Risk factors associated with postoperative respiratory failure in tuberculous empyema patients

This randomised, double-blinded, placebo-controlled study was primarily aimed to evaluate the potential of risperidone to prevent postoperative delirium following cardiac surgery with cardiopulmonary bypass and the secondary objective was to explore clinical factors associated with postoperative delirium. One-hundred-and-twenty-six adult patients undergoing elective cardiac surgery with cardiopulmonary bypass were randomly assigned to receive either 1 mg of risperidone or placebo sublingually when they regained consciousness. Delirium and other outcomes were assessed. The confusion assessment method for intensive care unit was used to assess postoperative delirium. The incidence of postoperative delirium in the risperidone group was lower than the placebo group (11.1% vs. 31.7% respectively, P=0.009, relative risk=0.35, 95% confidence interval [CI]=0.16-0.77). Other postoperative outcomes were not statistically different between the groups. In exploring the factors associated with delirium, univariate analysis showed many factors were associated with postoperative delirium. However multiple logistic regression analysis showed a lapse of 70 minutes from the time of opening eyes to following commands and postoperative respiratory failure were independent risk factors (P=0.003, odds ratio [OR]=4.57, 95% CI=1.66-12.59 and P=0.038, OR=13.78, 95% CI=1.15-165.18 respectively). A single dose of risperidone administered soon after cardiac surgery with cardiopulmonary bypass reduces the incidence of postoperative delirium. Multiple factors tended to be associated with postoperative delirium, but only the time from opening eyes to following commands and postoperative respiratory failure were independent risk factors in this study.

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Risk Factors Associated With Early Postoperative Respiratory Failure: A Matched Case-Control Study

Journal of Surgical Research ◽

10.1016/j.jss.2020.12.043 ◽

2021 ◽

Vol 261 ◽

pp. 310-319

Author(s):

Jacqueline C. Stocking ◽

Christiana Drake ◽

J. Matthew Aldrich ◽

Michael K. Ong ◽

Alpesh Amin ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Failure ◽

Case Control Study ◽

Case Control ◽

Factors Associated ◽

Postoperative Respiratory Failure ◽

Matched Case ◽

Matched Case Control Study ◽

Control Study

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Risk Factors Associated With Respiratory Failure Requiring Non Invasive Mechanical Ventilation (NIMV) In Chronic Obstructive Pulmonary Disease (COPD) Exacerbation

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a3044 ◽

2012 ◽

Author(s):

Gabriel Patarroyo ◽

Carlos Giraldo ◽

Francis Ssali ◽

Hossam Amin ◽

Thomas Newman

Keyword(s):

Risk Factors ◽

Chronic Obstructive Pulmonary Disease ◽

Mechanical Ventilation ◽

Respiratory Failure ◽

Invasive Mechanical Ventilation ◽

Chronic Obstructive ◽

Copd Exacerbation ◽

Obstructive Pulmonary Disease ◽

Factors Associated ◽

Non Invasive

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Clinical Features and Risk Factors Associated with Mortality in Critically ill Children Requiring Continuous Renal Replacement Therapy

10.21203/rs.3.rs-40243/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Muhterem Duyu ◽

Ceren Turkozkan

Keyword(s):

Risk Factors ◽

Respiratory Failure ◽

Renal Replacement Therapy ◽

Renal Disease ◽

Continuous Renal Replacement Therapy ◽

Critically Ill ◽

Odds Ratio ◽

Critically Ill Children ◽

Factors Associated ◽

High Lactate

Abstract Background: The aims of this study were to describe the epidemiology and demographic characteristics of critically ill children requiring continuous renal replacement therapy (CRRT) at our pediatric intensive care unit (PICU) and to explore risk factors associated with mortality. Methods: A retrospective cohort of 121 critically ill children who received CRRT from May 2015 to May 2020 in the PICU of a tertiary healthcare institution was evalauted. The demographic information, admission diagnosis, indication for CRRT, clinical variables at the initiation of CRRT, time related variables and the laboratory results at initiation of CRRT were compared between survivors and non-survivors.Results: The most common diagnoses were renal disease (30.6%), hemato-oncological disease (12.4%), and sepsis (11.6%). The overall mortality was 29.8%. When compared according to diagnosis at admission, we found that patients with hemato-oncologic disease (73.3%) and those with pneumonia/respiratory failure (72.7%) had the highest mortality, while patients with renal disease had the lowest mortality (5.4%). The most common CRRT indications were: electrolyte or acid base imbalance (38.8%), acute kidney injury (29.8%) and fluid overload (14.9%). There was no relationship between mortality and indication for CRRT. The time interval between PICU admission and CRRT initiation was also unassociated with mortality (p=0.146). In patients diagnosed with sepsis, time until the initiation of CRRT was significantly shorter in survivors compared to non-survivors (p=0.004). Based on multivariate logistic regression, presence of comorbidity (odds ratio: 5.71; %95 CI: 1.16-27.97), being diagnosed with pneumonia/respiratory failure at admission (odds ratio: 16.16; %95 CI: 1.56-167.01), and high lactate level at the initiation of CRRT (odds ratio: 1.43; %95 CI: 1.17-1.79) were independently associated with mortality.Conclusions: In the context of the population studied mortality rate was lower than previously reported. In critically ill children requiring CRRT, mortality seems to be related to underlying disease, presence of comorbidity, and high lactate levels at CRRT initiation. We also found that early initiation of CRRT in sepsis can reduce mortality.

