scholarly journals The prognostic factors in sepsis patients after operation of gastrointestinal tumors in ICU

2020 ◽  
Author(s):  
Ren-Xiong Chen ◽  
Zhou-Qiao Wu ◽  
Zi-Yu Li ◽  
Hong-Zhi Wang ◽  
Jia-Fu Ji
Keyword(s):  
Risk Factors ◽  
Lactic Acid ◽  
Prognostic Factors ◽  
Protective Factor ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Tumor Surgery ◽  
Gastrointestinal Tumor ◽  
All Cause Mortality ◽  
Independent Risk Factors

Abstract Objectives: We studied the clinical profiles and the prognostic factors in patients with sepsis after thegastrointestinal tumor surgery in ICU.Methods: We retrospectively screened patients who underwent the gastrointestinal tumor surgery at the Peking University Cancer Hospital from January 2015 to December 2019. Among them, 181 patients who were diagnosed with sepsis in ICU were enrolled in our study. Cox regression was performed for multivariate adjusted factor analyses.Results: The 90-day all-cause mortality rate was 11.1% in our study. The univariate analysis showed that BMI, shock within 48h after entering ICU, number of blood leukocytes, the ratio of lymphocytes to neutrophils, INR, creatinine, procalcitonin, lactic acid, oxygenation index, SOFA score within 24h after entering ICU, APACHE II score within 24h after entering ICU were statistically significant. In multiple analysis, we found that BMI＞20kg/m2 was a protective factor, while lactic acid＞3 mmol/L after entering ICU and APACHE II score＞20 within 24h after entering ICU were independent risk factors for the prognosis of sepsis after the gastrointestinal tumor surgery in ICU. Conclusions: The 90-day all-cause mortality rate was 11.1% in our study. BMI＞20kg/m2 was a protective factor, while lactic acid＞3 mmol/L after entering ICU and APACHE II score＞20 within 24h after entering ICU were independent risk factors for the prognosis of sepsis after the gastrointestinal tumor surgery in ICU.

scholarly journals The Prognostic Factors in Patients With Sepsis After Operation of Gastrointestinal Tumors

2020 ◽  
Author(s):  
Ren-Xiong Chen ◽  
Zhou-Qiao Wu ◽  
Zi-Yu Li ◽  
Hong-Zhi Wang ◽  
Jia-Fu Ji
Keyword(s):  
Risk Factors ◽  
Lactic Acid ◽  
Prognostic Factors ◽  
Protective Factor ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Tumor Surgery ◽  
Gastrointestinal Tumor ◽  
All Cause Mortality ◽  
Independent Risk Factors

Abstract BackgroundWe studied the clinical profiles and the prognostic factors in patients with sepsis after thegastrointestinal tumor surgery in ICU.MethodsWe retrospectively screened patients who underwent the gastrointestinal tumor surgery at the Peking University Cancer Hospital from January 2015 to December 2019. Among them, 181 patients who were diagnosed with sepsis in ICU were enrolled in our study. Cox regression was performed for multivariate adjusted factor analyses.ResultsThe 90-day all-cause mortality rate was 11.1% in our study. The univariate analysis showed that BMI, shock within 48 h after entering ICU, number of blood leukocytes, the ratio of lymphocytes to neutrophils, INR, creatinine, procalcitonin, lactic acid, oxygenation index, SOFA score within 24 h after entering ICU, APACHE II score within 24 h after entering ICU were statistically significant. In multiple analysis, we found that BMI༞20 kg/m2 was a protective factor, while lactic acid༞3 mmol/L after entering the ICU and APACHE II score༞20 within 24 h after entering ICU were independent risk factors on the prognosis of sepsis after the gastrointestinal tumor surgery in ICU.ConclusionThe 90-day all-cause mortality rate was 11.1% in our study. BMI>20 kg/m2 was a protective factor, while lactic acid>3 mmol/L after entering the ICU and APACHE II score>20 within 24 h after entering ICU were independent risk factors on the prognosis of sepsis after the gastrointestinal tumor surgery in ICU.

scholarly journals The prognostic factors in sepsis patients after operation of gastrointestinal tumors in ICU

