scholarly journals Relationship between CRP Albumin Ratio and the Mortality in Critically Ill Patients with AKI: A Retrospective Observational Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Jiajia Wang ◽  
Kai Zhao ◽  
Xuehui Mao ◽  
Yabin Zhang ◽  
Jing Shao ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Critically Ill ◽  
Subgroup Analysis ◽  
Critically Ill Patients ◽  
Multivariate Regression ◽  
Prognostic Score ◽  
Vital Signs ◽  
Albumin Ratio ◽  
Provincial Hospital ◽  
Increased Risk

Background. AKI is known to be associated with inflammation and nutritional status. The novel inflammatory prognostic score CAR (CRP/albumin ratio), which combines inflammation and nutritional status, was hypothesized to be associated with mortality in critically ill AKI patients in this study. Methods. The included cases were patients admitted to the ICU of Shandong Provincial Hospital from January 2016 to November 2018 and diagnosed with AKI within 48 hours of ICU admission. From the electronic case database of Shandong Provincial Hospital, we extracted the baseline demographic information, vital signs, routine laboratory parameters, complications, and other data. The above records are measured within 48 hours of admission to ICU. The clinical endpoint was the total cause mortality rate in hospital and 2 years. We constructed two multivariate regression models to determine the statistically significant correlation between CAR and mortality and conducted subgroup analysis to determine the mortality among different subgroups. Results. A total of 580 patients were included in this study. In multivariate regression analysis, higher CAR was associated with an increase in hospital and two-year all-cause mortality in critically ill patients with AKI after adjusting gender, age, respiratory frequency, temperature, and other confounding factors (tertile 3 versus tertile 1: OR, 95% CI: 2.97, 1.70-5.17; 3.03, 1.68-5.47, respectively; P < 0.001 ). Subgroup analysis showed that the CAR level in each subgroup increases with hospital mortality in critically ill patients with AKI. Conclusion. The increase of CAR in critically ill patients with AKI was associated with an increased risk of all-cause death.

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

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.

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

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Yue Yu ◽  
Yu Liu ◽  
Xinyu Ling ◽  
Renhong Huang ◽  
Suyu Wang ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Albumin Ratio ◽  
Group Iii ◽  
Group I ◽  
Neutrophil Percentage ◽  
Increased Risk ◽  
Wide Range

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.

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

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
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.

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

2020 ◽  
Vol 148 ◽  
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.

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

2015 ◽  
Vol 37 (5) ◽  
pp. 1967-1972 ◽  
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.

Continuous Auscultation of Heart and Bilateral Breath Sounds

PEDIATRICS ◽  
1988 ◽  
Vol 81 (5) ◽  
pp. 745-746
Author(s):  
NATHAN SCHWARTZ ◽  
JAMES B. EISENKRAFT
Keyword(s):  
Heart Rate ◽  
Critically Ill ◽  
Vital Signs ◽  
Sleep Pattern ◽  
Monitoring Device ◽  
Challenging Problem ◽  
Breath Sounds ◽  
Increased Risk ◽  
Risk Of Exposure

To the Editor.— The frequent determination of vital signs, such as heart rate and bilateral breath sounds, is a mainstay in the care of critically ill infants. Unfortunately, the routine determination of such vital signs involves the manipulation and disturbance of the infant, unnecessary risk of exposure to cold, increased risk of apnea, and infection.1,2 In addition, the frequent disruption of the infant's sleep pattern may take an unaccountable physiologic and psychologic toll. To deal with this common and challenging problem we have devised a simple and inexpensive monitoring device, using readily available supplies, which facilitates the continuous or intermittent evaluation of heart rate and bilateral breath sounds.

scholarly journals Randomised controlled trial of GM-CSF in critically ill patients with impaired neutrophil phagocytosis

Thorax ◽  
2018 ◽  
Vol 73 (10) ◽  
pp. 918-925 ◽  
Author(s):  
Emma M Pinder ◽  
Anthony J Rostron ◽  
Thomas P Hellyer ◽  
Marie-Helene Ruchaud-Sparagano ◽  
Jonathan Scott ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Ex Vivo ◽  
Controlled Trial ◽  
Personalised Medicine ◽  
Common Adverse Event ◽  
Controlled Clinical Trial ◽  
Gm Csf ◽  
Hla Dr ◽  
Increased Risk

BackgroundCritically ill patients with impaired neutrophil phagocytosis have significantly increased risk of nosocomial infection. Granulocyte-macrophage colony-stimulating factor (GM-CSF) improves phagocytosis by neutrophils ex vivo. This study tested the hypothesis that GM-CSF improves neutrophil phagocytosis in critically ill patients in whom phagocytosis is known to be impaired.MethodsThis was a multicentre, phase IIa randomised, placebo-controlled clinical trial. Using a personalised medicine approach, only critically ill patients with impaired neutrophil phagocytosis were included. Patients were randomised 1:1 to subcutaneous GM-CSF (3 μg/kg/day) or placebo, once daily for 4 days. The primary outcome measure was neutrophil phagocytosis 2 days after initiation of GM-CSF. Secondary outcomes included neutrophil phagocytosis over time, neutrophil functions other than phagocytosis, monocyte HLA-DR expression and safety.ResultsThirty-eight patients were recruited from five intensive care units (17 randomised to GM-CSF). Mean neutrophil phagocytosis at day 2 was 57.2% (SD 13.2%) in the GM-CSF group and 49.8% (13.4%) in the placebo group, p=0.73. The proportion of patients with neutrophil phagocytosis≥50% at day 2, and monocyte HLA-DR, appeared significantly higher in the GM-CSF group. Neutrophil functions other than phagocytosis did not appear significantly different between the groups. The most common adverse event associated with GM-CSF was fever.ConclusionsGM-CSF did not improve mean neutrophil phagocytosis at day 2, but was safe and appeared to increase the proportion of patients with adequate phagocytosis. The study suggests proof of principle for a pharmacological effect on neutrophil function in a subset of critically ill patients.

