scholarly journals Relationship between 24-h venous blood glucose variation and mortality among patients with acute respiratory failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xiaoling Zhang ◽  
Jingjing Zhang ◽  
Jiamei Li ◽  
Ya Gao ◽  
Ruohan Li ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Venous Blood ◽  
Sensitivity Analyses ◽  
Icu Mortality ◽  
Logistic Regression Models ◽  
The Mean ◽  
The Relationship

AbstractEvidence indicates that glucose variation (GV) plays an important role in mortality of critically ill patients. We aimed to investigate the relationship between the coefficient of variation of 24-h venous blood glucose (24-hVBGCV) and mortality among patients with acute respiratory failure. The records of 1625 patients in the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database were extracted. The 24-hVBGCV was calculated as the ratio of the standard deviation (SD) to the mean venous blood glucose level, expressed as a percentage. The outcomes included ICU mortality and in-hospital mortality. Participants were divided into three subgroups based on tertiles of 24-hVBGCV. Multivariable logistic regression models were used to evaluate the relationship between 24-hVBGCV and mortality. Sensitivity analyses were also performed in groups of patients with and without diabetes mellitus. Taking the lowest tertile as a reference, after adjustment for all the covariates, the highest tertile was significantly associated with ICU mortality [odds ratio (OR), 1.353; 95% confidence interval (CI), 1.018–1.797] and in-hospital mortality (OR, 1.319; 95% CI, 1.003–1.735), especially in the population without diabetes. The 24-hVBGCV may be associated with ICU and in-hospital mortality in patients with acute respiratory failure in the ICU, especially in those without diabetes.

Abstract 3775: Average Blood Glucose and Mortality in Patients Hospitalized with Acute Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Mikhail Kosiborod ◽  
Silvio Inzucchi ◽  
Harlan M Krumholz ◽  
Lan Xiao ◽  
Phillip G Jones ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Hospital Mortality ◽  
Regression Models ◽  
Independent Predictor ◽  
Laboratory Data ◽  
Logistic Regression Models ◽  
Average Blood Glucose ◽  
The Relationship ◽  
Multivariable Adjustment ◽  
Better Than

Background: Elevated blood glucose (BG) on admission is associated with higher mortality risk in patients (pts) hospitalized with AMI. However, the prognostic value of average BG, which reflects overall glycemic exposure much better than admission BG, is unknown. Furthermore, the nature of the relationship between average BG and mortality has not been determined. Methods: We evaluated a cohort of 16,871 AMI pts hospitalized from January 2000-December 2005, using Cerner Corporation’s Health Facts® database from 40 hospitals, which contains demographics, clinical and comprehensive laboratory data. Logistic regression models evaluated the nature of the relationship between mean BG during the entire AMI hospitalization and in-hospital mortality, after adjusting for multiple patient factors and confounders. Similar analyses were performed in subgroups of pts with and without diabetes (DM). Results: A J-shaped relationship was observed between mean BG and in-hospital mortality, which persisted after multivariable adjustment (Figure ). Mortality increased with each 10 mg/dL incremental rise in mean BG over >120 mg/dL, and with incremental decline in mean BG <80 mg/dL. The slope of these relationships was much steeper in pts without DM. Conclusions: Average BG during the entire AMI hospitalization is a powerful independent predictor of in-hospital mortality. Both persistent hyper- and hypoglycemia are associated with adverse prognosis. Whether strategies directed at optimizing BG control will improve survival remains to be established. Association Between Mean BG and In-Hospital Mortality After Multivariable Adjustment (Reference: Mean BG 100 to <110)

scholarly journals Blood glucose-related indicators are associated with in-hospital mortality in critically ill patients with acute pancreatitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yan Lu ◽  
Qiaohong Zhang ◽  
Jianjie Lou
Keyword(s):  
Acute Pancreatitis ◽  
Blood Glucose ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Variability ◽  
Logistic Regression Models ◽  
Patient Prognosis ◽  
Mean Glucose ◽  
The Relationship

