scholarly journals Course of lactate, pH and base excess for prediction of mortality in medical intensive care patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261564
Author(s):  
Anja Schork ◽  
Kathrin Moll ◽  
Michael Haap ◽  
Reimer Riessen ◽  
Robert Wagner
Keyword(s):  
Intensive Care ◽  
Base Excess ◽  
Risk Group ◽  
Hazard Ratio ◽  
University Hospital ◽  
Standard Deviation Increase ◽  
Icu Patients ◽  
Predictors Of Mortality ◽  
Prediction Of Mortality ◽  
Maximum Lactate

Introduction As base excess had shown superiority over lactate as a prognostic parameter in intensive care unit (ICU) surgical patients we aimed to evaluate course of lactate, base excess and pH for prediction of mortality of medical ICU patients. Materials and methods For lactate, pH and base excess, values at the admission to ICU, at 24 ± 4 hours, maximum or minimum in the first 24 hours and in 24–48 hours after admission were collected from all patients admitted to the Medical ICU of the University Hospital Tübingen between January 2016 until December 2018 (N = 4067 at admission, N = 1715 with ICU treatment > 48 h) and investigated for prediction of in-hospital-mortality. Results Mortality was 22% and significantly correlated with all evaluated parameters. Strongest predictors of mortality determined by ROC were maximum lactate in 24 h (AUROC 0.74, cut off 2.7 mmol/L, hazard ratio of risk group with value > cut off 3.20) and minimum pH in 24 h (AUROC 0.71, cut off 7.31, hazard ratio for risk group 2.94). Kaplan Meier Curves stratified across these cut offs showed early and clear separation. Hazard ratios per standard deviation increase were highest for maximum lactate in 24 h (HR 1.65), minimum base excess in 24 h (HR 1.56) and minimum pH in 24 h (HR 0.75). Conclusion Lactate, pH and base excess were all suitable predictors of mortality in internal ICU patients, with maximum / minimum values in 24 and 24–48 h after admission altogether stronger predictors than values at admission. Base excess and pH were not superior to lactate for prediction of mortality.

scholarly journals Course of Lactate, pH and Base Excess for Prediction of Mortality in Medical Intensive Care Patients

2021 ◽  
Author(s):  
Anja Schork ◽  
Kathrin Moll ◽  
Michael Haap ◽  
Reimer Riessen ◽  
Robert Wagner
Keyword(s):  
Intensive Care ◽  
Base Excess ◽  
Risk Group ◽  
Hazard Ratio ◽  
Standard Deviation Increase ◽  
Icu Patients ◽  
Predictors Of Mortality ◽  
Prediction Of Mortality ◽  
Maximum Minimum ◽  
Maximum Lactate

Abstract Introduction: As base excess (BE) had shown superiority over lactate as a prognostic parameter in intensive care unit (ICU) surgical patients we aimed to evaluate course of lactate, base excess and pH for prediction of mortality of medical ICU patients. Materials and Methods: For lactate, pH and base excess, values at the admission to ICU, at 24 ± 4 hours, maximum / minimum in the first 24 hours and in 24 – 48 hours after admission were collected from all patients admitted to the Medical ICU of the University Hospital Tübingen between January 2016 until December 2018 and investigated for prediction of in-hospital-mortality. Results: Mortality in the cohort of 4067 patients was 22 % and significantly correlated with all evaluated parameters. Strongest predictors of mortality determined by ROC were maximum lactate in 24 h (AUROC 0.74, cut off 2.7 mmol/L, hazard ratio of risk group with value > cut off 3.20) and minimum pH in 24 h (AUROC 0.71, cut off 7.31, hazard ratio for risk group 2.94). Kaplan Meier Curves stratified across these cut offs showed early and clear separation. Hazard ratios per standard deviation increase were highest for maximum lactate in 24 h (HR 1.65), minimum base excess in 24 h (HR 1.56) and minimum pH in 24 h (HR 0.75). In multiple logistic regression analysis, age, minimum pH in 24 h, pH at 24 h after admission, maximum lactate in 24 h, maximum lactate in 24 – 48 h, minimum base excess in 24 h and minimum base excess in 24 – 48 h were independent predictors of mortality. Discussion: Lactate, pH and base excess were all suitable predictors of mortality in internal ICU patients, with maximum / minimum values in 24 and 24-48 h after admission altogether stronger predictors than values at admission. Base excess and pH were not superior to lactate for prediction of mortality.

