Time to Lactate Measurement Affects Efficacy of Initial Lactate on Mortality in critically ill patients with sepsis.

2020 ◽  
Author(s):  
Xueying Luo ◽  
Xiaobo Zheng ◽  
Xi Rao ◽  
Ya Li ◽  
Sujing Zheng ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Lactate Level ◽  
P Value ◽  
Detection Time ◽  
Lactate Measurement ◽  
Unit Increase ◽  
The Impact ◽  
The Relationship

Abstract Background: Evidence regarding the effect of time to lactate measurement on the relationship between the initial lactate level and mortality is limited. We aimed to investigate the relationships between time to lactate measurement, initial lactate level, and in-hospital mortality in critically ill patients with sepsis.Methods and Results: Of the 14339 eligible adult patients with recognized sepsis upon admission to the ICU based on the MIMIC-III database, the median value of initial lactate was 1.70 mmol/L (interquartile range [IQR] 1.20-2.80), and its detection time was 3.50 hours ([IQR] 1.31-10.24). The results of fully adjusted multivariate analyses demonstrated that lactate was positively associated with in-hospital mortality (odds ratio: 1.126, 95% confidence interval: 1.090 to 1.163, P<0.001), and there was an increase in the odds of death with hourly delays in lactate measurement (OR: 1.006, 95% CI: 1.004 to 1.008, P<0.001). In stratified analyses, delays in lactate measurement significantly interfered with the impact of increased lactate level on mortality (P-value for interaction<0.001). The hospital mortality rate substantially increased by 43.5% for each unit increase in lactate when measurement was delayed by 24 hours (OR: 1.435, 95% CI: 1.260 to 1.635, P<0.001).Discussion: The association of initial lactate with in-hospital mortality is likely to vary with delays in detection time (grouping based on the “1-hour bundle”) in critically ill patients with recognized sepsis upon admission to the ICU.

scholarly journals 540. Does Remdesivir Impact the Clinical Outcome of Patients with COVID 19 Infection?

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S371-S372
Author(s):  
Karthik Gunasekaran ◽  
Jisha S John ◽  
Hanna Alexander ◽  
Naveena Gracelin ◽  
Prasanna Samuel ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Primary Outcome ◽  
P Value ◽  
Invasive Ventilation ◽  
Quick Recovery ◽  
Significant Difference ◽  
Male Preponderance ◽  
The Impact

Abstract Background Remdesivir (RDV), was included for the treatment of mild to moderate COVID-19 since July 2020 in our institution, following the initial results from ACTT-1 interim analysis report. With the adoption of RDV, there seems to be anecdotal evidence of efficacy as evidenced by early fever defervescence, quick recovery when on oxygen with decreased need for ventilation and ICU care. We aimed to study the impact of RDV on clinical outcomes among patients with moderate to severe COVID –19. Methods Nested case control study in the cohort of consecutive patients with moderate to severe COVID – 19. Cases were patients initiated on RDV and age and sex- matched controls who did not receive RDV were included. The primary outcome was in-hospital mortality. Secondary outcomes were, duration of hospital stay, need for ICU, duration of oxygen therapy and need for ventilation. Results A total of 926 consecutive patients with COVID – 19 were included, among which 411 patients were cases and 515 controls. The mean age of the cohort was 57.05±13.5 years, with male preponderance (75.92%). The overall in-hospital mortality was 22.46%(n=208). On comparison between cases and controls there was no statistically significant difference with respect to primary outcome [22.54% vs. 20.78%, (p value: 0.17)]. Progression to non-invasive ventilation (NIV) was higher among the controls [24.09% vs. 40.78% (p value: &lt; 0.001*)]. Progression to invasive ventilation was also higher among the controls [5.35% vs. 9.71% (p value: 0.014*)]. In subgroup analysis among critically ill patients, the use of RDV showed decrease in mortality (OR 0.32 95% CI; 0.13 – 0.75 p value – 0.009*). Conclusion RDV did not decrease the in-hospital mortality among moderate to severe COVID – 19. However, there seems to be a significant reduction in mortality in critically ill patients. Disclosures All Authors: No reported disclosures

scholarly journals ASSOCIATION OF ACID-BASE PARAMETERS WITH LACTATE LEVEL IN CRITICALLY ILL PATIENTS WITH METABOLIC ACIDOSIS

2018 ◽  
Vol 24 (2) ◽  
pp. 141
Author(s):  
Donaliazarti Donaliazarti ◽  
Rismawati Yaswir ◽  
Hanifah Maani ◽  
Efrida Efrida
Keyword(s):  
Metabolic Acidosis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Lactate Level ◽  
Linear Regression Analysis ◽  
P Value ◽  
Acid Base Balance ◽  
Acid Base ◽  
Base Parameters ◽  
Base Balance

