Impact of Ursodeoxycholic Acid in Critically Ill Patients With Sepsis: A Retrospective Study

Background: Using ursodeoxycholic acid (UDCA) in critically ill patients as adjunctive therapy for sepsis/septic shock in neonates and children is controversial, while it has not been extensively investigated in adults. This study aims to assess the effect of UDCA use on the early resolution of sepsis/septic shock in critically ill adult patients. Method: A retrospective study of critically ill adult patients in the intensive care unit (ICU) admitted with sepsis/septic shock at King Abdulaziz Medical City. Based on their usage of UDCA, patients were categorized into two groups. A total of 88 patients were included for analysis after matching, based on severity of illness scores within 24-hours of ICU admission. The primary outcome was to assess the effect of UDCA on the severity and resolution of shock at day three of ICU admission. The secondary outcomes were 30-day in-hospital mortality, mechanical ventilation (MV) duration, and ICU length of stay (LOS). Results: Out of the 88 patients matched, 44 patients (50%) received UDCA during the study period. Using UDCA was neither associated with improvement in Sequential Organ Failure Assessment (SOFA) score ( p-value: 0.32), inotropes/vasopressors requirement ( p-value: 0.79), Glasgow Coma Scale (GCS) ( p-value: 0.59) nor total bilirubin levels ( p-value: 0.79) at day three compared with the control. There was a significant association between using UDCA and improvement in PaO2/FiO2 ratio ( p-value: 0.01) and early extubation at day three ( p-value: 0.04). Conclusion: Using UDCA in critically ill patients with sepsis/septic shock was not associated with improvement in shock severity and resolution. However, patients who received UDCA were more likely to be extubated and not require MV on day three of ICU admission.

Download Full-text

Early Versus Late Use of Dexamethasone in Critically Ill Patients With COVID-19: A Multicenter, Prospective Cohort Study

10.21203/rs.3.rs-349677/v1 ◽

2021 ◽

Author(s):

Khalid Al Sulaiman ◽

Alaa Alhubaishi ◽

Ohoud Al Juhani ◽

Khalid Eljaaly ◽

Omar Al Harbi ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Early Initiation ◽

P Value ◽

Icu Mortality ◽

Icu Admission ◽

Icu Length Of Stay ◽

Beta Coefficient ◽

Multicenter Prospective Cohort Study

Abstract Background: Corticosteroids, especially dexamethasone, showed a survival benefit in critically ill COVID 19 patients. However, it is unclear whether the timing of dexamethasone initiation is associated with positive outcomes. The aim of this study is to evaluate the timing of dexamethasone initiation and 30-day ICU mortality in critically ill patients with COVID19. Methods: A multicenter, non-interventional, prospective study for all adult COVID19 admitted to intensive care units (ICUs) who received systemic dexamethasone between March 01 to December 31, 2020. Patients were divided into two groups based on the timing for dexamethasone initiation (early vs. late). Early use defined as the initiation of dexamethasone within three days of ICU admission. Multivariate logistic and generalized linear regression were used. We considered a P value of < 0.05 statistically significant. Results: A total of 475 patients were included in the study; dexamethasone was initiated early within three days of ICU admission in 433 patients. Early initiation of dexamethasone was associated with lower 30-day ICU mortality (OR [95%CI]: 0.43 [0.23, 0.81], p-value = 0.01), and acute kidney injury during ICU stay, (OR [95%CI]: 0.45 [0.21, 0.94], p-value = 0.03). Additionally, among survivors, early initiation was associated with shorter MV duration (beta coefficient [95% CI]: -0.94 [-1.477, -0.395], p-value = 0.0001), ICU length of stay (LOS) (beta coefficient [95%CI]: -0.73 [-0.9971, -0.469], p-value = 0.0001), and hospital LOS (beta coefficient [95%CI]: -0.68 [-0.913, -0.452], p-value = 0.0001). Conclusion: Early initiation of dexamethasone within three days of ICU admission in COVID-19 critically ill patients was associated with a mortality benefit. Additionally, it was associated with shorter MV duration, hospital, and ICU LOS.

Download Full-text

Colistin-Resistant Acinetobacter Baumannii Bacteremia: A Serious Threat for Critically Ill Patients

Microorganisms ◽

10.3390/microorganisms8020287 ◽

2020 ◽

Vol 8 (2) ◽

pp. 287 ◽

Cited By ~ 4

Author(s):

Georgios Papathanakos ◽

Ioannis Andrianopoulos ◽

Athanasios Papathanasiou ◽

Efthalia Priavali ◽

Despoina Koulenti ◽

...