scholarly journals Course of Lactate, pH and Base Excess for Prediction of Mortality in Medical Intensive Care Patients - A Retrospective Cohort Analysis

2020 ◽  
Author(s):  
Anja Schork ◽  
Kathrin Moll ◽  
Michael Haap ◽  
Reimer Riessen ◽  
Robert Wagner
Keyword(s):  
Intensive Care ◽  
Base Excess ◽  
Risk Group ◽  
Hazard Ratio ◽  
Predictors Of Mortality ◽  
Intensive Care Patients ◽  
Prediction Of Mortality ◽  
Medical Intensive Care ◽  
Maximum Minimum ◽  
Maximum Lactate

Abstract Background: We aimed to evaluate the value of lactate, base excess and pH for prediction of mortality in the course of the disease of medical intensive care patients. Methods: For lactate, pH and base excess, values at the admission to intensive care unit (ICU), at 24 ± 4 hours, maximum / minimum in the first 24 hours and in 24 – 48 hours after admission were collected from all patients admitted to the Medical ICU of the University Hospital Tübingen between January 2016 until December 2018 and investigated for prediction of in-hospital-mortality.Results: Mortality in the cohort of 4067 patients was 22 % and significantly correlated with all evaluated parameters. Strongest predictors of mortality determined by ROC were maximum lactate in 24 h (AUROC 0.74, cut off 2.7 mmol/L, hazard ratio of risk group with value > cut off 2.27) and minimum pH in 24 h (AUROC 0.71, cut off 7.43, hazard ratio for risk group 2.94). Kaplan Meier Curves stratified across these cut offs showed early and clear separation. Hazard ratios per standard deviation were highest for maximum lactate in 24 h (HR 1.65), minimum base excess in 24 h (HR 1.56) and minimum pH in 24 h (HR 0.75). In multiple logistic regression analysis, age, minimum pH in 24 h, pH at 24 h after admission, maximum lactate in 24 h, maximum lactate in 24 – 48 h, minimum base excess in 24 h and minimum base excess in 24 – 48 h were independent predictors of mortality. Conclusions: Lactate, pH and base excess were all suitable predictors of mortality in internal ICU patients, with maximum / minimum values in 24 and 24-48 h after admission altogether stronger predictors than values at admission. Base excess and pH were not superior to lactate for prediction of mortality.

Predictors of Mortality of Critically Ill Gynecological Patients

2016 ◽  
Vol 8 (2) ◽  
pp. 96-100
Author(s):  
Rahat Qureshi ◽  
Sheikh Irfan Ahmed ◽  
Amir Raza ◽  
Azra Amerjee
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Gynecological Cancer ◽  
Invasive Mechanical Ventilation ◽  
Central Line ◽  
University Hospital ◽  
Arterial Line ◽  
Predictors Of Mortality ◽  
Line Insertion

