Association Effects Of Comorbid Versus Uncomorbid Diabetes And Blood Glucose Concentrations On Short-term Outcomes In Patients With Critical Illness: A Real-World Study Based On Propensity Score Analyses

2020 ◽  
Author(s):  
Shan Lin ◽  
Shanhui Ge ◽  
Wanmei He ◽  
Mian Zeng
Keyword(s):  
Critical Illness ◽  
Glycemic Control ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Model ◽  
Inverse Probability Weighting ◽  
Probability Weighting ◽  
Optimal Range ◽  
Short Term ◽  
Inverse Probability

Abstract Background: The effects of combined diabetes and glycemic control strategies on the short-term prognosis in patients with a critical illness are currently ambiguous. The objectives of our study were to determine whether comorbid diabetes affects short-term prognosis and the optimal range of glycemic control in critically ill patients.Methods: We performed this study with the critical care database. The primary outcomes were 28-day mortality in critically ill patients with comorbid diabetes and the optimal range of glycemic control. Association of comorbid diabetes with 28-day mortality was assessed by multivariable Cox regression model with inverse probability weighting. Smooth curves were applied to fit the association for glucose and 28-day mortality.Results: Of the 33,680 patients enrolled in the study, 8,701 (25.83%) had diabetic comorbidity. Cox model with inverse probability weighting showed that the 28-day mortality rate was reduced by 29% (HR=0.71, 95% CI 0.67-0.76) in the group with diabetes in comparison to the group without diabetes. The E value of 2.17 indicated robustness to unmeasured confounders. The effect of the association between comorbid diabetes and 28-day mortality was generally in line for all subgroup variables, significant interactions were observed for glucose on first day, admission type, and use of insulin or not (Interaction P <0.05). A V-shaped relationship was observed between glucose concentrations and 28-day mortality in patients without diabetes, with the lowest 28-day mortality corresponding to the glucose level was 101.75 mg/dl (95% CI 94.64-105.80 mg/dl); whereas in patients with comorbid diabetes, the effect of glucose concentration on 28-day mortality was structurally softer than in those with uncomorbid diabetes. Lastly, of all patients, hyperglycemia had the greatest deleterious effect on patients admitted to CSRU.Conclusions: Our study further confirmed the protective effect of comorbid diabetes on the short-term prognosis of critically ill patients, resulting in an approximately 29% reduction in 28-day mortality. Besides, we also demonstrated the personalized glycemic control strategy for critically ill patients. Lastly, clinicians should be aware of the occurrence and the prompt management of hyperglycemia in critically ill patients admitted to the CSRU.

scholarly journals Effect of Diabetes and Admission Blood Glucose Levels on Short-term Outcomes in Patients with Critical illnesses: A Real-world Study Based on Propensity Score Analyses

2020 ◽  
Author(s):  
Shan Lin ◽  
Shanhui Ge ◽  
Wanmei He ◽  
Mian Zeng
Keyword(s):  
Blood Glucose ◽  
Propensity Score ◽  
Blood Glucose Level ◽  
Critically Ill ◽  
Glucose Level ◽  
Critically Ill Patients ◽  
Surgical Intensive Care Unit ◽  
Optimal Range ◽  
Short Term ◽  
Patients With Diabetes

Abstract Background: Effect of diabetes and optimal range of blood glucose level on the short-term prognosis in patients with critical illnesses are currently ambiguous. We aimed to determine whether diabetes affects short-term prognosis and optimal range of blood glucose level for critically ill patients.Methods: We performed a retrospective analysis of data on 46,476 critically ill patients from the critical care database (version 1.4), collected prospectively between 2002 and 2012. Association of diabetes with 28-day mortality was assessed by inverse probability weighting based on the propensity score. Smoothing splines and threshold effect analysis were applied to explore the optimal glucose range.Results: Of the 33,680 patients enrolled in the study, 8,701 (25.83%) had diabetes. In the main analysis, the 28-day mortality was reduced by 29% (hazard ratio (HR)=0.71, 95% confidence interval (CI) 0.67-0.76) in patients with diabetes compared to those without diabetes. The E-value of 2.17 indicated robustness to unmeasured confounders. The effect of the association between with diabetes and 28-day mortality was generally in line for all subgroup variables, significant interactions were observed for glucose at ICU admission, admission type, and insulin use (Interaction P <0.05). A V-shaped relationship was observed between glucose and 28-day mortality in patients without diabetes, with the lowest 28-day mortality corresponding to the glucose level was 101.75 mg/dl (95% CI 94.64-105.80 mg/dl), and hypoglycemia or hyperglycemia should be avoided, especially in patients admitted to the surgical intensive care unit (SICU), cardiac surgery recovery unit (CSRU), and coronary care unit (CCU); for patients with diabetes, no optimal threshold for glucose was found, and elevated blood glucose does not appear to be associated with a poor prognosis, and perhaps may be beneficial except for CCU and CSRU.Conclusions: The non-detrimental effect of diabetes on the short-term prognosis of critically ill patients was further confirmed, which would reduce 28-day mortality by approximately 29%. For patients without diabetes, the glucose level corresponding to the lowest 28-day mortality was 101.75 mg/dl (95% CI 94.64-105.80 mg/dl); however, for patients with diabetes, the appropriate optimal blood glucose threshold remains unresolved.