2020 ◽  
Author(s):  
Ren-Xiong Chen ◽  
Zhou-Qiao Wu ◽  
Zi-Yu Li ◽  
Hong-Zhi Wang ◽  
Jia-Fu Ji
Keyword(s):  
Risk Factors ◽  
Lactic Acid ◽  
Prognostic Factors ◽  
Protective Factor ◽  
Univariate Analysis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Tumor Surgery ◽  
Gastrointestinal Tumor ◽  
Independent Risk Factors

Abstract Background: We studied the clinical profiles and the prognostic factors in patients with sepsis after the gastrointestinal tumor surgery in ICU.Methods: We retrospectively screened patients who underwent the gastrointestinal tumor surgery at the Peking University Cancer Hospital from January, 2015 to December, 2019. Among them, 181 patients who were diagnosed with sepsis in ICU were enrolled in our study. Cox regression was performed for multivariate adjusted factor analyses.Results: The 90-day all-cause mortality rate was 11.1% in our study. The univariate analysis showed that BMI, shock within 48 h after entering ICU, number of blood leukocytes, ratio of lymphocytes to neutrophils, INR, creatinine, procalcitonin, lactic acid, oxygenation index, SOFA score within 24 h after entering ICU, APACHE II score within 24 h after entering ICU were statistically significant. In multiple analysis, we found that BMI༞20 kg/m2 was a protective factor, while lactic acid༞3 mmol/L after entering ICU and APACHE II score༞20 within 24 h after entering ICU were independent risk factors for the prognosis of sepsis after the gastrointestinal tumor surgery in ICU.Conclusions: BMI༞20 kg/m2 was a protective factor, while lactic acid༞3 mmol/L after entering ICU and APACHE II score༞20 within 24 h after entering ICU were independent risk factors for the prognosis of sepsis after the gastrointestinal tumor surgery in ICU.

scholarly journals Patients With Perforated Peptic Ulcers: Risk Factors for Morbidity and Mortality

2019 ◽  
Vol 103 (11-12) ◽  
pp. 578-584
Author(s):  
Fatih Ciftci ◽  
Fazilet Erözgen
Keyword(s):  
Risk Factors ◽  
Peptic Ulcer ◽  
Postoperative Period ◽  
Perforated Peptic Ulcer ◽  
Apache Ii ◽  
Morbidity And Mortality ◽  
Apache Ii Score ◽  
Peptic Ulcers ◽  
Presentation Time ◽  
Independent Risk Factors

Perforated peptic ulcers continue to be an important problem in surgical practice. In this study, risk factors for peptic ulcer perforation-associated mortality and morbidity were evaluated. This is a retrospective study of patients surgically treated for perforated peptic ulcer over a decade (March 1999–December 2014). Patient age, sex, complaints at presentation, time lapse between onset of complaints and presentation to the hospital, physical findings, comorbidities, laboratory and imaging findings, length of hospitalization, morbidity, and mortality were recorded. The Mannheim peritonitis index (MPI) and Acute Physiology and Chronic Health Evaluation (APACHE) II score were calculated and recorded for each patient on admission to the hospital. Of the 149 patients, mean age was 50.6 ± 19 years (range: 17–86). Of these, 129 (86.5%) were males and 20 (13.4%) females. At least 1 comorbidity was found in 42 (28.1%) of the patients. Complications developed in 36 (24.1%) of the patients during the postoperative period. The most frequent complication was wound site infection. There was mortality in 26 (17.4%) patients and the most frequent cause of mortality was sepsis. Variables that were found to have statistically significant effects on morbidity included age older than 60 years, presence of comorbidities, and MPI (P = 0.029, 0.013, and 0.013, respectively). In a multivariate analysis, age older than 60 years, presence of comorbidities, and MPI were independent risk factors that affected morbidity. In the multivariate logistic regression analysis, age older than 60 years [P = 0.006, odds ratio (OR) = 5.99, confidence interval (CI) = 0.95] and comorbidities (OR = 2.73, CI = 0.95) were independent risk factors that affected morbidity. MPI and APACHE II scoring were both predictive of mortality. Age older than 60, presentation time, and MPI were independent risk factors for mortality. Undelayed diagnosis and appropriate treatment are of the utmost importance when presenting with a perforated peptic ulcer. We believe close observation of high-risk patients during the postoperative period may decrease morbidity and mortality rates.

