Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission

2018 ◽  
pp. emermed-2018-208032 ◽  
Author(s):  
Zhongheng Zhang ◽  
Faran Bokhari ◽  
Yizhan Guo ◽  
Hemant Goyal
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Prolonged Length ◽  
Icu Admission ◽  
Risk Of Death ◽  
Crude Mortality Rate ◽  
Crude Mortality ◽  
Increased Risk ◽  
Multivariable Regression Model ◽  
Multivariable Regression

Background and objectivesDelayed patient admission to the intensive care unit (ICU) from the ED is common in China. Patients with severe sepsis or septic shock requiring ICU admission are in need of specialised monitoring and tailored treatment. Delayed admission to the ICU might be associated with adverse clinical outcomes for patients with sepsis.MethodsPatients with sepsis admitted to the ICU from the ED from January 2010 to April 2018 were retrospectively identified from a clinical data warehouse. The primary endpoint was in-hospital mortality. Length of stay in ED (EDLOS) was compared between survivors and non-survivors. A multivariable regression model was employed to adjust for potential confounding due to patient clinical condition.ResultsA total of 1997 patients, including 473 non-survivors and 1524 survivors, were included. The crude mortality rate for patients with EDLOS <6 hours was 21.4%, which was significantly lower than patients with EDLOS of 12–24 hours (31.9%), and those with EDLOS >24 hours (31.8%). After adjusting for PaO2/FiO2, serum creatinine, age, Sequential Organ Failure Assessment, body mass index, lactate, comorbidities and infection site, EDLOS continued to be independently associated with increased risk of hospital mortality. Compared with the group with EDLOS <6 hours, those with EDLOS between 12and24 hours (OR 1.82, 95% CI 1.28 to 2.58) and EDLOS >24 hours (OR 1.79, 95% CI 1.27 to 2.52) showed a significantly increased risk of death.ConclusionsOur study shows that prolonged EDLOS is independently associated with increased risk of hospital mortality in patients with sepsis requiring ICU admission.

scholarly journals Prompt admission to intensive care is associated with improved survival in patients with severe sepsis and/or septic shock

2018 ◽  
Vol 46 (10) ◽  
pp. 4071-4081 ◽  
Author(s):  
Qiang Li ◽  
Jiajiong Wang ◽  
Guomin Liu ◽  
Meng Xu ◽  
Yanguo Qin ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Multivariable Model ◽  
Icu Admission ◽  
Survival Status ◽  
Healthcare Data ◽  
Multivariable Regression Model ◽  
Multivariable Regression

Objective To investigate the association between time from hospital admission to intensive care unit (ICU) admission (door to ICU time) and hospital mortality in patients with sepsis. Methods This retrospective observational study included routinely collected healthcare data from patients with sepsis. The primary endpoint was hospital mortality, defined as the survival status at hospital discharge. Door to ICU time was calculated and included in a multivariable model to investigate its association with mortality. Results Data from 13 115 patients were included for analyses, comprising 10 309 survivors and 2 806 non-survivors. Door to ICU time was significantly longer for non-survivors than survivors (median, 43.0 h [interquartile range, 12.4, 91.3] versus 26.7 h [7.0, 74.2]). In the multivariable regression model, door to ICU time remained significantly associated with mortality (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.006, 1.017) and there was a significant interaction between age and door to ICU time (OR 0.99, 95% CI 0.99, 1.00). Conclusion A shorter time from hospital door to ICU admission was shown to be independently associated with reduced hospital mortality in patients with severe sepsis and/or septic shock.

scholarly journals Elevated von Willebrand Factor Antigen is an Early Predictor of Mortality and Prolonged Length of Stay for Coronavirus Disease 2019 (COVID-19) Inpatients

2021 ◽  
Author(s):  
Alexander H. Cotter ◽  
Su-Jau T. Yang ◽  
Hedyeh Shafi ◽  
Timothy M. Cotter ◽  
Darryl Erik Palmer-Toy
Keyword(s):  
Length Of Stay ◽  
Fold Increase ◽  
Prolonged Length ◽  
Risk Of Death ◽  
Increased Risk ◽  
Von Willebrand ◽  
Willebrand Factor ◽  
Factor Antigen ◽  
D Dimer ◽  
Increase In Risk

