scholarly journals Preadmission Statin Use and 90-day Mortality in the Critically Ill

2019 ◽  
Vol 131 (2) ◽  
pp. 315-327 ◽  
Author(s):  
Tak Kyu Oh ◽  
In-Ae Song ◽  
Jae Ho Lee ◽  
Cheong Lim ◽  
Young-Tae Jeon ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Critically Ill ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Cox Regression Analysis ◽  
Statin Dose ◽  
Mortality Hazard Ratio ◽  
Statin Use

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background This study aimed to examine the association between preadmission statin use and 90-day mortality in critically ill patients and to investigate whether this association differed according to statin type and dose. We hypothesized that preadmission statin use was associated with lower 90-day mortality. Methods This retrospective cohort study analyzed the medical records of all adult patients admitted to the intensive care unit in a single tertiary academic hospital between January 2012 and December 2017. Data including preadmission statin use, statin subtype, and daily dosage were collected, and the associations between these variables and 90-day mortality after intensive care unit admission were examined. The primary endpoint was 90-day mortality. Results A total of 24,928 patients (7,396 statin users and 17,532 non–statin users) were included. After propensity score matching, 5,354 statin users and 7,758 non–statin users were finally included. The 90-day mortality rate was significantly higher in non–statin users (918 of 7,758; 11.8%) than in statin users (455 of 5,354; 8.5%; P < 0.001). In Cox regression analysis, the 90-day mortality rate was lower among statin users than among non–statin users (hazard ratio: 0.70, 95% CI: 0.63 to 0.79; P < 0.001). Rosuvastatin use was associated with 42% lower 90-day mortality (hazard ratio: 0.58, 95% CI: 0.47 to 0.72; P < 0.001). There were no specific significant differences in the association between daily statin dose and 90-day mortality. In competing risk analysis, the risk of noncardiovascular 90-day mortality in statin users was 32% lower than that in non–statin users (hazard ratio: 0.68, 95% CI: 0.60 to 0.78; P < 0.001). Meanwhile, cardiovascular 90-day mortality was not significantly associated with statin use. Conclusions Preadmission statin use was associated with a lower 90-day mortality. This association was more evident in the rosuvastatin group and with noncardiovascular 90-day mortality; no differences were seen according to daily dosage intensity.

scholarly journals Albumin–Globulin Ratio Is an Independent Determinant of 28-Day Mortality in Patients with Critical Illness

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Bin Liu ◽  
Kun Xiao ◽  
Peng Yan ◽  
Tianyu Sun ◽  
Jiang Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Independent Predictor ◽  
Laboratory Data ◽  
Cox Regression Analysis ◽  
Increased Risk

Background. Critical illness in the intensive care unit (ICU) has been a global health priority. Systemic nutritional status has turned out to be related to the prognosis of critically ill patients. The albumin-globulin ratio (AGR) has been reported to be a novel prognostic factor of many diseases. This study is aimed at investigating whether the AGR could predict the mortality risk in critically ill patients. Methods. We enrolled 582 adult patients admitted to the respiratory intensive care unit (RICU). We collected the clinical and laboratory data. X-tile software was used to determine the optimal cut-off values for the AGR. Patients were divided into three groups according to the AGR (low AGR group with AGR < 0.8 , medium AGR group with AGR ranging from 0.8 to 1.1, and high AGR group with AGR > 1.1 ). Kaplan-Meier analysis was used for survival analysis. A Cox proportional hazard model was applied to the univariate and multivariate analyses for the potential predictors associated with survival. Results. Our present study showed that the AGR was related to the 28-day survival of critically ill patients in the RICU. The rate of pneumonia in the low AGR group was significantly higher than that in the other groups. Patients with a lower AGR present an increased risk of 28-day mortality compared to patients with a higher AGR. Cox regression analysis showed that the AGR might be an independent predictor of prognosis to 28-day survival in critically ill patients in the RICU. Medium and high AGR values remained independently associated with better 28-day survival than low AGR values (HR: 0.484 (0.263-0.892) ( p = 0.02 ); HR: 0.332 (0.166-0.665) ( p = 0.002 )). Conclusion. The AGR might be an independent predictor of prognosis in critically ill patients.

scholarly journals Prognostic Value of Chromogranin A at Admission in Critically Ill Patients: A Cohort Study in a Medical Intensive Care Unit

