Infection management processes in intensive care and their association with mortality

Abstract Background ICU-specific tables of antimicrobial susceptibility for key microbial species (‘antibiograms’), antimicrobial stewardship (AMS) programmes and routine rounds by infectious diseases (ID) physicians are processes aimed at improving patient care. Their impact on patient-centred outcomes in Australian and New Zealand ICUs is uncertain. Objectives To measure the association of these processes in ICU with in-hospital mortality. Methods The Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database and Critical Care Resources registry were used to extract patient-level factors, ICU-level factors and the year in which each process took place. Descriptive statistics and hierarchical logistic regression were used to determine the relationship between each process and in-hospital mortality. Results The study included 799 901 adults admitted to 173 ICUs from July 2009 to June 2016. The proportion of patients exposed to each process of care was 38.7% (antibiograms), 77.5% (AMS programmes) and 74.0% (ID rounds). After adjusting for confounders, patients admitted to ICUs that used ICU-specific antibiograms had a lower risk of in-hospital mortality [OR 0.95 (99% CI 0.92–0.99), P = 0.001]. There was no association between the use of AMS programmes [OR 0.98 (99% CI 0.94–1.02), P = 0.16] or routine rounds with ID physicians [OR 0.96 (99% CI 0.09–1.02), P = 0.09] and in-hospital mortality. Conclusions Use of ICU-specific antibiograms was associated with lower in-hospital mortality for patients admitted to ICU. For hospitals that do not perform ICU-specific antibiograms, their implementation presents a low-risk infection management process that might improve patient outcomes.

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Early metabolic acidosis in critically ill patients: a binational multicentre study

Critical Care and Resuscitation ◽

10.51893/2021.1.oa6 ◽

2021 ◽

Vol 23 (1) ◽

pp. 67-75

Author(s):

Katsunori Mochizuki ◽

◽

Tomoko Fujii ◽

Eldho Paul ◽

Matthew Anstey ◽

...

Keyword(s):

Intensive Care ◽

Metabolic Acidosis ◽

New Zealand ◽

Hospital Mortality ◽

High Mortality ◽

Failure Assessment ◽

Patient Database ◽

Database Program ◽

Data Design ◽

Incidence Prevalence

Objective: We aimed to measure the incidence, prevalence, characteristics and outcomes of intensive care unit (ICU) patients with early (first 24 hours) metabolic acidosis (MA) according to two different levels of severity with a focus on recent data. Design: We retrospectively applied two diagnostic criteria to our analysis based on literature for early MA: i) severe MA criteria (pH  7.20 and PaCO2  45 mmHg and HCO3  20 mmol/L with total Sequential Organ Failure Assessment [SOFA] score  4 or lactate  2 mmol/L), and ii) moderate MA criteria (pH < 7.30 and base excess < 4 mmol/L and PaCO2  45 mmHg). Setting: ICUs in the Australian and New Zealand Intensive Care Society Adult Patient Database program. Participants: Adult patients registered to the database from 2008 to 2018. Main outcome measures: Incidence, prevalence, and hospital mortality of patients with MA by the two criteria. Results: We screened 1 076 087 patients. Given the Australian and New Zealand population during the study period, we estimated the incidence of severe MA at 39.5 per million per year versus 349.2–411.5 per million per year for moderate MA. In the most recent 2 years, we observed early severe MA in 1.5% (1350/87 110) of patients compared with 8.4% (20 679/244 740) for moderate MA. Overall, hospital mortality for patients with early severe MA was 48.3% (652/1350) compared with 21.5% (4444/20 679) for moderate MA. Conclusions: Early severe MA is uncommon in Australian and New Zealand ICUs and carries a very high mortality. Moderate MA is over seven-fold more common and still carries a high mortality.

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Platelet-Lymphocyte Ratio as a New Predictor of In-hospital Mortality in Cardiac Intensive Care Unit Patients

10.21203/rs.3.rs-763264/v1 ◽

2021 ◽

Author(s):