ABSTRACT Context: Coagulation factor and endothelial injury marker, von Willebrand factor antigen (vWF:Ag), is elevated in coronavirus disease 2019 (COVID-19). Objective: To assess prognostic value of vWF:Ag for COVID-19 inpatients. Design: Citrated plasma samples collected from COVID-19 inpatients for D-dimer measurement were tested for vWF:Ag. Measurements of vWF:Ag and common acute phase reactants (APRs) were correlated with clinical outcomes and length of stay (LOS). Results: We included 333 samples from a diverse group of 120 COVID-19 inpatients. There was a clear association of higher peak measurements of vWF:Ag and other APRs with adverse clinical outcomes. Peak vWF:Ag &gt;300% was associated with a 5-fold increased risk of death (Odds Ratio 5.08, P&lt;.001) and a 30-fold increased risk of prolonged (&gt;4 days) LOS (OR 29.65, P =.001). Peak D-dimer &gt;3.8 FEU mg/L was associated with a 15-fold increase in risk of death (OR 14.73, P &lt;.001) and a 5-fold increased risk of prolonged LOS (OR 4.55, P=.02). Using the earliest paired measurements of vWF:Ag and D-dimer from each patient and the same cut-offs, vWF:Ag was associated with a 3.5-fold increase in risk of death (OR 3.54, P=.004) and a 20-fold risk of prolonged LOS (OR 20.19, P=.004). Yet D-dimer was not significantly associated with either death (OR 1.9, P=.29) or prolonged LOS (OR 1.02, P=.98). Conclusions: Both peak and early post-admission vWF:Ag &gt;300% were highly predictive of death and prolonged length of stay among COVID-19 inpatients. Measurement of vWF:Ag may prove a valuable tool to guide escalation of COVID-19 treatment, particularly anticoagulation.

scholarly journals O24 Risk of death during the 2020 UK COVID-19 epidemic and annual influenza seasons among people with vasculitis compared to the general population: a whole-population study using data from the NDRS and the RECORDER project

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Megan Rutter ◽  
Peter C Lanyon ◽  
Matthew J Grainge ◽  
Richard B Hubbard ◽  
Emily J Peach ◽  
...  
Keyword(s):  
Mortality Rate ◽  
General Population ◽  
Mortality Rates ◽  
Published Data ◽  
Research Support ◽  
Risk Of Death ◽  
Crude Mortality Rate ◽  
Crude Mortality ◽  
Increased Risk ◽  
Using Data

Abstract Background/Aims  To quantify the risk of death among people with vasculitis during the UK 2020 COVID-19 epidemic compared with baseline risk, risk during annual influenza seasons and risk of death in the general population during COVID-19. Methods  We performed a cohort study using data from the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS) under their legal permissions (CAG 10-02(d)/2015). Coded diagnoses for vasculitis (ANCA-associated vasculitis, Takayasu arteritis, Behçet's disease, and giant cell arteritis) were identified from Hospital Episode Statistics from 2003 onwards. Previous coding validation work demonstrated a positive predictive value &gt;85%. The main outcome measure was age-standardised mortality rates (ASMRs) for all-cause death. ONS published data were used for general population mortality rates. Results  We identified 55,110 people with vasculitis (median age 74.9 (IQR 64.1-82.7) years, 68.0% female) alive 01 March 2020. During March-April 2020, 892 (1.6%) died of any cause. The crude mortality rate was 9773.0 (95% CI 9152.3-10,435.9) per 100,000 person-years. The ASMR was 2567.5 per 100,000 person-years, compared to 1361.1 (1353.6-1368.7) in the general population (see table). The ASMR in March-April 2020 was 1.4 times higher than the mean ASMR for March-April 2015-2019 (1965.6). The increase in deaths during March-April 2020 occurred at a younger age than in the general population. We went on to investige the effect of previous influenza seasons. The 2014/15 season saw the greatest excess all-cause mortality nationally in recent years, and there were 624 deaths in 38,888 people (6472.5 person-years) with vasculitis in our data (crude mortality rate 9640.8 (8913.3-10427.7); The ASMR was 2657.6, which was marginally higher than the ASMR among people with vasculitis recorded during March-April 2020 during the COVID-19 pandemic. Conclusion  People with vasculitis are at increased risk of death during circulating COVID-19 and influenza epidemics. The ASMR among people with vasculitis was high both during the 2014/15 influenza season and during the first wave of the COVID-19 epidemic. COVID-19 vaccination and annual influenza vaccination for people with vasculitis are both important, regardless of patient age. Disclosure  M. Rutter: None. P.C. Lanyon: Grants/research support; PCL has received funding for research from Vifor Pharma.. M.J. Grainge: None. R.B. Hubbard: None. E.J. Peach: Grants/research support; EJP has received funding for research from Vifor Pharma. M. Bythell: None. J. Aston: None. S. Stevens: None. F.A. Pearce: Grants/research support; FAP has received funding for research from Vifor Pharma..