2008 ◽  
Vol 54 (9) ◽  
pp. 1497-1503 ◽  
Author(s):  
Dan Zhang ◽  
Thomas Lavaux ◽  
Anne-Claire Voegeli ◽  
Thierry Lavigne ◽  
Vincent Castelain ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Regression Analysis ◽  
Intensive Care ◽  
Critically Ill ◽  
Chromogranin A ◽  
Prognostic Value ◽  
Cox Regression ◽  
Linear Regression Analysis ◽  
Cox Regression Analysis ◽  
Saps Ii

Abstract Background: Risk assessments of patients should be based on objective variables, such as biological markers that can be measured routinely. The acute response to stress causes the release of catecholamines from the adrenal medulla accompanied by chromogranin A (CGA). To date, no study has evaluated the prognostic value of CGA in critically ill intensive care unit patients. Methods: We conducted a prospective study of intensive care unit patients by measuring serum procalcitonin (PCT), C-reactive protein (CRP), and CGA at the time of admission. Univariate and multivariate analyses were performed to evaluate the ability of these biomarkers to predict mortality. Results: In 120 consecutive patients, we found positive correlations between CGA and the following: CRP (r2 = 0.216; P = 0.02), PCT (r2 = 0.396; P &lt; 0.001), Simplified Acute Physiologic Score II (SAPS II) (r2 = 0.438; P &lt; 0.001), and the Logistic Organ Dysfunction System (LODS) score (r2 = 0.374; P &lt; 0.001). Nonsurvivors had significantly higher CGA and PCT concentrations than survivors [median (interquartile range): 293.0 μg/L (163.5–699.5 μg/L) vs 86.0 μg/L (53.8–175.3 μg/L) for CGA, and 6.78 μg/L (2.39–22.92 μg/L) vs 0.54 μg/L (0.16–6.28 μg/L) for PCT; P &lt; 0.001 for both comparisons]. In a multivariable linear regression analysis, creatinine (P &lt; 0.001), age (P &lt; 0.001), and SAPS II (P = 0.002) were the only significant independent variables predicting CGA concentration (r2 = 0.352). A multivariate Cox regression analysis identified 3 independent factors predicting death: log-normalized CGA concentration [hazard ratio (HR), 7.248; 95% confidence interval (CI), 3.004–17.487], SAPS II (HR, 1.046; 95% CI, 1.026–1.067), and cardiogenic shock (HR, 3.920; 95% CI, 1.731–8.880). Conclusions: CGA is a strong and independent indicator of prognosis in critically ill nonsurgical patients.

Outcomes of Critically Ill Gynecological Cancer Patients Admitted to Intensive Care Unit

2012 ◽  
Vol 30 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Silvio A. Ñamendys-Silva ◽  
María O. González-Herrera ◽  
Julia Texcocano-Becerra ◽  
Angel Herrera-Gómez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Gynecological Cancer ◽  
Apache Ii ◽  
Apache Ii Score

Purpose: To assess the characteristics of critically ill patients with gynecological cancer, and to evaluate their prognosis. Methods: Fifty-two critically ill patients with gynecological cancer admitted to intensive care unit (ICU) were included. Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality. Results: Thirty-five patients (67.3%) had carcinoma of the cervix uteri and 11 (21.2%) had ovarian cancer. The mortality rate in the ICU was 17.3% (9 of 52) and hospital mortality rate were 23%(12 of 52). In the multivariate analysis, independent prognostic factors for hospital mortality were vasopressor use (odds ratio [OR] = 8.60, 95% confidence interval [CI] 2.05-36; P = .03) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.43, 95% CI 1.01-2.09; P = .048). Conclusions: The independent prognostic factors for hospital mortality were the need for vasopressors and the APACHE II score.

scholarly journals Insulin therapy for hyperglycemia in critically ill patients

2016 ◽  
Vol 53 (5) ◽  
pp. 250
Author(s):  
Julianti Julianti ◽  
Silvia Triratna ◽  
Aditiawati Aditiawati ◽  
Irfanuddin Irfanuddin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Mortality Rate ◽  
Insulin Therapy ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Therapy Group ◽  
Control Group

