Prediction of Patient Length of Stay on the Intensive Care Unit Following Cardiac Surgery: A Logistic Regression Analysis Based on the Cardiac Operative Mortality Risk Calculator, EuroSCORE

ABSTRACT:Background:Post-cardiac surgery patients exhibit a higher incidence of postoperative delirium (PD) compared to non-cardiac surgery patients. Patients with various cardiac diseases suffer from preoperative sleep disorder (SPD) induced by anxiety, depression, breathing disorder, or other factors.Objective:To examine the effect of sleep disorder on delirium in post-cardiac surgery patients.Methods:We prospectively selected 186 patients undergoing selective cardiac valve surgery. Preoperative sleep quality and cognitive function of all eligible participants were assessed through the Pittsburgh Sleep Quality Index (PSQI) and the Montreal Cognitive Assessment, respectively. The Confusion Assessment Method for Intensive Care Unit was used to assess PD from the first to seventh day postoperatively. Patients were divided into two groups according to the PD diagnosis: (1) No PD group and (2) the PD group.Results:Of 186 eligible patients, 29 (15.6%) were diagnosed with PD. A univariate analysis showed that gender (p = 0.040), age (p = 0.009), SPD (p = 0.008), intraoperative infusion volume (p = 0.034), postoperative intubation time (p = 0.001), and intensive care unit stay time (p = 0.009) were associated with PD. A multivariate logistic regression analysis demonstrated that age (odds ratio (OR): 1.106; p = 0.001) and SPD (OR: 3.223; p = 0.047) were independently associated with PD. A receiver operating characteristic curve demonstrated that preoperative PSQI was predictive of PD (area under curve: 0.706; 95% confidence interval: 0.595–0.816). A binomial logistic regression analysis showed that there was a significant association between preoperative 6 and 21 PSQI scores and PD incidence (p = 0.009).Conclusions:Preoperative SPD was significantly associated with PD and a main predictor of PD.

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Neonatal Mortality and Its Associated Factors among Neonates Admitted to Wollega University Referral Hospital Neonatal Intensive Care Unit, East Wollega, Ethiopia

Global Pediatric Health ◽

10.1177/2333794x211030157 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2110301

Author(s):

Tesfaye Abera ◽

Lami Bayisa ◽

Teshome Bekele ◽

Mulugeta Dessalegn ◽

Diriba Mulisa ◽

...

Keyword(s):

Intensive Care Unit ◽

Logistic Regression ◽

Regression Analysis ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Mortality ◽

Logistic Regression Analysis ◽

Neonatal Intensive Care ◽

Multiple Logistic Regression Analysis ◽

Birth Asphyxia

Ethiopia has a high neonatal mortality rate in spite of dearth of study. Therefore we aimed to assess magnitude and associated factors of neonatal mortality among neonates admitted to neonatal intensive care units of Wollega University Referral Hospital. Accordingly, a facility based cross-sectional study was conducted on 289 by reviewing medical records of neonates admitted to neonatal intensive care unit. The collected data were entered in to Epi data version 3.1 and Stata version 14 used for analysis. Variables with P-value < 0.25 at with 95% confidence interval in binary logistic regression analysis were taken to the multiple logistic regression analysis. Finally, variables with Likewise, variable with P-value < 0.05 at 95% confidence interval in multiple logistic regression analysis were considered as statistically significant. Among 289 neonates admitted to neonatal intensive care unit, 53 (18.34 %) were died. Majority 42(79.25%) of those deaths occurred at ≤ 7 days of birth. Preterm [AOR 4.15, 95% CI (1.67-10.33)], neonates faced birth asphyxia [AOR 3.26, 95% CI (1.33-7.98)], neonates who developed sepsis [AOR 2.29 95% CI (1.01-5.20)] and neonates encountered with jaundice [(AOR 11.08, 95% CI (1.03-119.59)] were more at risk to die. In general, the magnitude of neonatal mortality among neonates admitted to neonatal intensive care unit was high. Gestational age (maturity of new born), birth asphyxia, neonatal sepsis and neonatal jaundice were predictors of neonatal mortality. Neonates admitted to neonatal intensive care unit with sepsis, jaundice, and birth asphyxia demand special attention to reduce neonatal mortality.

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Applicability of Paediatric Index of Mortality 2 Score to Predict Outcome in Children Admitted to Paediatric Intensive Care Unit

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v38i3.23146 ◽

2018 ◽

Vol 38 (3) ◽

pp. 149-152

Author(s):

Shrikiran Aroor ◽

Sandeep Kumar ◽

Pushpa Kini ◽

Suneel Mundkur

Keyword(s):

