scholarly journals A Novel Prediction Prognosis Model of sepsis with acute respiratory failure: A cohort study from the MIMIC-IV database

2021 ◽  
Author(s):  
Lina Zhao ◽  
Jing Yang ◽  
Yunying Wang ◽  
Zheng Ge. Zeng ◽  
Tao Liu ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Medical Information ◽  
Cox Regression ◽  
Abdominal Cavity ◽  
Simplified Acute Physiology Score ◽  
Hospital Death ◽  
Short Term ◽  
Short Term Mortality ◽  
Prognosis Model

Abstract Objectives: Acute respiratory failure is significantly related to increased short-term mortality in sepsis patients. We aimed to develop a novel prognosis model for predicting the risk for hospital mortality in sepsis patients with acute respiratory failure.Methods: We researched the Medical Information Mart for Intensive Care (MIMIC)-IV database, and developed a matched cohort of adult sepsis with acute respiratory failure. After applying multivariate Cox regression, a nomogram was developed based on identified risk factors of the mortality in the cohort. Besides, the discrimination of the nomogram in predicting individual hospital death was evaluated by the area under o the characteristic operating curve (ROC).Results: A total of 663 sepsis patients with acute respiratory failure were included in this study. Systolic blood pressure, white blood cell count, neutrophils, mechanical ventilation, PaO2 < 60mmHg, abdominal cavity infection, Klebsiella pneumoniae, Acinetobacter baumannii, and immunosuppressive disease were the independent risk predictors of the mortality in sepsis patients with acute respiratory failure. The area under curve of the nomogram in the ROC was 0.880 (95% CI: 0.851-0.908) that provided significantly higher discrimination compared with simplified acute physiology score II [0.656 (95% CI: 0.612-0.701)].Conclusion: The model has good performance in predicting the mortality risk of sepsis patients with acute respiratory failure, and it can be clinically useful to evaluate the short-term prognosis in critically ill patients with sepsis and acute respiratory failure.

scholarly journals Association between lactate/albumin ratio and all-cause mortality in patients with acute respiratory failure: A retrospective analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255744
Author(s):  
Yan Lu ◽  
Haoyang Guo ◽  
Xuya Chen ◽  
Qiaohong Zhang
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Medical Information ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Severe Heart Failure ◽  
Albumin Ratio ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
All Cause Mortality

Previous studies have shown that lactate/albumin ratio (LAR) can be used as a prognostic biomarker to independently predict the mortality of sepsis and severe heart failure. However, the role of LAR as an independent prognostic factor in all-cause mortality in patients with acute respiratory failure (ARF) remains to be clarified. Therefore, we retrospectively analyzed 2170 patients with ARF in Medical Information Mart for Intensive Care Database III from 2001 to 2012. By drawing the receiver operating characteristic curve, LAR shows a better predictive value in predicting the 30-day mortality of ARF patients (AUC: 0.646), which is higher than that of albumin (AUC: 0.631) or lactate (AUC: 0.616) alone, and even higher than SOFA score(AUC: 0.642). COX regression analysis and Kaplan-Meier curve objectively and intuitively show that high LAR is a risk factor for patients with ARF, which is positively correlated with all-cause mortality. As an easy-to-obtain and objective biomarker, LAR deserves further verification by multi-center prospective studies.

scholarly journals Post-extubation oxygenation strategies in acute respiratory failure: a systematic review and network meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Hideto Yasuda ◽  
Hiromu Okano ◽  
Takuya Mayumi ◽  
Chihiro Narita ◽  
Yu Onodera ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Relative Risk ◽  
Confidence Interval ◽  
Acute Respiratory Failure ◽  
Meta Analysis ◽  
Positive Pressure ◽  
Cochrane Central Register ◽  
Short Term ◽  
Short Term Mortality ◽  
Registration Number

