Adding Tolvaptan Instead of Increasing Dose of Furosemide for the Patients Already Received Low-Dose Furosemide May Improve Hospital Mortality

2015 ◽  
Vol 21 (10) ◽  
pp. S153
Author(s):  
Naotaka Okamoto ◽  
Ryu Shutta ◽  
Akihiro Tanaka ◽  
Naoki Mori ◽  
Nobuhiko Makino ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Low Dose ◽  
Improve Hospital

Effect of parenteral energy or amino acid doses on in-hospital mortality, among patients with aspiration pneumonia: a cohort medical claims database study

2021 ◽  
Author(s):  
Keisuke Maeda ◽  
Kenta Murotani ◽  
Satoru Kamoshita ◽  
Yuri Horikoshi ◽  
Akiyoshi Kuroda
Keyword(s):  
Amino Acid ◽  
Hospital Mortality ◽  
Aspiration Pneumonia ◽  
Low Dose ◽  
Oral Intake ◽  
Reference Level ◽  
Claims Database ◽  
Medical Claims ◽  
Dose Levels ◽  
Medical Claims Database

Abstract Background This study examined the association between parenteral energy/amino acid doses and in-hospital mortality among inpatients on long-term nil per os (NPO) status, using a medical claims database in Japan. Methods Hospitalized patients with aspiration pneumonia, aged ≥65 years and on >7-days NPO status, were identified in a medical claims database between January 2013 and December 2018. Using multivariate logistic regression and regression analyses, we examined the association between mean parenteral energy/amino acid doses and in-hospital mortality, and secondarily the association between prognosis (in-hospital mortality, inability to receive full oral intake, re-admission, hospital stay length) among four groups classified by mean amino acid dose (No dose: 0 g/kg/day; Very low dose: >0, ≤0.3 g/kg/day; Low dose: >0.3, ≤0.6 g/kg/day; Moderate dose: >0.6 g/kg/day). Results The analysis population included 20,457 inpatients (≥80 years: 78.3%). In total, 5,920 mortalities were recorded. Increased amino acid doses were significantly associated with reduced in-hospital mortality (p <0.001). With a No dose reference level, the odds ratios (95% confidence interval) of in-hospital mortality adjusted for potential confounders, were 0.78 (0.72–0.85), 0.74 (0.67–0.82), and 0.69 (0.59–0.81) for Very low, Low, and Moderate amino acid doses, respectively. Additionally, patients prescribed amino acid dose levels >0.6 g/kg/day had shorter hospitalization periods than those prescribed none. Conclusions Increased amino acid doses were associated with reduced in-hospital mortality. Sufficient amino acid administration is recommended for patients with aspiration pneumonia requiring NPO status.

scholarly journals High-dose versus low-dose haemofiltration for the treatment of critically ill patients with acute kidney injury: an updated systematic review and meta-analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e014171 ◽  
Author(s):  
Peng Li ◽  
Li-ping Qu ◽  
Dong Qi ◽  
Bo Shen ◽  
Yi-mei Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Meta Analysis ◽  
Kidney Injury ◽  
High Dose

ObjectiveThe purpose of this study was to perform a systematic review and meta-analysis to evaluate the effect of high-dose versus low-dose haemofiltration on the survival of critically ill patients with acute kidney injury (AKI). We hypothesised that high-dose treatments are not associated with a higher risk of mortality.DesignMeta-analysis.SettingRandomised controlled trials and two-arm prospective and retrospective studies were included.ParticipantsCritically ill patients with AKI.InterventionsContinuous renal replacement therapy.Primary and secondary outcome measuresPrimary outcomes: 90-day mortality, intensive care unit (ICU) mortality, hospital mortality; secondary outcomes: length of ICU and hospital stay.ResultEight studies including 2970 patients were included in the analysis. Pooled results showed no significant difference in the 90-mortality rate between patients treated with high-dose or low-dose haemofiltration (pooled OR=0.90, 95% CI 0.73 to 1.11, p=0.32). Findings were similar for ICU (pooled OR=1.12, 95% CI 0.94 to 1.34, p=0.21) and hospital mortality (pooled OR=1.03, 95% CI 0.81 to 1.30, p=0.84). Length of ICU and hospital stay were similar between high-dose and low-dose groups. Pooled results are not overly influenced by any one study, different cut-off points of prescribed dose or different cut-off points of delivered dose. Meta-regression analysis indicated that the results were not affected by the percentage of patients with sepsis or septic shock.ConclusionHigh-dose and low-dose haemofiltration produce similar outcomes with respect to mortality and length of ICU and hospital stay in critically ill patients with AKI.This study was not registered at the time the data were collected and analysed. It has since been registered on 17 February 2017 athttp://www.researchregistry.com/, registration number: reviewregistry211.

