Perioperative Diabetes Insipidus in Patients Undergoing Off-Pump Coronary Bypass Grafting Surgery: A Study on Incidence, Related Factors and Clinical Significance

2020 ◽  
Author(s):  
Peng Zhong ◽  
Zijian Guo ◽  
Jiakai Lu ◽  
Weiping Cheng ◽  
Jin Mu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Diabetes Insipidus ◽  
Logistic Regression Analysis ◽  
Bypass Grafting ◽  
Off Pump ◽  
Ventilation Time ◽  
Icu Stay ◽  
Mechanical Ventilation Time

Abstract BackgroundPerioperative diabetes insipidus (DI) is a serious complication occurring in patients undergoing off-pump coronary artery bypass grafting (OPCABG). MethodsThis was a retrospective study of 199 patients who underwent OPCABG surgery in Anzhen hospital, Beijing, China, between January 2019 to December 2019. Patients were divided into a DI(+) group and a DI(-) group according to perioperative urine condition. The incidence of perioperative DI in patients undergoing OPCABG surgery was calculated as the main outcome. Multivariable binary logistic regression analysis was used to identify independent prognostic factors of DI.ResultsPerioperative DI occurred in 43.2% (86/199) of these patients. Mean patient age was 62.5 ± 9.0 years, and 156 (78.4%) were male. Multivariable logistic regression analysis showed a correlation between BMI(OR=0.772, 95%CI[0.670-0.890], P＜0.001), Crystal quantity(OR=1.001, 95%CI[1.000-1.001], P=0.008), perioperative Cr(OR=0.965, 95%CI[0.937-0.993], P=0.016). The DI(+) group had a significantly higher imbalance postoperative PH condition(41.9% vs 28.3%, P<0.05), higher median mechanical ventilation time than the DI(-) group (22.0 vs. 20.5, P<0.01) and higher median of ICU stay hours(27.0 vs 31.0, P=0.041).ConclusionCoronary artery disease(CAD) patients underwent OPCABG surgery were easy to have perioperative DI, which had a higher ICU stay and mechanical ventilation time than those without DI. BMI, Crystal quantity, perioperative creatinine was associated with the presence of DI. Prospective studies are needed to validate these findings.

scholarly journals The association between body mass index and severity of Coronavirus Disease 2019 (COVID-19): A cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247023
Author(s):  
Kulapong Jayanama ◽  
Sirawat Srichatrapimuk ◽  
Kanin Thammavaranucupt ◽  
Suppachok Kirdlarp ◽  
Supawadee Suppadungsuk ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cohort Study ◽  
Body Mass ◽  
Logistic Regression Analysis ◽  
Severe Pneumonia ◽  
Adverse Outcomes ◽  
Icu Stay ◽  
Underweight Patients

Objectives The coronavirus disease 2019 (COVID-19) has become a worst pandemic. The clinical characteristics vary from asymptomatic to fatal. This study aims to examine the association between body mass index (BMI) levels and the severity of COVID-19. Methods and study design A cohort study included 147 adult patients with confirmed COVID-19 were categorized into 4 groups by BMI levels on admission: <18.5 (underweight), 18.5–22.9 (normal weight), 23.0–24.9 (overweight), and ≥25.0 kg/m2 (obese). Rates of pneumonia, severe pneumonia, acute kidney injury (AKI), and ICU stay during hospitalization across BMI group was determined. Logistic regression analysis was used to determine the association between BMI and severe pneumonia. Results Of the totals, patients having a BMI <18.5, 18.5–22.9, 23.0–24.9, and ≥25.0 kg/m2 were 12.9%, 38.1%, 17.7%, and 31.3%, respectively. The rates of pneumonia and severe pneumonia tended to be higher in patients with higher BMI, whereas the rates of AKI and ICU stay were higher in patients with BMI <18.5 kg/m2 and ≥ 25 kg/m2, when compared to patients with normal BMI. After controlling for age, sex, diabetes, hypertension and dyslipidemia in the logistic regression analysis, having a BMI ≥25.0 kg/m2 was associated with higher risk of severe pneumonia (OR 4.73; 95% CI, 1.50–14.94; p = 0.003) compared to having a BMI 18.5–22.9 kg/m2. During admission, elevated hemoglobin and alanine aminotransferase levels on day 7 and 14 of illness were associated with higher BMI levels. In contrast, rising of serum creatinine levels was observed in underweight patients on days 12 and 14 of illness. Conclusions Obesity in patients with COVID-19 was associated with severe pneumonia and adverse outcomes such as AKI, transaminitis and ICU stay. Underweight patients should be closely monitored for AKI. Further studies in body composition are warranted to explore the links between adiposity and COVID-19 pathogenesis.

