scholarly journals Clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis: a retrospective observational study

2019 ◽  
Author(s):  
Yao Chen ◽  
Yanyan Hu ◽  
Jin Zhang ◽  
Yue Shen ◽  
Junling Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Immune Status ◽  
Secondary Infection ◽  
Hospital Length Of Stay ◽  
Rank Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
Infection Group ◽  
Acinetobacter Baumanii ◽  
Hla Dr

Abstract Background: Secondary infection has a higher incidence in septic patients and affects clinical outcomes. This study aims to investigate the clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis. Methods: A four-year retrospective study was carried out in Zhongshan Hospital, Fudan University, enrolling septic patients admitted between January, 2014 and January, 2018. Clinical data were acquired from medical records. CD14+ monocyte human leukocyte antigen-D related (HLA-DR) expression and serum cytokines levels were measured by flow cytometry and enzyme-linked immunosorbent assay (ELISA) respectively. Results: A total of 297 septic patients were enrolled, 92 of whom developed 150 cases of secondary infections. Respiratory tract was the most common site of secondary infection (n = 84, 56%) and Acinetobacter baumanii the most commonly isolated pathogen (n = 40, 31%). Urinary and deep venous catheterization increased the risk of secondary infection. Lower HLA-DR expression and elevated IL-10 level were found in secondary infection group. The expected prolonged in-hospital stay owing to secondary infection was 4.63 ± 1.87 days . Secondary infection was also associated with higher in-hospital, 30-day and 90-day mortality. Kaplan-Meier survival analysis and Log-rank test revealed that secondary infection group had worse survival between day 15 and day 90. Conclusions: Urinary and deep venous catheter indwelling increased the risk of developing secondary infection, in which underlying immunosuppression also played a role. Secondary infection affected outcomes of septic patients and prolonged in-hospital length of stay.

scholarly journals Clinical characteristics, risk factors, prognosis and immune status of secondary infection of sepsis: a retrospective observational study

2019 ◽  
Author(s):  
Yao Chen ◽  
Yanyan Hu ◽  
Jin Zhang ◽  
Yue Shen ◽  
Junling Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Immune Status ◽  
Secondary Infection ◽  
Hospital Length Of Stay ◽  
Rank Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
Infection Group ◽  
Acinetobacter Baumanii ◽  
Hla Dr

Abstract Background: Secondary infection has a higher incidence in septic patients and affects clinical outcomes. This study aims to investigate the clinical characteristics, risk factors, prognosis and immune status of secondary infection of sepsis. Methods: A four-year retrospective study was carried out in Zhongshan Hospital, Fudan University, enrolling septic patients admitted between January, 2014 and January, 2018. Clinical data were acquired from medical records. CD14+ monocyte human leukocyte antigen-D related (HLA-DR) expression and serum cytokines levels were measured by flow cytometry and enzyme-linked immunosorbent assay (ELISA) respectively. Results: A total of 297 septic patients were enrolled, 92 of whom developed 150 cases of secondary infections. Respiratory tract was the most common site of secondary infection (n = 84, 56%) and Acinetobacter baumanii the most commonly isolated pathogen (n = 40, 31%). Urinary and deep venous catheterization increased the risk of secondary infection development. Lower HLA-DR expression and elevated IL-10 level were found in secondary infection group. The expected prolonged in-hospital stay owing to secondary infection was 4.63 days. Secondary infection was also associated with higher in-hospital, 30-day and 90-day mortality. Kaplan-Meier survival curves and Log-rank test revealed secondary infection group had a worse survival between day 15 and day 90. Conclusions: Urinary and deep venous catheter indwelling increased the risk of developing secondary infection. Secondary infection influenced outcomes of septic patients and prolonged in-hospital length of stay. Underlying immunosuppression led to a higher tendency to developing secondary infection.

scholarly journals Clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis: a retrospective observational study