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

2020 ◽  
Author(s):  
Yanjuan Lin ◽  
Qiong Chen ◽  
Haoruo Zhang ◽  
Liang-Wan Chen ◽  
Yanchun Peng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stent Graft ◽  
Postoperative Delirium ◽  
Protective Factor ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Manual Work ◽  
Cox Regression Analysis ◽  
Stent Graft Implantation ◽  
Graft Implantation

Abstract Background: Neurological complications is a common complication following 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) are not completely clear. The aim of this study was to investigate 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 were followed up after surgery. Patients’ delirium was 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 were analyzed by the Cox proportional hazard models.Results: A total of 280 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)

scholarly journals A retrospective study of sepsis-associated encephalopathy: epidemiology, clinical features and adverse outcomes

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jiayi Chen ◽  
Xiaobei Shi ◽  
Mengyuan Diao ◽  
Guangyong Jin ◽  
Ying Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Clinical Features ◽  
Sofa Score ◽  
Adverse Outcomes ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Gastrointestinal Infections ◽  
Independent Risk Factors ◽  
Poor Outcomes

Abstract Background Sepsis-associated encephalopathy (SAE) is a common complication of sepsis that may result in worse outcomes. This study was designed to determine the epidemiology, clinical features, and risk factors of SAE. Methods This was a retrospective study of all patients with sepsis who were admitted to the Critical Care Medicine Department of Hangzhou First People’s Hospital Affiliated with Zhejiang University School of Medicine from January 2015 to December 2019. Results A total of 291 sepsis patients were screened, and 127 (43.6%) were diagnosed with SAE. There were significant differences in median age, proportion of underlying diseases such as hypertension, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, gastrointestinal infections, detection rate of Enterococcus, and 28-day mortality between the SAE and non-SAE groups. Both the SOFA score and APACHE II score were independent risk factors for SAE in patients with sepsis. All 127 SAE patients were divided into survival and non-survival groups. The age, SOFA score, and APACHE II score were independently associated with 28-day mortality in SAE patients. Conclusion In the present retrospective study, nearly half of patients with sepsis developed SAE, which was closely related to poor outcomes. Both the SOFA score and APACHE II score were independent risk factors for predicting the occurrence and adverse outcome of SAE.

scholarly journals Risk factors and prognosis of hypoalbuminemia in surgical septic patients

PeerJ ◽  
2015 ◽  
Vol 3 ◽  
pp. e1267 ◽  
Author(s):  
Jia-Kui Sun ◽  
Fang Sun ◽  
Xiang Wang ◽  
Shou-Tao Yuan ◽  
Shu-Yun Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Lactate ◽  
Early Stage ◽  
Albumin Level ◽  
Multiple Organ ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Reactive Protein ◽  
Retrospective Clinical Study ◽  
Independent Risk Factors

The aim of this study was to investigate the risk factors of hypoalbuminemia and effects of different albumin levels on the prognosis of surgical septic patients. We preformed a retrospective clinical study including 135 adult patients from September 2011 to June 2014. The albumin levels and severity markers were recorded during the first 48 h after enrollment, and logistic regression analyses were used to determine the risk factors. The outcomes of patients with different albumin levels were also compared. The acute physiology and chronic health evaluation II (APACHE II) score (OR 1.786, 95% CI [1.379–2.314],P< 0.001), C-reactive protein (CRP) (OR 1.016, 95% CI [1.005–1.027],P= 0.005), and blood lactate (OR 1.764, 95% CI [1.141–2.726],P= 0.011) were established as the independent risk factors of hypoalbuminemia in patients with surgical sepsis. The severity markers and outcomes of patients with albumin levels ≤20 g/L were significantly worse than that of 21–25 g/L and ≥26 g/L, whereas the latter two groups had similar prognosis. Every 1 g/L decrease of albumin level below the optimal cut-off (23 g/L) was associated with a 19.4% increase in hospital mortality and a 28.7% increase in the incidence of multiple organ dysfunction syndrome. In conclusion, APACHE II score (≥14.5), CRP (≥34.25 mg/L), and blood lactate (≥.35 mmol/L) were established as the independent risk factors of hypoalbuminemia in the early stage of surgical sepsis. Patients with baseline albumin level ≤20 g/L had worse prognosis than that of albumin level ≥21 g/L. Albumin levels were negatively correlated the prognosis of surgical sepsis when below about 23 g/L.