ABSTRACT Background Gynecological patients with serious underlying morbidities require admission into intensive care units (ICUs) albeit being few in numbers. Objectives To review gynecological cases with non-pregnancyrelated illness, admitted to ICU with respect to diagnosis, associated risk factors, intervention required, aspects of management, and rate of mortality. Materials and methods Retrospective record view of gynecological patients admitted in the ICU from 2005 to 2014. Setting Aga Khan University Hospital, Karachi. Findings Twenty-six patients were admitted with complications secondary to gynecological indications. The most common reason was pulmonary edema (26.9%); sepsis was documented in 23.1% of all patients. Hemorrhagic shock was found in 11.5% gynecological ICU admissions, cardiogenic shock in 15.4%, and renal failure in 7.7%. Fourteen critically ill women with gynecological cancer were admitted to the ICU (ovarian cancer, n = 8; cervical cancer, n = 1; and endometrial cancer, n = 5). The overall mortality of gynecological patients was 26.92%. The most common interventions were mechanical ventilation (96%) followed by arterial line insertion (88%) and central line insertion (85%). Conclusion Critically ill gynecological patients requiring invasive mechanical ventilation, central hemodynamic monitoring, and invasive arterial pressure monitoring should be admitted to an intensive care unit. How to cite this article Qureshi R, Ahmed SI, Raza A, Amerjee A. Predictors of Mortality of Critically Ill Gynecological Patients. J South Asian Feder Obst Gynae 2016;8(2):96-100.

Factors Associated with Risk and Prognosis of Intensive Care Unit Admission in Patients with Acute Myeloid Leukemia: A Danish Nationwide Cohort Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4783-4783
Author(s):  
Cecilie Velsoe Maeng ◽  
Christian Fynbo Christiansen ◽  
Kathleen Dori Liu ◽  
Lene Sofie Granfeldt Oestgaard
Keyword(s):  
Intensive Care ◽  
High Risk ◽  
Myeloid Leukemia ◽  
Risk Group ◽  
Remission Induction ◽  
First Year ◽  
Icu Patients ◽  
Icu Admission ◽  
Increased Risk ◽  
Acute Myeloid

Significance Patients with acute myeloid leukemia (AML) are at high risk of critical illness requiring admission to the intensive care unit (ICU) due to both disease- and treatment-related complications. A better understanding of risk factors for ICU admission and prognosis may help with prevention of life-threatening complications and informed decision-making when treating AML patients. Methods This study included all adult Danish AML patients, who received remission-induction chemotherapy alone or in combination with allogeneic stem cell transplantation from 2005 to 2016. The cohort was identified using the Danish Acute Leukemia Registry (DNLR) and information on ICU admission was obtained from the Danish Intensive Care Database. We examined risk of ICU admission within 1 and 3 years of diagnosis considering competing risk of death and investigated a number of possible risk factors for ICU admission. We computed 1-, 3-, and 5-year mortality from time of ICU admission and in the matched non-ICU comparison group using a risk set matching (1:1) on time since diagnosis, sex, and age. Finally, we used the pseudo-value approach to compute the relative risk (RR) of death in the ICU admitted cohort compared to the matched cohort. We adjusted for ECOG/WHO performance status (PS), year of diagnosis, cytogenetic risk group, number of comorbidities, and secondary/therapy-related AML. Results A total of 1383 AML patients were included in the study. The median follow-up time was 1.65 (IQR: 0.60-4.36) years. The risk of ICU admission within 1 year of AML diagnosis was 22.7%, and the risk within 3 years was 28.1%. Median time to ICU was 59 (IQR: 15-272) days. Male sex was associated with increased risk of ICU admission after 1 year (adjusted RR: 1.26, 95% CI: 1.01-1.57) and PS >1 was associated with an increased risk after both 1 year (adjusted RR: 1.74, 95% CI: 1.33-1.30) and 3 years (adjusted RR: 1.54, 95% CI: 1.22-1.96). Other factors listed in Table 1 (age, comorbidity, cytogenetic risk group, secondary or therapy-related AML, and year of diagnosis) were not associated with increased risk of ICU admission. In AML patients admitted to the ICU, the 1-year mortality from time of ICU admission was 69.2%, compared to a 1-year mortality rate of 31.0% in the matched non-ICU patients (adjusted RR: 3.25, 95% CI: 2.56-4.12). Long-term mortality was increased in ICU patients; 3-year mortality was 82.1% compared to 49.7% (adjusted RR: 2.43, 95% CI: 1.97-3.01), and the 5-year mortality was 83.1% compared to 60.6%, (adjusted RR: 2.12, 95% CI: 1.70-2.66). Conclusion In this national population-based cohort study, more than one fourth of AML patients treated with remission-induction chemotherapy were admitted to an ICU within 3 years of diagnosis with the majority of ICU admissions occurring within the first year. ICU admission was associated with high mortality, especially within the first year after admission. The risk of mortality decreased over time but remained increased 3 and 5 years after admission compared to the matched cohort. Early monitoring and management of high-risk patients may be effective in preventing ICU admissions and PS may serve as a possible tool to identify patients at high risk of ICU admission. Disclosures No relevant conflicts of interest to declare.