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Outcomes and prognostic factors of patients with anti-melanoma differentiation-associated protein 5 and anti-aminoacyl-RNA synthetase antibodies positive idiopathic inflammatory myopathies in intensive care unit

10.21203/rs.3.rs-50120/v1 ◽

2020 ◽

Author(s):

Shiyao Wang ◽

Xinran Zhang ◽

Yanhong Ren ◽

Yi Zhang ◽

Ye Tian ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Prognostic Factors ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Serum Ferritin ◽

Factors Associated ◽

Overall Mortality

Abstract Background: This study aims to identify prognostic factors for mortality of patients with anti-melanoma differentiation-associated protein 5 (anti-MDA5) or anti-aminoacyl-RNA synthetase (anti-ARS) antibodies positive and acute respiratory failure in the intensive care unit.Methods: Clinical characteristics, laboratory test findings, imaging performance, and management were retrospectively collected in all cases with anti-MDA5 and anti-ARS antibodies positive, as well as follow-up survival data. Risk factors related to prognosis were identified by Cox regression analysis.Results: The 28-day mortality of all patients was 68.8% (n=44/64). The patients who died were more likely to have anti-MDA5 antibody(p<0.001), presented more Gottron papules(p=0.021) or heliotrope rash(p=0.008), had a relatively lower level of WBC(p=0.038), CRP(p=0.004), and had a higher level of LDH(p=0.029), serum ferritin(p=0.002). The main risk factors associated with 28-day mortality were anti-MDA5 antibody positive [HR 10.827 (95% CI: 4.261-27.514), p<0.001], presence of Gottron papules [2.299 (1.203-4.394), p=0.012], heliotrope rash [3.423 (1.773-6.606), p<0.001], and arthritis/arthralgia [2.365 (1.130-4.948), p=0.022). At a median of 14 (IQR 6.33-35.0) months of follow-up, the overall mortality of all patients was 75.0% (n=48/64). The non-survivors were more likely to own anti-MDA5 antibody(p<0.001), had a higher rate of Gottron papules(p=0.020) or heliotrope rash(p=0.014), had lower PFR(p=0.032) while ICU admission, and existed a higher level of serum ferritin(p=0.005). Main risk factors associated with overall mortality were consistent with risk factors for 28-day mortality. Conclusions: Anti-MDA5 antibody positive, presence of Gottron papules, heliotrope rash, or arthritis/arthralgia were the main independent risk factors of poor prognosis for IIM patients admitted to the ICU due to acute respiratory failure.

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Acute Febrile Encephalopathy in Children: A Prospective Study of Clinical Features, Etiology, Mortality, and Risk Factors from Western India

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_93_17 ◽

2018 ◽

Vol 09 (01) ◽

pp. 019-025 ◽

Cited By ~ 1

Author(s):

Kirti Gupta ◽

Charul S. Purani ◽

Anirban Mandal ◽

Amitabh Singh

Keyword(s):

