scholarly journals T3 as predictor of mortality in any cause non-critically ill patient

2021 ◽  
Author(s):  
Erika Biegelmeyer ◽  
Iury Scanagata ◽  
Laura Alves ◽  
Murilo Reveilleau ◽  
Fernando Pereira Schwengber ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Critically Ill Patient ◽  
Total Serum ◽  
Population Total ◽  
Low T3 ◽  
Serum T3 ◽  
Overall Mortality

Background: Low T3 syndrome refers to a set of thyroid hormone metabolism alterations present in disease state. A correlation between low T3 and poor clinical outcomes in the intensive care unit is more established. Nonetheless, studies on non-critically ill patients are few and controversial. Objective: To evaluate the prevalence and predictive value of low T3 levels on 30 days- and six month-term mortality in non-critically ill patients. Secondary outcomes evaluated length of hospital stay, overall mortality, and hospital readmission. Design: Prospective cohort study. Methods: 345 consecutive patients from Internal medicine ward of a tertiary hospital in southern Brazil included from October 2018 to April 2019 and followed for 6 months. Levels of total serum T3 were measured weekly, from admission to discharge, and correlated with 30-day hospital mortality. Results: Prevalence of low T3 was 36.6%. Low T3 levels were associated with higher 30-days hospital mortality (15.1% versus 4.1%, p<0.001) and higher 6-months overall mortality (31.7% versus 13.2%, p<0.001). Total serum T3 at admission was an independent predictor of 30-days hospital mortality. Conclusion: Low T3 levels are a prevalent condition among non-critically ill patients and this condition is associated with poor clinical outcomes in this population. Total serum T3 levels, alone or in association with other predictive scores, were demonstrated to be an easy and valuable tool for risk stratification, and should be further employed in this setting.

scholarly journals The Burden of Hyperbilirubinemia in Critically Ill Patients with Hematological Malignancies: Post-hoc Analysis of a Prospective Multicenter Multinational Study

2020 ◽  
Author(s):  
Magali Bisbal ◽  
Michael Darmon ◽  
Colombe Saillard ◽  
Vincent Mallet ◽  
Charlotte Mouliade ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Cancer Progression ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hematological Malignancies ◽  
Severity Of Illness ◽  
Rank Test ◽  
Total Serum

Abstract BackgroundThe evidence on the clinical significance of hyperbilirubinemia (HB) in critically ill patients with hematological malignancies is scarce. We therefore studied its burden in a 2010-2011 Franco-Belgian multicenter prospective study designed to evaluate the prognosis of these patients.Patients and methodsThe cohort comprised 893 patients from 17 centers, 61% men, with a median (interquartile range) age of 60 (49 – 70) years, and preferentially with underlying non-Hodgkin lymphoma (32%) or acute myeloid leukemia (27%). HB was defined as a total serum bilirubin ≥ 33 µmol/L at intensive care unit (ICU) admission. Our main goal was to evaluate the relationship between HB and outcome of critically ill hematological patients. Causes and management of HB in the ICU were analyzed as secondary end points.ResultsHB concerned 185 (21%) patients. Cyclosporine and antimicrobial treatments, ascites and cirrhosis, acute kidney injury, neutropenia, and myeloma (adjusted odd ratio [aOR] 0.38, p=0.006) were risk factors. Hospital mortality was 56.3% and 36.3% in patients with and without HB, respectively (p<0.0001 with the log-rank test). Adjusted for severity of illness, the adjusted odds ratio (95% confidence interval) of HB for in-hospital mortality was 1.86 (1.28, 2.72). HB was overlooked by the ICU team for 92 (53%) patients. Overwise, liver workups for HB led to treatment modifications in 32 (40%) patients, including chemotherapy for cancer progression that was associated with reduced mortality with an adjusted odds ratio of 0.23, (p=0.02).ConclusionHB is associated with outcome of critically ill hematological adult patients and should be systematically explored and treated.

Association of delayed time in the emergency department with the clinical outcomes for critically ill patients

QJM ◽  
2020 ◽  
Author(s):  
S Lin ◽  
S Ge ◽  
W He ◽  
M Zeng
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Waiting Time ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Stratified Analysis ◽  
Delayed Time

Summary Background Previous studies have shown the association of waiting time in the emergency department with the prognosis of critically ill patients, but these studies linking the waiting time to clinical outcomes have been inconsistent and limited by small sample size. Aim To determine the relationship between the waiting time in the emergency department and the clinical outcomes for critically ill patients in a large sample population. Design A retrospective cohort study of 13 634 patients. Methods We used the Medical Information Mart for Intensive Care III database. Multivariable logistic regression was used to determine the independent relationships of the in-hospital mortality rate with the delayed time and different groups. Interaction and stratified analysis were conducted to test whether the effect of delayed time differed across various subgroups. Results After adjustments, the in-hospital mortality in the ≥6 h group increased by 38.1% (OR 1.381, 95% CI 1.221–1.562). Moreover, each delayed hour was associated independently with a 1.0% increase in the risk of in-hospital mortality (OR 1.010, 95% CI 1.008–1.010). In the stratified analysis, intensive care unit (ICU) types, length of hospital stay, length of ICU stay, simplified acute physiology score II and diagnostic category were found to have interactions with ≥6 h group in in-hospital mortality. Conclusions In this large retrospective cohort study, every delayed hour was associated with an increase in mortality. Furthermore, clinicians should be cautious of patients diagnosed with sepsis, liver/renal/metabolic diseases, internal hemorrhage and cardiovascular disease, and if conditions permit, they should give priority to transferring to the corresponding ICUs.

