The influence of volume and intensive care unit organization on hospital mortality in patients admitted with severe sepsis: a retrospective multicentre cohort study

Abstract The aim of this retrospective cohort study at eight hospitals in Germany was to specify influenza-associated in-hospital mortality during the 2017/2018 flu season, which was the strongest in Germany in the past 30 years. A total of 1560 patients were included in the study. Overall, in-hospital mortality was 6.7% (n = 103), in patients treated in the intensive care unit (n = 161) mortality was 22.4%. The proportion of deceased patients per hospital was between 0% and 7.0%. Influenza was the immediate cause of death in 82.8% (n = 82) of the decedents.

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Phosphate abnormalities and outcomes among admissions to the intensive care unit: A retrospective multicentre cohort study

Journal of Critical Care ◽

10.1016/j.jcrc.2021.03.012 ◽

2021 ◽

Author(s):

Jeremy Cheuk Kin Sin ◽

Kevin B. Laupland ◽

Mahesh Ramanan ◽

Alexis Tabah

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Multicentre Cohort Study ◽

Multicentre Cohort

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Functional Outcomes in Patients Admitted to the Intensive Care Unit with Traumatic Brain Injury and Exposed to Hyperoxia: A Retrospective Multicentre Cohort Study

Neurocritical Care ◽

10.1007/s12028-020-01033-y ◽

2020 ◽

Author(s):

M. Weeden ◽

M. Bailey ◽

B. Gabbe ◽

D. Pilcher ◽

R. Bellomo ◽

...

Keyword(s):

Intensive Care Unit ◽

Traumatic Brain Injury ◽

Cohort Study ◽

Intensive Care ◽

Brain Injury ◽

Functional Outcomes ◽

Multicentre Cohort Study ◽

Multicentre Cohort

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External validation of the quick Sequential Organ Failure Assessment score for mortality and bacteraemia risk evaluation in Japanese patients undergoing haemodialysis: a retrospective multicentre cohort study

BMJ Open ◽

10.1136/bmjopen-2018-028856 ◽

2019 ◽

Vol 9 (7) ◽

pp. e028856

Author(s):

Hiroki Nishiwaki ◽

Sho Sasaki ◽

Takeshi Hasegawa ◽

Fumihiko Sasai ◽

Hiroo Kawarazaki ◽

...

Keyword(s):

Cohort Study ◽

Blood Culture ◽

Hospital Mortality ◽

Secondary Care ◽

Tertiary Care ◽

External Validation ◽

Multicentre Cohort Study ◽

Failure Assessment ◽

Qsofa Score ◽

Multicentre Cohort

ObjectivesWe aimed to examine the validity of the quick Sequential Organ Failure Assessment (qSOFA) score for mortality and bacteraemia risk assessment in Japanese haemodialysis patients.DesignThis is a retrospective multicentre cohort study.SettingThe six participating hospitals are tertiary-care institutions that receive patients on an emergency basis and provide primary, secondary and tertiary care. The other participating hospital is a secondary-care institution that receives patients on an emergency basis and provides both primary and secondary care.ParticipantsThis study included haemodialysis outpatients admitted for bacteraemia suspicion, who had blood drawn for cultures within 48 hours of their initial admission.Primary and secondary outcome measuresThe primary outcome measure was overall in-hospital mortality. Secondary outcomes included 28-day in-hospital mortality and the incidence of bacteraemia diagnosed based on blood culture findings. The discrimination, calibration and test performance of the qSOFA score were assessed. Missing data were handled using multiple imputation.ResultsAmong the 507 haemodialysis patients admitted with bacteraemia suspicion between August 2011 and July 2013, the overall in-hospital mortality was 14.6% (74/507), the 28-day in-hospital mortality was 11.1% (56/507) and the incidence of bacteraemia, defined as a positive blood culture, was 13.4% (68/507). For predicting in-hospital mortality among haemodialysis patients, the area under the receiver operating characteristic curve was 0.61 (95% CI 0.56–0.67) for a qSOFA score ≥2. The Hosmer-Lemeshow χ2statistics for the qSOFA score as a predictor of overall and 28-day in-hospital mortality were 5.72 (p=0.02) and 7.40 (p<0.01), respectively.ConclusionOn external validation, the qSOFA score exhibited low diagnostic accuracy and miscalibration for in-hospital mortality and bacteraemia among haemodialysis patients.

