The impact of sustained new-onset atrial fibrillation on mortality and stroke incidence in critically ill patients: A retrospective cohort study

2018 ◽  
Vol 44 ◽  
pp. 267-272 ◽  
Author(s):  
Takuo Yoshida ◽  
Shigehiko Uchino ◽  
Taisuke Yokota ◽  
Tomoko Fujii ◽  
Shoichi Uezono ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Stroke Incidence ◽  
The Impact ◽  
Onset Atrial Fibrillation ◽  
New Onset

scholarly journals The Impact of Early Achievement of Therapeutic Levels of Vancomycin in Critically Ill Patients With Confirmed Gram-Positive Infection: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Abdulrahman Alshaya ◽  
Amjad Alsaeed ◽  
Nadiyah Alshehri ◽  
Ramesh Vishwakarma ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Gram Positive ◽  
The Impact ◽  
Trough Levels

Abstract BackgroundVancomycin is a commonly used antibiotic in critically ill patients for various indications. Critical illness imposes pharmacokinetic-pharmacodynamics challenges which makes optimizing vancomycin in this population cumbersome. Data are scarce on the clinical impact of time to therapeutic trough levels of vancomycin in critically ill patients. Objective (s)The aim of this study to evaluate the timing to achieve therapeutic trough level vancomycin on 30-day mortality in critically ill patients.SettingAdult critically ill patients admitted to intensive care units (ICUs) between January 1st, 2017 and December 31st, 2018 at a tertiary teaching hospital.MethodA retrospective cohort study for all adult critically ill patients aged 18 years or older with confirmed gram-positive infection and received vancomycin. We compared early (<48 hours) versus late (≥ 48 hours) attainment of vancomycin therapeutic trough levels. Main outcomesPrimary outcome was the 30-day mortality in critically ill patients. Secondary outcomes were development of resistant organisms, eradicating microorganisms within 4-5 days of vancomycin initiation, vancomycin-induced acute kidney injury (AKI), and ICU LOS. ResultsTwo hundred and nine patients were included. No significant differences between comparative groups in baseline characteristics. Achieving therapeutic levels were associated with better survival at 30 days (OR: 0.48; 95% CI [0.26-0.87]; p<0.01). Additionally, patients who achieved therapeutic levels of vancomycin early were less likely to develop resistant organisms (OR=0.08; 95% CI [0.01-0.59]; p=0.01). Acute kidney injury (AKI) and ICU length of stay (LOS) were not significant between the two groups.ConclusionEarly attainment of vancomycin therapeutic levels was associated with possible survival benefit.

Incidence, Predictors, and Outcomes of New-Onset Atrial Fibrillation in Critically Ill Patients with Sepsis. A Cohort Study

2017 ◽  
Vol 195 (2) ◽  
pp. 205-211 ◽  
Author(s):  
Peter M. C. Klein Klouwenberg ◽  
Jos F. Frencken ◽  
Sanne Kuipers ◽  
David S. Y. Ong ◽  
Linda M. Peelen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Onset Atrial Fibrillation ◽  
New Onset

scholarly journals The Impact of Early Achievement of Therapeutic Levels of Vancomycin in Critically ill Patients with Confirmed Gram-positive Infection: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Abdulrahman Alshaya ◽  
Amjad Alsaeed ◽  
Nadiyah Alshehri ◽  
Ramesh Vishwakarma ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Gram Positive ◽  
Tertiary Teaching ◽  
The Impact ◽  
Trough Levels

