The Impact of the Organization of High-Dependency Care on Acute Hospital Mortality and Patient Flow for Critically Ill Patients

Background: Coronavirus disease 2019 (COVID-19) has become one of the leading causes of death worldwide. The impact of poor nutritional status on increased mortality and prolonged ICU (intensive care unit) stay in critically ill patients is well-documented. This study aims to assess how nutritional status and BMI (body mass index) affected in-hospital mortality in critically ill COVID-19 patients Methods: We conducted a retrospective study and analysed medical records of 286 COVID-19 patients admitted to the intensive care unit of the University Clinical Hospital in Wroclaw (Poland). Results: A total of 286 patients were analysed. In the sample group, 8% of patients who died had a BMI within the normal range, 46% were overweight, and 46% were obese. There was a statistically significantly higher death rate in men (73%) and those with BMIs between 25.0–29.9 (p = 0.011). Nonsurvivors had a statistically significantly higher HF (Heart Failure) rate (p = 0.037) and HT (hypertension) rate (p < 0.001). Furthermore, nonsurvivors were statistically significantly older (p < 0.001). The risk of death was higher in overweight patients (HR = 2.13; p = 0.038). Mortality was influenced by higher scores in parameters such as age (HR = 1.03; p = 0.001), NRS2002 (nutritional risk score, HR = 1.18; p = 0.019), PCT (procalcitonin, HR = 1.10; p < 0.001) and potassium level (HR = 1.40; p = 0.023). Conclusions: Being overweight in critically ill COVID-19 patients requiring invasive mechanical ventilation increases their risk of death significantly. Additional factors indicating a higher risk of death include the patient’s age, high PCT, potassium levels, and NRS ≥ 3 measured at the time of admission to the ICU.

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Rapid Muscle Loss Negatively Impacts Survival in Critically Ill Patients With Cirrhosis

Journal of Intensive Care Medicine ◽

10.1177/0885066618775706 ◽

2018 ◽

Vol 35 (7) ◽

pp. 663-671 ◽

Cited By ~ 3

Author(s):

Sunmi Ju ◽

Sun Mi Choi ◽

Young Sik Park ◽

Chang-Hoon Lee ◽

Sang-Min Lee ◽

...

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Muscle Mass ◽

Critically Ill Patients ◽

Mass Change ◽

Apache Ii Score ◽

Muscle Loss ◽

Icu Mortality ◽

Skeletal Muscle Index ◽

The Impact

Purpose: To assess the impact of rapid muscle loss before admission to intensive care unit (ICU) in critically ill patients with cirrhosis. Materials and Methods: Patients with cirrhosis who had undergone 2 or more recent computed tomography scans before admission to the medical ICU were included. Muscle cross-sectional area at the level of the third lumbar vertebra was quantified using OsiriX software. The rate of muscle mass change and skeletal muscle index (SMI) were also calculated. Multivariable Cox proportional hazards regression was used to evaluate the association between muscle loss and mortality. Results: Among 125 patients, 113 (90.4%) patients were classified as having sarcopenia. The mean body mass index was 22.6 (3.9) kg/m2. Thirty-nine (31.2%) patients were within the normal range for muscle mass change, while 86 (68.8%) patients demonstrated rapid decline in muscle mass before admission to the ICU. Patients with rapid muscle loss showed high ICU mortality (59.3%) and in-hospital mortality (77.9%). Multivariate Cox analysis showed that ICU mortality and in-hospital mortality were independently associated with malignancy, Acute Physiology and Chronic Health Evaluation (APACHE) II score, SMI, and rapid muscle loss. Conclusion: Rapid muscle decline is correlated with increased ICU mortality and in-hospital mortality in critically ill patients with cirrhosis.

