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

2018 ◽  
Vol 35 (7) ◽  
pp. 663-671 ◽  
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.

scholarly journals Point-of-Care Ultrasound-Guided Conservative Fluid Therapy Improved the Outcome of Critically Ill Patients: A Before-and-After Study

2021 ◽  
Author(s):  
Hui He ◽  
Mingqiang Zeng ◽  
Jing Chen ◽  
Lei Deng ◽  
Youdai Chen
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Apache Ii Score ◽  
Point Of Care Ultrasound ◽  
Icu Mortality ◽  
Icu Stay ◽  
The Impact ◽  
Cumulative Fluid Balance

Abstract ObjectivesTo study the impact of fluid balance on the outcome of critically ill patients.MethodsCritically ill patients managed with point-of-care ultrasound were compared with those managed without. Distended internal jugular veins and inferior vena cava with reduced collapsibility were taken as signs of hypervolemia.ResultsCompared with critically ill patients admitted before application of point-of-care ultrasound assessment (from March, 2019 through October, 2019; 291 cases), cases admitted after (from November, 2019 through June, 2020; 285 cases) had significantly lower in-ICU mortality (34.7% vs 26.7%, p=0.038; Fisher’s exact test), together with a dramatic change from overall positive fluid balance to negative one (for cumulative fluid balance during ICU stay, 2820±1381ml vs -10±39ml; p=0.001). Multiple logistic regression showed that cumulative fluid balance during ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score on admission were independent risk factors for in-ICU mortality (p<0.001, p<0.001 and p=0.043 respectively). After controlling for disease severity, Cox hazard ratio of cases with a negative cumulative fluid balance during ICU stay was 0.683 (95% confidence interval 0.475-0.981; p=0039).ConclusionsNegative cumulative fluid balance during ICU stay was associated with a reduced in-ICU mortality.

scholarly journals Plasma Neutrophil Gelatinase-Associated Lipocalin Is Useful for Predicting Mortality in Critically Ill Patients

2021 ◽  
Vol 10 (12) ◽  
pp. 2576
Author(s):  
Izabela Duda ◽  
Łukasz Krzych
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Mortality Prediction ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Icu Admission ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Elevated neutrophil gelatinase-associated lipocalin (NGAL) occurs in a wide range of systemic diseases. This study examined the clinical utility of plasma NGAL to predict intensive care unit (ICU) and in-hospital mortality in critically ill patients. A total of 62 patients hospitalized in a mixed ICU were included; pNGAL, creatinine, and C-reactive protein (CRP) were assayed on four consecutive days (D1-D4) following ICU admission. APACHE II score (Acute Physiology and Chronic Health Evaluation) was calculated 24 h post-admission. ICU mortality reached 35% and in-hospital mortality was 39%. The median pNGAL at admission was 142.5 (65.6–298.3) ng/mL. pNGAL was significantly higher in non-survivors compared to survivors. The highest accuracy for ICU mortality prediction was achieved at the pNGAL cutoff of 93.91 ng/mL on D4 area under the curve (AUC) = 0.89; 95%CI 0.69–0.98 and for in-hospital mortality prediction was achieved at the pNGAL cutoff of 176.64 ng/mL on D3 (AUC = 0.86; 95%CI 0.69–0.96). The APACHE II score on ICU admission predicted ICU mortality with AUC = 0.89 (95%CI 0.79–0.96) and in-hospital mortality with AUC = 0.86 (95%CI 0.75–0.94). Although pNGAL on D1 poorly correlated with APACHE II (R = 0.3; p = 0.01), the combination of APACHE II and pNGAL on D1 predicted ICU mortality with AUC = 0.90 (95%CI 0.79–0.96) and in-hospital mortality with AUC = 0.95 (95%CI 0.78–0.99). Maximal CRP during study observation failed to predict ICU mortality (AUC = 0.62; 95%CI 0.49–0.74), but helped to predict in-hospital mortality (AUC = 0.67; 95%CI 0.54–0.79). Plasma NGAL with combination with the indices of critical illness is a useful biomarker for predicting mortality in heterogeneous population of ICU patients.

scholarly journals Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

2018 ◽  
Vol 46 (3) ◽  
pp. 1254-1262 ◽  
Author(s):  
Surat Tongyoo ◽  
Tanuwong Viarasilpa ◽  
Chairat Permpikul
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Serum Potassium ◽  
Critically Ill Patients ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Medical Intensive Care

Objective To compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+ level, and hospital outcomes were recorded. Patients with a mean K+ level of 3.5 to 4.5 mEq/L and with all individual K+ values of 3.0 to 5.0 mEq/L were allocated to the normal K+ group. The remaining patients were allocated to the abnormal K+ group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+ group comprised 74 (46.3%) patients. The abnormal K+ group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K+ level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K+ levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K+ levels.