scholarly journals Risk Potential for Organ Dysfunction Associated with Sodium Bicarbonate Therapy (SBT) in Critically Ill Patients with Hemodynamic Worsening

2021 ◽  
Author(s):  
Tiehua Wang ◽  
Lingxian Yi ◽  
Hua Zhang ◽  
Tianhao Wang ◽  
Jingjing Xi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Metabolic Acidosis ◽  
Sodium Bicarbonate ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Control Group ◽  
Increased Risk ◽  
Bicarbonate Therapy ◽  
Risk Potential

Abstract Background: The role of sodium bicarbonate therapy (SBT) remains controversial. This study aimed to investigate whether hemodynamic status before SBT contributed to the heterogeneous outcomes associated with SBT in acute critically ill patients.Methods: We obtained data from patients with metabolic acidosis from the Medical Information Mart for Intensive Care (MIMIC)-III database. Propensity score matching (PSM) was applied to match the SBT group with the control group. Logistic regression and Cox regression were used to analyze a composite of newly “developed or exacerbated organ dysfunction” (d/eOD) within 7 days of ICU admission and 28-day mortality associated with SBT for metabolic acidosis.Results: A total of 1765 patients with metabolic acidosis were enrolled, and 332 pairs obtained by PSM were applied to the final analyses in the study. An increased incidence of newly d/eOD was observed in the SB group compared with the control group (54.8% vs 44.6%, p<0.01). Multivariable logistic regression indicated that the adjusted OR of SBT for this composite outcome was no longer significant [OR (95% CI): 1.39 (0.9, 1.85); p=0.164]. This effect of SBT did not change with the quintiles stratified by pH. Interestingly, SBT was associated with an increased risk of the composite of newly d/eOD in the subgroup of patients with worsening hemodynamics before SBT [adjusted OR (95% CI): 3.6 (1.84, 7.22), p< 0.001]. Moreover, the risk potential for this composite of outcomes was significantly increased in patients characterized by both worsening [adjusted OR (95% CI): 2.91 (1.54, 5.47), p< 0.001] and unchanged hemodynamics [adjusted OR (95% CI): 1.94 (1.01, 3.72), p=0.046) compared to patients with improved hemodynamics before SBT. Our study failed to demonstrate an association between SBT and 28-day mortality in acute critically ill patients with metabolic acidosis.Conclusions: Our findings suggested that SBT for metabolic acidosis was associated with an increased risk potential for subsequent d/eOD, while the hemodynamic status remained unstable during the acute phase of critical illness.

New Onset of Atrial Fibrillation" as an Outcome Predictor in Critically Ill Patients with Sepsis: A Systemic Review

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed W Mohamed ◽  
Mostafa K Riyad ◽  
Ahmed M Khamis ◽  
Heba F Toulan
Keyword(s):  
Atrial Fibrillation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cardiac Arrhythmias ◽  
Meta Analysis ◽  
Systemic Review ◽  
Common Occurrence ◽  
Severity Of Disease ◽  
Increased Risk ◽  
New Onset

Abstract Background Evidence of various cardiac arrhythmias in septic patients has been demonstrated by multiple clinical reports and observations .Most cardiac arrhythmias in sepsis are new-onset and may be related to sepsis-induced myocardial dysfunction, autonomic dysfunction and, most likely also, by impairment and involvement of the cardiac conduction system. Aim of the Work to describe the incidence of NOAF and to determine the risk factors associated with its development, as well as its clinical course and its effect on the outcome of patients with sepsis admitted to the ICU. Patients and Methods A systematic search was conducted to retrieve articles that investigated the association of NOAF in patients diagnosed with sepsis. We identified potential Englishlanguage sources from the PubMed, Medline, and EMBASE databases. Keywords used were “atrial fibrillation” and (“sepsis” or “septic shock”). In addition, reference lists of any studies meeting inclusion criteria were reviewed manually to identify additional relevant publications. Results In our meta-analysis, we found that NOAF is a common occurrence in critically ill patients with sepsis, and its incidence rises with increasing severity of disease. Also, we found that NOAF in sepsis patients is significantly associated with increased risk of ICU. In hospital, and After hospital discharge mortality, as well as, increased risk of developing ischemic stroke. Conclusion NOAF is a common occurrence in critically ill patients with sepsis, and its incidence rises with increasing severity of disease. Our Meta-analysis suggests that it is independently associated with poor outcome. In view of these findings there is a need for better quality observational studies, because reliable identification of patients with sepsis who are prone for the development of AF may allow for early pharmacological interventions to prevent this complication.

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