scholarly journals Outcomes and Prognostic Factors in Patients with Hematologic Malignancies in the Intensive Care unit: A Single-Center Cohort Study of 233 Cases in Taiwan

2021 ◽  
Author(s):  
Chieh-Lung Chen ◽  
Sing-Ting Wang ◽  
Wen-Chien Cheng ◽  
Chih-Yu Chen ◽  
Wei-Cheng Chen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Hematologic Malignancies ◽  
Mortality Rates ◽  
Icu Mortality ◽  
Icu Admission

Abstract BackgroundPatients with a hematologic malignancies (HM) have one of the highest mortality rates among cancer patients admitted to the medical intensive care unit (ICU). The aim of this study was to identify outcomes and risk factors that predict the prognosis of critically ill patients with HM in the ICU.MethodsA retrospective observational study was conducted in a tertiary referral hospital in Taiwan over 40 months (January 1, 2017–April 30, 2020). All adult patients with HM who were admitted to medical ICU were enrolled. Clinical data upon hospital and ICU admission were collected. The predictors of ICU mortality were evaluated using a multivariate analysis.ResultsA total of 233 patients with HM met the inclusion criteria. The median age (SD) was 59.3 (15.1) years, and 76% of the HMs were classified as high-grade disease. The median (IQR) Sequential Organ Failure Assessment (SOFA) score at ICU admission was 11 (9–15); Simplified Acute Physiology Score II, 64 (51–80); and Acute Physiology and Chronic Health Evaluation II score, 28 (23–34). The most common reasons for ICU admission were acute respiratory failure (63.1%) and septic shock (19.7%). The ICU and hospital mortality rates were 54.1% and 67.8%, respectively. A multivariate analysis revealed that the initiation of renal replacement therapy in the ICU (odds ratio [OR], 3.88; 95% CI, 1.66–9.08) and SOFA score (OR, 1.16; 95% CI, 1.03–1.31) were independently associated with ICU mortality.ConclusionsThe ICU and hospital outcomes of critically ill patients with HM are improving. Performance status, cancer status, invasive mechanical ventilation, severe neutropenia, and transplantation status were not identified as predictive factors of ICU outcome. Initiation of renal replacement therapy in the ICU and the SOFA score upon ICU admission were independently associated with ICU mortality. We suggest early and timely ICU admission of patients at risk of multiorgan failure.

scholarly journals High Mobility Group Box 1 and Interleukin 6 at Intensive Care Unit Admission as Biomarkers in Critically Ill COVID-19 Patients

2021 ◽  
Author(s):  
Chaisith Sivakorn ◽  
Jutamas Dechsanga ◽  
Lawan Jamjumrus ◽  
Kobporn Boonnak ◽  
Marcus J. Schultz ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Sofa Score ◽  
Interleukin 6 ◽  
Plasma Levels ◽  
High Mobility ◽  
High Mobility Group ◽  
Icu Mortality ◽  
Icu Admission

Exuberant inflammation manifesting as a “cytokine storm” has been suggested as a central feature in the pathogenesis of severe coronavirus disease 2019 (COVID-19). This study investigated two prognostic biomarkers, the high mobility group box 1 (HMGB1) and interleukin-6 (IL-6), in patients with severe COVID-19 at the time of admission in the intensive care unit (ICU). Of 60 ICU patients with COVID-19 enrolled and analyzed in this prospective cohort study, 48 patients (80%) were alive at ICU discharge. HMGB1 and IL-6 plasma levels at ICU admission were elevated compared with a healthy control, both in ICU nonsurvivors and ICU survivors. HMGB1 and IL-6 plasma levels were higher in patients with a higher Sequential Organ Failure Assessment (SOFA) score (> 10), and the presence of septic shock or acute kidney injury. HMGB1 and IL-6 plasma levels were also higher in patients with a poor oxygenation status (PaO2/FiO2 < 150 mm Hg) and a longer duration of ventilation (> 7 days). Plasma HMGB1 and IL-6 levels at ICU admission also correlated with other prognostic markers, including the maximum neutrophil/lymphocyte ratio, D-dimer levels, and C-reactive protein levels. Plasma HMGB1 and IL-6 levels at ICU admission predicted ICU mortality with comparable accuracy to the SOFA score and the COVID-GRAM risk score. Higher HMGB1 and IL-6 were not independently associated with ICU mortality after adjustment for age, gender, and comorbidities in multivariate analysis models. In conclusion, plasma HMGB1 and IL6 at ICU admission may serve as prognostic biomarkers in critically ill COVID-19 patients.

