Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study.

Abstract Background: Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care.Methods: This study is part of a Delirium in Intensive Care (Deli) study. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of intensive care and hospital stay were explored.Results: During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63-79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1 – 42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n=127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.71, 95% Confidence Interval (CI) 1.20 – 2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72 – 3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU.Conclusion: Frailty and delirium significantly increase the risk of hospital mortality. Therefore, it important to identify patients who are frail and institute measures to reduce the risk of adverse events in the ICU such as delirium. And, importantly to discuss these issues in an open and empathetic way with the patient and their families.

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Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study.

10.21203/rs.3.rs-52423/v4 ◽

2020 ◽

Author(s):

David Sanchez ◽

Kathleen Brennan ◽

Masar El Safye ◽

Sharon-Ann Shunker ◽

Tony Bogdanoski ◽

...

Keyword(s):

Older Adults ◽

Intensive Care ◽

Hospital Mortality ◽

Hospital Stay ◽

Baseline Period ◽

Acute Episode ◽

Frailty Status ◽

Frail Patients ◽

Increased Risk ◽

Adjusted Rate

Abstract Background: As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care.Methods: This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the SWSLHD between May 1st 2019 and the end of April 2020. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of intensive care and hospital stay will be described.Results: During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63-79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1 – 42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n=127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.71, 95% Confidence Interval (CI) 1.20 – 2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72 – 3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU.Conclusion: We have been able to show that among older frail admissions to intensive care, not just delirium, but hospital mortality is high. Importantly, we have found that approximately one in three frail patients who experienced an acute episode of delirium during their stay in the intensive care did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the intensive care setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.

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Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study

Critical Care ◽

10.1186/s13054-020-03318-2 ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

David Sanchez ◽

Kathleen Brennan ◽

Masar Al Sayfe ◽

Sharon-Ann Shunker ◽

Tony Bogdanoski ◽

...

Keyword(s):

Older Adults ◽

Intensive Care ◽

Hospital Mortality ◽

Hospital Stay ◽

Baseline Period ◽

Acute Episode ◽

Frailty Status ◽

Frail Patients ◽

Increased Risk ◽

Adjusted Rate

Abstract Background Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients, an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. Methods This study is part of a Delirium in Intensive Care (Deli) Study. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50 years or more; acute episodes of delirium; and the outcomes of intensive care and hospital stay were explored. Results During the 6-month baseline period, 997 patients, aged 50 years or more, were included in this study. The average age was 71 years (IQR, 63–79); 55% were male (n = 537). Among these patients, 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted rate ratio (adjRR) = 1.71, 95% confidence interval (CI) 1.20–2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009) and had a higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72–3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality versus 10% among non-frail patients who also experienced delirium in the ICU. Conclusion Frailty and delirium significantly increase the risk of hospital mortality. Therefore, it is important to identify patients who are frail and institute measures to reduce the risk of adverse events in the ICU such as delirium and, importantly, to discuss these issues in an open and empathetic way with the patient and their families.

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Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study.

10.21203/rs.3.rs-52423/v3 ◽

2020 ◽

Author(s):

David Sanchez ◽

Kathleen Brennan ◽

Masar El Safye ◽

Sharon-Ann Shunker ◽

Tony Bogdanoski ◽

...

Keyword(s):

Older Adults ◽

Intensive Care ◽

Hospital Mortality ◽

Hospital Stay ◽

Baseline Period ◽

Acute Episode ◽

Frailty Status ◽

Frail Patients ◽

Increased Risk ◽

Adjusted Rate

Abstract Background: As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care.Methods: This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the SWSLHD between May 1st 2019 and the end of April 2020. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of intensive care and hospital stay will be described.Results: During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63-79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1 – 42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n=127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.71, 95% Confidence Interval (CI) 1.20 – 2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.54, 95% CI 1.72 – 3.75, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU.Conclusion: This study among adults, aged 50-years or more, admitted to intensive care has been able to show that clinical frailty on admission increases the risk of delirium by approximately 60%, and both increase the risk of hospital mortality. One in three frail patients who experienced an acute episode of delirium during their stay in the intensive care did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the intensive care setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.

