scholarly journals ICU Mortality is Increased in Septic Shock Patients Accompanied with Hypo- or Hyper- Serum Osmolarity: A Retrospective Study

2021 ◽  
Author(s):  
Gang Heng ◽  
Jiasi Zhang ◽  
Benqi Huang ◽  
Yanbing Shen ◽  
Zhonghu Li ◽  
...  
Keyword(s):  
Septic Shock ◽  
Patient Outcomes ◽  
Propensity Score Analysis ◽  
Multivariate Logistic Regression ◽  
Icu Mortality ◽  
Serum Osmolarity ◽  
Inverse Probability ◽  
Score Analysis ◽  
Significant Difference ◽  
Causal Mediation Analysis

Abstract Purpose: While many factors that are associated with increased mortality in septic shock patients have been identified, the effect of serum osmolarity to altering patient outcomes among ICU patients with septic shock has not been studied. This study was designed to examine the association of serum osmolarity with ICU 28-day mortality in that population. Methods: The MIMIC-IV database was employed to identify patients diagnosed with septic shock. The serum osmolarity was calculated according to the serum concentration of Na + , K + , glucose and urea nitrogen synchronously. The statistical approaches used included multivariate logistic regression, propensity score analysis, inverse probability-weighting and causal mediation analysis. Results: In this study, significant difference of 28-day mortality was observed in septic shock patients accompanied with hypo-osmolarity, hyper-osmolarity and normal osmolarity (30.8%, 35.0% and 23.0%, P<0.001) which was detected at ICU admission. We also found that transforming the hyper-osmolarity into normal osmolarity by fluid therapy in day 2 and day 3 would decrease this mortality. Conclusion: Serum abnormality is significantly associated with increased 28-day mortality in septic shock patients.

scholarly journals Usefulness of β-lactam and Macrolide Combination Therapy for Treating Community-acquired Pneumonia Patients Hospitalized in the Intensive Care Unit: Propensity Score Analysis of a Prospective Cohort Study

2020 ◽  
Author(s):  
Akihiro Ito ◽  
Tadashi Ishida ◽  
Hiromasa Tachibana ◽  
Yosuke Nakanishi ◽  
Fumiaki Tokioka ◽  
...  
Keyword(s):  
Propensity Score ◽  
Combination Therapy ◽  
Odds Ratio ◽  
Propensity Score Analysis ◽  
Therapy Group ◽  
Community Acquired Pneumonia ◽  
Icu Mortality ◽  
Inverse Probability ◽  
Score Analysis ◽  
Severe Community Acquired Pneumonia

Abstract Background: Previous studies reported that β-lactam and macrolide combination therapy significantly improved outcomes for patients with severe community-acquired pneumonia hospitalized in the intensive care unit (ICU) compared with a non-macrolide regimen. However, whether β-lactam and macrolide therapy truly reduces mortality is controversial, because no randomized, controlled trials have been conducted. The aim of the present study was to evaluate the usefulness of β-lactam and macrolide combination therapy for severe community-acquired pneumonia patients hospitalized in the ICU compared with a non-macrolide β-lactam-containing regimen.Methods: A prospective, observational, cohort study of hospitalized pneumonia patients was performed. Hospitalized severe community-acquired pneumonia patients admitted to the ICU within 24 hours between October 2010 and October 2017 were included for analysis. The primary outcome was 30-day mortality, and secondary outcomes were 14-day mortality and ICU mortality. Inverse probability of treatment weighting analysis as a propensity score analysis was used to reduce biases, including six covariates: age, sex, C-reactive protein, albumin, Pneumonia Severity Index score, and APACHE II score.Results: A total of 78 patients were included. There were 48 patients in the non-macrolide-containing β-lactam therapy group, including β-lactam monotherapy and β-lactam and non-macrolide-containing combination therapy, and 30 patients in the macrolide combination therapy group. β-lactam and macrolide combination therapy significantly decreased 30-day mortality (16.7% vs. 43.8%; P=0.015) and 14-day mortality (6.7% vs. 31.3%; P=0.020), but not ICU mortality (10% vs 27.1%, P=0.08) compared with non-macrolide-containing β-lactam therapy. After adjusting by inverse probability of treatment weighting, macrolide combination therapy also decreased 30-day mortality (odds ratio, 0.29; 95%CI, 0.09-0.96; P=0.04) and 14-day mortality (odds ratio, 0.19; 95%CI, 0.04-0.92; P=0.04), but not ICU mortality (odds ratio, 0.34; 95%CI, 0.08-1.36; P=0.13).Conclusions: Combination therapy with β-lactam and macrolides significantly improved the prognosis of severe community-acquired pneumonia patients hospitalized in the ICU compared with a non-macrolide-containing β-lactam regimen on propensity score analysis.Trial registration: UMIN Clinical Trials Registry, UMIN000004353. Registered on 7 October 2010,

