scholarly journals Incidence, Risk Factors and Outcomes of New Onset Supraventricular Arrhythmias in African American Patients with Severe Sepsis

2016 ◽  
Vol 26 (2) ◽  
pp. 205 ◽  
Author(s):  
O'Dene Lewis ◽  
Julius Ngwa ◽  
Richard F. Gillum ◽  
Alicia Thomas ◽  
Wayne Davis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Supraventricular Arrhythmias ◽  
Incidence Risk ◽  
New Onset

<p><strong>Purpose</strong>: New onset supraventricular arrhythmias (SVA) are commonly reported in mixed intensive care settings. We sought to determine the incidence, risk factors and outcomes of new onset SVA in African American (AA) patients with severe sepsis admitted to medical intensive care unit (MICU).</p><p><strong>Methods:</strong> Patients admitted to MICU between January 2012 through December 2012 were studied. Patients with a previous history of arrhythmia or with new onset of ventricular arrhythmia were excluded. Data on risk factors, critical care interventions and outcomes were obtained.</p><p><strong>Results:</strong> One hundred and thirty-one patients were identified. New onset SVA occurred in 34 (26%) patients. Of those 34, 20 (59%) had atrial fibrillation (AF), 6 (18%) had atrial flutter and 8 (24%) had other forms of SVA. Compared with patients without SVA, patients with new onset SVA were older (69 ± 12 yrs vs 59 ± 13 yrs, P=.003), had congestive heart failure (47% vs 24%, P=.015) and dyslipidemia (41% vs 15%, P=.002). Additionally, they had a higher mean mortality prediction model (MPM II) score (65 ± 25 vs 49 ± 26, P=.001) and an increased incidence of respiratory failure (85% vs 55%, P=.001). Hospital mortality in patients with new onset SVA was 18 (53%) vs 30 (31%); P=.024; however, in a multivariate analysis, new onset SVA was associated with nonsignificantly increased odds (OR 2.58, 95% CI 0.86-8.05) for in-hospital mortality.</p><p><strong>Conclusion:</strong> New onset SVA was prevalent in AA patients with severe sepsis and occurred more frequently with advanced age, increased severity of illness, congestive heart failure, and acute respiratory failure; it was associated with higher unadjusted in hospital mortality. However, after multiple adjustments, new onset SVA did not remain an independent predictor of mortality. <em>Ethn Dis.</em>2016;26(2):205-212; doi:10.18865/ ed.26.2.205</p>

scholarly journals Chirurginių ligonių, po pilvo organų operacijų gydomų Reanimacijos ir intensyviosios terapijos skyriuje, prognostinių veiksnių įvertinimas

2004 ◽  
Vol 2 (2) ◽  
pp. 0-0
Author(s):  
Saulius Vosylius ◽  
Jūratė Šipylaitė ◽  
Juozas Ivaškevičius
Keyword(s):  
Risk Factors ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Length Of Stay ◽  
Abdominal Surgery ◽  
Hospital Mortality ◽  
Organ Dysfunction ◽  
Severity Of Illness ◽  
Prolonged Stay ◽  
Saps Ii

