Value of early critical care transthoracic echocardiography for patients undergoing mechanical ventilation: a retrospective study

ObjectivesTo evaluate whether early intensive care transthoracic echocardiography (TTE) can improve the prognosis of patients with mechanical ventilation (MV).DesignA retrospective cohort study.SettingPatients undergoing MV for more than 48 hours, based on the Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU-CRD), were selected.Participants2931 and 6236 patients were recruited from the MIMIC-III database and the eICU database, respectively.Primary and secondary outcome measuresThe primary outcome was in-hospital mortality. Secondary outcomes were 30-day mortality from the date of ICU admission, days free of MV and vasopressors 30 days after ICU admission, use of vasoactive drugs, total intravenous fluid and ventilator settings during the first day of MV.ResultsWe used propensity score matching to analyse the association between early TTE and in-hospital mortality and sensitivity analysis, including the inverse probability weighting model and covariate balancing propensity score model, to ensure the robustness of our findings. The adjusted OR showed a favourable effect between the early TTE group and in-hospital mortality (MIMIC: OR 0.78; 95% CI 0.65 to 0.94, p=0.01; eICU-CRD: OR 0.76; 95% CI 0.67 to 0.86, p<0.01). Early TTE was also associated with 30-day mortality in the MIMIC database (OR 0.71, 95% CI 0.57 to 0.88, p=0.001). Furthermore, those who had early TTE had both more ventilation-free days (only in eICU-CRD: 23.48 vs 24.57, p<0.01) and more vasopressor-free days (MIMIC: 18.22 vs 20.64, p=0.005; eICU-CRD: 27.37 vs 28.59, p<0.001) than the control group (TTE applied outside of the early TTE and no TTE at all).ConclusionsEarly application of critical care TTE during MV is beneficial for improving in-hospital mortality. Further investigation with prospectively collected data is required to validate this relationship.

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Early Critical Care Transthoracic Echocardiography Improves the Mortality of Patients Undergoing Mechanical Ventilation: Observational Data From Two Large Databases.

10.21203/rs.3.rs-58841/v1 ◽

2020 ◽

Author(s):

Xueshu Yu ◽

Hao Jiang ◽

Wenjing Chen ◽

Lingling Pan ◽

Zhendong Fang ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critical Care ◽

Propensity Score ◽

Hospital Mortality ◽

Transthoracic Echocardiography ◽

Favourable Effect ◽

Research Database ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

Abstract Background: Critical care transthoracic echocardiography (TTE) can quickly and accurately assess haemodynamic changes in ICU patients. However, it is not clear whether transthoracic echocardiography improves the prognosis of mechanically ventilated patients. In this study, we hypothesized that early critical care transthoracic echocardiography independently contributes to improvements in mortality in mechanically ventilated patients in the ICU.Methods: This was a retrospective study based on the Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU-CRD). Patients undergoing mechanical ventilation for more than 48 hours were selected. The exposure of interest was early TTE. The primary outcome was in-hospital mortality. We used propensity score matching to analyse the association between early TTE and in-hospital mortality and sensitivity analysis, including the inverse probability weighting model and covariate balancing propensity score model, to ensure the robustness of our findings.Results: A total of 8862 patients undergoing mechanical ventilation were enrolled. The adjusted OR showed a favourable effect between the early TTE group and in-hospital mortality [MIMIC: OR 0.77, 95% CI (0.63–0.94), (P=0.01); eICU-CRD: OR 0.78, 95% CI (0.68–0.89), (P<0.01) ]. Furthermore, TTE was also associated with 30-day mortality in the MIMIC database [OR 0.74, 95% CI (0.6-0.92), P=0.01].Conclusions: Early application of critical care transthoracic echocardiography during mechanical ventilation is beneficial for improving in-hospital mortality. Further investigation with prospectively collected data is required to validate this relationship.

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Early Critical Care Transthoracic Echocardiography Improves The Mortality Of Patients Undergoing Mechanical Ventilation: Observational Data From Two Large Databases

10.21203/rs.3.rs-43581/v1 ◽

2020 ◽

Author(s):

Xueshu Yu ◽

Xiaojun Pan ◽

Xianwei Zhang ◽

Zhiqiang Chen ◽

Hao Pan ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critical Care ◽

Propensity Score ◽

Hospital Mortality ◽

Transthoracic Echocardiography ◽

Favourable Effect ◽

Research Database ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

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Prediction of in-hospital mortality of Clostriodiodes difficile infection using critical care database: a big data-driven, machine learning approach

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2021-000761 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000761

Author(s):

Hao Du ◽

Kewin Tien Ho Siah ◽

Valencia Zhang Ru-Yan ◽

Readon Teh ◽

Christopher Yu En Tan ◽

...

