Impact of Colloid Infusion on Outcomes in Patients with Septic Shock

Abstract Background: Although colloid solution has been widely used in practice, its impact on mortality in patients with septic shock remains unknown. We evaluated the association of colloid infusion with outcomes in septic shock patients.Methods: Medical Information Mart for Intensive Care (MIMIC)-III was used to identify patients with septic shock. Propensity score matching (PSM) was employed to balance the baseline differences. Cox proportional hazards model, Wilcoxon rank-sum test, and logistic regression were utilized to determine the associations of colloid infusion with mortality, length of stay, and recovery of kidney function, respectively.Results: A total of 4,553 septic shock patients were studied, including 1,158 with colloid infusion, and 3,395 without colloid infusion. After PSM, 1,012 pairs of patients were matched. Significant benefits in the mortality rate were observed in the colloid group compared with the non-colloid group, with the 28-day mortality [hazard ratio (HR) 0.62; 95% confidence interval [CI], 0.52-0.73; P < 0.001], and the 90-day mortality [HR 0.76; 95% CI 0.65-0.88; P < 0.001]. Colloid infusion was not associated with the renal function recovery [HR 1.06; 95% CI 0.87–1.29; P = 0.547] in either population. Nevertheless, subgroup analysis revealed that colloid infusion did not affect the 28-day mortality in people with sepsis of AKI stage 1. In addition, the use of dextran did not decrease the 28-day mortality (HR 1.41; 95% CI 0.19-10.59; P = 0.736). Conclusion: In septic shock patients, colloid infusion (albumin or hydroxyethyl starch) improved short-term survival, but had no clear effect on the recovery of renal function.

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Association between albumin infusion and outcomes in patients with acute kidney injury and septic shock

Scientific Reports ◽

10.1038/s41598-021-03122-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Chenglong Ge ◽

Qianyi Peng ◽

Wei Chen ◽

Wenchao Li ◽

Lina Zhang ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Medical Information ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Kidney Injury ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Albumin Infusion ◽

Hazards Model

AbstractSeptic shock with acute kidney injury (AKI) is common in critically ill patients. Our aim was to evaluate the association between albumin infusion and outcomes in patients with septic shock and AKI. Medical Information Mart for Intensive Care (MIMIC)-III was used to identify patients with septic shock and AKI. Propensity score matching (PSM) was employed to balance the baseline differences. Cox proportional hazards model, Wilcoxon rank-sum test, and logistic regression were utilized to determine the associations of albumin infusion with mortality, length of stay, and recovery of kidney function, respectively. A total of 2861 septic shock patients with AKI were studied, including 891 with albumin infusion, and 1970 without albumin infusion. After PSM, 749 pairs of patients were matched. Albumin infusion was associated with improved 28-day survival (HR 0.72; 95% CI 0.59–0.86; P = 0.002), but it was not difference in 90-day mortality between groups (HR 0.94; 95% CI 0.79–1.12; P = 0.474). Albumin infusion was not associated with the renal function recovery (HR 0.91; 95% CI 0.73–1.13; P = 0.393) in either population. Nevertheless, subgroup analysis showed that albumin infusion was distinctly associated with reduced 28-day mortality in patients with age > 60 years. The results need to be validated in more randomized controlled trials.

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A promising predictor of mortality— A cohort study (Preprint)

10.2196/preprints.28633 ◽

2021 ◽

Author(s):

Ji Ha Ling

Keyword(s):

Intensive Care ◽

Poor Prognosis ◽

Medical Information ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Hazards Model ◽

Clinical Biomarker ◽

Secondary Result

UNSTRUCTURED Severe inflammation leads to poor prognosis for intensive care unit hospitalized patients. The is a biomarker used to monitor inflammation and immune response, which can predict poor prognosis of various diseases. However, it is unclear whether NLR is associated with all-cause mortality in ICU patients. This study investigated the correlation between MLR and ICU results. Extract clinical data from Medical Information Mart for Intensive Care III (MIMIC-III) database, which contains health data of more than 50,000 patients. The main result was 30-day mortality, and the secondary result was 90-day mortality. Use the Cox proportional hazards model to reveal the association between MLR and results. Multivariable analyses were used to control for confounders. NLR is a promising clinical biomarker, which can be used as a available predictor of ICU mortality.

