The Relationship Between RBC Distribution Width at Hospital Discharge and Out-of-Hospital Mortality in Critically Ill Patients

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.

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The predictive value of red blood cell distribution width and platelet-to -lymphocyte ratio for acute kidney injury in critically ill patients

10.21203/rs.3.rs-1006561/v1 ◽

2021 ◽

Author(s):

Yan Tang ◽

Fen Jiang ◽

Li Zhang ◽

Jiaxuan Xiang ◽

Jie Lei ◽

...

Keyword(s):

Acute Kidney Injury ◽

Blood Cell ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Cell Distribution ◽

Platelet To Lymphocyte Ratio ◽

Distribution Width ◽

Red Blood Cell Distribution

Abstract Background Red blood cell distribution width (RDW) and the platelet-to-lymphocyte ratio (PLR) are associated with different types of prognoses in critically ill patients. But, the value of RDW and PLR in predicting the occurrence of acute kidney injury (AKI) in critically ill patients are unknown. The purpose of the study was to explore the associations of RDW and PLR with AKI incidence. Methods Among 1500 adult patients in the intensive care unit (ICU) between January 2016 and December 2019 were enrolled, we examined the associations of baseline RDW and PLR with the risk of AKI development using logistical analysis. In addition, we explored the value of RDW and PLR in predicting in-hospital mortality. Results The study participants included 951 men and 549 women, aged 60.1±16.14 years. The subjects had a mean RDW of 14.65±2.14% and a mean PLR of 188.16±129.2. Overall, 615 (41%) patients were diagnosed with AKI. There were remarkable differences in RDW and the PLR between the AKI and non-AKI groups (P<0.001). After adjustment, the association of RDW with AKI development risk strengthened (OR: 1.28, 95% CI: 1.19-1.36). Moreover, we divided the groups into two subgroups each; the high-RDW (≥14.045%) group had a high risk of developing AKI (OR=5.189, 95% CI: 4.088-6.588), while the high-PLR(≥172.067)group had a risk of developing AKI (OR=9.11,95% CI:7.09-11.71). The areas under the receiver operating characteristic curves (AUCs) for the prediction of AKI incidence based on RDW and PLR were 0.780 (95% CI: 0.755-0.804) and 0.728 (95% CI:0.702-0.754) (all P< 0.001), with cut-off values of 14.045 and 172.067, respectively. Moreover, a higher RDW was associated with a higher rate of hospital mortality (OR: 2.907, 2.190-3.858), and the risk of in-hospital mortality related to PLR was 1.534 (95%CI: 1.179-1.995). The AUC for in-hospital mortality based on RDW was 0.663 (95%CI:0.628-0.698), while the AUC for in-hospital mortality based on the PLR was 0.552 (0.514-0.589). Conclusions A higher RDW related to a higher risk of the occurrence of AKI and in-hospital mortality in ICU.The PLR also showed predictive value for the occurrence of AKI but did not show any clear prediction value of in-hospital mortality.

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Time to Lactate Measurement Affects Efficacy of Initial Lactate on Mortality in critically ill patients with sepsis.

10.21203/rs.3.rs-30867/v1 ◽

2020 ◽

Author(s):

Xueying Luo ◽

Xiaobo Zheng ◽

Xi Rao ◽

Ya Li ◽

Sujing Zheng ◽

...

