Lactate based Scoring System in the diagnosis of necrotizing fasciitis

2021 ◽  
Author(s):  
Marc Daniels ◽  
Henrik Oberländer ◽  
Jennifer Schiefer ◽  
Philipp Sonnenberg ◽  
Achim Jörres ◽  
...  
Keyword(s):  
Necrotizing Fasciitis ◽  
Clinical Signs ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Roc Curve Analysis ◽  
Laboratory Findings ◽  
Laboratory Markers ◽  
Clinical Presentations ◽  
Auc Value ◽  
Median Hospital

Abstract Introduction Necrotizing fasciitis (NF) is a rare and quickly progressing infection and leads to 100% mortality if untreated. Quick diagnosis and an early and radical surgical treatment are essential for stopping bacterial progression. Unfortunately, the absence of clear clinical signs makes the diagnosis often challenging. Therefore, we searched for easy determinable predictive laboratory markers for NF. This is the first study which includes lactate values in a new score. Material and Methods A retrospective analysis of patients with NF (n = 44) and patients with erysipelas (n = 150) was performed. Lactate values, patients` demographics, clinical presentations, site of infection, comorbidities, microbiological and laboratory findings, antibiotic therapies and LRINEC and modified LRINEC Scores were analyzed. Logistic regression analysis was used to derive adjusted weights, and final simple point score was assessed with a ROC curve analysis. Results Patients with NF had a mean age of 57 years, patients with erysipelas 65 years. The median hospital length of stay was 8 and 49 days in patients with erysipelas and NF, respectively. While only one patient (0.7 %) in the group of erysipelas died, the mortality rate of patients with NF was 9/44 (20.5 %). The lactate values were statistically significant higher in the NF group 4.1 vs. 2.0 mmol/l (p < 0.001). The new created CologNe-FaDe-Score shows the highest AUC-value with 0.907. Conclusion With the help of lactate values the CologNe-FaDe-Score consists of easily practicable and highly available parameters, which could sensitize diagnosis.

scholarly journals 562. Tocilizumab for the Treatment of Severe COVID-19: A Retrospective, Multi-Center, Case-Matched Series

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S346-S346
Author(s):  
Sarah Norman ◽  
Sara Jones ◽  
David Reeves ◽  
Christian Cheatham
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Fungal Infections ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Matched Design ◽  
Median Hospital

Abstract Background At the time of this writing, there is no FDA approved medication for the treatment of COVID-19. One medication currently under investigation for COVID-19 treatment is tocilizumab, an interleukin-6 (IL-6) inhibitor. It has been shown there are increased levels of cytokines including IL-6 in severe COVID-19 hospitalized patients attributed to cytokine release syndrome (CRS). Therefore, inhibition of IL-6 receptors may lead to a reduction in cytokines and prevent progression of CRS. The purpose of this retrospective study is to utilize a case-matched design to investigate clinical outcomes associated with the use of tocilizumab in severe COVID-19 hospitalized patients. Methods This was a retrospective, multi-center, case-matched series matched 1:1 on age, BMI, and days since symptom onset. Inclusion criteria included ≥ 18 years of age, laboratory confirmed positive SARS-CoV-2 result, admitted to a community hospital from March 1st – May 8th, 2020, and received tocilizumab while admitted. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, total mechanical ventilation days, mechanical ventilation mortality, and incidence of secondary bacterial or fungal infections. Results The following results are presented as tocilizumab vs control respectively. The primary outcome of in-hospital mortality for tocilizumab (n=26) vs control (n=26) was 10 (38%) vs 11 (42%) patients, p=0.777. The median hospital length of stay for tocilizumab vs control was 14 vs 11 days, p=0.275. The median days of mechanical ventilation for tocilizumab (n=21) vs control (n=15) was 8 vs 7 days, p=0.139, and the mechanical ventilation mortality was 10 (48%) vs 9 (60%) patients, p=0.463. In the tocilizumab group, for those expired (n=10) vs alive (n=16), 10 (100%) vs 7 (50%) patients respectively had a peak ferritin > 600 ng/mL, and 6 (60%) vs 8 (50%) patients had a peak D-dimer > 2,000 ng/mL. The incidence of secondary bacterial or fungal infections within 7 days of tocilizumab administration occurred in 5 (19%) patients. Conclusion These findings suggest that tocilizumab may be a beneficial treatment modality for severe COVID-19 patients. Larger, prospective, placebo-controlled trials are needed to further validate results. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