Saulius Vosylius, Jūratė Šipylaitė, Juozas IvaškevičiusVilniaus universiteto Anesteziologijos ir reanimatologijos klinika,Vilniaus greitosios pagalbos universitetinė ligoninė,Šiltnamių g. 29, LT-04130 VilniusEl paštas: [email protected] Įvadas / tikslas Chirurginiams sunkios būklės ligoniams po pilvo organų operacijų reikalinga ilgiau trunkanti intensyvioji terapija. Darbo tikslas – įvertinti prognostinius veiksnius, susijusius su užsitęsusiu gydymu Reanimacijos ir intensyviosios terapijos skyriuje (RITS), ir atlikti su mirštamumu susijusių veiksnių analizę. Ligoniai ir metodai Prospektyviam tyrimui atrinkti 644 chirurginiai ligoniai, po pilvo organų operacijų gydyti Vilniaus greitosios pagalbos universitetinės ligoninės RITS. Būklės sunkumas įvertintas pagal SAPS II, o organų funkcijų sutrikimo laipsnis – pagal SOFA sistemas. Pagal gydymo RITS trukmę ligoniai suskirstyti į dvi grupes: gydytų iki 2 parų ir ilgiau nei 2 paros; pagal hospitalizacijos baigtį – į pasveikusiųjų ir mirusiųjų. Rezultatai Iki RITS įgyta infekcija nustatyta 290 ligonių, daugumai jų (89%) buvo intraabdomininė infekcija. Vienos ir daugiau organų sistemų disfunkcija pirmąją parą RITS buvo 61% ligonių. Gydymo RITS trukmės vidurkis – 3 paros, ligoninėje – 17 parų. Kuo ilgiau užtruko gydymas RITS, tuo didesnei daliai ligonių pasireiškė infekcinių komplikacijų. RITS įgyta infekcija patvirtinta 59 ligoniams, dažniausiai pneumonija ir intraabdomininė infekcija. Dauginės tiesinės regresijos metodika nustatyti su ilgesne gydymo RITS trukme susiję prognostiniai veiksniai: RITS įgyta infekcija, sutrikusios funkcijos organų sistemų skaičius ir sunkios eigos sepsis. Hospitalinis mirštamumas – 18%. Jis laipsniškai didėjo daugėjant sutrikusios funkcijos organų sistemų. Dauginės loginės regresijos metodika nustatyti nepriklausomi mirštamumo ligoninėje prognostiniai veiksniai: sunkios eigos sepsis, RITS įgytos infekcijos, sutrikusios funkcijos organų sistemų skaičius, būklės sunkumas ir vyresnis amžius. Išvados RITS įgytos infekcijos, sunkios eigos sepsis ir organų sistemų funkcijų sutrikimai yra svarbiausi ilgesnę intensyviosios terapijos trukmę ir didesnį mirštamumą lemiantys prognostiniai veiksniai ligoniams po pilvo organų operacijų. Prasminiai žodžiai: chirurgija, intensyvioji terapija, infekcija, sepsis, organo disfunkcija Assessment of risk factors for abdominal surgery patients admitted to the intensive care unit Saulius Vosylius, Jūratė šipylaitė, Jjuozas Ivaškevičius Background Prolonged intensive care is often required for severely ill patients after abdominal surgery. The goal of the study was to assess the risk factors associated with prolonged stay in the intensive care unit (ICU) and the hospital mortality. Patients and methods 644 patients after abdominal surgery, admitted to the ICU, were included into a prospective study. The SAPS II system was used for the assessment of the severity of illness and the SOFA system for organ dysfunction assessment. The patients were divided into groups according to length of stay in the ICU and survival status at the hospital discharge. Results Infection acquired before ICU admission was present in 290 patients, most commonly (89%) in intra-abdominal site. 61% of patients had at least organ dysfunction on the first day. The mean length of stay in the ICU was 3 days and in the hospital 17 days. As the length of stay in the ICU increased, more patients had infection complications of diseases. An ICU-acquired infection was diagnosed in 59 patients (most commonly pneumonia and intra-abdominal infection). Multiple linear regression analysis was applied to find the variables related to prolonged stay in the ICU: severe sepsis, ICU-acquired infection and organ dysfunction score. Multiple logistic regression analysis revealed that severe sepsis, ICU-acquired infection, organ dysfunction score, severity of illness, and age were independently associated with hospital mortality. Conclusions ICU-acquired infection, severe sepsis and organ dysfunction are independent risk factors in a prolonged length stay in the ICU and in hospital mortality for patients after abdominal surgery. Keywords: surgery, intensive care, infection, sepsis, organ dysfunction

scholarly journals Severe Acute Kidney Injury in Critically Ill Patients with COVID-19 Admitted to ICU: Incidence, Risk Factors, and Outcomes

2021 ◽  
Vol 10 (6) ◽  
pp. 1217
Author(s):  
Muriel Ghosn ◽  
Nizar Attallah ◽  
Mohamed Badr ◽  
Khaled Abdallah ◽  
Bruno De Oliveira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Incidence Risk

