Procalcitonin as a biomarker of bacterial infection in critically ill patients admitted with suspected Sepsis in Intensive Care Unit of a tertiary care hospital

Objective: To compare the diagnostic accuracy of procalcitonin (PCT), C- reactive protein (CRP), total leukocyte count (TLC) and lactate in critically ill patients admitted with suspicion of sepsis. Methods: It was a cross sectional study conducted at the department of Chemical Pathology and Endocrinology AFIP, Rawalpindi, in collaboration with Medical and surgical intensive care units (ICU) of CMH Rawalpindi from January 2019 to December 2019. A total of 126 patients of both genders with age above 18 years and fulfilling the inclusion criteria of systemic inflammatory response syndrome (SIRS) were inducted in the study. Results: Out of 126 patients 82 (65%) patients have positive blood culture results. Male predominance was noted in patients with positive blood culture. Out of 82 patients with positive blood culture results 69(84%) patients have positive PCT results as well whereas 13(15%) patients with positive blood culture results have negative PCT values. 57(69%) patients had Gram negative bacterial infection and 25(30%) patients had Gram positive bacterial infection. Significant difference was noted between the medians of PCT in blood culture positive and blood culture negative group (p value< 0.05) whereas no significant difference was found between medians of CRP, TLC and lactate between blood culture positive and blood culture negative patients (p value > 0.05). ROC curve analysis of PCT, CRP and TLC were done, keeping blood culture as reference standard, PCT showed largest area under the curve (AUC) and clearly outperformed TLC and CRP. PCT showed AUC of 0.781 as compared to CRP and TLC, which was 0.568 and 0.617 respectively. PCT showed sensitivity of 93.9%, specificity of 47.7%, positive predictive value (PPV) of 77% and negative predictive value (NPV) of 80.8%. Conclusion: Higher NPV makes it a reliable marker for screening out sepsis in suspected cases. doi: https://doi.org/10.12669/pjms.37.7.4183 How to cite this:Bibi A, Basharat N, Aamir M, Haroon ZH. Procalcitonin as a biomarker of bacterial infection in critically ill patients admitted with suspected Sepsis in Intensive Care Unit of a tertiary care hospital. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4183 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Discomforts in Critically ill Patients: Our Experience in Intensive Care Unit of a Tertiary Care Hospital in India

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46882.14586 ◽

2021 ◽

Author(s):

Reetu Verma ◽

Sasmita Panda ◽

Rajeev Kumar Nishad

Keyword(s):

Intensive Care ◽

Environmental Factors ◽

Critically Ill ◽

Nursing Care ◽

Critically Ill Patients ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Icu Patients ◽

Common Cause

Introduction: Patients admitted in the Intensive Care Units (ICUs) experiences various discomforts which may be recognised or unrecognised. These discomforts may arise from the environment, may be related to the ICU care and discomfort related to the health status of the patient and critical care interventions. Aim: To identify the various discomforts in ICU patients, to classify them with respective causes, identify the most common cause among them and whether ICU sedation helps in reducing discomforts. Materials and Methods: This observational study was conducted from 15th July to 15th October 2018 on 120 mixed ICU patients in a Tertiary Care Hospital in India. Patients who were admitted to ICU for more than 24 hours, aged 18 years and above, those who gave written informed consent were observed and enquired for any discomfort. Discomforts have been identified and recorded by a fulltime intensivist by direct observation, by interacting with the patients and asking the family members and others (indirect approach). Through this study discomforts of critically ill patients were broadly classified into four categories 1. Due to existing illness, 2. Due to ICU interventions, 3. Due to improper nursing care and 4. Due to environmental factors. Results: Out of 120 patients studied, 84 patients (70%) reported some kind of discomfort during their ICU stay. Existing illness was the most common cause of discomfort, 80 patients (66.6%) suffered due to it. ICU interventions was the second most common cause, 71 patients (59.1%) had discomfort due to interventions. Thirty five patients (29.1%) suffered due to improper nursing care and 25 patients (20.8%) suffered due to the environmental factors. In this study, it was observed that sedation reduces all kind of discomforts. conclusion: In this study 70% of patients, who were admitted to ICU due to various illness reported some kind of discomfort. The most common cause of ICU discomforts was existing illness followed by ICU interventions. In this study it was observed that sedation reduces all kind of discomforts. Sedated patients tolerate the endotracheal tube better and they had less environmental and procedure related discomforts. With the present study observation it can be suggested that ICU charts of nurses and doctors can carry a separate column for mentioning discomforts in different duty shifts. However, with the use of appropriate analgesia and sedation discomfort can be reduced.

