scholarly journals Association between dysglycemia and mortality by diabetes status and risk factors of dysglycemia in critically ill patients: a retrospective study

2021 ◽  
Author(s):  
Haoming Ma ◽  
Guo Yu ◽  
Ziwen Wang ◽  
Peiru Zhou ◽  
Weitao Lv
Keyword(s):  
Logistic Regression ◽  
Retrospective Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glycemic Variability ◽  
Albumin Level ◽  
Three Dimensions ◽  
Contributing Factors ◽  
Diabetes Status ◽  
Glucose Management

Abstract Aims Dysglycemia, including the three domains hyperglycemia, hypoglycemia, and increased glycemic variability (GV), is associated with high mortality among critically ill patients. However, this association differs by diabetes status, and reports in this regard are limited. This study aimed to evaluate the associations between the three dysglycemia domains and mortality in critically ill patients by diabetes status and determined the contributing factors for dysglycemia. Methods This retrospective study included 958 critically ill patients (admitted to the ICU) with or without DM. Dysglycemia was defined as abnormality of any of the three dimensions. We evaluated the effects of the three domains of glucose control on mortality using binary logistic regression and then adjusted for confounders. The associations between dysglycemia and other variables were investigated using cumulative logistic regression analysis. Result GV independently and similarly affected mortality in both groups after adjustment for confounders (DM: odds ratio [OR], 1.05; 95% confidence interval [CI]: 1.03-1.08; p <0.001; non-DM: OR, 1.07; 95% CI, 1.03-1.11; p = 0.002). Hypoglycemia was strongly associated with ICU mortality among patients without DM (3.12; 1.76-5.53; p <0.001) and less so among those with DM (1.18; 0.49-2.83; p = 0.72). Hyperglycemia was non-significantly associated with mortality in both groups. However, the effects of dysglycemia seemed cumulative. The factors contributing to dysglycemia included disease severity, insulin treatment, glucocorticoid use, serum albumin level, total parenteral nutrition, duration of diabetes, elevated procalcitonin level, and need for mechanical ventilation and renal replacement therapy. Conclusion The association between the three dimensions of dysglycemia and mortality varied by diabetes status. Dysglycemia in critical patients is associated with excess mortality; however, glucose management in patients should be specific to the patient’s need considering the diabetes status and broader dimensions. The identified factors for dysglycemia could be used for risk assessment in glucose management requirement in critically ill patients, which may improve clinical outcomes.

scholarly journals Association Between Serum Osmolality and Acute Kidney Injury in Critically Ill Patients: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Jie Yang ◽  
Yisong Cheng ◽  
Ruoran Wang ◽  
Bo Wang
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
High Serum ◽  
Serum Osmolality ◽  
Multivariate Logistic Regression ◽  
Low Serum

Purposes: Acute kidney injury (AKI) is a common complication in critically ill patients and is usually associated with poor outcomes. Serum osmolality has been validated in predicting critically ill patient mortality. However, data about the association between serum osmolality and AKI is still lacking in ICU. Therefore, the purpose of the present study was to investigate the association between early serum osmolality and the development of AKI in critically ill patients.Methods: The present study was a retrospective cohort analysis based on the medical information mart for intensive care III (MIMIC-III) database. 20,160 patients were involved in this study and divided into six subgroups according to causes for ICU admission. The primary outcome was the incidence of AKI after ICU admission. The association between early serum osmolality and AKI was explored using univariate and multivariate logistic regression analyses.Results: The normal range of serum osmolality was 285–300 mmol/L. High serum osmolality was defined as serum osmolality &gt;300 mmol/L and low serum osmolality was defined as serum osmolality &lt;285 mmol/L. Multivariate logistic regression indicated that high serum osmolality was independently associated with increased development of AKI with OR = 1.198 (95% CL = 1.199–1.479, P &lt; 0.001) and low serum osmolality was also independently associated with increased development of AKI with OR = 1.332 (95% CL = 1.199–1.479, P &lt; 0.001), compared with normal serum osmolality, respectively.Conclusions: In critically ill patients, early high serum osmolality and low serum osmolality were both independently associated with an increased risk of development of AKI.

scholarly journals BEDSIDE LAPAROSCOPY AS DIAGNOSTIC TOOL REVIEW OF ABDOMINAL PATHOLOGIES IN CRITICALLY ILL PATIENTS: REVIEW

