Effect of A Positive Cumulative Fluid Balance On The Prognosis of Patients With Sepsis In The Xining Area

Abstract Background: The aim of this work is to analyze the effect of a positive cumulative fluid balance and relative clinical indicators on the prognosis of patients with sepsis in the Xining area, China.Methods: The clinical data of 480 sepsis patients (313 males and 167 females, aged 52–77 (65) years) admitted between January 2017 and December 2019 were retrospectively analyzed. The APACHE II score, SOFA score, SIRS score and clinical laboratory test indicators of the patients were collected. Receiver operating characteristic (ROC) curves were used to analyze the sensitivity and specificity of each indicator in predicting the poor prognosis of patients with sepsis, and the maximum Youden index was used to determine threshold values. Cox regression analysis was performed to assess patient prognosis using data from patients with different fluid balances. Results: The following clinical indicators were significantly different between the 2 groups (P<0.05): APACHE II score, SOFA score, SIRS score, PCT, IL-6, BNP, CRP, PLT, BUN, CREA, Lac and total fluid balance from days 1 to 5. The area under the ROC curve (AUC) for total fluid balance from days 1 to 5 was 0.558, the cut-off value was 2120.5 mL, the sensitivity was 54.0%, and the specificity was 58.1%. The survival rates were different between the 2 groups (60.9% vs 48.9%, P<0.05). Total fluid balance was significantly higher in patients with septic shock and with Lac>2.0 mmol/L (P<0.05). Cox regression analysis indicated that APACHE II score, SOFA score, PLT score, Lac, and total fluid balance from days 1 to 5 were independent risk factors for poor prognosis.Conclusion: A positive fluid balance from days 1 to 5 after ICU admission was associated with poor patient outcomes and was an independent risk factor for poor patient prognosis.

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Risk factors for mortality in critically ill patients with COVID-19: a multicenter retrospective case-control study

BMC Infectious Diseases ◽

10.1186/s12879-021-06300-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jinghua Gao ◽

Li Zhong ◽

Ming Wu ◽

Jingjing Ji ◽

Zheying Liu ◽

...

Keyword(s):

Risk Factors ◽

Organ Failure ◽

Critically Ill ◽

Sofa Score ◽

Lymphocyte Count ◽

Cox Regression ◽

Survival Curve ◽

Apache Ii ◽

Apache Ii Score ◽

Hospital Death

Abstract Background Coronavirus disease 2019 (COVID-19) has spread around the world, until now, the number of positive and death cases is still increasing. Therefore, it remains important to identify risk factors for death in critically patients. Methods We collected demographic and clinical data on all severe inpatients with COVID-19. We used univariable and multivariable Cox regression methods to determine the independent risk factors related to likelihood of 28-day and 60-day survival, performing survival curve analysis. Results Of 325 patients enrolled in the study, Multi-factor Cox analysis showed increasing odds of in-hospital death associated with basic illness (hazard ratio [HR] 6.455, 95% Confidence Interval [CI] 1.658–25.139, P = 0.007), lymphopenia (HR 0.373, 95% CI 0.148–0.944, P = 0.037), higher Sequential Organ Failure Assessment (SOFA) score on admission (HR 1.171, 95% CI 1.013–1.354, P = 0.033) and being critically ill (HR 0.191, 95% CI 0.053–0.687, P = 0.011). Increasing 28-day and 60-day mortality, declining survival time and more serious inflammation and organ failure were associated with lymphocyte count < 0.8 × 109/L, SOFA score > 3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 7, PaO2/FiO2 < 200 mmHg, IL-6 > 120 pg/ml, and CRP > 52 mg/L. Conclusions Being critically ill and lymphocyte count, SOFA score, APACHE II score, PaO2/FiO2, IL-6, and CRP on admission were associated with poor prognosis in COVID-19 patients.

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Risk factors for postoperative delirium in patients with triple-branched stent graft implantation

10.21203/rs.2.24838/v1 ◽

2020 ◽

Author(s):

Yanjuan Lin ◽

Qiong Chen ◽

Haoruo Zhang ◽

Liang-Wan Chen ◽

Yanchun Peng ◽

...

