scholarly journals Sepsis at ICU Admission Increases the ICU Mortality Rates Among Very Long ICU Stay Patients: A Secondary Analysis

2020 ◽  
Vol 5 (4) ◽  
pp. 134-140
Author(s):  
Farshid Rahimibashar ◽  
Mahmood Salesi ◽  
Amir Vahedian-Azimi ◽  
Masoum Khosh Fetrat
Keyword(s):  
Secondary Analysis ◽  
Mortality Rates ◽  
Icu Mortality ◽  
Icu Admission ◽  
Icu Stay

scholarly journals Sepsis Is Associated with a Preferential Diaphragmatic Atrophy

2014 ◽  
Vol 120 (5) ◽  
pp. 1182-1191 ◽  
Author(s):  
Boris Jung ◽  
Stephanie Nougaret ◽  
Matthieu Conseil ◽  
Yannaël Coisel ◽  
Emmanuel Futier ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Secondary Analysis ◽  
Lumbar Vertebra ◽  
Psoas Muscle ◽  
Cross Sectional ◽  
Icu Admission ◽  
Icu Stay ◽  
Peripheral Muscle ◽  
And Control

Abstract Background: Diaphragm and psoas are affected during sepsis in animal models. Whether diaphragm or limb muscle is preferentially affected during sepsis in the critically ill remains unclear. Methods: Retrospective secondary analysis study including 40 patients, comparing control (n = 17) and critically ill patients, with (n = 14) or without sepsis (n = 9). Diaphragm volume, psoas volume, and cross-sectional area of the skeletal muscles at the third lumbar vertebra were measured during intensive care unit (ICU) stay using tridimensional computed tomography scan volumetry. Diaphragm strength was evaluated using magnetic phrenic nerve stimulation. The primary endpoint was the comparison between diaphragm and peripheral muscle volume kinetics during the ICU stay among critically ill patients, with or without sepsis. Results: Upon ICU admission, neither diaphragm nor psoas muscle volumes were significantly different between critically ill and control patients (163 ± 53 cm3vs. 197 ± 82 cm3 for the diaphragm, P = 0.36, and 272 ± 116 cm3vs. to 329 ± 166 cm3 for the psoas, P = 0.31). Twenty-five (15 to 36) days after admission, diaphragm volume decreased by 11 ± 13% in nonseptic and by 27 ± 12% in septic patients, P = 0.01. Psoas volume decreased by 11 ± 10% in nonseptic and by 19 ± 13% in septic patients, P = 0.09. Upon ICU admission, diaphragm strength was correlated with diaphragm volume and was lower in septic (6.2 cm H2O [5.6 to 9.3]) than that in nonseptic patients (13.2 cm H2O [12.3 to 15.6]), P = 0.01. Conclusions: During the ICU stay, both diaphragm and psoas volumes decreased. In septic patients, the authors report for the first time in humans preferential diaphragm atrophy compared with peripheral muscles.

Insulin Treatment Is Associated With Increased Mortality in Critically Ill Patients With Type 2 Diabetes in the Intensive Care Unit

2021 ◽  
Author(s):  
Rongping Fan ◽  
Xuemin Peng ◽  
Bo Yu ◽  
Jiaojiao Huang ◽  
Xuefeng Yu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Insulin Treatment ◽  
Icu Mortality ◽  
Icu Admission ◽  
Icu Stay ◽  
Before And After ◽  
Length Of Icu Stay

Abstract Aims: Although insulin treatment is widely used in critically ill patients with type 2 diabetes mellitus in the intensive care unit (ICU), the clinical outcomes of insulin treatment remain unclear. This retrospective study aimed to explore the impact of insulin treatment on mortality and ICU stay among patients with type 2 diabetes. Methods: We consecutively recruited 578 ICU patients with type 2 diabetes, from 2011 to 2021. According to their medication history regarding insulin use before and after ICU admission, these patients were categorized into three groups: N-N (treated without insulin before and after ICU admission), N-I (treated without insulin before and with insulin after ICU admission) and I-I (treated with insulin before and after ICU admission). Clinical characteristics were analyzed, and clinical outcomes including mortality and the length of ICU stay were compared between the groups. Propensity score matching was performed to obtain comparable subpopulation and the Kaplan-Meier survival curves were graphed to describe the survival trend of different groups. Results: Compared with the N-N group, the N-I and I-I groups had significantly higher ICU mortality rates [20.0% (N-I) and 24.6% (I-I) vs. 0.0% (N-N); p < 0.001; respectively] and longer lengths of ICU stay [ 8.5 (N-I), 9 (I-I) vs. 6 (N-N), p < 0.05, respectively]. After propensity score matching, the N-I group had a significantly higher ICU mortality (15.4% vs. 0.0%, p = 0.025) and poorer survival rates (log-rank p = 0.040) than the N-N group. The length of ICU stay was significantly longer in the I-I group than in the N-N group (10 vs. 7, p = 0.026). Conclusions: Insulin treatment was associated with increased ICU mortality rate and longer length of ICU stay among critically ill patients with type 2 diabetes. Caution is warranted for the regular application of insulin in critical patients with type 2 diabetes.

