Comorbidity and Intensive Care Outcome — A Multivariable Analysis

2014 ◽  
Vol 15 (3) ◽  
pp. 205-212 ◽  
Author(s):  
Robert Docking ◽  
Andrew Mackay ◽  
Claire Williams ◽  
Jim Lewsey ◽  
John Kinsella ◽  
...  
Keyword(s):  
Intensive Care ◽  
Multivariable Analysis ◽  
Care Outcome

scholarly journals Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

Infection ◽  
2021 ◽  
Author(s):  
A. Oliva ◽  
G. Ceccarelli ◽  
C. Borrazzo ◽  
M. Ridolfi ◽  
G. D.’Ettorre ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Features ◽  
Multivariable Analysis ◽  
Invasive Pulmonary Aspergillosis ◽  
Lower Percentage ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Single Centre Study ◽  
Male Sex

Abstract Background Little is known in distinguishing clinical features and outcomes between coronavirus disease-19 (COVID-19) and influenza (FLU). Materials/methods Retrospective, single-centre study including patients with COVID-19 or FLU pneumonia admitted to the Intensive care Unit (ICU) of Policlinico Umberto I (Rome). Aims were: (1) to assess clinical features and differences of patients with COVID-19 and FLU, (2) to identify clinical and/or laboratory factors associated with FLU or COVID-19 and (3) to evaluate 30-day mortality, bacterial superinfections, thrombotic events and invasive pulmonary aspergillosis (IPA) in patients with FLU versus COVID-19. Results Overall, 74 patients were included (19, 25.7%, FLU and 55, 74.3%, COVID-19), median age 67 years (58–76). COVID-19 patients were more male (p = 0.013), with a lower percentage of COPD (Chronic Obstructive Pulmonary Disease) and chronic kidney disease (CKD) (p = 0.001 and p = 0.037, respectively) than FLU. SOFA score was higher (p = 0.020) and lymphocytes were significantly lower in FLU than in COVID-19 [395.5 vs 770.0 cells/mmc, p = 0.005]. At multivariable analysis, male sex (OR 6.1, p < 0.002), age > 65 years (OR 2.4, p = 0.024) and lymphocyte count > 725 cells/mmc at ICU admission (OR 5.1, p = 0.024) were significantly associated with COVID-19, whereas CKD and COPD were associated with FLU (OR 0.1 and OR 0.16, p = 0.020 and p < 0.001, respectively). No differences in mortality, bacterial superinfections and thrombotic events were observed, whereas IPA was mostly associated with FLU (31.5% vs 3.6%, p = 0.0029). Conclusions In critically ill patients, male sex, age > 65 years and lymphocytes > 725 cells/mmc are related to COVID-19. FLU is associated with a significantly higher risk of IPA than COVID-19.

P69 Moderate resuscitative hypothermia after brain trauma (simulated epidural hematoma) in new intensive care outcome model in dogs

Resuscitation ◽  
1994 ◽  
Vol 28 (2) ◽  
pp. S13 ◽  
Author(s):  
U. Ebmeyer ◽  
P. Safar ◽  
S. Pomeranz ◽  
S. Tisherman ◽  
A. Radovsky ◽  
...  
Keyword(s):  
Intensive Care ◽  
Epidural Hematoma ◽  
Brain Trauma ◽  
Care Outcome

scholarly journals ABC of intensive care: Outcome data and scoring systems

BMJ ◽  
1999 ◽  
Vol 319 (7204) ◽  
pp. 241-244 ◽  
Author(s):  
K. Gunning ◽  
K. Rowan
Keyword(s):  
Intensive Care ◽  
Scoring Systems ◽  
Outcome Data ◽  
Care Outcome

Association of Healthcare Access With Intensive Care Unit Utilization and Mortality in Patients of Hispanic Ethnicity Hospitalized With COVID-19