Abstract WP355: Intracerebral Hemorrhage Care in a Stroke Unit is Safe and Associated With Lower Costs

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Corey R Fehnel ◽  
Linda C Wendell ◽  
N. Stevenson Potter ◽  
Kimberly Glerum ◽  
Richard N Jones ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Stroke Unit ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Total Hospital ◽  
Reduced Costs ◽  
Reducing Costs ◽  
Ich Score ◽  
Median Hospital

Background: There is little data to support level of care decisions for lower risk intracerebral hemorrhage (ICH) patients. The addition of a dedicated stroke unit (SU) at our institution allowed for a comparison of such patients cared for in the intensive care unit (ICU) or SU. We hypothesized that SU care of select ICH patients would not change functional outcome, and result in reduced costs. Methods: Two retrospective cohorts of consecutive patients with small (<20 cc) supratentorial ICH and the absence of anticoagulation were enrolled. In the first study period from August 1, 2008 to February 1, 2011, patients were admitted to the neurological or medical ICU (historical control). In the second study period from August 1, 2012 to January 30, 2014, patients were admitted to a dedicated SU. Intubated patients, those requiring vasopressors, osmotic therapy, or ventriculostomy were excluded. Primary outcomes were discharge modified Rankin Score (mRS) and total hospital charges. Multivariate analyses were used for predicting mRS and early complications. Results: There were 104 patients included in the analysis (41 ICU, 63 SU). Mean age, gender and race did not differ significantly between groups. Mean ICH volume was 6cc in the SU group and 8cc in the ICU group (P>.05). Prior antiplatelet use, ICH location, and ICH score did not differ between groups. Intraventricular hemorrhage and hydrocephalus were more common in the ICU group (P<.001). Two SU patients transferred to the ICU for pneumonia and acute myocardial infarction. There were no significant differences in complications such as ICH expansion, use of osmotic therapy, seizures, or pneumonia. There was no difference in discharge mRS between groups (P>.05). Median hospital length of stay was 6 days in the ICU group and 3 days in SU group (P<.001). Median direct costs for the ICU group were $5,859 (IQR 4,782-9,733) and were $4,078 (IQR 2,861-6,865) for the SU group (P<.001). Unit of admission was not a significant predictor of early complication (P=.73) or discharge mRS (P=.43) in multivariate analysis. Conclusions: This preliminary retrospective study provides support for select low-risk ICH patients to be safely cared for in a lower intensity setting with potential for reducing costs.

scholarly journals The prediction of hospital length of stay using unstructured data

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jan Chrusciel ◽  
François Girardon ◽  
Lucien Roquette ◽  
David Laplanche ◽  
Antoine Duclos ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Traditional Approach ◽  
Secondary Analysis ◽  
Clinical Signs ◽  
Hospital Length ◽  
Structured Data ◽  
Unstructured Data ◽  
Hospital Length Of Stay ◽  
Postal Code ◽  
Exact Matching

Abstract Objective This study aimed to assess the performance improvement for machine learning-based hospital length of stay (LOS) predictions when clinical signs written in text are accounted for and compared to the traditional approach of solely considering structured information such as age, gender and major ICD diagnosis. Methods This study was an observational retrospective cohort study and analyzed patient stays admitted between 1 January to 24 September 2019. For each stay, a patient was admitted through the Emergency Department (ED) and stayed for more than two days in the subsequent service. LOS was predicted using two random forest models. The first included unstructured text extracted from electronic health records (EHRs). A word-embedding algorithm based on UMLS terminology with exact matching restricted to patient-centric affirmation sentences was used to assess the EHR data. The second model was primarily based on structured data in the form of diagnoses coded from the International Classification of Disease 10th Edition (ICD-10) and triage codes (CCMU/GEMSA classifications). Variables common to both models were: age, gender, zip/postal code, LOS in the ED, recent visit flag, assigned patient ward after the ED stay and short-term ED activity. Models were trained on 80% of data and performance was evaluated by accuracy on the remaining 20% test data. Results The model using unstructured data had a 75.0% accuracy compared to 74.1% for the model containing structured data. The two models produced a similar prediction in 86.6% of cases. In a secondary analysis restricted to intensive care patients, the accuracy of both models was also similar (76.3% vs 75.0%). Conclusions LOS prediction using unstructured data had similar accuracy to using structured data and can be considered of use to accurately model LOS.