Associations between early thiamine administration and clinical outcomes in critically ill patients with acute kidney injury

2021 ◽  
pp. 1-27
Author(s):  
Xunliang Li ◽  
Hong Luan ◽  
Hui Zhang ◽  
Chenyu Li ◽  
Quandong Bu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Information ◽  
Kidney Injury ◽  
Term Survival ◽  
Stage 1 ◽  
Thiamine Treatment

Abstract Background: The effects of early thiamine use on clinical outcomes in critically ill patients with acute kidney injury (AKI) are unclear. The purpose of this study was to investigate the associations between early thiamine administration and clinical outcomes in critically ill patients with AKI. Methods: The data of critically ill patients with AKI within 48 hours after ICU admission were extracted from the Medical Information Mart for Intensive Care III (MIMIC III) database. Propensity score matching (PSM) was used to match patients early receiving thiamine treatment to those not early receiving thiamine treatment. The association between early thiamine use and in-hospital mortality due to AKI was determined using a logistic regression model. Results: A total of 15,066 AKI patients were eligible for study inclusion. After PSM, 734 pairs of patients who did and did not receive thiamine treatment in the early stage were established. Early thiamine use was associated with lower in-hospital mortality (OR 0.65; 95% CI 0.49-0.87; P < 0.001) and 90-day mortality (OR 0.58; 95% CI 0.45-0.74; P < 0.001), and it was also associated with the recovery of renal function (OR 1.26; 95% CI 1.17-1.36; P < 0.001). In the subgroup analysis, early thiamine administration was associated with lower in-hospital mortality in patients with stage 1 to 2 AKI. Conclusions: Early thiamine use was associated with improved short-term survival in critically ill patients with AKI. It was possible beneficial role in patients with stage 1 to 2 AKI according to the KDIGO criteria.

scholarly journals High Chloride Burden and Clinical Outcomes in Critically Ill Patients With Large Hemispheric Infarction

2021 ◽  
Vol 12 ◽  
Author(s):  
Dong-Seok Gwak ◽  
Inyoung Chung ◽  
Baik-Kyun Kim ◽  
Sukyoon Lee ◽  
Han-Gil Jeong ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Scale Score ◽  
Critically Ill Patients ◽  
Neurocritical Care ◽  
Chloride Concentration ◽  
Maximum Serum ◽  
Serum Chloride ◽  
Hemispheric Infarction

Background: In general, disease severity has been found to be associated with abnormal chloride levels in critically ill patients, but hyperchloremia is associated with mixed results regarding patient-centered clinical outcomes. We aimed to investigate the impact of maximum serum chloride concentration on the clinical outcomes of critically ill patients with large hemispheric infarction (LHI).Methods: We conducted a retrospective observational cohort study using prospective institutional neurocritical care registry data from 2013 to 2018. Patients with LHIs involving over two-thirds of middle cerebral artery territory, with or without infarction of other vascular territories, and a baseline National Institutes of Health Stroke Scale score of ≥13 were assessed. Those with a baseline creatinine clearance of &lt;15 mL/min and required neurocritical care for &lt;72 h were excluded. Primary outcome was in-hospital mortality. Secondary outcomes included 3-month mortality and acute kidney injury (AKI) occurrence. Outcomes were compared to different maximum serum chloride levels (5 mmol/L increases) during the entire hospitalization period using multivariable logistic regression analyses.Results: Of 90 patients, 20 (22.2%) died in-hospital. Patients who died in-hospital had significantly higher maximum serum chloride levels than did those who survived up to hospital discharge (139.7 ± 8.1 vs. 119.1 ± 10.4 mmol/L; p &lt; 0.001). After adjusting for age, sex, and Glasgow coma scale score, each 5-mmol/L increase in maximum serum chloride concentration was independently associated with an increased risk of in-hospital mortality (adjusted odds ratio (aOR), 4.34; 95% confidence interval [CI], 1.98–9.50; p &lt; 0.001). Maximum serum chloride level was also an independent risk factor for 3-month mortality (aOR, 1.99 [per 5 mmol/L increase]; 95% CI, 1.42–2.79; p &lt; 0.001) and AKI occurrence (aOR, 1.57 [per 5 mmol/L increase]; 95% CI, 1.18–2.08; p = 0.002).Conclusions: High maximum serum chloride concentrations were associated with poor clinical outcomes in critically ill patients with LHI. This study highlights the importance of monitoring serum chloride levels and avoiding hyperchloremia in this patient population.