Keyword(s):

Septic Shock ◽

Acinetobacter Baumannii ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Problem ◽

Hospital Infections ◽

Colistin Resistance ◽

Icu Patients ◽

Icu Admission ◽

Comorbidity Index

The prevalence of acinetobacter baumannii (AB) as a cause of hospital infections has been rising. Unfortunately, emerging colistin resistance limits therapeutic options and affects the outcome. The aim of the study was to confirm our clinically-driven hypothesis that intensive care unit (ICU) patients with AB resistant-to-colistin (ABCoR) bloodstream infection (BSI) develop fulminant septic shock and die. We conducted a 28-month retrospective observational study including all patients developing AB infection on ICU admission or during ICU stay. From 622 screened patients, 31 patients with BSI sepsis were identified. Thirteen (41.9%) patients had ABCoR BSI and 18/31 (58.1%) had colistin-susceptible (ABCoS) BSI. All ABCoR BSI patients died; of them, 69% (9/13) presented with fulminant septic shock and died within the first 3 days from its onset. ABCoR BSI patients compared to ABCoS BSI patients had higher mortality (100% vs. 50%, respectively (p = 0.001)), died sooner (p = 0.006), had lower pH (p = 0.004) and higher lactate on ICU admission (p = 0.0001), and had higher APACHE II (p = 0.01) and Charlson Comorbidity Index scores (p = 0.044). In conclusion, we documented that critically ill patients with ABCoR BSI exhibit fulminant septic shock with excessive mortality. Our results highlight the emerging clinical problem of AB colistin resistance among ICU patients.

Download Full-text

The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study

10.21203/rs.3.rs-50431/v1 ◽

2020 ◽

Author(s):

Ling Sang ◽

Sibei Chen ◽

Xia Zheng ◽

Weijie Guan ◽

Zhihui Zhang ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Retrospective Study ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Right Heart Failure ◽

Right Heart ◽

Icu Admission ◽

Incidence Risk

Abstract Background: Since the clinical correlates, prognosis and determinants of AKI in patients with Covid-19 remain largely unclear, we perform a retrospective study to evaluate the incidence, risk factors and prognosis of AKI in severe and critically ill patients with Covid-19.Methods: We reviewed medical records of all adult patients (>18 years) with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University. The clinical data, including patient demographics, clinical symptoms and signs, laboratory findings, treatment [including respiratory supports, use of medications and continuous renal replacement therapy (CRRT)] and clinical outcomes, were extracted from the electronic records, and we access the incidence of AKI and the use of CRRT, risk factors for AKI, the outcomes of renal diseases, and the impact of AKI on the clinical outcomes.Results: Among 210 subjects, 131 were males (62.4%). The median age was 64 years (IQR: 56-71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) patients were classified as stage 1, 2 and 3, respectively. 54 cases (58.7%) received CRRT. Age, sepsis, Nephrotoxic drug, IMV and elevated baseline Scr were associated with AKI occurrence. The renal recover during hospitalization among 16 AKI patients (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure and higher P/F ratio. Of 210 patients, 93 patients deceased within 28 days of ICU admission. AKI stage 3, critical disease, greater age and minimum P/F <150mmHg independently associated with it.Conclusions: Among patients with Covid-19, the incidence of AKI was high. age , sepsis, nephrotoxic drug, IMV and baseline Scr were strongly associated with the development of AKI. Time from admission to AKI diagnosis, right heart failure and P/F ratio were independently associated with the potential of renal recovery. Finally, AKI KIDGO stage 3 independently predicted the risk of death within 28 days of ICU admission.

Download Full-text

Clinical characteristics and outcomes of patients with heart failure admitted to the intensive care unit with coronavirus disease 2019 (COVID19): a multicenter cohort study

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab060.041 ◽

2021 ◽

Vol 20 (Supplement_1) ◽

Author(s):

H Badreldin ◽

DR Hafidh ◽

DR Bin Saleh ◽

DR Al Sulaiman ◽

DR Al Juhani ◽

...

