Effect of Antipyretic Therapy on Mortality in Critically Ill Patients with Sepsis Receiving Mechanical Ventilation Treatment

Purpose. The study aimed to investigate the effectiveness of antipyretic therapy on mortality in critically ill patients with sepsis requiring mechanical ventilation. Methods. In this study, we employed the multiparameter intelligent monitoring in intensive care II (MIMIC-II) database (version 2.6). All patients meeting the criteria for sepsis and also receiving mechanical ventilation treatment were included for analysis, all of whom suffer from fever or hyperthermia. Logistic regression model and R language (R version 3.2.3 2015-12-10) were used to explore the association of antipyretic therapy and mortality risk in critically ill patients with sepsis receiving mechanical ventilation treatment. Results. A total of 8,711 patients with mechanical ventilator were included in our analysis, and 1523 patients died. We did not find any significant difference in the proportion of patients receiving antipyretic medication between survivors and nonsurvivors (7.9% versus 7.4%, p=0.49). External cooling was associated with increased risk of death (13.5% versus 9.5%, p<0.001). In our regression model, antipyretic therapy was positively associated with mortality risk (odds ratio [OR]: 1.41, 95% CI: 1.20–1.66, p<0.001). Conclusions. The use of antipyretic therapy is associated with increased risk of mortality in septic ICU patients requiring mechanical ventilation. External cooling may even be deleterious.

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416 - Risk of Mortality Associated with Antipsychotics in Alzheimer's Disease

International Psychogeriatrics ◽

10.1017/s1041610220002690 ◽

2020 ◽

Vol 32 (S1) ◽

pp. 132-132

Author(s):

Liliana P. Ferreira ◽

Núria Santos ◽

Nuno Fernandes ◽

Carla Ferreira

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Adverse Events ◽

Mortality Risk ◽

Antipsychotic Treatment ◽

Serious Adverse Events ◽

Risk Of Death ◽

Mesh Terms ◽

Risk Of Mortality ◽

Increased Risk

Objectives: Alzheimer's disease (AD) is the most common cause of dementia and it is associated with increased mortality. The use of antipsychotics is common among the elderly, especially in those with dementia. Evidence suggests an increased risk of mortality associated with antipsychotic use. Despite the short-term benefit of antipsychotic treatment to reduce the behavioral and psychological symptoms of dementia, it increases the risk of mortality in patients with AD. Our aim is to discuss the findings from the literature about risk of mortality associated with the use of antipsychotics in AD.Methods: We searched Internet databases indexed at MEDLINE using following MeSH terms: "Antipsychotic Agents" AND "Alzheimer Disease" OR "Dementia" AND "Mortality" and selected articles published in the last 5 years.Results: Antipsychotics are widely used in the pharmacological treatment of agitation and aggression in elderly patients with AD, but their benefit is limited. Serious adverse events associated with antipsychotics include increased risk of death. The risk of mortality is associated with both typical and atypical antipsychotics. Antipsychotic polypharmacy is associated with a higher mortality risk than monotherapy and should be avoided. The mortality risk increases after the first few days of treatment, gradually reducing but continues to increase after two years of treatment. Haloperidol is associated with a higher mortality risk and quetiapine with a lower risk than risperidone.Conclusions: If the use of antipsychotics is considered necessary, the lowest effective dose should be chosen and the duration should be limited because the mortality risk remains high with long-term use. The risk / benefit should be considered when choosing the antipsychotic. Further studies on the efficacy and risk of adverse events with antipsychotics are needed for a better choice of treatment and adequate monitoring with risk reduction.

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Serum Procalcitonin Level and Mortality Risk in Critically ill Patients with Ventilator-Associated Pneumonia

Cellular Physiology and Biochemistry ◽

10.1159/000438557 ◽

2015 ◽

Vol 37 (5) ◽

pp. 1967-1972 ◽

Cited By ~ 5

Author(s):

Bo Li ◽

Xin Zhao ◽

Shumei Li

Keyword(s):