scholarly journals 43 Pulmonary Artery dopplers for early prediction of Bronchopulmonary Dysplasia (BPD) in Extremely Low Birth Weight babies (ELBW): A forgotten tale

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e18-e19
Author(s):  
Renjini Lalitha ◽  
Eyad Bitar ◽  
Abbas Hyderi ◽  
Matthew Hicks ◽  
Kumar Kumaran
Keyword(s):  
At Risk ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Pulmonary Artery ◽  
Logistic Regression Analysis ◽  
Subsequent Development ◽  
Observer Agreement ◽  
Predictive Values ◽  
Tertiary Center

Abstract Introduction/Background BPD is a chronic lung disease that affects ELBW babies and contributes significantly to their morbidity and mortality. The early abnormal vasoreactivity observed in babies at risk of BPD increases the pulmonary vascular resistance and can be assessed non-invasively using Time to Peak Velocity: Right Ventricular Ejection Time ratio (TPV: RVET) that is calculated from pulmonary artery doppler waveform. We postulate that screening for this condition early may be useful to predict BPD in this cohort, which may provide prognostic information as well as early clinical management of the ELBW at risk of developing BPD and therefore can potentially present a window of opportunity for therapeutic intervention. Objectives 1. To determine utility of TPV/RVET ratio in predicting the risk for BPD in ELBW babies in a tertiary center. 2. To determine utility of TPV/RVET(c) ratio in predicting the risk for BPD in ELBW babies in a tertiary center. Design/Methods This is a retrospective cohort study of ELBW babies &lt;29 weeks admitted to the Neonatal Intensive Care Unit at Stollery Children Hospital (SCH) over a 4 year time period and had early echocardiograms performed between 7-21 days of life. These babies were further identified to have BPD or no BPD at 36 weeks CGA. TPV/RVET ratios were measured by two reviewers from pulmonary artery doppler waveforms and were corrected for heart rate. The predictive ability of TPV/RVET and TPV/RVET(c) for subsequent development of BPD were analyzed using ROC curve. Inter observer agreement was evaluated. Logistic regression analysis was performed to derive a model that can be used in the 2nd to 3rd weeks of life, to predict the subsequent development of BPD at 36 weeks CGA. Infants with congenital heart disease (other than PDA, persistent foramen ovale/atrial septal defect and Ventricular Septal Defects), congenital lung malformations, multiple congenital anomalies and chromosomal anomalies were excluded. Results Out of 589 ELBW babies &lt;29 weeks admitted to SCH NICU, 207 infants were eligible with early echocardiograms done at a mean age of 12.6 days (SD 4.1). One-hundred-and-twenty-five babies (60.4%) were found to have BPD. Babies with BPD were of lower gestational age (25.6 Vs 26.4, p-0.0001), sicker at birth (SNAPPE II 42.3 Vs 33.2, p-0.0024), had higher incidence of PDA needing surgical ligation (18.4% Vs 4.9%, p-0.005) and had spent more days on mechanical ventilation (39.8 Vs 12.5, p&lt;0.0001) than those without BPD. Both TPV, TPV/RVET and its corrected ratios were significantly lower in ELBW babies with BPD compared to non-BPD babies (p&lt;0.0001). The TPV/RVET ratio (cut off 0.34) and TPV/RVET(c) (cut off 0.54) had Sensitivities [76.8% (95%CI 68.4-83.9) and 72% (95%CI 63.3-79.7)], Specificities [85.4% (95%CI 75.8- 92.2) and 84.1% (95%CI 74.4-91.3)], Positive Predictive Values [88.9% (95%CI 81.4-94.1) and 87.4% (95%CI 79.4-93.1)], Negative Predictive values [70.7% (95%CI 60.7- 79) and 66.3% (95%CI 56.4-75.3)] and ROC area [0.811 (95% CI 0.757-0.864) and 0.781 (95% CI 0.725-0.837)] respectively. Multi variant logistic regression analysis showed Odds Ratio(OR) for having BPD at TPV/RVET cut off 0.34 and TPV/RVET(c) cut off 0.54 to be 19.9(95%CI 8.19-48.34) and 16.3(95% 6.78-39.33) respectively and the OR increased by 1.07(95%CI 1.05-1.09) and 1.08(95% CI 1.05-1.10) with every additional days of mechanical ventilation respectively. TPV/RVET ratio had 92.75% inter-observer agreement with kappa 0.83. Conclusion TPV/RVET and its corrected ratio are good and reliable early screening tools for subsequent development of BPD in ELBW babies with substantial inter-observer agreement. Two variable model namely TPV/RVET&lt;0.34 and mechanical ventilation or TPV/RVET(c) &lt;0.54 and mechanical ventilation can be used in the 2nd to 3rd week of life to predict subsequent development of BPD at 36 weeks CGA in ELBW babies.