Abstract Background High-flow nasal cannula oxygenation (HFNC) and noninvasive positive-pressure ventilation (NPPV) possibly decrease tracheal reintubation rates better than conventional oxygen therapy (COT); however, few large-scale studies have compared HFNC and NPPV. We conducted a network meta-analysis (NMA) to compare the effectiveness of three post-extubation respiratory support devices (HFNC, NPPV, and COT) in reducing the mortality and reintubation risk. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. COT, NPPV, and HFNC use were assessed in patients who were aged ≥ 16 years, underwent invasive mechanical ventilation for > 12 h for acute respiratory failure, and were scheduled for extubation after spontaneous breathing trials. The GRADE Working Group Approach was performed using a frequentist-based approach with multivariate random-effect meta-analysis. Short-term mortality and reintubation and post-extubation respiratory failure rates were compared. Results After evaluating 4631 records, 15 studies and 2600 patients were included. The main cause of acute hypoxic respiratory failure was pneumonia. Although NPPV/HFNC use did not significantly lower the mortality risk (relative risk [95% confidence interval] 0.75 [0.53–1.06] and 0.92 [0.67–1.27]; low and moderate certainty, respectively), HFNC use significantly lowered the reintubation risk (0.54 [0.32–0.89]; high certainty) compared to COT use. The associations of mortality with NPPV and HFNC use with respect to either outcome did not differ significantly (short-term mortality and reintubation, relative risk [95% confidence interval] 0.81 [0.61–1.08] and 1.02 [0.53–1.97]; moderate and very low certainty, respectively). Conclusion NPPV or HFNC use may not reduce the risk of short-term mortality; however, they may reduce the risk of endotracheal reintubation. Trial registration number and date of registration PROSPERO (registration number: CRD42020139112, 01/21/2020).

scholarly journals Post-extubation Oxygenation Strategies and Mortality and Reintubation Rates in Acute Respiratory Failure: A Systematic Review and Network Meta-Analysis

2021 ◽  
Author(s):  
Hideto Yasuda ◽  
Hiromu Okano ◽  
Takuya Mayumi ◽  
Chihiro Narita ◽  
Yu Onodera ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Relative Risk ◽  
Confidence Interval ◽  
Acute Respiratory Failure ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Positive Pressure ◽  
Short Term ◽  
Short Term Mortality ◽  
Registration Number

Abstract Background: High-flow nasal cannula oxygenation (HFNC) and noninvasive positive-pressure ventilation (NPPV) possibly decrease tracheal reintubation rates better than conventional oxygen therapy (COT); however, few large-scale studies have compared HFNC and NPPV. We conducted a network meta-analysis (NMA) to compare the effectiveness of three post-extubation respiratory support devices (HFNC, NPPV, COT) in reducing the mortality and reintubation risk.Methods: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. COT, NPPV, and HFNC use were assessed in patients aged ≥16 years who underwent invasive mechanical ventilation for >12 hours for acute respiratory failure and were scheduled for extubation after spontaneous breathing trials. The GRADE Working Group Approach was performed using a frequentist-based approach with multivariate random-effects meta-analysis. Short-term mortality and reintubation and post-extubation respiratory failure rates were compared. Results: After evaluating 4,631 records, 15 studies and 2,600 patients were included. The main cause of acute hypoxic respiratory failure was pneumonia. Although NPPV/HFNC use did not significantly lower the mortality risk (relative risk [95% confidence interval], 0.75 [0.53–1.06] and 0.92 [0.67–1.27]; low and moderate certainty, respectively), HFNC use significantly lowered the reintubation risk (0.54 [0.32–0.89]; high certainty) compared with COT use. The associations of mortality with NPPV and HFNC in either outcome did not differ significantly (short-term mortality and reintubation, relative risk [95% confidence interval], 0.81 [0.61–1.08] and 1.02 [0.53–1.97]; moderate and very low certainty, respectively).Conclusion: NPPV or HFNC use may reduce endotracheal reintubation risk, but not short-term mortality risk.Trial registration number and date of registrationPROSPERO (registration number: CRD42020139112, 01/21/2020).

scholarly journals Acute respiratory failure and inflammatory response after out-of-hospital cardiac arrest: results of the Post-Cardiac Arrest Syndrome (PCAS) pilot study

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S110-S121
Author(s):  
Katarzyna Czerwińska-Jelonkiewicz ◽  
Johannes Grand ◽  
Guido Tavazzi ◽  
Jordi Sans-Rosello ◽  
Alice Wood ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Respiratory Failure ◽  
Inflammatory Response ◽  
Acute Respiratory Failure ◽  
White Blood Cells ◽  
Short Term ◽  
Reactive Protein ◽  
Short Term Mortality ◽  
Post Cardiac Arrest Syndrome ◽  
Hospital Cardiac Arrest