Background Hyperglycemia in critically ill patients is associated with higher mortality. Insulin therapy may improve outcomes, not only by preventing deleterious effects of hyperglycemia, but by improving the molecular dynamics in organ dysfunction.Objectives To assess the effects of insulin therapy on critically ill patients in an intensive care unit (ICU) setting and the risk of hypoglycemia.Methods An open-label, clinical trial was conducted in the Pediatric Intensive Care Unit (PICU) of Dr. Moh. Hoesin Hospital, Palembang, from November 2011 to March 2012. Subjects were consecutively assigned to receive either regular insulin at a dose of 0.05 U/kg/h if the blood glucose level reached >200 mg%, or standard therapy (control group). Blood glucose levels were measured hourly until they reached 80-110 mg%. Dose adjustments were made when the blood glucose level reached 145 mg%, by reducing the insulin dose to 0.025 U/kg/h. Outcomes of therapy were measured by Pediatric Logistic Organ Dysfunction (PELOD) score improvement, mortality rate and the occurrence of hypoglycemia.Results Forty subjects were enrolled in this study, with 20 subjects assigned to the insulin therapy group and 20 subjects to the standard therapy group. Two subjects, one from each group, were not included in the final analysis due to their deaths within 24 hours. There was no significant difference in distribution of PELOD scores before intervention between the groups (OR=0.5; 95%CI 0.1 to 1.9, P=0.32). However, after intervention, the PELOD scores was significantly lower in insulin therapy group compared to control group (OR 0.2; 95% CI 0.05 to 0.8, P=0.02). In the insulin group after intervention, fewer subjects had scores >20.5 and more subjects had scores ≤20.5, indicated a lower risk of organ dysfunction. There was also a significantly lower mortality rate in the insulin group compared to the control group (OR 0.2; 95% CI 0.05 to 0.8, P=0.02). None of the subjects suffered hypoglycemia.Conclusion Insulin is beneficial in improving organ dysfunction and decreasing mortality for critically ill patients.

scholarly journals Arterial and venous thrombosis in coronavirus 2019 disease (Covid-19): relationship with mortality

2021 ◽  
Author(s):  
Francesco Violi ◽  
Giancarlo Ceccarelli ◽  
Roberto Cangemi ◽  
Francesco Cipollone ◽  
Damiano D’Ardes ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thrombosis ◽  
Arterial Thrombosis ◽  
Cox Regression ◽  
Thrombotic Event ◽  
White Blood Cells ◽  
Intensive Care Unit Treatment ◽  
Cox Regression Analysis ◽  
D Dimer

Abstract Background Patients with coronavirus disease 2019 (Covid-19) may experience venous thrombosis while data regarding arterial thrombosis are sparse. Methods Prospective multicenter study in 5 hospitals including 373 patients with Covid-19-related pneumonia. Demographic data, laboratory findings including coagulation tests and comorbidities were reported. During the follow-up any arterial or venous thrombotic events and death were registered. Results Among 373 patients, 75 (20%) had a thrombotic event and 75 (20%) died. Thrombotic events included 41 venous thromboembolism and 34 arterial thrombosis. Age, cardiovascular disease, intensive care unit treatment, white blood cells, D-dimer, albumin and troponin blood levels were associated with thrombotic events. In a multivariable regression logistic model, intensive care unit treatment (Odds Ratio [OR]: 6.0; 95% Confidence Interval [CI] 2.8–12.6; p < 0.001); coronary artery disease (OR: 2.4; 95% CI 1.4–5.0; p = 0.022); and albumin levels (OR: 0.49; 95% CI 0.28–0.87; p = 0.014) were associated with ischemic events. Age, sex, chronic obstructive pulmonary disease, diabetes, heart failure, coronary heart disease, intensive care unit treatment, in-hospital thrombotic events, D-dimer, C-reactive protein, troponin, and albumin levels were associated with mortality. A multivariable Cox regression analysis showed that in-hospital thrombotic events (hazard ratio [HR]: 2.72; 95% CI 1.59–4.65; p < 0.001), age (HR: 1.035; 95% CI 1.014–1.057; p = 0.001), and albumin (HR: 0.447; 95% CI 0.277–0.723; p = 0.001) predicted morality. Conclusions Covid-19 patients experience an equipollent rate of venous and arterial thrombotic events, that are associated with poor survival. Early identification and appropriate treatment of Covid-19 patients at risk of thrombosis may improve prognosis.

