Delirium in Meningitis and Encephalitis: Emergence and Prediction in a 6-Year Cohort

Background/Objective: Data regarding delirium in patients presenting with infections of the central nervous system, such as meningitis and/or encephalitis (ME), are scarce. We aimed to determine the frequency and early predictors of delirium in the acute phase of ME. Methods: We assessed clinical, radiologic, and laboratory data of patients with ME at a Swiss academic medical center from 2011 to 2017. The highest Intensive Care Delirium Screening Checklist (ICDSC) score was assessed within 24 hours around lumbar puncture. Multivariable logistic regression was performed to identify predictors of delirium (ICDSC ≥4). Results: Among 330 patients with ME, infectious pathogens were identified in 41%. An ICDSC >1 was found in 28% with and 19% without identified infectious pathogens. Delirium was diagnosed in 18% with and 14% without infectious pathogens and significantly associated with prolonged in-hospital treatment and mechanical ventilation, more frequent administration of neuroleptics and anesthetics (in 96% with delirium vs 35% without), complications, and less recovery to premorbid functional baseline. Low serum albumin at presentation was the only independent predictor of delirium (area under the receiver–operating curve [AUROC] = 0.792) in patients with pathogens. In patients with infections, the AUROC was smallest for encephalitis (AUROC = 0.641) and larger for patients with meningeal infections (meningitis AUROC = 0.807; meningoencephalitis AUROC = 0.896). Conclusions: Delirium in the context of ME is seen in almost every fifth patient and linked to prolonged treatment, complications, and incomplete recovery. Among clinical, radiologic, and laboratory parameters, the good calibration and discrimination of low albumin serum concentrations for the prediction of delirium in patients with ME seem promising, especially if meninges are affected.

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Inpatient Urine Cultures Are Frequently Performed Without Urinalysis or Microscopy: Findings From a Large Academic Medical Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.311 ◽

2017 ◽

Vol 38 (4) ◽

pp. 455-460 ◽

Cited By ~ 6

Author(s):

Abigail L. Carlson ◽

Satish Munigala ◽

Anthony J. Russo ◽

Kathleen M. McMullen ◽

Helen Wood ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Medical Center ◽

Academic Medical Center ◽

Laboratory Data ◽

Surgical Intensive Care ◽

Tertiary Referral Center ◽

Patient Admissions ◽

Academic Medical ◽

Tract Infections

OBJECTIVETo describe the frequency of urine cultures performed in inpatients without additional testing for pyuriaDESIGNRetrospective cohort studySETTINGA 1,250-bed academic tertiary referral centerPATIENTSHospitalized adultsMETHODSThis study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital’s medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as “isolated.” The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures.RESULTSDuring the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11–1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89–2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47–2.00; surgical ICU aOR, 1.82; 95% CI, 1.51–2.19), and obtaining the urine culture ≥1 calendar day after admission (1–7 days aOR, 1.91; 95% CI. 1.71–2.12; >7 days after admission aOR, 2.81; 95% CI, 2.37–3.34).CONCLUSIONSIsolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections.Infect Control Hosp Epidemiol2017;38:455–460

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Predicting Outcome After Out-of-Hospital Cardiac Arrest: Lactate, Need for Vasopressors, and Cytochrome c

Journal of Intensive Care Medicine ◽

10.1177/0885066619873315 ◽

2019 ◽

Vol 35 (12) ◽

pp. 1483-1489 ◽

Cited By ~ 1

Author(s):

Michael N. Cocchi ◽

Justin Salciccioli ◽

Tuyen Yankama ◽

Maureen Chase ◽

Parth V. Patel ◽

...

Keyword(s):

Cardiac Arrest ◽

Cytochrome C ◽

Prospective Observational Study ◽

Medical Center ◽

Academic Medical Center ◽

Receiver Operating Curve ◽

Academic Medical ◽

Predicting Outcome ◽

Logistic Regressions ◽

Hospital Cardiac Arrest

Background: Outcome prediction after out-of-hospital cardiac arrest (OHCA) is difficult. We hypothesized that lactate and need for vasopressors would predict outcome, and that addition of a mitochondrial biomarker would enhance performance of the tool. Methods: Prospective observational study of OHCA patients presenting to an academic medical center September 2008 to April 2016. We conducted univariate and multivariate logistic regressions. Results: Patients were divided based on 2 variables: vasopressor status and initial lactate (<5 mmol/L, 5-10, ≥10). Three hundred fifty-two patients were evaluated; 249 had a lactate within 3 hours and were included. Patients on vasopressors had higher mortality (74% vs 40%; P < .001). A stepwise increase in mortality is associated with increasing lactate (45% lactate <5, 66% 5-10, and 83% ≥10; P < 001). Multivariable models with lactate group and vasopressors as predictors demonstrated excellent discrimination (area under the receiver operating curve [AUC]: 0.73 [95% confidence interval, CI: 0.66-0.79]; adjusted for additional covariates: AUC: 0.81 [95% CI: 0.75-0.86]). Thirty-six patients had cytochrome c levels available; among these 36, when comparing models with and without cytochrome c, there was no difference (AUC: 0.88 [95% CI: 0.76-1.00] vs AUC: 0.85 [95% CI: 0.73-0.98], respectively; P = .30). Conclusion: In this prospective validation, the combination of lactate and vasopressors in the immediate postarrest period is predictive of mortality. Cytochrome c offered minimal additional predictive power.