2019 ◽  
Author(s):  
Yao Chen ◽  
Yanyan Hu ◽  
Jin Zhang ◽  
Yue Shen ◽  
Junling Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Immune Status ◽  
Secondary Infection ◽  
Hospital Length Of Stay ◽  
Rank Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
Infection Group ◽  
Hla Dr ◽  
Venous Catheterization

Abstract Background : Secondary infection has a higher incidence in septic patients and affects clinical outcomes. This study aims to investigate the clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis. Methods : A four-year retrospective study was carried out in Zhongshan Hospital, Fudan University, enrolling septic patients admitted between January, 2014 and January, 2018. Clinical data were acquired from medical records. CD14 + monocyte human leukocyte antigen-D related (HLA-DR) expression and serum cytokines levels were measured by flow cytometry and enzyme-linked immunosorbent assay (ELISA) respectively. Results: A total of 297 septic patients were enrolled, 92 of whom developed 150 cases of secondary infections. Respiratory tract was the most common site of secondary infection (n = 84, 56%) and Acinetobacter baumanii the most commonly isolated pathogen (n = 40, 31%). Urinary and deep venous catheterization increased the risk of secondary infection. Lower HLA-DR expression and elevated IL-10 level were found in secondary infection group. The expected prolonged in-hospital stay owing to secondary infection was 4.63 ± 1.87 days. Secondary infection was also associated with higher in-hospital, 30-day and 90-day mortality. Kaplan-Meier survival analysis and Log-rank test revealed that secondary infection group had worse survival between day 15 and day 90. Conclusions : Urinary and deep venous catheterization increased the risk of secondary infection, in which underlying immunosuppression might also play a role. Secondary infection affected the prognosis of septic patients and prolonged in-hospital length of stay.

scholarly journals Clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis: a retrospective observational study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yao Chen ◽  
Yanyan Hu ◽  
Jin Zhang ◽  
Yue Shen ◽  
Junling Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Immune Status ◽  
Secondary Infection ◽  
Hospital Length Of Stay ◽  
Rank Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
Infection Group ◽  
Hla Dr ◽  
Venous Catheterization

Abstract Background Secondary infection has a higher incidence in septic patients and affects clinical outcomes. This study aims to investigate the clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis. Methods A four-year retrospective study was carried out in Zhongshan Hospital, Fudan University, enrolling septic patients admitted between January, 2014 and January, 2018. Clinical data were acquired from medical records. CD14+ monocyte human leukocyte antigen-D related (HLA-DR) expression and serum cytokines levels were measured by flow cytometry and enzyme-linked immunosorbent assay (ELISA) respectively. Results A total of 297 septic patients were enrolled, 92 of whom developed 150 cases of secondary infections. Respiratory tract was the most common site of secondary infection (n = 84, 56%) and Acinetobacter baumanii the most commonly isolated pathogen (n = 40, 31%). Urinary and deep venous catheterization increased the risk of secondary infection. Lower HLA-DR expression and elevated IL-10 level were found in secondary infection group. The expected prolonged in-hospital stay owing to secondary infection was 4.63 ± 1.87 days. Secondary infection was also associated with higher in-hospital, 30-day and 90-day mortality. Kaplan-Meier survival analysis and Log-rank test revealed that secondary infection group had worse survival between day 15 and day 90. Conclusions Urinary and deep venous catheterization increased the risk of secondary infection, in which underlying immunosuppression might also play a role. Secondary infection affected the prognosis of septic patients and prolonged in-hospital length of stay.

scholarly journals Clinical characteristics, risk factors, prognosis and immune status of secondary infection of sepsis: a retrospective observational study

2019 ◽  
Author(s):  
Yao Chen ◽  
Yanyan Hu ◽  
Jin Zhang ◽  
Yue Shen ◽  
Junling Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Clinical Characteristics ◽  
Immune Status ◽  
Secondary Infection ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Enzyme Linked Immunosorbent Assay ◽  
Infection Group ◽  
Hla Dr