Guangyao Zhai ◽

Biyang Zhang ◽

Jianlong Wang ◽

Yuyang Liu ◽

Yujie Zhou

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cardiovascular Diseases ◽

Hospital Mortality ◽

Subgroup Analysis ◽

Cardiac Intensive Care Unit ◽

Lymphocyte Ratio ◽

Platelet Lymphocyte Ratio ◽

Cardiac Intensive Care ◽

The Relationship

Abstract Background: It has been discovered that both inflammation and platelet aggregation could cause crucial effect on the occurrence and development of cardiovascular diseases. As a combination of platelet and lymphocyte, platelet-lymphocyte ratio (PLR) was proved to be correlated with the severity as well as prognosis of cardiovascular diseases. Exploring the relationship between PLR and in-hospital mortality in cardiac intensive care unit (CICU) patients was the purpose of this study. Method: PLR was calculated by dividing platelet count by lymphocyte count. All patients were grouped by PLR quartiles and the primary outcome was in-hospital mortality. The independent effect of PLR was determined by binary logistic regression analysis. The curve in line with overall trend was drawn by local weighted regression (Lowess). Subgroup analysis was used to determine the relationship between PLR and in-hospital mortality in different subgroups. Result: We included 5577 CICU patients. As PLR quartiles increased, in-hospital mortality increased significantly (Quartile 4 vs Quartile 1: 13.9 vs 8.3, P <0.001). After adjusting for confounding variables, PLR was proved to be independently associated with increased risk of in-hospital mortality (Quartile 4 vs Quartile 1: OR, 95% CI: 1.99, 1.46-2.71, P<0.001, P for trend <0.001). The Lowess curves showed a positive relationship between PLR and in-hospital mortality. The subgroup analysis revealed that patients with low Acute Physiology and Chronic Health Evaluation IV (APACHE IV) or with less comorbidities had higher risk of mortality for PLR. Further, PLR quartiles had positive relation with length of CICU stay (Quartile 4 vs Quartile 1: 2.7, 1.6-5.2 vs 2.1, 1.3-3.9, P<0.001), and the length of hospital stay (Quartile 4 vs Quartile 1: 7.9, 4.6-13.1 vs 5.8, 3.3-9.8, P<0.001). Conclusion: PLR was independently associated with in-hospital mortality in CICU patients.

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Clinical Prognosis of Pericardial Effusion in COVID 19

10.21203/rs.3.rs-857221/v1 ◽

2021 ◽

Author(s):

İbrahim Saraç ◽

Gökhan Tonkaz ◽

Emrah Aksakal ◽

Faruk Aydınyılmaz ◽

Kaan Alişar ◽

...

Keyword(s):

Intensive Care ◽

Mortality Rate ◽

Pericardial Effusion ◽

Hospital Mortality ◽

Elevated Serum ◽

Clinical Prognosis ◽

Pneumonia Severity ◽

Polymerase Chain ◽

The Relationship

Abstract Purpose In our study, we investigated the relationship between pneumonia severity and pericardial effusion, predisposing factors and the effect of pericardial effusion on clinical prognosis and mortality in COVID-19 patients. Methods A total of 3794 patients who were diagnosed with COVID- 19 by polymerase chain reaction (PCR), were hospitalized between March 21 and November 30, 2020 were included in the study. For each of the 3794 patients, the initial chest CT images, pericardial efusion (PE), pleural efusion and pneumonia severity were evaluated. Results The mean age of patients with PE was higher and it was more common in males. Patients with PE had more comorbid diseases and significantly elevated serum cardiac and inflammatory biomarkers. In addition, the need for intensive care and mortality rates were higher in these patients. While the in-hospital mortality rate was 56.9% in patients with PE and AC involvement above 50%, in-hospital mortality rate was 34.4% in patients with AC involvement above 50% and without PE (p < 0.001). Conclusions In patients presenting with severe AC involvement on CT or being followed up with COVID-19 pneumonia, PE often accompanies the deterioration in the laboratories and clinics of the patients. The clinical prognosis in patients presenting with PE was quite poor, and the frequency of intensive care admissions and mortality were significantly higher. In conclusion, in our study, PE emerged as an important finding in the follow-up and management of patients with COVID-19 and reflects the clinical prognosis.