scholarly journals Procedural times in early non-intubated VATS program - a propensity score analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Isabella Metelmann ◽  
Johannes Broschewitz ◽  
Uta-Carolin Pietsch ◽  
Gerald Huschak ◽  
Uwe Eichfeld ◽  
...  
Keyword(s):  
Propensity Score ◽  
Surgical Procedure ◽  
Recovery Time ◽  
Propensity Score Analysis ◽  
Wedge Resection ◽  
University Hospital ◽  
Implementation Phase ◽  
Score Analysis ◽  
Significant Difference ◽  
Procedural Time

Abstract Background Non-intubated video-assisted thoracic surgery (NiVATS) has been introduced to surgical medicine in order to reduce the invasiveness of anesthetic procedures and avoid adverse effects of intubation and one-lung ventilation (OLV). The aim of this study is to determine the time effectiveness of a NiVATS program compared to conventional OLV. Methods This retrospective analysis included all patients in Leipzig University Hospital that needed minor VATS surgery between November 2016 and October 2019 constituting a NiVATS (n = 67) and an OLV (n = 36) group. Perioperative data was matched via propensity score analysis, identifying two comparable groups with 23 patients. Matched pairs were compared via t-Test. Results Patients in NiVATS and OLV group show no significant differences other than the type of surgical procedure performed. Wedge resection was performed significantly more often under NiVATS conditions than with OLV (p = 0,043). Recovery time was significantly reduced by 7 min (p = 0,000) in the NiVATS group. There was no significant difference in the time for induction of anesthesia, duration of surgical procedure or overall procedural time. Conclusions Recovery time was significantly shorter in NiVATS, but this effect disappeared when extrapolated to total procedural time. Even during the implementation phase of NiVATS programs, no extension of procedural times occurs.

Predicting value of prehospital body temperature for ICU admission of septic shock patients

2019 ◽  
Vol 18 (1) ◽  
pp. 56-58
Author(s):  
Romain Jouffroy ◽  
◽  
Anastasia Saade ◽  
Stephane Durand ◽  
Pascal Philippe ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Body Temperature ◽  
Propensity Score Analysis ◽  
Call Centre ◽  
Icu Patients ◽  
Icu Admission ◽  
Score Analysis ◽  
The Mean ◽  
Proper Orientation

To specify whether an association exists between pre-hospital body temperature collected by the emergency medical services (EMS) call centre, and intensive care unit (ICU) admission of patients with septic shock. An observational study based on data collected by the EMS of Paris. All septic shocks were included. Among, the 140 calls concerning septic shock, 22 patients (16%) were admitted to ICU. The mean core temperature was 37.4±1.6°C for ICU and 38.6±1.1°C (p<4.10^-5) for non-ICU patients. Using propensity score analysis, the relative risk for ICU admission of patients with pre-hospital fever or hypothermia was 0.31 and 2 respectively. The study highlights the potential usefulness of early temperature measurement in septic shock patients to allow early proper orientation.

scholarly journals LIMFOSIT T CD4+SEBAGAI PERAMAL PERJALANAN PENYAKIT PASIEN YANG MENGALAMI SEPSIS

2016 ◽  
Vol 19 (3) ◽  
pp. 178
Author(s):  
Lestari Ekowati ◽  
Aryati Aryati ◽  
Hardiono Hardiono
Keyword(s):  
Septic Shock ◽  
T Lymphocyte ◽  
Roc Curve ◽  
Lymphocyte Count ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Survival Group ◽  
Common Cause ◽  
Significant Difference ◽  
Very High

