Impact of Fluid Balance on Mortality Is Mediated by Fluid Accumulation Index in Sepsis: A Cohort Study

2020 ◽  
pp. 088506662096062
Author(s):  
Yanfei Shen ◽  
Xinmei Huang ◽  
Guolong Cai ◽  
Qianghong Xu ◽  
Caibao Hu ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Fluid Balance ◽  
Significant Risk ◽  
Logistic Models ◽  
Significant Risk Factor ◽  
Fluid Accumulation ◽  
Mediation Analyses ◽  
Accumulation Index ◽  
The Relationship ◽  
Intake Ratio

Fluid balance (FB) is associated with poor sepsis outcomes; however, it cannot accurately reflect the dynamic fluid accumulation status. Here, we explored a new index, the FB to fluid intake ratio (FB/FI), for evaluating dynamic fluid accumulation in sepsis. FB/FI values within 48 hours were recorded. Their association with in-hospital mortality was investigated using logistic regression and mediation analyses of data from 7,839 patients. In extended logistic models, a linear association was found between FB and mortality (odds ratio [OR]: 1.05-1.08, p < 0.001). However, this association became non-significant after the adjustment of FB/FI (OR: 1.00, 95% confidence interval [CI]: 0.98-1.02). For FB/FI and mortality, a cut-off value of 0.25 was defined. In the spline function logistic model, FB/FI > 0.25 was significantly associated with increased mortality (OR: 4.46, 95% CI: 2.92-6.80), whereas FB/FI ≤ 0.25 was not. For the FB/FI > 0.25 subgroup, mediation analysis was used to clarify the relationship between FB, FB/FI, and mortality. We observed that the direct effect of FB was non-significant (adjusted coefficient: −0.001, 95% CI: −0.005 to 0.002) while the indirect effect was significant (adjusted coefficient: 0.009, 95% CI: 0.006-0.011). In the FB/FI ≤ 0.25 subgroup, both the FB volume (0.9 ± 0.7 vs. −2.0 ± 1.9, p < 0.001) and the FB/FI ratio (0.14 ± 0.07 vs. −0.77 ± 1.60, p < 0.001) were significantly higher in patients with FB > 0 than those with FB ≤ 0. However, both the crude and adjusted comparisons of hospital mortality were non-significant. Similar associations were observed in septic shock patients. FB/FI > 0.25 is a significant risk factor for mortality in sepsis, while FB/FI ≤ 0.25 is not. The association between FB and mortality is completely mediated by this new fluid accumulation index. More comprehensive indices are required for evaluating dynamic fluid status in sepsis.

External Ventricular Drain Infection

2007 ◽  
Vol 107 (1) ◽  
pp. 248 ◽  
Author(s):  
George K. C. Wong ◽  
Wayne W. S. Poon
Keyword(s):  
Major Trauma ◽  
Independent Predictor ◽  
External Ventricular Drain ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
External Ventricular Drainage ◽  
Infection Rates ◽  
The Mean ◽  
The Relationship ◽  
Shed Light

Object The authors explored the relationship among the duration of external ventricular drainage, revision of external ventricular drains (EVDs), and cerebrospinal fluid (CSF) infection to shed light on the practice of electively revising these drains. Methods In a retrospective study of 199 patients with 269 EVDs in the intensive care unit at a major trauma center in Australasia, the authors found 21 CSF infections. Acinetobacter accounted for 10 (48%) of these infections. Whereas the duration of drainage was not an independent predictor of infection, multiple insertions of EVDs was a significant risk factor. Second and third EVDs in previously uninfected patients were more likely to become infected than first EVDs. An EVD infection was initially identified a mean of 5.5 ±0.7 days postinsertion (standard error of the mean); these data—that is, the number of days—were normally distributed. Conclusions This pattern of infection is best explained by EVD-associated CSF infections being acquired by the introduction of bacteria on insertion of the drain rather than by subsequent retrograde colonization. Elective EVD revision would be expected to increase infection rates in light of these results, and thus the practice has been abandoned by the authors' institution.