scholarly journals Cross-sectional observational study of epidemiology of COVID-19 and clinical outcomes of hospitalised patients in North West London during March and April 2020

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044384
Author(s):  
Guduru Gopal Rao ◽  
Alexander Allen ◽  
Padmasayee Papineni ◽  
Liyang Wang ◽  
Charlotte Anderson ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Severe Infection ◽  
Older Age ◽  
Cross Sectional ◽  
North West ◽  
Icu Admission ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk

ObjectiveThe aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London.DesignObservational cohort study.SettingLondon North West Healthcare NHS Trust (LNWH).ParticipantsPatients tested and/or admitted for COVID-19 at LNWH during March and April 2020Main outcome measuresDescriptive and analytical epidemiology of demographic and clinical outcomes (intensive care unit (ICU) admission, mechanical ventilation and mortality) of those who tested positive for COVID-19.ResultsThe outbreak began in the first week of March 2020 and reached a peak by the end of March and first week of April. In the study period, 6183 tests were performed in on 4981 people. Of the 2086 laboratory confirmed COVID-19 cases, 1901 were admitted to hospital. Older age group, men and those of black or Asian minority ethnic (BAME) group were predominantly affected (p<0.05). These groups also had more severe infection resulting in ICU admission and need for mechanical ventilation (p<0.05). However, in a multivariate analysis, only increasing age was independently associated with increased risk of death (p<0.05). Mortality rate was 26.9% in hospitalised patients.ConclusionThe findings confirm that men, BAME and older population were most commonly and severely affected groups. Only older age was independently associated with mortality.

scholarly journals Mortality and high risk of major adverse events in patients with COVID-19 and history of cardiovascular disease

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001526
Author(s):  
Elena Tessitore ◽  
David Carballo ◽  
Antoine Poncet ◽  
Nils Perrin ◽  
Cedric Follonier ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Male Gender ◽  
Hospital Death ◽  
Chronic Obstructive ◽  
University Hospitals ◽  
Adverse Cardiovascular Event ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
History Of

ObjectiveHistory of cardiovascular diseases (CVDs) may influence the prognosis of patients hospitalised for COVID-19. We investigated whether patients with previous CVD have increased risk of death and major adverse cardiovascular event (MACE) when hospitalised for COVID-19.MethodsWe included 839 patients with COVID-19 hospitalised at the University Hospitals of Geneva. Demographic characteristics, medical history, laboratory values, ECG at admission and medications at admission were collected based on electronic medical records. The primary outcome was a composite of in-hospital mortality or MACE.ResultsMedian age was 67 years, 453 (54%) were males and 277 (33%) had history of CVD. In total, 152 (18%) died and 687 (82%) were discharged, including 72 (9%) who survived a MACE. Patients with previous CVD were more at risk of composite outcomes 141/277 (51%) compared with those without CVD 83/562 (15%) (OR=6.0 (95% CI 4.3 to 8.4), p<0.001). Multivariate analyses showed that history of CVD remained an independent risk factor of in-hospital death or MACE (OR=2.4; (95% CI 1.6 to 3.5)), as did age (OR for a 10-year increase=2.2 (95% CI 1.9 to 2.6)), male gender (OR=1.6 (95% CI 1.1 to 2.3)), chronic obstructive pulmonary disease (OR=2.1 (95% CI 1.0 to 4.2)) and lung infiltration associated with COVID-19 at CT scan (OR=1.9 (95% CI 1.2 to 3.0)). History of CVD (OR=2.9 (95% CI 1.7 to 5)), age (OR=2.5 (95% CI 2.0 to 3.2)), male gender (OR=1.6 (95% CI 0.98 to 2.6)) and elevated C reactive protein (CRP) levels on admission (OR for a 10 mg/L increase=1.1 (95% CI 1.1 to 1.2)) were independent risk factors for mortality.ConclusionHistory of CVD is associated with higher in-hospital mortality and MACE in hospitalised patients with COVID-19. Other factors associated with higher in-hospital mortality are older age, male sex and elevated CRP on admission.