Intensive Care Utilization during Hospital Admission for Delivery

2000 ◽  
Vol 92 (6) ◽  
pp. 1537-1544 ◽  
Author(s):  
Sumedha Panchal ◽  
Amelia M. Arria ◽  
Andrew P. Harris
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Hospital Admission ◽  
Hospital Setting ◽  
Mortality Rates ◽  
Cerebrovascular Event ◽  
Icu Mortality ◽  
Factors Associated ◽  
Icu Admission ◽  
Common Risk Factors

Background During childbirth, the maternal need for intensive care unit (ICU) services is not well-defined. This information could influence the decision whether to incorporate ICU services into the labor and delivery suite. Methods This study reports (1) ICU use and mortality rates in a statewide population of obstetric patients during their hospital admission for childbirth, and (2) the risk factors associated with ICU admission and mortality. A case-control design using patient records from a state-maintained anonymous database for the years 1984-1997 was used. Outcome variables included ICU use and mortality rates. Results Of the 822,591 hospital admissions for delivery of neonates during the study period, there were 1,023 ICU admissions (0.12%) and 34 ICU deaths (3.3%). Age, race, hospital type, volume of deliveries, and source of admission independently and in combination were associated with ICU admission (P &lt; 0.05). The most common risk factors associated with ICU admission included cesarean section, preeclampsia or eclampsia, and postpartum hemorrhage (P &lt; 0.001). Black race, high hospital volume of deliveries, and longer duration of ICU stay were associated with ICU mortality (P &lt; 0.05). The most common risk factors associated with ICU mortality included pulmonary complications, shock, cerebrovascular event, and drug dependence (P &lt; 0.05). Conclusions This study shows that ICU use and mortality rate during hospital admission for delivery of a neonate is low. These results may influence the location of perinatal ICU services in the hospital setting.

scholarly journals Outcomes and Prognostic Factors in Patients with Hematologic Malignancies in the Intensive Care unit: A Single-Center Cohort Study of 233 Cases in Taiwan

2021 ◽  
Author(s):  
Chieh-Lung Chen ◽  
Sing-Ting Wang ◽  
Wen-Chien Cheng ◽  
Chih-Yu Chen ◽  
Wei-Cheng Chen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Hematologic Malignancies ◽  
Mortality Rates ◽  
Icu Mortality ◽  
Icu Admission

Abstract BackgroundPatients with a hematologic malignancies (HM) have one of the highest mortality rates among cancer patients admitted to the medical intensive care unit (ICU). The aim of this study was to identify outcomes and risk factors that predict the prognosis of critically ill patients with HM in the ICU.MethodsA retrospective observational study was conducted in a tertiary referral hospital in Taiwan over 40 months (January 1, 2017–April 30, 2020). All adult patients with HM who were admitted to medical ICU were enrolled. Clinical data upon hospital and ICU admission were collected. The predictors of ICU mortality were evaluated using a multivariate analysis.ResultsA total of 233 patients with HM met the inclusion criteria. The median age (SD) was 59.3 (15.1) years, and 76% of the HMs were classified as high-grade disease. The median (IQR) Sequential Organ Failure Assessment (SOFA) score at ICU admission was 11 (9–15); Simplified Acute Physiology Score II, 64 (51–80); and Acute Physiology and Chronic Health Evaluation II score, 28 (23–34). The most common reasons for ICU admission were acute respiratory failure (63.1%) and septic shock (19.7%). The ICU and hospital mortality rates were 54.1% and 67.8%, respectively. A multivariate analysis revealed that the initiation of renal replacement therapy in the ICU (odds ratio [OR], 3.88; 95% CI, 1.66–9.08) and SOFA score (OR, 1.16; 95% CI, 1.03–1.31) were independently associated with ICU mortality.ConclusionsThe ICU and hospital outcomes of critically ill patients with HM are improving. Performance status, cancer status, invasive mechanical ventilation, severe neutropenia, and transplantation status were not identified as predictive factors of ICU outcome. Initiation of renal replacement therapy in the ICU and the SOFA score upon ICU admission were independently associated with ICU mortality. We suggest early and timely ICU admission of patients at risk of multiorgan failure.