scholarly journals Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0251085
Author(s):  
Muhammed Elhadi ◽  
Ahmed Alsoufi ◽  
Abdurraouf Abusalama ◽  
Akram Alkaseek ◽  
Saedah Abdeewi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Univariate Analysis ◽  
The Body ◽  
Icu Admission ◽  
Risk Of Mortality

Background The coronavirus disease (COVID-19) pandemic has severely affected African countries, specifically the countries, such as Libya, that are in constant conflict. Clinical and laboratory information, including mortality and associated risk factors in relation to hospital settings and available resources, about critically ill patients with COVID-19 in Africa is not available. This study aimed to determine the mortality and morbidity of COVID-19 patients in intensive care units (ICU) following 60 days after ICU admission, and explore the factors that influence in‐ICU mortality rate. Methods This is a multicenter prospective observational study among COVID-19 critical care patients in 11 ICUs in Libya from May 29th to December 30th 2020. Basic demographic data, clinical characteristics, laboratory values, admission Sequential Organ Failure Assessment (SOFA) score, quick SOFA, and clinical management were analyzed. Result We included 465 consecutive COVID-19 critically ill patients. The majority (67.1%) of the patients were older than 60 years, with a median (IQR) age of 69 (56.5–75); 240 (51.6%) were male. At 60 days of follow-up, 184 (39.6%) were discharged alive, while 281 (60.4%) died in the intensive care unit. The median (IQR) ICU length of stay was 7 days (4–10) and non-survivors had significantly shorter stay, 6 (3–10) days. The body mass index was 27.9 (24.1–31.6) kg/m2. At admission to the intensive care unit, quick SOFA median (IQR) score was 1 (1–2), whereas total SOFA score was 6 (4–7). In univariate analysis, the following parameters were significantly associated with increased/decreased hazard of mortality: increased age, BMI, white cell count, neutrophils, procalcitonin, cardiac troponin, C-reactive protein, ferritin, fibrinogen, prothrombin, and d-dimer levels were associated with higher risk of mortality. Decreased lymphocytes, and platelet count were associated with higher risk of mortality. Quick SOFA and total SOFA scores increase, emergency intubation, inotrope use, stress myocardiopathy, acute kidney injury, arrythmia, and seizure were associated with higher mortality. Conclusion Our study reported the highest mortality rate (60.4%) among critically ill patients with COVID-19 60 days post-ICU admission. Several factors were found to be predictive of mortality, which may help to identify patients at risk of mortality during the ongoing COVID-19 pandemic.

Predictors of survival in patients with gastrointestinal malignancies admitted to the intensive care unit.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18050-e18050
Author(s):  
Heidi Chwan Ko ◽  
Melissa Yan ◽  
Rohan Gupta ◽  
Juhee Song ◽  
Kayla Kebbel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Sofa Score ◽  
Icu Mortality ◽  
Gastrointestinal Malignancies ◽  
Icu Admission ◽  
Risk Of Death ◽  
Gi Cancer

