scholarly journals Predictors and outcomes of acute respiratory failure in hospitalised patients with acute pancreatitis

2020 ◽  
pp. flgastro-2020-101496
Author(s):  
Mahesh Gajendran ◽  
Bharat Prakash ◽  
Abhilash Perisetti ◽  
Chandraprakash Umapathy ◽  
Vineet Gupta ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Significant Risk ◽  
Hospital Length Of Stay ◽  
Systemic Complications ◽  
Nationwide Inpatient Sample Database ◽  
Hospitalised Patients

Background and aimAcute pancreatitis (AP) is associated with organ failures and systemic complications, most commonly acute respiratory failure (ARF) and acute kidney injury. So far, no studies have analysed the predictors and hospitalisation outcomes, of patients with AP who developed ARF. The aim of this study was to measure the prevalence of ARF in AP and to determine the clinical predictors for ARF and mortality in AP.MethodsThis is a retrospective cohort study using the Nationwide Inpatient Sample database from the year 2005–2014. The study population consisted of all hospitalisations with a primary or secondary discharge diagnosis of AP, which is further stratified based on the presence of ARF. The outcome measures include in-hospital mortality, hospital length of stay and hospitalisation cost.ResultsIn our study, about 5.4% of patients with AP had a codiagnosis of ARF, with a mortality rate of 26.5%. The significant predictors for ARF include sepsis, pleural effusion, pneumonia and cardiogenic shock. Key variables that were associated with a higher risk of mortality include mechanical ventilation, age more than 65 years, sepsis and cancer (excluding pancreatic cancer). The presence of ARF increased hospital stay by 8.3 days and hospitalisation charges by US$103 460.ConclusionIn this study, we demonstrate that ARF is a significant risk factor for increased hospital mortality, greater length of stay and higher hospitalisation charges in patients with AP. This underlines significantly higher resource utilisation in patients with a dual diagnosis of AP-ARF.

Trends in Hospital Cost, Length of Stay, Mortality, and Complication Rates in Patients with Acute Myeloid Leukemia in Teaching Versus Non-Teaching Hospitals: Data from the Nationwide Inpatient Sample from 1999-2013

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2357-2357
Author(s):  
Ankit Shah ◽  
Stuthi Perimbeti ◽  
Parshva Patel ◽  
Rachel Nathan ◽  
Daniel Kyung ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Marrow Transplant ◽  
Neutropenic Fever ◽  
Teaching Hospitals ◽  
Complication Rates ◽  
Total Charges ◽  
Acute Myeloid

Abstract Background: Acute Myeloid Leukemia (AML) is the most common acute leukemia in adults and represents a heterogeneous group of clonal hematopoietic stem cell disorders with varying prognosis based on cytogenetic and host factors. Success in treatment of AML is thought to have only improved modestly in recent decades. We aimed to evaluate trends in hospital cost, length of stay, in-hospital mortality, and complication rates in adult patients admitted with active AML. We also sought to elucidate differences in these outcomes in teaching versus non-teaching institutions. Methods: Using ICD-9 codes for acute myeloid and acute monocytic leukemias, all adult admissions with a primary diagnosis of active AML between 1999-2013 were identified from the Nationwide Inpatient Sample (NIS). Admission information including length of stay (LOS), total charges, and mortality were extracted. Total cost was adjusted for inflation using data from the U.S. Bureau of Labor Statistics. ICD-9 codes were selected to reflect the most common etiologies of in-hospital complications such as clostridium difficile infection (CDI), bacteremia, sepsis, pneumonia, venous thromboembolism (VTE), neutropenic fever, candidiasis, urinary tract infection (UTI), and acute respiratory failure. Rates of these complications were determined over the 15-year interval and compared in subsets of teaching and non-teaching hospitals. Rates of bone marrow transplant were also queried. Results: We identified 51,684 admissions (weighted N = 247,747) with a primary diagnosis of AML from 1999-2013. Most of the admissions were at teaching hospitals (N = 32,982; weighted N = 158,952). Overall in-hospital mortality was determined to be 19.54%. LOS (days) was found to be longer in teaching (21.04 ±0.10) than in non-teaching (12.25 ±0.11) hospitals (p = .0001). Total charges were also greater in teaching ($157,709 ±1,089) versus non-teaching ($79,167 ±965) hospitals (p = .0001). Of note, after correcting for age, multivariate analysis yielded higher mortality in teaching than in non-teaching hospitals (OR = 1.11, CI: 1.04-1.19). Rates of CDI, bacteremia, neutropenic fever, sepsis, acute respiratory failure, and VTE were higher in teaching hospitals (p < .0001). On the other hand, rates of UTI were lower in teaching (7.31%) than in non-teaching (8.31%) hospitals (p=.0026). Rates of pneumonia and candidiasis did not have a statistically significant difference when comparing the two settings. Bone marrow transplant was more frequently performed at teaching (1.36%) than in non-teaching hospitals (0.56%) (p=.0001). Over the 15-year interval, in-hospital mortality has declined by greater than one third for all AML admissions (p <. 0001). Rates of nearly all of the complications, excluding candidiasis, but including CDI, neutropenic fever, bacteremia, UTI, pneumonia, VTE, and acute respiratory failure have increased during this interval, however. Total charges increased during this time period from $66,678 (±1,567) in 1999 to $197,439 (±4,532) in 2013 (p = .0001), which was greater than the expected inflationary increase to $93,235 over the same time period. Conclusions: Most admissions for AML occurred at teaching institutions. This may be due to increased resource requirements to care for this patient population. In-hospital mortality appears to have improved markedly from 1999-2013 for all admissions for AML, which may be a testament to well-established chemotherapy guidelines, use of less toxic chemotherapy regimens in the elderly, and standardized preventative practices such as the use of high-efficiency particulate air filtration and prophylactic antibiotics. On the other hand, rates of nearly all measured complications have increased during this interval. Given the opposite trend in mortality, we believe this may be in part due to improved surveillance and reporting. Rates of mortality as well several complication rates appear to be higher in teaching than in non-teaching institutions, which may be due to increased medical complexity and more aggressive therapy offered at teaching institutions. Further research is required to determine what additional factors and practice differences are contributing to these discrepancies. Total charges were higher at teaching institutions, which may be due to increased LOS, complication rates, medical complexity and resource consumption. Disclosures No relevant conflicts of interest to declare.

