scholarly journals Utility of Systemic Inflammatory Syndrome Score in Predicting Healthcare-Associated Infections in Critically Ill Patients: A Matched Case-Control Study

2022 ◽  
Author(s):  
Guang-ju Zhao ◽  
Chang Xu ◽  
Long-wang Chen ◽  
Guang-liang Hong ◽  
Meng-fang Li ◽  
...  
Keyword(s):  
Risk Factor ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Information ◽  
Final Analysis ◽  
Healthcare Associated Infections ◽  
Effective Prevention ◽  
Subgroup Analyses ◽  
Healthcare Associated ◽  
Inflammatory Syndrome

Abstract Background Effective prevention of healthcare-associated infections (HAIs) requires early identification of at-risk patients. There is no score designed to predict HAIs. The present study was aimed to explore an available score, Systemic inflammatory syndrome (SIRS) score, on admission in predicting HAIs among critically ill patients. Methods This study was based on the Medical Information Mart for Intensive Care III (MIMIC III) version 1.4. Patients with HAIs were matched with control patients who had no HAIs in a 1:1 ratio based on age, gender, mechanical ventilation, deep venous catheterization, urethral catheterization, and surgical operation. Subgroup analyses were conducted according to various variables including infection likelihood on admission. The prognostic values of SIRS and infectious SIRS on admission in predicting HAIs were analyzed using logistic regression. Results A total of 2437 patients with HAIs and 2437 matched controls were enrolled in the final analysis. Adjusted odds ratio (ORs) (95% confidence interval [CI]) for HAIs of SIRS scores (1 to 4) on admission was 1.48 (0.77-2.83), 1.86 (0.99-3.47), 2.14 (1.15-3.98), and 2.58 (1.39-4.80). Adjusted ORs (95%CI) for HAIs of SIRS (score≥2) and infectious SIRS were 1.57 (1.27-1.94) and 1.78 (1.52-2.09), respectively. Subgroup analyses showed that SIRS on admission was an independent risk factor for HAIs in patients admitted without definite and probable infection likelihood (OR=1.54, 95%CI 1.28-1.93). However, it was not a risk factor for HAIs inpatients admitted with infection, in non-white patients, and in patients with liver disease or obesity, and in patients who received total parenteral nutrition (TPN) (all P>0.05). In addition, it was showed that infectious SIRS on admission was not a risk factor for HAIs in black patients and in patients with obesity, and those received TPN (all P>0.05). Conclusions Infectious SIRS on admission significantly predicts HAIs among critical illness patients. SIRS on admission was a predictor of HAIs in ICU patients admitted without infection but not in patients admitted with infection.

scholarly journals Community- and healthcare-associated infections in critically ill patients: a multicenter cohort study

2015 ◽  
Vol 37 ◽  
pp. 80-85 ◽  
Author(s):  
George Dabar ◽  
Carine Harmouche ◽  
Pascale Salameh ◽  
Bertrand L. Jaber ◽  
Ghassan Jamaleddine ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Healthcare Associated Infections ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Healthcare Associated

scholarly journals Serum syndecan-1 reflects organ dysfunction in critically ill patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Keiko Suzuki ◽  
Hideshi Okada ◽  
Kazuyuki Sumi ◽  
Hiroyuki Tomita ◽  
Ryo Kobayashi ◽  
...  
Keyword(s):  
Risk Factor ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Repeated Measures ◽  
Significant Risk ◽  
Mixed Effects ◽  
Mixed Effects Models ◽  
Endothelial Glycocalyx ◽  
Outcome Variable

AbstractSyndecan-1 (SDC-1) is found in the endothelial glycocalyx and shed into the blood during systemic inflammatory conditions. We investigated organ dysfunction associated with changing serum SDC-1 levels for early detection of organ dysfunction in critically ill patients. To evaluate the effect of SDC-1 on laboratory parameters measured the day after SDC-1 measurement with consideration for repeated measures, linear mixed effects models were constructed with each parameter as an outcome variable. A total of 94 patients were enrolled, and 831 samples were obtained. Analysis using mixed effects models for repeated measures with adjustment for age and sex showed that serum SDC-1 levels measured the day before significantly affected several outcomes, including aspartate aminotransferase (AST), alanine transaminase (ALT), creatinine (CRE), blood urea nitrogen (BUN), antithrombin III, fibrin degradation products, and D-dimer. Moreover, serum SDC-1 levels of the prior day significantly modified the effect between time and several outcomes, including AST, ALT, CRE, and BUN. Additionally, increasing serum SDC-1 level was a significant risk factor for mortality. Serum SDC-1 may be a useful biomarker for daily monitoring to detect early signs of kidney, liver and coagulation system dysfunction, and may be an important risk factor for mortality in critically ill patients.