Abstract Background: Vancomycin is a commonly used antibiotic in critically ill patients for various indications. Critical illness imposes pharmacokinetic-pharmacodynamics challenges which makes optimizing vancomycin in this population cumbersome. Data are scarce on the clinical impact of time to therapeutic trough levels of vancomycin in critically ill patients. The aim of this study to evaluate the timing to achieve therapeutic trough level vancomycin on 30-day mortality in critically ill patients.Method: A retrospective cohort study for all adult critically ill patients aged 18 years or older with confirmed Gram-positive infection and received vancomycin between January 1st, 2017 and December 31st, 2018 at a tertiary teaching hospital. We compared early (<48 hours) versus late (≥ 48 hours) attainment of vancomycin therapeutic trough levels. Primary outcome was the 30-day mortality in critically ill patients. Secondary outcomes were development of resistant organisms, eradicating microorganisms within 4-5 days of vancomycin initiation, vancomycin-induced acute kidney injury (AKI), and ICU length of stay (LOS). Results: Two hundred and nine patients were included. No significant differences between comparative groups in baseline characteristics. Achieving therapeutic levels were associated with better survival at 30 days (OR: 0.48; 95% CI [0.26-0.87]; p<0.01). Additionally, patients who achieved therapeutic levels of vancomycin early were less likely to develop resistant organisms (OR=0.08; 95% CI [0.01-0.59]; p=0.01). The AKI and ICU LOS were not significant between the two groups.Conclusion: Early attainment of vancomycin therapeutic levels was associated with possible survival benefit.

scholarly journals The Impact of New-onset Atrial Fibrillation on Short-term and Long-term Mortality of Critically ill Patients with Candidemia

2021 ◽  
Author(s):  
zengli xiao ◽  
Qi Wang ◽  
Xuebin Li ◽  
Youzhong An
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Short Term ◽  
The Impact ◽  
Onset Atrial Fibrillation ◽  
Long Term Mortality ◽  
New Onset

Abstract Background Both new-onset atrial fibrillation (NOAF) and candidemia occurred frequently in critically ill patients, which are associated with poor outcomes. But, the association between NOAF and critically ill patients with candidemia is still uncertain. This study is try to identify the impact of NOAF on short-term and long-term mortality of critically ill patients with candidemia. Methods We retrospectively identified NOAF in all patients with candidemia admitted to a non-cardiac intensive care unit (ICU) from January 2011 to March 2018 in a teaching hospital. We categorized these patients into 3 groups (NOAF, Prior AF, No AF) and compared clinical information between groups. Risk factors for these patients’ short-term and long-term mortality were also analyzed. Results Ninety-two patients with candidemia were identified from 2011 to 2018. Among these patients, 26 (28.3%) developed NOAF during their hospital stay. The multivariable logistic regression analysis indicated that stroke, anemia, Sequential Organ Failure Assessment (SOFA) score and NOAF were independent risk factors for in-hospital mortality and NOAF was also the independent risk factor for 1 year mortality. Conclusions There was a high incidence of NOAF in critically ill patients with candidemia, which was associated with in-hospital mortality and 1 year mortality after hospital discharge. Further multicenter studies should be conducted to help confirm this relationship and to find effective interventions that reduce short-term and long-term mortality.

scholarly journals The impact of early target attainment of vancomycin in critically ill patients with confirmed Gram-positive infection: A retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Abdulrahman Alshaya ◽  
Ohoud Aljuhani ◽  
Amjad Alsaeed ◽  
Nadiyah Alshehri ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Gram Positive ◽  
The Impact ◽  
Trough Levels

Abstract Background Vancomycin is a commonly used antibiotic in critically ill patients for various indications. Critical illness imposes pharmacokinetic-pharmacodynamics challenges, which makes optimizing vancomycin in this population cumbersome. Data are scarce on the clinical impact of time to therapeutic trough levels of vancomycin in critically ill patients.  This study aims to evaluate the timing to achieve therapeutic trough level of vancomycin on 30-day mortality in critically ill patients. Method A retrospective cohort study was conducted for all adult critically ill patients with confirmed Gram-positive infection who received IV vancomycin between January 1, 2017, and December 31, 2020. We compared early (< 48 h) versus late (≥ 48 h) attainment of vancomycin therapeutic trough levels. The primary outcome was the 30-day mortality in critically ill patients. Secondary outcomes were the development of resistant organisms, microorganisms eradication within 4–5 days of vancomycin initiation, acute kidney injury (AKI), and length of stay (LOS). Propensity score-matched (1:1 ratio) used based on patient’s age, serum creatinine, and albumin values at baseline. Results A total of 326 patients were included; 110 patients attained the therapeutic trough levels within 48 h of vancomycin initiation. Late achievement of the therapeutic trough levels was associated with higher 30-day mortality (HR: 2.54; 95% CI [1.24–5.22]; p = 0.01). Additionally, patients who achieved therapeutic trough levels of vancomycin late were more likely to develop AKI (OR = 2.59; 95% CI [1.01–6.65]; p = 0.04). Other outcomes were not statistically significant between the two groups. Conclusion Early achievement of vancomycin therapeutic levels in patients with confirmed Gram-positive infection was associated with possible survival benefits.