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The relationship between serum potassium, potassium variability and in-hospital mortality in critically ill patients and a before-after analysis on the impact of computer-assisted potassium control

Critical Care ◽

10.1186/s13054-014-0720-9 ◽

2015 ◽

Vol 19 (1) ◽

pp. 4 ◽

Cited By ~ 26

Author(s):

Lara Hessels ◽

Miriam Hoekstra ◽

Lisa J Mijzen ◽

Mathijs Vogelzang ◽

Wim Dieperink ◽

...

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Serum Potassium ◽

Critically Ill Patients ◽

Computer Assisted ◽

The Impact ◽

The Relationship

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The Impact of Heart Rate Circadian Rhythm on In-hospital Mortality in Stroke and Critically Ill Patients: Insights from the eICU Collaborative Research Database

10.21203/rs.3.rs-1218231/v1 ◽

2022 ◽

Author(s):

Zhengning Yang ◽

Zhe Li ◽

Xu He ◽

Zhen Yao ◽

XiaoXia Xie ◽

...

Keyword(s):

Heart Rate ◽

Circadian Rhythm ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Peak Time ◽

Research Database ◽

Discriminative Ability ◽

The Impact ◽

Apache Iv

Abstract Background: The dysregulation of the heart rate circadian rhythm has been documented to be an independent risk factor in multiple diseases. However, data showing the impact of dysregulated heart rate circadian rhythm in stroke and critically ill patients are scarce.Methods: Stroke and critically ill patients in the ICU between 2014 and 2015 from the recorded eICU Collaborative Research Database were included in the current analyses. The impact of circadian rhythm of heart rate on in-hospital mortality was analyzed. Three variables, Mesor (rhythm-adjusted mean of heart rate), Amplitude (distance from the highest point of circadian rhythm of heart rate to Mesor), and Peak time (time when the circadian rhythm of heart rate reaches the highest point) were used to evaluate the heart rate circadian rhythm. The incremental value of circadian rhythm variables in addition to Acute Physiology and Chronic Health Evaluation (APACHE) IV score to predict in-hospital mortality was also explored.Results: A total of 6,201 eligible patients were included. The in-hospital mortality was 16.2% (1,002/6,201). The circadian rhythm variables of heart rate, Mesor, Amplitude, and Peak time, were identified to be independent risk factors of in-hospital mortality. After adjustments, Mesor per 10 beats per min (bpm) increase was associated with a 1.17-fold (95%CI: 1.11, 1.24, P<0.001) and Amplitude per 5 bpm was associated with a 1.14-fold (95%CI: 1.06, 1.24, P<0.001) increase in the risk of in-hospital mortality, respectively. The risk of in-hospital mortality was lower in patients who had Peak time reached between 18:00-24:00 or 00:00-06:00; whereas the risk was highest in patients who had Peak time reached between 12:00-18:00 (OR: 1.33, 95%CI: 1.05, 1.68, P=0.017). Compared with APACHE IV score only (c-index=0.757), combining APACHE IV score and circadian rhythm variables of heart rate (c-index=0.766) was associated with increased discriminative ability (P=0.003).Conclusion: Circadian rhythm of heart rate is an independent risk factor of the in-hospital mortality in stroke and critically ill patients. Including circadian rhythm variables regarding heart rate might increase the discriminative ability of the risk score to predict the short-term prognosis of patients.

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1170. Invasive Fungal Infections and Colonization in Critically Ill Patients: Impact of Diagnosis and Management on Outcomes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1356 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S610-S610

Author(s):