scholarly journals Analysis of Risk Factors For Sepsis And Indicators of Prognosis In Patients With Sepsis: A Retrospective Observational Study

2021 ◽  
Author(s):  
Huifeng Wang ◽  
Zhiling Zhao ◽  
Zhao-hui Tong
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Albumin Level ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Multivariate Logistic Regression ◽  
Independent Risk Factors

Abstract Background: To investigate the independent risk factors for sepsis and the prognostic indicators of sepsis-related mortality to guide clinical practice.Methods: Adult patients diagnosed with sepsis in the respiratory intensive care unit (RICU), emergency ICU (EICU), and surgical ICU (SICU) of Beijing Chao-Yang Hospital, Capital Medical University, from January 2016 to April 2021 were enrolled. Comorbidities, complications, and laboratory indicators were retrospectively analyzed. Variables with a p value < 0.05 in the univariate analysis were entered into multivariate logistic regression analysis to identify the independent risk factors for sepsis. Receiver operating characteristic curve (ROC) analysis was used for those variables with P < 0.05 in multivariate regression to evaluate the fit of the predictive model and its prognostic efficacy. Results: A total of 123 adult patients with sepsis were enrolled, with 80 males and 43 females and a mean age of 61.56 ± 17.12 years. Acute respiratory distress syndrome (ARDS) occurred in 84 patients (68.3%), acute kidney injury (AKI) occurred in 28 patients (22.8%), acute myocardial injury (AMI) occurred in 6 patients (4.9%), disseminated intravascular coagulation (DIC) occurred in 14 patients (11.4%), septic shock occurred in 40 patients (32.5%), and 41 patients (33.3%) died. Multivariate logistic regression analysis showed that mean arterial pressure (MAP), acute physiology and chronic health evaluation II (APACHE II) score, albumin level, and the presence of DIC were independent risk factors for sepsis (P < 0.05). The area under the ROC curve for the model including MAP, albumin, and APACHE II score was the highest at 0.890.Conclusion: The MAP, APACHE II score, albumin level, and DIC were independent risk factors for sepsis. The inclusion of the MAP, albumin level, and APACHE II score in the model yielded the most accurate prediction of the risk of mortality.

scholarly journals Prognostic Value of Serum Ammonia in Critical Patients with Non-Hepatic Disease : A Prospective, Observational, Multicenter Study

2021 ◽  
Author(s):  
Yue Li ◽  
Zhipeng Yao ◽  
Yunlong Li ◽  
Zhenyu Yang ◽  
Ming Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lactic Acid ◽  
Multicenter Study ◽  
Poor Prognosis ◽  
Roc Analysis ◽  
Elevated Serum ◽  
Serum Levels ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Patients

Abstract Background: Non-hepatic hyperammonemia can damage the central nervous system (CNS) and possible prognostic factors are lacking. This study aimed to investigate the prognostic and risk factors for patients admitted to the intensive care unit (ICU).Methods: This prospective, observational, multicenter study was conducted between November and December 2019 at 11 ICUs in the Chinese Heilongjiang province. Changes in blood ammonia level during and after ICU admission were continuously monitored, expressed as the high-level (H-), mean-level (M-), and initial-level (I-) of ammonia. The risk factors of poor prognosis were investigated by conducting univariate and multivariate logistic regression analyses. Receiver operating characteristic curve (ROC) analysis was conducted to compare predictive ability of APACHE-II score, lactic acid, TBil, M-ammonia.Results: A total of 1060 patients were included in this study, of which 707 (67%) had a favorable prognosis and 353 (33%) had a poor prognosis. As shown by univariate models, a poor prognosis was associated with elevated serum levels of lactic acid, TBil, and ammonia (P<0.05), and pathologic scores from three assessments: APACHE-II, GCS, and SOFA. Multivariate analysis revealed that circulating mean ammonia levels in ICU patients were independently associated with a poor prognosis (OR=1.73, 95% CI: 1.07-2.80, P=0.02). However, the APACHE-II score (AUC: 0.714, sensitivity: 0.86, specificity: 0.68, P <0.001) remained the most predictive factor for patient prognosis by ROC analysis.Conclusions: Elevated serum levels of ammonia in the blood were independently prognostic for ICU patients without liver disease.Trial registration: ChiCTR1900026632. Registered 16 October 2014.

