scholarly journals Potential interaction between sepsis and acute respiratory distress syndrome and effect on the 6-month clinical outcomes: A preliminary secondary analysis of a prospective observational study

2021 ◽  
Author(s):  
Tomoya Okazaki ◽  
Daisuke Kawakami ◽  
Shigeki Fujitani ◽  
Natsuyo Shinohara ◽  
Kenya Kawakita ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Acute Respiratory Distress Syndrome ◽  
Clinical Outcomes ◽  
Distress Syndrome ◽  
Secondary Analysis ◽  
Potential Interaction ◽  
Sepsis Group ◽  
P Value ◽  
Multiple Logistic Regression ◽  
Regression Analyses

Abstract Background The effect of the interaction between sepsis and acute respiratory distress syndrome (ARDS) on the clinical outcomes is unclear. Therefore, this study aimed to investigate the effect of the potential interaction between the two conditions on mortality and the occurrence of post-intensive care syndrome (PICS). Methods This secondary analysis of a prospective multicenter observational study included patients who were expected to receive mechanical ventilation for more than 48 h. Patients were stratified based on the incidence of sepsis and further subdivided according to the presence of ARDS. The primary endpoints for patients whose follow-up information was available included mortality (n=162) and the occurrence of PICS (n=96) at six months. The diagnosis of PICS was based on any of the following criteria: (1) decrease ≥ 10 points in the physical component score of the 36-item Short Form (SF36) questionnaire; (2) decrease ≥ 10 points in the mental component score of the SF-36; or (3) decline in the Short Memory Questionnaire (SMQ) score and SMQ score < 40 at six months after ICU admission. We conducted multivariate logistic regression analyses to assess the effect of the potential interaction between ARDS and sepsis on the 6-month clinical outcomes. Result The mortality in the ARDS sub-group was higher than that in the non-ARDS subgroup [47% (7/15) versus 21% (18/85)] in the non-sepsis group. However, the mortality in the ARDS and non-ARDS subgroups was similar in the sepsis group. Multiple logistic regression analyses revealed that ARDS was significantly associated with mortality in the non-sepsis group (adjusted OR: 5.25; 95% CI: 1.45–19.09; p = 0.012), but not in the sepsis group (P-value for the interaction=0.087). Multiple logistic regression analyses showed ARDS was not associated with PICS occurrence in the non-sepsis and sepsis groups (P-value for the interaction=0.039). Conclusions Our findings suggested that the effect of ARDS on the 6-month outcomes depended on the presence or absence of sepsis. The findings of this hypothesis-generating study should be validated by future studies.

Vitamin D Status and Clinical Outcomes in Acute Respiratory Distress Syndrome: A Secondary Analysis From the Assessment of Low Tidal Volume and Elevated End-Expiratory Volume to Obviate Lung Injury (ALVEOLI) Trial

2021 ◽  
pp. 088506662110281
Author(s):  
Sadeq A. Quraishi ◽  
Ishir Bhan ◽  
Michael A. Matthay ◽  
Boyd T. Thompson ◽  
Carlos A. Camargo ◽  
...  
Keyword(s):  
Vitamin D ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Outcomes ◽  
Distress Syndrome ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Vitamin D Status ◽  
Randomized Controlled

Background: Acute respiratory distress syndrome (ARDS) is a highly morbid condition that has limited therapeutic options. Optimal vitamin D status has been linked to immunological effects that may benefit critically ill patients. Therefore, we investigated whether admission 25-hydroxyvitamin D levels (25OHD) are associated with clinical outcomes in ARDS patients. Methods: We performed a secondary analysis of data from a randomized, controlled trial comparing oxygenation strategies in 549 patients with ARDS (NCT00000579). Baseline 25OHD was measured in stored plasma samples. We investigated the relationship between vitamin D status and ventilator-free days (VFD) as well as 90-day survival, using linear regression and Cox proportional hazard models, respectively. Analyses were adjusted for age, race, and Acute Physiology and Chronic Health Evaluation III score. Results: Baseline 25OHD was measured in 476 patients. 90% of these individuals had 25OHD <20 ng/ml and 40% had 25OHD <10 ng/ml. Patients with 25OHD <20 ng/ml were likely to be ventilated for 3 days longer than patients with levels ≥20 ng/ml (ß 3.41; 95%CI 0.42-6.39: P = 0.02). Patients with 25OHD <10 ng/ml were likely to be ventilated for 9 days longer (ß 9.27; 95%CI 7.24-11.02: P < 0.001) and to have a 34% higher risk of 90-day mortality (HR 1.34; 95% CI 1.06-1.71: P = 0.02) compared to patients with levels >10 ng/ml. Conclusions: In patients with ARDS, vitamin D status is associated with duration of mechanical ventilation and 90-day mortality. Randomized, controlled trials are warranted to determine whether vitamin D supplementation improves clinical outcomes in ARDS patients.

scholarly journals Postnatal Care Coverage and its Determinants in Sri Lanka : Analysis of the 2016 Demographic and Health Survey 