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Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study.

10.21203/rs.3.rs-52423/v2 ◽

2020 ◽

Author(s):

David Sanchez ◽

Kathleen Brennan ◽

Masar El Safye ◽

Sharon-Ann Shunker ◽

Tony Bogdanoski ◽

...

Keyword(s):

Older Adults ◽

Intensive Care ◽

Hospital Mortality ◽

Hospital Stay ◽

Baseline Period ◽

Acute Episode ◽

Hospital Death ◽

Frail Patients ◽

Increased Risk ◽

The Relationship

Abstract Background: As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care.Methods: This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the SWSLHD between May 1st 2019 and the end of April 2020. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of intensive care and hospital stay will be described. Mediation analysis was used to assess the relationship between frailty and increased risk of hospital death and delirium.Results: During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63-79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1 – 42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n=127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.61, 95% Confidence Interval (CI) 1.14 – 2.28, p = 0.007), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.43, 95% CI 1.68 – 3.57, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU (p = 0.034, for interaction between frailty, delirium and hospital mortality). The proportion of the effect of frailty and risk of hospital mortality mediated by an acute episode of delirium in the ICU was estimated to 9.4% (95% CI 2 – 24%).Conclusion: This study among adults, aged 50-years or more, admitted to intensive care has been able to show that clinical frailty on admission increases the risk of delirium by approximately 60%, and both increase the risk of hospital mortality. One in three frail patients who experienced an acute episode of delirium during their stay in the intensive care did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the intensive care setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.

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Frailty, delirium and hospital mortality of older adults admitted to intensive care, a mediation analysis: the Delirium (Deli) in ICU study.

10.21203/rs.3.rs-52423/v1 ◽

2020 ◽

Author(s):

David Sanchez ◽

Kathleen Brennan ◽

Masar El Safye ◽

Sharon-Ann Shunker ◽

Tony Bogdanoski ◽

...

Keyword(s):

Older Adults ◽

Intensive Care ◽

Hospital Mortality ◽

Hospital Stay ◽

Mediation Analysis ◽

Baseline Period ◽

Acute Episode ◽

Hospital Death ◽

Frail Patients ◽

The Relationship

Abstract Background As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of frail patients an acute episode of delirium is also common, and both frailty and delirium increase the risk of mortality. However, the complex relationship between frailty, delirium and mortality has not been extensively explored in the intensive care setting. Therefore, the aim of this study was to explore the relationship between clinical frailty, acute delirium and hospital mortality of older adults admitted to intensive care. Methods This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the South Western Sydney Local Health District, between May 2019 and April 2020. During the initial 6-month baseline period, clinical frailty status on admission to ICU, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of ICU and hospital stay will be described. Mediation analysis was used to assess the relationship between frailty, delirium and risk of hospital death. Results During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63–79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio (adjRR) = 1.61, 95% Confidence Interval (CI) 1.14–2.28, p = 0.007), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adjRR = 2.43, 95% CI 1.68–3.57, p < 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the ICU had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU (p = 0.034, for interaction between frailty, delirium and hospital mortality). The proportion of the effect of frailty and risk of hospital mortality mediated by an acute episode of delirium in the ICU was estimated to 9.4% (95% CI 2–24%). Conclusion This study has been able to show that clinical frailty on admission increases the risk of delirium by approximately 60%, and both increase the risk of hospital mortality. One in three frail patients who experienced an acute episode of delirium during their stay in the ICU did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the ICU setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.

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Higher sRAGE Levels Predict Mortality in Frail Older Adults with Cardiovascular Disease

Gerontology ◽

10.1159/000512287 ◽

2021 ◽

pp. 1-9

Author(s):

Lee Butcher ◽

Jose Antonio Carnicero ◽

Karine Pérès ◽

Marco Colpo ◽

David Gomez Cabrero ◽

...