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Predictors of Survival in Continuous Ambulatory Peritoneal Dialysis Patients: A Five-Year Prospective Study

Peritoneal Dialysis International ◽

10.1177/089686089601601s36 ◽

1996 ◽

Vol 16 (1_suppl) ◽

pp. 190-194 ◽

Cited By ~ 30

Author(s):

Morrell M. Avram ◽

Paul A. Fein ◽

Luigi Bonomini ◽

Neal Mittman ◽

Raphael Loutoby ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Serum Albumin ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Tertiary Care ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Term Survival ◽

Predictors Of Mortality

Our objective was to examine the influence of various demographic, clinical, and enrollment biochemical variables on the long-term survival of continuous ambulatory peritoneal dialysis (CAPD) patients. This was a prospective cohort study investigating the relationship between demographics and enrollment biochemical markers and mortality in CAPD patients in a CAPD unit in a large tertiary care teaching hospital. One hundred and sixtynine patients in the CAPD program were enrolled between 1989 and 1994, and were followed up to 60 months. Independent predictors of mortality determined by Cox proportional hazards model included age, diabetes, serum albumin and creatinine. Enrollment level of serum albumin, and creatinine can predict mortality in CAPD patients up to 60 months. Markers of visceral and somatic nutrition at enrollment are important predictors of mortality in CAPD patients up to five years.

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Effects of Serum Albumin Levels on Antithrombin Supplementation Outcomes Among Patients With Sepsis-Associated Coagulopathy: A Retrospective Study

Clinical Medicine Insights: Blood Disorders ◽

10.1177/1179545x19858361 ◽

2019 ◽

Vol 12 ◽

pp. 1179545X1985836

Author(s):

Masatomo Ebina ◽

Kazunori Fujino ◽

Akira Inoue ◽

Koichi Ariyoshi ◽

Yutaka Eguchi

Keyword(s):

Retrospective Study ◽

Serum Albumin ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Term Survival ◽

Hazards Model ◽

The Relationship

Background:Severe sepsis is commonly associated with mortality among critically ill patients and is known to cause coagulopathy. While antithrombin is an anticoagulant used in this setting, serum albumin levels are known to influence serum antithrombin levels. Therefore, this study aimed to evaluate the outcomes of antithrombin supplementation in patients with sepsis-associated coagulopathy, as well as the relationship between serum albumin levels and the effects of antithrombin supplementation.Methods:This retrospective study evaluated patients who were >18 years of age and had been admitted to either of two intensive care units for sepsis-associated coagulopathy. The groups that did and did not receive antithrombin supplementation were compared for outcomes up to 1 year after admission. Subgroup analyses were performed for patients with serum albumin levels of <2.5 g/dL or ⩾2.5 g/dL.Results:Fifty-one patients received antithrombin supplementation and 163 patients did not. The Cox proportional hazards model revealed that antithrombin supplementation was independently associated with 28-day survival (hazard ratio [HR]: 0.374, P = 0.025) but not with 1 year survival (HR: 0.915, P = 0.752). In addition, among patients with serum albumin levels of <2.5 g/dL, antithrombin supplementation was associated with a significantly lower 28-day mortality rate (9.4% vs 36.8%, P = .009).Conclusion:Antithrombin supplementation may improve short-term survival, but not long-term survival, among patients with sepsis-associated coagulopathy.

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Association Between Base Excess and Mortality Among Patients in ICU with Acute Kidney Injury

10.21203/rs.3.rs-746329/v1 ◽

2021 ◽

Author(s):

Yi Cheng ◽

Yuanjun Tang ◽

Boxiang Tu ◽

Xin Cheng ◽

Ran Qi ◽

...