Abstract Background: Secondary infection in hospital was found to have a higher incidence in septic patients and affect clinical outcomes. This study aimed to investigate the clinical characteristics, risk factors, prognosis and immune status of secondary infection of sepsis. Methods: A four-year retrospective study was carried out in Zhongshan Hospital, Fudan University, enrolling septic patients admitted between 2014 January and 2018 January. Data were acquired from medical records. The flow cytometry was performed to measure the CD14+ monocyte human leukocyte antigen-D related (HLA-DR) expression. Serum cytokines levels were measured by enzyme-linked immunosorbent assay (ELISA) method. Results: A total of 297 septic patients were enrolled, 92 of whom developed 150 cases of secondary infections. Respiratory tract was the most common site of secondary infection (n = 84, 56%) and Acinetobacter baumanii the most commonly isolated pathogen (n = 38, 32%). Urinary and deep venous catheterization increased the risk of developing secondary infection. Lower HLA-DR expression and elevated IL-10 level were found in secondary infection group. The expected prolonged in-hospital length of stay owing to secondary infection was 4.63 days. Secondary infection was also associated with higher in-hospital, 30-day and 90-day mortality. Kaplan-Meier survival curves and Log-rank test revealed secondary infection group had a worse survival between day 15 and day 90. Conclusions: Urinary and deep venous catheter indwelling increased the risk of developing secondary infection. Secondary infection influenced outcomes of septic patients and prolonged in-hospital length of stay. Immunosuppression led to a higher tendency to developing secondary infection. Keywords: Sepsis, Secondary infection, Immunosuppression, HLA-DR, Cytokine

Clinical characteristics and long-term clinical course of patients with Brugada syndrome without previous cardiac arrest: a multiparametric risk stratification approach

EP Europace ◽  
2019 ◽  
Author(s):  
Konstantinos P Letsas ◽  
George Bazoukis ◽  
Michael Efremidis ◽  
Stamatis Georgopoulos ◽  
Panagiotis Korantzopoulos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Stratification ◽  
Brugada Syndrome ◽  
Clinical Characteristics ◽  
Clinical Course ◽  
Electrophysiological Study ◽  
Rank Test ◽  
History Of ◽  
Event Rates

Abstract Aims Risk stratification in Brugada syndrome (BrS) still represents an unsettled issue. In this multicentre study, we aimed to evaluate the clinical characteristics and the long-term clinical course of patients with BrS. Methods and results A total of 111 consecutive patients (86 males; aged 45.3 ± 13.3 years) diagnosed with BrS were included and followed-up in a prospective fashion. Thirty-seven patients (33.3%) were symptomatic at enrolment (arrhythmic syncope). An electrophysiological study (EPS) was performed in 59 patients (53.2%), and ventricular arrhythmias were induced in 32 (54.2%). A cardioverter defibrillator was implanted in 34 cases (30.6%). During a mean follow-up period of 4.6 ± 3.5 years, appropriate device therapies occurred in seven patients. Event-free survival analysis (log-rank test) showed that spontaneous type-1 electrocardiogram pattern (P = 0.008), symptoms at presentation (syncope) (P = 0.012), family history of sudden cardiac death (P < 0.001), positive EPS (P = 0.024), fragmented QRS (P = 0.004), and QRS duration in lead V2 > 113 ms (P < 0.001) are predictors of future arrhythmic events. Event rates were 0%, 4%, and 60% among patients with 0–1 risk factor, 2–3 risk factors, and 4–5 risk factors, respectively (P < 0.001). Current multiparametric score models exhibit an excellent negative predictive value and perform well in risk stratification of BrS patients. Conclusions Multiparametric models including common risk factors appear to provide better risk stratification of BrS patients than single factors alone.

scholarly journals Clinical characteristics and durations of hospitalized patients with COVID-19 in Beijing: a retrospective cohort study