scholarly journals Hemoadsorption for management of Patients on Veno-venous ECMO Support for Severe COVID-19 Acute Respiratory Distress Syndrome

2021 ◽  
Author(s):  
Travis Geraci ◽  
Zachary Kon ◽  
Nader Moazami ◽  
Stephanie Chang ◽  
Julius Carillo ◽  
...  
Keyword(s):  
Clinical Effect ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
C Reactive Protein ◽  
Ecmo Circuit ◽  
Reactive Protein ◽  
Small Series ◽  
Cytokine Levels ◽  
Median Hospital ◽  
Vv Ecmo

Background and aim of the study: Patients with severe coronavirus disease 2019 (COVID-19) develop a profound cytokine-mediated pro-inflammatory response. This study reports outcomes in 10 patients with COVID-19 supported on veno-venous extracorporeal membrane oxygenation (VV-ECMO) who were selected for the emergency use of a hemoadsorption column integrated in the ECMO circuit. Materials and Methods: Pre and post treatment, clinical data and inflammatory markers were assessed to determine the safety and feasibility of using this system, and to evaluate the clinical effect. Results: During hemoadsorption, median levels of interleukin (IL)-2R, IL-6, and IL-10 decreased by 54%, 86%, and 64% respectively. Reductions in other markers were observed for LDH (-49%), ferritin (-46%), D-dimer (-7%), C-reactive protein (-55%), procalcitonin (-76%) and lactate (-44%). Vasoactive-inotrope scores decreased significantly over the treatment interval (-80%). The median hospital length of stay was 53 days (36-85) and at 90-days post cannulation, survival was 90% which was similar to a group of patients without the use of hemoadsorption. Conclusions: Addition of hemoadsorption to VV-ECMO in patients with severe COVID-19 is feasible and reduces measured cytokine levels. However, in this small series, the precise impact on the overall clinical course and survival benefit still remains unknown.

Association of Hyperchloremia With Unfavorable Clinical Outcomes in Adults With Diabetic Ketoacidosis

2019 ◽  
Vol 35 (11) ◽  
pp. 1307-1313 ◽  
Author(s):  
Nathan T. Goad ◽  
Rita N. Bakhru ◽  
James L. Pirkle ◽  
Michael T. Kenes
Keyword(s):  
Diabetic Ketoacidosis ◽  
Primary Outcome ◽  
Cox Regression ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cox Regression Analysis ◽  
Serum Chloride ◽  
Hospital Development ◽  
Median Hospital

Objective: Hyperchloremia is associated with worsened outcomes in various clinical situations; however, data are limited in patients with diabetic ketoacidosis (DKA). The purpose of this study was to determine the effect of hyperchloremia on time to DKA resolution. Methods: We conducted a retrospective cohort study of adult patients admitted with incident DKA from January 2013 through October 2017 and stratified by the development of hyperchloremia versus maintaining normochloremia. The primary outcome was time to final DKA resolution. Secondary outcomes included time to initial DKA resolution, incidence of acute kidney injury (AKI) on admission, in-hospital development of AKI, and hospital length of stay (LOS). Results: Of the 102 patients included, 52 developed hyperchloremia. Patients with hyperchloremia had longer times to final DKA resolution compared to those with normochloremia (median 22.3 [interquartile range, IQR, 15.2-36.9] vs 14.2 [IQR 8.8-21.1] hours; P = .001). Time to initial DKA resolution was also longer in patients who developed hyperchloremia compared to those who did not (median 16.3 vs 10.9 hours; P = .024). More patients with hyperchloremia developed in-hospital AKI (26.9% vs 8.0%; P = .01). Median hospital LOS was significantly longer in the hyperchloremia cohort ( P < .001). On Cox regression analysis, time to DKA resolution was significantly longer with each 1 mmol/L increase in serum chloride (HR 0.951; P < .001). Conclusion: The presence of hyperchloremia in patients with DKA was associated with increased time to DKA resolution, risk of in-hospital AKI, and hospital LOS. Further evaluation of the avoidance or treatment of hyperchloremia in DKA is needed.