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The Association Between Low Admission Peak Plasma Creatinine Concentration and In-Hospital Mortality in Patients Admitted to Intensive Care in Australia and New Zealand*

Critical Care Medicine ◽

10.1097/ccm.0000000000001348 ◽

2016 ◽

Vol 44 (1) ◽

pp. 73-82 ◽

Cited By ~ 12

Author(s):

Andrew A. Udy ◽

Carlos Scheinkestel ◽

David Pilcher ◽

Michael Bailey

Keyword(s):

Intensive Care ◽

New Zealand ◽

Hospital Mortality ◽

Peak Plasma ◽

Plasma Creatinine ◽

Creatinine Concentration ◽

Plasma Creatinine Concentration

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Resource Utilization and Outcome in Gravely Ill Intensive Care Unit Patients With Predicted In-hospital Mortality Rates of 95% or Higher by APACHE III Scores: The Relationship With Physician and Family Expectations

Mayo Clinic Proceedings ◽

10.4065/80.2.166 ◽

2005 ◽

Vol 80 (2) ◽

pp. 166-173 ◽

Cited By ~ 20

Author(s):

Keith H. Berge ◽

Deborah R. Maiers ◽

David P. Schreiner ◽

Stephen M. Jewell ◽

Perry S. Bechtle ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Resource Utilization ◽

Mortality Rates ◽

Family Expectations ◽

Apache Iii ◽

The Relationship

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Frailty, delirium and hospital mortality of older adults admitted to intensive care, a mediation analysis: the Delirium (Deli) in ICU study.

10.21203/rs.3.rs-52423/v1 ◽

2020 ◽

Author(s):

David Sanchez ◽

Kathleen Brennan ◽

Masar El Safye ◽

Sharon-Ann Shunker ◽

Tony Bogdanoski ◽

...

Keyword(s):

Older Adults ◽

Intensive Care ◽

Hospital Mortality ◽

Hospital Stay ◽

Mediation Analysis ◽

Baseline Period ◽

Acute Episode ◽

Hospital Death ◽

Frail Patients ◽

The Relationship

Abstract Background As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of frail patients an acute episode of delirium is also common, and both frailty and delirium increase the risk of mortality. However, the complex relationship between frailty, delirium and mortality has not been extensively explored in the intensive care setting. Therefore, the aim of this study was to explore the relationship between clinical frailty, acute delirium and hospital mortality of older adults admitted to intensive care. Methods This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the South Western Sydney Local Health District, between May 2019 and April 2020. During the initial 6-month baseline period, clinical frailty status on admission to ICU, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of ICU and hospital stay will be described. Mediation analysis was used to assess the relationship between frailty, delirium and risk of hospital death. Results During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63–79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.61, 95% Confidence Interval (CI) 1.14–2.28, p = 0.007), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.43, 95% CI 1.68–3.57, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the ICU had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU (p = 0.034, for interaction between frailty, delirium and hospital mortality). The proportion of the effect of frailty and risk of hospital mortality mediated by an acute episode of delirium in the ICU was estimated to 9.4% (95% CI 2–24%). Conclusion This study has been able to show that clinical frailty on admission increases the risk of delirium by approximately 60%, and both increase the risk of hospital mortality. One in three frail patients who experienced an acute episode of delirium during their stay in the ICU did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the ICU setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.

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Platelet-lymphocyte ratio as a new predictor of in-hospital mortality in cardiac intensive care unit patients

Scientific Reports ◽

10.1038/s41598-021-02686-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Guangyao Zhai ◽

Jianlong Wang ◽

Yuyang Liu ◽

Yujie Zhou

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cardiovascular Diseases ◽

Hospital Mortality ◽

Subgroup Analysis ◽

Cardiac Intensive Care Unit ◽

Lymphocyte Ratio ◽

Platelet Lymphocyte Ratio ◽

Cardiac Intensive Care ◽

The Relationship

AbstractIt has been discovered that both inflammation and platelet aggregation could cause crucial effect on the occurrence and development of cardiovascular diseases. As a combination of platelet and lymphocyte, platelet-lymphocyte ratio (PLR) was proved to be correlated with the severity as well as prognosis of cardiovascular diseases. Exploring the relationship between PLR and in-hospital mortality in cardiac intensive care unit (CICU) patients was the purpose of this study. PLR was calculated by dividing platelet count by lymphocyte count. All patients were grouped by PLR quartiles and the primary outcome was in-hospital mortality. The independent effect of PLR was determined by binary logistic regression analysis. The curve in line with overall trend was drawn by local weighted regression (Lowess). Subgroup analysis was used to determine the relationship between PLR and in-hospital mortality in different subgroups. We included 5577 CICU patients. As PLR quartiles increased, in-hospital mortality increased significantly (Quartile 4 vs. Quartile 1: 13.9 vs. 8.3, P < 0.001). After adjusting for confounding variables, PLR was proved to be independently associated with increased risk of in-hospital mortality (Quartile 4 vs. Quartile 1: OR 95% CI 1.55, 1.08–2.21, P = 0.016, P for trend < 0.001). The Lowess curves showed a positive relationship between PLR and in-hospital mortality. The subgroup analysis revealed that patients with low Acute Physiology and Chronic Health Evaluation IV (APACHE IV) or with less comorbidities had higher risk of mortality for PLR. Further, PLR quartiles had positive relation with length of CICU stay (Quartile 4 vs. Quartile 1: 2.7, 1.6–5.2 vs. 2.1, 1.3–3.9, P < 0.001), and the length of hospital stay (Quartile 4 vs. Quartile 1: 7.9, 4.6–13.1 vs. 5.8, 3.3–9.8, P < 0.001). PLR was independently associated with in-hospital mortality in CICU patients.