scholarly journals Staphylococcus aureusNasal Colonization and Subsequent Infection in Intensive Care Unit Patients: Does Methicillin Resistance Matter?

2010 ◽  
Vol 31 (6) ◽  
pp. 584-591 ◽  
Author(s):  
Hitoshi Honda ◽  
Melissa J. Krauss ◽  
Craig M. Coopersmith ◽  
Marin H. Kollef ◽  
Amy M. Richmond ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Confidence Interval ◽  
Methicillin Resistance ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Patient Specific ◽  
Icu Patients ◽  
Icu Admission

Background.Staphylococcus aureusis an important cause of infection in intensive care unit (ICU) patients. Colonization with methicillin-resistantS. aureus(MRSA) is a risk factor for subsequentS. aureusinfection. However, MRSA-colonized patients may have more comorbidities than methicillin-susceptibleS. aureus(MSSA)-colonized or noncolonized patients and therefore may be more susceptible to infection on that basis.Objective.To determine whether MRSA-colonized patients who are admitted to medical and surgical ICUs are more likely to develop anyS. aureusinfection in the ICU, compared with patients colonized with MSSA or not colonized withS. aureus,independent of predisposing patient risk factors.Design.Prospective cohort study.Setting.A 24-bed surgical ICU and a 19-bed medical ICU of a 1,252-bed, academic hospital.Patients.A total of 9,523 patients for whom nasal swab samples were cultured forS. aureusat ICU admission during the period from December 2002 through August 2007.Methods.Patients in the ICU for more than 48 hours were examined for an ICU-acquired S.aureusinfection, defined as development ofS. aureusinfection more than 48 hours after ICU admission.Results.S. aureuscolonization was present at admission for 1,433 (27.8%) of 5,161 patients (674 [47.0%] with MRSA and 759 [53.0%] with MSSA). An ICU-acquiredS. aureusinfection developed in 113 (2.19%) patients, of whom 75 (66.4%) had an infection due to MRSA. Risk factors associated with an ICU-acquiredS. aureusinfection included MRSA colonization at admission (adjusted hazard ratio, 4.70 [95% confidence interval, 3.07-7.21]) and MSSA colonization at admission (adjusted hazard ratio, 2.47 [95% confidence interval, 1.52-4.01]).Conclusion.ICU patients colonized with S.aureuswere at greater risk of developing aS. aureusinfection in the ICU. Even after adjusting for patient-specific risk factors, MRSA-colonized patients were more likely to developS. aureusinfection, compared with MSSA-colonized or noncolonized patients.

scholarly journals Use of a Combination Biomarker Algorithm To Identify Medical Intensive Care Unit Patients with Suspected Sepsis at Very Low Likelihood of Bacterial Infection

2015 ◽  
Vol 59 (10) ◽  
pp. 6494-6500 ◽  
Author(s):  
Jennifer H. Han ◽  
Irving Nachamkin ◽  
Susan E. Coffin ◽  
Jeffrey S. Gerber ◽  
Barry Fuchs ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Serum Amyloid ◽  
University Hospital ◽  
Bacterial Sepsis ◽  
Suspected Sepsis ◽  
Icu Patients ◽  
Predictive Values ◽  
Time Points ◽  
Amyloid A