2020 ◽  
Author(s):  
Wen Zhao ◽  
Shikai Yu ◽  
Xiangyi Zha ◽  
Ning Wang ◽  
Qiumei Pang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Ct Scan ◽  
Clinical Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Study Endpoint ◽  
Cumulative Probability ◽  
Illness Onset ◽  
Severity Of Disease

AbstractBackgroundCOVID-19 is still becoming an increasing global threat to public health. More detailed and specific characteristics of COVID-19 are needed to better understand this disease. Additionally, durations of COVID-19, e.g., the average time from exposure to recovery, which is of great value in understanding this disease, has not been reported so far.AimsTo give the information on clinical characteristics and different durations of COVID-19 and to identify the potential risk factors for longer hospitalization duration.MethodsIn this retrospective study, we enrolled 77 patients (mean age: 52±20 years; 44.2% males) with laboratory-confirmed COVID-19 admitted to Beijing YouAn Hospital during 21st Jan and 8th February 2020. Epidemiological, clinical and radiological data on admission were collected; complications and outcomes were followed up until 29th February 2020. The study’s endpoint was the discharge within two weeks. Cox proportional-hazards regression was performed to identify risk factors for longer hospitalization duration.ResultsOf 77 patients, there are 34 (44.2%) males, 24 (31.2%) with comorbidities, 22 (28.6%) lymphopenia, 20 (26.0%) categorized as severe patients, and 28 (36.4%) occurred complications. By the end of follow-up, 64 (83.1%) patients were discharged home after being tested negative for SARS-CoV-2 infections, 8 remained in hospital and 5 died. 36 (46.8%) patients were discharged within 14 days and thus reached the study endpoint, including 34 (59.6%) of 57 non-severe patients and 2 (10%) of 20 severe patients. The overall cumulative probability of the endpoint was 48.3%. Hospital length of stay and duration of exposure to discharge for 64 discharged patients were 13 (10-16.5) and 23 (18-24.5) days, respectively. Multivariable stepwise Cox regression model showed bilateral pneumonia on CT scan, shorter time from the illness onset to admission, severity of disease and lymphopenia were independently associated with longer hospitalized duration.ConclusionsCOVID-19 has significantly shorter duration of disease and hospital length of stay than SARS. Bilateral pneumonia on CT scan, shorter period of illness onset to admission, lymphopenia, severity of disease are the risk factors for longer hospitalization duration of COVID-19.

scholarly journals Bariatric Procedures in Older Adults in the United States: Analysis of a Multicenter Database

Geriatrics ◽  
2019 ◽  
Vol 4 (2) ◽  
pp. 32 ◽  
Author(s):  
Mendiratta ◽  
Dayama ◽  
Azhar ◽  
Prodhan ◽  
Wei
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Hospital Mortality ◽  
Clinical Characteristics ◽  
Skilled Nursing Facility ◽  
The United States ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Factors Associated ◽  
Choice Of Procedure

Background: Bariatric procedures help reduce obesity-related comorbidities and thus improve survival. Clinical characteristics and outcomes after bariatric procedures in older adults were investigated. Methods: A multi-institutional Nationwide Inpatient Sample (NIS) database was queried from years 2005 through 2012. Older adults >60 years of age with procedure codes for bariatric procedures and a diagnosis of obesity/morbid obesity were selected to compare clinical characteristics/outcomes between those undergoing closed versus open procedures and identify risk factors associated with in-hospital mortality and increased hospital length of stay (LOS). Results: Over the study period, 79,122 bariatric procedures were performed. Those undergoing open procedures compared to closed procedures had a higher in-hospital mortality (0.8% vs. 0.2%) and a longer hospital LOS (4.8 days vs. 2.2 days). Risk factors significantly associated with in-hospital mortality were open procedures, the Western region, and the Elixhauser comorbidity index. Risk factors associated with increased LOS were Medicaid insurance type, an open procedure, a higher Elixhauser comorbidity score, a required skilled nursing facility (SNF) discharge, and died in hospital. Conclusion: Closed bariatric procedures are increasingly being preferred in older adults, with a four-fold lower mortality compared to open procedures. Besides choice of procedure, the presence of specific comorbidities is associated with increased mortality in older adults.