Keyword(s):

Acute Kidney Injury ◽

Medical Information ◽

Proportional Hazards ◽

Base Excess ◽

Proportional Hazards Model ◽

Kidney Injury ◽

Prognostic Indicator ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Icu Patients

Abstract Objective This study aimed to explore the association between base excess (BE) and risk of 30-day mortality among patients with acute kidney injury (AKI) in ICU.Methods This retrospective study including ICU patients with AKI from Medical Information Mart for Intensive Care (MIMIC)-IV database. We used multivariate Cox proportional-hazards model to calculate the hazard ratio (HR) for risk of 30-day mortality among patients with AKI. Furthermore, we utilized Cox proportional-hazard model with restrict cubic splines (RCS) to explore the potential no-linear association. Results Of all the 14238 ICU patients with AKI, BE showed U-shaped relationship with risk of 30-day mortality for patients with AKI, and higher or lower BE value could increase the risk. Compared with normal base excess (-3~3 mmol/L), patients with difference groups (BE ≤ -9mmol/L, -9 mmol/L <BE≤-3 mmol/L, 3 mmol/L <BE≤9 mmol/L and BE＞9 mmol/L) had different HR for mortality: 1.57(1.40,1.76), 1.26(1.14,1.39), 0.97(0.83,1.12), 1.53(1.17,2.02) respectively. And the RCS analyses also showed U-shaped curve between BE and 30-day mortality risk.Conclusion Our results suggest both higher and lower BE in patients with AKI would increase the risk of 30-day mortality. BE measured at administration could be a critical prognostic indicator for ICU patients with AIK and provide guidance for clinicians.

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The Accolade TMZF stem fulfils the demands of modern stem design: Minimum 5-year survival in a cohort of 937 patients

Journal of Orthopaedic Surgery ◽

10.1177/2309499018807747 ◽

2018 ◽

Vol 26 (3) ◽

pp. 230949901880774 ◽

Cited By ~ 2

Author(s):

Joost AAM van den Hout ◽

Koen LM Koenraadt ◽

Robert Wagenmakers ◽

Stefan BT Bolder

Keyword(s):

Learning Effect ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Anterolateral Approach ◽

Stem Design ◽

Patient Age ◽

Term Survival ◽

Patient Âgé

Purpose: Modern hip stem design includes a prosthesis that has a predictable outcome in all total hip arthroplasty (THA) patients, regardless of approach, surgeon or patient characteristics. Introduction without a learning curve and, in cases of problems, the possibility for a simple revision are other prerequisites. The purpose of this study is to evaluate whether the Accolade TMZF stem (Stryker Orthopedics, Mahwah, New Jersey, USA) is suitable to fulfil these demands. We report our mid-term survival of the Accolade TMZF hip stem in all patients from the first implantation at our institute. Methods: From the start of using the Accolade TMZF stem (March 2009) until February 2011, 937 THA were performed by 12 surgeons using a posterolateral or anterolateral approach. Survival of the stem was calculated using Kaplan–Meier analysis. Effect of approach, patient age and comorbidity were analysed with a Cox proportional hazards’ model. The learning effect was determined by comparing the number of revisions in the surgeons’ first 20 THAs with their next 30 THAs and the subsequent THAs. Results: At 5 years, cumulative stem survival was 97.9% based on revisions for all reasons and 98.8% with aseptic loosening as endpoint. We found no effect of surgical approach, patient age or comorbidity on stem survival. No learning effect was found. Conclusion: The Accolade TMZF stem fulfilled the demands of modern stem design.

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Missed opportunity: An intersectional approach to disparities in long-term survival in bladder cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.476 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 476-476

Author(s):

Samuel L. Washington ◽

Stephen Gregorich ◽

Sikai Song ◽

Maxwell V. Meng ◽

Anne Suskind ◽

...