2021 ◽  
Vol 16 (11) ◽  
Author(s):  
Ferdinand Velasco ◽  
Donghan M Yang ◽  
Minzhe Zhang ◽  
Tanna Nelson ◽  
Thomas Sheffield ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Disease Severity ◽  
Healthcare System ◽  
Multivariable Analysis ◽  
Hospital Death ◽  
Primary Language ◽  
Hispanic Patients ◽  
English Speaking

BACKGROUND: Racial and ethnic minority groups in the United States experience a disproportionate burden of COVID-19 deaths. OBJECTIVE: To evaluate whether outcome differences between Hispanic and non-Hispanic COVID-19 hospitalized patients exist and, if so, to identify the main malleable contributing factors. DESIGN, SETTING, PARTICIPANTS: Retrospective, cross-sectional, observational study of 6097 adult COVID-19 patients hospitalized within a single large healthcare system from March to November 2020. EXPOSURES: Self-reported ethnicity and primary language. MAIN OUTCOMES AND MEASURES: Clinical outcomes included intensive care unit (ICU) utilization and in-hospital death. We used age-adjusted odds ratios (OR) and multivariable analysis to evaluate the associations between ethnicity/language groups and outcomes. RESULTS: 32.1% of patients were Hispanic, 38.6% of whom reported a non-English primary language. Hispanic patients were less likely to be insured, have a primary care provider, and have accessed the healthcare system prior to the COVID-19 admission. After adjusting for age, Hispanic inpatients experienced higher ICU utilization (non-English-speaking: OR, 1.75; 95% CI, 1.47-2.08; English-speaking: OR, 1.13; 95% CI, 0.95-1.33) and higher mortality (non-English-speaking: OR, 1.43; 95% CI, 1.10-1.86; English-speaking: OR, 1.53; 95% CI, 1.19-1.98) compared to non-Hispanic inpatients. There were no observed treatment disparities among ethnic groups. After adjusting for age, Hispanic inpatients had elevated disease severity at admission (non-English-speaking: OR, 2.27; 95% CI, 1.89-2.72; English-speaking: OR, 1.33; 95% CI, 1.10-1.61). In multivariable analysis, the associations between ethnicity/language and clinical outcomes decreased after considering baseline disease severity (P < .001). CONCLUSION: The associations between ethnicity and clinical outcomes can be explained by elevated disease severity at admission and limited access to healthcare for Hispanic patients, especially non-English-speaking Hispanics.

Intensive care outcome of adult patients operated on for congenital heart disease

2006 ◽  
Vol 33 (3) ◽  
pp. 524-528 ◽  
Author(s):  
Luc Jacquet ◽  
Olivier Vancaenegem ◽  
Jean Rubay ◽  
Fatima Laarbaui ◽  
Céline Goffinet ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Intensive Care ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Patients ◽  
Care Outcome

scholarly journals Impact of ToxigenicClostridium difficileColonization on the Risk of SubsequentC. difficileInfection in Intensive Care Unit Patients

2015 ◽  
Vol 36 (11) ◽  
pp. 1324-1329 ◽  
Author(s):  
Sarah Tschudin-Sutter ◽  
Karen C. Carroll ◽  
Pranita D. Tamma ◽  
Madeleine L. Sudekum ◽  
Reno Frei ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Relative Risk ◽  
Independent Risk Factor ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Johns Hopkins Hospital ◽  
Increased Risk ◽  
Colonization Rates