2020 ◽  
Author(s):  
Upuli Perera ◽  
Uttara Amilani ◽  
Yibeltal Assefa
Keyword(s):  
Logistic Regression ◽  
Health Survey ◽  
Urban Areas ◽  
Postnatal Care ◽  
Maternal Age ◽  
Secondary Analysis ◽  
Institutional Care ◽  
Demographic And Health Survey ◽  
P Value ◽  
Multiple Logistic Regression

Abstract Background: Postnatal care (PNC) is important for preventing morbidity and mortality in mothers and newborns. Even though its importance is highlighted, PNC received less attention than antenatal care. This study determines the level of PNC coverage and its determinants in Srilanka. Methods: This is a secondary analysis of the 2016 Demographic and Health Survey. Receiving full postnatal care (FPNC) was defined with a set of indicators to detect adequate care for mother and newborn. Demographic and socio-economic associated factors for receiving FPNC were identified using binary and multiple logistic regression. Variables that had marginal relationship with receiving FPNC which p-value less than or equal to 0.2 at binary analysis were selected and included in the multiple logistic regression models. We used manual backward stepwise regression to identify variables which had independent association with receiving FPNC on the basis of adjusted odds ratios (AOR), with 95% confidence interval (CI) and p-value less than 0.05. All analyses were performed in SPSS 25. Results: Of the 8813 women with a live birth in the last five years, more than 98% had timely institutional care from skilled staff. More than three-fourth of mothers (n=5104) received the FPNC according to WHO guideline. Four factors were positively associated with receiving FPNC: mothers received antenatal home visits by Public health midwife (AOR=1.98, 95% CI 1.65-2.39), mothers who got information about antenatal complications and places to go at antenatal clinics (AOR=1.56, 95% CI 1.27 -1.92), been Sinhala (AOR= 1.89, 95% CI 1.35-2.66) and having own mobile phone (AOR=1.19, 95% CI 1.02 -1.38). Mothers who are residing in rural area (AOR=0.697 95% CI = 0.52 – 0.93] compared to those who reside in urban areas and maternal age between 20 and 34 years [AOR= 0.72, 95% CI 0.54 – 0.97] compared to maternal age less than 20 years were detected as negatively associated. Conclusion: Receiving FPNC in Srilanka is found to be higher than other countries in the region. However, inequity remains to be a challenge. Few socio-demographic factors are associated with FPNC coverage. Strategies that aim to improve postnatal care should target improvement of social determinates of health.

Abstract WMP88: Shorter Door-to-Needle Times of Intravenous Alteplase Improve “Efficiency” of Care and Moderately Affect “Quality” of Care: Study Based on a Large Comprehensive Stroke Center

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Suja S Rajan ◽  
Jessica N Wise ◽  
Marquita Decker-palmer ◽  
Thanh Dao ◽  
Cynthia Salem ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Clinical Outcomes ◽  
Heart Association ◽  
P Value ◽  
Regression Analyses ◽  
Inpatient Mortality ◽  
Care Outcomes ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Introduction: The American Heart Association (AHA) recently raised the bar on timely treatment of acute ischemic stroke (AIS) with intravenous (IV) alteplase, by recommending door-to-needle times of 30 minutes or less for 50% or more of the AIS patients. Our study looks at the effectiveness of this new standard, by examining the effect of varying door-to-needle times on efficiency and quality of care, and clinical outcomes. Methods: Our study examined 762 AIS patients treated with IV alteplase in a large academic health system from 2015-2018, and compared their outcomes after treatment within 30, 45 and 60 minutes of arrival. The outcomes compared were: 1) Efficiency of care outcome - Length of stay (LOS); 2) Quality of care outcomes - Inpatient mortality and Disability at discharge; 3) Clinical outcomes - Discharge and 90-day modified Rankin Scale (mRS), and Post-alteplase (24 hr) NIH Stroke Scale (NIHSS). Adjusted logistic and linear regression analyses were used, after controlling for baseline patient socio-demographic and clinical characteristics. Results: Based on the adjusted regression analyses (Table 1), being treated within 30 minutes of arrival reduced the average LOS by 1.3 days (p-value: 0.02), but did not affect the quality of care outcomes. Similarly, being treated within 45 minutes of arrival reduced LOS by 0.9 days (p-value: 0.04). Being treated within 60 minutes of arrival did not affect LOS, but reduced the odds of inpatient mortality by 68% (p-value: 0.00), and disability at discharge by 29% (p-value: 0.08). Being treated within 30 minutes of arrival was associated with better mRS and NIHSS scores as compared with being treated within 45 or 60 minutes. Conclusion: Quicker IV alteplase treatment significantly improved efficiency of care and clinical outcomes. Quality of care outcomes did not improve beyond the 60 minute door-to-needle threshold. This study provides evidence supporting AHA’s new recommendation of 30 minutes or less door-to-needle time.

