scholarly journals Αξιολόγηση οργανικών βλαβών μετά από ενδονοσοκομειακή καρδιακή ανακοπή

2018 ◽  
Author(s):  
Ιωσηφίνα Κολιαντζάκη
Keyword(s):  
Confidence Interval ◽  
Competing Risks ◽  
Cumulative Incidence ◽  
Cerebral Performance Category ◽  
Performance Category ◽  
Intention To Treat ◽  
Hazard Ratios ◽  
Cerebral Performance Category Score ◽  
Category Score

Σκοπός: Η χαμηλή δόση στεροειδών μπορεί να φανεί ωφέλιμη σε βαρέως πάσχοντες ασθενείς με σηπτική καταπληξία. Οι ασθενείς με καρδιακή ανακοπή είναι επηρρεπείς σε νοσοκομειακές λοιμώξεις, οι οποίες συμβάλλουν στη μετά την αναζωογώνηση θνησιμότητα. Υποθέσαμε ότι στρες-δόση στεροειδών κατά τη διάρκεια και/ή μετά την ανάταξη μπορεί να συσχετίζεται με μειωμένο κίνδυνο θανάτου εξ αιτίας μετά της ανακοπής λοιμώξεων που οδηγούν σε σηπτική καταπληξία. Μέθοδοι: Διεξάγαμε μια επανανάλυση [cumulative incidence competing risks (CICR)] στοιχείων από 2 προηγούμενες, τυχαιοποιημένες κλινικές μελέτες. Οι μελέτες αυτές αξιολογούσαν τη βαζοπρεσσίνη, τα στεροειδή και την επινεφρίνη [vasopressin, steroids, and epinephrine (VSE)] κατά τη διάρκεια της αναζωογώνησης και τη στρες-δόση στεροειδών μετά την αναζωογώνηση σε ασθενείς που είχαν υποστεί ενδονοσοκομειακή ανακοπή. Στις πρωτογενείς αναλύσεις, οι ασθενείς με μετά την ανάταξη καταπληξία χωρίστηκαν σε μια ομάδα που έλαβε Στεροειδή (n=118) ή στην ομάδα Μη Στεροειδή (n=73) , σύμφωνα με την αρχή «as treated». Εφαρμόσαμε CICR Cox ανάλυση παλινδρόμησης ώστε να καθορίσουμε σχετικές με την αιτία αναλογίες κινδύνου [cause-specific hazard ratios (CSHRs)] για προκαθορισμένους προγνωστικούς παράγοντες μοιραίας σηπτικής καταπληξίας (πρωτογενής έκβαση), θάνατο από μη λοιμώδη αίτια και πτωχή ενδονοσοκομειακή έκβαση outcome (cerebral performance category score ≥3). Στις αναλύσεις ευαισθησίας, τα δεδομένα επεξεργάστηκαν σύμφωνα με την αρχή intention-to-treat (ITT) (ομάδα VSE, n=103; Ομάδα ελέγχου, n=88). Αποτελέσματα: Η μοιραία σηπτική καταπληξία ήταν λιγότερο πιθανή στην ομάδα Στεροειδή έναντι στην ομάδα Μη Στεροειδή [CSHR, 0.40, 95% confidence interval (CI), 0.20-0.82; p=0.012]. Ο θάνατος από μη λοιμώδη αίτια και η πτωχή ενδονοσοκομειακή έκβαση προβλέφθηκαν από την ομάδα και από τη σχετιζόμενη με την αναζωογώνηση δόση διττανθρακικών. Τα αποτελέσματα της ανάλυσης ΙΤΤ για τη μοιραία σηπτική καταπληξία και την πτωχή ενδονοσοκομειακή έκβαση ήταν παρόμοια. Η ομάδα Στεροειδή σε σχέση με την ομάδα ΜηΣτεροειδή είχε περισσότερες ημέρες ελεύθερες οργανικής ανεπάρκειας και εκτός αναπνευστήρα, καθώς και χωρίς επεισόδια υπεργλυκαιμίας/ χρήσης ινσουλίνης. Συμπέρασμα: Σε αυτήν την επανανάλυση, η στρες-δόση στεροειδών συσχετίστηκε με χαμηλότερο κίνδυνο μετά την αναζωογώνηση μοιραίας σηπτικής καταπληξίας. Η απόδειξη της αιτιότητας απαιτεί επιβεβαιώση από μελλοντικές τυχαιοποιημένες μελέτες.

