Respiratory events in ward are associated with later intensive care unit (ICU) admission and hospital mortality in onco-hematology patients not admitted to ICU after a first request

PURPOSE To develop prospectively and validate a model for probability of hospital survival at admission to the intensive care unit (ICU) of patients with malignancy. PATIENTS AND METHODS This was an inception cohort study in the setting of four ICUs of academic medical centers in the United States. Defined continuous and categorical variables were collected on consecutive patients with cancer admitted to the ICU. A preliminary model was developed from 1,483 patients and then validated on an additional 230 patients. Multiple logistic regression modeling was used to develop the models and subsequently evaluated by goodness-of-fit and receiver operating characteristic (ROC) analysis. The main outcome measure was hospital survival after ICU admission. RESULTS The observed hospital mortality rate was 42%. Continuous variables used in the ICU admission model are PaO2/FiO2 ratio, platelet count, respiratory rate, systolic blood pressure, and days of hospitalization pre-ICU. Categorical entries include presence of intracranial mass effect, allogeneic bone marrow transplantation, recurrent or progressive cancer, albumin less than 2.5 g/dL, bilirubin > or = 2 mg/dL, Glasgow Coma Score less than 6, prothrombin time greater than 15 seconds, blood urea nitrogen (BUN) greater than 50 mg/dL, intubation, performance status before hospitalization, and cardiopulmonary resuscitation (CPR). The P values for the fit of the preliminary and validation models are .939 and .314, respectively, and the areas under the ROC curves are .812 and .802. CONCLUSION We report a disease-specific multivariable logistic regression model to estimate the probability of hospital mortality in a cohort of critically ill cancer patients admitted to the ICU. The model consists of 16 unambiguous and readily available variables. This model should move the discussion regarding appropriate use of ICU resources forward. Additional validation in a community hospital setting is warranted.

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SAPS 3—From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission

Intensive Care Medicine ◽

10.1007/s00134-005-2763-5 ◽

2005 ◽

Vol 31 (10) ◽

pp. 1345-1355 ◽

Cited By ~ 628

Author(s):

Rui P. Moreno ◽

Philipp G. H. Metnitz ◽

Eduardo Almeida ◽

Barbara Jordan ◽

Peter Bauer ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Prognostic Model ◽

Saps 3 ◽

Icu Admission

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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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Faculty Opinions recommendation of SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.3049.460525 ◽

2005 ◽

Author(s):

Massimo Antonelli

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Prognostic Model ◽

Saps 3 ◽

Icu Admission

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The knowledge of Cormack–Lehane intubation grade and intensive care unit outcome

Journal of the Intensive Care Society ◽

10.1177/1751143719832178 ◽

2019 ◽

Vol 21 (1) ◽

pp. 48-56

Author(s):

Vinodh B Nanjayya ◽

Christopher J Hebel ◽

Patrick J Kelly ◽

Jason McClure ◽

David Pilcher

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Invasive Mechanical Ventilation ◽

Severity Of Illness ◽

Secondary Outcome ◽

Mortality Data ◽

Icu Admission ◽

Icu Outcome ◽

Multivariable Analyses

Background For patients on invasive mechanical ventilation (MV), it is unclear if knowledge of intubation grade influences intensive care unit (ICU) outcome. We aimed to determine if there was an independent relationship between knowledge of intubation grade during ICU admission and in-hospital mortality. Methods We performed a retrospective cohort study of all patients receiving invasive MV at the Alfred ICU between December 2011 and February 2015. Demographics, details of admission, the severity of illness, chronic health status, airway detail (unknown or known Cormack–Lehane (CL) grade), MV duration and in-hospital mortality data were collected. Univariable and multivariable analyses were conducted to assess the relationship. The primary outcome was in-hospital mortality, and the secondary outcome was the duration of MV. Results Amongst 3556 patients studied, 611 (17.2%) had an unknown CL grade. Unadjusted mortality was higher in patients with unknown CL grade compared to known CL grade patients (21.6% vs. 9.9%). After adjusting for age, sex, severity of illness, type of ICU admission, cardiac arrest, limitations to treatment and diagnosis, having an unknown CL grade during invasive MV was independently associated with an increase in mortality (adjusted OR 1.5, 95% CI 1.14–1.98, p < 0.01). Conclusion Amongst ICU patients receiving MV, not knowing CL grade appears to be independently associated with increased mortality. This information should be communicated and documented in all patients receiving MV in ICU.

