Serum Lactate is an Independent Predictor of Hospital Mortality in Critically Ill Patients in the Emergency Department

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.

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Critically ill patients boarding in the emergency department and the association with intensive care unit length of stay and hospital mortality during the COVID-19 pandemic

Baylor University Medical Center Proceedings ◽

10.1080/08998280.2021.2014761 ◽

2022 ◽

pp. 1-4

Author(s):

Erin Tuttle ◽

Ciara Wisecup ◽

Eric Lemieux ◽

Xuan Wang ◽

Ariel Modrykamien

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Unit Length ◽

Intensive Care Unit Length

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Effect of emergency critical care nurses and emergency department boarding time on in-hospital mortality in critically ill patients

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2020.12.067 ◽

2021 ◽

Vol 41 ◽

pp. 120-124

Author(s):

Jason Nesbitt ◽

Tsuyoshi Mitarai ◽

Garrett K. Chan ◽

Jennifer G. Wilson ◽

Kian Niknam ◽

...

Keyword(s):

Emergency Department ◽

Critical Care ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Critical Care Nurses

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Differences in Characteristics, Hospital Care, and Outcomes between Acute Critically Ill Emergency Department Patients Receiving Palliative Care and Usual Care

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312546 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12546

Author(s):

Julia Chia-Yu Chang ◽

Che Yang ◽

Li-Ling Lai ◽

Hsien-Hao Huang ◽

Shih-Hung Tsai ◽

...

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Palliative Care ◽

Intensive Care ◽

Hospital Mortality ◽

Usual Care ◽

Critically Ill ◽

Resource Utilization ◽

Critically Ill Patients ◽

Hospital Care

Background: The early integration of palliative care in the emergency department (ED-PC) provides several benefits, including improved quality of life with optimal comfort measures, and symptom control. Whether palliative care could affect the intensive care unit admissions, hospital care and resource utilization requires further investigation. Aim: To determine the differences in inpatient characteristics, hospital care, survival, and resource utilization between patients receiving palliative care (ED-PC) and usual care (UC). Design: Retrospective observational study. Setting/participants: We enrolled consecutive, acute, critically ill patients admitted to the emergency intensive care unit at Taipei Veterans General Hospital from 1 February 2018 to 31 January 2020. Results: A total of 1273 patients were evaluated for unmet palliative care needs; 685 patients received ED-PC and 588 received UC. The palliative care patients were more severely frail (AOR 2.217 (1.295–3.797), p = 0.004), had functional deterioration with three ADLs (AOR 1.348 (1.040–1.748), p = 0.024), biopsychosocial discomfort (AOR 1.696 (1.315–2.187), p < 0.001), higher Taiwan Triage and Acuity Scale 1 (p = 0.024), higher in-hospital mortality (AOR 1.983 (1.540–2.555), p < 0.001), were four times more likely to sign an DNR (AOR 4.536 (2.522–8.158), p < 0.001), and were twice as likely to sign an DNR at admission (AOR 2.1331.619–2.811), p < 0.001). Palliative care patients received less epinephrine (AOR 0.424 (0.265–0.678), p < 0.001), more frequent withdrawal of an endotracheal tube (AOR 8.780 (1.122–68.720), p = 0.038), and more narcotics (AOR1.675 (1.132–2.477), p = 0.010). Palliative care patients exhibited lower 7-day, 30-day, and 90-day survival rates (p < 0.001). There was no significant difference in the hospital length of stay (LOS) (21.2 ± 26.6 vs. 21.7 ± 20.6, p = 0.709) nor total hospital expenses (293,169 ± 350,043 vs. 294,161 ± 315,275, p = 0.958). Conclusion: Acute critically ill patients receiving palliative care were more frail, more critical, and had higher in-hospital mortality. Palliative care patients received less epinephrine, more endotracheal extubation, and more narcotics. There was no difference in the hospital LOS or hospital costs between the palliative and usual care groups. The synthesis of ED-PC is new but achievable with potential benefits to align care with patient goals.