Keyword(s):

Older Adults ◽

Cox Regression ◽

Population Based ◽

Blood Levels ◽

Roc Curve Analysis ◽

Baseline Serum ◽

Frailty Status ◽

Risk Of Death ◽

Survival Difference ◽

Increased Risk

Introduction: The evidence that blood levels of the soluble receptor for advanced glycation end products (sRAGE) predict mortality in people with cardiovascular diseases (CVD) is inconsistent. To clarify this matter, we investigated if frailty status influences this association. Methods: We analysed data of 1,016 individuals (median age, 75 years) from 3 population-based European cohorts, enrolled in the FRAILOMIC project. Participants were stratified by history of CVD and frailty status. Mortality was recorded during 8 years of follow-up. Results: In adjusted Cox regression models, baseline serum sRAGE was positively associated with an increased risk of mortality in participants with CVD (HR 1.64, 95% CI 1.09–2.49, p = 0.019) but not in non-CVD. Within the CVD group, the risk of death was markedly enhanced in the frail subgroup (CVD-F, HR 1.97, 95% CI 1.18–3.29, p = 0.009), compared to the non-frail subgroup (CVD-NF, HR 1.50, 95% CI 0.71–3.15, p = 0.287). Kaplan-Meier analysis showed that the median survival time of CVD-F with high sRAGE (>1,554 pg/mL) was 2.9 years shorter than that of CVD-F with low sRAGE, whereas no survival difference was seen for CVD-NF. Area under the ROC curve analysis demonstrated that for CVD-F, addition of sRAGE to the prediction model increased its prognostic value. Conclusions: Frailty status influences the relationship between sRAGE and mortality in older adults with CVD. sRAGE could be used as a prognostic marker of mortality for these individuals, particularly if they are also frail.

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Lack of Association between Preoperative Statin Use and Respiratory and Neurologic Complications after Cardiac Surgery

Anesthesiology ◽

10.1097/aln.0000000000001569 ◽

2017 ◽

Vol 126 (5) ◽

pp. 799-809 ◽

Cited By ~ 4

Author(s):

Ryu Komatsu ◽

Huseyin Oguz Yilmaz ◽

Jing You ◽

C. Allen Bashour ◽

Shobana Rajan ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Hospital Mortality ◽

Hospital Stay ◽

Odds Ratio ◽

Hospital Length Of Stay ◽

Neurologic Complications ◽

Prolonged Ventilation ◽

Statin Use

Abstract Background Statins may reduce the risk of pulmonary and neurologic complications after cardiac surgery. Methods The authors acquired data for adults who had coronary artery bypass graft, valve surgery, or combined procedures. The authors matched patients who took statins preoperatively to patients who did not. First, the authors assessed the association between preoperative statin use and the primary outcomes of prolonged ventilation (more than 24 h), pneumonia (positive cultures of sputum, transtracheal fluid, bronchial washings, and/or clinical findings consistent with the diagnosis of pneumonia), and in-hospital all-cause mortality, using logistic regressions. Second, the authors analyzed the collapsed composite of neurologic complications using logistic regression. Intensive care unit and hospital length of stay were evaluated with Cox proportional hazard models. Results Among 14,129 eligible patients, 6,642 patients were successfully matched. There was no significant association between preoperative statin use and prolonged ventilation (statin: 408/3,321 [12.3%] vs. nonstatin: 389/3,321 [11.7%]), pneumonia (44/3,321 [1.3%] vs. 54/3,321 [1.6%]), and in-hospital mortality (52/3,321 [1.6%] vs. 43/3,321 [1.3%]). The estimated odds ratio was 1.06 (98.3% CI, 0.88 to 1.27) for prolonged ventilation, 0.81 (0.50 to 1.32) for pneumonia, and 1.21 (0.74 to 1.99) for in-hospital mortality. Neurologic outcomes were not associated with preoperative statin use (53/3,321 [1.6%] vs. 56/3,321 [1.7%]), with an odds ratio of 0.95 (0.60 to 1.50). The length of intensive care unit and hospital stay was also not associated with preoperative statin use, with a hazard ratio of 1.04 (0.98 to 1.10) for length of hospital stay and 1.00 (0.94 to 1.06) for length of intensive care unit stay. Conclusions Preoperative statin use did not reduce pulmonary or neurologic complications after cardiac surgery.