scholarly journals Predictors of Prolonged Mechanical Ventilation After Cardiopulmonary Bypass in Infants with Congenital Heart Disease Less than 3 Months Old

2020 ◽  
Author(s):  
Ruonan Wang ◽  
Di Yu ◽  
Liang Zou ◽  
Yaqin Shu ◽  
Xuming Mo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Heart Disease ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Heart Disease ◽  
Cardiopulmonary Bypass ◽  
Logistic Regression Analysis ◽  
Congenital Heart ◽  
Prolonged Mechanical Ventilation ◽  
Multiple Logistic Regression Analysis

Abstract Objective: To identify the predictors of prolonged mechanical ventilation (PMV) after cardiopulmonary bypass (CPB) in infants with congenital heart disease (CHD) less than 3 months. Methods: From June 2017 to May 2020, a total of 165 infants less than 3 months old with CHD admitted to the Children's Hospital of Nanjing Medical University for CPB were enrolled in this study. The following data were collected including gender, age, weight, Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) score, preoperative levels of thyroid hormones, CPB time, aortic cross-clamping (ACC) time, mechanical ventilation time, ICU mortality and infection. The PMV was defined as the ventilator assisted time > 72h. PMV prediction was assessed by multivariate binary logistic regression analysis. Results: Compared with non-PMV group, PMV group was younger (44.74 ± 25.27 days vs. 35.44 ± 26.91 days, P= 0.001), and most were newborns (41/93 vs. 10/57, P=0.000), with a higher proportion of RACHS-1 (29/93 vs.6/57, P=0.000) and more cases of infection (47/93 vs. 17/57,P= 0.004).PMV group had significantly lower weight than non-PMV group (3.79 ± 0.83Kg vs. 4.28 ± 1.01Kg, P=0.001). In PMV group, CPB (133.74 ± 89.65 vs. 72.30 ± 44.82, P =0.000) and ACC time (52.02 ± 24.80 vs. 36.98 ± 16.63, P =0.000) were both longer. FT4 and TT4 were higher while FT3, TT3 and TSH were lower in PMV group, but only FT3 (4.99 ± 1.67 vs. 5.29 ± 1.23, P =0.017) and TT3 (1.91 ± 0.59 vs. 1.96 ± 0.49, P =0.050) showed significant differences between PMV group and non-PMV group. Conclusion: Multiple logistic regression analysis showed that weight, infection, FT3 and CPB time were independent predictors of PMV after CPB in infants with CHD.

scholarly journals The Efficacy and Immunomodulatory Effects of Ulinastatin and Thymosinα1 for Sepsis: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Feng Yun Wang ◽  
Bin Fang ◽  
Xin Hua Qiang ◽  
Tie Ou Yu ◽  
Jia Rong Zhong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
T Cells ◽  
Survival Rate ◽  
Meta Analysis ◽  
Apache Ii Score ◽  
Immunomodulatory Effects ◽  
Ventilation Time ◽  
Icu Stay ◽  
Mechanical Ventilation Time

Objective. To systematically review the efficacy and potential immunomodulatory effect of ulinastatin combined with thymosinα1 (UTI) for sepsis.Design. A systematic review and meta-analysis of randomized controlled trials (RCTs).Data Sources. The following databases: PubMed, Embase, and Cochrane Central were searched to identify related clinical trials. The search terms were “ulinastatin”, “thymosin”, and “sepsis”.Results. Six RCTs, 944 septic patients in total, were included in this meta-analysis. The result shows UTI increased the 28-day survival rate of septic patients, odds ratio (OR) = 2.01, 95% CI [1.53, 2.64]. After the treatment with UTI, the APACHE II score (four studies) dropped 4.72 further, mean = −4.72, 95% CI [−6.54, −2.91] (p<0.00001). The mean time of ICU stay (four studies) in UTI group decreased 3.03 days further, mean = −3.03 [−6.99, 0.95] (p=0.14), and mechanical ventilation time (four studies) decreased 2.05 days, mean = −1.81 [−2.96, −0.66] (p=0.002). With the treatment of UTI, CD4+T cells raised 5.13%, mean = 5.13, 95% CI [2.75, 7.50] (p<0.0001); there was no significant change in CD8+T cells, mean = −0.74 [−2.93, 1.45] (p=0.51).Conclusion. According to this meta-analysis, with the treatment of UTI, the short-term survival rate of septic patients was increased and the illness severity was alleviated. ICU stay and mechanical ventilation time were effectively shortened. The beneficial effect of UTI might be due to the potential immunomodulatory effects of these two drugs.