Keyword(s):

Machine Learning ◽

Critical Care ◽

Intensive Care ◽

Hospital Mortality ◽

Receiver Operating Curve ◽

Study Cohort ◽

Risk Of Death ◽

Severity Scores ◽

Mimic Iii ◽

Care Database

Research objectivesClostriodiodes difficile infection (CDI) is a major cause of healthcare-associated diarrhoea with high mortality. There is a lack of validated predictors for severe outcomes in CDI. The aim of this study is to derive and validate a clinical prediction tool for CDI in-hospital mortality using a large critical care database.MethodologyThe demographics, clinical parameters, laboratory results and mortality of CDI were extracted from the Medical Information Mart for Intensive Care-III (MIMIC-III) database. We subsequently trained three machine learning models: logistic regression (LR), random forest (RF) and gradient boosting machine (GBM) to predict in-hospital mortality. The individual performances of the models were compared against current severity scores (Clostridiodes difficile Associated Risk of Death Score (CARDS) and ATLAS (Age, Treatment with systemic antibiotics, leukocyte count, Albumin and Serum creatinine as a measure of renal function) by calculating area under receiver operating curve (AUROC). We identified factors associated with higher mortality risk in each model.Summary of resultsFrom 61 532 intensive care unit stays in the MIMIC-III database, there were 1315 CDI cases. The mortality rate for CDI in the study cohort was 18.33%. AUROC was 0.69 (95% CI, 0.60 to 0.76) for LR, 0.71 (95% CI, 0.62 to 0.77) for RF and 0.72 (95% CI, 0.64 to 0.78) for GBM, while previously AUROC was 0.57 (95% CI, 0.51 to 0.65) for CARDS and 0.63 (95% CI, 0.54 to 0.70) for ATLAS. Albumin, lactate and bicarbonate were significant mortality factors for all the models. Free calcium, potassium, white blood cell, urea, platelet and mean blood pressure were present in at least two of the three models.ConclusionOur machine learning derived CDI in-hospital mortality prediction model identified pertinent factors that can assist critical care clinicians in identifying patients at high risk of dying from CDI.

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The knowledge of Cormack–Lehane intubation grade and intensive care unit outcome

Journal of the Intensive Care Society ◽

10.1177/1751143719832178 ◽

2019 ◽

Vol 21 (1) ◽

pp. 48-56

Author(s):

Vinodh B Nanjayya ◽

Christopher J Hebel ◽

Patrick J Kelly ◽

Jason McClure ◽

David Pilcher

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Invasive Mechanical Ventilation ◽

Severity Of Illness ◽

Secondary Outcome ◽

Mortality Data ◽

Icu Admission ◽

Icu Outcome ◽

Multivariable Analyses

Background For patients on invasive mechanical ventilation (MV), it is unclear if knowledge of intubation grade influences intensive care unit (ICU) outcome. We aimed to determine if there was an independent relationship between knowledge of intubation grade during ICU admission and in-hospital mortality. Methods We performed a retrospective cohort study of all patients receiving invasive MV at the Alfred ICU between December 2011 and February 2015. Demographics, details of admission, the severity of illness, chronic health status, airway detail (unknown or known Cormack–Lehane (CL) grade), MV duration and in-hospital mortality data were collected. Univariable and multivariable analyses were conducted to assess the relationship. The primary outcome was in-hospital mortality, and the secondary outcome was the duration of MV. Results Amongst 3556 patients studied, 611 (17.2%) had an unknown CL grade. Unadjusted mortality was higher in patients with unknown CL grade compared to known CL grade patients (21.6% vs. 9.9%). After adjusting for age, sex, severity of illness, type of ICU admission, cardiac arrest, limitations to treatment and diagnosis, having an unknown CL grade during invasive MV was independently associated with an increase in mortality (adjusted OR 1.5, 95% CI 1.14–1.98, p < 0.01). Conclusion Amongst ICU patients receiving MV, not knowing CL grade appears to be independently associated with increased mortality. This information should be communicated and documented in all patients receiving MV in ICU.