2022 ◽  
Vol 6 (1) ◽  
Author(s):  
Danilo Coco ◽  
Silvana Leanza
Keyword(s):  
Retrospective Study ◽  
Diagnostic Accuracy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Laboratory Tests ◽  
Diagnostic Laparoscopy ◽  
Delayed Diagnosis ◽  
Definite Diagnosis ◽  
Imaging Results ◽  
Increase Rate

Introduction: The diagnosis of abdominal pathologies in critically ill patients is often difficult because of inconclusive laboratory tests or imaging results, or the inability to safely transfer a patient to the radiology room. These causes give a delayed diagnosis of abdominal pathology in the intensive care unit (ICU) and increase rate of morbidity and mortality. The aim of this retrospective study is to evaluate the safety and diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Aim: The aim of this retrospective study is to evaluate the safety and diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Materials and Methods: A  literature research was carried out including PubMed, Medline, Embase, Cochrane and Google Scholar databases to identify articles reporting on importance of diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Conclusions: Bedside diagnostic laparoscopy represents a safe and accurate technique for diagnosing intraabdominal pathology in an ICU setting and should be taken into consideration when patient transfer to radiology or the operating room is considered unsafe or when routine radiological examinations are not conclusive enough to reach a definite diagnosis. Keywords: Bedside laparoscopy, critically ill patients, ultrasonography (US), computed tomography (CT) , emergency surgery

scholarly journals A novel procalcitonin-based score for detecting sepsis among critically ill patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245748
Author(s):  
Tung-Lin Tsui ◽  
Ya-Ting Huang ◽  
Wei-Chih Kan ◽  
Mao-Sheng Huang ◽  
Min-Yu Lai ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Validation Cohort ◽  
Multivariate Logistic Regression Analysis ◽  
Sepsis Group ◽  
C Reactive Protein ◽  
Multivariate Logistic Regression ◽  
Reactive Protein

Background Procalcitonin (PCT) has been widely investigated as an infection biomarker. The study aimed to prove that serum PCT, combining with other relevant variables, has an even better sepsis-detecting ability in critically ill patients. Methods We conducted a retrospective cohort study in a regional teaching hospital enrolling eligible patients admitted to intensive care units (ICU) between July 1, 2016, and December 31, 2016, and followed them until March 31, 2017. The primary outcome measurement was the occurrence of sepsis. We used multivariate logistic regression analysis to determine the independent factors for sepsis and constructed a novel PCT-based score containing these factors. The area under the receiver operating characteristics curve (AUROC) was applied to evaluate sepsis-detecting abilities. Finally, we validated the score using a validation cohort. Results A total of 258 critically ill patients (70.9±16.3 years; 55.4% man) were enrolled in the derivation cohort and further subgrouped into the sepsis group (n = 115) and the non-sepsis group (n = 143). By using the multivariate logistic regression analysis, we disclosed five independent factors for detecting sepsis, namely, “serum PCT level,” “albumin level” and “neutrophil-lymphocyte ratio” at ICU admission, along with “diabetes mellitus,” and “with vasopressor.” We subsequently constructed a PCT-based score containing the five weighted factors. The PCT-based score performed well in detecting sepsis with the cut-points of 8 points (AUROC 0.80; 95% confidence interval (CI) 0.74–0.85; sensitivity 0.70; specificity 0.76), which was better than PCT alone, C-reactive protein and infection probability score. The findings were confirmed using an independent validation cohort (n = 72, 69.2±16.7 years, 62.5% men) (cut-point: 8 points; AUROC, 0.79; 95% CI 0.69–0.90; sensitivity 0.64; specificity 0.87). Conclusions We proposed a novel PCT-based score that performs better in detecting sepsis than serum PCT levels alone, C-reactive protein, and infection probability score.

scholarly journals Augmented Renal Clearance in Iranian Critically Ill Patients: Retrospective Study at Masih Daneshvari Hospital

2017 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Seyed Reza Saghebi ◽  
Behrooz Farzanegan ◽  
Payam Tabarsi ◽  
Rokhsaneh Zangooi ◽  
Batoul Khoundabi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Renal Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Augmented Renal Clearance

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.

