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

2013 ◽  
Vol 109 (02) ◽  
pp. 272-279 ◽  
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.

The prognostic efficacy of beta2-microglobulin in acute pulmonary embolism

2017 ◽  
Vol 16 (2) ◽  
pp. 52-59
Author(s):  
Sotirios Kakavas ◽  
◽  
Aggeliki Papanikolaou ◽  
Evangelos Balis ◽  
Evgenios Metaxas ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Increased Risk ◽  
Preliminary Study ◽  
Wbc Count ◽  
A Prospective Study ◽  
Acute Pe

Our aim was to prospectively assess the prognostic value of beta2- microglobulin (b2-M) in patients with acute pulmonary embolism (PE). We conducted a prospective study of 109 patients admitted in a pulmonary clinic due to acute PE. A panel of inflammatory markers including b2-M white blood cell (WBC) count and C-reactive protein (CRP) was determined for each patient. In this preliminary study, baseline b2-M levels significantly correlated with the impairment of oxygenation and with all the parameters that are used for the early risk stratification of patients. In multivariate analysis, patients’ age and baseline b2-M levels were significantly associated with an increased risk of death. These findings require further prospective validation.

scholarly journals Association between Malnutrition and Hospital Mortality and Duration of Intensive Care Unit Admission in the Critically Ill: A Prospective Cohort Study

2017 ◽  
Author(s):  
Charles Chin Han Lew ◽  
Gabriel Jun Yung Wong ◽  
Ka Po Cheung ◽  
Ai Ping Chua ◽  
Mary Foong Fong Chong ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Prospective Cohort Study ◽  
Critically Ill Patients ◽  
Prospective Cohort ◽  
Unit Length ◽  
Increased Risk

There is limited evidence for the association between malnutrition and hospital mortality as well as Intensive Care Unit length-of-stay (ICU-LOS) in critically ill patients. We aimed to examine the aforementioned associations by conducting a prospective cohort study in an ICU of a Singapore tertiary hospital. Between August 2015 and October 2016, all adult patients with ≥24 h of ICU-LOS were included. The 7-point Subjective Global Assessment (7-point SGA) was used to determine patients’ nutritional status within 48 hours of ICU admission. Multivariate analyses were conducted in two ways: 1) presence versus absence of malnutrition, and 2) dose-dependent association for each 1-point decrease in the 7-point SGA. There were 439 patients of which 28.0% were malnourished, and 29.6% died before hospital discharge. Malnutrition was associated with an increased risk of hospital mortality [adjusted-RR 1.39 (95%CI: 1.10–1.76)], and this risk increased with a greater degree of malnutrition [adjusted-RR 1.09 (95%CI: 1.01–1.18) for each 1-point decrease in the 7-point SGA]. No significant association was found between malnutrition and ICU-LOS. Conclusion: There was a clear association between malnutrition and higher hospital mortality in critically ill patients. The association between malnutrition and ICU-LOS could not be replicated and hence requires further evaluation.

scholarly journals Thrombotic Complications in a Canadian Population of Critically Ill Patients with COVID-19

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 41-42
Author(s):  
Simard Camille ◽  
Maral Koolian ◽  
Diana Escobar ◽  
Mark Blostein ◽  
Jed Lipes ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
The United States ◽  
Hospital Death ◽  
Thrombotic Complication ◽  
Arterial Thromboembolism ◽  
Increased Risk ◽  
Thrombotic Complications