scholarly journals Apixaban or Rivaroxaban Versus Warfarin for Treatment of Submassive Pulmonary Embolism After Catheter-Directed Thrombolysis

2018 ◽  
Vol 24 (6) ◽  
pp. 908-913 ◽  
Author(s):  
Lara M. Groetzinger ◽  
Taylor J. Miller ◽  
Ryan M. Rivosecchi ◽  
Roy E. Smith ◽  
Mark T. Gladwin ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Factor Xa ◽  
Multivariate Regression Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
Catheter Directed Thrombolysis ◽  
Submassive Pulmonary Embolism ◽  
Median Hospital

Background: Little data exist on the use of direct oral anticoagulant (DOAC) factor Xa inhibitors for submassive pulmonary embolism (PE) after catheter-directed thrombolysis (CDT). The objective of this evaluation was to determine whether the transition from parenteral anticoagulation to DOACs for submassive PE after CDT would decrease hospital length of stay (LOS) compared to warfarin. Methods: A retrospective review of patients diagnosed with submassive PE who underwent CDT was conducted from January 1, 2012, to February 28, 2017. Hospital LOS and major and minor bleeding events were recorded during hospitalization and at 90 days. Results: Sixty-two patients met the inclusion criteria, 36 in warfarin group and 26 in the DOAC group. Overall, patients receiving rivaroxaban or apixaban had a shorter median hospital LOS compared to warfarin (4.0 vs 6.1 days, P = .002). In the multivariate regression analysis, administration of DOAC was an independent predictor of decreased hospital LOS, β: −2.1, 95% confidence interval (−3.5 to −0.7). Conclusion: Among patients with submassive PE, initiation of a DOAC shortly after CDT may result in a decreased hospital LOS compared to parenterally bridged warfarin.

Complications of high-dose methotrexate (HDMTX) in lymphoma patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e20035-e20035
Author(s):  
Darragh O'Donoghue ◽  
Huong Truong ◽  
Heidi Diann Finnes ◽  
Jennifer McDonald ◽  
Stephen M. Ansell ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Kidney Injury ◽  
Hospital Length ◽  
Significant Rise ◽  
Curve Analysis ◽  
Hospital Length Of Stay ◽  
High Dose ◽  
Roc Curve Analysis ◽  
Dose Methotrexate ◽  
The Mean

e20035 Background: HDMTX is a vital treatment of lymphoma secondary to central nervous system penetrance. MTX is nephrotoxic and may cause acute kidney injury (AKI). AKI results in delayed MTX elimination, increased hospital length of stay (LOS) and intensive care unit (ICU) stays. Our aim was to characterise the complications and associated 48-hour MTX levels in lymphoma patients undergoing HDMTX. Methods: A retrospective review of the electronic medical record was conducted to identify lymphoma patients who received HDMTX from 1/1/2002 to 12/31/18. We assessed the incidence of AKI using AKIN criteria, ICU admission, and LOS across 48 hour MTX levels per the table. Results: 2704 cycles of HDMTX were identified. The mean age was 64 years, 54% were male and 72.2% received high dose (≥8g/m2). A significant increase in AKI severity (p < 0.0001) and LOS (p < 0.01) occurred with increasing 48 hour MTX levels, (p < 0.001, Table). All 7 patients requiring dialysis had MTX levels > 10. ROC curve analysis for AKI grade ≥ 2 demonstrated a 48 hour MTX level threshold of 1.28 (AUC 0.79) with relative risk of 7.6 (95% CI 5.3-11) and odds ratio of 8.8 (95% CI 5.9-13.1). A significant increase occurred in LOS across escalating 48 hour MTX level subgroups (p < 0.01, Table). A significant rise in ICU admissions occurred with increasing MTX levels ( < 0.01% for MTX < 2 compared to 15% with MTX > 5). Conclusions: Complications of HDMTX are significantly increased with elevated 48 hour MTX levels, particularly with levels > 1 μmol/L. [Table: see text]