Background: Critically ill patients with COVID-19 are prone to develop severe acute kidney injury (AKI), defined as KDIGO (Kidney Disease Improving Global Outcomes) stages 2 or 3. However, data are limited in these patients. We aimed to report the incidence, risk factors, and prognostic impact of severe AKI in critically ill patients with COVID-19 admitted to the intensive care unit (ICU) for acute respiratory failure. Methods: A retrospective monocenter study including adult patients with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection admitted to the ICU for acute respiratory failure. The primary outcome was to identify the incidence and risk factors associated with severe AKI (KDIGO stages 2 or 3). Results: Overall, 110 COVID-19 patients were admitted. Among them, 77 (70%) required invasive mechanical ventilation (IMV), 66 (60%) received vasopressor support, and 9 (8.2%) needed extracorporeal membrane oxygenation (ECMO). Severe AKI occurred in 50 patients (45.4%). In multivariable logistic regression analysis, severe AKI was independently associated with age (odds ratio (OR) = 1.08 (95% CI (confidence interval): 1.03–1.14), p = 0.003), IMV (OR = 33.44 (95% CI: 2.20–507.77), p = 0.011), creatinine level on admission (OR = 1.04 (95% CI: 1.008–1.065), p = 0.012), and ECMO (OR = 11.42 (95% CI: 1.95–66.70), p = 0.007). Inflammatory (interleukin-6, C-reactive protein, and ferritin) or thrombotic (D-dimer and fibrinogen) markers were not associated with severe AKI after adjustment for potential confounders. Severe AKI was independently associated with hospital mortality (OR = 29.73 (95% CI: 4.10–215.77), p = 0.001) and longer hospital length of stay (subhazard ratio = 0.26 (95% CI: 0.14–0.51), p < 0.001). At the time of hospital discharge, 74.1% of patients with severe AKI who were discharged alive from the hospital recovered normal or baseline renal function. Conclusion: Severe AKI was common in critically ill patients with COVID-19 and was not associated with inflammatory or thrombotic markers. Severe AKI was an independent risk factor of hospital mortality and hospital length of stay, and it should be rapidly recognized during SARS-CoV-2 infection.

scholarly journals Predictors of mortality in COPD exacerbation cases presenting to the respiratory intensive care unit

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yang Cao ◽  
Zhenzhen Xing ◽  
Huanyu Long ◽  
Yilin Huang ◽  
Ping Zeng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Chronic Heart Failure ◽  
Hospital Mortality ◽  
Invasive Mechanical Ventilation ◽  
Copd Exacerbation ◽  
Factors Associated ◽  
Respiratory Intensive Care Unit

Abstract Background Studies report high in-hospital mortality of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) especially for those requiring admission to an intensive care unit. Recognizing factors associated with mortality in these patients could reduce health care costs and improve end-of-life care. Methods This retrospective study included AECOPD patients admitted to the respiratory intensive care unit of a tertiary hospital in Beijing from Jan 1, 2011 to Dec 31, 2018. Patients demographic characteristics, blood test results and comorbidities were extracted from the electronic medical record system and compared between survivors and non-survivors. Results We finally enrolled 384 AECOPD patients: 44 (11.5%) patients died in hospital and 340 (88.5%) were discharged. The most common comorbidity was respiratory failure (294 (76.6%)), followed by hypertension (214 (55.7%)), coronary heart disease (115 (29.9%)) and chronic heart failure (76 (19.8%)). Multiple logistic regression analysis revealed that independent risk factors associated with in-hospital mortality included lymphocytopenia, leukopenia, chronic heart failure and requirement for invasive mechanical ventilation. Conclusions The in-hospital mortality of patients with acute COPD exacerbation requiring RICU admission is high. Lymphocytes < 0.8 × 109/L, leukopenia, requirement for invasive mechanical ventilation, and chronic heart failure were identified as risk factors associated with increased mortality rates.

scholarly journals Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study

2021 ◽  
Vol 18 (11) ◽  
pp. 5865
Author(s):  
Salma Younes ◽  
Muthanna Samara ◽  
Rana Al-Jurf ◽  
Gheyath Nasrallah ◽  
Sawsan Al-Obaidly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Population Based ◽  
Incidence Rates ◽  
Large For Gestational Age ◽  
Mortality And Morbidity ◽  
Early Term ◽  
Incidence Risk