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Utility of electronic AKI alerts in intensive care: A national multicentre cohort study

Journal of Critical Care ◽

10.1016/j.jcrc.2017.10.024 ◽

2018 ◽

Vol 44 ◽

pp. 185-190 ◽

Cited By ~ 5

Author(s):

Jennifer Holmes ◽

Gethin Roberts ◽

John Geen ◽

Alan Dodd ◽

Nicholas M. Selby ◽

...

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Multicentre Cohort Study ◽

Multicentre Cohort

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Association Between Nighttime Discharge from the Intensive Care Unit and Hospital Mortality: A Multi-Center Retrospective Cohort Study

BMC Health Services Research ◽

10.1186/s12913-015-1044-4 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 21

Author(s):

Luciano CP Azevedo ◽

Ivens A. de Souza ◽

David A. Zygun ◽

Henry T. Stelfox ◽

Sean M. Bagshaw

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Hospital Mortality ◽

Retrospective Cohort Study ◽

Retrospective Cohort

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Association between Malnutrition and Hospital Mortality and Duration of Intensive Care Unit Admission in the Critically Ill: A Prospective Cohort Study

10.20944/preprints201711.0066.v1 ◽

2017 ◽

Author(s):

Charles Chin Han Lew ◽

Gabriel Jun Yung Wong ◽

Ka Po Cheung ◽

Ai Ping Chua ◽

Mary Foong Fong Chong ◽

...

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Hospital Mortality ◽

Critically Ill ◽

Prospective Cohort Study ◽

Critically Ill Patients ◽

Prospective Cohort ◽

Unit Length ◽

Increased Risk

There is limited evidence for the association between malnutrition and hospital mortality as well as Intensive Care Unit length-of-stay (ICU-LOS) in critically ill patients. We aimed to examine the aforementioned associations by conducting a prospective cohort study in an ICU of a Singapore tertiary hospital. Between August 2015 and October 2016, all adult patients with ≥24 h of ICU-LOS were included. The 7-point Subjective Global Assessment (7-point SGA) was used to determine patients’ nutritional status within 48 hours of ICU admission. Multivariate analyses were conducted in two ways: 1) presence versus absence of malnutrition, and 2) dose-dependent association for each 1-point decrease in the 7-point SGA. There were 439 patients of which 28.0% were malnourished, and 29.6% died before hospital discharge. Malnutrition was associated with an increased risk of hospital mortality [adjusted-RR 1.39 (95%CI: 1.10–1.76)], and this risk increased with a greater degree of malnutrition [adjusted-RR 1.09 (95%CI: 1.01–1.18) for each 1-point decrease in the 7-point SGA]. No significant association was found between malnutrition and ICU-LOS. Conclusion: There was a clear association between malnutrition and higher hospital mortality in critically ill patients. The association between malnutrition and ICU-LOS could not be replicated and hence requires further evaluation.

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Characteristics and resource utilization of high-cost users in the intensive care unit: a population-based cohort study

BMC Health Services Research ◽

10.1186/s12913-021-07318-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Claudia Dziegielewski ◽

Robert Talarico ◽

Haris Imsirovic ◽

Danial Qureshi ◽

Yasmeen Choudhri ◽

...

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Healthcare Costs ◽

Healthcare Expenditure ◽

Healthcare Spending ◽

Population Based ◽

Icu Length Of Stay

Abstract Background Healthcare expenditure within the intensive care unit (ICU) is costly. A cost reduction strategy may be to target patients accounting for a disproportionate amount of healthcare spending, or high-cost users. This study aims to describe high-cost users in the ICU, including health outcomes and cost patterns. Methods We conducted a population-based retrospective cohort study of patients with ICU admissions in Ontario from 2011 to 2018. Patients with total healthcare costs in the year following ICU admission (including the admission itself) in the upper 10th percentile were defined as high-cost users. We compared characteristics and outcomes including length of stay, mortality, disposition, and costs between groups. Results Among 370,061 patients included, 37,006 were high-cost users. High-cost users were 64.2 years old, 58.3% male, and had more comorbidities (41.2% had ≥3) when likened to non-high cost users (66.1 years old, 57.2% male, 27.9% had ≥3 comorbidities). ICU length of stay was four times greater for high-cost users compared to non-high cost users (22.4 days, 95% confidence interval [CI] 22.0–22.7 days vs. 5.56 days, 95% CI 5.54–5.57 days). High-cost users had lower in-hospital mortality (10.0% vs.14.2%), but increased dispositioning outside of home (77.4% vs. 42.2%) compared to non-high-cost users. Total healthcare costs were five-fold higher for high-cost users ($238,231, 95% CI $237,020–$239,442) compared to non-high-cost users ($45,155, 95% CI $45,046–$45,264). High-cost users accounted for 37.0% of total healthcare costs. Conclusion High-cost users have increased length of stay, lower in-hospital mortality, and higher total healthcare costs when compared to non-high-cost users. Further studies into cost patterns and predictors of high-cost users are necessary to identify methods of decreasing healthcare expenditure.