Keyword(s):

Risk Factors ◽

Stent Graft ◽

Postoperative Delirium ◽

Cox Regression ◽

Apache Ii ◽

Apache Ii Score ◽

Manual Work ◽

Cox Regression Analysis ◽

Stent Graft Implantation ◽

Graft Implantation

Abstract Background: The incidence of neurological complications is relatively high after novel triple-branched stent graft implantation in patients with Stanford type A aortic dissection (AAD). But the incidence and risk factors of postoperative delirium (POD) have not been studied. The aim of this study was to investigated the incidence and risk factors of POD after novel triple-branched stent graft implantation.Methods: An observational study of AAD patients who underwent novel triple-branched stent graft implantation between January 2017 and July 2019 was followed up after surgery. Patients’ delirium is screened by the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the intensive care unit from the first day after the operation, lasted 5 days. The risk factors of POD was analyzed by the Cox proportional hazard models.Results: A total of 280 cases of AAD patients were enrolled in this research, the incidence of POD was 37.86%. Adjusting for age, body mass index, and mechanical ventilation duration, multivariate Cox regression analysis model revealed that non-manual work (adjusted hazard ratio [AHR] = .554; 95% CI: 0.335-0.915; P = .021), Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores > 20 (AHR = 3.359, 95% CI: 1.707-6.609, P < .001), hypoxemia (AHR = 1.846, 95% CI: 1.118-3.048, P = .017), and more than two types of analgesics and sedatives were independently associated with POD.Conclusions: This study showed that risk factors independently associated with POD were APACHE-II score > 20, hypoxemia and more types of analgesics and sedatives, and non-manual work was the protective factor.Trial registration: This study was retrospectively registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR1900022408; Date: 2019/4/10)

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Prognostic factors for ARDS: clinical, physiological and atypical immunodeficiency

10.21203/rs.2.13000/v3 ◽

2020 ◽

Author(s):

Min Song ◽

Yijie Liu ◽

Zhiwen Lu ◽

Hong Luo ◽

Hong Peng ◽

...

Keyword(s):

Sofa Score ◽

Hazard Analysis ◽

Area Under The Curve ◽

Oxygenation Index ◽

Mortality Rates ◽

Apache Ii ◽

Apache Ii Score ◽

Factors Affecting ◽

Patient Prognosis ◽

Definition Of

Abstract Background: Risk factors affecting the prognosis of acute respiratory distress syndrome (ARDS) in adults were investigated. The aim was to identify new predictors for ARDS patient prognosis, including those with clinical, pathophysiological, and atypical immunodeficiency. Methods: ARDS patients were retrospectively included. The patients were grouped and analysed according to different oxygenation index grades and prognosis, and factors influencing prognosis and survival were examined. Adolescent patients, patients with typical immunodeficiency and patients who died within 24 hours after being diagnosed with ARDS were excluded. The predictive value for mortality was determined by Cox proportional hazard analysis. Results: In total, 201 patients who fulfilled the Berlin definition of ARDS were included. The severity of critical illness on the day of enrolment, as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) II score (P=0.016), Sequential Organ Failure Assessment (SOFA) score (P=0.027), and PaO2/FiO2 (P=0.000), worsened from mild to severe ARDS cases. Compared with survivors, non-survivors were significantly older and had higher APACHE II and SOFA scores. Moreover, significantly lower lymphocyte/neutrophil ratios and leukocyte counts were found among non-survivors than survivors (P=0.008, P=0.012). A moderate positive correlation between the lymphocyte/neutrophil and PaO2/FiO2 ratios (P=0.023) was observed. In predicting 100-day survival in patients with ARDS, the area under the curve (AUC) for the lymphocyte/neutrophil ratio was significantly higher than those for the PaO2/FiO2 ratio alone, body mass index (BMI) alone, and the lymphocyte count alone (P=0.0062, 0.0001, and 0.0154). Age (per log10 years), BMI<24, SOFA score, leukocyte count, and the lymphocyte/neutrophil ratio were independent predictors of 28-day mortality in ARDS patients. Additionally, ARDS patients with a lymphocyte/neutrophil ratio <0.0537 had increased 28-day mortality rates (P=0.0283). Old age affected both 28-day and 100-day mortality rates (P=0.0064,0.0057). Conclusions: Age (per log10 years), BMI<24, SOFA score, lymphocytes, and the lymphocyte/neutrophil ratio were independent predictors of 100-day mortality in patients with ARDS. The lymphocyte/neutrophil ratio may represent a potential molecular marker to evaluate atypical immunosuppression or impairment in patients with ARDS.