Keyword(s):

Heart Failure ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Characteristics ◽

P Value ◽

Heart Failure Patients ◽

Icu Admission ◽

Patients With Heart Failure

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients with heart failure in the setting of COVID-19 requiring admission to the intensive care unit may present a set of unique challenges. There is limited data to describe the clinical characteristics and outcomes in this subset of the patient population. Purpose The study"s purpose was to extensively describe the characteristics and outcomes of heart failure patients admitted to the intensive care unit with COVID-19 compared to non-heart failure patients . Methods We conducted a multicenter, prospective analysis for all adult critically ill patients with heart failure admitted to intensive care units (ICUs) between March 1 to August 31, 2020, with an objectively confirmed diagnosis of COVID-19. Results A total of 723 critically ill patients with COVID-19 had been admitted in ICUs, 59 patients with heart failure, and 664 patients with no heart failure before ICU admission. Heart failure patients had significantly more comorbid conditions such as diabetes mellitus, hypertension, dyslipidemia, atrial fibrillation, and acute coronary syndrome. Higher baseline severity scores (APACHE II & SOFA score) and nutritional risk (NUTRIC Score) were observed in heart failure patients. Also, heart failure patients had more acute kidney injury during ICU admission and required more mechanical ventilation within 24 hours of ICU admission. Patients with heart failure had a similar incidence of thrombosis compared to patients with no heart failure. Critically ill patients with COVID-19 and heart failure had similar ICU length of stay (LOS), mechanical ventilation duration, and hospital LOS compared to patients with no heart failure. During ICU stay, patients with heart failure had more in-hospital and ICU deaths in comparison to the non-heart failure group (64.3% vs. 44.6%, P-value <0.01) and (54.5% vs. 39%, P-value = 0.02) respectively. Conclusion In this observational study evaluating the clinical characteristics and outcomes of critically ill COVID-19 patients with heart failure, patients with COVID-19 and heart failure had similar ICU LOS, duration of MV and hospital LOS, thrombosis rate compared to patients with no heart failure. However, during ICU stay, patients with heart failure had more in-hospital and ICU deaths than the non-heart failure group.

Download Full-text

Evaluation of standard dosing for selected broad spectrum Hydrophilic antibiotics in critically ill patients with Augmented renal clearance: An observational Study

10.21203/rs.3.rs-726484/v3 ◽

2021 ◽

Author(s):

Majed Almutairi ◽

Khalid Al Sulaiman ◽

Sultan Alenazi ◽

Ramesh Vishwakarma ◽

Ohoud Aljuhani

Keyword(s):

Renal Clearance ◽

Clinical Outcomes ◽

Critically Ill ◽

Broad Spectrum ◽

Critically Ill Patients ◽

P Value ◽

Augmented Renal Clearance ◽

Medical City ◽

Calculated Creatinine Clearance ◽

Inappropriate Antibiotics

Abstract Background: Inappropriate antibiotics dosing in critically ill patients with augmented renal clearance (ARC) may be associated with pathogens resistance and worse outcomes. Unfortunately, studies regarding the relationship between ARC and clinical outcomes in patients treated with antibiotics medication are rare. The study evaluates the efficacy and clinical outcomes of selected broad-spectrum hydrophilic antibiotics in ARC critically ill patients with confirmed infections. Methods: A retrospective cohort study in adult critically ill patients who were admitted to intensive care units (ICUs) at King Abdulaziz Medical City (KAMC)-Riyadh and received standard dosing of selected broad-spectrum hydrophilic antibiotics (Meropenem, Imipenem, or Piperacillin/Tazobactam) with confirmed infection. All the patients who met our inclusion criteria during the study period (01/01/2018 – 31/12/2019) were included. Eligible patients have been divided into two groups (ARC Vs. non-ARC) according to the calculated creatinine clearance using the Cockcroft-Gault equation. The primary outcome was to assess pathogen eradication at 10-14 days; other outcomes were considered secondary. Multivariate logistic and generalized linear regression analyses were used. We considered a P value of < 0.05 statistically significant. Results: A total of 133 patients were included in the study; 67 Patients had ARC. The distribution of infections and types of pathogens between the groups were the same. The pathogen eradication at 10-14 days was similar between the two groups (OR 1.08; 95% CI, 0.41–2.78 p = 0.88). Moreover, the odds of resistance development and persistence after 3 days were not significantly different between the groups ((OR 0.78; 95% CI, 0.25–2.40 p = 0.66) and (OR 0.88; 95% CI, 0.35–2.18 p = 0.78) respectively). Conclusion: Using standard dosing of Meropenem, Imipenem, or Piperacillin/Tazobactam in ARC patients was not associated with therapy failure. Further randomized clinical and interventional studies are required to confirm our findings.