The incidence of postoperative hyponatremia and associated neurological sequelae in children with intracranial neoplasms

2014 ◽  
Vol 13 (3) ◽  
pp. 283-290 ◽  
Author(s):  
Cydni N. Williams ◽  
Jennifer S. Belzer ◽  
Jay Riva-Cambrin ◽  
Angela P. Presson ◽  
Susan L. Bratton
Keyword(s):  
Obstructive Hydrocephalus ◽  
Cerebral Performance Category ◽  
Young Age ◽  
Neurosurgical Procedures ◽  
Intracranial Tumors ◽  
Performance Category ◽  
Increased Risk ◽  
Neurosurgical Patients ◽  
Cerebral Performance Category Score ◽  
Category Score

Object Intracranial tumors are common pediatric neoplasms and account for substantial morbidity among children with cancer. Hyponatremia is a known complication of neurosurgical procedures and is associated with higher morbidity among neurosurgical patients. The authors aimed to estimate the incidence of hyponatremia, identify clinical characteristics associated with hyponatremia, and assess the association between hyponatremia and patient outcome among children undergoing surgery for intracranial tumors. Methods This is a retrospective cohort study of children ranging in age from 0 to 19 years who underwent an initial neurosurgical procedure for an intracranial tumor between January 2001 and February 2012. Hyponatremia was defined as serum sodium ≤ 130 mEq/L during admission. Results Hyponatremia during admission occurred in 39 (12%) of 319 patients and was associated with young age and obstructive hydrocephalus (relative risk [RR] 2.9 [95% CI 1.3–6.3]). Hyponatremic patients were frequently symptomatic; 21% had seizures and 41% had altered mental status. Hyponatremia was associated with complicated care including mechanical ventilation (RR 4.4 [95% CI 2.5–7.9]), physical therapy (RR 4 [95% CI 1.8–8.8]), supplemental nutrition (RR 5.7 [95% CI 3.3–9.8]), and infection (RR 5.7 [95% CI 3.3–9.5]). Hyponatremic patients had a 5-fold increased risk of moderate or severe disability on the basis of their Pediatric Cerebral Performance Category score at discharge (RR 5.3 [95% CI 2.9–9.8]). Obstructive hydrocephalus (adjusted odds ratio [aOR] 3.24 [95% CI 1.38–8.94]) and young age (aOR 0.92 [95% CI 0.85–0.99]) were independently associated with hyponatremia during admission. Hyponatremia was independently associated with moderate or worse disability by Pediatric Cerebral Performance Category score at discharge (aOR 6.2 [95% CI 3.0–13.03]). Conclusions Hyponatremia was common, particularly among younger children and those with hydrocephalus. Hyponatremia was frequently symptomatic and was associated with more complicated hospital courses. Hyponatremia was independently associated with worse neurological outcome when adjusted for age and tumor factors. This study serves as an exploratory analysis identifying important risk factors for hyponatremia and associated sequelae. Further research into the causes of hyponatremia and the association with poor outcome is needed to determine if prevention and treatment of hyponatremia can improve outcomes in these children.

scholarly journals Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Konrad Kirsch ◽  
Stefan Heymel ◽  
Albrecht Günther ◽  
Kathleen Vahl ◽  
Thorsten Schmidt ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
White Matter ◽  
Circulatory Arrest ◽  
Cerebral Performance Category ◽  
Time Interval ◽  
Performance Category ◽  
Neurologic Outcomes ◽  
Ischaemic Brain ◽  
Cerebral Performance Category Score ◽  
Category Score

Abstract Background This study aimed to assess the prognostic value regarding neurologic outcome of CT neuroimaging based Gray-White-Matter-Ratio measurement in patients after resuscitation from cardiac arrest. Methods We retrospectively evaluated CT neuroimaging studies of 91 comatose patients resuscitated from cardiac arrest and 46 non-comatose controls. We tested the diagnostic performance of Gray-White-Matter-Ratio compared with established morphologic signs of hypoxic-ischaemic brain injury, e. g. loss of distinction between gray and white matter, and laboratory parameters, i. e. neuron-specific enolase, for the prediction of poor neurologic outcomes after resuscitated cardiac arrest. Primary endpoint was neurologic function assessed with cerebral performance category score 30 days after the index event. Results Gray-White-Matter-Ratio showed encouraging interobserver variability (ICC 0.670 [95% CI: 0.592–0.741] compared to assessment of established morphologic signs of hypoxic-ischaemic brain injury (Fleiss kappa 0.389 [95% CI: 0.320–0.457]) in CT neuroimaging studies. It correlated with cerebral performance category score with lower Gray-White-Matter-Ratios associated with unfavourable neurologic outcomes. A cut-off of 1.17 derived from the control population predicted unfavourable neurologic outcomes in adult survivors of cardiac arrest with 100% specificity, 50.3% sensitivity, 100% positive predictive value, and 39.3% negative predictive value. Gray-White-Matter-Ratio prognostic power depended on the time interval between circulatory arrest and CT imaging, with increasing sensitivity the later the image acquisition was executed. Conclusions A reduced Gray-White-Matter-Ratio is a highly specific prognostic marker of poor neurologic outcomes early after resuscitation from cardiac arrest. Sensitivity seems to be dependent on the time interval between circulatory arrest and image acquisition, with limited value within the first 12 h.