Metabolic acidosis is prevalent among critically ill patients and the common cause of metabolic acidosis in ICU is lactic acidosis. However, not all ICUs can provide lactate measurement. The traditional method that uses Henderson-Hasselbach equation (completed with BE and AG) and alternative method consisting of Stewart and its modification (BDEgap and SIG), are acid-base balance parameters commonly used by clinicians to determine metabolic acidosis in critically ill patients. The objective of this study was to discover the association between acid-base parameters (BE, AGobserved, AGcalculated, SIG, BDEgap) with lactate level in critically ill patients with metabolic acidosis. This was an analytical study with a cross-sectional design. Eighty-four critically ill patients hospitalized in the ICU department Dr. M. Djamil Padang Hospital were recruited in this study from January to September 2016. Blood gas analysis and lactate measurement were performed by potentiometric and amperometric method while electrolytes and albumin measurement were done by ISE and colorimetric method (BCG). Linear regression analysis was used to evaluate the association between acid-base parameters with lactate level based on p-value less than 0.05. Fourty five (54%) were females and thirty-nine (46%) were males with participant’s ages ranged from 18 to 81 years old. Postoperative was the most reason for ICU admission (88%). Linear regression analysis showed that p-value for BE, AGobserved, AGcalculated, SIG and BDEgap were 119; 0.967; 0.001; 0.001; 0.689, respectively. Acid-base balance parameters which were mostly associated with lactate level in critically ill patients with metabolic acidosis were AGcalculated and SIG. 

scholarly journals Proximity to the Treating Centre and Outcomes Following Subarachnoid Hemorrhage

2011 ◽  
Vol 38 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Cian J. O'Kelly ◽  
Julian Spears ◽  
David Urbach ◽  
M. Christopher Wallace
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Survival Benefit ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mortality Rates ◽  
Limited Resources ◽  
Early Complications ◽  
The Impact ◽  
The Relationship

Abstract:Background:In the management of subarachnoid hemorrhage (SAH), the potential for early complications and the centralization of limited resources often challenge the delivery of timely neurosurgical care. We sought to determine the impact of proximity to the accepting neurosurgical centre on outcomes following aneurysmal SAH.Methods:Using administrative data, we analyzed patients undergoing treatment for aneurysmal subarachnoid hemorrhage at neurosurgical centres in Ontario between 1995 and 2004. We compared mortality for patients receiving treatment at a centre in their county (in-county) versus those treated from outside counties (out-of-county). We also examined the impact of distance from the patient's residence to the treating centre.Results:The mortality rates were significantly lower for in-county versus out-of-county patients (23.5% vs. 27.6%, p=0.009). This advantage remained significant after adjusting for potential confounders (HR=0.84, p=0.01). The relationship between distance from the treating centre and mortality was biphasic. Under 300km, mortality increased with increasing distance. Over 300km, a survival benefit was observed.Conclusions:Proximity to the treating neurosurgical centre impacts survival after aneurysmal SAH. These results have significant implications for the triage of these critically ill patients.

scholarly journals The Association between Nutritional Status and In-Hospital Mortality of COVID-19 in Critically-Ill Patients in the ICU

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3302
Author(s):  
Michał Czapla ◽  
Raúl Juárez-Vela ◽  
Vicente Gea-Caballero ◽  
Stanisław Zieliński ◽  
Marzena Zielińska
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nutritional Status ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Nutritional Risk ◽  
Risk Of Death ◽  
The Impact

Background: Coronavirus disease 2019 (COVID-19) has become one of the leading causes of death worldwide. The impact of poor nutritional status on increased mortality and prolonged ICU (intensive care unit) stay in critically ill patients is well-documented. This study aims to assess how nutritional status and BMI (body mass index) affected in-hospital mortality in critically ill COVID-19 patients Methods: We conducted a retrospective study and analysed medical records of 286 COVID-19 patients admitted to the intensive care unit of the University Clinical Hospital in Wroclaw (Poland). Results: A total of 286 patients were analysed. In the sample group, 8% of patients who died had a BMI within the normal range, 46% were overweight, and 46% were obese. There was a statistically significantly higher death rate in men (73%) and those with BMIs between 25.0–29.9 (p = 0.011). Nonsurvivors had a statistically significantly higher HF (Heart Failure) rate (p = 0.037) and HT (hypertension) rate (p < 0.001). Furthermore, nonsurvivors were statistically significantly older (p < 0.001). The risk of death was higher in overweight patients (HR = 2.13; p = 0.038). Mortality was influenced by higher scores in parameters such as age (HR = 1.03; p = 0.001), NRS2002 (nutritional risk score, HR = 1.18; p = 0.019), PCT (procalcitonin, HR = 1.10; p < 0.001) and potassium level (HR = 1.40; p = 0.023). Conclusions: Being overweight in critically ill COVID-19 patients requiring invasive mechanical ventilation increases their risk of death significantly. Additional factors indicating a higher risk of death include the patient’s age, high PCT, potassium levels, and NRS ≥ 3 measured at the time of admission to the ICU.

