Factors Predicting the Outcome of the Blood and Marrow Transplant Patients Admitted to Intensive Care Unit.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3340-3340
Author(s):  
Nalini K Pati ◽  
Biju George ◽  
Ian Kerridge ◽  
Nicole Gilroy ◽  
Vineet Nayyar ◽  
...  
Keyword(s):  
Intensive Care ◽  
Organ Failure ◽  
Apache Ii ◽  
Haematopoietic Stem Cell ◽  
Apache Ii Score ◽  
Allogeneic Hsct ◽  
Icu Admission ◽  
Poor Outcome ◽  
Organ Failures ◽  
Steroid Refractory

Abstract Abstract 3340 Poster Board III-228 Aim: To identify factors predicting outcome of patients admitted to intensive care (ICU) following allogeneic haematopoietic stem cell transplantation (allo-HSCT). Methods: Retrospective audit of all allo-HSCT patients requiring ICU admission. Results: Between 2000 and 2009, 392 patients underwent allo-HSCT. Of these, 106 (27%) had 129 ICU admissions. The median age was 47 (range 16-65) with myeloablative transplant in 89 and reduced intensity in 40 patients. Respiratory failure was the main reason for admission (54.6%) followed by sepsis (41.5%). During the period of ICU admission, 29.2% demonstrated improvement in organ failures, 39.2% remained stable and 28.4% deteriorated. Sixty-seven patients (51.9%) were discharged from ICU but only 48 (37%) were subsequently discharged from the hospital (ICU). Univariate analysis identified ICU admission within 30 days post HSCT, number of organ failures at admission, progression of organ failure during ICU admission, APACHE II score at admission, steroid refractory GVHD, and requirement for inotropic support or dialysis as significant predictors for survival in ICU. Patients requiring intubation and mechanical ventilation had a poorer outcome than the group who did not (84.4% Vs 20.0%, p=0.001). Those who required only non-invasive ventilation generally had a good outcome with 84.4% surviving til ICU discharge. While bacterial infection prior to ICU admission did not alter the outcome (p=0.221), the onset of a new infection in ICU was associated with a poor outcome (p=0.0001). Logistic regression analysis identified steroid refractory GvHD (P=0.027; 95% CI of 1.17-14.8), APACHE II score > 30 (p=0.003; 95% CI 1.5-10.5), admission <30 days post HSCT (p = 0.015; 95% CI 0.12-0.8), requirement of invasive ventilatory support (p = 0.005, 95% CI 2.58 – 223.83) and dialysis (p = 0.011; 95%CI 1.401 – 13.20) as significant factors for a poor outcome. Conclusion: More than 50% of patients admitted to ICU following allogeneic HSCT survive. A high APACHE II score, steroid refractory GVHD, admission into ICU within 30 days of HSCT, multiorgan failure, progression of organ failure during ICU stay, and the need for ventilation or dialysis, carries a dismal prognosis. Identification of risk factors associated with a poor outcome will assist in clinical management and may ultimately improve the outcome of patients requiring ICU admission following allogeneic HSCT. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

2020 ◽  
Author(s):  
Toshifumi Fujiwara ◽  
Kentaro Tokuda ◽  
Kenta Momii ◽  
Kyohei Shiomoto ◽  
Hidetoshi Tsushima ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Intensive Care Units ◽  
Fatal Outcome ◽  
Laboratory Data ◽  
International Normalized Ratio ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Admission

Abstract Background: Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs). Methods: This was a retrospective observational study. This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and December 2017. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU.Results: Upon admission, the median age was 70 (range, 33–96) years, and RA duration was 10 (range, 0–61) years. The 5-year survival after ICU admission was 47%, and 30-day, 90-day, and 1-year mortality rates were 22%, 27%, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvival was associated with a significantly higher glucocorticoid dose, updated Charlson’s comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. Laboratory data obtained at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. The multivariate Cox proportional hazard model revealed that nonuse of csDMARDs, high updated CCI, increased APACHE II score, and prolonged PT-INR were associated with a higher risk of mortality after ICU admission.Conclusion: Our study demonstrated that the nonuse of csDMARDs, high updated CCI, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU.