scholarly journals Hanging and asphyxia: Interventions, patient outcomes and resource utilisation in a UK tertiary intensive care unit

2017 ◽  
Vol 19 (3) ◽  
pp. 201-208 ◽  
Author(s):  
William JC Sutcliffe ◽  
Anton G Saayman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Organ Donation ◽  
Cerebral Performance Category ◽  
Temperature Management ◽  
Performance Category ◽  
History Of ◽  
Cerebral Performance Category Score ◽  
Category Score

Introduction Suicide is increasing in the UK, and hanging is now the commonest mechanism. United Kingdom intensive care unit outcomes (including organ donation) after hanging have not been reported. Methods Retrospective analysis of cases admitted to a UK tertiary intensive care unit with a primary or secondary diagnosis of hanging/asphyxia. Case analysis divided between those with and without a history of cardiopulmonary resuscitation, and outcomes described using the cerebral performance category score. Results A total of 33 cases were reviewed, 19 with a history of cardiopulmonary resuscitation (three survivors with cerebral performance category of 1–2), 14 without history of cardiopulmonary resuscitation (14 survivors, 11 cerebral performance category score of 1, 3 cerebral performance category score of 3). Three cases went on to have a good neurological outcome with a cerebral performance category score of one, and 16 died. The three survivors only had bystander cardiopulmonary resuscitation and cardiac arrest was not independently confirmed. All three had a good neurological recovery despite two having hypoxic–ischaemic encephalopathy on computed tomography head. Of the three survivors, one received no temperature management and two received targeted temperature management. Median intensive care unit length of stay after hanging with cardiopulmonary resuscitation was 3.0 days (2.4–6.7 days). Fifteen patients were discussed with the organ donation specialist nurse, with six consenting to donation and six declining consent, with 18 solid organs donated. All 14 of those without a history of cardiopulmonary resuscitation survived, 11 with a cerebral performance category score of 1 and three having a cerebral performance category score of 3. No patients received active temperature management. Median intensive care unit length of stay in this group was 2.9 days (1.2–3.8). Conclusions Outcomes after confirmed cardiac arrest following hanging are poor, in keeping with existing international data, even in those surviving to intensive care unit admission. Despite low rates of consent to organ donation, the overall organ donation is high due to high referral rates. Despite the poor prognosis in this population, early initiation of full resuscitation should be offered to optimise survival and facilitate the possibility of donation.

scholarly journals Predictors of Functional Outcome after Intraoperative Cardiac Arrest

2014 ◽  
Vol 121 (3) ◽  
pp. 482-491 ◽  
Author(s):  
Anne-Laure Constant ◽  
Claire Montlahuc ◽  
David Grimaldi ◽  
Nicolas Pichon ◽  
Nicolas Mongardon ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Ventricular Fibrillation ◽  
Odds Ratio ◽  
Functional Outcomes ◽  
Cerebral Performance Category ◽  
Performance Category ◽  
Cerebral Performance Category Score ◽  
Category Score

Abstract Background: Few outcome data are available about intraoperative cardiac arrest (IOCA). The authors studied 90-day functional outcomes and their determinants in patients admitted to the intensive care unit after IOCA. Methods: Patients admitted to 11 intensive care units in a period of 2000–2013 were studied retrospectively. The main outcome measure was a day-90 Cerebral Performance Category score of 1 or 2. Results: Of the 140 patients (61 women and 79 men; median age, 60 yr [interquartile range, 46 to 70]), 131 patients (93.6%) had general anesthesia, 80 patients (57.1%) had emergent surgery, and 73 patients (52.1%) had IOCA during surgery. First recorded rhythms were asystole in 73 patients (52.1%), pulseless electrical activity in 44 patients (31.4%), and ventricular fibrillation/ventricular tachycardia in 23 patients (16.4%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation were 0 min (0 to 0) and 10 min (5 to 20), respectively. Postcardiac arrest shock was identified in 114 patients (81.4%). Main causes of IOCA were preoperative complications (n = 46, 32.9%), complications of anesthesia (n = 39, 27.9%), and complications of surgical procedures (n = 36, 25.7%). On day 90, 63 patients (45.3%) were alive with Cerebral Performance Category score 1/2. Independent predictors of day-90 Cerebral Performance Category score 1/2 were day-1 Logistic Organ Dysfunction score (odds ratio, 0.78 per point; 95% CI, 0.71 to 0.87; P = 0.0001), ventricular fibrillation/tachycardia as first recorded rhythm (odds ratio, 4.78; 95% CI, 1.38 to 16.53; P = 0.013), and no epinephrine therapy during postcardiac arrest syndrome (odds ratio, 3.14; 95% CI, 1.29 to 7.65; P = 0.012). Conclusions: By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the intensive care unit management of postcardiac arrest syndrome may be amenable to improvement.