Outcomes of Critically Ill Gynecological Cancer Patients Admitted to Intensive Care Unit

2012 ◽  
Vol 30 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Silvio A. Ñamendys-Silva ◽  
María O. González-Herrera ◽  
Julia Texcocano-Becerra ◽  
Angel Herrera-Gómez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Gynecological Cancer ◽  
Apache Ii ◽  
Apache Ii Score

Purpose: To assess the characteristics of critically ill patients with gynecological cancer, and to evaluate their prognosis. Methods: Fifty-two critically ill patients with gynecological cancer admitted to intensive care unit (ICU) were included. Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality. Results: Thirty-five patients (67.3%) had carcinoma of the cervix uteri and 11 (21.2%) had ovarian cancer. The mortality rate in the ICU was 17.3% (9 of 52) and hospital mortality rate were 23%(12 of 52). In the multivariate analysis, independent prognostic factors for hospital mortality were vasopressor use (odds ratio [OR] = 8.60, 95% confidence interval [CI] 2.05-36; P = .03) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.43, 95% CI 1.01-2.09; P = .048). Conclusions: The independent prognostic factors for hospital mortality were the need for vasopressors and the APACHE II score.

scholarly journals A Differential Therapeutic Consideration for use of Corticosteroids According to Established COVID-19 Clinical Phenotypes in Critically Ill Patients

2021 ◽  
Author(s):  
Gerard Moreno ◽  
Manuel Ruíz- Botella ◽  
Ignacio Martin-Loeches ◽  
Josep Gómez Alvarez ◽  
María Jiménez Herrera ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Cox Proportional Hazards ◽  
High Dose ◽  
Icu Mortality ◽  
Clinical Phenotypes ◽  
Biphasic Effect ◽  
The Impact ◽  
Assumption Violation

Abstract Background: The steroids are currently used as standard treatment for severe COVID-19. However, the evidence is weak. Our aim is to determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes.Methods: A secondary analysis derived from multicenter, observational study of adult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain. Three phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). The primary outcome was ICU mortality. We performed a Multivariate analysis after propensity score full matching (PS), Cox proportional hazards (CPH), Cox covariate time interaction (TIR), Weighted Cox Regression (WCR) and Fine-Gray analysis(sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes. Results: A total of 2,017 patients were analyzed, 1171(58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR:1.0,95%CI:0.98-1.15). Corticosteroids were administered in 298/537(55.5%) patients of “A” phenotype and their use was not associated with ICU mortality (HR=0.85[0.55-1.33]). A total of 338/623(54.2%) patients in “B” phenotype received corticosteroids. The CPH (HR =0.65 [0.46-0.91]) and TIR regression (1- 25 day tHR=0.56[0.39-0.82] and >25 days tHR=1.53[1.03-7.12]) showed a biphasic effect of corticosteroids due to proportional assumption violation. No effect of corticosteroids on ICU mortality was observed when WCR was performed (wHR=0.72[0.49-1.05]). Finally, 535/857(62.4%) patients in “C” phenotype received corticosteroids. The CPH (HR=0.73[0.63-0.98]) and TIR regression (1- 25 day tHR=0.69[ 0.53-0.89] and >25 days tHR=1.30[ 1.14-3.25]) showed a biphasic effect of corticosteroids and proportional assumption violation. However, wHR (0.75[0.58-0.98]) and sHR (0.79[0.63-0.98]) suggest a protective effect of corticosteroids on ICU mortality. Conclusion: Our finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate-high dose. Only patients with the highest severity could benefit from steroid treatment although this effect on clinical outcome was minimized during ICU stay.

scholarly journals The Association between Nutritional Status and In-Hospital Mortality of COVID-19 in Critically-Ill Patients in the ICU

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3302
Author(s):  
Michał Czapla ◽  
Raúl Juárez-Vela ◽  
Vicente Gea-Caballero ◽  
Stanisław Zieliński ◽  
Marzena Zielińska
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nutritional Status ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Nutritional Risk ◽  
Risk Of Death ◽  
The Impact

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.

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

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.

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

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

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

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: &lt; 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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