AbstractAcute pancreatitis (AP) results in potentially harmful blood glucose fluctuations, affecting patient prognosis. This study aimed to explore the relationship between blood glucose-related indicators and in-hospital mortality in critically ill patients with AP. We extracted data on AP patients from the Multiparameter Intelligent Monitoring in Intensive Care III database. Initial glucose (Glucose_initial), maximum glucose (Glucose_max), minimum glucose (Glucose_min), mean glucose (Glucose_mean), and glucose variability (glucose standard deviation [Glucose_SD] and glucose coefficient of variation [Glucose_CV]) were selected as blood glucose-related indicators. Logistic regression models and the Lowess smoothing curves were used to display the association between significant blood glucose-related indicators and in-hospital mortality. Survivors and non-survivors showed significant differences in Glucose_max, Glucose_mean, Glucose_SD, and Glucose_CV (P < 0.05). Glucose_max, Glucose_mean, Glucose_SD, and Glucose_CV were risk factors for in-hospital mortality in AP patients (OR > 1; P < 0.05). According to the Lowess smoothing curve, the overall trends of blood glucose-related indicators showed a non-linear correlation with in-hospital mortality. Glucose_max, Glucose_mean, Glucose_SD, and Glucose_CV were associated with in-hospital mortality in critically ill patients with AP.

scholarly journals Mortality and Life-Sustaining Therapy Decisions in Patients With Cancer and Acute Respiratory Failure Due to COVID-19 or Other Causes: An Observational Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Renato Scarsi Testa ◽  
Ana Paula Agnolon Praça ◽  
Antonio Paulo Nassar Junior ◽  
Pauliane Vieira Santana ◽  
Valdelis Novis Okamoto ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Performance Status ◽  
Primary Analysis ◽  
Metastatic Tumors ◽  
Logistic Regression Models ◽  
Patients With Cancer ◽  
Adjusted Model

It is unknown if patients with cancer and acute respiratory failure due to COVID-19 have different clinical or cancer-related characteristics, decisions to forgo life-sustaining therapies (LST), and mortality compared to patients with cancer and acute respiratory failure due to other causes. In a cohort study, we tested the hypothesis that COVID-19 was associated with increased in-hospital mortality and decreased decisions to forgo LST in patients with cancer and acute respiratory failure. We employed two multivariate logistic regression models. Propensity score matching was employed as sensitivity analysis. We compared 382 patients without COVID-19 with 65 with COVID-19. Patients with COVID-19 had better performance status, less metastatic tumors, and progressive cancer. In-hospital mortality of patients with COVID-19 was lower compared with patients without COVID-19 (46.2 vs. 74.6%; p &lt; 0.01). However, the cause of acute respiratory failure (COVID-19 or other causes) was not associated with increased in-hospital mortality [adjusted odds ratio (OR) 1.27 (0.55–2.93; 95% confidence interval, CI)] in the adjusted model. The percentage of patients with a decision to forgo LST was lower in patients with COVID-19 (15.4 vs. 36.1%; p = 0.01). However, COVID-19 was not associated with decisions to forgo LST [adjusted OR 1.21 (0.44–3.28; 95% CI)] in the adjusted model. The sensitivity analysis confirmed the primary analysis. In conclusion, COVID-19 was not associated with increased in-hospital mortality or decreased decisions to forgo LST in patients with cancer and acute respiratory failure. These patients had better performance status, less progressive cancer, less metastatic tumors, and less organ dysfunctions upon intensive care unit (ICU) admission than patients with acute respiratory failure due to other causes.

scholarly journals Acute Care of Older Patients with COVID-19: Clinical Characteristics and Outcomes

Geriatrics ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 65
Author(s):  
Zara Steinmeyer ◽  
Sara Vienne-Noyes ◽  
Marc Bernard ◽  
Armand Steinmeyer ◽  
Laurent Balardy ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Final Analysis ◽  
Geriatric Syndromes ◽  
Global Pandemic ◽  
Clinical Presentations ◽  
The Mean