scholarly journals Invasive Blood Pressure Measurement and In-hospital Mortality in Critically Ill Patients With Hypertension

2021 ◽  
Vol 8 ◽  
Author(s):  
Bin Zhou ◽  
Liang-Ying Lin ◽  
Xiao-Ai Liu ◽  
Ye-Sheng Ling ◽  
Yuan-Yuan Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Invasive Blood Pressure

Background: Invasive blood pressure (IBP) measurement is common in the intensive care unit, although its association with in-hospital mortality in critically ill patients with hypertension is poorly understood.Methods and Results: A total of 11,732 critically ill patients with hypertension from the eICU-Collaborative Research Database (eICU-CRD) were enrolled. Patients were divided into 2 groups according to whether they received IBP. The primary outcome in this study was in-hospital mortality. Propensity score matching (PSM) and inverse probability of treatment weighing (IPTW) models were used to balance the confounding covariates. Multivariable logistic regression was used to evaluate the association between IBP measurement and hospital mortality. The IBP group had a higher in-hospital mortality rate than the no IBP group in the primary cohort [238 (8.7%) vs. 581 (6.5%), p &lt; 0.001]. In the PSM cohort, the IBP group had a lower in-hospital mortality rate than the no IBP group [187 (8.0%) vs. 241 (10.3%), p = 0.006]. IBP measurement was associated with lower in-hospital mortality in the PSM cohort (odds ratio, 0.73, 95% confidence interval, 0.59–0.92) and in the IPTW cohort (odds ratio, 0.81, 95% confidence interval, 0.67–0.99). Sensitivity analyses showed similar results in the subgroups with high body mass index and no sepsis.Conclusions: In conclusion, IBP measurement was associated with lower in-hospital mortality in critically ill patients with hypertension, highlighting the importance of IBP measurement in the intensive care unit.

scholarly journals Association of Prior to Intensive Care Unit Statin Use With Outcomes on Patients With Acute Kidney Injury

2021 ◽  
Vol 8 ◽  
Author(s):  
Boxiang Tu ◽  
Yuanjun Tang ◽  
Yi Cheng ◽  
Yuanyuan Yang ◽  
Cheng Wu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Mortality Rate ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Icu Mortality ◽  
Propensity Score Methods ◽  
Statin Use

Purpose: To evaluate the association of prior to intensive care unit (ICU) statin use with the clinical outcomes in critically ill patients with acute kidney injury (AKI).Materials and Methods: Patients with AKI were selected from the Medical Information Mart for Intensive Care IV (version 1.0) database for this retrospective observational study. The primary outcome was 30-day intensive care unit (ICU) mortality. A 30-day in-hospital mortality and ICU length of stay (LOS) were considered as secondary outcomes. Comparison of mortality between pre-ICU statin users with non-users was conducted by the multivariate Cox proportional hazards model. Comparison of ICU LOS between two groups was implemented by multivariate linear model. Three propensity score methods were used to verify the results as sensitivity analyses. Stratification analyses were conducted to explore whether the association between pre-ICU statin use and mortality differed across various subgroups classified by sex and different AKI stages.Results: We identified 3,821 pre-ICU statin users and 9,690 non-users. In multivariate model, pre-ICU statin use was associated with reduced 30-day ICU mortality rate [hazard ratio (HR) 0.68 (0.59, 0.79); p &lt; 0.001], 30-day in-hospital mortality rate [HR 0.64 (0.57, 0.72); p &lt; 0.001] and ICU LOS [mean difference −0.51(−0.79, −0.24); p &lt; 0.001]. The results were consistent in three propensity score methods. In subgroup analyses, pre-ICU statin use was associated with decreased 30-day ICU mortality and 30-day in-hospital mortality in both sexes and AKI stages, except for 30-day ICU mortality in AKI stage 1.Conclusion: Patients with AKI who were administered statins prior to ICU admission might have lower mortality during ICU and hospital stay and shorter ICU LOS.

scholarly journals Atrial fibrillation increased in-hospital and 4-year all-cause mortality in Critically ill patients with liver cirrhosis