scholarly journals Clinical Characteristics and Durations of Hospitalized Patients with COVID-19 in Beijing: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Zhao Wen
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Ct Scan ◽  
Clinical Characteristics ◽  
Cox Regression ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cumulative Probability ◽  
Illness Onset ◽  
End Point

Objective: To provide information on clinical characteristics and different durations of COVID-19 and to identify thepotential risk factors for longer hospitalization of patients with COVID-19.Methods: In this retrospective study, we enrolled 77 patients (age 52 ± 20 years; 44.2% males) with laboratory confirmedCOVID-19 admitted to Beijing YouAn Hospital between January 21 and February 8, 2020. Epidemiological,clinical, and radiological data on admission were collected; complications and outcomes were followed up untilFebruary 26, 2020. The end point of the study was discharge alive within 2 weeks. Cox proportional-hazards regressionwas performed to identify risk factors for longer hospitalization.Results: Of 77 patients, there were 34 males (44.2%), 24 (31.2%) with comorbidities, 22 (28.6%) with lymphopenia,20 (26.0%) with severe COVID-19, and 28 (36.4%) with complications. By the end of follow-up, 64 patients (83.1%)were discharged home, eight remained in hospital, and five had died. Thirty-six patients (46.8%) were dischargedwithin 14 days and thus reached the study end point, including 34 of the 57 patients with nonsevere COVID-19(59.6%) and two of the 20 patients with severe COVID-19 (10%). The overall cumulative probability of the end pointwas 48.3%. Hospital length of stay and the duration from exposure to discharge for the 64 discharged patients were13 (10–16.5) days and 23 (18–24.5) days, respectively. A multivariable stepwise Cox regression model showed thatbilateral pneumonia on CT scan, shorter time from illness onset to admission, severity of disease, and lymphopeniawere independently associated with longer hospitalization.Conclusions: COVID-19 has a shorter duration of disease and hospital length of stay than severe acute respiratorysyndrome. Bilateral pneumonia on CT scan, shorter period from illness onset to admission, lymphopenia, and severityof disease are the risk factors for longer hospitalization of patients with COVID-19.

scholarly journals Secondary infections in mechanically ventilated patients with COVID-19: An overlooked matter?

2021 ◽  
Author(s):  
Alejandro Suarez-de-la-Rica ◽  
◽  
Patricia Serrano ◽  
Rodrigo de-la-Oliva ◽  
Pedro Sánchez-Díaz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Secondary Infection ◽  
Demographic Data ◽  
Rank Test ◽  
Mechanically Ventilated ◽  
Log Rank Test ◽  
Secondary Infections ◽  
Nosocomial Bacteremia

Introduction. The susceptibility to infection probably increases in COVID-19 patients due to a combination of virusand drug-induced immunosuppression. The reported rate of secondary infections was quite low in previous studies. The objectives of our study were to investigate the rate of secondary infections, risk factors for secondary infections and risk factors for mortality in COVID-19 critically ill patients. Material and methods. We performed a single-center retrospective study in mechanically ventilated critically ill COVID-19 patients admitted to our Critical Care Unit (CCU). We recorded the patients’ demographic data; clinical data; microbiology data and incidence of secondary infection during CCU stay, including ventilator-associated pneumonia (VAP) and nosocomial bacteremia (primary and secondary). Results. A total of 107 patients with a mean age 62.2 ± 10.6 years were included. Incidence of secondary infection during CCU stay was 43.0% (46 patients), including nosocomial bacteremia (34 patients) and VAP (35 patients). Age was related to development of secondary infection (65.2 ± 7.3 vs. 59.9 ± 12.2 years, p=0.007). Age ≥ 65 years and secondary infection were independent predictors of mortality (OR=2.692, 95% CI 1.068-6.782, p<0.036; and OR=3.658, 95% CI 1.385- 9.660, p=0.009, respectively). The hazard ratio for death within 90 days in the ≥ 65 years group and in patients infected by antimicrobial resistant pathogens was 1.901 (95% CI 1.198- 3.018; p= 0.005 by log-rank test) and 1.787 (95% CI 1.023-3.122; p= 0.036 by log-rank test), respectively. Conclusions. Our data suggest that the incidence of secondary infection and infection by antimicrobial resistant pathogens is very high in critically ill patients with COVID-19 with a significant impact on prognosis.