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Characteristics and Outcomes of Critically Ill Patients with Raised Cardiac Troponins Admitted in the Intensive Care Unit

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.4.2021.060 ◽

2021 ◽

Author(s):

Sunil K. Nadar ◽

Muhammad M. Shaikh ◽

Muhammad A. Khatri ◽

Wael A. Abdelmottaleb ◽

Sheeraz Ahmed ◽

...

Keyword(s):

Myocardial Infarction ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Myocardial Injury ◽

Tertiary Care ◽

Hospital Length Of Stay ◽

Care Hospital ◽

Coronary Syndrome

Objectives: Critically ill patients have been shown to have raised troponins. The aim of our study was to assess the incidence of myocardial injury in the intensive care unit (ICU) a tertiary care hospital in Oman and assess their management and prognosis. Methods: This was a retrospective study involving adult patients admitted to the ICU of our institution between 1st January and 31st December 2019 who had a high sensitive cardiac troponin (Hs-CTn) assay performed. We excluded patients who were admitted with a primary diagnosis of myocardial infarction. Results: A total of 264 patients had a Hs-cTn measured during this period. Of these 128 patients (64.3+17.1 years; 58.5% male) had elevated levels giving an incidence of around 48.4%. Those with raised troponin were older and had more co-morbidities. These patients were also more critical with lower blood pressure, higher heart rates, hypotensive episodes. Of the 128 patients, 47 were treated as acute coronary syndrome and 32 underwent coronary angiography. Of these only 3 patients required stenting. Patients with raised troponin had a poor outcome with only 45 (35.1%) surviving to discharge as compared to 73.5% where troponin was normal. They had a shorter hospital length of stay as compared to those with normal troponin (16(8-25) vs 19(13-28) p=0.017). Conclusion: A high proportion of critically ill patients have evidence of myocardial injury without significant coronary artery disease. It is associated with poor prognosis. Further prospective studies are required to ascertain the best mode of treatment in these patients. Keywords: Troponin; Biomarkers; Intensive Care; Myocardial Infarction.

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303. Physiological Changes Due to Bloodstream Infection in Intensive Care Unit Patients Differ According to Transplant Status

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.346 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S149-S150

Author(s):

Alex Zimmet ◽

Douglas Lake ◽

Amanda M Zimmet ◽

Shrirang M Gadrey ◽

Taison Bell ◽

...

Keyword(s):