scholarly journals Comparison of clinical characteristics and outcomes between alcohol-induced and gallstone-induced acute pancreatitis: An Australian retrospective observational study

2021 ◽  
Vol 9 ◽  
pp. 205031212110308
Author(s):  
Santiago Cegarra Garcia ◽  
Michael Toolis ◽  
Max Ubels ◽  
Taha Mollah ◽  
Eldho Paul ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Acute Pancreatitis ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Intensive Care Unit Mortality ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Index Of Severity

Objectives: To compare the characteristics and outcomes of patients presenting to hospital with alcohol-induced and gallstone-induced acute pancreatitis. Methods: Retrospective study of all patients with alcohol-induced or gallstone-induced pancreatitis during the period 1 June 2012 to 31 May 2016. The primary outcome measure was hospital mortality. Secondary outcome measures included hospital length of stay, requirements for intensive care unit admission, intensive care unit mortality, mechanical ventilation, renal replacement therapy, requirement of inotropes and total parenteral nutrition. Results: A total of 642 consecutive patients (49% alcohol; 51% gallstone) were included. No statistically significant differences were found between alcohol-induced and gallstone-induced acute pancreatitis with respect to hospital mortality, requirement for intensive care unit admission, intensive care unit mortality and requirement for mechanical ventilation, renal replacement therapy, inotropes or total parenteral nutrition. There was significant difference in hospital length of stay (3.07 versus 4.84; p  < 0.0001). On multivariable regression analysis, Bedside Index of Severity in Acute Pancreatitis score (estimate: 0.393; standard error: 0.058; p < 0.0001) and admission haematocrit (estimate: 0.025; standard error: 0.008; p = 0.002) were found to be independently associated with prolonged hospital length of stay. Conclusion: Hospital mortality did not differ between patients with alcohol-induced and gallstone-induced acute pancreatitis. The duration of hospital stay was longer with gallstone-induced pancreatitis. Bedside Index of Severity in Acute Pancreatitis score and admission haematocrit were independently associated with hospital length of stay.

scholarly journals High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Ricard Mellado-Artigas ◽  
◽  
Bruno L. Ferreyro ◽  
Federico Angriman ◽  
María Hernández-Sanz ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Adult Patients ◽  
Icu Length Of Stay ◽  
Early Intubation

Abstract Purpose Whether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high-flow nasal oxygen on ventilator-free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19. Methods We conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units (ICUs). Main exposure was the use of high-flow nasal oxygen (conservative group), while early invasive mechanical ventilation (within the first day of ICU admission; early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. ICU length of stay and all-cause in-hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding. Results Out of 468 eligible patients, a total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high-flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days; 95% confidence interval (CI): 4.4 to 11.7 days) and a reduction in ICU length of stay (mean difference: − 8.2 days; 95% CI − 12.7 to − 3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64; 95% CI: 0.25 to 1.64). Conclusions The use of high-flow nasal oxygen upon ICU admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in ICU length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.

scholarly journals High flow nasal oxygen in patients with COVID-19 associated acute respiratory failure

2021 ◽  
Author(s):  
Ricard Mellado Artigas ◽  
Bruno L. Ferreyro ◽  
Federico Angriman ◽  
María Hernández-Sanz ◽  
Egoitz Arruti ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Adult Patients ◽  
Icu Length Of Stay ◽  
Early Intubation