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Lactate Level ◽

P Value ◽

Detection Time ◽

Lactate Measurement ◽

Unit Increase ◽

The Impact ◽

The Relationship

Abstract Background: Evidence regarding the effect of time to lactate measurement on the relationship between the initial lactate level and mortality is limited. We aimed to investigate the relationships between time to lactate measurement, initial lactate level, and in-hospital mortality in critically ill patients with sepsis.Methods and Results: Of the 14339 eligible adult patients with recognized sepsis upon admission to the ICU based on the MIMIC-III database, the median value of initial lactate was 1.70 mmol/L (interquartile range [IQR] 1.20-2.80), and its detection time was 3.50 hours ([IQR] 1.31-10.24). The results of fully adjusted multivariate analyses demonstrated that lactate was positively associated with in-hospital mortality (odds ratio: 1.126, 95% confidence interval: 1.090 to 1.163, P<0.001), and there was an increase in the odds of death with hourly delays in lactate measurement (OR: 1.006, 95% CI: 1.004 to 1.008, P<0.001). In stratified analyses, delays in lactate measurement significantly interfered with the impact of increased lactate level on mortality (P-value for interaction<0.001). The hospital mortality rate substantially increased by 43.5% for each unit increase in lactate when measurement was delayed by 24 hours (OR: 1.435, 95% CI: 1.260 to 1.635, P<0.001).Discussion: The association of initial lactate with in-hospital mortality is likely to vary with delays in detection time (grouping based on the “1-hour bundle”) in critically ill patients with recognized sepsis upon admission to the ICU.

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Association Between Dexamethasone and Delirium in Critically ill Patients: A Retrospective Cohort Study of a Large Clinical Database

10.21203/rs.3.rs-89771/v1 ◽

2020 ◽

Author(s):

Zehao Wu ◽

Huili Li ◽

Kaihua Liao ◽

Yun Wang

Keyword(s):

Cohort Study ◽

Length Of Stay ◽

Hospital Mortality ◽

Critically Ill ◽

Retrospective Cohort Study ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Hospital Death ◽

Icu Stay ◽

The Relationship

Abstract BackgroundDelirium is a common complication in ICU patients, and it can significantly increase the length of hospital stay and cost. Dexamethasone is widely used in various inflammatory diseases and is a glucocorticoid commonly used in critically ill patients. There are no studies on the effect of dexamethasone on the development of delirium in critically ill patients, therefore, this study aimed to confirm the effect of dexamethasone use and the dose on the incidence of delirium and patient prognosis in critically ill patients through a large cohort study.MethodsA retrospective cohort study was conducted using data extracted from the MIMIC III database, and the primary outcome was the development of delirium, using multivariate logistic regression analysis to reveal the relationship between dexamethasone and delirium. Secondary endpoints were in-hospital mortality, total length of stay and length of ICU stay, and the relationship between dexamethasone and prognosis was assessed with Cox proportional hazards models. The Lowess smoothing technique was used to investigate the dose correlation between dexamethasone and outcomes, subgroup analysis was used to account for heterogeneity, and different correction models and propensity matching analysis were used to eliminate potential confounders.ResultsFinally, 38,509 patients were included, and 2,204 (5.7%) used dexamethasone. A significantly higher incidence of delirium (5.0% vs. 3.4%, P < 0.001), increased in-hospital mortality (15.0% vs. 11.3%, P < 0.001), and longer length of stay and ICU stay were observed in patients taking dexamethasone compared with those not taking dexamethasone. Multivariate logistic and Cox regression analyses confirmed that dexamethasone was significantly associated with delirium (adjusted OR = 1.45, 95% CI = 1.08-1.95, P = 0.014) and in-hospital mortality (adjusted HR = 1.19, 95% CI = 1.02-1.40, P = 0.032). The risk of delirium and in-hospital death was lower with dexamethasone less than 10 mg, and subjects with 10-14 mg had the shortest length of hospital stay.ConclusionsThis study demonstrated that the use of dexamethasone in critically ill patients exacerbated the occurrence of delirium, while increasing the risk of in-hospital death and length of stay, and the use of low-dose dexamethasone had a lower risk of delirium and death, which appeared to be safer.

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Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

Scientific Reports ◽

10.1038/s41598-021-90013-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yongfang Zhou ◽

Steven R. Holets ◽

Man Li ◽

Gustavo A. Cortes-Puentes ◽

Todd J. Meyer ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

History Of ◽

Training Background ◽

The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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