scholarly journals Admission Oxygen Saturation and Mortality in Acute Pulmonary Embolism Patients: Observational Data From Large ICU Databases

2021 ◽  
Author(s):  
Xiaolin Xu ◽  
Anping Peng ◽  
Jing Tian ◽  
Runnan Shen ◽  
Guochang You ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Logistic Regression ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Oxygen Saturation ◽  
Acute Pulmonary Embolism ◽  
Research Database ◽  
Optimal Range ◽  
Subgroup Analyses ◽  
The Relationship

Abstract Background The relationship between blood oxygenation and clinical outcomes of acute pulmonary embolism (APE) patients in intensive care unit (ICU) is unclear, which could be nonlinear. The study aimed to determine the association between admission pulse oximetry-derived oxygen saturation (SpO2) levels and mortality, and to determine the optimal range with real-world data. Methods Patients diagnosed with APE on admission and staying in ICU for at least 24 hours in the Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU-CRD) were included. Logistic regression and restricted cubic spline (RCS) models were applied to determine the nonlinear relationship between mean SpO2 levels within the first 24 hours after ICU admission and in-hospital mortality, from which we derived an optimal range of SpO2. Subgroup analyses were based on demographics, treatment information, scoring system and comorbidities. Results We included 1109 patients who fulfilled inclusion criteria, among whom 129 (12%) died during hospitalization and 80 (7.2%) died in ICU. The RCS showed that the relationship between admission SpO2 levels and in-hospital mortality of APE patients was nonlinear and U-shaped. The optimal range of SpO2 with the lowest mortality was 95–98%. Multivariate stepwise logistic regression analysis with backward elimination confirmed that the admission SpO2 levels of 95%-98% was associated with decreased hospital mortality compared to the group with SpO2 < 95% (Odds ratio [OR] = 2.321; 95% confidence interval [CI]: 1.405–3.786; P < 0.001) and 100% (OR = 2.853; 95% CI: 1.294–5.936; P = 0.007), but there was no significant difference compared with 99% SpO2 (OR = 0.670, 95% CI: 0.326–1.287; P > 0.05). This association was consistent across subgroup analyses. Conclusions The relationship between admission SpO2 levels and in-hospital mortality followed a U-shaped curve among patients with APE. The optimal range of SpO2 for APE patients was 95–98%.

scholarly journals MR-proADM and MR-proANP levels in patients with acute pulmonary embolism

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Önsel Öner ◽  
Figen Deveci ◽  
Selda Telo ◽  
Mutlu Kuluöztürk ◽  
Mehmet Balin
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Acute Pulmonary Embolism ◽  
Low Risk ◽  
Control Group ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Relationship

Summary Background The aim of this study was to determine levels of Mid-regional Pro-adrenomedullin (MR-proADM) and Mid-regional Pro-atrial Natriuretic Peptide (MR-proANP) in patients with acute pulmonary embolism (PE), the relationship between these parameters and the risk classification in addition to determining the relationship between 1- and 3-month mortality. Methods 82 PE patients and 50 healthy control subjects were included in the study. Blood samples for MR-proANP and MR-proADM were obtained from the subjects prior to the treatment. Risk stratification was determined according to sPESI (Simplified Pulmonary Embolism Severity Index). Following these initial measurements, cases with PE were assessed in terms of all causative and PE related mortalities. Results The mean serum MR-proANP and MR-proADM levels in acute PE patients were found to be statistically higher compared to the control group (p < 0.001, p < 0.01; respectively) and statistically significantly higher in high-risk patients than low-risk patients (p < 0.01, p < 0.05; respectively). No statistical difference was determined in high-risk patients in case of sPESI compared to low-risk patients while hospital mortality rates were higher. It was determined that the hospital mortality rate in cases with MR-proANP ≥ 123.30 pmol/L and the total 3-month mortality rate in cases with MR-proADM ≥ 152.2 pg/mL showed a statistically significant increase. Conclusions This study showed that MR-proANP and MR-proADM may be an important biochemical marker for determining high-risk cases and predicting the mortality in PE patients and we believe that these results should be supported by further and extensive studies.