scholarly journals Outcomes of major trauma among patients with chronic kidney disease and receiving dialysis in Nova Scotia: a retrospective analysis

2021 ◽  
Vol 6 (1) ◽  
pp. e000672
Author(s):  
Ryan Pratt ◽  
Mete Erdogan ◽  
Robert Green ◽  
David Clark ◽  
Amanda Vinson ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Nova Scotia ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Major Trauma ◽  
Injury Severity ◽  
Cox Regression ◽  
Trauma Patients ◽  
Risk Of Death ◽  
Increased Risk

BackgroundThe risk of death and complications after major trauma in patients with chronic kidney disease (CKD) is higher than in the general population, but whether this association holds true among Canadian trauma patients is unknown.ObjectivesTo characterize patients with CKD/receiving dialysis within a regional major trauma cohort and compare their outcomes with patients without CKD.MethodsAll major traumas requiring hospitalization between 2006 and 2017 were identified from a provincial trauma registry in Nova Scotia, Canada. Trauma patients with stage ≥3 CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) or receiving dialysis were identified by cross-referencing two regional databases for nephrology clinics and dialysis treatments. The primary outcome was in-hospital mortality; secondary outcomes included hospital/intensive care unit (ICU) length of stay (LOS) and ventilator-days. Cox regression was used to adjust for the effects of patient characteristics on in-hospital mortality.ResultsIn total, 6237 trauma patients were identified, of whom 4997 lived within the regional nephrology catchment area. CKD/dialysis trauma patients (n=101; 28 on dialysis) were older than patients without CKD (n=4896), with higher rates of hypertension, diabetes, and cardiovascular disease, and had increased risk of in-hospital mortality (31% vs 11%, p<0.001). No differences were observed in injury severity, ICU LOS, or ventilator-days. After adjustment for age, sex, and injury severity, the HR for in-hospital mortality was 1.90 (95% CI 1.33 to 2.70) for CKD/dialysis compared with patients without CKD.ConclusionIndependent of injury severity, patients without CKD/dialysis have significantly increased risk of in-hospital mortality after major trauma.

scholarly journals Hemogram as marker of in-hospital mortality in COVID-19

2021 ◽  
pp. jim-2021-001810
Author(s):  
Alejandro López-Escobar ◽  
Rodrigo Madurga ◽  
José María Castellano ◽  
Santiago Ruiz de Aguiar ◽  
Sara Velázquez ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Admission ◽  
White Blood Cells ◽  
Rate Of Change ◽  
Hospital Death ◽  
Direct Role ◽  
Lymphocyte Ratio ◽  
Risk Of Death ◽  
Rate Of Increase ◽  
Increased Risk