Background: Although the lungs are potentially highly susceptible to post-cardiac arrest syndrome injury, the issue of acute respiratory failure after out-of-hospital cardiac arrest has not been investigated. The objectives of this analysis were to determine the prevalence of acute respiratory failure after out-of-hospital cardiac arrest, its association with post-cardiac arrest syndrome inflammatory response and to clarify its importance for early mortality. Methods: The Post-Cardiac Arrest Syndrome (PCAS) pilot study was a prospective, observational, six-centre project (Poland 2, Denmark 1, Spain 1, Italy 1, UK 1), studying patients resuscitated after out-of-hospital cardiac arrest of cardiac origin. Primary outcomes were: (a) the profile of organ failure within the first 72 hours after out-of-hospital cardiac arrest; (b) in-hospital and short-term mortality, up to 30 days of follow-up. Respiratory failure was defined using a modified version of the Berlin acute respiratory distress syndrome definition. Inflammatory response was defined using leukocytes (white blood cells), platelet count and C-reactive protein concentration. All parameters were assessed every 24 hours, from admission until 72 hours of stay. Results: Overall, 148 patients (age 62.9±15.27 years; 27.7% women) were included. Acute respiratory failure was noted in between 50 (33.8%) and 75 (50.7%) patients over the first 72 hours. In-hospital and short-term mortality was 68 (46.9%) and 72 (48.6%), respectively. Inflammation was significantly associated with the risk of acute respiratory failure, with the highest cumulative odds ratio of 748 at 72 hours (C-reactive protein 1.035 (1.001–1.070); 0.043, white blood cells 1.086 (1.039–1.136); 0.001, platelets 1.004 (1.001–1.007); <0.005). Early acute respiratory failure was related to in-hospital mortality (3.172, 95% confidence interval 1.496–6.725; 0.002) and to short-term mortality (3.335 (1.815–6.129); 0.0001). Conclusions: An inflammatory response is significantly associated with acute respiratory failure early after out-of-hospital cardiac arrest. Acute respiratory failure is associated with a worse early prognosis after out-of-hospital cardiac arrest.

scholarly journals Association between body mass index and short-term mortality in patients with intra-abdominal infections: a retrospective, single-centre cohort study using the Medical Information Mart for Intensive Care database

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e046623
Author(s):  
Qinglin Li ◽  
Yingmu Tong ◽  
Sinan Liu ◽  
Kaibo Yang ◽  
Chang Liu ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cohort Study ◽  
Intensive Care ◽  
Body Mass ◽  
Medical Information ◽  
Cox Regression ◽  
Obese Patients ◽  
Short Term ◽  
Short Term Mortality ◽  
Mimic Iii

ObjectivesThis study aimed to determine the relationship between the body mass index (BMI) and short-term mortality of patients with intra-abdominal infection (IAI) using the Medical Information Mart for Intensive Care (MIMIC-III) database.DesignRetrospective cohort study.SettingAdult intensive care units (ICUs) at a tertiary hospital in the USA .ParticipantsAdult IAI ICU patients from 2001 to 2012 in the MIMIC-III database.InterventionsIn univariate analysis, we compared the differences in the characteristics of patients in each BMI group. Cox regression models were used to evaluate the relationships between BMI and short-term prognosis.Primary and secondary outcome measures90-day survival.ResultsIn total, 1161 patients with IAI were included. There were 399 (34.4%) patients with a normal BMI (<25 kg/m2), 357 (30.8%) overweight patients (25–30 kg/m2) and 405 (34.9%) obese patients (>30 kg/m2) who tended to be younger (p<0.001) and had higher Sequential Organ Failure Assessment scores (p<0.05). The mortality of obese patients at 90 days was lower than that of patients with a normal BMI (20.74% vs 23.25%, p<0.05), but their length of stay in the ICU was higher (4.9 days vs 3.6 days, p<0.001); however, their rate of mechanical ventilation utilisation was higher (61.48% vs 56.86%, p<0.05). In the Cox regression model, we also confirmed that BMI was a protective factor in patients with IAIs, and the adjusted mortality rate of patients with a higher BMI was 0.97 times lower than that of patients with a lower BMI (p<0.001, HR=0.97, 95% CI 0.96 to 0.99).ConclusionsIAI patients with an overweight or obese status might have lower 90-day mortality than patients with a normal BMI.