Prognostic factors for patients with lymphoma requiring intensive care

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17519-17519
Author(s):  
A. Scheliga ◽  
F. M. Vieira ◽  
N. Spector ◽  
S. Romano ◽  
J. I. Salluh ◽  
...  
Keyword(s):  
Intensive Care ◽  
Hospital Mortality ◽  
Hodgkin’S Lymphoma ◽  
Male Gender ◽  
Apache Ii ◽  
Hodgkin's Lymphoma ◽  
Apache Ii Score ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Organ Failures

17519 Background: Prognosis of patients (pts) with hematological malignancies (HM) in the intensive care unit (ICU) seems to be improving, despite different biological behaviors and outcomes. The study of homogenous groups of pts might provide useful clinical insights. The aim of this study was to evaluate the outcomes of critically ill patients with lymphomas (CIPL). Methods: During 66 months, all consecutive CIPL admitted to an oncologic ICU were studied. Variables collected were: age, gender, performance status, type and status of lymphoma, neutropenia, infection at admission, use of mechanical ventilation (MV), the Acute Physiology and Chronic Health Evaluation (APACHE) II score, comorbidities and number of acute organ failures (AOF). Variables selected in the univariate analysis (p < 0.25) and those clinically relevant were entered in a multivariable logistic regression analysis [results expressed as odds-ratios (OR), 95% confidence interval (CI)]. The end-point was hospital mortality. Results: A total of 120 CIPL were studied. Mean age was 51 ± 20 years and 54% were males. APACHE II was 19 ± 7 points. Diagnoses were High Grade Non-Hodgkin’s Lymphoma (77.5%), Hodgkin’s disease (17.5%) and Low Grade Non-Hodgkin’s Lymphoma (5%). Reasons for ICU admission were severe sepsis (62%) and acute respiratory failure (22%). During ICU stay 90% pts received MV, 71% vasopressors and 27.5% dialysis. Twenty-three (19%) pts had neutropenia. End-of-life decisions were implemented in 31% pts and all of them died at the ICU. The ICU and hospital mortality rates were 53% and 67% respectively, with no difference among the groups of lymphomas (p = 0.877). Variables identified in the multivariate analysis were: age [OR = 1.03 (95% CI = 1.01–1.06)], male gender [3.72 (1.27–10.90)], uncontrolled disease [OR = 6.28 (1.80–21.95), for pts with newly diagnosed disease and OR = 5.33 (1.45–19.47), for those with recurrence/progression, sepsis [OR = 5.31 (1.62–17.37)] and AOF [OR = 2.35 (1.53–3.61)]. Conclusions: Higher age, male gender, the severity of organ failures, sepsis and disease status were the main adverse factors. Type of lymphoma and neutropenia had no impact in the outcome. The appropriate use of such easily available clinical characteristics may avoid forgoing intensive care for lymphoma pts with a chance of survival. No significant financial relationships to disclose.

Predictors of Mortality in Patients Undergoing Autologous Stem Cell Transplant (ASCT) Admitted to the Intensive Care Unit: An Institutional Review of 1013 Transplant Patients over Five Years.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2876-2876
Author(s):  
Martina A. Trinkaus ◽  
Stephen E. Lapinsky ◽  
David C. Hallett ◽  
Norman Franke ◽  
Andrew Winter ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Multiple Myeloma ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Febrile Neutropenia ◽  
Organ Failure ◽  
Admission Rate ◽  
Apache Ii ◽  
Gram Negative ◽  
Icu Admission