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Risk Factors for Mortality in Critically Ill Patients with COVID-19: A Multicenter Retrospective Case-Control Study

10.21203/rs.3.rs-80661/v1 ◽

2020 ◽

Author(s):

Jinghua Gao ◽

Li Zhong ◽

Ming Wu ◽

Jingjing Ji ◽

Ziyun Shao ◽

...

Keyword(s):

Risk Factors ◽

Organ Failure ◽

Critically Ill ◽

Sofa Score ◽

Lymphocyte Count ◽

Cox Regression ◽

Survival Curve ◽

Apache Ii ◽

Apache Ii Score ◽

Hospital Death

Abstract Background Coronavirus disease 2019 (COVID-19) has spread around the world and caused many deaths, but little is known about the risk factors for death in critically patients. Methods we collected demographic and clinical data on all severe inpatients with COVID-19 .We used univariable and multivariable Cox regression methods to determine the independent risk factors related to likelihood of 28-day and 60-day survival, performing survival curve analysis. Results Of 325 patients enrolled in the study, Multi-factor Cox analysis showed increasing odds of in-hospital death associated with basic illness (hazard ratio [HR] 6.455, 95% Confidence Interval [CI] 1.658–25.139, P = 0.007), lymphopenia (HR 0.373, 95% CI 0.148–0.944, P = 0.037), higher Sequential Organ Failure Assessment (SOFA) score on admission (HR 1.171, 95% CI 1.013–1.354, P = 0.033) and being critically ill (HR 0.191, 95% CI 0.053–0.687, P = 0.011). Increasing 28-day and 60-day mortality, declining survival time and more serious inflammation and organ failure were associated with lymphocyte count ≤ 0.8 × 109/L, SOFA score > 3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 7, PaO2/FiO2 ≤ 200 mmHg, IL-6 > 120 pg/ml, and CRP > 52 mg/L. Conclusions Being critically ill and lymphocyte count, SOFA score, APACHE II score, PaO2/FiO2, IL-6, and CRP on admission were associated with poor prognosis in COVID-19 patients.

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Does Antimicrobial Therapy Affect Mortality of Patients with Carbapenem-Resistant Klebsiella pneumoniae Bacteriuria? A Nationwide Multicenter Study in Taiwan

Microorganisms ◽

10.3390/microorganisms8122035 ◽

2020 ◽

Vol 8 (12) ◽

pp. 2035

Author(s):

Chien Chuang ◽

Chin-Fang Su ◽

Jung-Chung Lin ◽

Po-Liang Lu ◽

Ching-Tai Huang ◽

...

Keyword(s):

Regression Analysis ◽

Klebsiella Pneumoniae ◽

Critically Ill ◽

Antimicrobial Therapy ◽

Critically Ill Patients ◽

Cox Regression ◽

Apache Ii ◽

Apache Ii Score ◽

Cox Regression Analysis ◽

Carbapenem Resistant

Few clinical studies have previously discussed patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bacteriuria. This study aimed to assess the effect of antimicrobial therapy on the mortality of patients with CRKP bacteriuria. Hospitalized adults with CRKP bacteriuria were enrolled retrospectively from 16 hospitals in Taiwan during 2013 and 2014. Critically ill patients were defined as those with an Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥ 20. Multivariate Cox regression analysis was used to determine independent risk factors for 14- and 28-day mortality. Of 107 patients with CRKP bacteriuria, the 14-day and 28-day mortality was 14.0% and 25.2%, respectively. Thirty-three patients received appropriate antimicrobial therapy. In the multivariate Cox regression analysis, the APACHE II score ≥ 20 was the only independent risk factor for 14-day mortality (hazard ratio [HR]: 6.15, p = 0.024). APACHE II score ≥ 20 (HR: 3.05, p = 0.018) and male sex (HR: 2.57, p = 0.037) were associated with 28-day mortality. Among critically ill patients with CRKP bacteriuria, appropriate antimicrobial therapy was not associated with 14-day or 28-day survival. In conclusion, in patients with CRKP bacteriuria, the use of appropriate antimicrobial therapy was not an independent factor associated with reduced mortality. Our findings may inform future antibiotic stewardship interventions for bacteriuria caused by multidrug resistant pathogens.