Logistic Regression ◽

Intensive Care ◽

Blood Culture ◽

Bloodstream Infection ◽

Critically Ill ◽

Positive Blood Culture ◽

Critically Ill Patients ◽

Regression Modeling ◽

Transplant Recipients ◽

Logistic Regression Modeling

Abstract Background Transplant recipients are at increased risk of bloodstream infection (BSI), which often leads to critical illness. Due to immunosuppression, BSI in these patients may manifest with different pathophysiology compared to non-transplant recipients. We aimed to identify different trends in the pathophysiology of critically ill patients with BSI based on transplant status. Methods We reviewed data from patients admitted to the medical and surgical/trauma intensive care units (ICUs) at the University of Virginia Medical Center from 2011 to 2015. We included both solid organ and hematopoietic stem cell transplant recipients. We performed univariate logistic regression modeling to evaluate trends in different physiological features in both transplant and non-transplant recipients in the 96 hours surrounding a positive blood culture. We then performed multivariate logistic regression modeling to identify features independently associated with a positive blood culture in the next 24 hours in transplant recipients. Results We analyzed 9,954 ICU patient-admissions (including 505 transplant recipients), with a total of 144 patient-years of physiological data, 1.3 million hourly measurements, and 15,577 blood culture instances. Of the 1,068 blood culture instances in transplant recipients, 125 (12%) were positive, compared to 1,051 of 14,509 (7%) blood culture instances in non-transplant recipients. Critically ill transplant recipients with BSI had greater abnormalities in vital signs, oxygen requirement, markers of organ damage, APACHE score, and Charlson Comorbidity Index (CCI) compared to non-transplant recipients (Figure 1). Trends in many of these features also differed based on transplant status. The multivariable logistic regression model of BSI in transplant recipients included, in decreasing strength of association: total bilirubin, systolic blood pressure, fraction of inspired oxygen, number of intravenous lines, and CCI. This model had an AUC of 0.75. Figure 1. Trends in pathophysiological abnormalities in 9,954 critically ill patients with BSI based on transplant status, 2011–2015. Each graph demonstrates the average value of the physiological variable over time relative to the acquisition of a positive blood culture. Blue curves depict trends in transplant recipients, while red curves depict trends in non-transplant recipients. We assessed 108 physiological features and show the 24 features with the greatest change around the time of blood culture. Conclusion Critically ill transplant recipients have a higher prevalence of BSI and different pathophysiological manifestations of BSI compared to non-transplant recipients. This may have implications regarding early detection and treatment of BSI in these patients. Disclosures Randall Moorman, MD, Advanced Medical Predictive Devices, Diagnostics, and Displays (Board Member, Shareholder)

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Knowledge, Attitude, and Practices towards Physical Assessment of Critically Ill Patients among Nurses Working in Intensive Care Unit: A Cross-Sectional Study in Lahore, Pakistan

International Journal of Health, Medicine and Nursing Practice ◽

10.47941/ijhmnp.569 ◽

2021 ◽

Vol 3 (1) ◽

pp. 44-61

Author(s):

Muhammad Saghir ◽

Muhammad Hussain ◽

Kousar Perveen ◽

Muhammad Afzal ◽

Maliha Shoukat Shoukat

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Pearson Correlation ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Cross Sectional ◽

Physical Assessment

Purpose: The purpose of the study to examine nurses' knowledge, attitudes, and practices towards physical assessment of critically ill patients in Tertiary Care Hospital, Lahore Pakistan. Methodology: The cross-sectional study was performed. A well-designed questionnaire was used to observe responses. Statistical Package for the Social Sciences (SPSS) version 25 was used to analyze the data. For the analysis, descriptive statistics of demographic data were used, meaning standard deviation and frequency. The Pearson correlation test was used to measure the correlation between knowledge, attitude, and practice towards physical assessment of critically ill patients. The study results display in tables and charts. Pearson correlation at p <0.05 consider as significant. Findings: The study was carried out to assess the knowledge, attitude, and practice among intensive care unit nurses towards physical assessment of critically sick patients in Tertiary Care Hospital Lahore, Pakistan. In this study, around 57.2% of nurses had good knowledge, 59.4% positive attitude, and 68.1% good practice towards critical ill patient’s physical assessment Unique contribution to theory, practice and policy: This study provide the opportunity to the nurses better to enhance their level of knowledge and skill of practice on physical assessment. Nurses, who had better knowledge and skill, should also teach their respective colleagues. Keywords: Knowledge, Attitude, Practice, Intensive Care Unit, Nurses, Physical Assessment.

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Use of blood components in critically ill patients in the medical intensive care unit of a tertiary care hospital

Asian Journal of Transfusion Science ◽

10.4103/0973-6247.53879 ◽

2009 ◽

Vol 3 (2) ◽

pp. 82 ◽

Cited By ~ 2

Author(s):

RN Makroo ◽

RK Mani ◽

Raina Vimarsh ◽

Sudha Kansal ◽

Kumar Pushkar ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Tertiary Care Hospital ◽

Medical Intensive Care Unit ◽

Tertiary Care ◽

Care Hospital ◽

Blood Components ◽

Medical Intensive Care

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Predicting Infection-related Consultations on Intensive Care Units - Development of a Machine Learning Prediction Model

10.1101/2021.03.31.21254530 ◽

2021 ◽

Author(s):

Christian Friedemann Luz ◽

Dimitrios Soudis ◽

Maurits H Renes ◽

Leslie R Zwerwer ◽

Nicoletta Giudice ◽

...