Critically Ill ◽

Mortality Risk ◽

Critically Ill Patients ◽

Cox Regression ◽

High Serum ◽

Ventilator Associated Pneumonia ◽

Prognostic Role ◽

Procalcitonin Level ◽

Increased Risk

Background/Aims: The prognostic role of serum procalcitonin level in critically ill patients with ventilator-associated pneumonia was unclear. The aim of our study was to investigate the relationship between serum procalcitonin level and mortality risk in critically ill patients with ventilator-associated pneumonia. Methods: Data of critically ill patients with ventilator-associated pneumonia were retrospectively collected. Demographics, comorbidities, and serum procalcitonin level were extracted from electronic medical records. The primary outcome was mortality within two months after diagnosis. Multivariable Cox regression analyses were performed to assess the prognostic role of serum procalcitonin level in those patients. Results: A total of 115 critically ill patients with ventilator-associated pneumonia were enrolled in our study. Serum procalcitonin level was not associated with age, gender, or other comorbidities. Univariate Cox regression model showed that high serum procalcitonin level was associated increased risk of morality within 2 months after diagnosis (OR = 2.32, 95% CI 1.25-4.31, P = 0.008). Multivariable Cox regression model showed that high serum procalcitonin level was independently associated increased risk of morality within 2 months after diagnosis (OR = 2.38, 95% CI 1.26-4.50, P = 0.008). Conclusion: High serum procalcitonin level is an independent prognostic biomarker of mortality risk in critically ill patients with ventilator-associated pneumonia, and it's a promising biomarker of prognosis in critically ill patients.

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Biomarker-assisted identification of sepsis-related acute liver impairment: a frequent and deadly condition in critically ill patients

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2018-1350 ◽

2019 ◽

Vol 57 (9) ◽

pp. 1422-1431 ◽

Cited By ~ 1

Author(s):

Jens-Ulrik Stæhr Jensen ◽

Lars Peters ◽

Theis S. Itenov ◽

Morten Bestle ◽

Katrin M. Thormar ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Prognostic Impact ◽

Surgical Intensive Care ◽

Positive Interaction ◽

Liver Impairment ◽

Risk Of Death ◽

Increased Risk ◽

Co Morbidity ◽

All Cause Mortality

Abstract Background The prognostic impact of mild/moderate liver impairment among critically ill patients is not known. We aimed to determine whether acute liver impairment, as measured by several biomarkers, (i) is frequent, (ii) influences prognosis and (iii) to determine whether such an effect is specific for infected critically ill patients. Methods A biomarker and clinical cohort study based on a randomized controlled trial. All-cause mortality was the primary endpoint. Biomarkers hyaluronic acid (HA), bilirubin, albumin, alkaline phosphatase and the international normalized ratio (INR) were determined. Multivariable statistics were applied to estimate risk increase according to liver biomarker increase at baseline and the model was adjusted for age, APACHE II, severe sepsis/septic shock vs. milder infection, chronic alcohol abuse Charlson’s co-morbidity index, cancer disease, surgical or medical patient, body mass index, sex, estimated glomerular filtration rate, mechanical ventilation and the other biomarkers. Time-to-event graphs were used. The patients were critically ill patients (n = 1096) from nine mixed medical/surgical intensive care units without known hepatobiliary disease. Results HA levels differed between infected patients (median 210.8 ng/mL [IQR: 93.2–556.6]) vs. the non-infected (median 56.8 ng/mL [IQR: 31.9–116.8], p < 0.001). Serum HA quartiles 2, 3 and 4 were independent predictors of 90-day all-cause mortality for the entire population (infected and non-infected). However, the signal was driven by the infected patients (positive interaction test, no signal in non-infected patients). Among infected patients, HA quartiles corresponded directly to the 90-day risk of dying: 1st quartile: 57/192 = 29.7%, 2nd quartile: 84/194 = 43.3%, 3rd quartile: 90/193 = 46.6%, 4th quartile: 101/192 = 52.3 %, p for trend: <0.0001. This finding was confirmed in adjusted analyses: hazard ratio vs. 1st quartile: 2nd quartile: 1.3 [0.9–1.8], p = 0.14, 3rd quartile: 1.5 [1.1–2.2], p = 0.02, 4th quartile: 1.9 [1.3–2.6], p < 0.0001). High bilirubin was also an independent predictor of mortality. Conclusions Among infected critically ill patients, subtle liver impairment, (elevated HA and bilirubin), was associated with a progressive and highly increased risk of death for the patient; this was robust to adjustment for other predictors of mortality. HA can identify patients at high risk.