scholarly journals High-flow nasal cannula oxygen therapy to treat acute respiratory failure in patients with acute exacerbation of idiopathic pulmonary fibrosis

2019 ◽  
Vol 13 ◽  
pp. 175346661984713 ◽  
Author(s):  
Andrea Vianello ◽  
Giovanna Arcaro ◽  
Beatrice Molena ◽  
Cristian Turato ◽  
Fausto Braccioni ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Mortality Rate ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Oxygen Therapy ◽  
Treatment Algorithm ◽  
High Flow ◽  
High Flow Nasal Cannula ◽  
Short Term ◽  
Short Term Mortality

Background: Some patients with idiopathic pulmonary fibrosis (IPF) develop acute exacerbation (AE-IPF) leading to severe acute respiratory failure (ARF); despite conventional supportive therapy, the mortality rate remains extremely high. The aim of this study was to assess how a treatment algorithm incorporating high-flow nasal cannula (HFNC) oxygen therapy affects the short-term mortality of patients with AE-IPF who develop ARF. Method and design: A retrospective cohort analysis was conducted. Patients and interventions: The study consisted of 17 patients with AE-IPF admitted to a respiratory intensive care unit (RICU) for ARF managed using a treatment algorithm incorporating HFNC. The outcome measure was mortality rate during their stay in the RICU. Results: Implementation of the treatment algorithm led to a successful outcome in nine patients and to a negative one in eight patients (47.1%) who died within 39 days of being admitted to the RICU. The survival rate was 70.6% (±0.1 %) at 15 days, 52.9% (±0.1%) at 30 days, 35.3% (±0.1%) at 90 days, and 15.6% (±9.73 %) at 365 days. Overall, 4 out of 10 patients who did not respond to conventional oxygen therapy showed a satisfactory response to HFNC. Conclusions: Short-term mortality fell to below 50% when a treatment algorithm incorporating HFNC was implemented in a group of patients with AE-IPF admitted to a RICU for ARF. Patients not responding to conventional oxygen therapy seemed to benefit from HFNC. The reviews of this paper are available via the supplementary material section.

scholarly journals TNFR1 is associated with short-term mortality in patients with diabetes and acute dyspnea seeking care at the emergency department

2020 ◽  
Vol 57 (10) ◽  
pp. 1145-1150 ◽  
Author(s):  
P. Wändell ◽  
A. C. Carlsson ◽  
A. Larsson ◽  
O. Melander ◽  
T. Wessman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cox Regression ◽  
Secondary Analysis ◽  
Medical Emergency ◽  
Acute Dyspnea ◽  
Short Term ◽  
Patients With Diabetes ◽  
Short Term Mortality ◽  
Study Association ◽  
Circulating Levels

Abstract Background Circulating levels of TNF alpha receptor 1 (TNFR1) and 2 (TNFR2) are associated with increased long-term mortality and impaired kidney function. Aim To study association between circulating levels of TNFR1 and TNFR2 and short-term mortality in patients with diabetes and dyspnea. Population and methods Patients aged ≥ 18 years seeking at emergency department (ED) during daytime on weekdays between December 2013 and July 2018, with diabetes and acute dyspnea, identified at the triage process, were included. Participants (n = 291) were triaged according to Medical Emergency Triage and Treatment System-Adult score, and blood samples were collected. Association between TNFR1 and TNFR2, respectively, and 90-day mortality were estimated by Cox regression models adjusted for age, sex, BMI, creatinine and CRP. Results Univariate models showed significant associations between TNFR1 and TNFR2, respectively, and CRP, age and creatinine. TNFR1 and TNFR2 tended to be elevated in patients with the highest triage level, compared to patients with lower triage levels (ns). In longitudinal analyses, TNFR1 but not TNFR2 was associated with increased short-term mortality, HR adjusted for age, BMI and creatinine 1.43 (95% CI 1.07–1.91), but not in the model also adjusted for CRP, HR 1.29 (95% CI 0.94–1.77). In secondary analysis for quartile 4 versus quartiles 1–3 of TNFR1, corresponding HRs were 2.46 (95% CI 1.27–5.15) and 2.21 (95% CI 1.07–2.56). Conclusions We found a trend for the association between circulating TNFR1 levels and short-term mortality in patients with diabetes and acute dyspnea at the ED, possibly suggesting an inflammatory pathway for the association.

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