Prevalence of thrombocytosis in critically ill patients and its association with symptomatic acute pulmonary embolism

2013 ◽  
Vol 109 (02) ◽  
pp. 272-279 ◽  
Author(s):  
Shaila Chavan ◽  
Kwok Ho
Keyword(s):  
Pulmonary Embolism ◽  
Intensive Care ◽  
Platelet Count ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Acute Pulmonary Embolism ◽  
Increased Risk ◽  
Wide Range ◽  
The Relationship ◽  
Acute Pe

SummaryIt is uncertain whether thrombocytosis without underlying myeloproliferative diseases is associated with an increased risk of acute pulmonary embolism (PE). We investigated the relationship between thrombocytosis and risk of symptomatic acute PE, and whether Pulmonary Embolism Severity Index (PESI) was reliable in predicting mortality of acute PE. This multicentre registry study involved a total of 609,367 critically ill patients admitted to 160 intensive care units (ICUs) in Australia or New Zealand between 2006 and 2011. Forward stepwise logistic regression was used to assess the relationship between risk of acute PE and platelet counts on intensive care unit (ICU) admission. Acute PE (n=3387) accounted for 0.9% of all emergency ICU admissions. Over 20% of all PE required mechanical ventilation, 4.2% had cardiac arrest, and the mortality was high (14.8%). Thrombocytosis, defined by a platelet count >500×109 per litre, occurred in 2.1% of the patients and was more common in patients with acute PE than other diagnoses (3.4 vs. 2.0%). The platelet counts explained about 4.5% of the variability and had a linear relationship with the risk of acute PE (odds ratio 1.19 per 100×109 per litre increment in platelet count, 95% confidence interval 1.06–1.34), after adjusting for other covariates. The PESI had a reasonable discriminative ability (area under receiver-operating-characteristic curve = 0.78) and calibration to predict mortality across a wide range of severity of acute PE. In summary, thrombocytosis was associated with an increased risk of symptomatic acute PE. PESI was useful in predicting mortality across a wide range of severity of acute PE.

scholarly journals Optimal Oxygen Saturation Targets in Patients with Sepsis- Associated Encephalopathy: A Cohort Study from the MIMIC-IV Database

2021 ◽  
Author(s):  
Lina Zhao ◽  
Yunying Wang ◽  
Zengzheng Ge ◽  
Huadong Zhu ◽  
Yi Li
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Oxygen Saturation ◽  
Medical Information ◽  
Generalized Additive Models ◽  
Additive Models ◽  
Optimal Range ◽  
Oxygenation Status ◽  
The Impact

Abstract Objectives: Patients with sepsis-associated encephalopathy (SAE) in the intensive care unit (ICU) are treated with supplemental oxygen. However, few studies have investigated the impact of oxygenation status on the patient with SAE, and the optimal oxygenation status target remains unclear. We aimed to investigate the relationship between optimal oxygenation status and patients with SAE.Methods: This study is a retrospective cohort study. Patients were diagnosed with sepsis3.0 at the first ICU admission between 2008 and 2019 from Medical Information Mart for Intensive Care IV (MIMIC IV). We use generalized additive models to estimate the optimal oxygen saturation targets in patients with SAE. Multivariate logistic analysis to further confirm it. Measurements and Main Results: A total of 6714 patients with SAE were included. The incidence of patients with SAE was 66.8%, and hospital mortality was 7.9%. SpO2≤92% was the independent risk factor of incidence in patients with SAE. The optimal range of SpO2 was 93%–97%, which can reduce the incidence of patients with SAE. The optimal range of SpO2 was 92%–96%, reducing the hospital mortality of patients with SAE.Conclusions: The optimal range of SpO2 was 93%–96% reduce the hospital mortality and incidence of patients with SAE. SAE patients need conservative oxygen therapy

Infection management processes in intensive care and their association with mortality

2021 ◽  
Author(s):  
Leigh P. Fitzpatrick ◽  
Bianca Levkovich ◽  
Steve McGloughlin ◽  
Edward Litton ◽  
Allen C. Cheng ◽  
...  
Keyword(s):  
Intensive Care ◽  
New Zealand ◽  
Hospital Mortality ◽  
Process Of Care ◽  
Infection Management ◽  
Hierarchical Logistic Regression ◽  
Management Processes ◽  
Patient Database ◽  
Improving Patient Care ◽  
The Relationship