scholarly journals Risk Potential for Organ Dysfunction Associated with Sodium Bicarbonate Therapy (SBT) in Critically Ill Patients with Hemodynamic Worsening

2021 ◽  
Author(s):  
Tiehua Wang ◽  
Lingxian Yi ◽  
Hua Zhang ◽  
Tianhao Wang ◽  
Jingjing Xi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Metabolic Acidosis ◽  
Sodium Bicarbonate ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Control Group ◽  
Increased Risk ◽  
Bicarbonate Therapy ◽  
Risk Potential

Abstract Background: The role of sodium bicarbonate therapy (SBT) remains controversial. This study aimed to investigate whether hemodynamic status before SBT contributed to the heterogeneous outcomes associated with SBT in acute critically ill patients.Methods: We obtained data from patients with metabolic acidosis from the Medical Information Mart for Intensive Care (MIMIC)-III database. Propensity score matching (PSM) was applied to match the SBT group with the control group. Logistic regression and Cox regression were used to analyze a composite of newly “developed or exacerbated organ dysfunction” (d/eOD) within 7 days of ICU admission and 28-day mortality associated with SBT for metabolic acidosis.Results: A total of 1765 patients with metabolic acidosis were enrolled, and 332 pairs obtained by PSM were applied to the final analyses in the study. An increased incidence of newly d/eOD was observed in the SB group compared with the control group (54.8% vs 44.6%, p<0.01). Multivariable logistic regression indicated that the adjusted OR of SBT for this composite outcome was no longer significant [OR (95% CI): 1.39 (0.9, 1.85); p=0.164]. This effect of SBT did not change with the quintiles stratified by pH. Interestingly, SBT was associated with an increased risk of the composite of newly d/eOD in the subgroup of patients with worsening hemodynamics before SBT [adjusted OR (95% CI): 3.6 (1.84, 7.22), p< 0.001]. Moreover, the risk potential for this composite of outcomes was significantly increased in patients characterized by both worsening [adjusted OR (95% CI): 2.91 (1.54, 5.47), p< 0.001] and unchanged hemodynamics [adjusted OR (95% CI): 1.94 (1.01, 3.72), p=0.046) compared to patients with improved hemodynamics before SBT. Our study failed to demonstrate an association between SBT and 28-day mortality in acute critically ill patients with metabolic acidosis.Conclusions: Our findings suggested that SBT for metabolic acidosis was associated with an increased risk potential for subsequent d/eOD, while the hemodynamic status remained unstable during the acute phase of critical illness.

scholarly journals Laboratory findings and a combined multifactorial approach to predict death in critically ill patients with COVID-19: a retrospective study

2020 ◽  
Vol 148 ◽  
Author(s):  
Q. Liu ◽  
N. C. Song ◽  
Z. K. Zheng ◽  
J. S. Li ◽  
S. K. Li
Keyword(s):  
Logistic Regression ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Scoring System ◽  
Related Factors ◽  
Laboratory Findings ◽  
Medical College ◽  
Multivariable Logistic Regression ◽  
Union Hospital ◽  
Multifactorial Approach

Abstract To describe the laboratory findings of cases of death with coronavirus disease 2019 (COVID-19) and to establish a scoring system for predicting death, we conducted this single-centre, retrospective, observational study including 336 adult patients (≥18 years old) with severe or critically ill COVID-19 admitted in two wards of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology in Wuhan, who had definite outcomes (death or discharge) between 1 February 2020 and 13 March 2020. Single variable and multivariable logistic regression analyses were performed to identify mortality-related factors. We combined multiple factors to predict mortality, which was validated by receiver operating characteristic curves. As a result, in a total of 336 patients, 34 (10.1%) patients died during hospitalisation. Through multivariable logistic regression, we found that decreased lymphocyte ratio (Lymr, %) (odds ratio, OR 0.574, P < 0.001), elevated blood urea nitrogen (BUN) (OR 1.513, P = 0.009), and raised D-dimer (DD) (OR 1.334, P = 0.002) at admission were closely related to death. The combined prediction model was developed by these factors with a sensitivity of 100.0% and specificity of 97.2%. In conclusion, decreased Lymr, elevated BUN, and raised DD were found to be in association with death outcomes in critically ill patients with COVID-19. A scoring system was developed to predict the clinical outcome of these patients.

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