Preoperative in-hospital mortality in neonates with critical CHD

2021 ◽  
pp. 1-7
Author(s):  
Dennis R. Delany ◽  
Shahryar M. Chowdhury ◽  
Corinne Corrigan ◽  
Jason R. Buckley
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Patient Care ◽  
Multivariable Analysis ◽  
Health Information System ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Interrupted Aortic Arch ◽  
Administrative Dataset ◽  
Care Improvement

Abstract Objective: Data regarding preoperative mortality in neonates with critical CHD are sparse and would aid patient care and family counselling. The objective of this study was to utilise a multicentre administrative dataset to report the rate of and identify risk factors for preoperative in-hospital mortality in neonates with critical CHD across US centres. Study design: The Pediatric Health Information System database was utilised to search for newborns ≤30 days old, born 1 January 2009 to 30 June 2018, with an ICD-9/10 code for d-transposition of the great arteries, truncus arteriosus, interrupted aortic arch, or hypoplastic left heart syndrome. Preoperative in-hospital mortality was defined as patients who died prior to discharge without an ICD code for cardiac surgery or interventional catheterisation. Results: Overall preoperative mortality rate was at least 5.4% (690/12,739) and varied across diagnoses (d-TGA 2.9%, TA 8.3%, IAA 5.5%, and HLHS 7.3%) and centres (0–20.5%). In multivariable analysis, risk factors associated with preoperative mortality included preterm delivery (<37 weeks) (OR 2.3, 95% CI: 1.8–2.9; p < 0.01), low birth weight (<2.5 kg) (OR 3.8, 95% CI: 3.0–4.7; p < 0.01), and genetic abnormality (OR 1.6, 95% CI: 1.2–2.2; p < 0.01). Centre average surgical volume was not a significant risk factor. Conclusion: Approximately 1 in 20 neonates with critical CHD suffered preoperative in-hospital mortality, and rates varied across diagnoses and centres. Better understanding of the factors that drive the variation (e.g. patient factors, preoperative care models, surgical timing) could help identify patient care improvement opportunities and inform conversations with families.

scholarly journals High dose intravenous vitamin C treatment in Sepsis: associations with acute kidney injury and mortality

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thomas R. McCune ◽  
Angela J. Toepp ◽  
Brynn E. Sheehan ◽  
Muhammad Shaheer K. Sherani ◽  
Stephen T. Petr ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Vitamin C ◽  
Hospital Mortality ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
High Dose ◽  
Clinical Covariates ◽  
Observational Cohort ◽  
Intravenous Vitamin

Abstract Background The effects of vitamin C on clinical outcomes in critically ill patients remain controversial due to inconclusive studies. This retrospective observational cohort study evaluated the effects of vitamin C therapy on acute kidney injury (AKI) and mortality among septic patients. Methods Electronic medical records of 1390 patients from an academic hospital who were categorized as Treatment (received at least one dose of 1.5 g IV vitamin C, n = 212) or Comparison (received no, or less than 1.5 g IV vitamin C, n = 1178) were reviewed. Propensity score matching was conducted to balance a number of covariates between groups. Multivariate logistic regressions were conducted predicting AKI and in-hospital mortality among the full sample and a sub-sample of patients seen in the ICU. Results Data revealed that vitamin C therapy was associated with increases in AKI (OR = 2.07 95% CI [1.46–2.93]) and in-hospital mortality (OR = 1.67 95% CI [1.003–2.78]) after adjusting for demographic and clinical covariates. When stratified to examine ICU patients, vitamin C therapy remained a significant risk factor of AKI (OR = 1.61 95% CI [1.09–2.39]) and provided no protective benefit against mortality (OR = 0.79 95% CI [0.48–1.31]). Conclusion Ongoing use of high dose vitamin C in sepsis should be appraised due to observed associations with AKI and death.