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507 Outcomes After the Administration of Hydroxocobalamin

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.139 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S90-S90

Author(s):

Kaitlin A Pruskowski ◽

Leopoldo C Cancio

Keyword(s):

Hospital Mortality ◽

Hospital Stay ◽

Hospital Setting ◽

Kidney Injury ◽

Retrospective Chart Review ◽

Lactate Clearance ◽

Inhalation Injury ◽

Icu Admission ◽

Increased Risk ◽

Lactate Levels

Abstract Introduction Hydroxocobalamin is administered to patients after injures sustained during structure fires or fires in enclosed spaces. It is unknown how the administration of hydroxocobalamin affects patient outcomes, however, there have been reports of increased risk of acute kidney injury (AKI). The purpose of this study was to determine the population in which hydroxocobalamin is administered and to assess outcomes in patients who receive this medication in the ICU setting. Methods This was a retrospective chart review that included all patients admitted to the burn ICU between July 2016 and April 2019. Patients were included if they received hydroxocobalamin after ICU admission. Patients who received hydroxocobalamin in the pre-ICU or pre-hospital setting were not included in this analysis. Data collected included demographic information, number of hydroxocobalamin doses administered, burn size (% TBSA), presence of inhalation injury (II), lactate levels during the first 72 hours of hospitalization, carboxyhemoglobin levels, need for continuous renal replacement therapy (CRRT), and in-hospital mortality. Results Thirty-five patients received hydroxocobalamin after ICU admission. Patients were, on average, 48 ± 19 years old with a 25.5 ± 24.8% TBSA burn. Twenty-nine patients (82.9%) who received hydroxocobalamin in the ICU were diagnosed with II via bronchoscopy. The median 24-hour fluid resuscitation requirement was 7.4 mL/kg/% TBSA (IQR 4.6, 12.7). Twenty-two patients (63%) who received hydroxocobalamin developed AKI during the first 72 hours of admission. Twenty-one patients (60%) required CRRT during their hospital stay; 42.8% of patients were started on CRRT during the resuscitation period. The mean admission lactate level was 4.4 ± 2.3 mmol/L. On average, lactate clearance occurred in 34.6 hours; 11 (31.4%) patients did not clear lactate within 72 hours. One patient had a carboxyhemoglobin level greater than 10% on admission. Ten (28.9%) patients died during their hospital stay. Conclusions Most patients who receive hydroxocobalamin after ICU admission developed AKI within the first 72 hours. Further studies on the relationship between the administration of hydroxocobalamin and the development of AKI and in-hospital mortality are warranted. Applicability of Research to Practice The use of hydroxocobalamin may carry an increased risk of AKI. Providers should be aware of this risk when prescribing this medication.

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Performance of Sequential Organ Failure Assessment and Simplified Acute Physiology Score II for Post-Cardiac Surgery Patients in Intensive Care Unit

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.774935 ◽

2021 ◽

Vol 8 ◽

Author(s):

Fei Xu ◽

Weina Li ◽

Cheng Zhang ◽

Rong Cao

Keyword(s):