scholarly journals Invasive Mechanical Ventilation May Be an Important Factor of Mortality in Severe/Critical COVID-19 Pneumonia: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Jing Wei ◽  
Lei Shi ◽  
Zhi Cheng ◽  
Xinye Jin ◽  
Wei Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Invasive Mechanical Ventilation ◽  
Trial Registration ◽  
Hospital Death ◽  
Multivariable Logistic Regression Analysis ◽  
Multivariable Logistic Regression

Abstract Background: Many of severe COVID-19 patients are admitted to the hospital or even to the Intensive Care Unit(ICU). The present study was aimed to investigated the risk factors in death from COVID-19.Methods: In this retrospective study, all inpatients confirmed severe or critical COVID-19 from two tertiary hospital in Huangshi were included, who had been discharged or died by March19,2020. Demographic,clinical,treatment,laboratory data and information were extracted from electronic medical records and compared between survivors group and non-survivors group. The univariable and multivariable logistic regression analysis was used to analyze the risk factors associated with in-hospital death.Results: 81 patients were included in this study, of whom 55 were discharged and 26 died in hospital. In all patients, 36(44.4%) patients had comorbidity, including hypertension(27[33.3%]), diabetes(11[13.6%]) and coronary heart disease (CHD)(11[13.6%]), and 16(19.8%) patients accompanied with more than 2 kinds of underlying diseases. The proportion of CHD in non-survivors group was significantly higher than that in survivors group(26.9% vs 7.3%, P=0.032), but there were no differences in hypertension, diabetes and COPD between the non-survivors group and the survivors group. Multivariable logistic regression analysis showed increasing odds of in-hospital death associated with aspartate aminotransferase(AST) and invasive mechanical ventilation (IMV) (P<0.001)(P=0.017）.Conclusions: Invasive Mechanical Ventilation may contribute to mortality of severe/critical COVID-19 pneumonia, and with higher AST at admission was one of the indicators of poor prognosis.Trial registration: Chinese Clinical Trial Registration; ChiCTR2000031494; Registered 02 April 2020; http://www.medresman.org

Dexmedetomidine and Mortality From Sepsis Requiring Mechanical Ventilation: A Japanese Nationwide Retrospective Cohort Study

2020 ◽  
pp. 088506662094215
Author(s):  
Shotaro Aso ◽  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
Hideo Yasunaga
Keyword(s):  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Propensity Score ◽  
Logistic Regression Analysis ◽  
Instrumental Variable ◽  
Diagnosis Procedure Combination ◽  
Instrumental Variable Analysis ◽  
Mechanically Ventilated ◽  
Variable Analysis

Background: Dexmedetomidine has a mild sedative effect and may reduce mortality in mechanically ventilated critically ill patients. However, few studies have examined the effects of dexmedetomidine in patients with sepsis who require mechanical ventilation. The aim of this study was to investigate the association between dexmedetomidine and mortality in patients with sepsis requiring mechanical ventilation, using a nationwide inpatient database in Japan. Methods: Using the Diagnosis Procedure Combination database from July 1, 2010, to March 31, 2016, we identified adult patients with sepsis who required mechanical ventilation for more than 2 days. Patients were divided into those who received dexmedetomidine and those who received midazolam or propofol within 1 day after admission. Logistic regression analysis, propensity score-matched analysis, and instrumental variable analysis were performed to compare all-cause 28-day mortality and duration of mechanical ventilation between the groups. Results: In total, 50 671 were eligible patients, including dexmedetomidine group (n = 13 759) and propofol or midazolam group (n = 36 912). The dexmedetomidine group had significantly lower all-cause 28-day mortality compared with the group receiving midazolam or propofol, as shown by the logistic regression analysis (odds ratio [OR]: 0.78; 95% confidence interval [CI]: 0.73-0.84), the propensity score–matched analysis (OR: 0.85; 95% CI: 0.80-0.91), and the instrumental variable analysis (OR: 0.64; 95% CI: 0.57-0.73). The duration of mechanical ventilation in the dexmedetomidine group was significantly shorter than that in the midazolam or propofol group. Conclusions: Dexmedetomidine was associated with a reduction in all-cause 28-day mortality and duration of mechanical ventilation.