The clinical impact of COVID-19 disease calls for the identification of routine variables to identify patients at increased risk of death. Current understanding of moderate-to-severe COVID-19 pathophysiology points toward an underlying cytokine release driving a hyperinflammatory and procoagulant state. In this scenario, white blood cells and platelets play a direct role as effectors of such inflammation and thrombotic response. We investigate whether hemogram-derived ratios such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio and the systemic immune-inflammation index may help to identify patients at risk of fatal outcomes. Activated platelets and neutrophils may be playing a decisive role during the thromboinflammatory phase of COVID-19 so, in addition, we introduce and validate a novel marker, the neutrophil-to-platelet ratio (NPR).Two thousand and eighty-eight hospitalized patients with COVID-19 admitted at any of the hospitals of HM Hospitales group in Spain, from March 1 to June 10, 2020, were categorized according to the primary outcome of in-hospital death.Baseline values, as well as the rate of increase of the four ratios analyzed were significantly higher at hospital admission in patients who died than in those who were discharged (p<0.0001). In multivariable logistic regression models, NLR (OR 1.05; 95% CI 1.02 to 1.08, p=0.00035) and NPR (OR 1.23; 95% CI 1.12 to 1.36, p<0.0001) were significantly and independently associated with in-hospital mortality.According to our results, hemogram-derived ratios obtained at hospital admission, as well as the rate of change during hospitalization, may easily detect, primarily using NLR and the novel NPR, patients with COVID-19 at high risk of in-hospital mortality.

scholarly journals Antibiotic-Induced Neutropenia During Treatment of Hematogenous Osteoarticular Infections in Otherwise Healthy Children

2019 ◽  
Vol 24 (5) ◽  
pp. 431-437
Author(s):  
Krystian Solis ◽  
Walter Dehority
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Information ◽  
Healthy Children ◽  
Osteoarticular Infections ◽  
Younger Age ◽  
Increased Risk ◽  
Multivariable Regression Model ◽  
Multivariable Regression ◽  
Time To Onset ◽  
Prolonged Antibiotic Therapy

OBJECTIVES We studied the frequency and characteristics of antibiotic-induced neutropenia in otherwise healthy children receiving antibiotic therapy for hematogenous osteoarticular infections (OAIs). METHODS We retrospectively enrolled otherwise healthy children between 1 month and 18 years of age discharged with an OAI from our institution over an 11-year period. An absolute neutrophil count (ANC) ≤1500 cells/μL was defined as neutropenia. We recorded demographic and clinical information, as well as the value and timing of each ANC in relation to changes in antibiotic therapy. A multivariable regression model assessed the contributions of various risk factors. RESULTS A total of 186 children were enrolled (mean age, 7.6 years; 67.2% boys). β-Lactams represented 61.2% of all prescriptions. During treatment, 61 subjects (32.8%) developed neutropenia (median time to onset, 24 days). An ANC &lt; 500 cells/μL occurred in 7 subjects (3.8%). Neutropenic subjects (mean age, 6.0 years) were significantly younger than those without neutropenia (mean age, 8.5 years) (OR = 0.86; 95% CI: 0.79–0.93; p &lt; 0.001) and received significantly longer courses of total (89.3 vs. 55.8 days) and parenteral (24.6 vs. 19.9 days) antibiotic therapy (OR = 1.01; 95% CI: 1.01–1.02; p = 0.004 and OR = 1.02; 95% CI: 1.01–1.04; p = 0.041, respectively). Recurrent neutropenia occurred in 23.0% of all neutropenic subjects and was significantly more common in those with a longer mean duration of parenteral therapy (OR = 1.05; 95% CI: 1.02–1.09; p = 0.004.). No complications from neutropenia occurred. CONCLUSIONS Neutropenia was common in our cohort of children receiving prolonged antibiotic therapy for OAIs. Younger age and longer courses of therapy were associated with an increased risk of neutropenia.

scholarly journals Factors associated with COVID-19 related hospitalisation, critical care admission and mortality using linked primary and secondary care data

2021 ◽  
Author(s):  
Lisa Cummins ◽  
Irene Ebyarimpa ◽  
Nathan Cheetham ◽  
Victoria Tzortziou Brown ◽  
Katie Brennan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Learning Disabilities ◽  
Secondary Care ◽  
Multivariate Logistic Regression Analysis ◽  
Additional Patient ◽  
Factors Associated ◽  
Icu Admission ◽  
Risk Of Death ◽  
North East ◽  
Increased Risk