Introduction Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), a virus strain that appeared in Wuhan China in December 2019, that has since spread to become pandemic. An increased risk of venous and arterial thromboembolism has been consistently reported in critically ill patients with COVID-19 in several countries. The mechanism is thought to be multifactorial, largely mediated by the interplay between inflammation and the coagulation system, or thromboinflammation. We aim to report the risk of thrombosis in a Canadian patient population admitted to the intensive care unit (ICU) with COVID-19. Method We conducted a retrospective cohort study of all consecutive patients with COVID-19 admitted to the ICU between March 1st, 2020 and May 10th, 2020 at the Jewish General Hospital (JGH) in Montreal, Canada. The JGH is a tertiary care centre in Montreal, the epicenter of the COVID-19 pandemic in Canada, and the JGH was the first designated hospitalization centre in Montreal for COVID-19 patients. Patients were followed from date of ICU admission to the earliest of the following: objectively confirmed venous or arterial thrombosis; discharge from hospital; death; or study end date (May 24th, 2020). We determined risk of venous (pulmonary embolism (PE) and deep vein thrombosis (DVT)) and arterial (myocardial infarction, cerebrovascular accident, arterial limb ischemia, and mesenteric ischemia) thrombotic events. Results During the study period, a total of 90 patients admitted to the ICU with COVID-19 were included. The median age was 66 years (standard deviation (SD) 13.8), and 41.1% of patients were female. The median body mass index was 30 kg/m2(SD 5.1), and 64% of patients were mechanically ventilated and 10.1% received continuous renal replacement therapy. The median duration of follow-up was 17.1 days (SD 13.4). In all, 98.9% of patients were prescribed anticoagulation, among whom 78.2% were on a prophylaxis dose, 15.0% intermediate dose, and 6.9% therapeutic dose. In all, 11 (12.2%) patients developed a thrombotic complication among whom 9 patients had objectively diagnosed pulmonary embolism (PE) and 2 patients had an arterial thromboembolism. Both arterial events were cerebrovascular accidents. All PE episodes involved segmental arteries. One PE was incidental, and 3 patients had a concomitant diagnosis of DVT. Overall, death was observed in 16.7% of cohort patients and 12.2% of patients were still admitted to hospital at study end date. Conclusion In this first Canadian study of critically ill patients with COVID-19, we found a 12.2% risk of thrombotic complications despite almost 100% use of anticoagulation primarily with standard prophylaxis dosing. This risk is considerably lower than most reported estimates to date from critical care COVID-19 cohorts in Europe, China and the United States. Our results fuel the ongoing discussion of optimal dose of anticoagulation in these patients. Disclosures No relevant conflicts of interest to declare.

Evaluation of Time to Therapeutic Anticoagulation and Associated Outcomes in Critically Ill, Obese Patients With Pulmonary Embolism Receiving Unfractionated Heparin

2019 ◽  
pp. 089719001987807
Author(s):  
Lauren H. Sutton ◽  
Bethany R. Tellor ◽  
Hannah E. Pope ◽  
Jennifer N. Riney ◽  
Katherine L. Weaver
Keyword(s):  
Pulmonary Embolism ◽  
Unfractionated Heparin ◽  
Critically Ill ◽  
Obese Patients ◽  
Therapeutic Anticoagulation ◽  
Hemodynamic Deterioration ◽  
Clinically Significant ◽  
Poor Outcomes ◽  
The Relationship ◽  
Acute Pe

Background: Delays in time to therapeutic activated partial thromboplastin time (aPTT) have been associated with poor outcomes in patients with acute pulmonary embolism (PE). Objective: To investigate the relationship between time to therapeutic anticoagulation and in-hospital mortality in critically ill, obese patients with acute PE. Methods: This study examined 204 critically ill patients with a body mass index (BMI) ≥30 kg/m2 receiving unfractionated heparin (UFH) for PE treatment. Patients achieving therapeutic anticoagulation within 24 hours of UFH initiation (early) were compared to those in >24 hours (delayed). Additional end points included 30-day mortality, median time to therapeutic aPTT, proportion of therapeutic and supratherapeutic aPTT values, hemodynamic deterioration, thrombolytic therapy after UFH initiation, length of stay, and bleeding. Results: No difference in in-hospital or 30-day all-cause mortality was seen (odds ratio [OR]: 1.33, confidence interval [CI]: 0.647-2.72; OR: 1.003, CI: 0.514-1.96). Patients in the early group had a greater proportion of therapeutic aPTT values (66.7% vs 50%, P < .001) and higher percentage of supratherapeutic aPTT values (20.9% vs 11.3%, P < .001); however, no increase in clinically significant bleeding was evident (15.2% vs 10.9%, P = .366). Conclusion: In this population, a shorter time to therapeutic aPTT was not associated with improved survival.