Cardiac Surgery ◽

Intensive Care ◽

Hospital Mortality ◽

Hospital Stay ◽

Scoring System ◽

Simplified Acute Physiology Score ◽

Saps Ii ◽

Icu Stay ◽

Cutoff Values ◽

Adjusted Model

Background: The aim of this study is to assess the performance of Sequential Organ Failure Assessment (SOFA) score and Simplified Acute Physiology Score (SAPS II) on outcomes of patients with cardiac surgery and identify the cutoff values to provide a reference for early intervention.Methods: All data were extracted from MIMIC-III (Medical Information Mart for Intensive Care-III) database. Cutoff values were calculated by the receiver-operating characteristic curve and Youden indexes. Patients were grouped, respectively, according to the cutoff values of SOFA and SAPS II. A non-adjusted model and adjusted model were established to evaluate the prediction of risk. Comparison of clinical efficacy between two scoring systems was made by decision curve analysis (DCA). The primary outcomes of this study were in-hospital mortality, 28-day mortality, 90-day mortality, and 1-year mortality after cardiac surgery. The secondary outcomes included length of hospital stay and intensive care unit (ICU) stay and the incidence of acute kidney injury (AKI) within 7 days after ICU admission.Results: A total of 6,122 patients were collected and divided into the H-SOFA group (SOFA ≥ 7) and L-SOFA group (SOFA < 7) or H-SAPS II group (SAPS II ≥ 43) and L-SAPS II group (SAPS II < 43). In-hospital mortality, 28-day mortality, 90-day mortality, and 1-year mortality were higher, the length of hospital and ICU stay were longer in the H-SOFA group than in the L-SOFA group (p < 0.05), while the incidence of AKI was not significantly different. In-hospital mortality, 28-day mortality, 90-day mortality, 1-year mortality, and the incidence of AKI were all significantly higher in the H-SAPS II group than in the L-SAPS II group (p < 0.05). Hospital stay and ICU stay were longer in the H-SAPS II group than in the L-SAPS II group (p < 0.05). According to DCA, the SAPS II scoring system had more net benefits on assessing the long-term mortality compared with the SOFA scoring system.Conclusion: Exceeding the cutoff values of SOFA and SAPS II scores could lead to increased mortality and extended length of ICU and hospital stay. The SAPS II scoring system had a better discriminative performance of 90-day mortality and 1-year mortality in post-cardiac surgery patients than the SOFA scoring system. Emphasizing the critical value of the scoring system is of significance for timely treatment.

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Prognostic Value of High-sensitivity Cardiac Troponin in Non-cardiac Surgical Patients in Intensive Care Units

10.21203/rs.3.rs-754326/v1 ◽

2021 ◽

Author(s):

Jitain Sivarajah ◽

Michael Toolis ◽

Samantha Seminoff ◽

Jesse Smith ◽

Vikram Bhalla ◽

...

Keyword(s):

Intensive Care ◽

Hospital Mortality ◽

Cardiac Troponin ◽

Prognostic Value ◽

Myocardial Injury ◽

High Sensitivity ◽

Surgical Patients ◽

Type Ii ◽

Icu Admission ◽

Increased Risk

Abstract Background: Type II myocardial injury following surgical procedures is associated with adverse outcomes. The prognostic value of prognostic value of high-sensitivity cardiac troponin (hs-cTn) due to type II myocardial injury in surgical patients admitted to intensive care unit (ICU) remains unclear. The aim of this study was to assess prognostic value of hs-cTn in type II acute myocardial injury in noncardiac surgical patients requiring post-operative ICU admission.Methods: Retrospective analysis of patients admitted to two level III ICUs following surgery and had hs-cTn measured on the day of ICU admission. Patients who had type I acute myocardial infarction (AMI) during their admission were excluded from the study. The primary outcome was hospital mortality. Secondary outcomes included ICU mortality, ICU length of stay (LOS) and hospital LOS.Results: A total of 420 patients were included. On univariable analysis, higher hs-cTn was associated with increased hospital mortality (14.6% vs 6.3%, p = 0.008), ICU LOS (41.1, vs 25 hours, p = 0.004) and hospital LOS (253 hours vs 193 hours, p = 0.02). On multivariable analysis, hs-cTn was not independently associated with increased risk of hospital mortality. However, in patients who had elective surgery, hs-cTn was associated with increased risk (OR 1.048; 95% CI 1.004-1.094; p = 0.031) of hospital morality with area under the receiver operating characteristic curves of 0.753 (95% CI 0.598- 0.908).Conclusions: In elective surgical patients, hs-cTn was associated with increased risk of mortality. Larger multicentre studies are required to confirm this association that may assist in risk stratification of elective surgical patients requiring ICU admission.

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