The Neutrophil Percentage-to-Albumin Ratio as a New Predictor of All-Cause Mortality in Patients with Cardiogenic Shock

Background. Although the neutrophil percentage-to-albumin ratio (NPAR) has proven to be a robust systemic inflammation-based predictor of mortality in a wide range of diseases, the prognostic value of the NPAR in critically ill patients with cardiogenic shock (CS) remains unknown. This study aimed at investigating the association between the admission NPAR and clinical outcomes in CS patients using real-world data. Methods. Critically ill patients diagnosed with CS in the Medical Information Mart for Intensive Care-III (MIMIC-III) database were included in our study. The study endpoints included all-cause in-hospital, 30-day, and 365-day mortality in CS patients. First, the NPAR was analyzed as a continuous variable using restricted cubic spline Cox regression models. Second, X-tile analysis was used to calculate the optimal cut-off values for the NPAR and divide the cohort into three NPAR groups. Moreover, multivariable Cox regression analyses were used to assess the association of the NPAR groups with mortality. Results. A total of 891 patients hospitalized with CS were enrolled in this study. A nonlinear relationship between the NPAR and in-hospital and 30-day mortality was observed (all P values for nonlinear trend<0.001). According to the optimal cut-off values by X-tile, NPARs were divided into three groups: group I ( NPAR < 25.3 ), group II ( 25.3 ≤ NPAR < 34.8 ), and group III ( 34.8 ≤ NPAR ). Multivariable Cox analysis showed that higher NPAR was independently associated with increased risk of in-hospital mortality (group III vs. group I: hazard ratio [HR] 2.60, 95% confidence interval [CI] 1.72-3.92, P < 0.001 ), 30-day mortality (group III vs. group I: HR 2.42, 95% CI 1.65-3.54, P < 0.001 ), and 365-day mortality (group III vs. group I: HR 6.80, 95% CI 4.10-11.26, P < 0.001 ) in patients with CS. Conclusions. Admission NPAR was independently associated with in-hospital, 30-day, and 365-day mortality in critically ill patients with CS.

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Admission Serum Ionized and Total Calcium as New Predictors of Mortality in Patients with Cardiogenic Shock

BioMed Research International ◽

10.1155/2021/6612276 ◽

2021 ◽

Vol 2021 ◽

pp. 1-15

Author(s):

Yue Yu ◽

Jingwen Yu ◽

Renqi Yao ◽

Pei Wang ◽

Yufeng Zhang ◽

...

Keyword(s):

Cardiogenic Shock ◽

Critically Ill ◽

Serum Calcium ◽

Critically Ill Patients ◽

Medical Information ◽

Cox Regression ◽

Nonlinear Relationship ◽

Total Calcium ◽

Increased Risk ◽

Wide Range

Background. Although serum calcium has been proven to be a predictor of mortality in a wide range of diseases, its prognostic value in critically ill patients with cardiogenic shock (CS) remains unknown. This retrospective observational study is aimed at investigating the association of admission calcium with mortality among CS patients. Methods. Critically ill patients diagnosed with CS in the Medical Information Mart for Intensive Care-III (MIMIC-III) database were included in our study. The study endpoints included 30-day, 90-day, and 365-day all-cause mortalities. First, admission serum ionized calcium (iCa) and total calcium (tCa) levels were analyzed as continuous variables using restricted cubic spline Cox regression models to evaluate the possible nonlinear relationship between serum calcium and mortality. Second, patients with CS were assigned to four groups according to the quartiles (Q1-Q4) of serum iCa and tCa levels, respectively. In addition, multivariable Cox regression analyses were used to assess the independent association of the quartiles of iCa and tCa with clinical outcomes. Results. A total of 921 patients hospitalized with CS were enrolled in this study. A nonlinear relationship between serum calcium levels and 30-day mortality was observed (all P values for nonlinear trend < 0.001 ). Furthermore, multivariable Cox analysis showed that compared with the reference quartile (Q3: 1.11 ≤ iCa < 1.17 mmol / L ), the lowest serum iCa level quartile (Q1: iCa < 1.04 mmol / L ) was independently associated with an increased risk of 30-day mortality (Q1 vs. Q3: HR 1.35, 95% CI 1.00-1.83, P = 0.049 ), 90-day mortality (Q1 vs. Q3: HR 1.36, 95% CI 1.03-1.80, P = 0.030 ), and 365-day mortality (Q1 vs. Q3: HR 1.28, 95% CI 1.01-1.67, P = 0.046 ) in patients with CS. Conclusions. Lower serum iCa levels on admission were potential predictors of an increased risk of mortality in critically ill patients with CS.

