scholarly journals Risk assessment models for potential use in the emergency department have lower predictive ability in older patients compared to the middle-aged for short-term mortality – a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Martin Schultz ◽  
Line Jee Hartmann Rasmussen ◽  
Nicolas Carlson ◽  
Rasmus Bo Hasselbalch ◽  
Birgitte Nybo Jensen ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Emergency Department ◽  
Cohort Study ◽  
Older Patients ◽  
Retrospective Cohort ◽  
Predictive Ability ◽  
Short Term ◽  
Risk Assessment Models ◽  
Short Term Mortality ◽  
Potential Use

scholarly journals Abdominal Obesity and Short-term Mortality in Critically Ill Patients with Sepsis: A Retrospective Cohort Study Based on the MIMIC-IV Database

2021 ◽  
Author(s):  
Zhou Lv ◽  
Minglu Gu ◽  
Miao Zhou ◽  
Yanfei Mao ◽  
Lai Jiang
Keyword(s):  
Metabolic Syndrome ◽  
Cohort Study ◽  
Intensive Care ◽  
Abdominal Obesity ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Obese Patients ◽  
Short Term ◽  
Icu Admission ◽  
Short Term Mortality

Abstract Purpose: Multiple studies have demonstrated an obesity paradox such that obese septic patients have a lower mortality rate and a relatively favorable prognosis. However, less is known on the association between abdominal obesity and short-term mortality in patients with sepsis. We conducted this study to determine whether the obesity-related survival benefit remains among abdominal obese patients.Methods: A retrospective cohort study was conducted using data derived from the Medical Information Mart for Intensive Care IV database. Septic patients (≥18 years) with or without abdominal obesity of first intensive care units (ICU) admission in the database were enrolled. The primary outcome was mortality within 28 days of ICU admission and multivariable logistic regression analyses were employed to assess any association between abdominal obesity and the outcome variable.Results: A total of 21534 patients were enrolled finally, the crude 28-day mortality benefit after ICU admission was not observed in patients with abdominal obesity (15.8% vs. 15.3%, p=0.32). In the extended multivariable logistic models, the odds ratio (OR) of abdominal obesity was significantly inversed after incorporating metabolic variables into the logistic model (OR range 1.094-2.872, p = 0.02). The subgroup analysis showed interaction effects in impaired fasting blood glucose/diabetes and metabolic syndrome subgroups (P = 0.001 and <0.001, respectively). In the subgroups of blood pressure, high-density lipoprotein cholesterol, and triglyceride level, no interaction was detected in the association between abdominal obesity and mortality. After propensity score matching, 6523 pairs of patients were selected. The mortality significantly higher in the abdominal obesity group (17.0% vs. 14.8%, p = 0.015). Notably, the non-abdominal obese patients were weaned off vasopressors and mechanical ventilation more quickly than those in the abdominal obesity group (vasopressor‑free days on day 28 of 27.0 vs. 26.8, p < 0.001; ventilation-free days on day 28 of 26.7 vs. 25.6, p < 0.001).Conclusion: Abdominal obesity was associated with increased risk of adjusted sepsis-related mortality within 28 days after ICU admission and was partially mediated through metabolic syndrome components.

scholarly journals Systolic blood pressure and short-term mortality in the emergency department and prehospital setting: a hospital-based cohort study

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
Author(s):  
Anders Kasper Bruun Kristensen ◽  
Jon Gitz Holler ◽  
Søren Mikkelsen ◽  
Jesper Hallas ◽  
Annmarie Lassen
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Cohort Study ◽  
Systolic Blood Pressure ◽  
Prehospital Setting ◽  
Short Term ◽  
Short Term Mortality

scholarly journals Risk Factors Associated with 30-Day Mortality in Older Patients with Influenza

2021 ◽  
Vol 10 (16) ◽  
pp. 3521
Author(s):  
Charles Guesneau ◽  
Anne Sophie Boureau ◽  
Céline Bourigault ◽  
Gilles Berrut ◽  
Didier Lepelletier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Patients ◽  
Retrospective Cohort ◽  
Antiviral Treatment ◽  
Prevention Measures ◽  
Rt Pcr ◽  
Short Term ◽  
Factors Associated ◽  
Cohort Design ◽  
Short Term Mortality

Background: Influenza is a common viral condition, but factors related to short-term mortality have not been fully studied in older adults. Our objective was to determine whether there is an association between geriatric factors and 30-day mortality. Methods: This was a retrospective cohort design. All patients aged 75 years and over, with a diagnosis of influenza confirmed by a positive RT-PCR, were included. The primary endpoint was death within the 30 days after diagnosis. Results: 114 patients were included; 14 (12.3%) patients died within 30 days. In multivariate analysis these patients were older (OR: 1.37 95% CI (1.05, 1.79), p = 0.021), and had a lower ADL score (OR: 0.36 95% CI (0, 17; 0.75), p = 0.006), and a higher SOFA score (OR: 2.30 95% CI (1.07, 4.94), p = 0.03). Oseltamivir treatment, initiated within the first 48 h, was independently associated with survival (OR: 0.04 95% CI (0.002, 0.78), p = 0.034). Conclusions: Identification of mortality risk factors makes it possible to consider specific secondary prevention measures such as the rapid introduction of antiviral treatment. Combined with primary prevention, these measures could help to limit the mortality associated with influenza in older patients.

scholarly journals Validating the RISE UP score for predicting prognosis in patients with COVID-19 in the emergency department: a retrospective study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045141
Author(s):  
Paul MEL van Dam ◽  
Noortje Zelis ◽  
Patricia Stassen ◽  
Daan J L van Twist ◽  
Peter W De Leeuw ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Adverse Outcome ◽  
Characteristic Curve ◽  
Favourable Outcome ◽  
Secondary Outcome ◽  
Care Hospital ◽  
Short Term ◽  
Short Term Mortality ◽  
Patients At Risk

ObjectiveTo mitigate the burden of COVID-19 on the healthcare system, information on the prognosis of the disease is needed. The recently developed Risk Stratification in the Emergency Department in Acutely ill Older Patients (RISE UP) score has very good discriminatory value for short-term mortality in older patients in the emergency department (ED). It consists of six readily available items. We hypothesised that the RISE UP score could have discriminatory value for 30-day mortality in ED patients with COVID-19.DesignRetrospective analysis.SettingTwo EDs of the Zuyderland Medical Centre, secondary care hospital in the Netherlands.ParticipantsThe study sample consisted of 642 adult ED patients diagnosed with COVID-19 between 3 March and until 25 May 2020. Inclusion criteria were (1) admission to the hospital with symptoms suggestive of COVID-19 and (2) positive result of the PCR or (very) high suspicion of COVID-19 according to the chest CT scan.OutcomePrimary outcome was 30-day mortality, secondary outcome was a composite of 30-day mortality and admission to intensive care unit (ICU).ResultsWithin 30 days after presentation, 167 patients (26.0%) died and 102 patients (15.9%) were admitted to ICU. The RISE UP score showed good discriminatory value for 30-day mortality (area under the receiver operating characteristic curve (AUC) 0.77, 95% CI 0.73 to 0.81) and for the composite outcome (AUC 0.72, 95% CI 0.68 to 0.76). Patients with RISE UP scores below 10% (n=121) had favourable outcome (zero deaths and six ICU admissions), while those with scores above 30% (n=221) were at high risk of adverse outcome (46.6% mortality and 19.0% ICU admissions).ConclusionThe RISE UP score is an accurate prognostic model for adverse outcome in ED patients with COVID-19. It can be used to identify patients at risk of short-term adverse outcome and may help guide decision-making and allocating healthcare resources.

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