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Pulmonary Hypertension at Admission predicts ICU Mortality in Elderly Critically ill with Severe COVID-19 Pneumonia: retrospective cohort study

10.21203/rs.3.rs-1247509/v1 ◽

2022 ◽

Author(s):

Marko Kurnik ◽

Helena Božič ◽

Anže Vindišar ◽

Petra Kolar ◽

Matej Podbregar

Keyword(s):

Elderly Patients ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Independent Predictor ◽

Strong Predictor ◽

Invasive Mechanical Ventilation ◽

Icu Mortality ◽

Non Invasive ◽

Icu Stay

Abstract BackgroundPoint-of-care ultrasound (POCUS) is a useful diagnostic tool for non-invasive assessment of critically ill patients. Mortality of elderly patients with COVID-19 pneumonia is high and there is still scarcity of definitive predictors. Aim of our study was to assess the prediction value of combined lung and heart POCUS data on mortality of elderly critically ill patients with severe COVID-19 pneumonia.MethodsThis was a retrospective observational study. Data of patients older than 70 years, with severe COVID-19 pneumonia admitted to 25-bed mixed, level 3, intensive care unit (ICU) was analyzed retrospectively. POCUS was performed at admission; our parameters of interest were pulmonary artery systolic pressure (PASP) and presence of diffuse B-line pattern (B-pattern) on lung ultrasound.ResultsBetween March 2020 and February 2021, 117 patients aged 70 years or more (average age 77±5 years) were included. Average length of ICU stay was 10.7±8.9 days. High-flow oxygenation, non-invasive ventilation and invasive mechanical ventilation were at some point used to support 36/117 (31%), 39/117 (33%) and 75/117 (64%) patients respectively. ICU mortality was 50.9%. ICU stay was shorter in survivors (8.8±8.3 vs 12.6±9.3 days, p=0.02). PASP was lower in ICU survivors (32.5±9.8 vs. 40.4±14.3 mmHg, p=0.024). B-pattern was more often detected in non-survivals (35/59 (59%) vs. 19/58 (33%), p=0.005). PASP and B-pattern at admission were both univariate predictors of mortality. PASP at admission was an independent predictor of ICU (OR 1.0683, 95%CI: 1.0108-1.1291, p=0.02) and hospital (OR 1.0813, 95%CI 1.0125-1.1548, p=0.02) mortality. Ventilator associated pneumonia (VAP) was a strong predictor of ICU and hospital mortality.ConclusionsPASP at admission is an independent predictor of ICU and hospital mortality of elderly patients with severe COVID-19 pneumonia. During ICU stay development of VAP was a strong predictor of ICU and hospital mortality.

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Hyperglycemia is an independent predictor of in-hospital mortality in critically ill patients with acute kidney injury-a cohort study

Journal of Epidemiological Research ◽

10.5430/jer.v2n1p102 ◽

2015 ◽

Vol 2 (1) ◽

pp. 102

Author(s):

Maristela Bohlke ◽

Laura Madeira ◽

Tulio Reichert ◽

Ana Carolina Brochado Geist ◽

Pedro Funari Pereira ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Roc Analysis ◽