(1) Background: COVID-19 has become a global pandemic and older patients present higher mortality rates. However, studies on the characteristics of this population set are limited. The objective of this study is to describe clinical characteristics and outcomes of older patients hospitalized with COVID-19. (2) Methods: This retrospective cohort study was conducted from March to May 2020 and took place in three acute geriatric wards in France. Older patients hospitalized for COVID-19 infections were included. We collected clinical, radiological, and laboratory outcomes. (3) Results: Ninety-four patients were hospitalized and included in the final analysis. Mean age was 85.5 years and 55% were female. Sixty-four (68%) patients were confirmed COVID-19 cases and 30 (32%) were probable. A majority of patients were dependent (77%), 45% were malnourished, and the mean number of comorbidities was high in accordance with the CIRS-G score (12.3 ± 25.6). The leading causes of hospitalization were fever (30%), dyspnea (28%), and geriatric syndromes (falls, delirium, malaise) (18%). Upon follow-up, 32% presented acute respiratory failure and 30% a geriatric complication. Frailty and geriatric characteristics were not correlated with mortality. Acute respiratory failure (p = 0.03) and lymphopenia (p = 0.02) were significantly associated with mortality. (4) Conclusions: Among older patients hospitalized with COVID-19, clinical presentations were frequently atypical and complications occurred frequently. Frailty and geriatric characteristics were not correlated with mortality.

scholarly journals Procalcitonin in patients with influenza A (H1N1) infection and acute respiratory failure

2011 ◽  
Vol 9 (1) ◽  
pp. 52-55
Author(s):  
Péricles Almeida Delfino Duarte ◽  
Carla Sakuma de Oliveira Bredt ◽  
Gerson Luís Bredt Jr ◽  
Amaury César Jorge ◽  
Alisson Venazzi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Influenza A ◽  
Laboratory Data ◽  
Sepsis Group ◽  
Influenza A H1n1 ◽  
Low Serum

ABSTRACT Objective: To verify serum procalcitonin levels of patients with acute respiratory failure secondary to influenza A (H1N1) upon their admission to the Intensive Care Unit and to compare these results to values found in patients with sepsis and trauma admitted to the same unit. Methods: Analysis of records of patients infected with influenza A (H1N1) and respiratory failure admitted to the General Intensive Care Unit during in a period of 60 days. The values of serum procalcitonin and clinical and laboratory data were compared to those of all patients admitted with sepsis or trauma in the previous year. Results: Among patients with influenza A (H1N1) (n = 16), the median serum procalcitonin level upon admission was 0.11 ng/mL, lower than in the sepsis group (p < 0.001) and slightly lower than in trauma patients. Although the mean values were low, serum procalcitonin was a strong predictor of hospital mortality in patients with influenza A (H1N1). Conclusion: Patients with influenza A (H1N1) with severe acute respiratory failure presented with low serum procalcitonin values upon admission, although their serum levels are predictors of hospital mortality. The kinetics study of this biomarker may be a useful tool in the management of this group of patients.

scholarly journals NIV for acute respiratory failure in COPD: high in-hospital mortality is determined by patient selection

2019 ◽  
Vol 6 (1) ◽  
pp. 1571332 ◽  
Author(s):  
Caroline Hedsund ◽  
Kasper Linde Ankjærgaard ◽  
Daniel Bech Rasmussen ◽  
Signe Høyer Schwaner ◽  
Helle Frost Andreassen ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Patient Selection

Trends in Hospital Cost, Length of Stay, Mortality, and Complication Rates in Patients with Acute Myeloid Leukemia in Teaching Versus Non-Teaching Hospitals: Data from the Nationwide Inpatient Sample from 1999-2013

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2357-2357
Author(s):  
Ankit Shah ◽  
Stuthi Perimbeti ◽  
Parshva Patel ◽  
Rachel Nathan ◽  
Daniel Kyung ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Marrow Transplant ◽  
Neutropenic Fever ◽  
Teaching Hospitals ◽  
Complication Rates ◽  
Total Charges ◽  
Acute Myeloid