Anthony Siudela ◽

Afshin Khan ◽

Marjorie E Bateman

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

High Mortality ◽

Critically Ill Patients ◽

Hospital Admissions ◽

Fungal Infections ◽

Invasive Fungal Infections ◽

Fungal Colonization ◽

Post Discharge ◽

The Impact

Abstract Background Invasive fungal infections (IFIs), though uncommon, are on the rise and have a high mortality rate. Fungal colonization is common, but its clinical significance is unclear. Our study aims to characterize the impact of these diagnoses and their management on outcomes in a large ICU population. Methods We utilized the Multiparameter Intelligent Monitoring in Intensive Care III database for this retrospective cohort study. Adults with positive fungal cultures were classified as colonized or infected using definitions from the EORTC/MSG guidelines and the Blot protocol for Aspergillus. Outcomes were compared between groups matched by age, SOFA score, admission diagnosis, culture results, and comorbidities. Results There were 595 hospital admissions with IFI (11.7/1000 admissions) and 5789 with colonization (114/1000 admissions). In-hospital mortality was 52% in patients with IFIs and 36% in colonized patients. Mortality post-discharge remained high and was not significantly different in the two groups. 67% of patients with IFIs had the diagnosis documented. 24% of patients with IFIs and 8% of colonized patients received antifungal therapy. Treatment did not significantly impact mortality in infected or colonized patients but was associated with increased length of hospital and ICU stay. Infectious disease (ID) consultation was performed in 39.8% of patients with IFIs and 20% of patients with colonization. In the group of IFI patients with ID consultation, in-hospital mortality was higher, but survival post-discharge increased significantly. There was a significant increase in diagnosis of IFI in the ID group and a trend toward increased treatment. In colonized patients with ID consultation, in-hospital mortality and survival post-discharge improved. Hospital and ICU length of stay were longer for patients with ID consultation. Conclusion Critically ill patients with IFIs have high mortality rates, which were not reduced by treatment. The prevalence of colonization was high, and colonized patients experienced significant in-hospital and post-discharge mortality. This study supports the need for additional investigation into ID consultation, which may improve outcomes in critically ill patients with fungal infection and colonization. Disclosures All Authors: No reported disclosures

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540. Does Remdesivir Impact the Clinical Outcome of Patients with COVID 19 Infection?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.739 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S371-S372

Author(s):

Karthik Gunasekaran ◽

Jisha S John ◽

Hanna Alexander ◽

Naveena Gracelin ◽

Prasanna Samuel ◽

...

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Primary Outcome ◽

P Value ◽

Invasive Ventilation ◽

Quick Recovery ◽

Significant Difference ◽

Male Preponderance ◽

The Impact

Abstract Background Remdesivir (RDV), was included for the treatment of mild to moderate COVID-19 since July 2020 in our institution, following the initial results from ACTT-1 interim analysis report. With the adoption of RDV, there seems to be anecdotal evidence of efficacy as evidenced by early fever defervescence, quick recovery when on oxygen with decreased need for ventilation and ICU care. We aimed to study the impact of RDV on clinical outcomes among patients with moderate to severe COVID –19. Methods Nested case control study in the cohort of consecutive patients with moderate to severe COVID – 19. Cases were patients initiated on RDV and age and sex- matched controls who did not receive RDV were included. The primary outcome was in-hospital mortality. Secondary outcomes were, duration of hospital stay, need for ICU, duration of oxygen therapy and need for ventilation. Results A total of 926 consecutive patients with COVID – 19 were included, among which 411 patients were cases and 515 controls. The mean age of the cohort was 57.05±13.5 years, with male preponderance (75.92%). The overall in-hospital mortality was 22.46%(n=208). On comparison between cases and controls there was no statistically significant difference with respect to primary outcome [22.54% vs. 20.78%, (p value: 0.17)]. Progression to non-invasive ventilation (NIV) was higher among the controls [24.09% vs. 40.78% (p value: < 0.001*)]. Progression to invasive ventilation was also higher among the controls [5.35% vs. 9.71% (p value: 0.014*)]. In subgroup analysis among critically ill patients, the use of RDV showed decrease in mortality (OR 0.32 95% CI; 0.13 – 0.75 p value – 0.009*). Conclusion RDV did not decrease the in-hospital mortality among moderate to severe COVID – 19. However, there seems to be a significant reduction in mortality in critically ill patients. Disclosures All Authors: No reported disclosures

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Statins’ safety and impact on the clinical outcomes in COVID-19 critically ill patients: A Multicenter, Cohort Study