scholarly journals High Dose Intravenous Vitamin C Treatment in Sepsis: Associations with Acute Kidney Injury and Mortality Running Title Vitamin C associated AKI and mortality

2021 ◽  
Author(s):  
Thomas McCune ◽  
Brynn E Sheehan ◽  
Muhammad Shaheer K Sherani ◽  
Stephan T Petr ◽  
Angela J Toepp ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Vitamin C ◽  
Hospital Mortality ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
High Dose ◽  
Clinical Covariates ◽  
Observational Cohort ◽  
Intravenous Vitamin

Abstract The effects of vitamin C on clinical outcomes in critically ill patients remain controversial due to inconclusive studies. This retrospective observational cohort study evaluated the effects of vitamin C therapy on acute kidney injury (AKI) and mortality among septic patients. Participants were 1390 patients from an academic hospital who were categorized as Treatment (received at least one dose of 1.5g IV vitamin C, n = 212) or Comparison (received no, or less than 1.5g IV vitamin C, n = 1178). Propensity score matching was conducted to balance a number of covariates between groups. Multivariate logistic regressions were conducted predicting AKI and in-hospital mortality among the full sample and a sub-sample of patients seen in the ICU. Results revealed that vitamin C therapy was associated with increases in AKI (OR = 2.07 95% CI [1.46–2.93]) and in-hospital mortality (OR = 1.67 95% CI [1.003–2.78]) after adjusting for demographic and clinical covariates. When stratified to examine ICU patients, vitamin C therapy remained a significant risk factor of AKI (OR = 1.61 95% CI [1.09–2.39]) and provided no protective benefit against mortality (OR = 0.79 95% CI [0.48–1.31]). Ongoing use of high dose vitamin C in sepsis should be appraised due to observed associations with AKI and death.

scholarly journals Prevalence of Gastroesophageal Reflux in Infants with Recurrent Brief Apneic Episodes

1999 ◽  
Vol 6 (5) ◽  
pp. 401-404 ◽  
Author(s):  
Shahid Sheikh ◽  
Thomas C Stephen ◽  
Barbara Sisson
Keyword(s):  
Risk Factor ◽  
Gastroesophageal Reflux ◽  
Medical Records ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Acid Reflux ◽  
Diagnostic Dilemma ◽  
Esophageal Ph ◽  
Life Threatening ◽  
The Relationship

BACKGROUND: Apnea in an infant can be a diagnostic dilemma for the treating pediatrician. It is suggested that in some infants, gastroesophageal reflux (GER) might be a factor in the pathogenesis of apnea, although its role as a cause of apnea is still controversial.OBJECTIVE: To evaluate the prevalence of GER in infants presenting with recurrent brief apneic periods.PATIENTS AND METHODS: A retrospective review of the medical records of all the infants who underwent prolonged esophageal pH studies for brief apneic episodes (n=105) at the Kosair Children’s Hospital in the six years from January 1992 to December 1997 was performed. Infants presenting with apparent life-threatening episodes were excluded.RESULTS: Of 105 infants, 72 (68.6%) were younger than two months of age and 22 (21%) were born preterm. Fifty of 105 infants (47.6%) had positive esophageal pH studies for acid reflux. Among infants with positive pH studies, only 21 (42%) had associated gastrointestinal or feeding complaints.CONCLUSION: GER is present in a large number of infants presenting with brief apneic episodes. Though the relationship between the two is still not fully established, GER may be a significant risk factor for such apneic episodes in infants.

scholarly journals The Relationship Between Padi4 -94G/A Polymorphism and Rheumatoid Arthritis: A Meta-analysis in Multi Ethnic Groups