ABSTRACTSepsis remains a diagnostic challenge in the intensive care unit (ICU), and the use of biomarkers may help in differentiating bacterial sepsis from other causes of systemic inflammatory syndrome (SIRS). The goal of this study was to assess test characteristics of a number of biomarkers for identifying ICU patients with a very low likelihood of bacterial sepsis. A prospective cohort study was conducted in a medical ICU of a university hospital. Immunocompetent patients with presumed bacterial sepsis were consecutively enrolled from January 2012 to May 2013. Concentrations of nine biomarkers (α-2 macroglobulin, C-reactive protein [CRP], ferritin, fibrinogen, haptoglobin, procalcitonin [PCT], serum amyloid A, serum amyloid P, and tissue plasminogen activator) were determined at baseline and at 24 h, 48 h, and 72 h after enrollment. Performance characteristics were calculated for various combinations of biomarkers for discrimination of bacterial sepsis from other causes of SIRS. Seventy patients were included during the study period; 31 (44%) had bacterial sepsis, and 39 (56%) had other causes of SIRS. PCT and CRP values were significantly higher at all measured time points in patients with bacterial sepsis. A number of combinations of PCT and CRP, using various cutoff values and measurement time points, demonstrated high negative predictive values (81.1% to 85.7%) and specificities (63.2% to 79.5%) for diagnosing bacterial sepsis. Combinations of PCT and CRP demonstrated a high ability to discriminate bacterial sepsis from other causes of SIRS in medical ICU patients. Future studies should focus on the use of these algorithms to improve antibiotic use in the ICU setting.

Candidemia in Intensive Care Units Over Nine Years at a Large Italian University Hospital 

2020 ◽  
Author(s):  
Sara Mazzanti ◽  
Lucia Brescini ◽  
Gianluca Morroni ◽  
Elena Orsetti ◽  
Antonella Pocognoli ◽  
...  
Keyword(s):  
Intensive Care ◽  
Incidence Rate ◽  
Intensive Care Units ◽  
Antifungal Therapy ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
University Hospital ◽  
Related Factors ◽  
Icu Patients ◽  
Over Time

Abstract Purpose: Candidemia is an alarming problem in critically ill patients including those admitted in intensive care units (ICUs). We aimed to describe the clinical and microbiological characteristics of bloodstream infections (BSIs) due to Candida spp. in patients admitted to ICUs of an italian tertiary referral university hospital over nine years. Methods: A retrospective observational study of all cases of candidemia in adult patients was carried out from January 1, 2010 to December 31, 2018 at a 980-bedded University Hospital in Ancona, Italy, counting five ICUs. The incidence, demographics, clinical and microbiologic characteristics, therapeutic approaches and outcomes of ICU-patients with candidemia were collected. Early (7 days from the occurrence of the episode of Candida BSI) and late (30 days) mortality rates were calculated. Results: During the study period, 188/505 (36%) episodes of candidemia occurred in ICU patients. Incidence rate was 9.9/1000 ICU admission and it showed to be stable over time. Candida albicans accounted for 52% of the cases, followed by C. parapsilosis (24%), and C. glabrata (14%). With the exception of isolates of C. tropicalis which showed to be fluconazole resistant in 25% of the cases, resistance to antifungals was not of concern in our patients. Early and late mortality rates were 19% and 41%, respectively and did not increased significantly over time. Independent risk factors for higher mortality were septic shock, acute kidney failure, pulmonary embolism and lack of antifungal therapy. The type of antifungal therapy did not influence the outcome. Conclusion: Neither incidence rate nor crude mortality of candidemia in ICU patients increased over time at our institution. However, mortality rate remained high and significantly associated with specific host-related factors.

scholarly journals P0628CREATININE-CYSTATIN C RATIO IS ASSOCIATED WITH MORTALITY IN ICU PATIENTS UNDERGOING CONTINUOUS RENAL REPLACEMENT THERAPY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Chan-Young Jung ◽  
Wonji Jo ◽  
Jaeyoung Kim ◽  
Jung Tak Park
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Serum Creatinine ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Muscle Mass ◽  
Cystatin C ◽  
Kidney Injury ◽  
Icu Patients ◽  
Prediction Of Mortality

