Ill Patients ◽  
Medical Information ◽  
Fibrinogen Level ◽  
Cox Model ◽  
Hazard Ratio

Background. Heart failure (HF) is a common cardiovascular disease, which is related to systemic inflammation for decades. Fibrinogen (FIB) is a sign of thrombosis and inflammation, which is associated with the prognosis of many diseases. Nevertheless, the role of fibrinogen level in the prognosis of critically ill patients with acute exacerbation of chronic heart failure is unclear. Methods. The data are from the Medical Information Mart for Intensive Care III (MIMIC III) database, which is a freely accessible critical care database. The primary outcome in our study was 90-day mortality. The prognostic value of fibrinogen was analyzed with receiver operating characteristic (ROC) curve analysis, Kaplan-Meier curve, and Cox model. Results. A total of 554 patients were included. Patients were divided into two groups, low fibrinogen level (<284 mg/dl) and high fibrinogen level (≥284 mg/dl), through the cut-off value of the ROC curve. The area under the ROC curve of fibrinogen for predicting 90-day mortality was 0.65 (95% CI: 0.59–0.70). In the unadjusted Cox model, compared with the low fibrinogen level (<284 mg/dl), the 90-day mortality of the hazard ratio (HR) with 95% confidence intervals (CI) of the high fibrinogen level is 3.33 (95% CI 2.15-5.15). In different multivariable Cox models, compared with the low fibrinogen level (<284 mg/dl), the 90-day mortality of the hazard ratio of the high fibrinogen level is from 2.83 to 3.13. In subgroup analyses, significant interactions were observed only in age, chronic kidney disease (CKD), and APS III scores. Conclusion. Our data suggest that high fibrinogen levels (≥284 mg/dl) independently predict mortality in critically ill patients with acute exacerbation of chronic heart failure. Our findings need to be further validated by large prospective studies and longer follow-up time.

scholarly journals Is It Time to Beta Block the Septic Patient?

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Philip Pemberton ◽  
Tonny Veenith ◽  
Catherine Snelson ◽  
Tony Whitehouse
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Chronic Heart Failure ◽  
Animal Models ◽  
Septic Patient ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Beta Blockers ◽  
Adrenergic System

Beta blockers are some of the most studied drugs in the pharmacopoeia. They are already widely used in medicine for treating hypertension, chronic heart failure, tachyarrhythmias, and tremor. Whilst their use in the immediate perioperative patient has been questioned, the use of esmolol in the patients with established septic shock has been recently reported to have favourable outcomes. In this paper, we review the role of the adrenergic system in sepsis and the evidence for the use of beta stimulation and beta blockers from animal models to critically ill patients.

scholarly journals Blood Urea Nitrogen and In-Hospital Mortality in Critically Ill Patients with Cardiogenic Shock: Analysis of the MIMIC-III Database

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
En-qian Liu ◽  
Chun-lai Zeng
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Critically Ill ◽  
Blood Urea Nitrogen ◽  
Critically Ill Patients ◽  
Medical Information ◽  
Multivariate Logistic Regression Model ◽  
Standard Deviation Increase ◽  
Urea Nitrogen

The association between blood urea nitrogen (BUN) and prognosis has been the focus of recent research. Therefore, the objective of this study was to investigate the association between BUN and hospital mortality in critically ill patients with cardiogenic shock (CS). This was a retrospective cohort study, in which data were obtained from the Medical Information Mart for Intensive Care III V1.4 database. Data from 697 patients with CS were analyzed. Logistic regression and subgroup analyses were used to assess the association between BUN and hospital mortality in patients with CS. The average age of the 697 participants was 71.14 years, and approximately 42.18% were men. In the multivariate logistic regression model, after adjusting for age, sex, diabetes, cardiac arrhythmias, urine output, simplified acute physiology score II, sequential organ failure assessment, creatinine, anion gap, and heart rate, high BUN demonstrated strong associations with increased in-hospital mortality (per standard deviation increase: odds ratio [OR] 1.47, 95% confidence interval [CI] 1.13–1.92). A similar result was observed in BUN tertile groups (BUN 23–37 mg/dL versus 6–22 mg/dL: OR [95% CI], 1.42 [0.86–2.34]; BUN 38–165 mg/dL versus 6–22 mg/dL: OR [95% CI], 1.99 [1.10–3.62]; P trend 0.0272). Subgroup analysis did not reveal any significant interactions among various subgroups, and higher BUN was associated with adverse clinical outcomes in patients with CS.

Association Effects Of Comorbid Versus Uncomorbid Diabetes And Blood Glucose Concentrations On Short-term Outcomes In Patients With Critical Illness: A Real-World Study Based On Propensity Score Analyses

2020 ◽  
Author(s):  
Shan Lin ◽  
Shanhui Ge ◽  
Wanmei He ◽  
Mian Zeng
Keyword(s):  
Critical Illness ◽  
Glycemic Control ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Model ◽  
Inverse Probability Weighting ◽  
Probability Weighting ◽  
Optimal Range ◽  
Short Term ◽  
Inverse Probability