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Dynamic APACHE II Score to Predict Outcome Among Intensive Care Unit Patients

10.21203/rs.3.rs-642050/v1 ◽

2021 ◽

Author(s):

Yao Tian ◽

Yang YAO ◽

Jing Zhou ◽

Xin Diao ◽

Hui Chen ◽

...

Keyword(s):

Intensive Care ◽

Hospital Mortality ◽

Goodness Of Fit ◽

Apache Ii ◽

Secondary Outcome ◽

Apache Ii Score ◽

Optimal Timing ◽

Goodness Of Fit Test ◽

Icu Patients ◽

Mimic Iii

Abstract Purpose: The Acute Physiology and Chronic Health Evaluation II (APACHE II) score is used to determine disease severity and predict outcomes in critically ill patients. However, there is no dynamic APACHE II score for predicting outcomes among ICU patients.The aim of this study is to explore the optimal timing to predict the outcomes of ICU patients by dynamically evaluating APACHE II score.Methods: Study data of demographics and comorbidities from the first 24 h after ICU admission were retrospectively extracted from MIMIC-III, a multiparameter intensive care database. The primary outcome was hospital mortality. 90-day mortality was a secondary outcome. APACHE II scores on days 1, 2, 3, 5, 7, 14 and 28 were compared using area under the receiver operating characteristic (AUROC) analysis. Hospital survival was visualised using Kaplan-Meier Curves.Results:A total of 6374 eligible subjects were extracted from the MIMIC-III. Mean APACHE II score on day 1 were 18.4±6.3, hospital and 90-day mortality was 19.1% and 25.8%, respectively.The optimal timing where predicted hospital mortality was on day 3 with an area under the cure of 0.666 (0.607-0.726)(P＜0.0001). The best tradeoff for preciction was found at 17 score, more than 17 score predicted mortality of non-survivors with a sensitivity of 92.8% and PPV of 23.1%. Hosmer-lemeshow goodness of fit test showed that APACHE II 3 has a good predictive calibration ability (X2 =6.198, P=0.625) and consistency of predicted death and actual death was 79.4%. The calibration of APACHE II 1 was poor (X2=294.898, P<0.001).Conclusions: APACHE II on 3 dayis the optimal prognostic marker and 17 score provided the best dignostic accuracy to predict outcomes for ICU patients. These finding will help medical make clinical judgment.

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Synergistic effect of hypoalbuminaemia and hypotension in predicting in-hospital mortality and intensive care admission: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2021-050216 ◽

2021 ◽

Vol 11 (10) ◽

pp. e050216

Author(s):

Eyal Klang ◽

Shelly Soffer ◽

Eyal Zimlichman ◽

Alexis Zebrowski ◽

Benjamin S Glicksberg ◽

...

Keyword(s):

New York ◽

Intensive Care ◽

Hospital Mortality ◽

Multivariable Analysis ◽

Vital Signs ◽

Secondary Outcome ◽

Logistic Regression Models ◽

Icu Admission ◽

Admission Rates ◽

Ed Visits

ObjectiveHypoalbuminaemia is an important prognostic factor. It may be associated with poor nutritional states, chronic heart and kidney disease, long-standing infection and cancer. Hypotension is a hallmark of circulatory failure. We evaluated hypoalbuminaemia and hypotension synergism as predictor of in-hospital mortality and intensive care unit (ICU) admission.DesignWe retrospectively analysed emergency department (ED) visits from January 2011 to December 2019.SettingData were retrieved from five Mount Sinai health system hospitals, New York.ParticipantsWe included consecutive ED patients ≥18 years with albumin measurements.Primary and secondary outcome measuresClinical outcomes were in-hospital mortality and ICU admission. The rates of these outcomes were stratified by systolic blood pressure (SBP) (<90 vs ≥90 mm Hg) and albumin levels. Variables included demographics, presenting vital signs, comorbidities (measured as ICD codes) and other common blood tests. Multivariable logistic regression models analysed the adjusted OR of different levels of albumin and SBP for predicting ICU admission and in-hospital mortality. The models were adjusted for demographics, vital signs, comorbidities and common laboratory results. Patients with albumin 3.5–4.5 g/dL and SBP ≥90 mm Hg were used as reference.ResultsThe cohort included 402 123 ED arrivals (27.9% of total adult ED visits). The rates of in-hospital mortality, ICU admission and overall admission were 1.7%, 8.4% and 47.1%, respectively. For SBP <90 mm Hg and albumin <2.5 g/dL, mortality and ICU admission rates were 34.0% and 40.6%, respectively; for SBP <90 mm Hg and albumin ≥2.5 g/dL 8.2% and 24.1%, respectively; for SBP ≥90 mm Hg and albumin <2.5 g/dL 11.4% and 18.6%, respectively; for SBP ≥90 mm Hg and albumin 3.5–4.5 g/dL 0.5% and 6.4%, respectively. Multivariable analysis showed that in patients with hypotension and albumin <2.5 g/dL the adjusted OR for in-hospital mortality was 37.1 (95% CI 32.3 to 42.6), and for ICU admission was 5.4 (95% CI 4.8 to 6.1).ConclusionCo-occurrence of hypotension and hypoalbuminaemia is associated with poor hospital outcomes.