scholarly journals The association between the quick sequential organ failure assessment score prior to emergency ICU admission and outcomes in adults with suspected infection

2020 ◽  
pp. 149-154
Author(s):  
S Pillay ◽  
T Kisten ◽  
HM Cassimjee
Keyword(s):  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Icu Mortality ◽  
Suspected Infection ◽  
Icu Admission ◽  
Icu Stay ◽  
Failure Assessment ◽  
Qsofa Score ◽  
Length Of Icu Stay

Background: Sepsis and septic shock are leading causes of mortality world-wide. In patients outside the intensive care unit (ICU) a rising qSOFA (quick Sequential Organ Failure Assessment) score correlates with mortality risk. We sought to investigate if the duration of a qSOFA score ≥ 2 prior to ICU admission further affects outcomes, namely: ICU mortality, in-hospital mortality and length of ICU stay. Method: A retrospective chart review was performed using the electronic ICU database at a quaternary level hospital in Durban, KwaZulu-Natal, examining entries from 1 January 2008 to 31 December 2017. The review included 235 emergency in-hospital adult admissions with suspected infection, of which 144 had a qSOFA score ≥ 2 prior to ICU admission. Results: There was no significant association between the duration of a qSOFA score ≥ 2 prior to ICU admission and ICU mortality (p = 0.975), in-hospital mortality (p = 0.918) and length of ICU stay until demise (p = 0.848) or discharge (p = 0.624). The qSOFA score was significantly associated with ICU mortality with scores of 0, 1, 2 and 3 resulting in ICU mortality rates of 0%, 22.5%, 53.7% and 84.6% respectively (p < 0.001). Conclusion: The duration of a qSOFA score ≥ 2 prior to emergency ICU admission was not significantly associated with ICU mortality, in-hospital mortality or length of ICU stay in adults with suspected infection.

scholarly journals SARS-CoV-2 Renal Impairment in Critical Care: An Observational Study of 42 Cases (Kidney COVID)

2021 ◽  
Vol 10 (8) ◽  
pp. 1571
Author(s):  
Antoine-Marie Molina Barragan ◽  
Emmanuel Pardo ◽  
Pierre Galichon ◽  
Nicolas Hantala ◽  
Anne-Charlotte Gianinazzi ◽  
...  
Keyword(s):  
Renal Impairment ◽  
Renal Injury ◽  
Kidney Injury ◽  
Critical Factor ◽  
University Hospital ◽  
Co2 Partial Pressure ◽  
Icu Admission ◽  
Icu Stay ◽  
Arterial Blood ◽  
Mixed Pattern

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to 5% to 16% hospitalization in intensive care units (ICU) and is associated with 23% to 75% of kidney impairments, including acute kidney injury (AKI). The current work aims to precisely characterize the renal impairment associated to SARS-CoV-2 in ICU patients. Forty-two patients consecutively admitted to the ICU of a French university hospital who tested positive for SARS-CoV-2 between 25 March 2020, and 29 April 2020, were included and classified in categories according to their renal function. Complete renal profiles and evolution during ICU stay were fully characterized in 34 patients. Univariate analyses were performed to determine risk factors associated with AKI. In a second step, we conducted a logistic regression model with inverse probability of treatment weighting (IPTW) analyses to assess major comorbidities as predictors of AKI. Thirty-two patients (94.1%) met diagnostic criteria for intrinsic renal injury with a mixed pattern of tubular and glomerular injuries within the first week of ICU admission, which lasted upon discharge. During their ICU stay, 24 patients (57.1%) presented AKI which was associated with increased mortality (p = 0.007), hemodynamic failure (p = 0.022), and more altered clearance at hospital discharge (p = 0.001). AKI occurrence was associated with lower pH (p = 0.024), higher PaCO2 (CO2 partial pressure in the arterial blood) (p = 0.027), PEEP (positive end-expiratory pressure) (p = 0.027), procalcitonin (p = 0.015), and CRP (C-reactive protein) (p = 0.045) on ICU admission. AKI was found to be independently associated with chronic kidney disease (adjusted OR (odd ratio) 5.97 (2.1–19.69), p = 0.00149). Critical SARS-CoV-2 infection is associated with persistent intrinsic renal injury and AKI, which is a risk factor of mortality. Mechanical ventilation settings seem to be a critical factor of kidney impairment.

scholarly journals Early Warning Scores at time of ICU admission to Predict Mortality in critically ill COVID-19 Patients