IN HOSPITAL MORTALITY BENEFIT WITH COMBINED LOW DOSE VITAMIN C AND HYDROCORTISONE IN SEVERE SEPSIS AND SEPTIC SHOCK

CHEST Journal ◽  
2019 ◽  
Vol 156 (4) ◽  
pp. A1645-A1646
Author(s):  
Elyana Matayeva ◽  
Theresa Henson ◽  
Nashreen Anderson ◽  
Donald Brown ◽  
Raghavendra Sanivarapu ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Vitamin C ◽  
Hospital Mortality ◽  
Low Dose ◽  
Mortality Benefit ◽  
Sepsis And Septic Shock

scholarly journals Evaluation of low-dose aspirin use among COVID-19 critically ill patients: A Multicenter Propensity Score Matched Study

2021 ◽  
Author(s):  
Abdullah Al Harthi ◽  
Khalid Al Sulaiman ◽  
Ohoud Aljuhani ◽  
Ghazwa B. Korayem ◽  
Ali F. Altebainawi ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
P Value ◽  
Icu Stay ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Anti Inflammatory

Abstract BackgroundMultiple medications with anti-inflammatory effects have been used to manage the hyper-inflammatory response associated with COVID-19. Aspirin is used widely as a cardioprotective agent due to its antiplatelet and anti-inflammatory properties. Its role in hospitalized COVID-19 patients has been assessed and evaluated in the literature. However, no data regards its role in COVID-19 critically ill patients. Therefore, this study aims to evaluate the use of low-dose aspirin (81-100 mg) and its impact on outcomes in COVID-19 critically ill patients. MethodThis is a multicenter, retrospective cohort study for all adult critically ill patients with confirmed COVID-19 admitted to Intensive Care Units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were classified into two groups based on aspirin use during ICU stay. The primary outcome is the in-hospital mortality; other outcomes were considered secondary. Propensity score-matched used based on patient’s age, SOFA score, MV status within 24 hours of ICU admission, prone position status, ischemic heart disease (IHD), and stroke as co-existing illness. We considered a P value of < 0.05 statistically significant.ResultsA total of 1033 patients were eligible; 352 patients were included after propensity score matching (1:1 ratio). The in-hospital mortality (HR (95%CI): 0.73 (0.56, 0.97), p-value=0.03) were lower in patients who received aspirin during hospital stay. On the other hand, patients who received aspirin have a higher risk of major bleeding compared to the control group (OR (95%CI): 2.92 (0.91, 9.36), p-value=0.07); but was not statistically significant.ConclusionAspirin use in COVID-19 critically ill patients may have a mortality benefit; nevertheless, it may be linked with an increased risk of significant bleeding. The benefit-risk evaluation for aspirin usage during an ICU stay should be tailored to each patient.

Effect of Low-Dose Hydrocortisone Therapy in Adult Patients With Septic Shock: A Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials

2018 ◽  
Vol 35 (10) ◽  
pp. 971-983 ◽  
Author(s):  
Qing-Quan Lyu ◽  
Qi-Hong Chen ◽  
Rui-Qiang Zheng ◽  
Jiang-Quan Yu ◽  
Xiao-Hua Gu
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Sequential Analysis ◽  
Low Dose ◽  
Meta Analysis ◽  
Adult Patients ◽  
Trial Sequential Analysis ◽  
Icu Mortality ◽  
Randomized Controlled ◽  
Shock Reversal

Background: The efficacy of low-dose hydrocortisone therapy in the management of septic shock remains controversial in critical care for many years. Hence, we performed this meta-analysis of randomized controlled trials (RCTs) with trial sequential analysis (TSA) to evaluate its effect on clinical outcome among adult patients with septic shock. Methods: We identified relevant RCTs published from inception to March 7, 2018 comparing low-dose hydrocortisone with placebo or no intervention in adults admitted to the intensive care unit (ICU) for septic shock. Meta-analyses were performed for the primary and secondary outcomes. The risk of bias was assessed using the Cochrane Collaboration’s instrument. Trial sequential analysis was used to pool the results from the included studies for the primary outcomes. Results: Thirteen studies were retrieved by our literature search strategy. There were no significant differences in 28-day mortality (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.81-1.00; P = .05) and hospital mortality (OR = 0.91, 95% CI = 0.82-1.02; P = .09) between the 2 groups, which were confirmed by TSA. However, there was a significant improvement in shock reversal in the hydrocortisone group (OR = 1.33, 95% CI = 1.02-1.72; P = .03). Furthermore, subgroup analyses revealed that hydrocortisone plus fludrocortisone statistically reduced the rate of 28-day mortality (OR = 0.79, 95% CI = 0.64-0.97; P = .03), ICU mortality (OR = 0.77, 95% CI = 0.63-0.95; P = .02), and hospital mortality (OR = 0.77, 95% CI = 0.63-0.95; P = .01) in comparison with the placebo, the results were also confirmed by TSA. Conclusion: Among adult patients with septic shock, the use of low-dose hydrocortisone compared with control did not confer overall survival benefits, albeit improving shock reversal rate. The benefit of reducing 28-day mortality, ICU mortality, and hospital mortality was observed in combination use of hydrocortisone and fludrocortisone.