scholarly journals Association between Latent Trajectories of Fluid Balance and Clinical Outcomes in Critically Ill Patients with Acute Kidney Injury: A Prospective Multicenter Observational Study

2021 ◽  
pp. 1-11
Author(s):  
Meiping Wang ◽  
Bo Zhu ◽  
Li Jiang ◽  
Xuying Luo ◽  
Na Wang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Icu Mortality ◽  
Increased Risk

<b><i>Introduction:</i></b> We aimed to identify different trajectories of fluid balance (FB) and investigate the effect of FB trajectories on clinical outcomes in intensive care unit (ICU) patients with acute kidney injury (AKI) and the dose-response association between fluid overload (FO) and mortality. <b><i>Methods:</i></b> We derived data from the Beijing Acute Kidney Injury Trial (BAKIT). A total of 1,529 critically ill patients with AKI were included. The primary outcome was 28-day mortality, and hospital mortality, ICU mortality and AKI stage were the secondary outcomes. A group-based trajectory model was used to identify the trajectory of FB during the first 7 days. Multivariable logistic regression was performed to examine the relationship between FB trajectories and clinical outcomes. A logistic regression model with restricted cubic splines was used to examine the dose relationship between FO and 28-day mortality. <b><i>Results:</i></b> Three distinct trajectories of FB were identified: low FB (1,316, 86.1%), decreasing FB (120, 7.8%), and high FB (93, 6.1%). Compared with low FB, high FB was associated with increased 28-day mortality (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.17–3.19) and AKI stage (OR 2.04, 95% CI 1.23–3.37), whereas decreasing FB was associated with a reduction in 28-day mortality by approximately half (OR 0.53, 95% CI 0.32–0.87). Similar results were found for the outcomes of ICU mortality and hospital mortality. We observed a J-shaped relationship between maximum FO and 28-day mortality, with the lowest risk at a maximum FO of 2.8% L/kg. <b><i>Conclusion:</i></b> Different trajectories of FB in critically ill patients with AKI were associated with clinical outcomes. An FB above or below a certain range was associated with an increased risk of mortality. Further studies should explore this relationship and search for the optimal fluid management strategies for critically ill patients with AKI.

scholarly journals Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Eleni Papoutsi ◽  
Vassilis G. Giannakoulis ◽  
Eleni Xourgia ◽  
Christina Routsi ◽  
Anastasia Kotanidou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
All Cause Mortality ◽  
Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

scholarly journals Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

2021 ◽  
Vol 10 (15) ◽  
pp. 3379
Author(s):  
Matthias Klingele ◽  
Lea Baerens
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Kidney Injury ◽  
Care Team ◽  
Critically Ill Patient ◽  
Late Start

Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

Evaluation of Delirium in Critically Ill Patients Prescribed Melatonin or Ramelteon

2021 ◽  
pp. 106002802110020
Author(s):  
Natasha Romero ◽  
Kevin M. Dube ◽  
Kenneth E. Lupi ◽  
Jeremy R. DeGrado
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Receptor Agonist ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Melatonin Receptor ◽  
Observational Cohort ◽  
Impaired Sleep ◽  
Retrospective Observational Cohort Study

Background: An impaired sleep-wake cycle may be one factor that affects the development of delirium in critically ill patients. Several small studies suggest that exogenous melatonin or ramelteon may decrease the incidence and/or duration of delirium. Objective: To compare the effect of prophylactic administration of melatonin, ramelteon, or no melatonin receptor agonist on the development of delirium in the intensive care unit (ICU). Methods: This was a single-center, retrospective, observational cohort study of nondelirious patients in the ICU who received melatonin, ramelteon, or no melatonin receptor agonist. The primary end point was the incidence of delirium. Secondary end points included assessments of daily level of sedation and daily utilization of antipsychotic, sedative, and opioid agents. Results: No difference was observed in the incidence of delirium among the melatonin, ramelteon, and placebo cohorts (18.7% vs 14.3% vs 13.8%; P = 0.77). A difference was observed in the rate of agitation and sedation among the 3 groups, with the greatest observed in the melatonin cohort. Additionally, there was a difference in the use of propofol, dexmedetomidine, and opioids. Overall, there was no difference in clinical outcomes, including duration of mechanical ventilation and ICU or hospital length of stay. Conclusion and Relevance: Therapy with melatonin, ramelteon, and no melatonin receptor agonist resulted in similar rates of delirium in a mixed ICU population. Despite significant differences in agitation, sedation, and medication utilization, there was no differences in the clinical outcomes evaluated.

Obesity, Inflammatory and Thrombotic Markers, and Major Clinical Outcomes in Critically Ill Patients with COVID‐19 in the US

Obesity ◽  
2021 ◽  
Author(s):  
Allon N. Friedman ◽  
John Guirguis ◽  
Raj Kapoor ◽  
Shruti Gupta ◽  
David E. Leaf ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
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