Intensive Care Unit ◽

Logistic Regression ◽

Regression Analysis ◽

Intensive Care ◽

Logistic Regression Analysis ◽

Paediatric Intensive Care Unit ◽

Death Rate ◽

Paediatric Intensive Care ◽

P Value ◽

The Mean

Introduction: Research on critically ill children admitted to the intensive care unit has shown the usefulness of Paediatric Index of Mortality 2 (PIM2) score at admission to predict outcome. This study was conducted to estimate PIM2 score in children admitted to Paediatric Intensive Care Unit and its correlation with clinical outcome. Methods: This prospective observational study was conducted in children of age group one month to 18 years admitted to the paediatric intensive care unit of a tertiary care hospital. Data including demographics, diagnostic categories, duration of hospital stay, predicted death rate (PDR) measured by PIM2 score was compared between survivors and non survivors. Logistic regression analysis was performed to arrive at a risk adjusted relationship between the different predictor variables and the probability of death. Results: Consecutive 130 children admitted to PICU during the study period were enrolled. The mean PDR (%) of the total study population was 22.4 ± 10.60. The mean PDR in survivors was 12.4 ± 7.80 while the PDR in non survivors was 44.2 ± 12.62 (p value < 0.001). Children with PDR < 1% had a mortality rate of 2.4% when compared to 71.4% in children with PDR > 5% (p value < 0.001). PDR by PIM2 score and the presence of hypo-albuminemia remained significant even after adjusting for age in multivariate logistic regression analysis. Conclusion: PDR measured by PIM2 score differentiated well between survivors and non survivors in PICU. The predicted death rate was less than the observed death rate. PIM2 score is a useful tool to assess the severity of illness and predict outcome.

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Prediction of the Length of Intensive Care After Cardiac Surgery Under Cardiopulmonary Bypass: Logistic Regression Analysis Based on Troponin I And EuroSCORE II

The Heart Surgery Forum ◽

10.1532/hsf.3917 ◽

2021 ◽

Vol 24 (4) ◽

pp. E751-E757

Author(s):

Tai Lai Ti Tai Wan Gu ◽

Jianjiang Wu ◽

Haiting Zhan ◽

Yidan Huang ◽

Jiang Wang

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cardiac Surgery ◽

Intensive Care ◽

Cardiopulmonary Bypass ◽

Predictive Model ◽

Logistic Regression Analysis ◽

Troponin I ◽

Predictive Performance ◽

Binary Logistic Regression Analysis

Aim: This study is to establish a model for patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) to predict the length of intensive care. Methods: This is a single center retrospective study. A total of 265 patients admitted to the ICU after CPB from 2016 to 2017 were enrolled in the study. Preoperative indicators, intraoperative parameters, and postoperative data were collected. Each patient was scored for EuroSCORE II before surgery. According to the length of intensive care, all patients were divided into two groups: short stay (< 72 h) and long stay (≥ 72 h). A binary logistic regression analysis was performed to establish a regression model to evaluate the predictive performance of the indicators and the EuroSCORE II scoring system on the length of the intensive care. Results: Both troponin I and EuroSCORE II could predict the length of intensive care of patients undergoing cardiac surgery under CPB. After combing the two factors, the prediction efficiency was higher. Comparing the prediction results with the actual data, it showed that the method had high overall accuracy. Conclusions: The predictive model based on cTnI and EuroSCORE II can accurately predict the length of intensive care of patients undergoing cardiac surgery under CPB. This predictive model may help to improve ICU resource management.

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Multicenter Validation of a Risk Index for Mortality, Intensive Care Unit Stay, and Overall Hospital Length of Stay After Cardiac Surgery

Circulation ◽

10.1161/01.cir.91.3.677 ◽

1995 ◽

Vol 91 (3) ◽

pp. 677-684 ◽

Cited By ~ 255

Author(s):

Jack V. Tu ◽

Susan B. Jaglal ◽

C. David Naylor

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Intensive Care Unit Stay ◽

Risk Index ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Multicenter Validation

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Postoperative delirium after cardiac surgery of elderly patients as an independent risk factor for prolonged length of stay in intensive care unit and in hospital

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01842-x ◽

2021 ◽

Author(s):

Andrea Kirfel ◽

Jan Menzenbach ◽

Vera Guttenthaler ◽

Johanna Feggeler ◽

Andreas Mayr ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Elderly Patients ◽

Postoperative Delirium ◽

Confusion Assessment Method ◽

Assessment Method ◽

Hospital Length Of Stay ◽

Confusion Assessment

Abstract Background Postoperative delirium (POD) is a relevant and underdiagnosed complication after cardiac surgery that is associated with increased intensive care unit (ICU) and hospital length of stay (LOS). The aim of this subgroup study was to compare the frequency of tested POD versus the coded International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis of POD and to evaluate the influence of POD on LOS in ICU and hospital. Methods 254 elective cardiac surgery patients (mean age, 70.5 ± 6.4 years) at the University Hospital Bonn between September 2018 and October 2019 were evaluated. The endpoint tested POD was considered positive, if one of the tests Confusion Assessment Method for ICU (CAM-ICU) or Confusion Assessment Method (CAM), 4 'A's Test (4AT) or Delirium Observation Scale (DOS) was positive on one day. Results POD occurred in 127 patients (50.0%). LOS in ICU and hospital were significantly different based on presence (ICU 165.0 ± 362.7 h; Hospital 26.5 ± 26.1 days) or absence (ICU 64.5 ± 79.4 h; Hospital 14.6 ± 6.7 days) of POD (p < 0.001). The multiple linear regression showed POD as an independent predictor for a prolonged LOS in ICU (48%; 95%CI 31–67%) and in hospital (64%; 95%CI 27–110%) (p < 0.001). The frequency of POD in the study participants that was coded with the ICD F05.0 and F05.8 by hospital staff was considerably lower than tests revealed by the study personnel. Conclusion Approximately 50% of elderly patients who underwent cardiac surgery developed POD, which is associated with an increased ICU and hospital LOS. Furthermore, POD is highly underdiagnosed in clinical routine.

