scholarly journals Persistent eosinopenia is associated with in-hospital mortality among older patients: unexpected prognostic value of a revisited biomarker

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bethsabee Partouche ◽  
Marion Pepin ◽  
Pauline Mary de Farcy ◽  
Jean-Emmanuel Kahn ◽  
Bruno Sawczynski ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Hospital Mortality ◽  
Bacterial Infection ◽  
Neutrophil Count ◽  
Eosinophil Count ◽  
Older Patients ◽  
Predictive Ability ◽  
Mortality And Morbidity ◽  
Reactive Protein ◽  
Causes Of Mortality

Abstract Introduction Infection is one of the major causes of mortality and morbidity in older adults. Available biomarkers are not associated with prognosis in older patients. This study aimed to analyze the value of eosinopenia (eosinophil count< 100/mm3) as a prognosis marker among older patients with suspected or confirmed bacterial infection. Methods A retrospective study was performed from 1 January to 31 December 2018 among patients in a geriatrics ward suffering from a bacterial infection treated with antibiotics. Biomarker data including the eosinophil count, neutrophil count and C-reactive protein (CRP) were collected within 4 days after patient diagnosis. Persistent eosinopenia was defined as a consistent eosinophil count< 100/mm3 between Day 2 and Day 4. The association of biomarkers with 30-day hospital mortality in a multivariate analysis was assessed and their predictive ability using the area under the ROC curve (AUC) was compared. Results Our study included 197 patients with a mean age of 90 ± 6 years. A total of 36 patients (18%) died during their stay in hospital. The patients who died were more likely to have persistent eosinopenia in comparison to survivors (78% versus 34%, p < 0.001). In the multivariate analysis, persistent eosinopenia was associated with in-hospital mortality with an adjusted HR of 8.90 (95%CI 3.46–22.9). The AUC for eosinophil count, CRP and neutrophil count between Day 2 and Day 4 were 0.7650, 0.7130, and 0.698, respectively. Conclusion Persistent eosinopenia within 4 days of diagnosis of bacterial infection appeared to be a predictor of in-hospital mortality in older patients.

scholarly journals Obvious but Always Ignored: Nutritional Status Affects Cardiac Surgery Mortality

2021 ◽  
Author(s):  
Arif Gucu ◽  
Ozlem Arican Ozluk ◽  
Sadik Ahmet Sunbul ◽  
Nail Kahraman ◽  
Deniz Demir ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cardiac Surgery ◽  
Nutritional Status ◽  
Hospital Mortality ◽  
Prognostic Nutritional Index ◽  
Mortality And Morbidity ◽  
Nutritional Index ◽  
Group I ◽  
Group Ii ◽  
Index Value

Background: The nutritional status of the patient is an important parameter in patients undergoing surgery. This study aims to determine of prognostic nutritional index value that predicts hospital mortality and morbidity in on-pump cardiac surgery. Methods: In this study, we scanned the medical data of 1003 patients who underwent on-pump cardiac surgery. Patients’ divided into two groups according to in-hospital mortality. 934 patients without in-hospital mortality were defined as Group I, and 69 patients who died in the hospital were defined as Group II. Their preoperative nutritional status was determined using the prognostic nutritional index classification. Results: In our series, age is statistically higher in Group II rather than Group I (62.5 ± 0.3 vs. 67.4 ± 1.2; p=0.001). There was a significantly different a higher tendency of hospital-acquired infection in Group II (151; 16.2% vs. 44; 63.8%; p=0.001). Postoperative stroke significantly higher in Group II (35; 3.7% vs. 62; 89.9%; p=0.001). Multivariate analysis revealed that cross clamp time, cardiopulmonary bypass time, intraaortic balloon pump usage and intensive care unit stay significantly higher in Group II (p<0.05, respectively). The prognostic nutritional index value was found statistically low in Group II (48.34 ± 6.71 vs. 44.76 ± 7.63; p=0.001). Multivariate analysis revealed that male gender, age, and the prognostic nutritional index were independently associated with postoperative survival. Conclusion: In on-pump cardiac surgery, postoperative mortality and morbidity are significantly associated with preoperative low prognostic nutritional index, and the prognostic nutritional index can be a useful and suitable parameter for preoperative risk evaluation.