Sepsis is the most common cause of ICU mortality in USA. Mortality of sepsis in developing countries is still very high, about 50- 70% and has became a 80% incidence in septic shock. There was a decrease of CD4+ T lymphocyte count in patients with sepsis caused by apoptosis indicating septic patients suffered from immune functional impairment. CD4+ T lymphocyte count can reflect the severity of sepsis and predict the prognosis of the patients with sepsis effectively. Eighty eight (88) patients who met sepsis criteria were studied. The researchers collected clinical variables of all patients within 24 hours diagnosis of sepsis, and calculated APACHE II score. At the same time, blood sample were taken to measure the CD4+ T lymphocyte count. The data were analyzed using independent Student-T-test and ROC curve was used for prognosis. There is a significant difference in CD4+ T lymphocyte count between non survival and survival group (non survival group 203±178 cells/μL, survival group 442±303 cells/μL, p<0.001), and the percentage of CD4+ T lymphocyte (non survival group 25.05±11.55%, survival group 34.38±9.15%, p<0.001). There is an under ROC curve for CD4+ T lymphocyte count was 0.81, and for the percentage of CD4+ T lymphocyte was 0.748. Cut off value for CD4+ T lymphocyte count was 204 cells/μL, and the percentage of CD4+ T lymphocytes was 25.23%. Based on this study, the CD4+ T lymphocyte count can be used as a predictor of prognosis in sepsis patients.

scholarly journals Neutrophil-to-lymphocyte ratio is a prognostic factor for colon cancer: a propensity score analysis

2020 ◽  
Author(s):  
Junichi Mazaki ◽  
Kenji katsumata ◽  
Kenta Kasahara ◽  
Tomoya Tago ◽  
Takahiro Wada ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Prognostic Factor ◽  
Propensity Score ◽  
Propensity Score Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Oncologic Outcomes ◽  
Lymphocyte Ratio ◽  
Score Analysis ◽  
Significant Difference

Abstract Background: A large number of patients suffer recurrence after curative resection, and mortality from colon cancer remains high. The role of cancer-associated malnutrition such as the neutrophil-to-lymphocyte ratio (NLR) in cancer recurrence and death has been increasingly recognized. This study aimed to analyze long-term oncologic outcomes of Stage II-III colon cancer to examine the prognostic value of NLR using a propensity score analysis.Methods: A total of 442 patients with colon cancer underwent radical surgery between 2000 and 2014 at Tokyo Medical University Hospital. Long-term oncologic outcomes of these patients were evaluated according to NLR values. A cut-off NLR of 3.0 was used based on receiver operating characteristic curve analysis. A propensity score analysis according to tumor sidedness was also performed. Primary outcomes were overall survival (OS) and relapse-free survival (RFS). Results: Patients with lower NLR values (“lower NLR group”) were more likely to have lymph node metastasis compared to those with higher NLR values (“higher NLR group”) before case matching. After case matching, clinical outcomes were similar between the two groups. There were no significant difference in 5-year OS and 5-year RFS rates between the two groups before case matching based on propensity scores. After case matching, 5-year OS rates were 94.5% in the lower NLR group (n = 135) and 87.0% in the higher NLR group (n = 135), showing a significant difference (p = 0.042). Five-year RFS rates were 87.8% in the lower NLR group and 77.9% in the higher NLR group, also showing a significant difference (p = 0.032). Among patients with left-sided colon cancer, 5-year OS and 5-year RFS rates were 95.2% and 87.3% in the lower NLR group (n = 88), respectively, and 86.4% and 79.2% in the higher NLR group (n = 71), respectively, showing significant differences (p = 0.014 and p = 0.047, respectively).Conclusions: The NLR is an important prognostic factor for advanced colon cancer, especially for left-sided colon cancer.

scholarly journals Effect of High-dose Antithrombin Supplementation in Patients with Septic Shock and Disseminated Intravascular Coagulation

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Youn-Jung Kim ◽  
Byuk Sung Ko ◽  
Seo Young Park ◽  
Dong Kyu Oh ◽  
Sang-Bum Hong ◽  
...  
Keyword(s):  
Septic Shock ◽  
Disseminated Intravascular Coagulation ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
High Dose ◽  
Inverse Probability ◽  
Intravascular Coagulation ◽  
Significant Difference ◽  
Observational Prospective Cohort Study ◽  
Improvement In Survival