Abstract Purpose: Whether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high-flow nasal oxygen on ventilator-free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19.Methods: We conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units (ICUs). Main exposure was the use of high-flow nasal oxygen (conservative group), while early invasive mechanical ventilation (within the first day of ICU admission; early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. ICU length of stay and all-cause in-hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding.Results: Out of 468 eligible patients, a total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high-flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days; 95% confidence interval (CI): 4.4 to 11.7 days), and a reduction in ICU length of stay (mean difference: -8.2 days; 95% CI -12.7 to -3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64; 95% CI: 0.25 to 1.64).Conclusions: The use of high-flow nasal oxygen upon ICU admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in ICU length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.

scholarly journals Standardized Rehabilitation and Hospital Length of Stay Among Patients With Acute Respiratory Failure

JAMA ◽  
2016 ◽  
Vol 315 (24) ◽  
pp. 2694 ◽  
Author(s):  
Peter E. Morris ◽  
Michael J. Berry ◽  
D. Clark Files ◽  
J. Clifton Thompson ◽  
Jordan Hauser ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Length Of Stay ◽  
Acute Respiratory Failure ◽  
Hospital Length ◽  
Hospital Length Of Stay

scholarly journals Serum Triglyceride Level: A Predictor of Complications and Outcomes in Acute Pancreatitis?

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Hassan Tariq ◽  
Vinaya Gaduputi ◽  
Richard Peralta ◽  
Naeem Abbas ◽  
Suresh Kumar Nayudu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Pancreatitis ◽  
Intensive Care ◽  
Length Of Stay ◽  
Triglyceride Level ◽  
Independent Predictor ◽  
Serum Triglyceride ◽  
Hospital Length Of Stay ◽  
Serum Triglyceride Level ◽  
Systemic Complications

Aim.To study serum triglyceride level as a predictor of complications and outcomes in acute pancreatitis.Methods.In this retrospective observational study, 582 patients admitted with acute pancreatitis, who had serum triglyceride levels measured within the first 24 hours, were divided into two groups. The study group consisted of patients with a triglyceride level ≥2.26 mmol/L (group 2) and the control group consisted of triglyceride level of <2.26 mmol/L (group 1). We collected data for baseline demographics, laboratory values, incidence of complications (local and systemic), admission to the intensive care unit (ICU), ICU length of stay, length of total hospital stay, and death in the two groups.Results.A triglyceride level of ≥2.26 mmol/L was found to be an independent predictor of developing altered mental status (p: 0.004), pancreatic necrosis (p: 0.001), acute respiratory distress syndrome (p: 0001), systemic Inflammatory response syndrome (p: 0.001), acute kidney injury (p: 0.001), hospital length of stay (LOS) (p: 0.002), admission to intensive care unit (ICU) (p: 0.002), and ICU LOS (p: 0.003).Conclusion.A triglyceride level of ≥2.26 mmol/L on admission in acute pancreatitis is an independent predictor of developing local and systemic complications, hospital LOS, admission to ICU, and ICU LOS.

Acute Kidney Injury in Children With Acute Respiratory Failure

2018 ◽  
Vol 57 (11) ◽  
pp. 1340-1348 ◽  
Author(s):  
Sindy M. Villacrés ◽  
Shivanand S. Medar ◽  
Scott I. Aydin
Keyword(s):  
Acute Kidney Injury ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Serum Creatinine ◽  
Acute Respiratory Failure ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Critically Ill Children ◽  
Positive End Expiratory Pressure

Background. Acute kidney injury (AKI) is common in critically ill children and develops in association with organ system dysfunction, with acute respiratory failure (ARF) one of the most common. We aim to study AKI in the pediatric ARF population. Methods. Data were retrospectively collected on children aged 1 day to 18 years admitted to the pediatric intensive care unit (PICU) with ARF between 2010 and 2013. Descriptive statistics and multivariate analyses utilizing Mann-Whitney U, Wilcoxon signed rank, χ2, or Fisher’s exact tests were performed to identify risk factors associated with AKI. Results. A total of 186 patients, with median age of 36 months (interquartile range 4-120 months) met the inclusion criteria. ARF was related to pulmonary disease in 49%. AKI was noted in 53% of patients. Patients with AKI had significantly higher serum creatinine ( P < .001) and lower estimated creatinine clearance ( P < .001) compared with those without AKI. Among patients with moderate and severe acute respiratory distress syndrome (ARDS), 64% had AKI versus 46% with mild or no ARDS ( P = .02). Patients with AKI had significantly lower PaO2/FiO2 ratio ( P = .03), longer PICU ( P = .03), and longer hospital length of stay ( P = .01). ARDS patients were less likely to be AKI free on day 7 of hospitalization, as compared with those without ARDS. Multivariate analysis revealed positive end expiratory pressure (odds ratio [OR] = 1.2, confidence interval [CI] = 1.0-1.4; P = .03) and admission serum creatinine (OR = 27.9, CI = 5.2-148.5; P < .001) to be independently associated with AKI. Conclusions. AKI is common in children with ARF. In patients with ARF and AKI, AKI is associated with ARDS and longer PICU and hospital length of stay. Positive end expiratory pressure and serum creatinine are independently associated with AKI.

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