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Disparities in Intensive Care Unit Admission and Mortality Among Patients With Schizophrenia and COVID-19: A National Cohort Study

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa158 ◽

2020 ◽

Cited By ~ 1

Author(s):

Guillaume Fond ◽

Vanessa Pauly ◽

Marc Leone ◽

Pierre-Michel Llorca ◽

Veronica Orleans ◽

...

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Mental Illness ◽

Cohort Study ◽

Intensive Care ◽

Hospital Mortality ◽

Severe Mental Illness ◽

Vulnerable Population ◽

Icu Admission ◽

Risk Of Death

Abstract Patients with schizophrenia (SCZ) represent a vulnerable population who have been understudied in COVID-19 research. We aimed to establish whether health outcomes and care differed between patients with SCZ and patients without a diagnosis of severe mental illness. We conducted a population-based cohort study of all patients with identified COVID-19 and respiratory symptoms who were hospitalized in France between February and June 2020. Cases were patients who had a diagnosis of SCZ. Controls were patients who did not have a diagnosis of severe mental illness. The outcomes were in-hospital mortality and intensive care unit (ICU) admission. A total of 50 750 patients were included, of whom 823 were SCZ patients (1.6%). The SCZ patients had an increased in-hospital mortality (25.6% vs 21.7%; adjusted OR 1.30 [95% CI, 1.08–1.56], P = .0093) and a decreased ICU admission rate (23.7% vs 28.4%; adjusted OR, 0.75 [95% CI, 0.62–0.91], P = .0062) compared with controls. Significant interactions between SCZ and age for mortality and ICU admission were observed (P = .0006 and P < .0001). SCZ patients between 65 and 80 years had a significantly higher risk of death than controls of the same age (+7.89%). SCZ patients younger than 55 years had more ICU admissions (+13.93%) and SCZ patients between 65 and 80 years and older than 80 years had less ICU admissions than controls of the same age (−15.44% and −5.93%, respectively). Our findings report the existence of disparities in health and health care between SCZ patients and patients without a diagnosis of severe mental illness. These disparities differed according to the age and clinical profile of SCZ patients, suggesting the importance of personalized COVID-19 clinical management and health care strategies before, during, and after hospitalization for reducing health disparities in this vulnerable population.

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Unplanned Transfers From Intermediate Care Units to Intensive Care Units: A Cohort Study

American Journal of Critical Care ◽

10.4037/ajcc2021453 ◽

2021 ◽

Vol 30 (5) ◽

pp. 397-400

Author(s):

Joao Gabriel Rosa Ramos ◽

Gabriel Machado Naus dos Santos ◽

Marina Chetto Coutinho Bispo ◽

Renata Cristina de Almeida Matos ◽

Gil Mario Lopes Santos de Carvalho ◽

...

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Observational Study ◽

Hospital Mortality ◽

Odds Ratio ◽

Intermediate Care ◽

Icu Mortality ◽

Patient Transfers ◽

Reason For Admission

This study evaluated unplanned transfers from the intermediate care unit (IMCU) to the intensive care unit (ICU) among urgent admissions. This retrospective, observational study was conducted in 2 ICUs and 1 IMCU. Three patterns of urgent admission were assessed: admissions to the ICU only, admissions to the IMCU only, and admissions to the IMCU with subsequent transfer to the ICU. Of 5296 admissions analyzed, 1396 patients (26.4%) were initially admitted to the IMCU. Of these, 172 (12.3%) were transferred from the IMCU to the ICU. Mortality was higher in patients transferred from the IMCU to the ICU than in the 3900 ICU-only patients (odds ratio, 3.22; 95% CI, 1.52-6.80). Most transfers from the IMCU to the ICU (135; 78.5%) were due to deterioration of the condition for which the patient was admitted. Patient transfers from the IMCU to the ICU were common, were associated with increased hospital mortality, and were mostly due to deterioration in the condition that was the reason for admission.

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