Download Full-text

Serum renin and major adverse kidney events in critically ill patients: a multicenter prospective study

Critical Care ◽

10.1186/s13054-021-03725-z ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Alexander H. Flannery ◽

Victor Ortiz-Soriano ◽

Xilong Li ◽

Fabiola G. Gianella ◽

Robert D. Toto ◽

...

Keyword(s):

Critically Ill ◽

Multicenter Study ◽

Critically Ill Patients ◽

Kidney Injury ◽

Severity Of Illness ◽

Renin Angiotensin System ◽

Icu Admission ◽

Kidney Replacement Therapy ◽

The Individual ◽

Major Adverse Kidney Events

Abstract Background Preliminary studies have suggested that the renin-angiotensin system is activated in critical illness and associated with mortality and kidney outcomes. We sought to assess in a larger, multicenter study the relationship between serum renin and Major Adverse Kidney Events (MAKE) in intensive care unit (ICU) patients. Methods Prospective, multicenter study at two institutions of patients with and without acute kidney injury (AKI). Blood samples were collected for renin measurement a median of 2 days into the index ICU admission and 5–7 days later. The primary outcome was MAKE at hospital discharge, a composite of mortality, kidney replacement therapy, or reduced estimated glomerular filtration rate to ≤ 75% of baseline. Results Patients in the highest renin tertile were more severely ill overall, including more AKI, vasopressor-dependence, and severity of illness. MAKE were significantly greater in the highest renin tertile compared to the first and second tertiles. In multivariable logistic regression, this initial measurement of renin remained significantly associated with both MAKE as well as the individual component of mortality. The association of renin with MAKE in survivors was not statistically significant. Renin measurements at the second time point were also higher in patients with MAKE. The trajectory of the renin measurements between time 1 and 2 was distinct when comparing death versus survival, but not when comparing MAKE versus those without. Conclusions In a broad cohort of critically ill patients, serum renin measured early in the ICU admission is associated with MAKE at discharge, particularly mortality.

Download Full-text

Association between phosphate disturbances and mortality among critically ill patients with sepsis or septic shock

BMC Pharmacology and Toxicology ◽

10.1186/s40360-021-00487-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Shmeylan A. Al Harbi ◽

Hasan M. Al-Dorzi ◽

Albatool M. Al Meshari ◽

Hani Tamim ◽

Sheryl Ann I. Abdukahil ◽

...

Keyword(s):

Septic Shock ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Clinical Characteristics ◽

Serum Phosphate ◽

The Other ◽

Icu Admission ◽

Surgical Icus

Abstract Objective The aim of this study is to examine the association of hypophosphatemia and hyperphosphatemia on the first day of ICU admission with mortality in septic critically ill patients. Methods In this retrospective cohort study, all adult patients who were admitted to the medical-surgical ICUs between 2014 and 2017 with sepsis or septic shock were categorized as having hypophosphatemia, normophosphatemia and hyperphosphatemia based on day 1 serum phosphate values. We compared the clinical characteristics and outcomes between the three groups. We used multivariate analysis to examine the association of hypophosphatemia and hyperphosphatemia with these outcomes. Results Of the 1422 patients enrolled in the study, 188 (13%) had hypophosphatemia, 865 (61%) normophosphatemia and 369 (26%) had hyperphosphatemia. The patients in the hyperphosphatemia group had significantly lower GCS, higher APACHE II scores, higher serum creatinine, increased use of vasopressors, and required more mechanical ventilation with lower PaO2/FiO2 ratio compared with the other two groups. In addition, the hyperphosphatemia group showed significantly higher ICU and hospital mortality in comparison with the other two groups. Conclusion Hyperphosphatemia and not hypophosphatemia on the first ICU admission day was associated with an increase in the ICU and hospital mortality in septic critically ill patients.