scholarly journals Prognostic value of hematocrit levels among critically ill patients with acute kidney injury

2019 ◽  
Vol 17 ◽  
pp. 205873921984682
Author(s):  
Ying Zhou ◽  
Ming-Hua Zheng ◽  
Chao-Sheng Chen ◽  
Dan-Qin Sun ◽  
Xin-Xin Chen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prognostic Value ◽  
Univariate Analysis ◽  
Kidney Injury ◽  
Inverse Association ◽  
Risk Of Mortality ◽  
Increased Risk

The aim of this study was to investigate the value of hematocrit (HCT) level in predicting the outcomes of critically ill patients with acute kidney injury (AKI). A retrospective study of a total of 14,350 intensive care unit (ICU) patients, who were selected from Beth Israel Deaconess Medical Center (Boston, MA, USA) and met the inclusion criteria, was carried out. And the patient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3 (MIMIC-III v1.3). In our study, HCT quintiles were used to categorize the subjects into groups. The clinical outcomes were 30- and 90-day mortality in the ICU. Cox proportional-hazards models were used to evaluate the association between the HCT and survival. A total of 2827 30-day deaths and 3828 90-day deaths occurred. In univariate analysis, low HCT was significantly associated with increased 30- and 90-day mortality among females, which, however, was not observed in multivariate analysis adjusted for age, ethnicity, dialysate, continuous renal replacement therapy (CRRT), use of insulin, use of ventilator, AKI stages, and report of obesity. In subgroup analysis, an inverse association between HCT levels and risk of mortality for 90-day outcome was observed for female patients by exclusion of dialysate use, receiving CRRT, and obesity reports. Therefore, these findings suggest that lower HCT was associated with an increased risk of mortality in critically ill patients with AKI, and the effect appears to be stronger among women than men. The prognostic value of HCT seems dependent on other factors, for example, dialysate use, CRRT, and obesity. Further multicenter study is in demand to confirm the validity of the results presented in this article.

scholarly journals Admission Oxygen Saturation and Mortality in Acute Pulmonary Embolism Patients: Observational Data From Large ICU Databases

2021 ◽  
Author(s):  
Xiaolin Xu ◽  
Anping Peng ◽  
Jing Tian ◽  
Runnan Shen ◽  
Guochang You ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Logistic Regression ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Oxygen Saturation ◽  
Acute Pulmonary Embolism ◽  
Research Database ◽  
Optimal Range ◽  
Subgroup Analyses ◽  
The Relationship

Abstract Background The relationship between blood oxygenation and clinical outcomes of acute pulmonary embolism (APE) patients in intensive care unit (ICU) is unclear, which could be nonlinear. The study aimed to determine the association between admission pulse oximetry-derived oxygen saturation (SpO2) levels and mortality, and to determine the optimal range with real-world data. Methods Patients diagnosed with APE on admission and staying in ICU for at least 24 hours in the Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU-CRD) were included. Logistic regression and restricted cubic spline (RCS) models were applied to determine the nonlinear relationship between mean SpO2 levels within the first 24 hours after ICU admission and in-hospital mortality, from which we derived an optimal range of SpO2. Subgroup analyses were based on demographics, treatment information, scoring system and comorbidities. Results We included 1109 patients who fulfilled inclusion criteria, among whom 129 (12%) died during hospitalization and 80 (7.2%) died in ICU. The RCS showed that the relationship between admission SpO2 levels and in-hospital mortality of APE patients was nonlinear and U-shaped. The optimal range of SpO2 with the lowest mortality was 95–98%. Multivariate stepwise logistic regression analysis with backward elimination confirmed that the admission SpO2 levels of 95%-98% was associated with decreased hospital mortality compared to the group with SpO2 < 95% (Odds ratio [OR] = 2.321; 95% confidence interval [CI]: 1.405–3.786; P < 0.001) and 100% (OR = 2.853; 95% CI: 1.294–5.936; P = 0.007), but there was no significant difference compared with 99% SpO2 (OR = 0.670, 95% CI: 0.326–1.287; P > 0.05). This association was consistent across subgroup analyses. Conclusions The relationship between admission SpO2 levels and in-hospital mortality followed a U-shaped curve among patients with APE. The optimal range of SpO2 for APE patients was 95–98%.