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Characteristics and outcomes of culture-negative versus culture-positive with fungus in sepsis patients: a retrospective analysis of the MIMIC-III database

10.21203/rs.3.rs-71457/v1 ◽

2020 ◽

Author(s):

Zhiye Zou ◽

Ming Wu

Keyword(s):

Intensive Care ◽

Propensity Score ◽

Hospital Mortality ◽

Propensity Score Matching ◽

Antifungal Therapy ◽

Antifungal Drugs ◽

Positive Group ◽

Mimic Iii ◽

Culture Positive ◽

Culture Negative

Abstract BACKGROUND: We compared the characteristics of culture-positive and culture-negative with fungi in septic patients to determine whether fungi culture status is associated with mortality and the relationship between antifungal therapy and sepsis patient mortality.METHODS: The study was based on the Medical Information Mart for Intensive Care (MIMIC) III database, we included all intensive care unit (ICU) admissions between 2001 and 2012 with sepsis, which met the Martin’s criteria. The primary outcome was hospital mortality. Secondary outcomes included the usage of antifungal drugs, duration of mechanical ventilation and hospital stay. Multivariable logistic regression and propensity score matching were used to investigate any association.RESULTS: The study population included 836 fungi-positive patients (16.6%) and 4191 fungi-negative patients (83.4%). Fungi-positive patients had more congestive heart failure and chronic pulmonary, higher sequential organ failure assessment (SOFA), and more need for renal replacement therapy on day one than fungi-negative patients. There was no correlation between antifungal therapy and hospital mortality (adjusted odds ratio = 1.03, 95% CI [0.89, 1.20]; P=0.676）. Hospital mortality was lower in the fungi-negative group (25.5%) than in the fungi-positive group (37.3%, P<0.001). After propensity score matching, 613 cases from each group were matched. The hospital mortality remained significantly higher in the fungi-positive group (167/613 vs. 216/613, p=0.003).CONCLUSIONS: Although residual confounding cannot be excluded, significant differences between fungi-positive and fungi-negative sepsis are identified, with the former group having more comorbidities, worse severity of illness, longer hospitalizations, and higher mortality. Antifungal therapy does not affect the outcome.

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3541 The association of corticosteroid use with inpatient mortality in acute exacerbation of idiopathic pulmonary fibrosis

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.290 ◽

2019 ◽

Vol 3 (s1) ◽

pp. 127-128

Author(s):

Erica Farrand ◽

Eric Vittinghoff ◽

Brett Ley ◽

Harold Collard

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Propensity Score ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Corticosteroid Therapy ◽