Predictors of Neurological Outcome of Tuberculous Meningitis in Childhood

2016 ◽  
Vol 31 (14) ◽  
pp. 1622-1627 ◽  
Author(s):  
Sumeet R. Dhawan ◽  
Anju Gupta ◽  
Pratibha Singhi ◽  
Naveen Sankhyan ◽  
Prahbhjot Malhi ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Tuberculous Meningitis ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Cerebral Performance Category ◽  
Category Scale ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Performance Category ◽  
Normal Functional

Aims: To assess the long-term outcome of childhood tuberculous meningitis treated with modern 4-drug antitubercular regimens and to determine predictors of survival and morbidity. Methods: In this single-center prospective cohort, outcome of children with tuberculous meningitis treated with standard regimens was assessed at 6 months and 12 months after discharge using the Pediatric Cerebral Performance Category Scale. Results: Of 130 children, 38 died in hospital and 34 were either severely disabled or comatose/vegetative at discharge. At 6 and 12 months, 87% of the survivors were either normal (n = 62) or mildly disabled (n = 17, on the Pediatric Cerebral Performance Category scale). On multivariate analysis, the factors associated with poor outcome at 12 months were stage III at admission (adjusted odds ratio 4.4, 95% confidence interval, 1.7-11.2, P = .002) and presence of infarcts on neuroimaging (adjusted odds ratio 2.6, 95% confidence interval, 1.1-6.6, P = .037). Conclusions: Despite the high in-hospital mortality, in resource-constraint settings, the survivors showed remarkable improvement, with two-thirds returning to a normal functional status at 6 months’ follow-up.

scholarly journals SAT0131 CARDIO- AND CEREBROVASCULAR RISK WITH CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (CSDMARDS) IN RHEUMATOID ARTHRITIS (RA): A REAL-WORLD COMPARATIVE ASSESSMENT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1002-1002
Author(s):  
A. Prats-Uribe ◽  
B. Illingens ◽  
D. Vizcaya ◽  
J. Weaver ◽  
E. Burn ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Meta Analysis ◽  
Hazard Ratio ◽  
Health Improvement ◽  
Research Support ◽  
Intention To Treat ◽  
Covariate Balance ◽  
Hazard Ratios ◽  
The Health Improvement Network