Predictive Factors of Severe Sepsis and Septic Shock in Patients with Hematological Malignancies and Pseudomonas Infections.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4552-4552
Author(s):  
Ramzi Jeddi ◽  
Hèla Ghédira ◽  
Ramzi ben Amor ◽  
Lamia Aissaoui ◽  
Karima Kacem ◽  
...  
Keyword(s):  
Septic Shock ◽  
Multivariate Analysis ◽  
Severe Sepsis ◽  
Neutrophil Count ◽  
Hematological Malignancies ◽  
Univariate Analysis ◽  
Skin Lesions ◽  
Hemoglobin Level ◽  
C Reactive Protein ◽  
Reactive Protein

Abstract Abstract 4552 Background Pseudomonas aeruginosa is a leading cause of nosocomial infections usually associated with high mortality. The aim of this study was to determine the predictive factors of severe sepsis or septic shock in patients with hematological malignancies and pseudomonas infections. Methods This study was conducted in a teaching hospital (Aziza Othmana University Hospital, Tunis, Tunisia) to evaluate the clinical profile of infections due to Pseudomonas species and to determine risk factors for severe sepsis or septic shock defined according to the criteria of the ACCP/SCCM. Pearson test was used for univariate analysis, and logistic regression for multivariate analysis. Results Between 2004 and 2009,a total of 73 pseudomonas isolates (70 P, aeruginosa) was collected in 60 patients : 47 with acute leukemia (78%), 7 with lymphoma (12%), and 6 with others hematological disorders (10%).The median age was 29 yrs (range, 2-64). Most common sites of the isolates were from bloodstream (45%), and skin lesions (31.5%). At least 11 patients (18%) had 2 or more infections due to Pseudomonas. The most common clinical signs observed were isolated fever (18%), respiratory symptoms (15%), diarrhea (21%), and skin lesions (29%).Susceptibility to major anti-pseudomonas antibiotics revealed that isolates tested were resistant to:piperacillin/tazobactam (40%), cefatazidim (28%), ciprofloxacin (20.5%), imipenem (22%), and amikacin (22%).Severe sepsis or septic shock occurred in 49% of episodes. Crude mortality was (18%, 11 of the 60 patients) all caused by septic shock. In univariate analysis factors associated with severe sepsis or septic shock were: Isolates from more than one site (p=0.04), Absolute neutrophil count < 0.1 × 109/l (p=0.003), concomitant infection with other microorganism (p=0.019), fever lasting for more than 3 days in patients with antibiotherapy (p=0.003), C-reactive protein > 100 mg/l (p <0.0001), serum lactate >2.2 mmol/l (p< 0.0001), serum bicarbonate < 19 mmol/l (p=0.002), hemoglobin level < 70g/l (p<0.0001), renal failure (p=0.006), hypophosphatemia <0.8mmol/l (p=0.003), total bilirubin > 50 μmol/l (p=0.03), and hypoproteinemia <64g/l (p<0.0001). By multivariate analysis, antibiotherapy for more than 3 days (p=0.025,OR=0.217, 95%CI:0.05-0.82), absolute neutrophil count <0.1× 109/l (p=0.046,OR=170;95% CI:1-267), C-reactive protein >100 (p=0.04,OR=15,95%CI: 1,1-219,8), hemoglobin level <70g/l (p=0.037,OR=17,95%CI: 1,1- 243), and hypophosphatemia (p=0.02,OR=148,95%CI:2.2-942) remained as independent predictors of severe sepsis or septic shock. Conclusions This study revealed that several factors such as level of neutrophil count, C-reactive protein, hemoglobin level, severe hypophosphatemia, and antibiotherapy > 72 h before microbiological documentation may play a significant and independent role for the development of severe sepsis/septic shock and increase mortality of Pseudomonas infections in patients with hematological malignancies. Disclosures: No relevant conflicts of interest to declare.

Prediction of in-hospital mortality and morbidity using high-sensitivity C-reactive protein after burr hole craniostomy

2016 ◽  
Vol 30 (6) ◽  
pp. 956-960 ◽  
Author(s):  
Jung Ju Choi ◽  
Hong Soon Kim ◽  
Kyung Cheon Lee ◽  
Hojin Hur ◽  
Youn Yi Jo
Keyword(s):  
Hospital Mortality ◽  
High Sensitivity ◽  
Burr Hole ◽  
C Reactive Protein ◽  
Mortality And Morbidity ◽  
Reactive Protein

scholarly journals Infective Endocarditis, Predictors of Mortality and Morbidity

2021 ◽  
Author(s):  
Aditya Eranki ◽  
Akshat Saxena ◽  
Umar Ali ◽  
Eric Slimani
Keyword(s):  
Multivariate Analysis ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Heart Block ◽  
Complete Heart Block ◽  
Univariate Analysis ◽  
Secondary Outcome ◽  
Mortality And Morbidity ◽  
Factors Associated ◽  
Valvular Surgery