Abstract The efficacy of antithrombin (AT) administration in patients with septic shock and disseminated intravascular coagulation (DIC) was uncertain. This study aimed to investigate whether high-dose AT administration improves outcomes in patients with septic shock and DIC. This observational, prospective cohort study included consecutive adult septic shock patients with DIC who showed AT activity <70% between March 2016 and August 2018. The 28 day mortality of the patients treated with AT and without AT was evaluated by propensity score matching and inverse probability of treatment weighting. Among 142 patients with septic shock and DIC, 45 patients (31.7%) received AT supplementation and 97 did not. The 28 day mortality rate was lower in the AT group, but no statistically significant difference persisted after matching. Multivariable analysis showed that AT supplementation was independently associated with 28 day mortality (odds ratio [OR], 0.342; 95% CI [confidence interval], 0.133−0.876; P = 0.025); however, no such association was observed after matching (OR, 0.480; 95% CI, 0.177−1.301; P = 0.149). High-dose AT administration in septic shock patients with DIC showed the improvement in survival, but the improvement was not observed after matching. Further larger studies are needed to conclusively confirm these findings.

scholarly journals Neutrophil-to-lymphocyte ratio is a prognostic factor for colon cancer: a propensity score analysis

2020 ◽  
Author(s):  
Junichi Mazaki ◽  
Kenji katsumata ◽  
Kenta Kasahara ◽  
Tomoya Tago ◽  
Takahiro Wada ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Prognostic Factor ◽  
Propensity Score ◽  
Propensity Score Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Oncologic Outcomes ◽  
Lymphocyte Ratio ◽  
Score Analysis ◽  
Significant Difference

Abstract Background: A large number of patients suffer recurrence after curative resection, and mortality from colon cancer remains high. The role of systemic inflammatory response, as reflected by neutrophil-to-lymphocyte ratio (NLR), in cancer recurrence and death has been increasingly recognized. This study aimed to analyze long-term oncologic outcomes of Stage II-III colon cancer to examine the prognostic value of NLR using a propensity score analysis.Methods: A total of 375 patients with colon cancer underwent radical surgery between 2000 and 2014 at Tokyo Medical University Hospital. Long-term oncologic outcomes of these patients were evaluated according to NLR values. A cut-off NLR of 3.0 was used based on receiver operating characteristic curve analysis. Primary outcomes were overall survival (OS) and relapse-free survival (RFS). An analysis of outcomes according to tumor sidedness was also performed.Results: Patients with lower NLR values (“lower NLR group”) were more likely to have lymph node metastasis compared to those with higher NLR values (“higher NLR group”) before case matching. After case matching, clinical outcomes were similar between the two groups. There were no significant differences in 5-year OS and 5-year RFS rates between the two groups before case matching based on propensity scores. After case matching, 5-year OS rates were 94.5% in the lower NLR group (n = 135) and 87.0% in the higher NLR group (n = 135), showing a significant difference (p = 0.042). Five-year RFS rates were 87.8% in the lower NLR group and 77.9% in the higher NLR group, also showing a significant difference (p = 0.032). Among patients with left-sided colon cancer in the matched cohort, 5-year OS and 5-year RFS rates were 95.2% and 87.3% in the lower NLR group (n = 88), respectively, and 86.4% and 79.2% in the higher NLR group (n = 71), respectively, showing significant differences (p = 0.014 and p = 0.047, respectively).Conclusions: The NLR is an important prognostic factor for advanced colon cancer, especially for left-sided colon cancer.

scholarly journals Neutrophil-to-lymphocyte ratio is a prognostic factor for colon cancer: a propensity score analysis

2020 ◽  
Author(s):  
Junichi Mazaki ◽  
Kenji katsumata ◽  
Kenta Kasahara ◽  
Tomoya Tago ◽  
Takahiro Wada ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Prognostic Factor ◽  
Propensity Score ◽  
Propensity Score Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Oncologic Outcomes ◽  
Lymphocyte Ratio ◽  
Score Analysis ◽  
Significant Difference