Abstract Study Objective: To describe the outcomes of ASCT recipients transferred to the Intensive Care Unit (ICU), and identify predictors for mortality. Methods: Retrospective review of all ASCT recipients from Jan 2001-July 2006 who required ICU transfer up to 100 days post ASCT. Measurements and main Results: Thirty-four of 1013 patients (3.3%) who underwent ASCT, were admitted to the ICU. The mean age at admission was 54.9 +/− 11.1 (range 28–71), 53% being female. Indications for ASCT included multiple myeloma (50%), amyloidosis (32%), or other malignancies (18%). Table 1 highlights the admission rate to the ICU by diagnosis. The primary admitting diagnosis in the ICU included sepsis (32%), cardiac related events (26%), or respiratory compromise (29%). Median days post ASCT was 10.0 days with a median in ICU stay of 4.0 days (range 1–37 days). Twenty patients (including all non-survivors) required mechanical ventilation for > 24 hours with a median duration of 3.0 days. Thirteen patients died (38%) in the ICU, with 11 dying of multi-system organ failure and 2 from cardiac arrest. Retrospectively collected parameters restricted to the first 24 hours of admission revealed that Sequential Organ Failure Assessment (SOFA) score (OR 1.30; CI95 1.09–1.64, P=0.003) and Acute Physiology and Chronic Health Evaluation (APACHE II) score (OR 1.43; CI95 1.14–2.16; P=0.0002) were statistically associated with mortality in univariate analysis. The variables predictive of mortality at 24 hours after admission are displayed in Table 2. Conclusion: ICU admission is uncommon, occuring in 3% of patients undergoing ASCT, of which 38% die (1% of total ASCTs). Admission is influenced by underlying diagnosis, with amyloid patients portending the highest risk. Mortality in ASCT patients admitted to the ICU can be predicted in the first 24 hours by specific assessment scores (SOFA and APACHE II); specific supportive care requirements: inotropic dependence, hemodialysis, and need for ventilation; and clinical findings of gram negative sepsis or > 2 organ failure. Patients with febrile neutropenia had a low risk of mortality (possibly due to aggressive antibiotic use, growth factors, and rapid engraftment post ASCT). These results may assist clinical decision making regarding the continuation of intensive care delivered 24 hours after admission. Percentage Admission Rate by Diagnosis (n = 1013) Diagnosis ASCT (#) ICU Admission (#)/ (%) Non-survivors (#) Multiple Myeloma 615 17 / (2.8%) 6 Non-Hodgkin’s Lymphoma 199 2/ (1.0%) 1 Hodgkin’s Lymphoma 112 1 / (0.9%) 0 Amyloidosis 39 11/ (28.2%) 6 Acute Myeloid Leukemia 17 1/ (5.9%) 0 Other (Germ Cell Tumour, Waldenstrom’s Macroglobuliemia, POEMS) 31 2/ (6.4%) 0 Variables Predictive of Mortality at 24 hours after Admission Variable Predictors Number of Patients Survivors (n = 21) Non-survivors (n = 13) P-value Febrile Neutropenia 15 13 (62%) 2 (15%) 0.013 Failure of > 2 organs 20 9 (43%) 11 (85%) 0.030 Mechanical Ventilation 20 9 (43%) 11 (85%) 0.030 Inotropic Support > 4 hours 10 3 (14%) 7 (54%) 0.022 Hemodialysis 12 4 (19%) 8 (62%) 0.025 Gram Negative Infection 6 1 (5%) 5 (42%) 0.016

scholarly journals Association of Vitamin D Status of Septic Patients in Intensive Care Units With Altered Procalcitonin Levels and Mortality

2015 ◽  
Vol 100 (2) ◽  
pp. 516-523 ◽  
Author(s):  
Zhaoyan Chen ◽  
Zuojie Luo ◽  
Xiaoqin Zhao ◽  
Qiang Chen ◽  
Jieyu Hu ◽  
...  
Keyword(s):  
Vitamin D ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Mortality Rates ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Intact Pth ◽  
Serum 25Ohd ◽  
Icu Admission ◽  
Fluid Load

Abstract Objective: The purpose of this study was to determine whether vitamin D levels correlate with procalcitonin (PCT) levels and mortality in septic patients. Methods: The following data were collected from 236 patients upon admission to intensive care units (ICUs): demographics; Acute Physiology and Chronic Health Evaluation (APACHE) II score; Sequential Organ Failure Assessment (SOFA) score; 25-hydroxyvitamin D (25OHD), PCT, intact PTH, albumin, creatinine, and ionized calcium (iCa) levels; 25OHD sampling seasonality; fluid load (colloid and crystalloid before 25OHD sampling); mechanical ventilation duration; and length of stay (LOS) in the ICU. The primary endpoint was all-cause mortality 28 days after ICU admission. Results: Patients with 25OHD deficiency had significantly higher APACHE II and SOFA scores, positive blood culture rates, PCT levels, intact PTH levels, and 28-day mortality rates. These patients also had lower iCa levels, longer LOS in the ICU, and longer ventilator durations than patients with 25OHD insufficiency or sufficiency. Age, sex, 25OHD sampling seasonality, serum albumin and creatinine levels, and fluid load did not vary among the 3 groups. Serum 25OHD levels at admission were significantly negatively correlated with PCT levels. PTH responders had significantly higher 28-day mortality rates than did PTH nonresponders. Cox regression showed that a 25OHD level of &lt;20 ng/mL was an independent risk factor for 28-day mortality. Conclusions: Lower serum 25OHD levels at ICU admission were associated with 28-day mortality in septic patients. Serum 25OHD levels were inversely correlated with PCT levels. Hypovitaminosis D was associated with higher mortality rates in PTH responders than in nonresponders.