2021 ◽  
Author(s):  
Yanting Luo ◽  
Bingyuan Wu ◽  
Yuankai Wu ◽  
Long Peng ◽  
Zexiong Li ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Liver Cirrhosis ◽  
Intensive Care ◽  
Mortality Rate ◽  
Critically Ill ◽  
Clinical Data ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Kaplan Meier ◽  
All Cause Mortality

Abstract ObjectiveThe purpose of this study was to use a large database that contains information on patient intensive care unit (ICU) admissions to study critically ill patients with cirrhosis and the relation with atrial fibrillation and short-term and 4-year mortality. MethodsThe Monitoring in Intensive Care Database III database was used to identify patients with cirrhosis hospitalized in an ICU from 2001 to 2012. Demographic and clinical data were extracted from the database. Clinical data and demographic information were collected for each patient in our study. Kaplan-Meier analysis and multivariate Cox regression models were performed to examine the relation between atrial fibrillation and in-hospital and 4-year all-cause mortality. ResultsA total of 1,481 patients (mean age 58 years, 68% male) with liver cirrhosis treated in an ICU were included in the analysis, and the prevalence of atrial fibrillation was 14.2%. The in-hospital all-cause mortality rate was 26.60%, and patients who had a significantly higher rate of atrial fibrillation (21.57% vs. 11.50%, P < 0.001). Multivariate analysis indicated that atrial fibrillation was significantly associated with in-hospital all-cause mortality (hazard ratio [HR] = 1.52, 95% confidence interval [CI]: 1.19 to 1.95; P < 0.001), and 4-year all-cause mortality (HR = 1.55, 95% CI: 1.12 to 2.13; P = 0.008). Kaplan-Meier survival analysis showed that patients with atrial fibrillation had a significantly higher in-hospital and 4-year all-cause mortality rate than patients without atrial fibrillation. ConclusionsCritically ill patients with liver cirrhosis have a significantly increased rate of atrial fibrillation, and the presence of atrial fibrillation is an independent risk for in-hospital and 4-year all-cause mortality.

Impact of Non-Hepatic Hyperammonemia on Mortality in Intensive Care Unit Patients: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Jae Heon Kim ◽  
Hankyu Jeon ◽  
Sang Soo Lee ◽  
Hee Jin Kim ◽  
Ra Ri Cha ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Regression Analysis ◽  
Intensive Care ◽  
Cox Regression ◽  
Multivariate Logistic Regression Analysis ◽  
Hepatic Disease ◽  
Cox Regression Analysis ◽  
Entire Cohort ◽  
Factors Associated ◽  
The Impact

Abstract Background: The effect of hyperammonemia on the mortality in patients with liver cirrhosis is well documented. However, little is known about the impact of hyperammonemia on mortality in intensive care unit patients without hepatic disease. We aimed to investigate factors associated with non-hepatic hyperammonemia in intensive care unit patients and evaluate the factors related to 90-day mortality. Methods: Between February 2016 and February 2020, 972 cases in 948 intensive care unit patients without hepatic disease were retrospectively enrolled and classified as hyperammonemia grades 0 (≤80 µg/dL; n=585 (60.2%)), 1 (≤160 µg/dL; n=291 (29.9%)), 2 (≤240 µg/dL; n=55 (5.7%)), and 3 (>240 µg/dL; n=41 (4.2%)). Factors associated with hyperammonemia and 90-day mortality were evaluated by multivariate logistic regression analysis and Cox regression analysis, respectively. Kaplan-Meier survival curves for 90-day mortality were constructed.Results: The independent risk factors for hyperammonemia were male sex (odds ratio, 1.517), age (0.984 per year), acute brain failure (2.467), acute kidney injury (1.437), prothrombin time-international normalized ratio (2.272 per unit), and albumin (0.694 per g/dL). The 90-day mortality rate in the entire cohort was 24.3% and gradually increased with increasing hyperammonemia grade at admission (17.9%, 28.2%, 43.6%, and 61.0% in patients with grades 0, 1, 2, and 3, respectively). Additionally, non-hepatic hyperammonemia was an independent predictor of 90-day mortality in intensive care unit patients. Conclusions: Non-hepatic hyperammonemia is common (39.8%) and associated with 90-day mortality in intensive care unit patients. Therefore, clinicians must examine serum ammonia levels in patients before admission to intensive care unit.

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