Rapid Muscle Loss Negatively Impacts Survival in Critically Ill Patients With Cirrhosis

2018 ◽  
Vol 35 (7) ◽  
pp. 663-671 ◽  
Author(s):  
Sunmi Ju ◽  
Sun Mi Choi ◽  
Young Sik Park ◽  
Chang-Hoon Lee ◽  
Sang-Min Lee ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Muscle Mass ◽  
Critically Ill Patients ◽  
Mass Change ◽  
Apache Ii Score ◽  
Muscle Loss ◽  
Icu Mortality ◽  
Skeletal Muscle Index ◽  
The Impact

Purpose: To assess the impact of rapid muscle loss before admission to intensive care unit (ICU) in critically ill patients with cirrhosis. Materials and Methods: Patients with cirrhosis who had undergone 2 or more recent computed tomography scans before admission to the medical ICU were included. Muscle cross-sectional area at the level of the third lumbar vertebra was quantified using OsiriX software. The rate of muscle mass change and skeletal muscle index (SMI) were also calculated. Multivariable Cox proportional hazards regression was used to evaluate the association between muscle loss and mortality. Results: Among 125 patients, 113 (90.4%) patients were classified as having sarcopenia. The mean body mass index was 22.6 (3.9) kg/m2. Thirty-nine (31.2%) patients were within the normal range for muscle mass change, while 86 (68.8%) patients demonstrated rapid decline in muscle mass before admission to the ICU. Patients with rapid muscle loss showed high ICU mortality (59.3%) and in-hospital mortality (77.9%). Multivariate Cox analysis showed that ICU mortality and in-hospital mortality were independently associated with malignancy, Acute Physiology and Chronic Health Evaluation (APACHE) II score, SMI, and rapid muscle loss. Conclusion: Rapid muscle decline is correlated with increased ICU mortality and in-hospital mortality in critically ill patients with cirrhosis.

The Impact of Heart Rate Circadian Rhythm on In-hospital Mortality in Stroke and Critically Ill Patients: Insights from the eICU Collaborative Research Database

2022 ◽  
Author(s):  
Zhengning Yang ◽  
Zhe Li ◽  
Xu He ◽  
Zhen Yao ◽  
XiaoXia Xie ◽  
...  
Keyword(s):  
Heart Rate ◽  
Circadian Rhythm ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Peak Time ◽  
Research Database ◽  
Discriminative Ability ◽  
The Impact ◽  
Apache Iv

Abstract Background: The dysregulation of the heart rate circadian rhythm has been documented to be an independent risk factor in multiple diseases. However, data showing the impact of dysregulated heart rate circadian rhythm in stroke and critically ill patients are scarce.Methods: Stroke and critically ill patients in the ICU between 2014 and 2015 from the recorded eICU Collaborative Research Database were included in the current analyses. The impact of circadian rhythm of heart rate on in-hospital mortality was analyzed. Three variables, Mesor (rhythm-adjusted mean of heart rate), Amplitude (distance from the highest point of circadian rhythm of heart rate to Mesor), and Peak time (time when the circadian rhythm of heart rate reaches the highest point) were used to evaluate the heart rate circadian rhythm. The incremental value of circadian rhythm variables in addition to Acute Physiology and Chronic Health Evaluation (APACHE) IV score to predict in-hospital mortality was also explored.Results: A total of 6,201 eligible patients were included. The in-hospital mortality was 16.2% (1,002/6,201). The circadian rhythm variables of heart rate, Mesor, Amplitude, and Peak time, were identified to be independent risk factors of in-hospital mortality. After adjustments, Mesor per 10 beats per min (bpm) increase was associated with a 1.17-fold (95%CI: 1.11, 1.24, P<0.001) and Amplitude per 5 bpm was associated with a 1.14-fold (95%CI: 1.06, 1.24, P<0.001) increase in the risk of in-hospital mortality, respectively. The risk of in-hospital mortality was lower in patients who had Peak time reached between 18:00-24:00 or 00:00-06:00; whereas the risk was highest in patients who had Peak time reached between 12:00-18:00 (OR: 1.33, 95%CI: 1.05, 1.68, P=0.017). Compared with APACHE IV score only (c-index=0.757), combining APACHE IV score and circadian rhythm variables of heart rate (c-index=0.766) was associated with increased discriminative ability (P=0.003).Conclusion: Circadian rhythm of heart rate is an independent risk factor of the in-hospital mortality in stroke and critically ill patients. Including circadian rhythm variables regarding heart rate might increase the discriminative ability of the risk score to predict the short-term prognosis of patients.