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

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.

scholarly journals Brain Natriuretic Peptide, Troponin and D-Dimer Levels in Relation to Long-Term Functional Outcome after a First Episode of Pulmonary Embolism: Results from the E.L.O.P.E. Study

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 649-649
Author(s):  
Susan R Kahn ◽  
Andrew Hirsch ◽  
Margaret Beddaoui ◽  
Arash Akaberi ◽  
David Anderson ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Relative Risk ◽  
Brain Natriuretic Peptide ◽  
First Episode ◽  
Increased Risk ◽  
The Relationship ◽  
Acute Pe ◽  
D Dimer ◽  
Age And Sex

Abstract Background: Biomarkers such as brain natriuretic peptide (BNP), high-sensitivity cardiac troponin (hsTnT) and d-dimer (DD) are useful for acute or short-term risk stratification after pulmonary embolism (PE) to predict right ventricular dysfunction, recurrent PE or death. However, whether acute or convalescent levels of these biomarkers predict longterm functional limitation after PE has not been evaluated. To address this knowledge gap, we performed the ELOPE (Evaluation of Longterm Outcomes after PE) Study, a prospective, observational, multicenter cohort study of long-term outcomes after acute PE (www.clinicaltrials.gov NCT01174628). Objectives: To describe levels of NT-proBNP, hsTnT and d-dimer at baseline and 6 months in patients with acute PE, and to assess the relationship between biomarker levels and functional status at 1 year. Methods: Patients ³ 18 years old with a 1st episode of acute PE diagnosed within the previous 10 days screened at 5 Canadian recruiting centers were potentially eligible to participate. Exclusion criteria were subsegmental-only PE, preexisting severe cardiopulmonary comorbidity, previous proximal DVT, contraindication to CT pulmonary angiography (CTPA), life expectancy <1 year, unable to read questionnaire in English and French or to attend follow-up visits, and unable or unwilling to consent. Patients attended study visits at baseline, 1, 3, 6 and 12 months. Blood samples to assay NT-proBNP (serum), hsTnT (serum) and DD (plasma) were obtained at baseline and 6 months. NT-proBNP and hsTnT were measured using the cobas® 8000 modular analyzer (Roche Diagnostics, Laval, Quebec); cut-off for normal is <300pg/mL and <15ng/mL, respectively. DD was measured with the immune-turbidimetric STA®-Liatest® assay run on a STA® analyser (DiagnosticaStago, Asnieres, France); cut off for normal is <500ug FEU/L. The primary outcome for the ELOPE Study was maximal aerobic capacity as defined by peak oxygen uptake (VO2) as a percent of predicted maximal VO2 (VO2max) on a cardiopulmonary exercise test (CPET) performed at the 1-year visit, with <80% predicted VO2max considered abnormal, as per American Thoracic Society guidelines. For each biomarker at baseline and 6 months, we calculated median (IQR) values, % of values above the cutoff, and univariate relative risk (RR) for VO2max <80% predicted on 1-year CPET (see Table). Multivariate logistic regression analysis (multiple log-binomial regression) was done, adjusted for age and sex, to assess the relationship between NT-proBNP, hsTnT, DD and 1-year CPET result. Results: 984 patients were screened for participation; of these, 150 were eligible and 100 (67%) consented to participate. Mean (SD) age was 50 (15) years, 57% were male, 80% were outpatients, and 33% had concomitant DVT. PE was provoked in 21% and unprovoked in 79%; none were cancer-related. Table. Median biomarker values, % of values above cutoff, and univariate RR for VO2max <80% predicted on 1-year CPET Variable NT-proBNP (pg/mL) hsTroponin T (ng/L) D-Dimer (ug FEU/L) Visit Date Baseline 6 months Baseline 6 months Baseline 6 months Median (IQR) 46 (21, 98) 37 (21, 81) 6 (3, 11) 5 (3, 8) 1230 (550, 2050) 200 (110, 370) N (%) > cut-off* 8 (10.1%) 4 (5.8%) 8 (10.1%) 5 (7.2%) 62 (78.5%) 8 (11.6%) Univariate RR for VO2 max <80% predicted at 1 year 1.74(0.99, 3.04) 1.15(0.41, 3.18) 1.34(0.66, 2.71) 0.44(0.07, 2.57) 1.42(0.66, 3.06) 0.84(0.33, 2.14) *Cut-offs: see Methods In a multiple model adjusted for age and sex, baseline NT-proBNP >300 pg/mL was associated with a relative risk (RR) of 2.31 (95% CI 1.10, 4.86; p=0.027) for VO2max <80% predicted on 1-year CPET, whereas DD and hsTnT did not influence this risk. Conclusion: In a prospective cohort of patients with a first episode of PE without preexisting severe cardiopulmonary comorbidity, baseline NT-proBNP >300 pg/mL predicted a greater than 2-fold increased risk of abnormal CPET at 1 year after PE. This finding may allow early identification of PE patients at increased risk of poor longterm outcome after PE. Further analyses are in progress to assess the relationship between changes in biomarker levels from baseline to 6 months and 1-year CPET result. Funding: Canadian Institutes of Health Research (MOP-93627) Disclosures Wells: BMS/Pfizer: Research Funding; Bayer: Honoraria.