Prediction of Prolonged Ventilation after Coronary Artery Bypass Grafting: Data from an Artificial Neural Network

2017 ◽  
Vol 20 (1) ◽  
pp. 007 ◽  
Author(s):  
Eric Stephen Wise ◽  
David P. Stonko ◽  
Zachary A. Glaser ◽  
Kelly L. Garcia ◽  
Jennifer J. Huang ◽  
...  
Keyword(s):  
Neural Network ◽  
Mechanical Ventilation ◽  
Artificial Neural Network ◽  
Logistic Regression ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Early Identification ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Prolonged Ventilation

Objectives: The need for mechanical ventilation 24 hours after coronary artery bypass grafting (CABG) is considered a morbidity by the Society of Thoracic Surgeons. The purpose of this investigation was twofold: to identify simple preoperative patient factors independently associated with prolonged ventilation and to optimize prediction and early identification of patients prone to prolonged ventilation using an artificial neural network (ANN).Methods: Using the institutional Adult Cardiac Database, 738 patients who underwent CABG since 2005 were reviewed for preoperative factors independently associated with prolonged postoperative ventilation. Prediction of prolonged ventilation from the identified variables was modeled using both “traditional” multiple logistic regression and an ANN. The two models were compared using Pearson r2 and area under the curve (AUC) parameters.Results: Of 738 included patients, 14% (104/738) required mechanical ventilation ≥ 24 hours postoperatively. Upon multivariate analysis, higher body-mass index (BMI; odds ratio [OR] 1.10 per unit, P < 0.001), lower ejection fraction (OR 0.97 per %, P = 0.01) and use of cardiopulmonary bypass (OR 2.59, P = 0.02) were independently predictive of prolonged ventilation. The Pearson r2 and AUC of the multivariate nominal logistic regression model were 0.086 and 0.698 ± 0.05, respectively; analogous statistics of the ANN model were 0.159 and 0.732 ± 0.05, respectively.BMI, ejection fraction and cardiopulmonary bypass represent three simple factors that may predict prolonged ventilation after CABG. Early identification of these patients can be optimized using an ANN, an emerging paradigm for clinical outcomes modeling that may consider complex relationships among these variables.

ANALISIS HUBUNGAN SARANA, PENGETAHUAN, DAN SIKAP BIDAN PRAKTIK MANDIRI DENGAN KEPATUHAN MENJALANKAN STANDAR PELAYANAN ANTENATAL CARE DI KOTA PADANGSIDIMPUAN

2019 ◽  
Vol 2 (1) ◽  
pp. 27-33
Author(s):  
Megawati Sinambela ◽  
Evi Erianty Hasibuan
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Logistic Regression Analysis ◽  
Care Service ◽  
Multivariate Logistic Regression Analysis ◽  
Bivariate Analysis ◽  
Cross Sectional ◽  
The North

Antenatal care is a service provided to pregnant women to monitor, support maternal health and detect mothers whether normal or problematic pregnant women. According to the WHO, globally more than 70% of maternal deaths are caused by complications of pregnancy and childbirth such as hemorrhage, hypertension, sepsis, and abortion. Based on data obtained from the profile of the North Sumatra provincial health office in 2017, in the city of Padangsidimpuan in 2017 the coverage of ANC visits reached (76.58%) and had not reached the target in accordance with the 2017 Provincial Health Office strategy plan (95%). This type of research was an observational analytic study with a cross sectional design. The population in this study were independent practice midwives who were in the Padangsidimpuan, the sample in this study amounted to 102 respondents. The technique of collecting data used questionnaires and data analysis used univariate, bivariate and multivariate analysis with logistic regression analysis. Based on bivariate analysis showed that there was a relationship between facilities, knowledge and attitudes of independent midwives with compliance with the standards of antenatal care services with a value of p <0.05. The results of the study with multivariate logistic regression analysis showed that the factors associated with the compliance of independent midwives in carrying out antenatal care service standards were attitudes with values (p = 0.026).

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