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Comparison of the Development and Prognosis in Patients of Hypertriglyceridemic Pancreatitis with and without Diabetes

Gastroenterology Research and Practice ◽

10.1155/2021/8895268 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Wenjian Liao ◽

Xiuxiu Niu ◽

Wei Zhang ◽

Xiaobing Liu

Keyword(s):

Cox Regression ◽

Age Of Onset ◽

Previous History ◽

Apache Ii ◽

Apache Ii Score ◽

Cox Regression Analysis ◽

Glucose Levels ◽

Heart Ischemia ◽

Blood Glucose Levels ◽

History Of

Aim. To investigate the clinical features and prognosis in patients of hyperlipidemic acute pancreatitis with or without diabetes. Methods. 157 patients with hypertriglyceridemic pancreatitis (HTGP) were included in this study. Patients with a previous history of diabetes were identified in the group of HTGP with diabetes (HTGPD), while patients without a history of diabetes were identified in the group of HTGP. The clinical characteristics and prognosis data of these patients in the two groups were analyzed. Results. Multivariate Cox regression analysis showed that age, body mass index, glycated serum protein (GSP), and Acute Physiology and Chronic Health Evaluation (APACHE) II score were significantly associated with mortality in patients with HTGP. The mortality was significantly higher in the HTGPD group than in the HTGP group ( p < 0.001 ). Compared to patients of HTGP, those of HTGPD had older age of onset, higher blood glucose levels, and higher GSP levels on admission. Electrocardiograms showed that patients of HTGPD had a significantly higher risk of heart ischemia than those of HTGP ( p < 0.05 ). Patients of HTGPD had higher APACHE II scores than those of HTGP ( p < 0.001 ). Single-factor analysis showed that higher triglyceride levels, GSP, LDL, and previous history of diabetes were associated with HTGP recurrence. Conclusions. Clinicians should be alert to patients of HTGP with diabetes. Diabetes is an important risk factor for HTGP and hyperglycemia may affect the development and prognosis of HTGP.

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Breakthrough Mucormycosis Developing on Mucorales-Active Antifungals Portrays a Poor Prognosis in Patients with Hematologic Cancer

Journal of Fungi ◽

10.3390/jof7030217 ◽

2021 ◽

Vol 7 (3) ◽

pp. 217

Author(s):

Dierdre B. Axell-House ◽

Sebastian Wurster ◽

Ying Jiang ◽

Andreas Kyvernitakis ◽

Russell E. Lewis ◽

...

Keyword(s):

Amphotericin B ◽

Symptom Onset ◽

Poor Prognosis ◽

Treatment Initiation ◽

Cox Regression ◽

Severe Neutropenia ◽

Apache Ii Score ◽

Cell Transplant ◽

Hematopoietic Stem ◽

Cox Regression Analysis

Although breakthrough mucormycosis (BT-MCR) is known to develop on mold-active antifungals without Mucorales activity, it can also occur while on Mucorales-active antifungals. Herein, we retrospectively compared the characteristics and outcomes of patients with hematologic malignancies (HMs) or hematopoietic stem cell transplant (HSCT) who developed BT-MCR on mold-active antifungals with or without Mucorales activity. Of the patients developing BT-MCR, 16 were on Mucorales-active antifungals (9 isavuconazole, 6 posaconazole, 1 amphotericin B), and 87 were on other mold-active agents (52 voriconazole, 22 echinocandins, 8 itraconazole, 5 echinocandin + voriconazole). Both groups were largely comparable in clinical characteristics. Patients developing BT-MCR while on Mucorales-active antifungals had higher 42-day mortality, from either symptom onset (63% versus 25%, p = 0.006) or treatment initiation (69% versus 39%, p = 0.028). In multivariate Cox regression analysis, exposure to Mucorales-active antifungals prior to BT-MCR had a hazard ratio of 2.40 (p = 0.015) for 42-day mortality from treatment initiation and 4.63 (p < 0.001) for 42-day mortality from symptom onset. Intensive care unit (ICU) admission and APACHE II score at diagnosis, non-recovered severe neutropenia, active HM, and amphotericin B/caspofungin combination treatment were additional independent predictors of 42-day mortality. In summary, BT-MCR on Mucorales-active antifungals portrays poor prognosis in HM/HSCT patients. Moreover, improvements in early diagnosis and treatment are urgently needed in these patients.