Preterm birth (PTB) and early term birth (ETB) are associated with high risks of perinatal mortality and morbidity. While extreme to very PTBs have been extensively studied, studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes of PTB and ETB births in Qatar. We examined 15,865 singleton live births using 12-month retrospective registry data from the PEARL-Peristat Study. PTB and ETB incidence rates were 8.8% and 33.7%, respectively. PTB and ETB in-hospital mortality rates were 16.9% and 0.2%, respectively. Advanced maternal age, pre-gestational diabetes mellitus (PGDM), assisted pregnancies, and preterm history independently predicted both PTB and ETB, whereas chromosomal and congenital abnormalities were found to be independent predictors of PTB but not ETB. All groups of PTB and ETB were significantly associated with low birth weight (LBW), large for gestational age (LGA) births, caesarean delivery, and neonatal intensive care unit (NICU)/or death of neonate in labor room (LR)/operation theatre (OT). On the other hand, all or some groups of PTB were significantly associated with small for gestational age (SGA) births, Apgar <7 at 1 and 5 minutes and in-hospital mortality. The findings of this study may serve as a basis for taking better clinical decisions with accurate assessment of risk factors, complications, and predictions of PTB and ETB.

Population-based assessment of intensive care unit-acquired bloodstream infections in adults: Incidence, risk factors, and associated mortality rate

2002 ◽  
Vol 30 (11) ◽  
pp. 2462-2467 ◽  
Author(s):  
Kevin B. Laupland ◽  
David A. Zygun ◽  
H. Dele Davies ◽  
Deirdre L. Church ◽  
Thomas J. Louie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Bloodstream Infections ◽  
Population Based ◽  
Incidence Risk

scholarly journals Early resuscitation orders in hospitalized oldest-old with COVID-19: A multicenter cohort study

2021 ◽  
pp. 026921632110183
Author(s):  
Ruth Piers ◽  
Eva Van Braeckel ◽  
Dominique Benoit ◽  
Nele Van Den Noortgate
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Oldest Old ◽  
Case Report Form ◽  
Resuscitation Orders ◽  
Intensive Care Admission ◽  
Treatment Limitation ◽  
Early Decision

Background: In particular older people are at risk of mortality due to corona virus disease 2019 (COVID-19). Advance care planning is essential to assist patient autonomy and prevent non-beneficial medical interventions. Aim: To describe early (taken within 72 h after hospital admission) resuscitation orders in oldest-old hospitalized with COVID-19. Setting/participants: A cohort of patients aged 80 years and older admitted to the acute hospital in March and April 2020 with COVID-19 were retrospectively recruited from 10 acute hospitals in Belgium. Recruitment was done through a network of geriatricians. Results: Overall, 766 octogenarians were admitted of whom 49 were excluded because no therapeutic relationship with the geriatrician and six because of incomplete case report form. Early decisions not to consider intensive care admission were taken in 474/711 (66.7%) patients. This subgroup was characterized by significantly higher age, higher number of comorbidities and higher frailty level. There was a significant association between the degree of the treatment limitation and the degree of premorbid frailty ( p < 0.001). Overall in-hospital mortality was 41.6% in patients with an early decision not to consider intensive care admission (67.1% in persons who developed respiratory failure vs 16.7% in patients without respiratory failure ( p < 0.001)). Of 104 patients without early decision not to consider intensive care admission but who developed respiratory failure, 59 were eventually not transferred to intensive care unit with in-hospital mortality of 25.4%; 45 were transferred to the intensive care unit with mortality of 64.4%. Conclusions: Geriatricians applied all levels of treatment in oldest-old hospitalized with COVID-19. Early decisions not to consider intensive care admission were taken in two thirds of the cohort of whom more than 50% survived to hospital discharge by means of conservative treatment.

Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock

2021 ◽  
pp. 088506662110614
Author(s):  
Mohinder R. Vindhyal ◽  
Liuqiang (Kelsey) Lu ◽  
Sagar Ranka ◽  
Prakash Acharya ◽  
Zubair Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Congestive Heart Failure ◽  
Hospital Mortality ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Cross Sectional ◽  
Increased Risk ◽  
Icd 10 ◽  
Nationwide Readmission Database

Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings’ mechanisms to improve outcomes in patients with SS and underlying CHF.

O210 Risk factors for congestive heart failure in patients with chronic kidney disease: the CRIC study

Global Heart ◽  
2014 ◽  
Vol 9 (1) ◽  
pp. e58
Author(s):  
Jiang He ◽  
Wei Yang ◽  
Amanda Anderson ◽  
Harold Feldman ◽  
John Kusek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Congestive Heart Failure ◽  
Kidney Disease
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