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The Neutrophil Percentage-to-Albumin Ratio is Associated with All-Cause Mortality in Critically Ill Patients with Acute Myocardial Infarction

10.21203/rs.3.rs-877233/v1 ◽

2021 ◽

Author(s):

Ya Lin ◽

Yanhan Lin ◽

Juanqing Yue ◽

Qianqian Zou

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Critically Ill ◽

Critically Ill Patients ◽

Medical Information ◽

Cox Proportional Hazards ◽

Albumin Ratio ◽

Neutrophil Percentage ◽

Increased Risk ◽

All Cause Mortality

Abstract Aim In this study, we evaluated the utility of neutrophil percentage-to-albumin ratio (NPAR) in predicting in critically ill patients with acute myocardial infarction (AMI). Methods the information of patients were collected from Medical Information Mart for Intensive Care III (MIMIC III) database. Admission NPAR was calculated as neutrophil percentage divided by serum albumin. The endpoints of this study were 30-day, 90-day, 180-day, and 365-day all-cause mortality. Cox proportional hazards models and subgroup analyses were used to determine the relationship between admission NPAR and these endpoints. Results 798 critically ill patients with AMI were enrolled in. After adjustments for age, race and gender, higher admission NPAR was associated with increased risk of 30-day, 90-day, 180-day, and 365-day all-cause mortality in critically ill patients with AMI. And after adjusting for possible confounding variables, two different trends have emerged. Stratified by tertiles, high admission NPAR was independently associated with 180-day and 365-day all-cause mortality in critically ill patients with AMI (tertile 3 vs. tertile 1: adjusted HR, 95%CI: 1.71,1.10-2.66, p<0.05;1.66,1.10-2.51, p<0.05). In other hand, stratified by quartiles, highest admission NPAR levels were independently associated with 90-day, 180-day and 365-day all-cause mortality (quartile 4 vs. quartile 1: adjusted HR, 95% CI: 2.36,1.32-4.23, p<0.05; 2.58,1.49-4.47, p<0.05; 2.61,1.56-4.37, p<0.05). ROC test showed that admission NPAR had a moderate ability to predict all-cause mortality of critically ill patients with AMI. No obvious interaction was found by subgroup analysis in most subgroups. Conclusions admission NPAR was an independent predictor for 180-day and 365-day all-cause mortality in critically ill patients with AMI.

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The Neutrophil Percentage-to-Albumin Ratio Is Associated with All-Cause Mortality in Critically Ill Patients with Acute Kidney Injury

BioMed Research International ◽

10.1155/2020/5687672 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Benji Wang ◽

Diwen Li ◽

Bihuan Cheng ◽

Binyu Ying ◽

Yuqiang Gong

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Proportional Hazards ◽

Kidney Injury ◽

Cox Proportional Hazards ◽

Albumin Ratio ◽

Neutrophil Percentage ◽

Increased Risk ◽

All Cause Mortality

Background. There is no evidence to suggest the predictive power of neutrophil percentage-to-albumin ratio (NPAR) in patients with acute kidney injury (AKI). We hypothesized that NPAR would correlate with all-cause mortality in critically ill patients with AKI. Methods. From the MIMIC-III V1.4 database, we extracted demographics, vital signs, comorbidities, laboratory tests, and other clinical data. The clinical endpoints were 30-, 90- and 365-day all-cause mortality in critically ill patients with AKI. Cox proportional hazards models were used to evaluate the prognostic values of NPAR, and subgroup analyses were performed to measure mortality across various subgroups. Results. A total of 7,481 eligible subjects were enrolled. In multivariate analysis, after adjustments for age, ethnicity, gender, and other confounding factors, higher NPARs were associated with an increased risk of 30-, 90- and 365-day all-cause mortality in critically ill patients with AKI (tertile 3 versus tertile 1: adjusted HR, 95% CI: 1.48, 1.30–1.69; 1.47, 1.31–1.66; 1.46, 1.32–1.62, respectively; P trend <0.01). A similar trend was observed in the NPAR group division by quintiles. Subgroup analysis revealed no significant interactions in most strata. Conclusions. Increased NPAR correlates with increased risk of all-cause mortality in critically ill patients with AKI.