Abstract Background: Acute Myeloid Leukemia (AML) is the most common acute leukemia in adults and represents a heterogeneous group of clonal hematopoietic stem cell disorders with varying prognosis based on cytogenetic and host factors. Success in treatment of AML is thought to have only improved modestly in recent decades. We aimed to evaluate trends in hospital cost, length of stay, in-hospital mortality, and complication rates in adult patients admitted with active AML. We also sought to elucidate differences in these outcomes in teaching versus non-teaching institutions. Methods: Using ICD-9 codes for acute myeloid and acute monocytic leukemias, all adult admissions with a primary diagnosis of active AML between 1999-2013 were identified from the Nationwide Inpatient Sample (NIS). Admission information including length of stay (LOS), total charges, and mortality were extracted. Total cost was adjusted for inflation using data from the U.S. Bureau of Labor Statistics. ICD-9 codes were selected to reflect the most common etiologies of in-hospital complications such as clostridium difficile infection (CDI), bacteremia, sepsis, pneumonia, venous thromboembolism (VTE), neutropenic fever, candidiasis, urinary tract infection (UTI), and acute respiratory failure. Rates of these complications were determined over the 15-year interval and compared in subsets of teaching and non-teaching hospitals. Rates of bone marrow transplant were also queried. Results: We identified 51,684 admissions (weighted N = 247,747) with a primary diagnosis of AML from 1999-2013. Most of the admissions were at teaching hospitals (N = 32,982; weighted N = 158,952). Overall in-hospital mortality was determined to be 19.54%. LOS (days) was found to be longer in teaching (21.04 ±0.10) than in non-teaching (12.25 ±0.11) hospitals (p = .0001). Total charges were also greater in teaching ($157,709 ±1,089) versus non-teaching ($79,167 ±965) hospitals (p = .0001). Of note, after correcting for age, multivariate analysis yielded higher mortality in teaching than in non-teaching hospitals (OR = 1.11, CI: 1.04-1.19). Rates of CDI, bacteremia, neutropenic fever, sepsis, acute respiratory failure, and VTE were higher in teaching hospitals (p < .0001). On the other hand, rates of UTI were lower in teaching (7.31%) than in non-teaching (8.31%) hospitals (p=.0026). Rates of pneumonia and candidiasis did not have a statistically significant difference when comparing the two settings. Bone marrow transplant was more frequently performed at teaching (1.36%) than in non-teaching hospitals (0.56%) (p=.0001). Over the 15-year interval, in-hospital mortality has declined by greater than one third for all AML admissions (p <. 0001). Rates of nearly all of the complications, excluding candidiasis, but including CDI, neutropenic fever, bacteremia, UTI, pneumonia, VTE, and acute respiratory failure have increased during this interval, however. Total charges increased during this time period from $66,678 (±1,567) in 1999 to $197,439 (±4,532) in 2013 (p = .0001), which was greater than the expected inflationary increase to $93,235 over the same time period. Conclusions: Most admissions for AML occurred at teaching institutions. This may be due to increased resource requirements to care for this patient population. In-hospital mortality appears to have improved markedly from 1999-2013 for all admissions for AML, which may be a testament to well-established chemotherapy guidelines, use of less toxic chemotherapy regimens in the elderly, and standardized preventative practices such as the use of high-efficiency particulate air filtration and prophylactic antibiotics. On the other hand, rates of nearly all measured complications have increased during this interval. Given the opposite trend in mortality, we believe this may be in part due to improved surveillance and reporting. Rates of mortality as well several complication rates appear to be higher in teaching than in non-teaching institutions, which may be due to increased medical complexity and more aggressive therapy offered at teaching institutions. Further research is required to determine what additional factors and practice differences are contributing to these discrepancies. Total charges were higher at teaching institutions, which may be due to increased LOS, complication rates, medical complexity and resource consumption. Disclosures No relevant conflicts of interest to declare.

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