scholarly journals Varying association of laboratory values with reference ranges and outcomes in critically ill patients: an analysis of data from five databases in four countries across Asia, Europe and North America

2021 ◽  
Vol 28 (1) ◽  
pp. e100419
Author(s):  
Haoran Xu ◽  
Louis Agha-Mir-Salim ◽  
Zachary O’Brien ◽  
Dora C Huang ◽  
Peiyao Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cross Sectional Study ◽  
Specific Reference ◽  
Reference Ranges ◽  
Cross Sectional ◽  
Laboratory Values ◽  
Laboratory Results ◽  
The Usa

BackgroundDespite wide usage across all areas of medicine, it is uncertain how useful standard reference ranges of laboratory values are for critically ill patients.ObjectivesThe aim of this study is to assess the distributions of standard laboratory measurements in more than 330 selected intensive care units (ICUs) across the USA, Amsterdam, Beijing and Tarragona; compare differences and similarities across different geographical locations and evaluate how they may be associated with differences in length of stay (LOS) and mortality in the ICU.MethodsA multi-centre, retrospective, cross-sectional study of data from five databases for adult patients first admitted to an ICU between 2001 and 2019 was conducted. The included databases contained patient-level data regarding demographics, interventions, clinical outcomes and laboratory results. Kernel density estimation functions were applied to the distributions of laboratory tests, and the overlapping coefficient and Cohen standardised mean difference were used to quantify differences in these distributions.ResultsThe 259 382 patients studied across five databases in four countries showed a high degree of heterogeneity with regard to demographics, case mix, interventions and outcomes. A high level of divergence in the studied laboratory results (creatinine, haemoglobin, lactate, sodium) from the locally used reference ranges was observed, even when stratified by outcome.ConclusionStandardised reference ranges have limited relevance to ICU patients across a range of geographies. The development of context-specific reference ranges, especially as it relates to clinical outcomes like LOS and mortality, may be more useful to clinicians.

scholarly journals Trimester-specific reference ranges for thyroid hormones of pregnant females at tertiary care hospitals in Lahore, Pakistan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Asim Mumtaz ◽  
Fauzia Sadiq ◽  
Saima Zaki ◽  
Hijab Batool ◽  
Muhammad Ibrahim ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Thyroid Function Test ◽  
Cross Sectional Study ◽  
Thyroid Stimulating Hormone ◽  
Specific Reference ◽  
Thyroid Peroxidase ◽  
Reference Ranges ◽  
Cross Sectional ◽  
Pregnant Females ◽  
Tertiary Care Hospitals

Abstract Background The significance of investigation for diagnosing and managing thyroid dysfunction in pregnant females has been extensively documented in the medical literature. This study aimed to determine trimester-specific reference ranges for thyroid-stimulating hormones (TSH), free T3 (FT3), and free T4 (FT4) in apparently healthy pregnant women attending tertiary care hospitals in Lahore. Methods This cross-sectional study was conducted at two tertiary care Hospitals in Lahore, Pakistan. In this multi-centric study, 500 pregnant females were initially enrolled from September 2019 to December 2019 who fulfilled the inclusion criteria. For measurement of serum FT3, FT4, thyroid stimulating hormone (TSH), anti-thyroid peroxidase (anti-TPO), and thyroglobulin antibodies, 5 ml of the blood sample was drawn, under aseptic conditions, from each subject using Maglumi 800 chemiluminescence immunoassay (CLIA) system. Results Out of 500 subjects, 23 subjects with positive anti-TPO, 19 subjects with anti-TG antibodies, and 12 subjects due to less volume of serum yielded from whole blood (serum less than 3 ml) were excluded from the analysis. Ten samples were hemolyzed and not included in the analysis. A total of 436 samples were examined for analysis. Of the remaining 436 subjects, 133 (30.5%) were from 1st trimester, 153 (35.1%) from 2nd trimester, and 150 (34.4%) from 3rd trimester. As the data were non-normal, the 2.5th, 50th, and 97.5th percentiles were calculated to express each group's results. Trimester specific range of TSH 0.168-4.294, 0.258-4.584 and 0.341-4.625 mIU/mL, FT31.857-4.408, 1.958-4.621 and 2.025-4.821 pmol/L and FT4 8.815-18.006, 8.306-17.341 and 7.402-17.292 pmol/L. Conclusion In this study, we established a trimester-specific reference range for our local population's thyroid function test. The results of this study have complemented the results of previous studies.