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Increased neutrophil percentage-to-albumin ratio is associated with all-cause mortality in patients with severe sepsis or septic shock

Epidemiology and Infection ◽

10.1017/s0950268820000771 ◽

2020 ◽

Vol 148 ◽

Cited By ~ 2

Author(s):

Yuqiang Gong ◽

Diwen Li ◽

Bihuan Cheng ◽

Binyu Ying ◽

Benji Wang

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Critically Ill ◽

Critically Ill Patients ◽

Albumin Ratio ◽

Icu Admission ◽

Clinical Endpoints ◽

Neutrophil Percentage ◽

Increased Risk ◽

All Cause Mortality

Abstract There has been no study exploring the prognostic values of neutrophil percentage-to-albumin ratio (NPAR). We hypothesised that NPAR is a novel marker of inflammation and is associated with all-cause mortality in patients with severe sepsis or septic shock. Patient data were extracted from the MIMIC-III V1.4 database. Only the data for the first intensive care unit (ICU) admission of each patient were used and baseline data were extracted within 24 h after ICU admission. The clinical endpoints were 30-, 90- and 365-day all-cause mortality in critically ill patients with severe sepsis or septic shock. Cox proportional hazards models and subgroup analyses were used to determine the relationship between NPAR and these clinical endpoints. A total of 2166 patients were eligible for this analysis. In multivariate analysis, after adjustments for age, ethnicity and gender, higher NPAR was associated with increased risk of 30-, 90- and 365-day all-cause mortality in critically ill patients with severe sepsis or septic shock. Furthermore, after adjusting for more confounding factors, higher NPAR remained a significant predictor of all-cause mortality (tertile 3 vs. tertile 1: HR, 95% CI: 1.29, 1.04–1.61; 1.41, 1.16–1.72; 1.44, 1.21–1.71). A similar trend was observed in NPAR levels stratified by quartiles. Higher NPAR was associated with increased risk of all-cause mortality in critically ill patients with severe sepsis or septic shock.

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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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Prevalence of thrombocytosis in critically ill patients and its association with symptomatic acute pulmonary embolism

Thrombosis and Haemostasis ◽

10.1160/th12-09-0658 ◽

2013 ◽

Vol 109 (02) ◽

pp. 272-279 ◽

Cited By ~ 11

Author(s):

Shaila Chavan ◽

Kwok Ho

Keyword(s):

Pulmonary Embolism ◽

Intensive Care ◽

Platelet Count ◽

Critically Ill ◽

Critically Ill Patients ◽

Acute Pulmonary Embolism ◽

Increased Risk ◽

Wide Range ◽

The Relationship ◽

Acute Pe

SummaryIt is uncertain whether thrombocytosis without underlying myeloproliferative diseases is associated with an increased risk of acute pulmonary embolism (PE). We investigated the relationship between thrombocytosis and risk of symptomatic acute PE, and whether Pulmonary Embolism Severity Index (PESI) was reliable in predicting mortality of acute PE. This multicentre registry study involved a total of 609,367 critically ill patients admitted to 160 intensive care units (ICUs) in Australia or New Zealand between 2006 and 2011. Forward stepwise logistic regression was used to assess the relationship between risk of acute PE and platelet counts on intensive care unit (ICU) admission. Acute PE (n=3387) accounted for 0.9% of all emergency ICU admissions. Over 20% of all PE required mechanical ventilation, 4.2% had cardiac arrest, and the mortality was high (14.8%). Thrombocytosis, defined by a platelet count >500×109 per litre, occurred in 2.1% of the patients and was more common in patients with acute PE than other diagnoses (3.4 vs. 2.0%). The platelet counts explained about 4.5% of the variability and had a linear relationship with the risk of acute PE (odds ratio 1.19 per 100×109 per litre increment in platelet count, 95% confidence interval 1.06–1.34), after adjusting for other covariates. The PESI had a reasonable discriminative ability (area under receiver-operating-characteristic curve = 0.78) and calibration to predict mortality across a wide range of severity of acute PE. In summary, thrombocytosis was associated with an increased risk of symptomatic acute PE. PESI was useful in predicting mortality across a wide range of severity of acute PE.