Abstract Background: The effects of combined diabetes and glycemic control strategies on the short-term prognosis in patients with a critical illness are currently ambiguous. The objectives of our study were to determine whether comorbid diabetes affects short-term prognosis and the optimal range of glycemic control in critically ill patients.Methods: We performed this study with the critical care database. The primary outcomes were 28-day mortality in critically ill patients with comorbid diabetes and the optimal range of glycemic control. Association of comorbid diabetes with 28-day mortality was assessed by multivariable Cox regression model with inverse probability weighting. Smooth curves were applied to fit the association for glucose and 28-day mortality.Results: Of the 33,680 patients enrolled in the study, 8,701 (25.83%) had diabetic comorbidity. Cox model with inverse probability weighting showed that the 28-day mortality rate was reduced by 29% (HR=0.71, 95% CI 0.67-0.76) in the group with diabetes in comparison to the group without diabetes. The E value of 2.17 indicated robustness to unmeasured confounders. The effect of the association between comorbid diabetes and 28-day mortality was generally in line for all subgroup variables, significant interactions were observed for glucose on first day, admission type, and use of insulin or not (Interaction P <0.05). A V-shaped relationship was observed between glucose concentrations and 28-day mortality in patients without diabetes, with the lowest 28-day mortality corresponding to the glucose level was 101.75 mg/dl (95% CI 94.64-105.80 mg/dl); whereas in patients with comorbid diabetes, the effect of glucose concentration on 28-day mortality was structurally softer than in those with uncomorbid diabetes. Lastly, of all patients, hyperglycemia had the greatest deleterious effect on patients admitted to CSRU.Conclusions: Our study further confirmed the protective effect of comorbid diabetes on the short-term prognosis of critically ill patients, resulting in an approximately 29% reduction in 28-day mortality. Besides, we also demonstrated the personalized glycemic control strategy for critically ill patients. Lastly, clinicians should be aware of the occurrence and the prompt management of hyperglycemia in critically ill patients admitted to the CSRU.

Visit-to-Visit B-Type Natriuretic Peptide Variability during the Previous Year Has Independent Prognostic Value in Patients with Stable Chronic Heart Failure

Cardiology ◽  
2019 ◽  
Vol 143 (3-4) ◽  
pp. 92-99 ◽  
Author(s):  
Nobuyuki Kagiyama ◽  
Takuya Yuri ◽  
Akihiro Hayashida ◽  
Atsushi Hirohata ◽  
Keizo Yamamoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Natriuretic Peptide ◽  
Risk Score ◽  
Prognostic Value ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Hazard Ratio ◽  
Stable Phase ◽  
Wide Variability

Background: There is wide variability of visit-to-visit (V2V) B-type natriuretic peptide (BNP) in patients with chronic heart failure (CHF), even when they are stable. The prognostic significance of V2V-BNP variability has not been investigated. We aimed to test whether V2V-BNP variability during the stable period of CHF has prognostic value regardless of BNP level. Methods: In 278 stable outpatients (75 ± 10 years, 65% male) with CHF, we studied V2V-BNP variability, which was defined as the coefficient of variance of BNP values measured during 1 year before enrollment. All-cause death and rehospitalization due to HF were considered the primary endpoint. Results: The median V2V-BNP variability was 25.7% (IQR: 19.2–34.4%). During the follow-up period (median 3.2 years), 100 patients reached the endpoint and those with high V2V-BNP variability (≥25.7%) had a significantly higher rate of events (p = 0.001). CHF severity in terms of BNP level and MAGGIC risk score was not significantly different between those with high and low V2V-BNP variability. Multivariable analysis showed that high V2V-BNP variability was independently associated with increased event rates even after adjustment for other known prognostic predictors, including BNP (hazard ratio 1.90, p = 0.003), or for MAGGIC risk score and BNP (hazard ratio 1.72, p = 0.010). The hazard for the outcome consistently increased as V2V-BNP variability increased, with a marked increase up to about 30%. Conclusions: Even in the stable phase of CHF, V2V-BNP variability was associated with worse long-term outcomes, independent of BNP level.

Prognosis of Critically Ill Patients With Cancer and Acute Renal Dysfunction

2006 ◽  
Vol 24 (24) ◽  
pp. 4003-4010 ◽  
Author(s):  
Márcio Soares ◽  
Jorge I.F. Salluh ◽  
Marilia S. Carvalho ◽  
Michael Darmon ◽  
José R. Rocco ◽  
...  
Keyword(s):  
Renal Dysfunction ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Model ◽  
Mortality Rates ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Acute Renal Dysfunction ◽  
Patients With Cancer ◽  
Organ Failures

Purpose To evaluate the outcomes of critically ill patients with cancer and acute renal dysfunction. Patients and Methods Prospective cohort study conducted at a 10-bed oncologic medical-surgical intensive care unit (ICU) over a 56-month period. Results Of 975 patients, 309 (32%) had renal dysfunction and were studied. Their mean age was 60.9 ± 15.9 years; 233 patients (75%) had solid tumors and 76 (25%) had hematologic malignancies. During the ICU stay, 98 patients (32%) received dialysis. Renal dysfunction was multifactorial in 56% of the patients, and the main associated factors were shock/ischemia (72%) and sepsis (63%). Overall hospital and 6-month mortality rates were 64% and 73%, respectively. Among patients who required dialysis, mortality rates were lower in patients who received dialysis on the first day of ICU in comparison with those who required it thereafter. In a multivariable Cox model, age more than 60 years, uncontrolled cancer, impaired performance status, and more than two associated organ failures were associated with increased 6-month mortality. Renal function was completely re-established in 82% and partially re-established in 12%, and only 6% of survivors required chronic dialysis. Conclusion Acute renal dysfunction is frequent in critically ill patients with cancer. Although mortality rates are high, selected patients can benefit from ICU care and advanced organ support. When evaluating prognosis and the appropriateness of dialysis in these patients, older age, functional capacity, cancer status and the severity of associated organ failures are important variables to take into consideration.

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