Characteristics and outcomes of oncology patients requiring admission to an Australian intensive care unit.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21653-e21653
Author(s):  
Aaron Tan ◽  
Sarah Freyberg ◽  
Meredith Oatley ◽  
Alexander David Guminski
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Data Collection ◽  
Hospital Mortality ◽  
Palliative Treatment ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Oncology Patients ◽  
Icu Admission

e21653 Background: Patients with advanced malignancies have historically been considered poor candidates for the intensive care unit (ICU), however survival and prognosis is continually improving and requirements for use of intensive care services is increasing. This study aimed to understand the characteristics and outcomes of oncology patients admitted to an Australian ICU and identify potential prognostic factors. Methods: A single-centre, retrospective, cohort study was conducted at Royal North Shore Hospital, a tertiary public hospital in Sydney, Australia with a 58-bed quaternary ICU. All patients aged > 18 years, admitted under the medical oncology team requiring ICU admission between June 2014 and June 2016 were evaluated. Data collected included basic demographics, cancer type and status, performance status (ECOG) and co-morbidities (ACE-27 score). Clinical outcomes were determined including ICU and hospital mortality, requirements (ventilation, dialysis, vasopressors, infection) and APACHE II scores. Results: There were 96 patients admitted to the ICU during the study period. Mean age was 61 years, 58% were male and 76% had metastatic disease. Most patients were receiving palliative treatment (89%), with recent chemotherapy (43%), immunotherapy (10%) and other therapies (5%). Of the 10 patients with recent immunotherapy, three (all melanoma) required ICU admission due to immunotoxicity with all three alive at time of data collection (mean 222 days follow-up). 13% were admitted due to an oncological emergency. Most common primary tumour site was thoracic (20%), genitourinary (11%), breast (10%) and melanoma (10%). Mean APACHE II score was 17 (SD 5.33), mean SOFA score was 4 (SD 2.70), ICU mortality was 5% and hospital mortality was 22%. For the 75 patients (78%) discharged from hospital, 42 (56%) were still alive at time of data collection (mean 321 days follow-up). Conclusions: Our patient population had good short-term outcomes for survival despite most receiving palliative treatment, although prognostic scores were also favourable. This suggests cancer patients can achieve positive outcomes after ICU admission with appropriate selection of patients crucial.

scholarly journals Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Toshifumi Fujiwara ◽  
Kentaro Tokuda ◽  
Kenta Momii ◽  
Kyohei Shiomoto ◽  
Hidetoshi Tsushima ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Intensive Care Units ◽  
Fatal Outcome ◽  
Laboratory Data ◽  
International Normalized Ratio ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Admission

Abstract Background Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs). Methods This was a retrospective observational study. This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and December 2017. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU. Results Upon admission, the median age was 70 (range, 33–96) years, and RA duration was 10 (range, 0–61) years. The 5-year survival after ICU admission was 47%, and 30-day, 90-day, and 1-year mortality rates were 22, 27, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvival was associated with a significantly higher glucocorticoid dose, updated Charlson’s comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. Laboratory data obtained at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. The multivariate Cox proportional hazard model revealed that nonuse of csDMARDs, high updated CCI, increased APACHE II score, and prolonged PT-INR were associated with a higher risk of mortality after ICU admission. Conclusion Our study demonstrated that the nonuse of csDMARDs, high updated CCI, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU.

scholarly journals Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

2020 ◽  
Author(s):  
Toshifumi Fujiwara ◽  
Kentaro Tokuda ◽  
Kenta Momii ◽  
Kyohei Shiomoto ◽  
Hidetoshi Tsushima ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Intensive Care Units ◽  
Fatal Outcome ◽  
Laboratory Data ◽  
International Normalized Ratio ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Admission

Abstract Background: Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs). Methods: This was a retrospective observational study. This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and December 2017. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU.Results: Upon admission, the median age was 70 (range, 33–96) years, and RA duration was 10 (range, 0–61) years. The 5-year survival after ICU admission was 47%, and 30-day, 90-day, and 1-year mortality rates were 22%, 27%, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvival was associated with a significantly higher glucocorticoid dose, updated Charlson’s comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. Laboratory data obtained at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. The multivariate Cox proportional hazard model revealed that nonuse of csDMARDs, high updated CCI, increased APACHE II score, and prolonged PT-INR were associated with a higher risk of mortality after ICU admission.Conclusion: Our study demonstrated that the nonuse of csDMARDs, high updated CCI, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU.