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Association of Low Alanine Aminotransferase Values with Extubation Failure in Adult Critically Ill Patients: A Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10153282 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3282

Author(s):

Yoav Weber ◽

Danny Epstein ◽

Asaf Miller ◽

Gad Segal ◽

Gidon Berger

Keyword(s):

Cohort Study ◽

High Risk ◽

Critically Ill ◽

Critically Ill Patients ◽

Alanine Aminotransferase ◽

Cox Regression ◽

Independent Predictor ◽

Extubation Failure ◽

Increased Risk ◽

Ventilated Patients

Background: Liberation from mechanical ventilation is a cardinal landmark during hospitalization of ventilated patients. Decreased muscle mass and sarcopenia are associated with a high risk of extubation failure. A low level of alanine aminotransferase (ALT) is a known biomarker of sarcopenia. This study aimed to determine whether low levels of ALT are associated with increased risk of extubation failure among critically ill patients. Methods: This was a retrospective single-center cohort study of mechanically ventilated patients undergoing their first extubation. The study’s outcome was extubation failure within 48 h and 7 days. Multivariable logistic and Cox regression were performed to determine whether ALT was an independent predictor of these outcomes. Results: The study included 329 patients with a median age of 62.4 years (IQR 48.1–71.2); 210 (63.8%) patients were at high risk for extubation failure. 66 (20.1%) and 83 (25.2%) failed the extubation attempt after 48 h and 7 days, respectively. Low ALT values were more common among patients requiring reintubation (80.3–61.5% vs. 58.6–58.9%, p < 0.002). Multivariable logistic regression analysis identified ALT as an independent predictor of extubation failure at 48 h and 7 days. ALT ≤ 21 IU/L had an adjusted hazard ratio (HR) of 2.41 (95% CI 1.31–4.42, p < 0.001) for extubation failure at 48 h and ALT ≤ 16 IU/L had adjusted HR of 1.94 (95% CI 1.25–3.02, p < 0.001) for failure after 7 days. Conclusions: Low ALT, an established biomarker of sarcopenia and frailty, is an independent risk factor for extubation failure among hospitalized patients. This simple laboratory parameter can be used as an effective adjunct predictor, along with other weaning parameters, and thereby facilitate the identification of high-risk patients.

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The repurposed use of anesthesia machines to ventilate critically ill patients with coronavirus disease 2019 (COVID-19)

BMC Anesthesiology ◽

10.1186/s12871-021-01376-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maurizio Bottiroli ◽

Angelo Calini ◽

Riccardo Pinciroli ◽

Ariel Mueller ◽

Antonio Siragusa ◽

...

Keyword(s):

Critical Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Cox Regression ◽

Northern Italy ◽

Mechanical Ventilators ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Increased Risk ◽

Anesthesia Machines

Abstract Background The surge of critically ill patients due to the coronavirus disease-2019 (COVID-19) overwhelmed critical care capacity in areas of northern Italy. Anesthesia machines have been used as alternatives to traditional ICU mechanical ventilators. However, the outcomes for patients with COVID-19 respiratory failure cared for with Anesthesia Machines is currently unknow. We hypothesized that COVID-19 patients receiving care with Anesthesia Machines would have worse outcomes compared to standard practice. Methods We designed a retrospective study of patients admitted with a confirmed COVID-19 diagnosis at a large tertiary urban hospital in northern Italy. Two care units were included: a 27-bed standard ICU and a 15-bed temporary unit emergently opened in an operating room setting. Intubated patients assigned to Anesthesia Machines (AM group) were compared to a control cohort treated with standard mechanical ventilators (ICU-VENT group). Outcomes were assessed at 60-day follow-up. A multivariable Cox regression analysis of risk factors between survivors and non-survivors was conducted to determine the adjusted risk of death for patients assigned to AM group. Results Complete daily data from 89 mechanically ventilated patients consecutively admitted to the two units were analyzed. Seventeen patients were included in the AM group, whereas 72 were in the ICU-VENT group. Disease severity and intensity of treatment were comparable between the two groups. The 60-day mortality was significantly higher in the AM group compared to the ICU-vent group (12/17 vs. 27/72, 70.6% vs. 37.5%, respectively, p = 0.016). Allocation to AM group was associated with a significantly increased risk of death after adjusting for covariates (HR 4.05, 95% CI: 1.75–9.33, p = 0.001). Several incidents and complications were reported with Anesthesia Machine care, raising safety concerns. Conclusions Our results support the hypothesis that care associated with the use of Anesthesia Machines is inadequate to provide long-term critical care to patients with COVID-19. Added safety risks must be considered if no other option is available to treat severely ill patients during the ongoing pandemic. Clinical trial number Not applicable.