Risk Factors ◽

Respiratory Failure ◽

Clinical Features ◽

High Mortality ◽

Tertiary Care ◽

Primary Objective ◽

Medical Emergency ◽

Western India ◽

Care Hospital ◽

Factors Associated

ABSTRACT Introduction: Acute febrile encephalopathy (AFE) in children is a medical emergency and could be a manifestation of many systemic and central nervous system pathologies. The clinical features of AFE are nonspecific and etiological spectrum variable depending on the studied population. Materials and Methods: A prospective, observational study was carried out including children aged between 1 month and 12 years with AFE admitted to the Pediatric Intensive Care Unit of a tertiary care hospital in Western India. The primary objective was to assess the clinical presentation and etiology of AFE while the secondary objectives were to correlate the clinical and etiological findings and to determine the risk factors associated with mortality. Results: Out of the ninety children with AFE included in this study, male:female ratio was 1.2:1; most of them were aged between 1 and 5 years and came with a history of <7 days (82.2%). All of them had altered sensorium, about 2/3rd had seizures and 47.8% having a Glasgow Coma Score (GCS) <8. Etiology remained elusive in about 40% of the cases, and viral infections were the most common among the ones with an identifiable cause. A variety of morbidity (shock, disseminated intravascular coagulopathy, respiratory failure, etc.) and high mortality (40%) was observed with risk factors associated with mortality being GCS <8, the presence of raised intracranial pressure, shock, and respiratory failure. Conclusion: AFE, though a rare diagnosis in children, is associated with significant morbidity and high mortality in a developing country like India.

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Risk factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19 in Wuhan, China

10.21203/rs.3.rs-37538/v1 ◽

2020 ◽

Author(s):

Xiao-huan Ma ◽

Fang Yin ◽

Jie Zhang ◽

Meng-yun Peng ◽

Hong Guan ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Failure ◽

Oxygen Therapy ◽

Laboratory Data ◽

Male Gender ◽

High Flow ◽

Binary Logistic Regression Analysis ◽

Hypoxemic Respiratory Failure ◽

Factors Associated ◽

Independent Risk Factors

Abstract Background Acute hypoxemic respiratory failure is prevalent in severe Coronavirus Disease 2019 (COVID-19). High-flow nasal canula (HFNC) is currently the most common ventilation strategy for COVID-19 patients with respiratory failure. This study is to analyze the risk factors associated with high-flow nasal canula (HFNC) oxygen therapy failure in patients with severe COVID-19.Methods: In this single-center, retrospective, observational study, we enrolled patients with confirmed severe COVID-19 admitted to Renmin Hospital of Wuhan university (Wuhan, China) from 1 February 2020 to 26 March 26 2020. Epidemiological, clinical, and laboratory data, and treatments and outcomes upon hospital admission, were obtained from electronic medical records. Sequential organ failure assessment (SOFA) scores were calculated.Results: Of 54 patients with severe COVID-19, HFNC was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC failure was seen more commonly in patients aged ≥60 years and in men. In addition, compared with patients successfully treated with HFNC, patients with HFNC failure had the following characteristics: higher percentage of fatigue and anorexia as well as cardiovascular disease; increased time from onset to diagnosis and SOFA scores; elevated body temperature, respiratory rate, and heart rate; more complications including ARDS, septic shock, myocardial damage, and acute kidney injury; increased neutrophil counts and prothrombin time; and decreased arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (all P < 0.05). However, binary logistic regression analysis showed that only male gender and PaO2/FiO2 were independent risk factors significantly associated with HFNC failure (both, P < 0.05). Conclusion: Patients with severe COVID-19 had a high HFNC treatment failure rate. Male gender and decreased PaO2/FiO2 were independent risk factors associated with HFNC failure in severe COVID-19 patients.

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A Study in the Clinical Characteristics of Stenotrophomonas Maltophilia Bacteremia in Hematological Patients

Blood ◽

10.1182/blood.v126.23.4631.4631 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4631-4631

Author(s):

Haiyan Bao ◽

Jia Chen ◽

Xiaojin Wu ◽

Xiao Ma ◽

Chengcheng Fu ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Respiratory Failure ◽