Abstract Objectives: Infective endocarditis is a disease with high mortality and morbidity. The primary outcome of this study is to assess factors associated with in-hospital mortality in patients undergoing valvular surgery for infective endocarditis. The secondary outcome of this study is to assess the incidence and factors associated with post-operative morbidity; namely post-operative stroke, renal failure and dialysis, complete heart block and return to theatre for bleeding or tamponade. Methods Between the years of 2015 to 2019, a total of 89 patients underwent surgery for infective endocarditis at Fiona Stanley Hospital. Data was collected from the Australia and New Zealand Cardiac Surgery Database from 2015 to 2019 as well as patients electronic medical record (EMR). A number of preoperative and perioperative factors were assessed in relation to patient mortality and morbidity. Univariate and multivariate logistical regression analysis was done to assess for the association between factors and in-hospital mortality and morbidity Results: A total of 89 patients underwent surgery for infective endocarditis, affecting 101 valves. The mean age of patients was 53.7. A total of 79 patients had a positive blood culture pre-operatively, with Staphylococcus Aureus being the most frequently cultured organism (39%). Fourteen patients (16%) were deemed emergent and underwent surgery within 24 hours of review. A total of five patients died within their hospital stay postoperatively. Variables significantly associated with mortality on univariate analysis were intravenous drug use, emergent surgery, perioperative dialysis, perioperative inotropes, cardiopulmonary bypass (CPB) time and cross clamp time (CCT). Only CBP time was significantly associated with mortality on multivariate analysis. A total of 19 patients (21%) required hemodialysis after surgery, 10 patients sustained a postoperative stroke (11%), 15 patients required to return to theatre (17%) and 11 patients developed a complete heart block post operatively (12%). Conclusion There are a number of factors associated with mortality and morbidity in patients undergoing surgery with infective endocarditis. Our study demonstrates a lower mortality rate in these patients than previously quoted in literature. Exposure of prolonged CBP times was the only factor significantly associated with increased mortality on multivariate analysis, although a critical perioperative state was highly significant on univariate analysis.

scholarly journals Yale observation scale for bacterial infection in febrile children

2020 ◽  
Vol 7 (2) ◽  
pp. 424
Author(s):  
Shiwani Mangla ◽  
Hemant Jain
Keyword(s):  
Blood Culture ◽  
Bacterial Infection ◽  
Roc Curve ◽  
Early Recognition ◽  
Predictive Ability ◽  
Cost Effective ◽  
P Value ◽  
Observation Scale ◽  
Causes Of Mortality ◽  
Yale Observation Scale

Background: Sepsis is one of the leading causes of mortality in children under 5 years by UNICEF statistics which is difficult to diagnose because of nonspecific initial clinical presentation and potential for rapid deterioration. In this regard use of Yale Observation Scale assists in early recognition of serious bacterial infection than other laboratory investigation as it is simple, quick, easy to apply and cost-effective bed side scale.Methods: All eligible young febrile infants and children were consecutively enrolled in the study. Axillary temperatures of the cases were documented. Yale observation scoring was done. Blood sample were sent for culture and sensitivity. Colonies were identified morphologically by Gram stain and biochemically. The collected data was analyzed using ROC curve for finding cut off scores of Yale Observation Scale for prediction of severe bacterial illness and final outcome. Statistical analysis was performed using the Statistical Packages for Social Sciences (SPSS) version 14 for MS Window.Results: Bacteremia was found in 23(15.3%) out of total 150 young febrile children enrolled in the present study. It shows that in lower YOS score blood culture was sterile and in higher YOS score blood culture was positive for bacteremia, which is statistically significant with p value (<0.05). As per ROC curve analyses the best cut off value of YOS for prediction of bacteremia was 17.5 with sensitivity 91.3%, specificity 81.9%, PPV 47.7% and NPV of 98.1%.Conclusions: YOS of  >17.5 has a good predictive ability for prediction of bacteraemia in young febrile children.