e18050 Background: Cancer patients have a high use of healthcare utilization at the end of life which can frequently involve admissions to the intensive care unit (ICU). We sought to evaluate the predictors for outcome in gastrointestinal (GI) cancer patients admitted to the ICU for non-surgical conditions. Methods: The objective of this study was to determine the factors associated with ICU mortality, hospital mortality and overall survival (OS). A total of 200 patients with GI cancer admitted to the ICU at The University of Texas MD Anderson Cancer Center between November 2012 and February 2015 were retrospectively analyzed. Cancer characteristics, treatment characteristics, and Sequential Organ Failure Assessment (SOFA) scores defining severity based on 6 organ systems with scores ranging from 0 to 24 were analyzed for their effects on survival endpoints using multivariate logistic regression models and a multivariate Cox proportional hazards regression model. Results: The characteristics of the 200 patients were: 64.5% male, mean age of 60 years, median admission SOFA score of 6.0, and tumor types of primary intestinal (37.5%), hepatobiliary/pancreatic (36%), and gastroesophageal (GE) (24%). The ICU mortality was 26%, hospital mortality was 41%, and 6-month OS estimate was 25%. In multivariate analysis, ICU admission SOFA score > 10 (odds ratio (OR) 17.1, p < 0.0001), poorly differentiated tumor grade (OR 3.2, p = 0.02), and shorter duration of metastatic disease (OR 2.3, p = 0.07) were associated with increased odds of ICU mortality. These same variables were associated with increased odds of hospital mortality. In multivariate OS analysis, SOFA score 6-10 (hazard ratio (HR) 2.1, p = 0.0006) and SOFA score > 10 (HR 4.4, p < 0.0001), patients with GE primary (HR 2.2, p = 0.002) and patients with a poor outpatient performance status that precluded active chemotherapy (HR 2.2, p = 0.01) were associated with increased risk of death. Conclusions: The SOFA score was the most predictive factor for ICU mortality, hospital mortality, and OS for GI cancer patients admitted to the ICU. It should be utilized in all GI cancer patients upon ICU admission to improve both acute and longer-term prognostication.

scholarly journals Intensive Care Unit Capacity Strain and Outcomes of Critical Illness in a Resource-Limited Setting: A 2-Hospital Study in South Africa

2018 ◽  
Vol 35 (10) ◽  
pp. 1104-1111 ◽  
Author(s):  
George L. Anesi ◽  
Nicole B. Gabler ◽  
Nikki L. Allorto ◽  
Carel Cairns ◽  
Gary E. Weissman ◽  
...  
Keyword(s):  
South Africa ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Primary Outcome ◽  
Resource Limited Setting ◽  
Icu Mortality ◽  
Icu Admission ◽  
Resource Limited ◽  
Limited Setting

Objective: To measure the association of intensive care unit (ICU) capacity strain with processes of care and outcomes of critical illness in a resource-limited setting. Methods: We performed a retrospective cohort study of 5332 patients referred to the ICUs at 2 public hospitals in South Africa using the country’s first published multicenter electronic critical care database. We assessed the association between multiple ICU capacity strain metrics (ICU occupancy, turnover, census acuity, and referral burden) at different exposure time points (ICU referral, admission, and/or discharge) with clinical and process of care outcomes. The association of ICU capacity strain at the time of ICU admission with ICU length of stay (LOS), the primary outcome, was analyzed with a multivariable Cox proportional hazard model. Secondary outcomes of ICU triage decision (with strain at ICU referral), ICU mortality (with strain at ICU admission), and ICU LOS (with strain at ICU discharge), were analyzed with linear and logistic multivariable regression. Results: No measure of ICU capacity strain at the time of ICU admission was associated with ICU LOS, the primary outcome. The ICU occupancy at the time of ICU admission was associated with increased odds of ICU mortality (odds ratio = 1.07, 95% confidence interval: 1.02-1.11; P = .004), a secondary outcome, such that a 10% increase in ICU occupancy would be associated with a 7% increase in the odds of ICU mortality. Conclusions: In a resource-limited setting in South Africa, ICU capacity strain at the time of ICU admission was not associated with ICU LOS. In secondary analyses, higher ICU occupancy at the time of ICU admission, but not other measures of capacity strain, was associated with increased odds of ICU mortality.

scholarly journals Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

2018 ◽  
Vol 46 (3) ◽  
pp. 1254-1262 ◽  
Author(s):  
Surat Tongyoo ◽  
Tanuwong Viarasilpa ◽  
Chairat Permpikul
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Serum Potassium ◽  
Critically Ill Patients ◽  
Medical Intensive Care Unit ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Mortality ◽  
Medical Intensive Care

Objective To compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+ level, and hospital outcomes were recorded. Patients with a mean K+ level of 3.5 to 4.5 mEq/L and with all individual K+ values of 3.0 to 5.0 mEq/L were allocated to the normal K+ group. The remaining patients were allocated to the abnormal K+ group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+ group comprised 74 (46.3%) patients. The abnormal K+ group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K+ level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K+ levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K+ levels.