scholarly journals Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

2020 ◽  
Author(s):  
Toshifumi Fujiwara ◽  
Kentaro Tokuda ◽  
Kenta Momii ◽  
Hidetoshi Tsushima ◽  
Yukio Akasaki ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Intensive Care Units ◽  
Fatal Outcome ◽  
International Normalized Ratio ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Prednisone Dose ◽  
Icu Admission

Abstract Background Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs).Materials and Methods This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and March 2018. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU.Results Upon admission, the mean age was 68 years, and RA duration was 14 years. The 30-day, 90-day, and 1-year mortality rates were 22%, 27%, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvivors were associated with a significantly higher prednisone dose, Charlson’s comorbidity index, and acute physiology and chronic health evaluation (APACHE) II score. Blood data at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. Multivariate analysis revealed that dose of prednisone, high APACHE II score, and prolonged PT-INR indicated a higher risk of 30-day mortality.Conclusion Our study revealed that high prednisone dose, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU.

scholarly journals Glutamine and glutathione at ICU admission in relation to outcome

2012 ◽  
Vol 122 (12) ◽  
pp. 591-597 ◽  
Author(s):  
Paul Castillo Rodas ◽  
Olav Rooyackers ◽  
Christina Hebert ◽  
Åke Norberg ◽  
Jan Wernerman
Keyword(s):  
Risk Factor ◽  
Organ Failure ◽  
Independent Predictor ◽  
Apache Ii ◽  
University Hospital ◽  
Glutathione Depletion ◽  
Glutamine Supplementation ◽  
Limiting Factor ◽  
Icu Patients ◽  
Icu Admission

Glutamine depletion is demonstrated to be an independent predictor of hospital mortality in ICU (intensive care unit) patients. Today glutamine supplementation is recommended to ICU patients on parenteral nutrition. In addition to glutamine, glutathione may be a limiting factor in ICU patients with MOF (multiple organ failure). To study the prevalence of glutamine and glutathione depletion an observational study was performed. The results were analysed in relation to mortality and the conventional predictors of mortality outcome, APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment). Consecutive patients admitted to the ICU at Karolinska University Hospital Huddinge were studied. Patient admission scoring of APACHE II and SOFA were registered as well as mortality up to 6 months. Plasma glutamine concentration and whole blood glutathione status at admittance were analysed. The admission plasma glutamine concentrations were totally independent of the conventional risk scoring at admittance, and a subnormal concentration was an independent predictor of mortality. In addition, glutathione redox status was also an independent mortality predictor, but here a normal ratio was the risk factor. In both cases the mortality risk was mainly confined to the post-ICU period. A low plasma concentration of glutamine at ICU admission is an independent risk factor for post-ICU mortality. The possible benefit of extending glutamine supplementation post-ICU should be evaluated prospectively.

scholarly journals Risk factors for mortality in critically ill patients with COVID-19: a multicenter retrospective case-control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jinghua Gao ◽  
Li Zhong ◽  
Ming Wu ◽  
Jingjing Ji ◽  
Zheying Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Organ Failure ◽  
Critically Ill ◽  
Sofa Score ◽  
Lymphocyte Count ◽  
Cox Regression ◽  
Survival Curve ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Hospital Death

Abstract Background Coronavirus disease 2019 (COVID-19) has spread around the world, until now, the number of positive and death cases is still increasing. Therefore, it remains important to identify risk factors for death in critically patients. Methods We collected demographic and clinical data on all severe inpatients with COVID-19. We used univariable and multivariable Cox regression methods to determine the independent risk factors related to likelihood of 28-day and 60-day survival, performing survival curve analysis. Results Of 325 patients enrolled in the study, Multi-factor Cox analysis showed increasing odds of in-hospital death associated with basic illness (hazard ratio [HR] 6.455, 95% Confidence Interval [CI] 1.658–25.139, P = 0.007), lymphopenia (HR 0.373, 95% CI 0.148–0.944, P = 0.037), higher Sequential Organ Failure Assessment (SOFA) score on admission (HR 1.171, 95% CI 1.013–1.354, P = 0.033) and being critically ill (HR 0.191, 95% CI 0.053–0.687, P = 0.011). Increasing 28-day and 60-day mortality, declining survival time and more serious inflammation and organ failure were associated with lymphocyte count < 0.8 × 109/L, SOFA score > 3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 7, PaO2/FiO2 < 200 mmHg, IL-6 > 120 pg/ml, and CRP > 52 mg/L. Conclusions Being critically ill and lymphocyte count, SOFA score, APACHE II score, PaO2/FiO2, IL-6, and CRP on admission were associated with poor prognosis in COVID-19 patients.

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