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Albumin–Globulin Ratio Is an Independent Determinant of 28-Day Mortality in Patients with Critical Illness

Disease Markers ◽

10.1155/2021/9965124 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Bin Liu ◽

Kun Xiao ◽

Peng Yan ◽

Tianyu Sun ◽

Jiang Wang ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critical Illness ◽

Critically Ill ◽

Critically Ill Patients ◽

Cox Regression ◽

Independent Predictor ◽

Laboratory Data ◽

Cox Regression Analysis ◽

Increased Risk

Background. Critical illness in the intensive care unit (ICU) has been a global health priority. Systemic nutritional status has turned out to be related to the prognosis of critically ill patients. The albumin-globulin ratio (AGR) has been reported to be a novel prognostic factor of many diseases. This study is aimed at investigating whether the AGR could predict the mortality risk in critically ill patients. Methods. We enrolled 582 adult patients admitted to the respiratory intensive care unit (RICU). We collected the clinical and laboratory data. X-tile software was used to determine the optimal cut-off values for the AGR. Patients were divided into three groups according to the AGR (low AGR group with AGR < 0.8 , medium AGR group with AGR ranging from 0.8 to 1.1, and high AGR group with AGR > 1.1 ). Kaplan-Meier analysis was used for survival analysis. A Cox proportional hazard model was applied to the univariate and multivariate analyses for the potential predictors associated with survival. Results. Our present study showed that the AGR was related to the 28-day survival of critically ill patients in the RICU. The rate of pneumonia in the low AGR group was significantly higher than that in the other groups. Patients with a lower AGR present an increased risk of 28-day mortality compared to patients with a higher AGR. Cox regression analysis showed that the AGR might be an independent predictor of prognosis to 28-day survival in critically ill patients in the RICU. Medium and high AGR values remained independently associated with better 28-day survival than low AGR values (HR: 0.484 (0.263-0.892) ( p = 0.02 ); HR: 0.332 (0.166-0.665) ( p = 0.002 )). Conclusion. The AGR might be an independent predictor of prognosis in critically ill patients.

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Milrinone is associated with lower in hospital mortality in patients with cardiogenic shock: a retrospective analysis of the MIMIC-III database

10.21203/rs.3.rs-15790/v1 ◽

2020 ◽

Author(s):

Yangjing Xue ◽

Jinsheng Wang ◽

Yangpei Peng ◽

Kaiyu Huang ◽

Lu Qian ◽

...

Keyword(s):

Hospital Mortality ◽

Cardiogenic Shock ◽

Regression Model ◽

Critically Ill ◽

Critically Ill Patients ◽

Medical Information ◽

Cox Regression ◽

Cox Regression Model ◽

The Impact ◽

Mimic Iii

Abstract BackgroundAlthough milrinone has been widely used in daily clinical practice, its effect on survival in patients with cardiogenic shock (CS) is not known. The primary purpose of this study was to evaluate the effectiveness of milrinone on in hospital mortality in a large critical care cohort of patients with CS of various etiological causes.MethodsPatients with CS were identified from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Propensity score matching (PSM) was used to account for the baseline differences in the probability to receive milrinone or not. Multivariate Cox regression model was employed to adjust for imbalance by including parameters and potential confounders.ResultsA total of 1068 critically ill patients with CS were enrolled for this analysis, including 161 in the milrinone group and 907 in the non-milrinone group. Multivariate Cox regression model results found milrinone was associated with a significantly decreased in hospital mortality in critically ill patients with CS (HR 0.61, 95% CI 0.45-0.83; P=0.001). The impact of milrinone on survival benefit in CS was remaining in patients with non-ACS, while it was not statistically significant in subgroup with ACS (HR 0.66, 95% CI 0.40-1.07; P=0.093). Similar results were replicated after PSM.ConclusionsOur study observed that milrinone was related with improved survival in patients with CS, but it was not associated with improved outcome in patients complicated with ACS. The results need to be verified in randomized controlled trials.

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