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Increased risk of death and readmission after hospital discharge of critically ill patients in a developing country: a retrospective multicenter cohort study

Intensive Care Medicine ◽

10.1007/s00134-018-5252-3 ◽

2018 ◽

Vol 44 (7) ◽

pp. 1090-1096 ◽

Cited By ~ 3

Author(s):

Vanessa Chaves Barreto Ferreira de Lima ◽

Ana Luiza Bierrenbach ◽

Gizelton Pereira Alencar ◽

Ana Lucia Andrade ◽

Luciano Cesar Pontes Azevedo

Keyword(s):

Cohort Study ◽

Developing Country ◽

Hospital Discharge ◽

Critically Ill ◽

Critically Ill Patients ◽

Multicenter Cohort Study ◽

Risk Of Death ◽

Multicenter Cohort ◽

Increased Risk

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Electroacupuncture Reduces the Dose of Midazolam Monitored by the Bispectral Index in Critically Ill Patients with Mechanical Ventilation: An Exploratory Study

Acupuncture in Medicine ◽

10.1136/acupmed-2011-010095 ◽

2012 ◽

Vol 30 (2) ◽

pp. 78-84 ◽

Cited By ~ 14

Author(s):

Xia Zheng ◽

Jian-biao Meng ◽

Qiang Fang

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Bispectral Index ◽

Critically Ill Patients ◽

Additional Treatment ◽

Acupuncture Points ◽

Sedative Drug ◽

Significant Difference ◽

Group A ◽

Group B

Objective Electroacupuncture, a modern variation on a traditional Chinese treatment, might be useful for sedation and analgesia. This study aims to investigate whether electroacupuncture can modify the dose of midazolam monitored by the bispectral index (BIS) in critically ill patients with mechanical ventilation. Methods Orotracheally intubated patients undergoing mechanical ventilation were randomly assigned into three groups (groups A, B and C). All patients were given an intravenous infusion of midazolam. Patients in group A received no additional treatment. Patients in group B were given acupuncture without electrical stimulation at acupuncture points GV24 and EX–HN3 ( Yintang) for 6 h simultaneously, and patients in group C were given electroacupuncture to the same points as in group B. Results Maintaining the BIS between 60 and 80, the hourly mean one dose of midazolam within the first 6 h after sedation in group C was 0.05 (±0.02 mg/kg per hour), which was significantly lower than both group A (0.08±0.03 mg/kg per hour, p<0.001) and group B (0.07±0.01 mg/kg per hour, p<0.021). The doses in groups A and B showed no significant difference. Between-group comparison analysis of hepatic and renal function and severe adverse reactions all showed no significant difference between the three groups. Conclusions Electroacupuncture appears to reduce markedly the dose of sedative drug required in critically ill patients with mechanical ventilation monitored by BIS, without any obvious severe adverse action, and larger studies to confirm the effect are justified.

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Effect of sedatives on in-hospital and long-term mortality of critically ill patients requiring extended mechanical ventilation for more than 48 hours

10.21203/rs.2.19879/v1 ◽

2020 ◽

Author(s):

Hannah Lee ◽

Seongmi Choi ◽

Eun Jin Jang ◽

Juhee Lee ◽

Dalho Kim ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Significant Risk ◽

Population Based ◽

Case Volume ◽

Increased Risk ◽

Benzodiazepine Use ◽

Comorbidity Index ◽

One Year

Abstract Background The purpose of this study was to assess the correlation between sedatives and mortality in critically ill patients who required mechanical ventilation (MV) for ≥48 hours from 2007 to 2016.Methods We conducted a nationwide retrospective cohort study using population-based healthcare reimbursement claims database. : Data from adult patients (aged ≥18) who underwent MV for ≥48 hours between 2008 and 2016 were identified and extracted from the National Health Insurance Service database. The benzodiazepine group consisted of patients who were administered benzodiazepines for sedation during MV. All other patients were assigned to the non-benzodiazepine group.Results A total of 158,712 patients requiring MV for ≥48 hours were admitted in 55 centers in Korea from 2007 to 2016. The benzodiazepine group had significantly higher in-hospital and one-year mortality compared to the non-benzodiazepine group (37.0% vs. 34.3%, 55.0% vs. 54.4%, respectively). Benzodiazepine use decreased from 2008 to 2016, after adjusting for age, sex, and mean Elixhauser comorbidity index in the Poisson regression analysis (incidence rate ratio, 0.968; 95% CI 0.954–0.983; p < 0.001) whereas dexmedetomidine sales have continuously increased since the second half of 2010. Benzodiazepine use, older age, lower case volume (≤500 cases/year), chronic kidney disease, and higher Elixhauser comorbidity index were common significant risk factors for in-hospital and one-year mortality.Conclusion In critically ill patients undergoing MV for >48 hours, the use of benzodiazepines for sedation was associated with an increased risk of in-hospital mortality and one-year mortality.

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HSV-1 reactivation is associated with an increased risk of mortality and pneumonia in critically ill COVID-19 patients

Critical Care ◽

10.1186/s13054-021-03843-8 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Antoine Meyer ◽

Niccolò Buetti ◽

Nadhira Houhou-Fidouh ◽

Juliette Patrier ◽

Moustafa Abdel-Nabey ◽

...