scholarly journals Prediction Scores Do Not Correlate with Clinically Adjudicated Categories of Pulmonary Embolism in Critically Ill Patients

2014 ◽  
Vol 21 (1) ◽  
pp. 36-42 ◽  
Author(s):  
CM Katsios ◽  
M Donadini ◽  
M Meade ◽  
S Mehta ◽  
R Hall ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pulmonary Embolism ◽  
Intensive Care ◽  
Randomized Trial ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pretest Probability ◽  
Icu Patients ◽  
Outpatient Settings ◽  
Diagnostic Scores

BACKGROUND: Prediction scores for pretest probability of pulmonary embolism (PE) validated in outpatient settings are occasionally used in the intensive care unit (ICU).OBJECTIVE: To evaluate the correlation of Geneva and Wells scores with adjudicated categories of PE in ICU patients.METHODS: In a randomized trial of thromboprophylaxis, patients with suspected PE were adjudicated as possible, probable or definite PE. Data were then retrospectively abstracted for the Geneva Diagnostic PE score, Wells, Modified Wells and Simplified Wells Diagnostic scores. The chance-corrected agreement between adjudicated categories and each score was calculated. ANOVA was used to compare values across the three adjudicated PE categories.RESULTS: Among 70 patients with suspected PE, agreement was poor between adjudicated categories and Geneva pretest probabilities (kappa 0.01 [95% CI −0.0643 to 0.0941]) or Wells pretest probabilities (kappa −0.03 [95% CI −0.1462 to 0.0914]). Among four possible, 16 probable and 50 definite PEs, there were no significant differences in Geneva scores (possible = 4.0, probable = 4.7, definite = 4.5; P=0.90), Wells scores (possible = 2.8, probable = 4.9, definite = 4.1; P=0.37), Modified Wells (possible = 2.0, probable = 3.4, definite = 2.9; P=0.34) or Simplified Wells (possible = 1.8, probable = 2.8, definite = 2.4; P=0.30).CONCLUSIONS: Pretest probability scores developed outside the ICU do not correlate with adjudicated PE categories in critically ill patients. Research is needed to develop prediction scores for this population.

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.

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