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The Angler in the Environment: Social, Economic, Biological, and Ethical Dimensions

The Angler in the Environment: Social, Economic, Biological, and Ethical Dimensions ◽

10.47886/9781934874240.ch18 ◽

2011 ◽

Keyword(s):

New Zealand ◽

Fisheries Management ◽

Social Economic ◽

Economic Interests ◽

Reporting Scheme ◽

Reporting Requirements ◽

Management Processes ◽

The Relationship

<i>Abstract</i>.—This paper investigates the obstacles in securing New Zealand charter operators’ support for the introduction of a marine recreational charter vessel registration and reporting scheme to improve the management of shared fisheries. Currently, charter operators are reluctant to be involved because they do not trust the Ministry of Fisheries’ (MFish) use of the information generated by the registration and reporting scheme. Charter operators believe the registration and reporting scheme is based on the premise that fisheries management does not account well for their interests. However, the information generated through registration and reporting is essential to improving the relationship between MFish and charter operators, so that they can be better represented in fisheries management processes that recognize and enhance their interests. I conclude that appealing to charter operators’ economic interests is the best way to explain the benefits of the registration and reporting requirements. Using this strategy has the potential to improve charter operators’ trust in MFish, secure their support for the registration and reporting scheme, and contribute to the improved management of New Zealand’s shared fisheries.

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Admission Oxygen Saturation and Mortality in Acute Pulmonary Embolism Patients: Observational Data From Large ICU Databases

10.21203/rs.3.rs-580015/v1 ◽

2021 ◽

Author(s):

Xiaolin Xu ◽

Anping Peng ◽

Jing Tian ◽

Runnan Shen ◽

Guochang You ◽

...

Keyword(s):

Pulmonary Embolism ◽

Logistic Regression ◽

Intensive Care ◽

Hospital Mortality ◽

Oxygen Saturation ◽

Acute Pulmonary Embolism ◽

Research Database ◽

Optimal Range ◽

Subgroup Analyses ◽

The Relationship

Abstract Background The relationship between blood oxygenation and clinical outcomes of acute pulmonary embolism (APE) patients in intensive care unit (ICU) is unclear, which could be nonlinear. The study aimed to determine the association between admission pulse oximetry-derived oxygen saturation (SpO2) levels and mortality, and to determine the optimal range with real-world data. Methods Patients diagnosed with APE on admission and staying in ICU for at least 24 hours in the Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU-CRD) were included. Logistic regression and restricted cubic spline (RCS) models were applied to determine the nonlinear relationship between mean SpO2 levels within the first 24 hours after ICU admission and in-hospital mortality, from which we derived an optimal range of SpO2. Subgroup analyses were based on demographics, treatment information, scoring system and comorbidities. Results We included 1109 patients who fulfilled inclusion criteria, among whom 129 (12%) died during hospitalization and 80 (7.2%) died in ICU. The RCS showed that the relationship between admission SpO2 levels and in-hospital mortality of APE patients was nonlinear and U-shaped. The optimal range of SpO2 with the lowest mortality was 95–98%. Multivariate stepwise logistic regression analysis with backward elimination confirmed that the admission SpO2 levels of 95%-98% was associated with decreased hospital mortality compared to the group with SpO2 < 95% (Odds ratio [OR] = 2.321; 95% confidence interval [CI]: 1.405–3.786; P < 0.001) and 100% (OR = 2.853; 95% CI: 1.294–5.936; P = 0.007), but there was no significant difference compared with 99% SpO2 (OR = 0.670, 95% CI: 0.326–1.287; P > 0.05). This association was consistent across subgroup analyses. Conclusions The relationship between admission SpO2 levels and in-hospital mortality followed a U-shaped curve among patients with APE. The optimal range of SpO2 for APE patients was 95–98%.

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