Background:RA is associated with an increased cardiovascular (CV) risk. csDMARDs are first-line treatments for RA and can mitigate this risk, but limited data exist on their CV effects. Previous trials have reported protective effects for methotrexate (MTX) and hydroxychloroquine (HCQ), but no similar data exist on sulfasalazine (SSZ) or leflunomide (LEF).Objectives:To assess the comparative effect of csDMARDs on the risk of myocardial infarction (MI) and stroke in RA patientsMethods:Data from 6 claims/electronic health records databases across Germany, US, and UK, all mapped to the Observational Medical Outcomes Partnership (OMOP) common data model. A cohort study was conducted including patients ≥18 years old, with first RA diagnosis in 2005-2019, initiating csDMARD monotherapy with MTX, HCQ, SSZ, or LEF. Those with a prior diagnosis of other inflammatory arthritis or <1 year prior follow-up were excluded. Patients were followed until first outcome, death, loss of or 5 years follow-up. Propensity score stratification was used, and hazard ratios (HR) estimated for HCQ, SSZ and LEF compared to MTX in each dataset using Cox regression. HR were calibrated (cHR) for residual confounding using negative control outcomes. Estimates were pooled where I2for heterogeneity <0.4. Intention to treat and an on treatment analyses are reported.Results:145,248 patients were included (MTX: 73,996, HCQ: 49,752, SSZ: 12,256, LEF: 9,244). Pooled rates of MI and stroke for MTX were 7.64 and 10.26 per 1,000 person years respectively. Detailed estimate cHRs are shown in Figure 1 for the intention to treat analysis. MI risk with SSZ and LEF was comparable to MTX. Risk of stroke was similar between LEF and MTX, but reduced for HCQ and SSZ compared to MTX, with pooled cHR (95% CI) 0.86 (0.78 to 0.95) and 0.71 (0.52 to 0.98) for HCQ and SSZ respectively. Similar results were found for “on treatment” analyses.Figure 1.Calibrated hazard ratios (cHRs) for MI and strokeConclusion:Overall, all four csDMARDs had similar effects on MI risk. HCQ and SSZ use were associated with a decreased risk of stroke compared to MTX. The observed differences may be attributable to differential effects on the atherosclerotic process, differential disease control, or both.Database estimates not reported where adequate covariate balance not attained. Meta-analysis results not reported where I2>0.4. MEDICARE did not pass diagnostics for SSZ and LEF analyses. cHR: calibrated Hazard Ratio; CI: Confidence Interval; MTX: Methotrexate; HCQ: Hydroxychloroquine; SSZ: sulphasalazine; LEF: Leflunomide; THIN: The Health Improvement Network (UK); Optum: Optum de-identified Clinformatics Datamart (US); MDCR: Medicare (US); GERMANY: IQVIA Disease Analyzer EMR (Germany); CCAE: IBM MarketScan Commercial Claims and Encounters (US); AMBEMR: IQVIA Ambulatory EMR (US)Database estimates not reported where adequate covariate balance not attained. Meta-analysis results not reported where I2>0.4. MEDICARE did not pass diagnostics for SSZ and LEF analyses. cHR: calibrated Hazard Ratio; CI: Confidence Interval; MTX: Methotrexate; HCQ: Hydroxychloroquine; SSZ: sulphasalazine; LEF: Leflunomide; THIN: The Health Improvement Network (UK); Optum: Optum de-identified Clinformatics Datamart (US); MDCR: Medicare (US); GERMANY: IQVIA Disease Analyzer EMR (Germany); CCAE: IBM MarketScan Commercial Claims and Encounters (US); AMBEMR: IQVIA Ambulatory EMR (US)Disclosure of Interests: :Albert Prats-Uribe: None declared, Ben Illingens: None declared, David Vizcaya Employee of: Bayer, James Weaver Shareholder of: J&J Shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen, Paid instructor for: Janssen employee, have instructed at conferences, Speakers bureau: Janssen employee, have spoken at conferences, Edward Burn: None declared, Ruta Sawant Shareholder of: AbbVie, Employee of: AbbVie, Karine Marinier Employee of: Servier, Patrick Ryan: None declared, Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen

Abstract 82: Mechanical CPR Is Associated with Poor Neurologically Intact Survival in a Statewide Registry

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Scott Youngquist ◽  
Patrick Ockerse ◽  
Chris Stratford ◽  
Peter Taillac
Keyword(s):  
Cardiac Arrest ◽  
Randomized Trials ◽  
Cerebral Performance Category ◽  
Comparative Performance ◽  
Performance Category ◽  
Neurologically Intact ◽  
Residual Confounding ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest ◽  
Category Score

BACKGROUND: Large, randomized trials have concluded that mechanical CPR (mech-CPR) is equivalent to manual CPR (man-CPR) with respect to outcomes from out-of-hospital cardiac arrest (OHCA). However, outside of such well-controlled settings, the performance of mech-CPR is uncertain. We sought to determine the association, if any, between mech-CPR use and outcomes in a large, statewide registry of cardiac arrest. METHODS: The Utah State CARES registry began collecting outcomes on all cardiac arrests in the state of Utah in July of 2012. We analyzed data from this registry to determine the comparative performance of resuscitations utilizing mech-CPR vs man-CPR. Neurologically-intact survival was defined as a Cerebral Performance Category score of 1 or 2. RESULTS: Mech-CPR was performed on 237/1,567 OHCAs (15%) during the 1.5 year period of analysis. The majority of devices used were of the load-distributing band type 213/237 (90%). Neurologically-intact survival was 10/237 (4%) in the cohort receiving mech-CPR vs 149/1,330 (11%) in the cohort receiving man-CPR. When controlling for Utstein variables (TABLE), mech-CPR was associated with significantly reduced odds of neurologically-intact survival, with an adjusted odds ratio 0.4 (95% CI 0.2-0.9). CONCLUSIONS: We observed a statistically significant association between mech-CPR use during resuscitation and reduced odds of neurologically-intact survival in our statewide cardiac arrest database. Outside of randomized trials, the resuscitation performance of mech-CPR devices may suffer from poor implementation or increased application to non-viable survivors. Residual confounding of this observational finding is also possible.

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