10.21203/rs.3.rs-828175/v2 ◽

2021 ◽

Author(s):

Khalid Al Sulaiman ◽

Ohoud Aljuhani ◽

Ghazwa B. Korayem ◽

Ali F. Altebainawi ◽

Shmeylan Al Harbi ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Hazard Ratio ◽

Icu Stay ◽

Markers Of Inflammation ◽

The Impact ◽

Statin Use

Abstract Purpose The complications of Severe Corona Virus Disease 2019 (COVID-19) are attributed to the overproduction of early response proinflammatory cytokines, causing a systemic hyperinflammatory state. Statins are potentially a potent adjuvant therapy in COVID-19 infection due to their pleiotropic and anti-inflammatory effects, which are independent of their cholesterol-lowering activity. This study investigates the impact of statin use on the outcome of critically ill patients with COVID-19. Methods A multicenter, retrospective cohort study of all adult critically ill patients with confirmed COVID-19 admitted to Intensive Care Units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were classified into two groups based on statin use during ICU stay and were matched with a propensity score which was based on patient’s age and admission APACHE II and SOFA scores. The primary endpoint was in-hospital mortality. Other outcomes were considered secondary... Results A total of 1049 patients were eligible; 502 patients were included after propensity score matching (1:1 ratio). The 30-day (hazard ratio 0.75 (95% CI 0.58, 0.98), P = 0.03) and in-hospital mortality (hazard ratio 0.69 (95% CI 0.54, 0.89), P = 0.004) were significantly lower in patients who received statin therapy on multivariable cox proportional hazards regression analysis. Moreover, patients who received statin have a lower risk of hospital-acquired pneumonia (OR 0.48(95% CI 0.32, 0.69), P = < 0.001), lower levels of markers of inflammation on follow up and no increased risk of liver injury. Conclusion The use of statin during ICU stay in COVID-19 critically ill patients may have a beneficial role and survival benefits with a good safety profile.

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Time to Lactate Measurement Affects Efficacy of Initial Lactate on Mortality in critically ill patients with sepsis.

10.21203/rs.3.rs-30867/v1 ◽

2020 ◽

Author(s):

Xueying Luo ◽

Xiaobo Zheng ◽

Xi Rao ◽

Ya Li ◽

Sujing Zheng ◽

...

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Lactate Level ◽

P Value ◽

Detection Time ◽

Lactate Measurement ◽

Unit Increase ◽

The Impact ◽

The Relationship

Abstract Background: Evidence regarding the effect of time to lactate measurement on the relationship between the initial lactate level and mortality is limited. We aimed to investigate the relationships between time to lactate measurement, initial lactate level, and in-hospital mortality in critically ill patients with sepsis.Methods and Results: Of the 14339 eligible adult patients with recognized sepsis upon admission to the ICU based on the MIMIC-III database, the median value of initial lactate was 1.70 mmol/L (interquartile range [IQR] 1.20-2.80), and its detection time was 3.50 hours ([IQR] 1.31-10.24). The results of fully adjusted multivariate analyses demonstrated that lactate was positively associated with in-hospital mortality (odds ratio: 1.126, 95% confidence interval: 1.090 to 1.163, P<0.001), and there was an increase in the odds of death with hourly delays in lactate measurement (OR: 1.006, 95% CI: 1.004 to 1.008, P<0.001). In stratified analyses, delays in lactate measurement significantly interfered with the impact of increased lactate level on mortality (P-value for interaction<0.001). The hospital mortality rate substantially increased by 43.5% for each unit increase in lactate when measurement was delayed by 24 hours (OR: 1.435, 95% CI: 1.260 to 1.635, P<0.001).Discussion: The association of initial lactate with in-hospital mortality is likely to vary with delays in detection time (grouping based on the “1-hour bundle”) in critically ill patients with recognized sepsis upon admission to the ICU.

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