Keyword(s):

Critically Ill ◽

Mortality Risk ◽

Risk Of Mortality ◽

Increased Risk ◽

Hospital Acquired Pneumonia ◽

Simplex Virus ◽

Healthcare Associated ◽

Hospital Acquired ◽

The Impact ◽

Hsv 1

Abstract Background Data in the literature about HSV reactivation in COVID-19 patients are scarce, and the association between HSV-1 reactivation and mortality remains to be determined. Our objectives were to evaluate the impact of Herpes simplex virus (HSV) reactivation in patients with severe SARS-CoV-2 infections primarily on mortality, and secondarily on hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP) and intensive care unit-bloodstream infection (ICU-BSI). Methods We conducted an observational study using prospectively collected data and HSV-1 blood and respiratory samples from all critically ill COVID-19 patients in a large reference center who underwent HSV tests. Using multivariable Cox and cause-specific (cs) models, we investigated the association between HSV reactivation and mortality or healthcare-associated infections. Results Of the 153 COVID-19 patients admitted for ≥ 48 h from Feb-2020 to Feb-2021, 40/153 (26.1%) patients had confirmed HSV-1 reactivation (19/61 (31.1%) with HSV-positive respiratory samples, and 36/146 (24.7%) with HSV-positive blood samples. Day-60 mortality was higher in patients with HSV-1 reactivation (57.5%) versus without (33.6%, p = 0.001). After adjustment for mortality risk factors, HSV-1 reactivation was associated with an increased mortality risk (hazard risk [HR] 2.05; 95% CI 1.16–3.62; p = 0.01). HAP/VAP occurred in 67/153 (43.8%) and ICU-BSI in 42/153 (27.5%) patients. In patients with HSV-1 reactivation, multivariable cause-specific models showed an increased risk of HAP/VAP (csHR 2.38, 95% CI 1.06–5.39, p = 0.037), but not of ICU-BSI. Conclusions HSV-1 reactivation in critically ill COVID-19 patients was associated with an increased risk of day-60 mortality and HAP/VAP.

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Neuromonitoring of delirium with quantitative pupillometry In sedated mechanically ventilated critically ill patients

10.21203/rs.2.19734/v2 ◽

2020 ◽

Author(s):

Eva Favre ◽

Adriano Bernini ◽

Paola Morelli ◽

Jerôme Pasquier ◽

John-Paul Miroz ◽

...

Keyword(s):

Mechanical Ventilation ◽

Brain Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Potential Utility ◽

Icu Patients ◽

Mechanically Ventilated ◽

Increased Risk ◽

Infrared Pupillometry ◽

Icu Delirium

Abstract Background. Intensive care unit (ICU) delirium is a frequent secondary neurological complication in critically ill patients undergoing prolonged mechanical ventilation. Quantitative pupillometry is an emerging modality for the neuromonitoring of primary acute brain injury, but its potential utility in patients at risk of ICU delirium is unknown. Methods. This was an observational cohort study of medical-surgical ICU patients, without acute or known primary brain injury, who underwent sedation and mechanical ventilation for at least 48 hours. Starting at day 3, automated infrared pupillometry – blinded to ICU caregivers – was used for repeated measurement of the pupillary function, including quantitative pupillary light reflex (q-PLR, expressed as % pupil constriction to a standardized light stimulus) and constriction velocity (CV, mm/sec). The relationship between delirium, using the CAM-ICU score, and quantitative pupillary variables was examined. Results. A total of 59/100 patients had ICU delirium, diagnosed at a median 8 (5-13) days from admission. Compared to non-delirious patients, subjects with ICU delirium had lower values of q-PLR (25 [19-31] vs. 20 [15-28] %) and CV (2.5 [1.7-2.8] vs. 1.7 [1.4-2.4] mm/sec) at day 3, and at all additional time-points tested ( p <0.05). After adjusting for the SOFA score and the cumulative dose of analgesia and sedation, lower q-PLR was associated with an increased risk of ICU delirium (OR 1.057 [1.007-1.113] at day 3; p =0.03). Conclusions. Sustained abnormalities of quantitative pupillary variables at the early ICU phase correlate with delirium and precede clinical diagnosis by a median 5 days. These findings suggest a potential utility of quantitative pupillometry in sedated mechanically ventilated ICU patients at high risk of delirium.

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Abstract P017: Serum N-Carboxymethyl-Lysine and Risk of Mortality in Older Adults

Circulation ◽

10.1161/circ.129.suppl_1.p017 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Mary Lou Biggs ◽

David Benkeser ◽

Joachim Ix ◽

Jorge Kizer ◽

Luc Djousse ◽

...