scholarly journals Optimal Antithrombin Activity Threshold for Initiating Antithrombin Supplementation in Patients With Sepsis-Induced Disseminated Intravascular Coagulation: A Multicenter Retrospective Observational Study

2018 ◽  
Vol 24 (6) ◽  
pp. 874-883 ◽  
Author(s):  
Mineji Hayakawa ◽  
Kazuma Yamakawa ◽  
Daisuke Kudo ◽  
Kota Ono
Keyword(s):  
Hospital Mortality ◽  
Disseminated Intravascular Coagulation ◽  
Low Dose ◽  
Activity Levels ◽  
Initial Activity ◽  
Intravascular Coagulation ◽  
Risk Of Bleeding ◽  
Antithrombin Activity ◽  
Hazard Ratios ◽  
Bottom Quartile

Low-dose antithrombin supplementation therapy (1500 IU/d for 3 days) improves outcomes in patients with sepsis-induced disseminated intravascular coagulation (DIC). This retrospective study evaluated the optimal antithrombin activity threshold to initiate supplementation, and the effects of supplementation therapy in 1033 patients with sepsis-induced DIC whose antithrombin activity levels were measured upon admission to 42 intensive care units across Japan. Of the 509 patients who had received antithrombin supplementation therapy, in-hospital mortality was significantly reduced only in patients with very low antithrombin activity (≤43%; bottom quartile; adjusted hazard ratio: 0.603; 95% confidence interval: 0.368-0.988; P = .045). Similar associations were not observed in patients with low, moderate, or normal antithrombin activity levels. Supplementation therapy did not correlate with the incidence of bleeding requiring transfusion. The adjusted hazard ratios for in-hospital mortality increased gradually with antithrombin activity only when initial activity levels were very low to normal but plateaued thereafter. We conclude that antithrombin supplementation therapy in patients with sepsis-induced DIC and very low antithrombin activity may improve survival without increasing the risk of bleeding.

Increasing the Number of Medical Emergency Calls Does Not Improve Hospital Mortality

2018 ◽  
Vol 46 (7) ◽  
pp. 1063-1069 ◽  
Author(s):  
John Santamaria ◽  
John Moran ◽  
David Reid
Keyword(s):  
Hospital Mortality ◽  
Medical Emergency ◽  
Emergency Calls ◽  
Improve Hospital

Abstract 125: Is In-hospital Mortality in ST-elevation Myocardial Infarction Associated With Core Measure Compliance?

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Stephen L Rennyson ◽  
Michael C Kontos ◽  
Anita Y Chen ◽  
Karen P Alexander ◽  
Matthew T Roe ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
High Mortality ◽  
Hospital Performance ◽  
Core Measure ◽  
St Elevation ◽  
Improve Hospital ◽  
Composite Scores ◽  
Core Measures

Introduction: The Center for Medicare and Medicaid Services (CMS) publicly reports mortality as well as 8 established core measures for patients (pts) with acute myocardial infarction (AMI) in an effort to measure and improve hospital performance. Our goal was to determine if compliance with CMS measures among PCI centers correlates with in-hospital STEMI mortality. Methods: We studied 96,340 consecutive STEMI pts from 349 PCI capable sites from the National Cardiovascular Data Registry’s ACTION Registry from 1/07-3/11. Hospitals were separated into groups by observed risk-adjusted in-hospital mortality: low (20%), middle (60%), and high mortality (20%). For each grouping, the proportional adherence to AMI core measures were reported, along with medians and inter-quartile ranges (IQR) for the composite 7 core measure score. Spearman correlations were calculated between core measures and risk adjusted mortality. Results: Low mortality hospitals had a median and IQR mortality of 3.5% (3.0, 3.9%), vs 5.9% (5.2, 6.6%) and 9.0% (8.3, 10.4%) for the middle and high mortality hospitals. Differences in the rate of individual and composite CMS core measure adherence were significantly different across most of the measures among the 3 hospital groups, although these differences were clinically small (Table). Most individual core measures and the composite scores were significantly correlated with mortality, although the associations were weak. Conclusion: Despite a high adherence to CMS core measures for STEMI patients there is only a weak correlation with risk adjusted in-hospital mortality. Thus, these core measures may not accurately differentiate quality of hospital care.

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