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Anemia at Intensive Care Unit Admission and Hospital Mortality Among Patients at a Referral Hospital in Malawi

The American Surgeon ◽

10.1177/0003134820973377 ◽

2020 ◽

pp. 000313482097337

Author(s):

Meghan Prin ◽

Shumin Rui ◽

Stephanie Pan ◽

Clement Kadyaudzu ◽

Parth S. Mehta ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Preliminary Evidence ◽

Sub Saharan Africa ◽

Icu Admission ◽

Cumulative Incidence Functions ◽

Sub Saharan ◽

Incidence Functions ◽

Competing Risk Models

Background Anemia is associated with intensive care unit (ICU) outcomes, but data describing this association in sub-Saharan Africa are scarce. Patients in this region are at risk for anemia due to endemic conditions like malaria and because transfusion services are limited. Methods This was a prospective cohort study of ICU patients at Kamuzu Central Hospital (KCH) in Malawi. Exclusion criteria included age <5 years, pregnancy, ICU readmission, or admission for head injury. Cumulative incidence functions and Fine-Gray competing risk models were used to evaluate hemoglobin (Hgb) at ICU admission and hospital mortality. Results Of 499 patients admitted to ICU, 359 were included. The median age was 28 years (interquartile ranges (IQRs) 20-40) and 37.5% were men. Median Hgb at ICU admission was 9.9 g/dL (IQR 7.5-11.4 g/dL; range 1.8-18.1 g/dL). There were 61 (19%) patients with Hgb < 7.0 g/dL, 59 (19%) with Hgb 7.0-8.9 g/dL, and 195 (62%) with Hgb ≥ 9.0 g/dL. Hospital mortality was 51%, 59%, and 54%, respectively. In adjusted analyses, anemia was associated with hospital mortality but was not statistically significant. Conclusions This study provides preliminary evidence that anemia at ICU admission may be an independent predictor of hospital mortality in Malawi. Larger studies are needed to confirm this association.

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Intensive Care Unit and Hospital Outcomes of Patients Admitted with Blastomycosis: A 14-Year Retrospective Study

10.21203/rs.3.rs-220663/v1 ◽

2021 ◽

Author(s):

Yahya Almodallal ◽

Adham K Alkurashi ◽

Hasan Ahmad Hasan Albitar ◽

Hussam Jenad ◽

Suartcha Prueksaritanond ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Hospital Mortality ◽

Replacement Therapy ◽

Distress Syndrome ◽

Clinical Presentation ◽

Admission Rate ◽

Icu Admission ◽

Life Threatening

Abstract Introduction: Blastomycosis is an uncommon; potentially life threatening granulomatous fungal infection. The aim of this study is to report hospital and intensive care unit (ICU) outcomes of patients admitted with blastomycosis. Methods: All patients admitted for treatment of blastomycosis at the Mayo Clinic-Rochester, Minnesota between 01/01/2006 and 09/30/2019 were included. Demographics, comorbidities, clinical presentation, ICU admission, and outcomes were reviewed.Results: A total of 84 Patients were identified with 93 unique hospitalizations primarily for blastomycosis. The median age at diagnosis was 49 (IQR 28.1-65, range: 6-85) years and 56 (66.7%) were male. The most frequent comorbidities included hypertension (n=28, 33.3%); immunosuppressed state (n=25, 29.8%) and diabetes mellitus (n=21, 25%). The lungs were the only organ involved in 56 (66.7%) cases and the infection was disseminated in 19 (22.6%) cases. A total of 29 patients (34.5%) underwent ICU admission due to complications of blastomycosis. ICU related events included mechanical ventilation (n=21, 25%), acute respiratory distress syndrome (ARDS) (n=13, 15.5%), tracheostomy (n=9, 10.7%), renal replacement therapy (n=8, 9.5%), and extracorporeal membrane oxygenation (ECMO) (n=4, 4.8%). A total of 12 patients (14.3%) died in the hospital; all of whom had undergone ICU admission. In-hospital mortality was associated with renal replacement therapy (RRT) (P=0.0255).Conclusions: Blastomycosis is a serious, potentially life-threatening infection that results in significant morbidity and mortality with a 34.5% ICU admission rate. Renal replacement therapy was associated with in-hospital mortality.