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Cerebral Microvascular Injury in Severe COVID-19

10.1101/2020.07.21.20159376 ◽

2020 ◽

Cited By ~ 2

Author(s):

John Conklin ◽

Matthew P. Frosch ◽

Shibani Mukerji ◽

Otto Rapalino ◽

Mary Maher ◽

...

Keyword(s):

White Matter ◽

Medical Center ◽

Brain Mri ◽

Academic Medical Center ◽

Laboratory Data ◽

Deep White Matter ◽

Microvascular Injury ◽

Neurologic Deficits ◽

Academic Medical ◽

Hypoxic Respiratory Failure

IMPORTANCE: Microvascular lesions are common in patients with severe COVID-19. Radiologic-pathologic correlation in one case suggests a combination of microvascular hemorrhagic and ischemic lesions that may reflect an underlying hypoxic mechanism of injury, which requires validation in larger studies. OBJECTIVE: To determine the incidence, distribution, and clinical and histopathologic correlates of microvascular lesions in patients with severe COVID-19. DESIGN: Observational, retrospective cohort study: March to May 2020. SETTING: Single academic medical center. PARTICIPANTS: Consecutive patients (16) admitted to the intensive care unit with severe COVID-19, undergoing brain MRI for evaluation of coma or focal neurologic deficits. EXPOSURES: Not applicable. MAIN OUTCOME AND MEASURES: Hypointense microvascular lesions identified by a prototype ultrafast high-resolution susceptibility-weighted imaging (SWI) MRI sequence, counted by two neuroradiologists and categorized by neuroanatomic location. Clinical and laboratory data (most recent measurements before brain MRI). Brain autopsy and cerebrospinal fluid PCR for SARS-CoV 2 in one patient who died from severe COVID-19. RESULTS: Eleven of 16 patients (69%) had punctate and linear SWI lesions in the subcortical and deep white matter, and eight patients (50%) had >10 SWI lesions. In 4/16 patients (25%), lesions involved the corpus callosum. Brain autopsy in one patient revealed that SWI lesions corresponded to widespread microvascular injury, characterized by perivascular and parenchymal petechial hemorrhages and microscopic ischemic lesions. CONCLUSIONS AND RELEVANCE: SWI lesions are common in patients with neurological manifestations of severe COVID-19 (coma and focal neurologic deficits). The distribution of lesions is similar to that seen in patients with hypoxic respiratory failure, sepsis, and disseminated intravascular coagulation. Collectively, these radiologic and histopathologic findings suggest that patients with severe COVID-19 are at risk for multifocal microvascular hemorrhagic and ischemic lesions in the subcortical and deep white matter.

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Hyperlipidemia in noise-induced hearing loss

Otolaryngology ◽

10.1016/j.otohns.2007.04.022 ◽

2007 ◽

Vol 137 (4) ◽

pp. 603-606 ◽

Cited By ~ 25

Author(s):

Ning-Chia Chang ◽

Ming-Lung Yu ◽

Kuen-Yao Ho ◽

Chi-Kung Ho

Keyword(s):

Hearing Loss ◽

Medical Center ◽

Academic Medical Center ◽

Laboratory Data ◽

Noise Induced Hearing Loss ◽

Academic Medical ◽

Southern Taiwan ◽

And Gender ◽

One Year ◽

The Relationship

Objectives To assess the influence of hyperlipidemia on the development of noise-induced hearing loss (NIHL). Study Design This case-control study analyzed data from the Department of Preventive Medicine at one academic medical center in southern Taiwan. Subjects and Methods We collected the laboratory data from routine health examinations administered to workers who were exposed to noise greater than 85 dBA over a one-year period. We analyzed the relationships of cholesterol and triglyceride levels with NIHL. Results A total of 4071 cases were analyzed. After adjusting for age and gender, hypertriglyceridemia was found to be related to NIHL (aOR = 1.281; 95% CI, 1.088–1.507), but hypercholesterolemia was not (aOR = 0.951; 95% CI, 0.795–1.138). Conclusions This study, one of the largest to date to study the relationship between hyperlipidemia and NIHL, found that individuals with hypertriglyceridemia are at greater risk of NIHL. On the basis of this finding, workers exposed to high noise levels should be educated on control of triglyceride levels to help reduce their risk of NIHL.

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