Abstract Background and Aims Development of acute kidney injury (AKI) in intensive care patients considerably increases the risk of mortality. Although several factors that are related to outcome have been recognized in this patient group, stratifying mortality risk still remains a challenge. While serum creatinine levels are confounded by muscle wasting in critical illness, cystatin C is expected to be less modulated by muscle mass. Speculating that the ratio between serum creatinine and cystatin C may reflect muscle mass in critically ill AKI patients, we evaluated the association between creatinine-cystatin C ratio and mortality in patients requiring continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). Method Retrospective analyses were conducted on 443 ICU patients who underwent CRRT between August 2009 and October 2016 at Severance Hospital of Yonsei University Health System, Seoul, South Korea. The patients were divided into four groups based on creatinine-cystatin C ratio at the time of CRRT commencement. The primary outcome was 90-day mortality after CRRT initiation. Results The mean age was 64 ± 15 years, and 57.3% of patients were male. The most common cause of AKI was sepsis. The median and range of the creatinine-cystatin C ratio was 0.83 (0.13-6.20). The 90-day mortality rate for each creatinine-cystatin C ratio quartiles 1, 2, 3, and 4 were 76.6%, 73.9%, 61.3%, and 51.8%, respectively. Multiple Cox proportional hazard models revealed that the creatinine-cystatin C ratio was an independent predictor of 90-day mortality even after adjusting for confounding factors (Hazard ratio, 0.97; 95% confidence interval, 0.95-0.99, P<0.01). The prediction of mortality was significantly improved when creatinine-cystatin C ratio was considered compared to APACHE-II or SOFA scores alone. Conclusion Creatinine-cystatin C ratio is associated with mortality in ICU patients undergoing CRRT, and may be a practical marker in predicting survival among ICU patients with AKI.

Nosocomial Infection After Septic Shock Among Intensive Care Unit Patients

2008 ◽  
Vol 29 (11) ◽  
pp. 1054-1065 ◽  
Author(s):  
Caroline Landelle ◽  
Alain Lepape ◽  
Adrien Français ◽  
Eve Tognet ◽  
Hélène Thizy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Nosocomial Infection ◽  
Initial Phase ◽  
Pulmonary Infection ◽  
University Hospital ◽  
Icu Patients ◽  
Significant Difference ◽  
The Impact

Objectives.To measure the incidence of nosocomial infection (NI) among patients with septic shock according to the place of septic shock acquisition and to evaluate the increase in the risk of pulmonary infection associated with septic shock.Design.Prospective cohort study.Setting.TWO intensive care units (ICUs) of a French university hospital.Patients and Methods.The study included a total of 209 septic shock patients during the period December 1, 2001 through April 30, 2005. The place of septic shock acquisition for 108 patients was the community; for 87, the hospital; and for 14, the ICU. To evaluate the impact of septic shock on the development of pulmonary infection, a competitive and adjusted hazard ratio (aHR) model was applied to nontrauma ICU patients.Results.Among the 209 study patients, 48 (23%) experienced 66 NIs after septic shock. There was no significant difference in the NI attack rates according to place of acquisition: for the community acquisition group, 24 cases per 100 patients (95% confidence interval [CI], 16-32); for the hospital acquisition group, 20 cases per 100 patients (95% CI, 11-28); and for the ICU acquisition group, 36 cases per 100 patients (95% CI, 11-61) (P = .3). For nontrauma ICU patients, the presence of community-acquired septic shock was found to be independently associated with a higher incidence of pulmonary infection, compared with the absence of septic shock (aHR, 2.12 [95% CI, 1.08-4.16]; P = .03).Conclusions.The risk of NI did not differ by the place of septic shock acquisition. The risk of pulmonary infection was higher for ICU patients with community-acquired septic shock who were admitted for underlying nontrauma disease. Studies are needed to investigate the pathogenic mechanisms that facilitate pulmonary infection in this population, taking into account exposure to invasive devices and immunosuppression after the initial phase of septic shock.

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