scholarly journals Analysis of oral risk-factors for ventilator-associated pneumonia in critically ill patients

2020 ◽  
Author(s):  
Ademar Takahama ◽  
Vitoria Iaros de Sousa ◽  
Elisa Emi Tanaka ◽  
Evelise Ono ◽  
Fernanda Akemi Nakanishi Ito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Physical Examination ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cross Sectional Study ◽  
Ventilator Associated Pneumonia ◽  
Cross Sectional ◽  
Logistic Regression Models

Abstract Objective: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). Material and Methods: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. Results: At oral physical examination, the most frequent findings were tooth loss (568 - 85.67%), coated tongue (422 - 63.65%) and oral bleeding (192 - 28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14% vs 13.69%: p=0.02; 23.44% vs 15.50%: p=0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development [OR=1.60 (1.02-2.47) and OR=1.59 (1.05 – 2.44), respectively]. Conclusions: The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. Clinical relevance: The results of this paper reinforces the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU. This is particularly important in the COVID-19 current scenario, where more people are expected to need mechanical ventilation, consequently increasing cases of VAP.

scholarly journals VALUE OF CLINICAL PULMONARY INFECTION SCORE IN CRITICALLY ILL PATIENTS: BETWEEN THE USE OF CHLORHEXIDINE AND PIPER BETLE LINN MOUTHWASH

2018 ◽  
Vol 4 (1) ◽  
pp. 76-82
Author(s):  
Irfany Nurul Hamid ◽  
Rr Sri Endang Pujiastuti ◽  
Dwi Ari Widigdo ◽  
Djenta Saha
Keyword(s):  
Treatment Group ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pulmonary Infection ◽  
Cross Sectional Study ◽  
Piper Betle ◽  
Ventilator Associated Pneumonia ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Mean

Background: One of the complications of ventilator use in patients in Intensive Care Unit (ICU) is Ventilator-Associated Pneumonia (VAP). Oral hygienes is one of the methods to prevent VAP.Objective: The objective of this study was to compare the value of clinical infection score (CPIS) in critically ill patients after given oral hygiene using chlorhexidine and Piper betle Linn mouthwash.Methods: This was an observational study with cross-sectional study design, which consisted of two intervention groups. Thirty respondents were selected using total sampling, with 15 respondents randomly assigned in each group. Independent t-test was used for data analysis.Results: Findings showed that  the mean of CPIS in the Piper betle Linn group was 3.80 and the mean of CPIS in the chlorhexidine group was 4.07.Conclusion: CPIS in the treatment group using Piper betle Linn mouthwash was lower than the mean of CPIS in the treatment group using clorhexidine. 

scholarly journals Effect of Alcohol on Clinical Outcomes of Hepatitis Virus-Induced Liver Cirrhosis: A Consecutive Ten-Year Study

2021 ◽  
Author(s):  
Kodjo-Kunale Abassa ◽  
Xiao-Ying Wu ◽  
Xiu-Ping Xiao ◽  
Hao-Xiong Zhou ◽  
Yun-Wei Guo ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Clinical Outcomes ◽  
Hepatitis Virus ◽  
Cross Sectional Study ◽  
Multivariate Logistic Regression ◽  
Cross Sectional ◽  
Liver Function Impairment ◽  
Alcohol Abstinence ◽  
Function Impairment ◽  
Laboratory Results