Keyword(s):

Bladder Cancer ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Care Providers ◽

Term Survival ◽

Race Ethnicity ◽

Muscle Invasive ◽

Better Than

476 Background: For individuals with muscle-invasive bladder cancer (MIBC), studies focused on racial disparities have shown black race is associated with 21% lower odds of guideline-based treatment (GBT) and differences in treatment explain 35% of observed black-white differences in survival. To characterize how the interaction between race/ethnicity and receipt of GBT drive within- and between-race differences in survival for black, white, and Latino individuals with MIBC. Methods: We identified a cohort of individuals with cT2-4 MIBC from 2004-2013 in the National Cancer Database. GBT was defined by American Urological Association guidelines. A Cox proportional hazards model of patient mortality estimated effects of patient GBT status, race/ethnicity, and the GBT-by-race/ethnicity interaction, adjusting for covariates. Results: Of 54,910 MIBC individuals with 125,821 person-years of post-treatment observation (max=11 years), 90.1% were white, 6.9% black, and 3.0% Latino. Half (50.2%) received GBT. Averaging across GBT status, Latino individuals had lower hazard of death compared to black (HR 0.81, 95% CI 0.75-0.87) and white individuals (HR 0.92, 0.86-0.98). With GBT, Latino and white individuals had similar outcomes (HR=1.00, 0.91-1.10) and both groups fared significantly better than black individuals (HR=0.88, 0.79-0.99 and HR=0.88, 0.83-0.94, respectively). Without GBT, Latino individuals fared better than white (HR=0.85, 0.77-0.93) and black individuals (HR=0.74, 0.67-0.82) while white individuals fared better than black individuals (HR=0.87, 0.83-0.92). Latino without GBT fared better than black individuals with GBT (H=0.98, 0.88-1.09), although not statistically significant. Conclusions: Our study finds that not only are GBT levels generally low, which is concerning, but there is also an apparent 'under-allocation' of GBT to a patient group who arguably needs it the most-- black individuals. Future efforts to improve the delivery of GBT, a factor directly impacted by urologic care providers, may mitigate the race-based survival differences observed in individuals with MIBC.

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Impact of renal function on mid-term outcomes in heart failure patients treated with tolvaptan

Therapeutic Advances in Cardiovascular Disease ◽

10.1177/1753944718819064 ◽

2019 ◽

Vol 13 ◽

pp. 175394471881906

Author(s):

Kensuke Fujioka ◽

Sumio Mizuno ◽

Taro Ichise ◽

Takao Matsui ◽

Hiroaki Hirase ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Free Water ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Cardiac Events ◽

Hazards Model ◽

Continuous Use

Background: Although tolvaptan, an electrolyte-free water diuretic for congestive heart failure (HF), is reported to have no effect on long-term mortality or HF-related morbidity, there may exist some subgroups of patients who may receive beneficial effect of tolvaptan. The purpose of this study was to identify clinical factors associated with mid-term effect of tolvaptan on clinical outcomes of patients who discharged after acute HF. Methods: We retrospectively analyzed 140 patients (88 male; mean age, 77.1 ± 11.0 years) with acute HF who received tolvaptan (initial dose 8.6 ± 3.6 mg/day) during their hospitalization. They were divided into two groups according to how the tolvaptan was used at discharge; 77 in the tolvaptan-continued group and 63 in the discontinued group. Results: The Cox proportional hazards model revealed that eGFR was the only independent predictor for the occurrence of mid-term cardiac events (composite of re-hospitalization due to HF and all-cause death; aHR = 0.9870, p = 0.02597). The Kaplan–Meier survival curves of the two groups demonstrated no difference in cumulative event-free rates. In the subgroup with preserved renal function at admission (eGFR ⩾ 30 ml/min/1.73 m2), the continuous use of tolvaptan increased composite events (aHR = 2.130, p = 0.02549). Conclusions: The continuous use of tolvaptan after discharge did not affect mid-term cardiac events of HF overall but may be associated with increased cardiac events in the subgroup with preserved renal function. These findings suggest that the tolvaptan administration might need to be limited to treatment of in-hospital acute HF.

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The long-term prognosis of pneumomediastinum associated with dermatomyositis: a two-centre retrospective cohort study

Rheumatology ◽

10.1093/rheumatology/keaa582 ◽

2020 ◽

Author(s):

Can Li ◽

Mei’e Liang ◽

Hui Jiang ◽

Jiuliang Zhao ◽

Chanyuan Wu ◽

...

