Characteristics and Risk Factors Associated with Early Mortality in Patients with Polymicrobial Bloodstream Infection: A Retrospective Clinical Study

2020 ◽  
Author(s):  
Lantian Pang ◽  
SenZhong Chen ◽  
Tiantian Ge ◽  
Chao Chen ◽  
Lichen Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Cell ◽  
White Blood Cell ◽  
Antimicrobial Therapy ◽  
Hospitalized Patients ◽  
Short Term ◽  
Survival Group ◽  
Empirical Antimicrobial Therapy ◽  
Retrospective Clinical Study ◽  
Short Term Mortality

Abstract Background and Objective Polymicrobial bloodstream infections (PBSI) in hospitalized patients are associated with increased mortality, while few studies have characterized the clinical features in this population. This study aimed to assess the risk factors and short-term prognosis of PBSI in hospitalized patients.Materials and Methods 4066 patients with culture-positive blood were included between January 1, 2015 and December 31, 2017 in the First Affiliated Hospital of Zhejiang University School of Medicine (Hangzhou, China) in our study. 218 patients were diagnosed as PBSI. The patients were divided into two groups according to the outcome after 30-day follow-up. The number of survival group were 129, while the number of non-survival group were 89. The clinical data, identified microorganisms and severity models were compared between the two groups. A cox regression model was used to identify the risk factors of 30-day mortality in PBSI patients. Five prediction models were compared by Z-test to test the value of these models to predict outcome of PBSI.Results The patients in the non-survival group were more likely to receive inappropriate antibiotic therapy at the time of PBSI and showed more severe in systemic inflammatory. They were more likely to develop to be septic shock and to be admitted in ICU than the patients in the survival group. Inappropriate initial empirical antimicrobial therapy (HR=1.713 95% CI: 1.063-2.760, p=0.027), white blood cell (HR=1.740 95% CI: 1.002-3.020, p=0.049) and platelet (HR=2.940 95% CI: 1.754-4.930, p<0.001) were independent risk factors for 30-day mortality in PBSI patients. SOFA (AUROC=0.882, 95% CI=0.832-0.922) scores was a good prognostic scoring system for predicting short-term mortality in PBSI patients. The SOFA score was more valuable than the other four models in predicting the outcome of PBSI according to the Z-test (p<0.05).Discussion and Conclusions Inappropriate initial empirical antimicrobial therapy, white blood cell and platelet were closely associated with short-term mortality.

scholarly journals Evaluation of the Relationship between Early Troponin Clearance and Short-Term Mortality in Patients with Chronic Renal Failure

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Ahmet Ozbek ◽  
Abdullah Algın ◽  
Gokhan Tas ◽  
Mehmet Ozgur Erdogan
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Survival Rates ◽  
Structural Heart Disease ◽  
Lactate Clearance ◽  
Acute Injury ◽  
Short Term ◽  
Survival Group ◽  
Parametric Data ◽  
Short Term Mortality

Objective. In patients with CKD, cTn concentrations may be elevated in the absence of AMI, which is a predicted finding caused by chronic structural heart disease rather than acute injury. The increase in troponin level observed in noncardiac conditions provides conflicting results when predicting mortality. Low lactate clearance was associated with increased mortality. Lactate clearance is calculated as follows: (early lactate − late lactate/early lactate) ∗ 100. We aimed to investigate whether troponin clearance calculated according to this formula had an effect on short-term mortality. Methods. The study included 300 patients with chronic renal failure who had a sepsis-related organ failure assessment (SOFA) score ≥3. By taking the baseline troponin at the time of emergency presentation as reference and comparing them with the fourth-hour troponin values, troponin clearance was investigated in the evaluation of mortality among hospitalized patients with CKD within the first month after discharge. The data obtained were analyzed using the SPSS data analysis software version 20.0. Student’s t-test was used for the parametric data, and the Chi-squared test for the nonparametric data. Results. Of the 300 patients evaluated, 189 patients survived (mean age 66.20 ± 14.597 years), and 111 died (mean age 74.81 ± 12.916 years). Troponin clearance was detected in 40 of the 111 patients in the mortality group and 119 of the 189 patients in the survival group. Troponin clearance was significantly more frequent in surviving patients (P=0.0000083). Conclusion. Troponin clearance can be considered as a valuable leading indicator of survival, but higher levels of troponin clearance did not lead to higher survival rates.

Issues on the Use of White Blood Cell Growth Factors in Oncology Practice

2016 ◽  
pp. e528-e532
Author(s):  
Gary H. Lyman
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Growth Factors ◽  
Cell Growth ◽  
Blood Cell ◽  
White Blood Cell ◽  
Patient Specific ◽  
Appropriate Use ◽  
Disease Free

Appropriate use of myeloid growth factors may reduce the risk of neutropenic complications including febrile neutropenia (FN) in patients receiving cancer chemotherapy. The recently updated American Society of Clinical Oncology (ASCO) Guidelines on the Use of the White Blood Cell Growth Factors recommends routine prophylaxis with these agents starting in the first cycle when the risk of FN is 20% or greater. However, the risks for neutropenic complications and the risk of serious adverse consequences from FN vary considerably with different chemotherapy regimens as well as other disease-, treatment-, and patient-specific risk factors. Considerably more information is now available on the major risk factors for FN. Multivariable risk models combining factors look promising but require further validation. Most clinical studies of myeloid growth factor prophylaxis assessed relative risk (RR) of FN but were not powered to evaluate the effect of prophylaxis on disease-free or overall survival. Accumulating evidence suggests, however, that the appropriate use of these agents in selected patients may improve both short-term and long-term survival by reducing the immediate risk of mortality accompanying patients with high-risk disease developing FN as well as improving disease-free and overall survival by enabling the delivery of full dose intensity chemotherapy and reducing the risk of disease recurrence in patients treated with curative intent. Further studies to evaluate risk factors and models for FN are needed to guide clinical and shared decision making for the optimal personalized use of these agents and offer patients at increased risk the best chance of long-term disease control.

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