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CRB-65: Predictor for Intensive Care Unit Admission in Patients with Biliary Tract Infection Presenting to An Emergency Department

10.22514/sv.2020.16.0049 ◽

2020 ◽

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Tract Infection ◽

Hospital Mortality ◽

Biliary Tract ◽

Screening Tools ◽

High Morbidity ◽

Biliary Tract Infection ◽

Icu Admission

Objectives: Biliary tract infection (BTI) is a common cause of bacteremia and is associated with high morbidity and mortality. However, studies on screening tools to predict disease severity in BTI patients are lacking. This study aimed to comparatively validate CRB, CRB-65, quick Sequential Organ Failure Assessment (qSOFA), and Systemic Inflammatory Response Syndrome (SIRS) in predicting the clinical outcomes of BTI patients. Methods: This retrospective cohort study included patients with BTI who visited the emergency department of a medical center between February 2018 and March 2020. Baseline patient data were compared to assess the prevalence of intensive care unit (ICU) admission and in-hospital mortality. The effectiveness of CRB, CRB-65, qSOFA, and SIRS scores as indicators of ICU admission and in-hospital mortality was evaluated using the area under the receiver operating characteristic (AUROC) curve. Results: This study included 745 patients, of whom 111 (14.8%) were admitted to the ICU and 20 (2.7%) died in-hospital. AUROC values (95% CI) for predicting ICU admission and in-hospital mortality were as follows: CRB, 0.774 and 0.707 (0.742 –0.803 and 0.673 – 0.739); CRB - 65, 0.816 and 0.735 (0.786 – 0.843 and 0.0.702 – 0.766); qSOFA, 0.779 and 0.724 (03747 – 0.808 and 0.690 – 0.755); and SIRS, 0.686 and 0.659 (0.651 – 0.719 and 0.623 – 0.693), respectively. Conclusions: CRB-65 can be used as useful screening tools to predict ICU admission in patients with BTI on presentation to the emergency department.

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Prognostication in urgent intensive care unit referrals: a cohort study

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-001567 ◽

2018 ◽

Vol 10 (1) ◽

pp. 118-121 ◽

Cited By ~ 1

Author(s):

Joao Gabriel Rosa Ramos ◽

Roger Daglius Dias ◽

Rogerio da Hora Passos ◽

Paulo Benigno Pena Batista ◽

Daniel Neves Forte

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Poor Prognosis ◽

Performance Status ◽

Multivariable Analysis ◽

Severe Disabilities ◽

Icu Admission ◽

Prediction Of Mortality ◽

Incorrect Classification

ObjectivesPrognostication is an essential ability to clinicians. Nevertheless, it has been shown to be quite variable in acutely ill patients, potentially leading to inappropriate care. We aimed to assess the accuracy of physician’s prediction of hospital mortality in acutely deteriorating patients referred for urgent intensive care unit (ICU) admission.MethodsProspective cohort of acutely ill patients referred for urgent ICU admission in an academic, tertiary hospital. Physicians’ prognosis assessments were recorded at ICU referral. Prognosis was assessed as survival without severe disabilities, survival with severe disabilities or no survival. Prognosis was further dichotomised in good prognosis (survival without severe disabilities) or poor prognosis (survival with severe disabilities or no survival) for prediction of hospital mortality.ResultsThere were 2374 analysed referrals, with 2103 (88.6%) patients with complete data on mortality and physicians’ prognosis. There were 593 (34.4%), 215 (66.4%) and 51 (94.4%) deaths in the groups ascribed a prognosis of survival without disabilities, survival with severe disabilities or no survival, respectively (p<0.001). Sensitivity was 31%, specificity was 91% and the area under the receiver operating characteristic curve was 0.61 for prediction of mortality. After multivariable analysis, severity of illness, performance status and ICU admission were associated with an increased likelihood of incorrect classification, while worse predicted prognosis was associated with a lower chance of incorrect classification.ConclusionsPhysician’s prediction was associated with hospital mortality, but overall accuracy was poor, mainly due to low sensitivity to detect risk of poor prognosis.

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

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e21653 ◽

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.

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