scholarly journals Epidemiology, Risk Factors, and Outcomes of Opportunistic Infections after Kidney Allograft Transplantation in the Era of Modern Immunosuppression: A Monocentric Cohort Study

2019 ◽  
Vol 8 (5) ◽  
pp. 594 ◽  
Author(s):  
Philippe Attias ◽  
Giovanna Melica ◽  
David Boutboul ◽  
Nathalie De Castro ◽  
Vincent Audard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protective Factor ◽  
Opportunistic Infections ◽  
Control Group ◽  
Kidney Allograft ◽  
Extended Criteria Donor ◽  
Allograft Transplantation ◽  
Kidney Recipients ◽  
Independent Risk Factors ◽  
Kidney Transplantations

Epidemiology of opportunistic infections (OI) after kidney allograft transplantation in the modern era of immunosuppression and the use of OI prevention strategies are poorly described. We retrospectively analyzed a single-center cohort on kidney allograft adult recipients transplanted between January 2008 and December 2013. The control group included all kidney recipients transplanted in the same period, but with no OI. We analyzed 538 kidney transplantations (538 patients). The proportion of OI was 15% (80 and 72 patients). OI occurred 12.8 (6.0–31.2) months after transplantation. Viruses were the leading cause (n = 54, (10%)), followed by fungal (n = 15 (3%)), parasitic (n = 6 (1%)), and bacterial (n = 5 (0.9%)) infections. Independent risk factors for OI were extended criteria donor (2.53 (1.48–4.31), p = 0.0007) and BK viremia (6.38 (3.62–11.23), p < 0.0001). High blood lymphocyte count at the time of transplantation was an independent protective factor (0.60 (0.38–0.94), p = 0.026). OI was an independent risk factor for allograft loss (2.53 (1.29–4.95), p = 0.007) but not for patient survival. Post-kidney transplantation OIs were mostly viral and occurred beyond one year after transplantation. Pre-transplantation lymphopenia and extended criteria donor are independent risk factors for OI, unlike induction therapy, hence the need to adjust immunosuppressive regimens to such transplant candidates.

scholarly journals Augmented renal clearance: a retrospective, cohort study of urinary creatinine clearance in critically ill patients in the United Kingdom

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110155
Author(s):  
Brian W Johnston ◽  
David Perry ◽  
Martyn Habgood ◽  
Miland Joshi ◽  
Anton Krige
Keyword(s):  
Risk Factors ◽  
United Kingdom ◽  
Creatinine Clearance ◽  
Renal Clearance ◽  
Repeated Measures ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Augmented Renal Clearance ◽  
Urinary Creatinine ◽  
The United Kingdom

Objective Augmented renal clearance (ARC) is associated with sub-therapeutic antibiotic, anti-epileptic, and anticoagulant serum concentrations leading to adverse patient outcomes. We aimed to describe the prevalence and associated risk factors for ARC development in a large, single-centre cohort in the United Kingdom. Methods We conducted a retrospective observational study of critically unwell patients admitted to intensive care between 2014 and 2016. Urinary creatinine clearance was used to determine the ARC prevalence during the first 7 days of admission. Repeated measures logistic regression was used to determine risk factors for ARC development. Results The ARC prevalence was 47.0% (95% confidence interval [95%CI]: 44.3%–49.7%). Age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and sepsis diagnosis were significantly associated with ARC. ARC was more prevalent in younger vs. older (odds ratio [OR] 0.95 [95%CI: 0.94–0.96]), male vs. female (OR 0.32 [95%CI: 0.26–0.40]) patients with lower vs. higher APACHE II scores (OR 0.94 [95%CI: 0.92–0.96]). Conclusions This patient group probably remains unknown to many clinicians because measuring urinary creatinine clearance is not usually indicated in this group. Clinicians should be aware of the ARC risk in this group and consider measurement of urinary creatinine clearance.

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