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Fr402 MELD-NA SCORE VERSUS SOFA SCORE AND APACHE II SCORE AS EARLY PREDICTORS OF MORTALITY IN COVID-19 PATIENTS WITH LIVER INVOLVEMENT

Gastroenterology ◽

10.1016/s0016-5085(21)01467-0 ◽

2021 ◽

Vol 160 (6) ◽

pp. S-312-S-313

Author(s):

Sandra R. Gomez ◽

Eric Lam ◽

Luis Gonzalez Mosquera ◽

Joshua Fogel ◽

Paul Mustacchia

Keyword(s):

Sofa Score ◽

Apache Ii ◽

Liver Involvement ◽

Apache Ii Score ◽

Predictors Of Mortality ◽

Early Predictors

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Serum Soluble Triggering Receptor Expressed on Myeloid Cells-1 and Procalcitonin Can Reflect Sepsis Severity and Predict Prognosis: A Prospective Cohort Study

Mediators of Inflammation ◽

10.1155/2014/641039 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 12

Author(s):

Zhenyu Li ◽

Hongxia Wang ◽

Jian Liu ◽

Bing Chen ◽

Guangping Li

Keyword(s):

Sofa Score ◽

Prognostic Significance ◽

Elevated Serum ◽

Myeloid Cells ◽

Serum Levels ◽

Clinical Severity ◽

Apache Ii ◽

Apache Ii Score ◽

Survival Group ◽

Severity Scores

Objective. To investigate the prognostic significance of serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), procalcitonin (PCT), N-terminal probrain natriuretic peptide (NT-pro-BNP), C-reactive protein (CRP), cytokines, and clinical severity scores in patients with sepsis.Methods. A total of 102 patients with sepsis were divided into survival group (n=60) and nonsurvival group (n=42) based on 28-day mortality. Serum levels of biomarkers and cytokines were measured on days 1, 3, and 5 after admission to an ICU, meanwhile the acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were calculated.Results. Serum sTREM-1, PCT, and IL-6 levels of patients in the nonsurvival group were significantly higher than those in the survival group on day 1 (P<0.01). The area under a ROC curve for the prediction of 28 day mortality was 0.792 for PCT, 0.856 for sTREM-1, 0.953 for SOFA score, and 0.923 for APACHE II score. Multivariate logistic analysis showed that serum baseline sTREM-1 PCT levels and SOFA score were the independent predictors of 28-day mortality. Serum PCT, sTREM-1, and IL-6 levels showed a decrease trend over time in the survival group (P<0.05). Serum NT-pro-BNP levels showed the predictive utility from days 3 and 5 (P<0.05).Conclusion. In summary, elevated serum sTREM-1 and PCT levels provide superior prognostic accuracy to other biomarkers. Combination of serum sTREM-1 and PCT levels and SOFA score can offer the best powerful prognostic utility for sepsis mortality.

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The Characteristics of Mortality Predictor Scoring for Sepsis Patients in Haji Adam Malik Hospital

International Journal of Research and Review ◽

10.52403/ijrr.20211046 ◽

2021 ◽

Vol 8 (10) ◽

pp. 339-344

Author(s):

Abdul Halim Harahap ◽

Franciscus Ginting ◽

Lenni Evalena Sihotang

Keyword(s):

Sofa Score ◽

Scoring System ◽

Scoring Systems ◽

Developed Countries ◽

Apache Ii ◽

Apache Ii Score ◽

P Value ◽

Cross Sectional ◽

Cross Sectional Design ◽

Score Apache

Introduction: Sepsis is a leading cause of death in the Intensive Care Unit (ICU) in developed countries and its incidence is increasing. Many scoring systems are used to assess the severity of disease in patients admitted to the ICU. SOFA score to assess the degree of organ dysfunction in septic patients. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is most often used for patients admitted to the ICU. CCI scoring system to assess the effect of comorbid disease in critically ill patients on mortality. The study aimed to describe the characteristics of the use of scoring to predict patients’ mortality admitted to Haji Adam Malik Hospital. Methods: This is an observational study with a cross-sectional design. A total of 299 study subjects met the inclusion criteria and exclusion criteria, three types of scoring, namely SOFA score, APACHE II score, and CCI score were used to assess the prognosis of septic patients. Data analysis was performed using SPSS. P-value <0.05 was considered statistically significant. Results: A total of 252 people (84.3%) of sepsis patients died. The mean age of the septic patients who died was 54.25 years. The SOFA score ranged from 0-24, the median SOFA score in deceased sepsis patients was 5.0. The APACHE II score ranged from 0-71, the median APACHE II score in deceased sepsis patients was 23.0. The CCI score ranged from 0-37, the median CCI score in deceased sepsis patients was 5.0. Conclusion: Higher scores are associated with an increased probability of death in septic patients. Keywords: Sepsis; mortality predictor; SOFA score; APACHE II score, CCI score.

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