Keyword(s):

Renal Failure ◽

Mortality Risk ◽

Community Dwelling ◽

Cardiovascular Health Study ◽

Risk Of Death ◽

Risk Of Mortality ◽

Organ Systems ◽

Increased Risk ◽

Carboxymethyl Lysine ◽

The Mean

Advanced glycation end products (AGEs) are compounds formed by the non-enzymatic glycation of proteins, lipids, and nucleic acids, and are thought to play a role in the pathogenesis of diseases across multiple organ systems. Carboxymethyl-lysine (CML) is a dominant AGE found in tissue proteins and in the circulation, and a commonly used AGE biomarker. Only a few epidemiological studies have evaluated the association between circulating CML and mortality risk, and none have evaluated the association between CML and cause-specific non-CVD mortality. We measured CML by ELISA on serum specimens collected from 3,373 Cardiovascular Health Study participants in 1996. Participants were followed for death through 2010, and cause of death was classified using death certificates, medical records, and proxy interview. We used Cox regression to estimate the relative risk of total and cause-specific mortality associated with circulating CML, adjusting for confounders (Models 1 & 2) and estimated glomerular filtration rate (eGFR) as a potential mediator (Model 3). We tested whether sex or diabetes modified the association between CML and mortality. The mean age among participants was 78 years and 60% were women. The mean CML level among participants was 629 ng/mL. Over median follow-up of 10 years, 2,322 deaths occurred (73.4 per 1,000 person-years). After adjustment for confounders (Models 1 & 2), CML was associated with an increased risk of death from CVD, dementia, infection, fracture/trauma, and renal failure (Table). Aside from renal failure, adjustment for eGFR attenuated the HR estimates modestly. There was no evidence for effect modification of the association of CML and all-cause mortality risk by sex or diabetes. In a cohort of community-dwelling older individuals, elevated circulating CML was associated with increased risk of mortality from cardiovascular causes, dementia, infection, fracture/trauma, and renal failure. A portion of the increased risk may be mediated through decreased renal function.

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Effect of Vitamin C on mortality of critically ill patients with severe pneumonia in intensive care unit: a preliminary study

BMC Infectious Diseases ◽

10.1186/s12879-021-06288-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ata Mahmoodpoor ◽

Kamran Shadvar ◽

Sarvin Sanaie ◽

Mir Reza Hadipoor ◽

Mohammad Ata Pourmoghaddam ◽

...

Keyword(s):

Mechanical Ventilation ◽

Mortality Rate ◽

Vitamin C ◽

Critically Ill ◽

Critically Ill Patients ◽

Intervention Group ◽

Severe Pneumonia ◽

High Dose ◽

Significant Difference ◽

Vasopressor Use

Abstract Background Critically ill patients frequently suffer from vitamin C deficiency. Previous studies showed that high doses of vitamin C administration had conflicting results on clinical outcomes in patients with severe sepsis, burns, and trauma. Because of the high incidence and morbidity/mortality with severe pneumonia, we aimed to investigate the effect of administration of high dose vitamin C in critically ill patients with severe pneumonia. Methods Eighty critically ill patients with pneumonia were enrolled in this randomized double-blinded clinical trial. Patients with a CURB-65 score > 3, one major criterion, or ≥ 3 minor criteria were considered as severe pneumonia. Patients were randomly assigned to intervention or placebo groups receiving standard treatment plus 60 mg/kg/day vitamin C as a continuous infusion or normal saline in the same volume correspondingly for 96 h. Serum levels of vitamin C were noted at baseline and 48 h after vitamin C administration. Duration of mechanical ventilation, ICU length of stay, PaO2/FiO2, and mortality rate were noted for all patients till the 28th day. Any complications related to the vitamin C administration were recorded. Results Duration of mechanical ventilation and vasopressor use were significantly lower in the intervention group (p: < 0.001 and 0.003, respectively). Baseline levels of vitamin C in both groups did not have a significant difference but its levels increased in the intervention group and decreased in the control group during the study period. Mortality rate insignificantly decreased in the intervention group (p = 0.17). Three patients showed hypotension and tachycardia during the administration of vitamin C which was self-limited with decreasing the dose of vitamin C. Our results showed that the intravenous administration of a relatively high dose of vitamin C to critically ill patients with severe pneumonia was safe and could decrease the inflammation, duration of mechanical ventilation, and vasopressor use without any significant effect on mortality. Trial registration: IRCT registration number: IRCT20190312043030N1, Registration date: 2019-08-26, Seied Hadi Saghaleini.

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