scholarly journals Clinical course after identification of new-onset atrial fibrillation in critically ill patients: a multicenter prospective cohort study

2020 ◽  
Author(s):  
Takuo Yoshida ◽  
Shigehiko Uchino ◽  
Yusuke Sasabuchi
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Adverse Events ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Cohort ◽  
Clinical Course ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract BackgroundNew-onset atrial fibrillation (AF) in critically ill patients is reportedly associated with poor outcomes. However, epidemiological data in intensive care units (ICUs) after new-onset AF identification are lacking. This study aimed to describe the clinical course after the identification of new-onset atrial fibrillation.Methods This prospective cohort study of 32 ICUs in Japan during 2017-2018 enrolled adult patients with new-onset AF. We collected data on patient comorbidities, physiological information before and at the AF onset, interventions, transition of cardiac rhythms, adverse events, and in-hospital death and stroke.Results The incidence of new-onset AF in the ICU was 2.9% (423 patients). At the AF onset, the mean atrial pressure decreased, and the heart rate increased. Sinus rhythm returned spontaneously in 84 patients (20%), and 328 patients (78%) were treated with pharmacological interventions (rate-control drugs, 67%; rhythm-control drugs, 34%). In total, 173 (40%) patients were treated with anticoagulants. Adverse events were more frequent in nonsurvivors than in survivors (bleeding: 14% vs 5%; p = 0.002, arrythmia other than AF: 6% vs 2%; p = 0.048). There were 92 (22%) and 15 patients (4%) patients who continued to have AF at 48 hours and 168 hours after onset, respectively. The hospital mortality rate of those patients were 32% and 60%, respectively. The overall hospital mortality was 26%, and the incidence of in-hospital stroke was 4.5%.Conclusions Although the proportion of patients continued to have AF within 168 hours decreased with various treatments, these patients were at a high risk of death. Moreover, adverse events occurred more frequently in nonsurvivors than in survivors. Further research to assess the management of new-onset AF in critically ill patients is strongly warranted.

scholarly journals The Impact of New-Onset Atrial Fibrillation on Short-Term and Long-Term Mortality of Critically Ill Patients with Candidemia

2021 ◽  
Author(s):  
Zengli Xiao ◽  
Anqi Du ◽  
Youzhong An
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Short Term ◽  
The Impact ◽  
Onset Atrial Fibrillation ◽  
Long Term Mortality ◽  
New Onset

Abstract Background: Both new-onset atrial fibrillation (NOAF) and candidemia occurred frequently in critically ill patients, which are associated with poor outcomes. But, the association between NOAF and critically ill patients with candidemia is still uncertain. This study is try to identify the impact of NOAF on short-term and long-term mortality of critically ill patients with candidemia.Methods: We retrospectively identified NOAF in all patients with candidemia admitted to a non-cardiac intensive care unit (ICU) from January 2011 to March 2018 in a teaching hospital. We categorized these patients into 3 groups (NOAF, Prior AF, No AF) and compared clinical information between groups. Risk factors for these patients’ short-term and long-term mortality were also analyzed.Results: Ninety-two patients with candidemia were identified from 2011 to 2018. Among these patients, 26 (28.3%) developed NOAF during their hospital stay. The multivariable logistic regression analysis indicated that stroke, anemia, Sequential Organ Failure Assessment (SOFA) score and NOAF were independent risk factors for in-hospital mortality and NOAF was also the independent risk factor for 1 year mortality.Conclusions: There was a high incidence of NOAF in critically ill patients with candidemia, which was associated with in-hospital mortality and 1 year mortality after hospital discharge. Further multicenter studies should be conducted to help confirm this relationship and to find effective interventions that reduce short-term and long-term mortality.

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