Odds Ratio ◽

Corticosteroid Treatment ◽

Time Dependent ◽

Icu Admission

OBJECTIVES/SPECIFIC AIMS: Objective: To assess the impact of corticosteroid therapy on in-hospital mortality in IPF patients admitted with acute respiratory failure. METHODS/STUDY POPULATION: Methods: Patients with IPF were retrospectively identified in the University of California San Francisco medical center’s electronic health records from January 1, 2010 to June 1, 2018. Cases with IPF were defined as age 50 years or older, having at least two codes one month apart for idiopathic fibrosing alveolitis or post-inflammatory fibrosis (ICD-9 516.3, 516.31 or 515.0 or ICD-10 codes J84.9, J84.10, J84.111 or J84.112), and a subsequent hospitalization for acute respiratory failure or acute respiratory symptoms. The prevalence of pre-selected co-morbidities, clinical events (ICU admission, mechanical ventilation, lung transplantation) and clinical outcomes were assessed. A propensity score model for corticosteroid use was constructed using a multivariable logistic regression with inclusion of corticosteroid-associated demographic and baseline variables (univariate p-value < 0.25). A marginal structural model (MSM) was used to address time-dependent confounding and mediating effects of ICU admission and mechanical ventilation by applying inverse probability weighting for receipt of corticosteroid treatment. Secondary outcome analysis was performed on patients who survived hospital admission. RESULTS/ANTICIPATED RESULTS: Results: A total of 132 patients with IPF and an acute respiratory admission were identified. 48 patients (36%) received corticosteroids during their admission. Applying inverse weighting to time-dependent co-variates (ICU admission and invasive mechanical ventilation) in a MSM, corticosteroid therapy was not associated with risk of in-hospital mortality (odds ratio 1.82; 95% CI, 0.47-6.99; p = 0.39). After adjusting for corticosteroid therapy using a propensity score, corticosteroid therapy remained unassociated with in-hospital mortality (odds ratio 1.53, 95% confidence interval [CI] 0.37, 6.29; p = 0.55). There was no difference in discharge disposition or time to hospital readmission by corticosteroid treatment. There was a possible increase in time to death following discharge in patients receiving corticosteroids (Figure). DISCUSSION/SIGNIFICANCE OF IMPACT: Conclusions: This study suggests that treatment of acute exacerbations of interstitial lung disease with corticosteroids does not improve short-term outcomes, including in-hospital mortality, all-cause non-elective re-hospitalization or death within 6 months of discharge. Further research in larger cohorts is needed to more definitively assess this relationship.

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Intensive care unit versus high-dependency care unit for patients with acute heart failure: a nationwide propensity score-matched cohort study

Journal of Intensive Care ◽

10.1186/s40560-021-00592-2 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Hiroyuki Ohbe ◽

Hiroki Matsui ◽

Hideo Yasunaga

Keyword(s):

Heart Failure ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Propensity Score ◽

Confidence Interval ◽

Hospital Mortality ◽

Acute Heart Failure ◽

High Dependency ◽

Significant Difference

Abstract Background A structure and staffing model similar to that in general intensive care unit (ICUs) is applied to cardiac intensive care unit (CICUs) for patients with acute heart failure. However, there is limited evidence on the structure and staffing model of CICUs. The present study aimed to assess whether critical care for patients with acute heart failure in the ICUs is associated with improved outcomes than care in the high-dependency care units (HDUs), the hospital units in which patient care levels and costs are between the levels found in the ICU and general ward. Methods This nationwide, propensity score-matched, retrospective cohort study was performed using a national administrative inpatient database in Japan. We identified all patients who were hospitalized for acute heart failure and admitted to the ICU or HDU on the day of hospital admission from April 2014 to March 2019. Propensity score-matching analysis was performed to compare the in-hospital mortality between acute heart failure patients treated in the ICU and HDU on the day of hospital admission. Results Of 202,866 eligible patients, 78,646 (39%) and 124,220 (61%) were admitted to the ICU and HDU, respectively, on the day of admission. After propensity score matching, there was no statistically significant difference in in-hospital mortality between patients who were admitted to the ICU and HDU on the day of admission (10.7% vs. 11.4%; difference, − 0.6%; 95% confidence interval, − 1.5% to 0.2%). In the subgroup analyses, there was a statistically significant difference in in-hospital mortality between the ICU and HDU groups among patients receiving noninvasive ventilation (9.4% vs. 10.5%; difference, − 1.0%; 95% confidence interval, − 1.9% to − 0.1%) and patients receiving intubation (32.5% vs. 40.6%; difference, − 8.0%; 95% confidence interval, − 14.5% to − 1.5%). There were no statistically significant differences in other subgroup analyses. Conclusions Critical care in ICUs was not associated with lower in-hospital mortality than critical care in HDUs among patients with acute heart failure. However, critical care in ICUs was associated with lower in-hospital mortality than critical care in HDUs among patients receiving noninvasive ventilation and intubation.

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Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211027759 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110277

Author(s):

Tyler Pitre ◽

Angela (Hong Tian) Dong ◽

Aaron Jones ◽

Jessica Kapralik ◽

Sonya Cui ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Cohort Study ◽

Hospital Mortality ◽

Disease Severity ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Kidney Injury ◽

Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

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