scholarly journals Lama Hari Rawat Pasien Stroke

2020 ◽  
Vol 9 (2) ◽  
pp. 117-122
Author(s):  
Novita Nirmalasari ◽  
Muhamat Nofiyanto ◽  
Rizqi Wahyu Hidayati
Keyword(s):  
Length Of Stay ◽  
Hemorrhagic Stroke ◽  
Treatment Process ◽  
Clinical Signs ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cerebral Function ◽  
Stroke Patients ◽  
Design Data

Background: Stroke has remained the leading cause of death globally in the last 15 years. Stroke is rapidly developing clinical signs of focal or global disturbance of cerebral function. Hospitalization is a treatment process which including patient to stay at the hospital. Length of stay is influenced by the type of stroke.  This  study aimed to know classification of stroke and length of stay of stroke patients. Methods: The study was a descriptive study with restrospective design. Data collected from medical record from May until December 2020 in RS PKU Muhammadiyah Yogyakarta. There were 207 patients with stroke. Descriptive data is then processed. Results: The results showed the highest percentage stroke patients male (50,24%), non hemorrhagic stroke (57,49%), length of stay hemorrhagic stroke 8 days. Conclusion: The result of this study may provide nursing research in patients with stroke.

scholarly journals Early Short-Course Corticosteroids in Hospitalized Patients With COVID-19

2020 ◽  
Vol 71 (16) ◽  
pp. 2114-2120 ◽  
Author(s):  
Raef Fadel ◽  
Austin R Morrison ◽  
Amit Vahia ◽  
Zachary R Smith ◽  
Zohra Chaudhry ◽  
...  
Keyword(s):  
Composite Endpoint ◽  
Standard Of Care ◽  
Multivariate Regression Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Short Course ◽  
Group 5 ◽  
Median Hospital

Abstract Background There is no proven antiviral or immunomodulatory therapy for coronavirus disease 2019 (COVID-19). The disease progression associated with the proinflammatory host response prompted us to examine the role of early corticosteroid therapy in patients with moderate to severe COVID-19. Methods We conducted a single pretest, single posttest quasi-experiment in a multicenter health system in Michigan from 12 March to 27 March 2020. Adult patients with confirmed moderate to severe COVID were included. A protocol was implemented on 20 March 2020 using early, short-course, methylprednisolone 0.5 to 1 mg/kg/day divided in 2 intravenous doses for 3 days. Outcomes of standard of care (SOC) and early corticosteroid groups were evaluated, with a primary composite endpoint of escalation of care from ward to intensive care unit (ICU), new requirement for mechanical ventilation, and mortality. All patients had at least 14 days of follow-up. Results We analyzed 213 eligible subjects, 81 (38%) and 132 (62%) in SOC and early corticosteroid groups, respectively. The composite endpoint occurred at a significantly lower rate in the early corticosteroid group (34.9% vs 54.3%, P = .005). This treatment effect was observed within each individual component of the composite endpoint. Significant reduction in median hospital length of stay was also observed in the early corticosteroid group (5 vs 8 days, P &lt; .001). Multivariate regression analysis demonstrated an independent reduction in the composite endpoint at 14-days controlling for other factors (adjusted odds ratio: 0.41; 95% confidence interval, .22 – .77). Conclusions An early short course of methylprednisolone in patients with moderate to severe COVID-19 reduced escalation of care and improved clinical outcomes. Clinical Trials Registration NCT04374071.

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