Abstract Background ICU-specific tables of antimicrobial susceptibility for key microbial species (‘antibiograms’), antimicrobial stewardship (AMS) programmes and routine rounds by infectious diseases (ID) physicians are processes aimed at improving patient care. Their impact on patient-centred outcomes in Australian and New Zealand ICUs is uncertain. Objectives To measure the association of these processes in ICU with in-hospital mortality. Methods The Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database and Critical Care Resources registry were used to extract patient-level factors, ICU-level factors and the year in which each process took place. Descriptive statistics and hierarchical logistic regression were used to determine the relationship between each process and in-hospital mortality. Results The study included 799 901 adults admitted to 173 ICUs from July 2009 to June 2016. The proportion of patients exposed to each process of care was 38.7% (antibiograms), 77.5% (AMS programmes) and 74.0% (ID rounds). After adjusting for confounders, patients admitted to ICUs that used ICU-specific antibiograms had a lower risk of in-hospital mortality [OR 0.95 (99% CI 0.92–0.99), P = 0.001]. There was no association between the use of AMS programmes [OR 0.98 (99% CI 0.94–1.02), P = 0.16] or routine rounds with ID physicians [OR 0.96 (99% CI 0.09–1.02), P = 0.09] and in-hospital mortality. Conclusions Use of ICU-specific antibiograms was associated with lower in-hospital mortality for patients admitted to ICU. For hospitals that do not perform ICU-specific antibiograms, their implementation presents a low-risk infection management process that might improve patient outcomes.

Hyperoxia is associated with adverse outcomes in the cardiac intensive care unit: insights from the Medical Information Mart for Intensive Care (MIMI-III) database

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.Y Lui ◽  
L Garber ◽  
M Vincent ◽  
L Celi ◽  
J Masip ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Logistic Regression ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Adverse Outcomes ◽  
Rank Test ◽  
Positive Pressure ◽  
Cardiac Intensive Care Unit ◽  
Multivariable Logistic Regression ◽  
Cardiac Intensive Care

Abstract Background Hyperoxia produces reactive oxygen species, apoptosis, and vasoconstriction, and is associated with adverse outcomes in patients with heart failure and cardiac arrest. Our aim was to evaluate the association between hyperoxia and mortality in patients (pts) receiving positive pressure ventilation (PPV) in the cardiac intensive care unit (CICU). Methods Patients admitted to our medical center CICU who received any PPV (invasive or non-invasive) from 2001 through 2012 were included. Hyperoxia was defined as time-weighted mean of PaO2 &gt;120mmHg and non-hyperoxia as PaO2 ≤120mmHg during CICU admission. Primary outcome was in-hospital mortality. Multivariable logistic regression was used to assess the association between hyperoxia and in-hospital mortality adjusted for age, female sex, Oxford Acute Severity of Illness Score, creatinine, lactate, pH, PaO2/FiO2 ratio, PCO2, PEEP, and estimated time spent on PEEP. Results Among 1493 patients, hyperoxia (median PaO2 147mmHg) during the CICU admission was observed in 702 (47.0%) pts. In-hospital mortality was 29.7% in the non-hyperoxia group and 33.9% in the hyperoxia group ((log rank test, p=0.0282, see figure). Using multivariable logistic regression, hyperoxia was independently associated with in-hospital mortality (OR 1.507, 95% CI 1.311–2.001, p=0.00508). Post-hoc analysis with PaO2 as a continuous variable was consistent with the primary analysis (OR 1.053 per 10mmHg increase in PaO2, 95% CI 1.024–1.082, p=0.0002). Conclusions In a large CICU cohort, hyperoxia was associated with increased mortality. Trials of titration of supplemental oxygen across the full spectrum of critically ill cardiac patients are warranted. Funding Acknowledgement Type of funding source: None

Trends in risk stratification, in-hospital management and mortality of patients with acute pulmonary embolism: an analysis from China pUlmonary thromboembolism REgistry Study (CURES)

2021 ◽  
pp. 2002963
Author(s):  
Zhenguo Zhai ◽  
Dingyi Wang ◽  
Jieping Lei ◽  
Yuanhua Yang ◽  
Xiaomao Xu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Acute Pulmonary Embolism ◽  
Severity Index ◽  
Disease Diagnosis ◽  
Initial Therapy ◽  
European Respiratory Society ◽  
Systemic Thrombolysis ◽  
All Cause Mortality