Serum procalcitonin concentration within 2 days postoperatively accurately predicts outcome after liver resection

2018 ◽  
Vol 56 (8) ◽  
pp. 1362-1372 ◽  
Author(s):  
Yuto Aoki ◽  
Nobuhiko Taniai ◽  
Masato Yoshioka ◽  
Youichi Kawano ◽  
Tetsuya Shimizu ◽  
...  
Keyword(s):  
Liver Resection ◽  
Predictive Ability ◽  
Predictive Marker ◽  
Early Postoperative Period ◽  
Mortality And Morbidity ◽  
Receiver Operating Characteristic Curves ◽  
Reactive Protein ◽  
Early Predictors ◽  
Prediction Of Complications ◽  
Wbc Count

Abstract Background: Relatively high mortality and morbidity rates are reported after liver resection (LR). However, the early predictors of complications after LR are not clear. This study was performed to clarify the usefulness of procalcitonin (PCT) for the early prediction of complications after elective LR. Methods: This observational study included 72 consecutive patients who underwent elective LR from December 2015 to March 2017. Patients were categorized into two groups: those with and without postoperative complications (Clavien-Dindo grade ≥II). The values of postoperative inflammatory markers (white blood cell [WBC] count, C-reactive protein [CRP] and PCT) were compared between the two groups. Results: CRP and PCT were significantly higher in patients with than without complications; however, the WBC count showed no difference within 5 days postoperatively. The maximum area under the receiver operating characteristic curves within 2 days after LR using the WBC count, CRP and PCT were 0.608, 0.697 and 0.860, respectively, PCT had the best predictive ability in the early postoperative period. The PCT level peaked within 2 days postoperatively in 61 patients (85%). The maximum PCT level within 2 days postoperatively (PCT1−2) was significantly higher in patients with than without complications (0.52 vs. 0.19 ng/mL, p<0.001). A cutoff PCT1−2 level of 0.35 ng/mL achieved 80% sensitivity and 83% specificity. In patients without complications, there was no difference in PCT1−2 even when the surgical procedure differed (p=0.935). Conclusions: PCT1−2 is an early predictive marker after LR and can be similarly used regardless of the LR procedure.

Chitosan-Based Hydrogel Nanoparticles for Cancer Therapy

2017 ◽  
Vol 7 (04) ◽  
Author(s):  
Azadi A. ◽  
Khazaei M. ◽  
Ashrafi H.
Keyword(s):  
Drug Delivery ◽  
Cancer Therapy ◽  
Recent Decade ◽  
Reticuloendothelial System ◽  
Malignant Neoplasms ◽  
Mortality And Morbidity ◽  
Hydrogel Nanoparticles ◽  
Tissue Invasion ◽  
Causes Of Mortality ◽  
Nanoparticulate Systems

Cancer, an uncontrollable growth of cells, is among the leading causes of mortality and morbidity throughout the world. Malignant neoplasms are difficult to treat diseases because of their single in kind characteristics such as tissue invasion, metastasis, evading reticuloendothelial system (RES) and so forth. In recent decade polymeric nanoparticulate systems has gained special attention in drug delivery and targeting among all biocompatible nanoforms. Among these systems, chitosan-based hydrogel nanoparticles have been wildly utilized for drug delivery purposes. The usage of chitosan nanogels in cancer therapy significantly improved in recent years. The various cancers were the target of chitosan nanogels. Also, modification of other delivery systems with chitosan were much reported. The aim of this study is the review and update of the recent studies on chitosan nanogels applications in cancer therapy by focus on cancer based classification.

scholarly journals Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study

2021 ◽  
Vol 18 (11) ◽  
pp. 5865
Author(s):  
Salma Younes ◽  
Muthanna Samara ◽  
Rana Al-Jurf ◽  
Gheyath Nasrallah ◽  
Sawsan Al-Obaidly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Population Based ◽  
Incidence Rates ◽  
Large For Gestational Age ◽  
Mortality And Morbidity ◽  
Early Term ◽  
Incidence Risk

Preterm birth (PTB) and early term birth (ETB) are associated with high risks of perinatal mortality and morbidity. While extreme to very PTBs have been extensively studied, studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes of PTB and ETB births in Qatar. We examined 15,865 singleton live births using 12-month retrospective registry data from the PEARL-Peristat Study. PTB and ETB incidence rates were 8.8% and 33.7%, respectively. PTB and ETB in-hospital mortality rates were 16.9% and 0.2%, respectively. Advanced maternal age, pre-gestational diabetes mellitus (PGDM), assisted pregnancies, and preterm history independently predicted both PTB and ETB, whereas chromosomal and congenital abnormalities were found to be independent predictors of PTB but not ETB. All groups of PTB and ETB were significantly associated with low birth weight (LBW), large for gestational age (LGA) births, caesarean delivery, and neonatal intensive care unit (NICU)/or death of neonate in labor room (LR)/operation theatre (OT). On the other hand, all or some groups of PTB were significantly associated with small for gestational age (SGA) births, Apgar <7 at 1 and 5 minutes and in-hospital mortality. The findings of this study may serve as a basis for taking better clinical decisions with accurate assessment of risk factors, complications, and predictions of PTB and ETB.

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