Independent Predictor ◽

Multivariate Logistic Regression Analysis ◽

Kidney Injury ◽

Threshold Level ◽

Operating Characteristics

Introduction: The association of hyperglycemia with poor outcomes has been described in several settings, including in generalintensive care unit (ICU) patients. However, it is not clear whether this relationship is consistent for all critically ill patients. Ourstudy assessed the association of blood glucose (BG) with in-hospital mortality in critically ill patients with acute kidney injury(AKI).Methods: A cohort of critical care patients with AKI was followed up until death or hospital discharge. The associationof BG level with in-hospital mortality was analyzed with multivariate logistic regression analysis adjusted for demographic,socioeconomic, laboratory and clinical variables. Receiver-operating characteristics (ROC) analysis was used to assess the abilityof various levels of BG to predict in-hospital mortality.Results: One hundred patients were followed, with a mean age of 62.2 years, 49 male, 41 surgical, 34 diabetics and 63 withsepsis. Nineteen patients needed renal replacement therapy and 67 died during hospital stay. In the final multivariate model, age,glucose level and sepsis had an independent association with the outcome death. The threshold level of BG that maximized thecombined sensitivity and specificity for the prediction of in-hospital mortality by ROC analysis was 109 mg/dl. In the stratifiedanalysis, BG was an independent predictor of death only among non-diabetic patients.Conclusions: To the best of our knowledge, this is the first study to describe an association between hyperglycemia and in-hospitalmortality in critically ill patients with AKI. Further studies are needed to confirm this finding and to assess the potential impact oftighter glucose control in this subpopulation.

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Delta Shock Index During Emergency Department Stay Is Associated With in Hospital Mortality in Critically Ill Patients

Frontiers in Medicine ◽

10.3389/fmed.2021.648375 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yi-Syun Huang ◽

I-Min Chiu ◽

Ming-Ta Tsai ◽

Chun-Fu Lin ◽

Chien-Fu Lin

Keyword(s):

Emergency Department ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Early Mortality ◽

Hospital Length Of Stay ◽

Shock Index ◽

Hospital Outcomes ◽

Icu Admission ◽

Delta Shock

Background: Delta shock index (SI; i.e., change in SI over time) has been shown to predict mortality and need for surgical intervention among trauma patients at the emergency department (ED). However, the usefulness of delta SI for prognosis assessment in non-traumatic critically ill patients at the ED remains unknown. The aim of this study was to analyze the association between delta SI during ED management and in-hospital outcomes in patients admitted to the intensive care unit (ICU).Method: This was a retrospective study conducted in two tertiary medical centers in Taiwan from January 1, 2016, to December 31, 2017. All adult non-traumatic patients who visited the ED and who were subsequently admitted to the ICU were included. We calculated delta SI by subtracting SI at ICU admission from SI at ED triage, and we analyzed its association with in-hospital outcomes. SI was defined as the ratio of heart rate to systolic blood pressure (SBP). The primary outcome was in-hospital mortality, and the secondary outcomes were hospital length of stay (HLOS) and early mortality. Early mortality was defined as mortality within 48 h of ICU admission.Result: During the study period, 11,268 patients met the criteria and were included. Their mean age was 64.5 ± 15.9 years old. Overall, 5,830 (51.6%) patients had positive delta SI. Factors associated with a positive delta SI were multiple comorbidities (51.2% vs. 46.3%, p < 0.001) and high Simplified Acute Physiology Score [39 (29–51) vs. 37 (28–47), p < 0.001). Patients with positive delta SI were more likely to have tachycardia, hypotension, and higher SI at ICU admission. In the regression analysis, high delta SI was associated with in-hospital mortality [aOR (95% CI): 1.21 (1.03–1.42)] and early mortality [aOR (95% CI): 1.26 (1.07–1.48)], but not for HLOS [difference (95% CI): 0.34 (−0.48 to 1.17)]. In the subgroup analysis, high delta SI had higher odds ratios for both mortality and early mortality in elderly [aOR (95% CI): 1.59 (1.11–2.29)] and septic patients [aOR (95% CI): 1.54 (1.13–2.11)]. It also showed a higher odds ratio for early mortality in patients with triage SBP <100 mmHg [aOR (95% CI): 2.14 (1.21–3.77)] and patients with triage SI ≥ 0.9 [aOR (95% CI): 1.62 (1.01–2.60)].Conclusion: High delta SI during ED stay is correlated with in-hospital mortality and early mortality in patients admitted to the ICU via ED. Prompt resuscitation should be performed, especially for those with old age, sepsis, triage SBP <100 mmHg, or triage SI ≥ 0.9.

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