scholarly journals Lactate Clearance as a Predictive Marker of Mortality in Adult Intensive Care Unit

2020 ◽  
Vol 5 (2) ◽  
pp. 32-38
Author(s):  
Shirish Raj Joshi ◽  
Renu Gurung ◽  
Subhash Prasad Acharya ◽  
Bashu Dev Parajuli ◽  
Navindra Raj Bista
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Lactate ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Lactate Clearance ◽  
Icu Mortality ◽  
Adult Intensive Care Unit ◽  
Icu Admission ◽  
Significant Difference

Introduction: Lactate clearance has been widely investigated. Serial lactate concentrations can be used to examine disease severity and predict mortality in the intensive care unit. We investigated the diagnostic accuracy of lactate concentration and lactate clearance in predicting mortality in critically ill patients during the first 24 hours in Intensive Care Unit (ICU).Methods: It was a Prospective, observational study conducted in ICU. Sixty eight consecutive patients having blood lactate level >2 mmol/L were included irrespective of disease and postoperative status. We measured blood lactate concentration at ICU admission(H0), at six hours(H6), 12 hours(H12), and 24 hours(H24). Lactate clearance was measured for H0-H6, H0-H12 and H0-H24 time period.Results: ICU mortality was 33.8%. Lactate clearance was 15.80 ± 17.21% in survivors and 1.73±11% in non survivors for the H0-H6 (p = 0.001) and remained higher in survivors than in non survivors over the study period of 24 hours; 17.97±15 vs. -2.04±19.84% for H0-H12 and 27.40 ± 11.41% vs. -14.83 ± 26.84% for the H0-H24 period (p < 0.001 for each studied period). There was significant difference in lactate concentration (static) between survivors and non survivors during the course of initial 24 hours. The best predictor of ICU mortality was lactate clearance for the H0-H24 period (AUC =0.89; 95% CI 0.78-1.01). Logistic regression found that H0-H24 lactate clearance was independently correlated to a survival status (p = 0.005, OR = 0.922 and 95% CI 0.871-0.976).Conclusion: Blood lactate concentration and lactate clearance are both predictive for mortality during initial 24 hours of ICU admission.

scholarly journals Clinical characteristics and outcomes of patients with heart failure admitted to the intensive care unit with coronavirus disease 2019 (COVID19): a multicenter cohort study

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
H Badreldin ◽  
DR Hafidh ◽  
DR Bin Saleh ◽  
DR Al Sulaiman ◽  
DR Al Juhani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Characteristics ◽  
P Value ◽  
Heart Failure Patients ◽  
Icu Admission ◽  
Patients With Heart Failure

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients with heart failure in the setting of COVID-19 requiring admission to the intensive care unit may present a set of unique challenges. There is limited data to describe the clinical characteristics and outcomes in this subset of the patient population. Purpose The study"s purpose was to extensively describe the characteristics and outcomes of heart failure patients admitted to the intensive care unit with COVID-19 compared to non-heart failure patients . Methods We conducted a multicenter, prospective analysis for all adult critically ill patients with heart failure admitted to intensive care units (ICUs) between March 1 to August 31, 2020, with an objectively confirmed diagnosis of COVID-19. Results A total of 723 critically ill patients with COVID-19 had been admitted in ICUs, 59 patients with heart failure, and 664 patients with no heart failure before ICU admission. Heart failure patients had significantly more comorbid conditions such as diabetes mellitus, hypertension, dyslipidemia, atrial fibrillation, and acute coronary syndrome. Higher baseline severity scores (APACHE II & SOFA score) and nutritional risk (NUTRIC Score) were observed in heart failure patients. Also, heart failure patients had more acute kidney injury during ICU admission and required more mechanical ventilation within 24 hours of ICU admission. Patients with heart failure had a similar incidence of thrombosis compared to patients with no heart failure. Critically ill patients with COVID-19 and heart failure had similar ICU length of stay (LOS), mechanical ventilation duration, and hospital LOS compared to patients with no heart failure. During ICU stay, patients with heart failure had more in-hospital and ICU deaths in comparison to the non-heart failure group (64.3% vs. 44.6%, P-value &lt;0.01) and (54.5% vs. 39%, P-value = 0.02) respectively. Conclusion In this observational study evaluating the clinical characteristics and outcomes of critically ill COVID-19 patients with heart failure, patients with COVID-19 and heart failure had similar ICU LOS, duration of MV and hospital LOS, thrombosis rate compared to patients with no heart failure. However, during ICU stay, patients with heart failure had more in-hospital and ICU deaths than the non-heart failure group.