scholarly journals 669. Rapid Molecular Testing of Sputum for Identification of Pulmonary Tuberculosis: Impact on Duration of Respiratory Isolation

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S389-S390
Author(s):  
Tommy J Parraga Acosta ◽  
Amit T Vahia ◽  
Zachary W Hanna ◽  
Sashi N Nair ◽  
Robert Tibbetts ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Tuberculosis ◽  
Clinical Characteristics ◽  
Tertiary Care ◽  
Hospital Length Of Stay ◽  
Categorical Variables ◽  
Molecular Testing ◽  
Before And After ◽  
Implementation Period ◽  
The Impact

Abstract Background Current guidelines recommend molecular testing directly on sputum of patients with suspected pulmonary tuberculosis (TB) to facilitate discontinuation of airborne infection isolation (AII). Henry Ford Hospital (HFH), a tertiary care center in Detroit, MI serves a population at high-risk for TB. Molecular testing of sputum using GeneXpert/MTB RIF (Xpert; Cepheid) (GXTB) was implemented at HFH on March 2019. Providers were permitted to remove patients from AII using 3 negative acid-fast bacillus smears (AFB) or 2 negative GXTB results. We evaluated the impact of GXTB on duration of AII over a 2-year period: Pre-implementation (January 2018 to February 2019) and post-implementation (March 2019 to February 2020). Methods Retrospective data was abstracted for all patients placed in AII during the study period. Demographic data, TB risk factors, duration of AII, length of hospital stay (LOS), accuracy and turn-around-times (TAT) of AFB and GXTB were compared in the pre- and post-implementation periods. Categorical variables were studied using chi-square testing, and continuous variables were studied using T-test or Mann Whitney U test as appropriate. Results During the study period, 269 patients with suspected TB were placed in AII: 137 pre-implementation and 132 post-implementation. Clinical characteristics and TB risk factors were generally comparable in both groups (Table 1). Abnormal chest X-ray was more frequent in patients in the post-implementation phase. All cases of culture positive TB were detected by AFB and GXTB. TAT of AFB results before and after implementation were similar and ranged from 20-24 hours (Table 2). In the post-implementation period, TAT of GXTB compared to AFB was 6.35 vs 21.28 hours (p &lt; 0.0001). Duration of AII was shortened by almost 24 hours (70.2 vs 93.7 hours, p=0.031) (Table 3). Time from first sample collection to final results of all samples was 19.2 vs 52.6 hours, p&lt; 0.0001. There was no difference in total LOS pre and post-implementation. Table 1. Clinical Characteristics of Patients with Suspected Pulmonary Tuberculosis Table 2. Turnaround times (TAT) of AFB and GeneXpert/MTB (Xpert) RIF before and after implementation Table 3. Duration of Airborne Isolation, Total Turn-Around Times, and Hospital Length of Stay in the Pre- and Post-implementation Period Conclusion Implementation of rapid direct molecular testing reduced the duration of respiratory isolation for patients with suspected pulmonary TB. Further provider education regarding the reliability of GXTB in excluding TB may be necessary to reduce overall hospital LOS. Disclosures All Authors: No reported disclosures

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