Keyword(s):

Machine Learning ◽

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Critically Ill Patients ◽

Short Term Memory ◽

Positive Impact ◽

Tertiary Care ◽

Gradient Boosting ◽

Care Hospital

Objectives: Infection-related consultations on intensive care units (ICU) build an important cornerstone in the care for critically ill patients with (suspected) infections. The positive impact of consultations on quality of care and clinical outcome has previously been demonstrated. However, timing is essential and to date consultations are typically event-triggered and reactive. Here, we investigate a proactive approach by predicting infection-related consultations using machine learning models and routine electronic health records (EHR). Methods: We used data from a mixed ICU at a large academic tertiary care hospital including 9684 admissions. EHR data comprised demographics, laboratory results, point-of-care tests, vital signs, line placements, and prescriptions. Consultations were performed by clinical microbiologists. The predicted target outcome (occurrence of a consultation) was modelled using random forest (RF), gradient boosting machines (RF), and long short-term memory neural networks (LSTM). Results: Overall, 7.8 % of all admission received a consultation. Time-sensitive modelling approaches and increasing numbers of patient features (parameters) performed better than static approaches in predicting infection-related consultations at the ICU. Splitting a patient admission into eight-hour intervals and using LSTM resulted in the accurate prediction of consultations up to eight hours in advance with an area under the receiver operator curve of 0.921 and an area under precision recall curve of 0.673. Conclusion: We could successfully predict of infection-related consultations on an ICU up to eight hours in advance, even without using classical triggers, such as (interim) microbiology reports. Predicting this key event can potentially streamline ICU and consultant workflows and improve care and outcome for critically ill patients with (suspected) infections.

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Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

10.2196/preprints.23937 ◽

2020 ◽

Author(s):

Dr. Animesh Ray ◽

Dr. Komal Singh ◽

Souvick Chattopadhyay ◽

Farha Mehdi ◽

Dr. Gaurav Batra ◽

...

Keyword(s):

Tertiary Care ◽

Age Groups ◽

Hospitalized Patients ◽

North India ◽

P Value ◽

Care Hospital ◽

Igg Antibodies ◽

Igg Antibody ◽

Increased Risk ◽

Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

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Detection of SARS-CoV-2 and Other Infectious Agents in Lower Respiratory Tract Samples Belonging to Patients Admitted to Intensive Care Units of a Tertiary-Care Hospital, Located in an Epidemic Area, during the Italian Lockdown

Microorganisms ◽

10.3390/microorganisms9010185 ◽

2021 ◽

Vol 9 (1) ◽

pp. 185

Author(s):

Adriana Calderaro ◽

Mirko Buttrini ◽

Sara Montecchini ◽

Giovanna Piccolo ◽

Monica Martinelli ◽

...

Keyword(s):

Intensive Care ◽

Respiratory Tract ◽

Intensive Care Units ◽

Lower Respiratory Tract ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Infectious Agents ◽

Epidemic Area ◽

Significant Difference

The aim of this study was the detection of infectious agents from lower respiratory tract (LRT) samples in order to describe their distribution in patients with severe acute respiratory failure and hospitalized in intensive care units (ICU) in an Italian tertiary-care hospital. LRT samples from 154 patients admitted to ICU from 27 February to 10 May 2020 were prospectively examined for respiratory viruses, including SARS-CoV-2, bacteria and/or fungi. SARS-CoV-2 was revealed in 90 patients (58.4%, 72 males, mean age 65 years). No significant difference was observed between SARS-CoV-2 positives and SARS-CoV-2 negatives with regard to sex, age and bacterial and/or fungal infections. Nonetheless, fungi were more frequently detected among SARS-CoV-2 positives (44/54, 81.4%, p = 0.0053). Candida albicans was the overall most frequently isolated agent, followed by Enterococcus faecalis among SARS-CoV-2 positives and Staphylococcus aureus among SARS-CoV-2 negatives. Overall mortality rate was 40.4%, accounting for 53 deaths: 37 among SARS-CoV-2 positives (mean age 69 years) and 16 among SARS-CoV-2 negatives (mean age 63 years). This study highlights the different patterns of infectious agents between the two patient categories: fungi were prevalently involved among SARS-CoV-2-positive patients and bacteria among the SARS-CoV-2-negative patients. The different therapies and the length of the ICU stay could have influenced these different patterns of infectious agents.

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