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Term Survival ◽

Long Term Survival ◽

Hazards Model ◽

Long Term Prognosis

Abstract Objectives Pneumomediastinum (PnM) is a rare but life-threatening complication of DM. The present study aims to characterize the long-term prognosis and prognostic factors of DM-associated PnM. Methods Inpatients with DM-associated PnM were retrospectively enrolled from two tertiary referral centres for rheumatic disease. The enrolled patients were divided into survivors or non-survivors. Information about the demographics, clinical manifestations, CT scan features, laboratory findings and outcomes were collected from their medical records. A least absolute shrinkage and selection operator regularized Cox regression model was used to select the most relevant factors. Prognosis was analysed using a Kaplan–Meier curve. A Cox proportional hazards model was used to identify independent predictive factors for long-term survival. Results A total of 62 patients (26 women) with DM-associated PnM were enrolled. The mean age was 44.3 years (s.d. 11.7). The median follow-up duration was 17 days (quartiles 7, 266.5). Thirty-five patients died during follow-up. The survival rates were 75.4% at 1 week, 46.2% at 3 months and 41.9% at 1 year. The Cox proportional hazards model identified the development of fever [hazard ratio (HR) 3.23 (95% CI 1.25, 8.35), P = 0.02] and a decrease in the number of lymphocytes [HR 2.19 (95% CI 1.10, 4.39), P = 0.03] as independent risk factors for death. Conclusion The results suggest poor overall survival among patients with DM-associated PnM. Survival during the first 3 months is crucial for long-term survival. Meanwhile, the development of fever and a decrease in the number of lymphocytes were associated with long-term mortality. Early recognition and prompt treatment of this high-risk group of DM patients is therefore important.

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Diagnostic and prognostic value of presepsin and procalcitonin in non-infectious organ failure, sepsis, and septic shock: a prospective observational study according to the Sepsis-3 definitions

BMC Infectious Diseases ◽

10.1186/s12879-021-07012-8 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Sukyo Lee ◽

Juhyun Song ◽

Dae Won Park ◽

Hyeri Seok ◽

Sejoong Ahn ◽

...

Keyword(s):

Septic Shock ◽

Organ Failure ◽

Prospective Observational Study ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Hazards Model ◽

Sepsis And Septic Shock ◽

Diagnostic And Prognostic Value

Abstract Background We investigated the diagnostic and prognostic value of presepsin among patients with organ failure, including sepsis, in accordance with the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Methods This prospective observational study included 420 patients divided into three groups: non-infectious organ failure (n = 142), sepsis (n = 141), and septic shock (n = 137). Optimal cut-off values of presepsin to discriminate between the three groups were evaluated using receiver operating characteristic curve analysis. We determined the optimal cut-off value of presepsin levels to predict mortality associated with sepsis and performed Kaplan–Meier survival curve analysis according to the cut-off value. Cox proportional hazards model was performed to determine the risk factors for 30-day mortality. Results Presepsin levels were significantly higher in sepsis than in non-infectious organ failure cases (p < 0.001) and significantly higher in patients with septic shock than in those with sepsis (p = 0.002). The optimal cut-off value of the presepsin level to discriminate between sepsis and non-infectious organ failure was 582 pg/mL (p < 0.001) and between sepsis and septic shock was 1285 pg/mL (p < 0.001). The optimal cut-off value of the presepsin level for predicting the 30-day mortality was 821 pg/mL (p = 0.005) for patients with sepsis. Patients with higher presepsin levels (≥ 821 pg/mL) had significantly higher mortality rates than those with lower presepsin levels (< 821 pg/mL) (log-rank test; p = 0.004). In the multivariate Cox proportional hazards model, presepsin could predict the 30-day mortality in sepsis cases (hazard ratio, 1.003; 95% confidence interval 1.001–1.005; p = 0.042). Conclusions Presepsin levels could effectively differentiate sepsis from non-infectious organ failure and could help clinicians identify patients with sepsis with poor prognosis. Presepsin was an independent risk factor for 30-day mortality among patients with sepsis and septic shock.

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