BACKGROUNDClostridium difficileinfection (CDI) in hospitalized patients is generally attributed to the current stay, but recent studies reveal highC. difficilecolonization rates on admission.OBJECTIVETo determine the rate of colonization with toxigenicC. difficileamong intensive care unit patients upon admission as well as acquired during hospitalization, and the risk of subsequent CDI.METHODSProspective cohort study from April 15 through July 8, 2013. Adults admitted to an intensive care unit within 48 hours of admission to the Johns Hopkins Hospital, Baltimore, Maryland, were screened for colonization with toxigenicC. difficile. The primary outcome was risk of developing CDI.RESULTSAmong 542 patients, 17 (3.1%) were colonized with toxigenicC. difficileon admission and an additional 3 patients were found to be colonized during hospitalization. Both colonization with toxigenicC. difficileon admission and colonization during hospitalization were associated with an increased risk for development of CDI (relative risk, 10.29 [95% CI, 2.24–47.40],P=.003; and 15.66 [4.01–61.08],P<.001, respectively). Using multivariable analysis, colonization on admission and colonization during hospitalization were independent predictors of CDI (relative risk, 8.62 [95% CI, 1.48–50.25],P=.017; and 10.93 [1.49–80.20],P=.019, respectively), while adjusting for potential confounders.CONCLUSIONSIn intensive care unit patients, colonization with toxigenicC. difficileis an independent risk factor for development of subsequent CDI. Further studies are needed to identify populations with higher toxigenicC. difficilecolonization rates possibly benefiting from screening or avoidance of agents known to promote CDI.Infect. Control Hosp. Epidemiol.2015;36(11):1324–1329

scholarly journals Lower Blood pH as a High Predisposing Factor for a Fatal Outcome in Critically Ill COVID-19 Patients at Intensive Care Unit: a Multivariable Analysis

2021 ◽  
Author(s):  
Martin Kieninger ◽  
Annemarie Sinning ◽  
Timea Vadász ◽  
Michael Gruber ◽  
Wolfram Gronwald ◽  
...  
Keyword(s):  
Intensive Care ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Clinical Decision Making ◽  
Ph Value ◽  
Fatal Outcome ◽  
Multivariable Analysis ◽  
Blood Ph

Abstract Background: Data of critically ill COVID-19 patients are being evaluated worldwide, not only to understand the various aspects of this disease and to refine treatment strategies but also to improve clinical decision-making. For the last aspect in particular, predictors of a lethal course of disease would be highly relevant.Methods:In this retrospective cohort study, we analyzed the first 59 adult critically ill Covid-19 patients treated in one of the intensive care units of the University Medical Center Regensburg, Germany. Using uni- and multivariable regression models, we extracted a set of parameters that allowed predictions of in-hospital mortality.Results:Blood pH value, mean arterial pressure, base excess, troponin, and procalcitonin were identified as highly significant predictors (p < 0.001) of in-hospital mortality. In the multivariable logistic regression analysis, the pH value and the mean arterial pressure turned out to be the most influential predictors and thus predisposing factors for a lethal course.Conclusions:We developed a formula that enables the easy calculation of the probability of a fatal outcome in COVID-19 intensive care patients. Currently a follow-up study with a larger group of patients is in progress to re-evaluate the established predictors.

scholarly journals Hypertriglyceridemia-associated acute pancreatitis: Response to continuous insulin infusion

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260495
Author(s):  
Vishnu Priya Pulipati ◽  
Ambika Amblee ◽  
Sara Elizabeth T. Yap ◽  
Hafeez Shaka ◽  
Bettina Tahsin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Pancreatitis ◽  
Intensive Care ◽  
Alcohol Use ◽  
Retrospective Analysis ◽  
Insulin Infusion ◽  
Multivariable Analysis ◽  
Serum Triglycerides ◽  
Rate Of Decline ◽  
Continuous Insulin Infusion