scholarly journals Association between Hydroxyzine Use and Reduced Mortality in Patients Hospitalized for Coronavirus Disease 2019: Results from a multicenter observational study

2020 ◽  
Author(s):  
Nicolas Hoertel ◽  
Marina Sánchez ◽  
Raphaël Vernet ◽  
Nathanaël Beeker ◽  
Antoine Neuraz ◽  
...  
Keyword(s):  
Observational Study ◽  
Cox Model ◽  
Inverse Probability Weighting ◽  
Dose Effect ◽  
Sensitivity Analyses ◽  
Study Endpoint ◽  
Probability Weighting ◽  
Inverse Probability ◽  
Effect Relationship ◽  
Anti Inflammatory

ABSTRACTObjectiveTo examine the association between hydroxyzine use and mortality in patients hospitalized for COVID-19, based on its anti-inflammatory and antiviral properties.DesignMulticenter observational retrospective cohort study.SettingGreater Paris University hospitals, France.Participants7,345 adults hospitalized for COVID-19 between 24 January and 1 April 2020, including 138 patients (1.9%) who received hydroxyzine during the visit at a mean dose of 49.8 mg (SD=51.5) for an average of 22.4 days (SD=25.9).Data sourceAssistance Publique-Hôpitaux de Paris Health Data Warehouse.Main outcome measuresThe study endpoint was death. We compared this endpoint between patients who received hydroxyzine and those who did not in time-to-event analyses adjusting for patient characteristics (such as age, sex, and comorbidities), clinical and biological markers of disease’s severity, and use of other medications. The primary analysis was a multivariable Cox model with inverse probability weighting. Sensitivity analyses included a multivariable Cox model and a univariate Cox regression model in a matched analytic sample in a 1:1 ratio.ResultsOver a mean follow-up of 20.3 days (SD=27.5), 994 patients (13.5%) had a primary end-point event. The primary multivariable analysis with inverse probability weighting showed a significant association between hydroxyzine use and reduced mortality (HR, 0.42; 95% CI, 0.25 to 0.71; p=0.001) with a significant dose-effect relationship (HR, 0.10; 95% CI, 0.02 to 0.45; p=0.003). This association was similar in sensitivity analyses. In secondary analyses conducted among subsamples of patients, we found a significant association between hydroxyzine use and a faster decrease in biological inflammatory markers associated with COVID-19-related mortality, including neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-C-reactive protein ratio (LCRP), and circulating interleukin 6 levels (IL-6) (all p<0.016), with a significant dose-effect relationship for NLR and LCRP (both p<0.037).ConclusionsIn this retrospective observational study, hydroxyzine use was associated with reduced mortality in patients hospitalized for COVID-19. This association may be partially mediated by specific anti-inflammatory properties of H1 antihistamines. Double-blind controlled randomized clinical trials of hydroxyzine for COVID-19 are needed to confirm these results.

scholarly journals Adrenal Insufficiency In Critically Ill Patients

2015 ◽  
Vol 3 (1) ◽  
pp. 27-30
Author(s):  
SM Ashrafuzzaman
Keyword(s):  
Septic Shock ◽  
Critical Illness ◽  
Adrenal Insufficiency ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
High Index ◽  
Acth Level ◽  
Short Term ◽  
High Index Of Suspicion ◽  
Low Cortisol