Abstract Background: A large number of patients suffer recurrence after curative resection, and mortality from colon cancer remains high. The role of systemic inflammatory response, as reflected by neutrophil-to-lymphocyte ratio (NLR), in cancer recurrence and death has been increasingly recognized. This study aimed to analyze long-term oncologic outcomes of Stage II-III colon cancer to examine the prognostic value of NLR using a propensity score analysis.Methods: A total of 375 patients with colon cancer underwent radical surgery between 2000 and 2014 at Tokyo Medical University Hospital. Long-term oncologic outcomes of these patients were evaluated according to NLR values. A cut-off NLR of 3.0 was used based on receiver operating characteristic curve analysis. Primary outcomes were overall survival (OS) and relapse-free survival (RFS). An analysis of outcomes according to tumor sidedness was also performed.Results: Patients with lower NLR values (“lower NLR group”) were more likely to have lymph node metastasis compared to those with higher NLR values (“higher NLR group”) before case matching. After case matching, clinical outcomes were similar between the two groups. There were no significant differences in 5-year OS and 5-year RFS rates between the two groups before case matching based on propensity scores. After case matching, 5-year OS rates were 94.5% in the lower NLR group (n = 135) and 87.0% in the higher NLR group (n = 135), showing a significant difference (p = 0.042). Five-year RFS rates were 87.8% in the lower NLR group and 77.9% in the higher NLR group, also showing a significant difference (p = 0.032). Among patients with left-sided colon cancer in the matched cohort, 5-year OS and 5-year RFS rates were 95.2% and 87.3% in the lower NLR group (n = 88), respectively, and 86.4% and 79.2% in the higher NLR group (n = 71), respectively, showing significant differences (p = 0.014 and p = 0.047, respectively).Conclusions: The NLR is an important prognostic factor for advanced colon cancer, especially for left-sided colon cancer.

scholarly journals Neutrophil-to-lymphocyte ratio is a prognostic factor for colon cancer: a propensity score analysis

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Junichi Mazaki ◽  
Kenji Katsumata ◽  
Kenta Kasahara ◽  
Tomoya Tago ◽  
Takahiro Wada ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Prognostic Factor ◽  
Propensity Score ◽  
Propensity Score Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Oncologic Outcomes ◽  
Lymphocyte Ratio ◽  
Score Analysis ◽  
Significant Difference

Abstract Background A large number of patients suffer recurrence after curative resection, and mortality from colon cancer remains high. The role of systemic inflammatory response, as reflected by neutrophil-to-lymphocyte ratio (NLR), in cancer recurrence and death has been increasingly recognized. This study aimed to analyze long-term oncologic outcomes of Stage II-III colon cancer to examine the prognostic value of NLR using a propensity score analysis. Methods A total of 375 patients with colon cancer underwent radical surgery between 2000 and 2014 at Tokyo Medical University Hospital. Long-term oncologic outcomes of these patients were evaluated according to NLR values. A cut-off NLR of 3.0 was used based on receiver operating characteristic curve analysis. Primary outcomes were overall survival (OS) and relapse-free survival (RFS). An analysis of outcomes according to tumor sidedness was also performed. Results Patients with lower NLR values (“lower NLR group”) were more likely to have lymph node metastasis compared to those with higher NLR values (“higher NLR group”) before case matching. After case matching, clinical outcomes were similar between the two groups. There were no significant differences in 5-year OS and 5-year RFS rates between the two groups before case matching based on propensity scores. After case matching, 5-year OS rates were 94.5% in the lower NLR group (n = 135) and 87.0% in the higher NLR group (n = 135), showing a significant difference (p = 0.042). Five-year RFS rates were 87.8% in the lower NLR group and 77.9% in the higher NLR group, also showing a significant difference (p = 0.032). Among patients with left-sided colon cancer in the matched cohort, 5-year OS and 5-year RFS rates were 95.2 and 87.3% in the lower NLR group (n = 88), respectively, and 86.4 and 79.2% in the higher NLR group (n = 71), respectively, showing significant differences (p = 0.014 and p = 0.047, respectively). Conclusions The NLR is an important prognostic factor for advanced colon cancer, especially for left-sided colon cancer.

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