2021 ◽  
pp. 1-15
Author(s):  
Asha Tyagi ◽  
Surbhi Tyagi ◽  
Ananya Agrawal ◽  
Aparna Mohan ◽  
Devansh Garg ◽  
...  
Keyword(s):  
Developing Country ◽  
Cox Regression ◽  
Vital Signs ◽  
Developed Countries ◽  
Operating Characteristics ◽  
Icu Mortality ◽  
Prospective Data ◽  
Icu Admission ◽  
Reactive Protein ◽  
Time Of Admission

Abstract Objective: To assess ability of NEWS2, SIRS, qSOFA and CRB-65 calculated at the time of Intensive Care Unit (ICU) admission for predicting ICU-mortality in patients of laboratory confirmed COVID-19 infection. Methods: This prospective data analysis was based on chart reviews for laboratory confirmed COVID-19 patients admitted to ICUs over a 1month period. The NEWS2, CURB-65, qSOFA and SIRS were calculated from the first recorded vital signs upon admission to ICU and assessed for predicting mortality. Results: Total of 140 patients aged between 18 to 95 years were included in the analysis of whom majority were >60 years (47.8%), with evidence of pre-existing comorbidities (67.1%). The commonest symptom at presentation was dyspnea (86.4%). Based upon the Receiver Operating Characteristics-Area Under Curve (AUC), the best discriminatory power to predict ICU mortality was for the CRB65 (AUC: 0.720 [95% CI: 0.630 – 0.811]) followed closely by NEWS2 (AUC: 0.712 [95% CI: 0.622 – 0.803]). Additionally, a multivariate cox regression model showed Glasgow Coma Score at time of admission [P < 0.001; adjusted Hazard Ratio = 0.808 (95% CI: 0.715-0.911)] to be the only significant predictor of ICU mortality. Conclusion: CRB65 and NEWS2 scores assessed at the time of ICU admission offer only a fair discriminatory value for predicting mortality. Further evaluation after adding laboratory markers such as C-reactive protein and D-dimer may yield a more useful prediction model. Much of the earlier data is from developed countries and uses scoring at time of hospital admission. This study was from a developing country, with the scores assessed at time of ICU admission, rather than the emergency department as with existing data from developed countries, for patients with moderate/severe COVID disease. Since the scores showed some utility for predicting ICU mortality even when measured at time of ICU admission, their use in allocation of limited ICU resources in a developing country merits further research.

scholarly journals Intensive Care Unit Capacity Strain and Outcomes of Critical Illness in a Resource-Limited Setting: A 2-Hospital Study in South Africa

2018 ◽  
Vol 35 (10) ◽  
pp. 1104-1111 ◽  
Author(s):  
George L. Anesi ◽  
Nicole B. Gabler ◽  
Nikki L. Allorto ◽  
Carel Cairns ◽  
Gary E. Weissman ◽  
...  
Keyword(s):  
South Africa ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Primary Outcome ◽  
Resource Limited Setting ◽  
Icu Mortality ◽  
Icu Admission ◽  
Resource Limited ◽  
Limited Setting

Objective: To measure the association of intensive care unit (ICU) capacity strain with processes of care and outcomes of critical illness in a resource-limited setting. Methods: We performed a retrospective cohort study of 5332 patients referred to the ICUs at 2 public hospitals in South Africa using the country’s first published multicenter electronic critical care database. We assessed the association between multiple ICU capacity strain metrics (ICU occupancy, turnover, census acuity, and referral burden) at different exposure time points (ICU referral, admission, and/or discharge) with clinical and process of care outcomes. The association of ICU capacity strain at the time of ICU admission with ICU length of stay (LOS), the primary outcome, was analyzed with a multivariable Cox proportional hazard model. Secondary outcomes of ICU triage decision (with strain at ICU referral), ICU mortality (with strain at ICU admission), and ICU LOS (with strain at ICU discharge), were analyzed with linear and logistic multivariable regression. Results: No measure of ICU capacity strain at the time of ICU admission was associated with ICU LOS, the primary outcome. The ICU occupancy at the time of ICU admission was associated with increased odds of ICU mortality (odds ratio = 1.07, 95% confidence interval: 1.02-1.11; P = .004), a secondary outcome, such that a 10% increase in ICU occupancy would be associated with a 7% increase in the odds of ICU mortality. Conclusions: In a resource-limited setting in South Africa, ICU capacity strain at the time of ICU admission was not associated with ICU LOS. In secondary analyses, higher ICU occupancy at the time of ICU admission, but not other measures of capacity strain, was associated with increased odds of ICU mortality.

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