The ART of Antiretroviral Therapy in Critically Ill Patients With HIV

2018 ◽  
Vol 34 (11-12) ◽  
pp. 897-909 ◽  
Author(s):  
Tyler Finocchio ◽  
William Coolidge ◽  
Thomas Johnson
Keyword(s):  
Intensive Care ◽  
Antiretroviral Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critically Ill Patient ◽  
Intensive Care Setting ◽  
Antiretroviral Medications ◽  
Immunodeficiency Virus ◽  
Inflammatory Syndrome

The management of patients with human immunodeficiency virus (HIV) can be a complicated specialty within itself, made even more complex when there are so many unanswered questions regarding the care of critically ill patients with HIV. The lack of consensus on the use of antiretroviral medications in the critically ill patient population has contributed to an ongoing clinical debate among intensivists. This review focuses on the pharmacological complications of antiretroviral therapy (ART) in the intensive care setting, specifically the initiation of ART in patients newly diagnosed with HIV, immune reconstitution inflammatory syndrome (IRIS), continuation of ART in those who were on a complete regimen prior to intensive care unit admission, barriers of drug delivery alternatives, and drug-drug interactions.

scholarly journals Blood Urea Nitrogen and In-Hospital Mortality in Critically Ill Patients with Cardiogenic Shock: Analysis of the MIMIC-III Database

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
En-qian Liu ◽  
Chun-lai Zeng
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Critically Ill ◽  
Blood Urea Nitrogen ◽  
Critically Ill Patients ◽  
Medical Information ◽  
Multivariate Logistic Regression Model ◽  
Standard Deviation Increase ◽  
Urea Nitrogen

The association between blood urea nitrogen (BUN) and prognosis has been the focus of recent research. Therefore, the objective of this study was to investigate the association between BUN and hospital mortality in critically ill patients with cardiogenic shock (CS). This was a retrospective cohort study, in which data were obtained from the Medical Information Mart for Intensive Care III V1.4 database. Data from 697 patients with CS were analyzed. Logistic regression and subgroup analyses were used to assess the association between BUN and hospital mortality in patients with CS. The average age of the 697 participants was 71.14 years, and approximately 42.18% were men. In the multivariate logistic regression model, after adjusting for age, sex, diabetes, cardiac arrhythmias, urine output, simplified acute physiology score II, sequential organ failure assessment, creatinine, anion gap, and heart rate, high BUN demonstrated strong associations with increased in-hospital mortality (per standard deviation increase: odds ratio [OR] 1.47, 95% confidence interval [CI] 1.13–1.92). A similar result was observed in BUN tertile groups (BUN 23–37 mg/dL versus 6–22 mg/dL: OR [95% CI], 1.42 [0.86–2.34]; BUN 38–165 mg/dL versus 6–22 mg/dL: OR [95% CI], 1.99 [1.10–3.62]; P trend 0.0272). Subgroup analysis did not reveal any significant interactions among various subgroups, and higher BUN was associated with adverse clinical outcomes in patients with CS.

Clinical effectiveness of a silicone foam dressing for the prevention of heel pressure ulcers in critically ill patients: Border II Trial

2020 ◽  
Vol 29 (Sup9a) ◽  
pp. S26-S31
Author(s):  
N. Santamaria ◽  
M. Gerdtz ◽  
W. Liu ◽  
S. Rakis ◽  
S. Sage ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Pressure Ulcers ◽  
Final Analysis ◽  
Clinical Effectiveness ◽  
Control Group ◽  
Royal Melbourne Hospital ◽  
Physiological Variables ◽  
Silicone Foam ◽  
Initial Cohort

• Objective: Critically ill patients are at high risk of developing pressure ulcers (PU), with the sacrum and heels being highly susceptible to pressure injuries. The objective of our study was to evaluate the clinical effectiveness of a new multi-layer, self-adhesive soft silicone foam heel dressing to prevent PU development in trauma and critically ill patients in the intensive care unit (ICU). • Method: A cohort of critically ill patients were enrolled at the Royal Melbourne Hospital. Each patient had the multi-layer soft silicone foam dressing applied to each heel on admission to the emergency department. The dressings were retained with a tubular bandage for the duration of the patients' stay in the ICU. The skin under the dressings was examined daily and the dressings were replaced every three days. The comparator for our cohort study was the control group from the recently completed Border Trial. • Results: Of the 191 patients in the initial cohort, excluding deaths, loss to follow-up and transfers to another ward, 150 patients were included in the final analysis. There was no difference in key demographic or physiological variables between the cohorts, apart from a longer ICU length of stay for our current cohort. No PUs developed in any of our intervention cohort patients compared with 14 patients in the control cohort (n=152; p<0.001) who developed a total of 19 heel PUs. • Conclusion: We conclude, based on our results, that the multi-layer soft silicone foam dressing under investigation was clinically effective in reducing ICU-acquired heel PUs. The findings also support previous research on the clinical effectiveness of multi-layer soft silicone foam dressings for PU prevention in the ICU.

scholarly journals Obesity as a risk factor for unfavourable outcomes in critically ill patients affected by Covid 19

2020 ◽  
Author(s):  
Andrea P. Rossi ◽  
Leonardo Gottin ◽  
Katia Donadello ◽  
Vittorio Schweiger ◽  
Riccardo Nocini ◽  
...  
Keyword(s):  
Risk Factor ◽  
Critically Ill ◽  
Critically Ill Patients
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