AbstractBackgroundTo identify risk factors associated with increased risk of hospitalisation, intensive care unit (ICU) admission and mortality in inner North East London (NEL) during the first UK COVID-19 wave.MethodsMultivariate logistic regression analysis on linked primary and secondary care data from people aged 16 or older with confirmed COVID-19 infection between 01/02/2020-30/06/2020 determined odds ratios (OR), 95% confidence intervals (CI) and p-values for the association between demographic, deprivation and clinical factors with COVID-19 hospitalisation, ICU admission and mortality.ResultsOver the study period 1,781 people were diagnosed with COVID-19, of whom 1,195 (67%) were hospitalised, 152 (9%) admitted to ICU and 400 (23%) died. Results confirm previously identified risk factors: being male, or of Black or Asian ethnicity, or aged over 50. Obesity, type 2 diabetes and chronic kidney disease (CKD) increased the risk of hospitalisation. Obesity increased the risk of being admitted to ICU. Underlying CKD, stroke and dementia in-creased the risk of death. Having learning disabilities was strongly associated with increased risk of death (OR=4.75, 95%CI=(1.91,11.84), p=0.001). Having three or four co-morbidities increased the risk of hospitalisation (OR=2.34,95%CI=(1.55,3.54),p<0.001;OR=2.40, 95%CI=(1.55,3.73), p<0.001 respectively) and death (OR=2.61, 95%CI=(1.59,4.28), p<0.001;OR=4.07, 95% CI= (2.48,6.69), p<0.001 respectively).ConclusionsWe confirm that age, sex, ethnicity, obesity, CKD and diabetes are important determinants of risk of COVID-19 hospitalisation or death. For the first time, we also identify people with learning disabilities and multi-morbidity as additional patient cohorts that need to be actively protected during COVID-19 waves.

507 Outcomes After the Administration of Hydroxocobalamin

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S90-S90
Author(s):  
Kaitlin A Pruskowski ◽  
Leopoldo C Cancio
Keyword(s):  
Hospital Mortality ◽  
Hospital Stay ◽  
Hospital Setting ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Lactate Clearance ◽  
Inhalation Injury ◽  
Icu Admission ◽  
Increased Risk ◽  
Lactate Levels

Abstract Introduction Hydroxocobalamin is administered to patients after injures sustained during structure fires or fires in enclosed spaces. It is unknown how the administration of hydroxocobalamin affects patient outcomes, however, there have been reports of increased risk of acute kidney injury (AKI). The purpose of this study was to determine the population in which hydroxocobalamin is administered and to assess outcomes in patients who receive this medication in the ICU setting. Methods This was a retrospective chart review that included all patients admitted to the burn ICU between July 2016 and April 2019. Patients were included if they received hydroxocobalamin after ICU admission. Patients who received hydroxocobalamin in the pre-ICU or pre-hospital setting were not included in this analysis. Data collected included demographic information, number of hydroxocobalamin doses administered, burn size (% TBSA), presence of inhalation injury (II), lactate levels during the first 72 hours of hospitalization, carboxyhemoglobin levels, need for continuous renal replacement therapy (CRRT), and in-hospital mortality. Results Thirty-five patients received hydroxocobalamin after ICU admission. Patients were, on average, 48 ± 19 years old with a 25.5 ± 24.8% TBSA burn. Twenty-nine patients (82.9%) who received hydroxocobalamin in the ICU were diagnosed with II via bronchoscopy. The median 24-hour fluid resuscitation requirement was 7.4 mL/kg/% TBSA (IQR 4.6, 12.7). Twenty-two patients (63%) who received hydroxocobalamin developed AKI during the first 72 hours of admission. Twenty-one patients (60%) required CRRT during their hospital stay; 42.8% of patients were started on CRRT during the resuscitation period. The mean admission lactate level was 4.4 ± 2.3 mmol/L. On average, lactate clearance occurred in 34.6 hours; 11 (31.4%) patients did not clear lactate within 72 hours. One patient had a carboxyhemoglobin level greater than 10% on admission. Ten (28.9%) patients died during their hospital stay. Conclusions Most patients who receive hydroxocobalamin after ICU admission developed AKI within the first 72 hours. Further studies on the relationship between the administration of hydroxocobalamin and the development of AKI and in-hospital mortality are warranted. Applicability of Research to Practice The use of hydroxocobalamin may carry an increased risk of AKI. Providers should be aware of this risk when prescribing this medication.

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