scholarly journals 1170. Invasive Fungal Infections and Colonization in Critically Ill Patients: Impact of Diagnosis and Management on Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S610-S610
Author(s):  
Anthony Siudela ◽  
Afshin Khan ◽  
Marjorie E Bateman
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
High Mortality ◽  
Critically Ill Patients ◽  
Hospital Admissions ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Fungal Colonization ◽  
Post Discharge ◽  
The Impact

Abstract Background Invasive fungal infections (IFIs), though uncommon, are on the rise and have a high mortality rate. Fungal colonization is common, but its clinical significance is unclear. Our study aims to characterize the impact of these diagnoses and their management on outcomes in a large ICU population. Methods We utilized the Multiparameter Intelligent Monitoring in Intensive Care III database for this retrospective cohort study. Adults with positive fungal cultures were classified as colonized or infected using definitions from the EORTC/MSG guidelines and the Blot protocol for Aspergillus. Outcomes were compared between groups matched by age, SOFA score, admission diagnosis, culture results, and comorbidities. Results There were 595 hospital admissions with IFI (11.7/1000 admissions) and 5789 with colonization (114/1000 admissions). In-hospital mortality was 52% in patients with IFIs and 36% in colonized patients. Mortality post-discharge remained high and was not significantly different in the two groups. 67% of patients with IFIs had the diagnosis documented. 24% of patients with IFIs and 8% of colonized patients received antifungal therapy. Treatment did not significantly impact mortality in infected or colonized patients but was associated with increased length of hospital and ICU stay. Infectious disease (ID) consultation was performed in 39.8% of patients with IFIs and 20% of patients with colonization. In the group of IFI patients with ID consultation, in-hospital mortality was higher, but survival post-discharge increased significantly. There was a significant increase in diagnosis of IFI in the ID group and a trend toward increased treatment. In colonized patients with ID consultation, in-hospital mortality and survival post-discharge improved. Hospital and ICU length of stay were longer for patients with ID consultation. Conclusion Critically ill patients with IFIs have high mortality rates, which were not reduced by treatment. The prevalence of colonization was high, and colonized patients experienced significant in-hospital and post-discharge mortality. This study supports the need for additional investigation into ID consultation, which may improve outcomes in critically ill patients with fungal infection and colonization. Disclosures All Authors: No reported disclosures

scholarly journals Blood glucose-related indicators are associated with in-hospital mortality in critically ill patients with acute pancreatitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yan Lu ◽  
Qiaohong Zhang ◽  
Jianjie Lou
Keyword(s):  
Acute Pancreatitis ◽  
Blood Glucose ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Variability ◽  
Logistic Regression Models ◽  
Patient Prognosis ◽  
Mean Glucose ◽  
The Relationship

AbstractAcute pancreatitis (AP) results in potentially harmful blood glucose fluctuations, affecting patient prognosis. This study aimed to explore the relationship between blood glucose-related indicators and in-hospital mortality in critically ill patients with AP. We extracted data on AP patients from the Multiparameter Intelligent Monitoring in Intensive Care III database. Initial glucose (Glucose_initial), maximum glucose (Glucose_max), minimum glucose (Glucose_min), mean glucose (Glucose_mean), and glucose variability (glucose standard deviation [Glucose_SD] and glucose coefficient of variation [Glucose_CV]) were selected as blood glucose-related indicators. Logistic regression models and the Lowess smoothing curves were used to display the association between significant blood glucose-related indicators and in-hospital mortality. Survivors and non-survivors showed significant differences in Glucose_max, Glucose_mean, Glucose_SD, and Glucose_CV (P < 0.05). Glucose_max, Glucose_mean, Glucose_SD, and Glucose_CV were risk factors for in-hospital mortality in AP patients (OR > 1; P < 0.05). According to the Lowess smoothing curve, the overall trends of blood glucose-related indicators showed a non-linear correlation with in-hospital mortality. Glucose_max, Glucose_mean, Glucose_SD, and Glucose_CV were associated with in-hospital mortality in critically ill patients with AP.

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