2020 ◽  
Author(s):  
Changchun Jian ◽  
Jingsong Pu
Keyword(s):  
Rheumatoid Arthritis ◽  
Ethnic Groups ◽  
Meta Analysis ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Peptidylarginine Deiminase ◽  
Increased Risk ◽  
Different Populations ◽  
The Relationship ◽  
Strength Of Association

Abstract Background: A number of studies have reported the association between peptidylarginine deiminase 4 (PADI4) -94G/A polymorphisms and rheumatoid arthritis (RA) risk in different populations, however, the results remained inconclusive. Objecitve: We therefore aim to address this association by performed an updated meta-analysis in multi ethnic groups. Methods: The PubMed and Chinese related databases were searched up to January 2019. The strength of association between PADI -94G/A polymorphism and RA susceptibility was assessed with odds ratios (ORs) and 95% confidence intervals (CIs). Results: A total of 22 studies with 14514 RA cases and 21138 controls were finally included in the analysis. Six ethnic groups such as China, Japan, USA, UK, Sweden and Spain were contained. In the overall population, it revealed that PADI -94G/A polymorphism was significantly associated with an increased risk of RA. In the subgroup analyses by ethnicity, significant association was found in China as well as in Japan and USA. Conclusions: This meta-analysis demonstrates that the PADI4 -94G/A polymorphisms may represent a significant risk factor for RA in China, in Japan and USA. Further studies are needed to clarify this finding, since most available studies were conducted among Chinese and Japanese in this study.

scholarly journals Anticoagulant Use as an Independent Risk Factor and Higher In-Hospital Mortality in Patients Showing Alveolar Hemorrhage in Diffuse Lung Disease

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1094
Author(s):  
Motoi Ugajin ◽  
Hisanori Kani ◽  
Hideo Hattori
Keyword(s):  
Risk Factor ◽  
Hospital Mortality ◽  
Lung Disease ◽  
Interstitial Pneumonia ◽  
Lupus Erythematosus ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Alveolar Hemorrhage ◽  
Diffuse Lung Disease ◽  
Diffuse Lung

Background and objectives: Bronchoalveolar lavage (BAL) is commonly performed to evaluate diffuse lung disease and occasionally to identify alveolar hemorrhage. However, the clinical impact of alveolar hemorrhage and its risk factors in patients with diffuse lung disease have not been clarified. Materials and Methods: We retrospectively analyzed the medical records of all patients who underwent BAL to evaluate diffuse lung disease from January 2017 to December 2020. Alveolar hemorrhage was defined as progressive hemorrhagic BAL fluid or the presence of ≥20% hemosiderin-laden macrophages in the BAL fluid. Logistic regression analysis was performed to assess the association between alveolar hemorrhage and other factors. Results: Sixty subjects were enrolled in this study. Alveolar hemorrhage was observed in 19 subjects (31.7%) with idiopathic interstitial pneumonia, acute respiratory distress syndrome, interstitial pneumonia with autoimmune features, drug-induced lung injury, eosinophilic pneumonia, adenocarcinoma, and systemic lupus erythematosus. The use of anticoagulants was a significant risk factor for alveolar hemorrhage (odds ratio 7.57, p = 0.049). Patients with alveolar hemorrhage required intubated mechanical ventilation more frequently (63.2% vs. 24.4%, p = 0.005) and had higher in-hospital mortality rates (26.3% vs. 4.9%, p = 0.028) than those without alveolar hemorrhage. Conclusions: Alveolar hemorrhage was observed in various etiologies. The use of anticoagulants was a significant risk factor for alveolar hemorrhage. Patients with alveolar hemorrhage showed more severe respiratory failure and had higher in-hospital mortality than those without alveolar hemorrhage.