Stenotrophomonas Maltophilia ◽

Clinical Characteristics ◽

Univariate Analysis ◽

P Value ◽

Hematological Diseases ◽

Factors Associated

Abstract Introduction: Stenotrophomonas maltophilia is an important nosocomial pathogen, particularly in immunocompromised patients, especially in patients with hematologic diseases. Methods: We reviewed the clinical characteristics and prognosis of patients with S. maltophilia bacteremia over a five-year period from January 2010 to December 2014. Species identification was performed using the automated Vitek 2 compact system (bioMe rieux). Results: The incidence of S. maltophilia bacteremia was 25.1 per 10 000 admissions in our study. Thirty-four patients (median age: 34 years; 64.7% males) with S. maltophilia bacteremia were analyzed. The S. maltophilia bacteremia related 30-day mortality was 44.1%. Risk factors associated with mortality in patients with S. maltophilia infection in the univariate and multivariate analysis were represented in Tables I and II. In the univariate analysis, risk factors included T>39.0¡æ, septic shock, respiratory failure and non-remission after treatment for primary hematological diseases (P <0.05). In the multivariate analysis, respiratory failure and non-remission status after treatment forhematological diseases were independent prognostic factors for mortality. In vitro susceptibility was higher to ciprofloxacin(82.4%), ceftazidime(70.6%), sulbactam and cefoperazone(58.8%), which was shown in Table III. Conclusion: Combination regimens with ciprofloxacin and ceftazidime, or sulbactam and cefoperazone could be alternative treatment. Novel antibiotics are required for treatment of S. maltophilia infection, as well as infection control practices of environmental reserves, rapid detection of pathogens, risk stratification strategy and appropriate treatment for primary hematologic malignancies, which might conjointly contribute to better survival outcome of S. maltophilia bacteremia. Univariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Table 1. Factor Mortality HR 95%CI P-value Withfactor Withoutfactor T>39.0¡æ 75% 16.7% 2.490 1.318-4.704 0.005 Septic shock 90.0% 25.0% 2.544 1.473-4.393 0.001 Respiratory failure 100% 20.8% 4.672 2.366-9.225 0.000 Treatment outcome for hematological diseases Remission 10.0% 85.7% 0.247 0.116-0.526 0.000 HR, hazard ratio; CI, confidence interval; HSCT, Hematopoietic stem cell transplantation Table 2. Multivariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Factor HR 95%CI P-value Respiratory failure 2.688 1.297-5.569 0.008 Remission after treatment for hematological diseases 0.367 0.153-0.879 0.025 HR, hazard ratio; CI, confidence interval Table 3. Susceptibility pattern of the 34 patients with Stenotrophomonas maltophilia bacteremia Antimicrobial agents S (%) I (%) Ceftazidime 24(70.6%) 1(2.9%) Cefoperazone 19(44.1%) 6(17.6%) Sulbactam and Cefoperazone 20(58.8%) 5(14.7%) Piperacillin 7(20.6%) 6(17.6%) Piperacillin-Tazobactam 11(32.3%) 7(20.6%) Amikacin 6(17.6%) 0(0%) Ciprofloxacin 28(82.4%) 1(2.9%) S, susceptible; I, intermediately susceptible. Disclosures No relevant conflicts of interest to declare.

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Risk factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19 in Wuhan, China

10.21203/rs.3.rs-41316/v2 ◽

2021 ◽

Author(s):

Xiao-Huan Ma ◽

Meng-Meng An ◽

Fang Yin ◽

Jie Zhang ◽

Meng-Yun Peng ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Failure ◽

Oxygen Therapy ◽

Laboratory Data ◽

High Flow ◽

Binary Logistic Regression Analysis ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Factors Associated ◽

Independent Risk Factors

Abstract Background: Acute hypoxemic respiratory failure is prevalent in severe Coronavirus Disease 2019 (COVID-19). High-flow nasal canula oxygen therapy (HFNC) is currently one of the most common ventilation strategies for COVID-19 patients with respiratory failure. This study is to analyze the risk factors associated with HFNC failure in patients with severe COVID-19.Methods: In this single-center, retrospective, observational study, we enrolled patients with confirmed severe COVID-19 admitted to Renmin Hospital of Wuhan university (Wuhan, China) from 1 February 2020 to 26 March 26 2020. Epidemiological, clinical, and laboratory data, and treatments and outcomes upon hospital admission, were obtained from electronic medical records. Sequential organ failure assessment (SOFA) scores were calculated.Results: Of 54 patients with severe COVID-19, HFNC was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC failure was seen more commonly in patients aged ≥60 years and in men. In addition, compared with patients successfully treated with HFNC, patients with HFNC failure had the following characteristics: higher percentage of fatigue and anorexia as well as cardiovascular disease; increased time from onset to diagnosis and SOFA scores; elevated body temperature, respiratory rate, and heart rate; more complications including ARDS, septic shock, myocardial damage, and acute kidney injury; increased C-reactive protein, neutrophil counts and prothrombin time; and decreased arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (all P < 0.05). However, binary logistic regression analysis showed that only male, PaO2/FiO2 and SOFA scores were independent risk factors significantly associated with HFNC failure (all P < 0.05). Conclusion: Patients with severe COVID-19 had a high HFNC treatment failure rate. Male, low PaO2/FiO2 and SOFA scores were independent risk factors associated with HFNC failure in severe COVID-19 patients. However, studies with larger sample sizes or multi-center studies are warranted.

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