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Prolonged Central Venous Desaturation Measured by Continuous Oximetry Is Associated with Adverse Outcomes in Pediatric Cardiac Surgery

Anesthesiology ◽

10.1097/aln.0b013e318233056e ◽

2011 ◽

Vol 115 (5) ◽

pp. 1033-1043 ◽

Cited By ~ 16

Author(s):

Ryan Crowley ◽

Elizabeth Sanchez ◽

Jonathan K. Ho ◽

Kate J. Lee ◽

Johanna Schwarzenberger ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Adverse Events ◽

Clinical Outcomes ◽

Pediatric Patients ◽

Adverse Outcomes ◽

Central Venous ◽

Major Adverse Events

Background The role of continuous central venous oxygen saturation (ScvO₂) oximetry during pediatric cardiac surgery for predicting adverse outcomes is not known. Using a recently available continuous ScvO₂ oximetry catheter, we examined the association between venous oxygen desaturations and patient outcomes. We hypothesized that central venous oxygen desaturations are associated with adverse clinical outcomes. Methods Fifty-four pediatric patients undergoing cardiac surgery were prospectively enrolled in an unblinded observational study. ScvO₂ was measured continuously in the operating room and for up to 24 h post-Intensive Care Unit admission. The relationships between ScvO₂ desaturations, clinical outcomes, and major adverse events were determined. Results More than 18 min of venous saturations less than 40% were associated with major adverse events with 100% sensitivity and 97.6% specificity. Significant correlations resulted between the ScvO₂ area under the curve less than 40% and creatinine clearance at 12 h in the Intensive Care Unit (r = -0.58), Intensive Care Unit length of stay (r = 0.56), max inotrope use (r = 0.52), inotrope use at 24 h (r = 0.40), inotrope index score (r = 0.39), hospital length of stay (r = 0.36), and length of intubation (r = 0.32). Conclusions We demonstrate that ScvO₂ desaturations by continuous oximetry are associated with major adverse events in pediatric patients undergoing cardiac surgery. The most significant associations with major adverse events are seen in patients with greater than 18 min of central venous saturations less than 40%. Our results support the further investigation of ScvO₂ as a potential target parameter in high-risk pediatric patients to minimize the risk of major adverse events.

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Minimally invasive surfactant therapy failure: risk factors and outcome

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2018-316258 ◽

2019 ◽

Vol 104 (6) ◽

pp. F636-F642 ◽

Cited By ~ 8

Author(s):

Lobke CE Janssen ◽

Jooske Van Der Spil ◽

Anton H van Kaam ◽

Jeanne P Dieleman ◽

Peter Andriessen ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Intensive Care ◽

Minimally Invasive ◽

Logistic Regression Analysis ◽

Neonatal Intensive Care ◽

Multivariate Logistic Regression Analysis ◽

Surfactant Therapy ◽

Multivariate Logistic Regression

ObjectiveTo evaluate incidence of minimally invasive surfactant therapy (MIST) failure, identify risk factors and assess the impact of MIST failure on neonatal outcome.DesignRetrospective cohort study. MIST failure was defined as need for early mechanical ventilation (<72 hours of life). Multivariate logistic regression analysis was performed to identify risk factors for MIST failure and compare outcomes between groups.SettingTwo tertiary neonatal intensive care centres in the Netherlands.PatientsInfants born between 24 weeks’ and 31 weeks’ gestational age (GA) (n=185) with MIST for respiratory distress syndrome.InterventionsMIST procedure with poractant alfa (100–200 mg/kg).Main outcome measuresContinuous positive airway pressure (CPAP) failure after MIST in the first 72 hours of life.Results30% of the infants failed CPAP after MIST. In a multivariate logistic regression analysis, four risk factors were independently associated with failure: GA <28 weeks, C reactive protein ≥10 mg/L, absence of antenatal corticosteroids and lower surfactant dose. Infants receiving 200 mg/kg surfactant had a failure rate of 14% versus 35% with surfactant dose <200 mg/kg. Mean body temperature was 0.4°C lower at neonatal intensive care unit admission and before the procedure in infants with MIST failure.Furthermore, MIST failure was independently associated with an increased risk of severe intraventricular haemorrhage.ConclusionWe observed moderate MIST failure rates in concordance with the results of earlier studies. Absence of corticosteroids and lower surfactant dose are risk factors for MIST failure that may be modifiable in order to improve MIST success and patient outcome.

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