scholarly journals Factors contributing to delay intensive care unit admission of critically ill patients from the adult emergency Department in Tikur Anbessa Specialized Hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Helen Teklie ◽  
Hywet Engida ◽  
Birhanu Melaku ◽  
Abdata Workina
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Transfer Time ◽  
Multivariate Logistic Regression ◽  
Icu Admission ◽  
Specialized Hospital

Abstract Background The transfer time for critically ill patients from the emergency department (ED) to the Intensive care unit (ICU) must be minimal; however, some factors prolong the transfer time, which may delay intensive care treatment and adversely affect the patient’s outcome. Purpose To identify factors affecting intensive care unit admission of critically ill patients from the emergency department. Patients and methods A cross-sectional study design was conducted from January 13 to April 12, 2020, at the emergency department of Tikur Anbesa Specialized Hospital. All critically ill patients who need intensive care unit admission during the study period were included in the study. A pretested structured questionnaire was adapted from similar studies. The data were collected by chart review and observation. Then checked data were entered into Epi-data version 4.1 and cleaned data was exported to SPSS Version 25 for analysis. Descriptive statistics, bivariate and multivariate logistic regression were used to analyze the data. Result From the total of 102 critically ill patients who need ICU admission 84.3% of them had prolonged lengths of ED stay. The median length of ED stay was 13.5 h with an IQR of 7–25.5 h. The most common reasons for delayed ICU admission were shortage of ICU beds 56 (65.1%) and delays in radiological examination results 13(15.1%). On multivariate logistic regression p < 0.05 male gender (AOR = 0.175, 95% CI: (0.044, 0.693)) and shortage of ICU bed (AOR = 0.022, 95% CI: (0.002, 0.201)) were found to have a significant association with delayed intensive care unit admission. Conclusion there was a delay in ICU admission of critically ill patients from the ED. Shortage of ICU bed and delay in radiological investigation results were the reasons for the prolonged ED stay.

scholarly journals Association of multiple glycemic parameters at intensive care unit admission with mortality and clinical outcomes in critically ill patients

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Priscila Bellaver ◽  
Ariell F. Schaeffer ◽  
Diego P. Dullius ◽  
Marina V. Viana ◽  
Cristiane B. Leitão ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glycemic Variability ◽  
Stress Hyperglycemia ◽  
Critically Ill Adults ◽  
Ill Adults

AbstractThe aim of the present study was to investigate the association of multiple glycemic parameters at intensive care unit (ICU) admission with outcomes in critically ill patients. Critically ill adults admitted to ICU were included prospectively in the study and followed for 180 days until hospital discharge or death. Patients were assessed for glycemic gap, hypoglycemia, hyperglycemia, glycemic variability, and stress hyperglycemia ratio (SHR). A total of 542 patients were enrolled (30% with preexisting diabetes). Patients with glycemic gap >80 mg/dL had increased need for renal replacement therapy (RRT; 37.7% vs. 23.7%, p = 0.025) and shock incidence (54.7% vs. 37.4%, p = 0.014). Hypoglycemia was associated with increased mortality (54.8% vs. 35.8%, p = 0.004), need for RRT (45.1% vs. 22.3%, p < 0.001), mechanical ventilation (MV; 72.6% vs. 57.5%, p = 0.024), and shock incidence (62.9% vs. 35.8%, p < 0.001). Hyperglycemia increased mortality (44.3% vs. 34.9%, p = 0.031). Glycemic variability >40 mg/dL was associated with increased need for RRT (28.3% vs. 14.4%, p = 0.002) and shock incidence (41.4% vs.31.2%, p = 0.039). In this mixed sample of critically ill subjects, including patients with and without preexisting diabetes, glycemic gap, glycemic variability, and SHR were associated with worse outcomes, but not with mortality. Hypoglycemia and hyperglycemia were independently associated with increased mortality.

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