BackgroundSimilar trends of management and in-hospital mortality of acute pulmonary embolism (PE) have been reported in European and American populations. However, these tendencies were not clear in Asian countries.ObjectivesWe retrospectively analyzed the trends of risk stratification, management and in-hospital mortality for patients with acute PE through a multicenter registry in China (CURES).MethodsAdult patients with acute symptomatic PE were included between 2009 and 2015. Trends in disease diagnosis, treatment and death in hospital were fully analyzed. Risk stratification was retrospectively classified by hemodynamical status and the simplified Pulmonary Embolism Severity Index (sPESI) score according to the 2014 European Society of Cardiology/European Respiratory Society guidelines.ResultsAmong overall 7438 patients, the proportions with high (hemodynamically instability), intermediate (sPESI≥1) and low (sPESI=0) risk were 4.2%, 67.1% and 28.7%, respectively. Computed tomographic pulmonary angiography was the widely employed diagnostic approach (87.6%) and anticoagulation was the frequently adopted initial therapy (83.7%). Between 2009 and 2015, a significant decline was observed for all-cause mortality (from 3.1% to 1.3%, adjusted Pfor trend=0.0003), with a concomitant reduction in use of initial systemic thrombolysis (from 14.8% to 5.0%, Pfor trend<0.0001). The common predictors for all-cause mortality shared by hemodynamically stable and unstable patients were co-existing cancer, older age, and impaired renal function.ConclusionsThe considerable reduction of mortality over years was accompanied by changes of initial treatment. These findings highlight the importance of risk stratification-guided management throughout the nation.

Abstract 13317: Acute Pulmonary Embolism in Covid-19 Patients: Presenting Characteristics, Outcomes and Risk Stratification Strategies

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hai Xu ◽  
Angel Martin ◽  
Avneet SINGH ◽  
Mangala Narasimhan ◽  
Joe Lau ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Intensive Care ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Risk Stratification ◽  
Clinical Outcomes ◽  
Acute Pulmonary Embolism ◽  
Severe Bleeding ◽  
Study Cohort ◽  
D Dimer

Introduction: Pulmonary Embolism in coronavirus disease 2019 (COVID-19) patients have been increasingly reported in observational studies. However, limited knowledge describing their diagnostic features and clinical outcomes exist to date. Our study aims to systemically analyze their clinical characteristics and to investigate strategies for risk stratification. Methods: We retrospectively studied 101 patients with concurrent diagnoses of acute pulmonary embolism and COVID-19 infection, admitted at two tertiary hospitals within the Northwell Health System in New York City area. Clinical features including laboratory and imaging findings, therapeutic interventions, intensive care unit (ICU) admission, mortality and length of stay were recorded. D-dimer values were respectively documented at COVID-19 and PE diagnoses for comparison. Pulmonary Severity Index (PESI) scores were used for risk stratification of clinical outcomes. Results: The most common comorbidities were hypertension (50%), obesity (27%) and hyperlipidemia (32%) among our study cohort. Baseline D-dimer abnormalities (4647.0 ± 8281.8) were noted on admission with a 3-fold increase at the time of PE diagnosis (13288.4 ± 14917.9; p<0.05). 5 (5%) patients required systemic thrombolysis and 12 (12%) patients experienced moderate to severe bleeding. 31 (31%) patients developed acute kidney injury (AKI) and 1 (1%) patient required renal replacement therapy. Throughout hospitalization, 23 (23%) patients were admitted to intensive care units, of which 20 (20%) patients received invasive mechanical ventilation. The overall mortality rate was 20%. Majority of patients (65%) had Intermediate to high risk PESI scores (>85), which portended a worse prognosis with higher mortality rate and length of stay. Conclusions: This study provides characteristics and early outcomes for hospitalized patients with COVID-19 and acute pulmonary embolism. D-dimer levels and PESI scores may be utilized to risk stratify and guide management in this patient population. Our results should serve to alert the medical community to heighted vigilance of this VTE complication associated with COVID-19 infection, despite the preliminary and retrospective nature inherent to this study.

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