Abstract BACKGROUND & AIM: Coexisting alcoholic liver disease and virus-induced liver cirrhosis (ALD+HBV and ALD+HCV) has not been thoroughly studied. This cross-sectional study aims to showcase the influence of alcohol on the laboratory values and on the clinical outcomes of patients with hepatitis B and C virus-induced liver cirrhosis.METHOD: Patients diagnosed with liver cirrhosis (n=22287) from January 2010 to December 2019 were collected from our hospital electronic database, and divided into five groups according to the etiology: ALD (1652 cases, 7.4%), HBV (18079 cases, 81.1%), HCV (682 cases, 3.1%), ALD+HBV (1594 cases, 7.2%) and ALD+HCV (280 cases, 1.3%). Laboratory results and proportion of different liver cirrhosis complications were contrasted between groups.RESULTS: ALD+HBV and ALD+HCV presented with higher proportions of poor prognosis patients and cirrhosis complications compared to HBV and HCV respectively. Multivariate logistic regression revealed that the risk of HCC and that of EGVB in the ALD+HBV group was respectively 2.14-fold and 1.47-fold that in the HBV group (HCC: OR=2.14, 95%CI: [1.71-2.69]; EGVB: OR=1.47, 95%CI: [1.17-1.84]) after adjusting for potential confounders. Furthermore, a decrease in the risk of HCC and EGVB with the duration of alcohol abstinence was observed. Similar pattern was noticed while comparing ALD+HCV group to HCV group.CONCLUSION: Alcohol significantly increased the severity of liver function impairment and the prevalence of liver cirrhosis complications such as HCC and EGVB in hepatitis virus-induced liver cirrhosis patients. Remarkably, long period of alcohol abstinence significantly decreased the prevalence of HCC and EGVB in these populations.

Prediction of Hypoglycemia During Admission of Non-Critically Ill Patients: Results from the MENU Study

2020 ◽  
Vol 52 (09) ◽  
pp. 660-668
Author(s):  
Israel Khanimov ◽  
Meital Ditch ◽  
Henriett Adler ◽  
Sami Giryes ◽  
Noa Felner Burg ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Monitoring ◽  
Cross Sectional Study ◽  
Nutritional Risk ◽  
Blood Glucose Monitoring ◽  
Cross Sectional ◽  
Hospitalization Period ◽  
Diabetes Mellitus Status

AbstractThe objective of the work was to study admission parameters associated with an increased incidence of hypoglycemia during hospitalization of non-critically ill patients. Included in this cross-sectional study were patients admitted to internal medicine units. The Nutritional Risk Screening 2002 (NRS2002) was used for nutritional screening. Data recorded included admission serum albumin (ASA) and all glucose measurements obtained by the institutional blood glucose monitoring system. Neither of these are included in the NRS2002 metrics. Hypoalbuminemia was defined as ASA<3.5 g/dl. Patients were categorized as hypoglycemic if they had at least one documented glucose≤70 mg/dl during the hospitalization period. Included were 1342 patients [median age 75 years (IQR 61–84), 51.3% male, 52.5% with diabetes mellitus, (DM)], who were screened during three distinct periods of time from 2011–2018. The incidence of hypoglycemia was 10.8% with higher rates among DM patients (14.6 vs. 6.6%, p<0.001). Hypoglycemia incidence was negatively associated with ASA regardless of DM status. Multivariable regression showed that ASA (OR 0.550 per g/dl, 95% CI 0.387–0.781, p=0.001) and positive NRS2002 (OR 1.625, 95% CI 1.072–2.465, p=0.022) were significantly associated with hypoglycemia. The addition of hypoalbuminemia status to the NRS2002 tool improved the overall sensitivity from 0.55 to 0.71, but reduced specificity from 0.63 to 0.46. The negative predictive value was 0.93. Our data suggest that the combination of positive malnutrition screen and hypoalbuminemia upon admission are independently associated with the incidence of hypoglycemia among non-critically ill patients, regardless of diabetes mellitus status.

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