Adrenal insufficiency means hypo function of the adrenal cortex, usually resulting in low glucocorticoid level and it may be associated with low mineralocorticoid, rarely low adrenal androgen level. It can be categorized into two types: primary and secondary. Primary adrenal insufficiency or Addison's disease is associated with low cortisol and high ACTH level. Secondary/tertiary adrenal insufficiency is due to pituitary or hypothalamic disorders and is associated with both low cortisol and ACTH level. Among critically ill patients (CIP) adrenal insufficiency is not uncommon. The reported incidence of adrenal insufficiency varies greatly depending on the population of critically ill patients studied, the type of test, cut off levels used, and the severity of illness. Several studies have shown increased mortality in patients with very low or very high baseline cortisol levels. Manifestations of adrenal insufficiency in the critically ill patient are numerous and nonspecific, so clinicians are urged to have a high index of suspicion while taking history and doing physical examination and be alert to important diagnostic clues, such as hyponatremia, hyperkalemia, and hypotension, that are refractory to fluids and vasopressor without any clear causation. In current literature there is no consensus level of cortisol (basal/random/stimulated) in critically ill subjects. But it is shown that both high and low cortisol level is associated with increased mortality. In one study Basal Serum Cortisol <414 nmol/L and > 696 nmol/L is shown as indicative of higher risk among critically ill patients. Even with Septicemia or ARDS all subjects don’t suffer from adrenal insufficiency often termed relative adrenal insufficiency or critical illness associated adrenal insufficiency. It has been observed that short term low dose IV hydrocortisone may be beneficial in selective group of patients in intensive care unit (ICU) with critical illness. Diagnosis of adrenal insufficiency associated with critical illness is still challenging for physicians working in ICU. Treatment should be started without delay in emergency situation with Injection Hydrocortisone intravenously or even intramuscularly. Since the condition appears to be common in patients with septic shock, clinicians should have a high index of suspicion for its occurrence in critically ill patients with persistent hypotension despite adequate fluid resuscitation and/or poor hemodynamic response to vasopressor. Adrenal insufficiency associated with other illnesses in ICU are attributed to previous primary or secondary adrenal insufficiency. Treatment with physiologic doses of corticosteroids should be started as soon as possible since short-term treatment carries very few risks and has been shown to decrease both morbidity and mortality. Only suspected cases should be evaluated and could be treated with 100-200 mg Hydrocortisone in divided doses for 5-7 days. Glucocorticoid cannot be recommended as a routine adjuvant therapy in all cases of septic shock or ARDS. But glucocorticoid earned its position among other rescue strategies in subgroups of ICU patients with the highest mortality risk. Steroid use is an art and needs to be used by experienced physician. Otherwise it may do more harm than benefit.Bangladesh Crit Care J March 2015; 3 (1): 27-30

scholarly journals Impact of Adopting Improved Seeds on Access to Broader Food Groups Among Small-Scale Sorghum Producers in Tanzania

SAGE Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 215824402097999
Author(s):  
Aloyce R. Kaliba ◽  
Anne G. Gongwe ◽  
Kizito Mazvimavi ◽  
Ashagre Yigletu
Keyword(s):  
Food Security ◽  
Dietary Diversity ◽  
Sampling Technique ◽  
Inverse Probability Weighting ◽  
Reproductive Age ◽  
Small Scale ◽  
Probability Weighting ◽  
Food Groups ◽  
Inverse Probability ◽  
Double Robust

In this study, we use double-robust estimators (i.e., inverse probability weighting and inverse probability weighting with regression adjustment) to quantify the effect of adopting climate-adaptive improved sorghum varieties on household and women dietary diversity scores in Tanzania. The two indicators, respectively, measure access to broader food groups and micronutrient and macronutrient availability among children and women of reproductive age. The selection of sample households was through a multistage sampling technique, and the population was all households in the sorghum-producing regions of Central, Northern, and Northwestern Tanzania. Before data collection, enumerators took part in a 1-week training workshop and later collected data from 822 respondents using a structured questionnaire. The main results from the study show that the adoption of improved sorghum seeds has a positive effect on both household and women dietary diversity scores. Access to quality food groups improves nutritional status, food security adequacy, and general welfare of small-scale farmers in developing countries. Agricultural projects that enhance access to improved seeds are, therefore, likely to generate a positive and sustainable effect on food security and poverty alleviation in sorghum-producing regions of Tanzania.

scholarly journals Inverse probability weighting for clustered nonresponse

Biometrika ◽  
2011 ◽  
Vol 98 (4) ◽  
pp. 953-966 ◽  
Author(s):  
C. J. Skinner ◽  
D'arrigo
Keyword(s):  
Inverse Probability Weighting ◽  
Probability Weighting ◽  
Inverse Probability

Pharmacological Management of Seizures and Status Epilepticus in Critically Ill Patients

2010 ◽  
Vol 23 (5) ◽  
pp. 441-454 ◽  
Author(s):  
Eljim P. Tesoro ◽  
Gretchen M. Brophy
Keyword(s):  
Status Epilepticus ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Neurological Disease ◽  
Medical Emergency ◽  
Significant Morbidity ◽  
First Line ◽  
Short Term ◽  
Pharmacological Management ◽  
First Line Treatment

Seizures are serious complications seen in critically ill patients and can lead to significant morbidity and mortality if the cause is not identified and treated quickly. Uncontrolled seizures can lead to status epilepticus (SE), which is considered a medical emergency. The first-line treatment of seizures is an intravenous (IV) benzodiazepine followed by anticonvulsant therapy. Refractory SE can evolve into a nonconvulsive state requiring IV anesthetics or induction of pharmacological coma. To prevent seizures and further complications in critically ill patients with acute neurological disease or injury, short-term seizure prophylaxis should be considered in certain patients.

scholarly journals Second pilot trials of the STAR-Liege protocol for tight glycemic control in critically ill patients

2012 ◽  
Vol 11 (1) ◽  
pp. 58 ◽  
Author(s):  
Sophie Penning ◽  
Aaron J Le Compte ◽  
Paul Massion ◽  
Katherine T Moorhead ◽  
Christopher G Pretty ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tight Glycemic Control ◽  
Pilot Trials
Sign in / Sign up

Export Citation Format

Share Document