Obesity and hypertension

2013 ◽  
Vol 154 (44) ◽  
pp. 1736-1742 ◽  
Author(s):  
Gábor Simonyi ◽  
Réka Kollár
Keyword(s):  
Sympathetic Activity ◽  
Cardiac Death ◽  
Cardiovascular Events ◽  
Significant Risk ◽  
Vagal Tone ◽  
Significant Risk Factor ◽  
Autonomous Nervous System ◽  
Body Fat Mass ◽  
The Relationship ◽  
Increased Activity

The frequency of hypertension and obesity is gradually growing in Hungary. At present 68.5% of men and 78% of women are obese. Hypertension and obesity are the most important risk factors of morbidity and mortality from cardiovascular disease. The relationship between increased sympathetic activity and hypertension is well known. Waist circumference and body fat mass correlate significantly with sympathetic activity, in which hyperlipidemia plays also a role. The increased activity of renin-angiotensin-aldosterone system via its vascular and renal effects also contributes to an increase of blood pressure. Increased sympathetic activity with decreasing vagal tone accompanying the imbalance of the autonomous nervous system is independent and significant risk factor of cardiovascular events including sudden cardiac death. Orv. Hetil., 154 (44), 1736–1742.

Tobacco Use and Its Effects on the Periodontium and Periodontal Therapy

2008 ◽  
Vol 9 (7) ◽  
pp. 97-107 ◽  
Author(s):  
Vandana K. Laxman ◽  
Sridhar Annaji
Keyword(s):  
Periodontal Disease ◽  
Tobacco Use ◽  
Tobacco Smoking ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Periodontal Therapy ◽  
Response To Treatment ◽  
Periodontal Health ◽  
Health Maintenance ◽  
The Relationship

Abstract Aim The purpose of this article is to present a review of the potential biological mechanisms underlying the effects of tobacco smoking on periodontal health and periodontal therapy. Background Periodontitis is the result of complex interrelationships between infectious agents and host factors. Environmental, acquired, and genetic risk factors modify the expression of disease and may, therefore, affect the onset or progression of periodontitis. Review Results The study of the relationship between periodontal disease and smoking has received increased attention during the last few years. Tobacco smoking has wide spread systemic effects, many of which may provide mechanisms for the increased susceptibility to periodontitis and the poorer response to treatment. Conclusion Tobacco smoking is a significant risk factor for periodontal disease. Clinical Significance The role smoking plays in periodontal disease should be considered by clinicians and patients during active periodontal therapy and the oral health maintenance phases of care. Citation Laxman VK, Annaji S. Tobacco Use and Its Effects on the Periodontium and Periodontal Therapy. J Contemp Dent Pract 2008 November; (9)7:097-107.

scholarly journals Risk of Dementia Associated with Elevated Plasma Homocysteine in a Latin American Population

2009 ◽  
Vol 2009 ◽  
pp. 1-6 ◽  
Author(s):  
Inara J. Chacón ◽  
Aldrín E. Molero ◽  
Gloria Pino-Ramírez ◽  
José A. Luchsinger ◽  
Joseph H. Lee ◽  
...  
Keyword(s):  
Latin American ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Dementia Risk ◽  
High Prevalence ◽  
Aging Study ◽  
History Of ◽  
Total Homocysteine ◽  
The Relationship ◽  
Latin American Population

The relationship between total homocysteine (tHcy) and dementia risk remains controversial, as the association varies among populations and dementia subtypes. We studied a Venezuelan population that has high prevalence of both elevated tHcy and dementia. We tested the hypotheses that (1) elevated tHcy is associated with increased dementia risk, (2) the risk is greater for vascular dementia (VaD) than for Alzheimer's disease (AD), and (3) a history of stroke may partly explain this association. 2100 participants (≥55 years old) of the Maracaibo Aging Study underwent standardized neurological, neuropsychiatric, and cardiovascular assessments. Elevated tHcy was significantly associated with dementia, primarily VaD. When history of stroke and other confounding factors were taken into account, elevated tHcy remained a significant risk factor in older (>66 years), but not in younger (55–66 years) subjects. Ongoing studies of this population may provide insight into the mechanism by which tHcy increases risk for dementia.

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