Download Full-text

Evaluation of standard dosing for selected broad spectrum Hydrophilic antibiotics in critically ill patients with Augmented renal clearance: An observational Study

10.21203/rs.3.rs-726484/v2 ◽

2021 ◽

Author(s):

Majed Almutairi ◽

Khalid Al Sulaiman ◽

Sultan Alenazi ◽

Ramesh Vishwakarma ◽

Ohoud Aljuhani

Keyword(s):

Renal Clearance ◽

Clinical Outcomes ◽

Critically Ill ◽

Broad Spectrum ◽

Critically Ill Patients ◽

P Value ◽

Augmented Renal Clearance ◽

Medical City ◽

Calculated Creatinine Clearance ◽

Inappropriate Antibiotics

Download Full-text

Association Between Phosphate Disturbances and Mortality Among Critically Ill Patients With Sepsis or Septic Shock

10.21203/rs.3.rs-149787/v1 ◽

2021 ◽

Author(s):

Shmeylan Al Harbi ◽

Hasan Al-Dorzi ◽

Albatool Al Meshari ◽

Hani Tamim ◽

Sheryl Ann Abdukahil ◽

...

Keyword(s):

Septic Shock ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Serum Phosphate ◽

The Other ◽

Icu Mortality ◽

Icu Admission ◽

Surgical Icus

Abstract Objective: The aim of this study is to examine the association of hypophosphatemia and hyperphosphatemia on the first day of ICU admission with mortality in septic critically ill patients. Methods: In this retrospective cohort study, all adult patients who were admitted to medical-surgical ICUs between 2014 and 2017 with sepsis or septic shock were categorized as having hypophosphatemia, hyperphosphatemia or based on day 1 serum phosphate values. We compared the clinical characteristics and outcomes between the three groups. We used multivariate analysis to examine the association of hypophosphatemia and hyperphosphatemia with these outcomes.Results: Of the 1422 patients enrolled in the study, 188 (13%) had hypophosphatemia, 865 (61%) normophosphatemia and 369 (26%) had hyperphosphatemia. Among the three groups, the patients in the hyperphosphatemia group had significantly lower GCS, higher APACHE II scores, higher serum creatinine, increased use of vasopressors, and required mechanical ventilation with lower PaO2/FiO2 ratio compared with the other two groups. In addition, hyperphosphatemia group also showed significantly higher ICU mortality and hospital mortality in comparison to the other two groups. Conclusion: Hyperphosphatemia and not hypophosphatemia on the first ICU admission day was associated with an increase in the ICU and hospital mortality in septic critically ill patients.

Download Full-text

Clinical characteristics and risk factors for severe-critically ill COVID-19 adult patients in Jiangsu, China: a multiple-centered, retrospective study

10.21203/rs.3.rs-28628/v1 ◽

2020 ◽

Author(s):

Jiangnan Zhao ◽

Meiying Zhu ◽

Xin Su ◽

Mao Huang ◽

Yi Yang ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Characteristics ◽

Final Analysis ◽

Adult Patients ◽

Potential Risk Factors ◽

Critically Illness ◽

D Dimer

Abstract Background A number of reports have documented the clinical characteristics of patients with severe coronavirus disease 2019 (COVID-19) in Wuhan. Clinical features of severe-critically ill COVID-19 patients in Jiangsu, outside Wuhan, remains unknown. Methods This multi-centered retrospective study collected the information of 631 laboratory-confirmed COVID-19 patients hospitalized at 28 authorized hospitals in Jiangsu province between January 23, 2019 and March 13, 2020. Epidemiological and demographic information, clinical and radiological characteristics, laboratory results and treatment of these patients were analyzed. Results A total of 583 adult patients with laboratory-confirmed COVID-19 were enrolled for final analysis, including 84 severe-critically ill patients and 499 mild-moderate patients. Median age of the severe-critically ill patients was 57.0 years [interquartile range (IQR), 49.0-65.8], and 50 (59.5%) were males. Multisystemic laboratory abnormalities were observed on admission in severe-critically ill patients. The severe-critically ill patients showed more noticeable radiologic abnormalities and more coexisting health issues as compared to mild-moderate patients. Most of the severe-critically ill COVID-19 patients become deteriorated in two weeks after diagnosis. Age [odds ratio (OR) 1.08, 95% confidence interval (CI) (1.03-1.14)], D-dimer (OR 3.21, 95% CI 1.39-7.40), and lymphocytes (OR 0.28, 95% CI 0.04-0.88) were independently associated with the progression of severe-critically illness. Conclusions Older age, higher D-dimer levels and less lymphocyte counts on admission are potential risk factors for COVID-19 patients to develop into severe and critically illness. The results would help clinicians to identify high-risk patients in advance.

Download Full-text