Objective To assess the response of serum triglycerides (TG) to continuous insulin infusion (CII) in adults with hypertriglyceridemia-associated acute pancreatitis (HTGP). Methods Retrospective analysis of TG response to standardized CII therapy in 77 adults admitted to intensive care with TG >1000 mg/dL and HTGP. Results Participants had initial TG 3869.0 [2713.5, 5443.5] mg/dL and were 39.3 ± 9.7 years old, 66.2% males, 58.4% Hispanic, BMI 30.2 [27.0, 34.8] kg/m2, 74.0% with diabetes mellitus (DM) and 50.6% with excess alcohol use. TG-goal, defined as ≤1,000 ± 100 mg/dL, was achieved in 95%. Among the 73 TG-goal achievers (responders), 53.4% reached TG-goal in <36 hours after CII initiation (rapid responders). When compared to slow responders taking≥36 hours, rapid responders had lower initial TG (2862.0 [1965.0, 4519.0] vs 4814.5 [3368.8, 6900.0] mg/dL), BMI (29.4 [25.9, 32.8] vs 31.9 [28.2, 38.3] kg/m2), DM prevalence (56.4 vs 94.1%), and reached TG-50% (half of respective initial TG) faster (12.0 [6.0, 17.0] vs 18.5 [13.0, 32.8] hours). Those with DM (n = 57) vs non-DM (n = 20) were obese (31.4 [28.0, 35.6] vs 27.8 [23.6, 30.3] kg/m2), took longer to reach TG-final (41.0 [25.0, 60.5] vs 14.5 [12.5, 25.5] hours) and used more daily insulin (1.7 [1.3, 2.1] vs 1.1 [0.5, 1.9] U/kg/day). Among those with DM, the rapid responders had higher daily use of insulin vs slow responders 1.9 [1.4, 2.3] vs 1.6 [1.1, 1.8] U/kg/day. All results significant. In multivariable analysis, predictors of faster TG response were absence of DM, lower BMI and initial TG. Conclusion CII was effective in reaching TG-goal in 95% of patients with HTGP. Half achieved TG-goal within 36 hours. Presence of DM, higher BMI and initial TG slowed the time to reach TG-goal. These baseline parameters and rate of decline to TG-50% may be real-time indicators to initiate and adjust the CII for quicker response.

scholarly journals Prior Carriage Predicts Intensive Care Unit Infections Caused by Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae

2022 ◽  
Author(s):  
Hatem Kallel ◽  
Stephanie Houcke ◽  
Dabor Resiere ◽  
Thibault Court ◽  
Cesar Roncin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Strong Predictor ◽  
Multivariable Analysis ◽  
Surgical Intensive Care Unit ◽  
Beta Lactamase ◽  
Surgical Intensive Care ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
The Impact

Intensive care unit–acquired infection (ICU-AI) and extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-PE) carriage are a major concern worldwide. Our objective was to investigate the impact of ESBL-PE carriage on ICU-AI. Our study is prospective, observational, and noninterventional. It was conducted over a 5-year period (Jan 2013–Dec 2017) in the medical-surgical intensive care unit of the Cayenne General Hospital (French Amazonia). During the study period, 1,340 patients were included, 271 (20.2%) developed ICU-AI, and 16.2% of these were caused by ESBL-PE. The main sites of ICU-AI were ventilator-associated pneumonia (35.8%) and primary bloodstream infection (29.8%). The main responsible microorganisms were Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae (ESBL-P in 35.8% of isolates), and Enterobacter cloacae (ESBL-P in 29.8% of isolates). Prior ESBL-PE carriage was diagnosed in 27.6% of patients with ICU-AI. In multivariable analysis, the sole factor associated with ESBL-PE as the responsible organism of ICU-AI was ESBL-PE carriage before ICU-AI (P < 0.001; odds ratio: 7.9 95% CI: 3.4-18.9). ESBL-PE carriers (74 patients) developed ICU-AI which was caused by ESBL-PE in 32 cases (43.2%). This proportion of patients carrying ESBL-PE who developed ICU-AI to the same microorganism was 51.2% in ESBL-P K. pneumoniae, 5.6% in ESBL-P Escherichia coli, and 40% in ESBL-P Enterobacter spp. NPV of ESBL-PE carriage to predict ICU-AI caused by ESBL-PE was above 94% and PPV was above 43%. Carriage of ESBL-P K pneumoniae and Enterobacter spp. is a strong predictor of ICU-AI caused by these two microorganisms.

Sign in / Sign up

Export Citation Format

Share Document