Acute respiratory distress syndrome phenotypes with distinct clinical outcomes in PHARLA trial cohort

2021 ◽  
Vol 23 (2) ◽  
pp. 163-170
Author(s):  
Shailesh Bihari ◽  
◽  
Andrew Bersten ◽  
Eldho Paul ◽  
Shay McGuinness ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Outcomes ◽  
Distress Syndrome ◽  
Lung Ventilation ◽  
Tumour Necrosis Factor Receptor ◽  
Open Lung ◽  
Inflammatory Phenotype ◽  
Parsimonious Model

Background: The Permissive Hypercapnia, Alveolar Recruitment and Low Airway Pressure (PHARLAP) randomised controlled trial compared an open lung ventilation strategy with control ventilation, and found that open lung ventilation did not reduce the number of ventilator-free days (VFDs) or mortality in patients with moderate-to-severe acute respiratory distress syndrome (ARDS). Parsimonious models can identify distinct phenotypes of ARDS (hypo-inflammatory and hyperinflammatory) which are associated with different outcomes and treatment responses. Objective: To test the hypothesis that a parsimonious model would identify patients with distinctly different clinical outcomes in the PHARLAP study. Design, setting and participants: Blood and lung lavage samples were collected in a subset of PHARLAP patients who were recruited in Australian and New Zealand centres. A previously validated parsimonious model (interleukin-8, soluble tumour necrosis factor receptor-1 and bicarbonate) was used to classify patients with blood samples into hypo-inflammatory and hyperinflammatory groups. Generalised linear modelling was used to examine the interaction between inflammatory phenotype and treatment group (intervention or control). Main outcome measure: The primary outcome was number of VFDs at Day 28. Results: Data for the parsimonious model were available for 56 of 115 patients (49%). Within this subset, 38 patients (68%) and 18 patients (32%) were classified as having hypo-inflammatory and hyperinflammatory phenotypes, respectively. Patients with the hypo-inflammatory phenotype had more VFDs at Day 28 when compared with those with the hyperinflammatory phenotype (median [IQR], 19.5 [11–24] versus 8 [0–21]; P = 0.03). Patients with the hyperinflammatory phenotype had numerically fewer VFDs when managed with an open lung strategy than when managed with control “protective” ventilation (median [IQR], 0 [0–19] versus 16 [8–22]). Conclusion: In the PHARLAP trial, ARDS patients classified as having a hyperinflammatory phenotype, with a parsimonious three-variable model, had fewer VFDs at Day 28 compared with patients classified as having a hypo-inflammatory phenotype. Future clinical studies of ventilatory strategies should consider incorporating distinct ARDS phenotypes into their trial design.

Alveolar MMP28 is Associated With Clinical Outcomes and Measures of Lung Injury in Acute Respiratory Distress Syndrome

2020 ◽  
Author(s):  
Eric Morrell ◽  
Carmen Mikacenic ◽  
Ke-Qin Gong ◽  
Susanna Kosamo ◽  
Renee D. Stapleton ◽  
...  
Keyword(s):  
Gene Expression ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Outcomes ◽  
Peripheral Blood ◽  
Distress Syndrome ◽  
Lavage Fluid ◽  
Peripheral Blood Monocyte ◽  
Omega 3

Abstract Background Excessive inflammation leading to increased alveolar-capillary barrier permeability remains the pathogenic model for acute respiratory distress syndrome (ARDS). Alveolar macrophage (AM) polarization has been shown to modify the activity of various matrix metalloproteinases (MMPs) that have downstream effects on key ARDS cytokines/chemokines, however the relationship between AMs, MMP28 (the newest member of the MMP family), and ARDS clinical outcomes is unknown.Methods We analyzed bronchoalveolar lavage fluid (BALF) and peripheral blood from subjects previously enrolled in a phase-II trial of omega-3 fatty acids for the treatment of ARDS ( n = 76). In a subset of these patients ( n = 25), we tested for assocations between AM- and peripheral blood monocyte (PBM)-specific MMP28 gene expression and clincal outcomes [ventilator-free days (VFDs), P a O 2 /F i O 2 ratio (P/F ratio), and sequential organ failure assessment score (SOFA)]. We tested for assocations between soluble BALF or plasma MMP28 concentrations and ARDS clinical outcomes and inflammatory mediator concentrations in the entire cohort.Results Increased AM MMP28 gene expression was significantly associated with worse VFDs and P/F ratio ( p < 0.05). Higher BALF MMP28 concentrations were associated with worse P/F, but not VFDs. Increased BALF MMP28 concentrations were associated with increased % neutrophils as well as BALF total protein, IL-6, IL-17A, and MCP-1 concentrations (all p < 0.05). Plasma MMP28 concentrations were not associated with any clinical outcome. Increased PBM MMP28 gene expression was associated with worse P/F ratio but not VFDs.Conclusions Higher AM MMP28 gene expression and BALF MMP28 concentrations are associated with poor clinical outcomes and with increased alveolar inflammatory mediators in patients with ARDS.

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