Effect of Hypomagnesemia On The Prognosis of Patients With Sepsis in ICU: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Chenwei Lv ◽  
Jing Hu ◽  
Xingxing Hu ◽  
Jiangyun Liu
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Drug Use ◽  
Hospital Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Serum Magnesium ◽  
Vasoactive Drug ◽  
Magnesium Supplementation ◽  
Length Of Icu Stay

Abstract Objective Existing studies have shown that the incidence of hypomagnesemia may be as high as 60%. However, the correlation between hypomagnesia and sepsis mortality remains elusive. The current study evaluated the effect of hypomagnesemia on the prognosis of patients with sepsis in ICU. Methods It was a retrospective cohort study based on an online database named MIMIC III. A total of 1448 sepsis patients with serum magnesium were admitted to the database, among which 645 patients were screened out. Results At 28 days, 99 patients (30.84%) in the hypomagnesemia group and 123 patients (38.0%) (P = 0.06) in the non-hypomagnesemia group died. There was no correlation between hypomagnesemia and 28-day mortality in patients with sepsis (HR = 1.07; P = 0.87, 95% CI). However, the duration of mechanical ventilation (P < 0.01), the duration of vasoactive drug use (P < 0.01), the length of ICU stay (P < 0.01), and the length of hospital stay (P < 0.01) of patients in the hypomagnesemia group were higher than those in the non-hypomagnesemia group. In the subgroup analysis, the time of no vasopressor (P < 0.01) and the time of no mechanical ventilation (P < 0.01) in the magnesium supplementation group were significantly longer than those in the non-magnesium supplementation group. More importantly, the 14-day mortality (30.8% vs 48.9%, P < 0.01) and 28-day mortality (33.8% vs 48.9%, P = 0.03) in patients with magnesium supplementation were lower than patients without magnesium supplementation. Conclusions For sepsis patients in ICU, although hypomagnesemia had no significant correlation with 28-day mortality, it still prolonged the duration of mechanical ventilation and vasoactive drug use, and increased the length of ICU stay and hospital stay. Even for patients with normal serum magnesium levels, optimizing serum magnesium levels may improve the prognosis of patients with sepsis.

scholarly journals Intravenous immunoglobulin-based adjuvant therapy for severe COVID-19: a single-center retrospective cohort study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Xiao Hou ◽  
Li Tian ◽  
Lei Zhou ◽  
Xinhua Jia ◽  
Li Kong ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Adjuvant Therapy ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Intravenous Immunoglobulin ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Length Of Hospital Stay ◽  
Single Center

Abstract Objective Coronavirus disease 2019 (COVID-19) is a major challenge facing the world. Certain guidelines issued by National Health Commission of the People's Repubilic of China recommend intravenous immunoglobulin (IVIG) for adjuvant treatment of COVID-19. However, there is a lack of clinical evidence to support the use of IVIG. Methods This single-center retrospective cohort study included all adult patients with laboratory-confirmed severe COVID-19 in the Respiratory and Critical Care Unit of Dabie Mountain Regional Medical Center, China. Patient information, including demographic data, laboratory indicators, the use of glucocorticoids and IVIG, hospital mortality, the application of mechanical ventilation, and the length of hospital stay was collected. The primary outcome was the composite end point, including death and the use of mechanical ventilation. The secondary outcome was the length of hospital stay. Results Of the 285 patients with confirmed COVID-19, 113 severely ill patients were included in this study. Compared to the non-IVIG group, more patients in the IVIG group reached the composite end point [12 (25.5%) vs 5 (7.6%), P = 0.008] and had longer hospital stay periods [23.0 (19.0–31.0) vs 16.0 (13.8–22.0), P < 0.001]. After adjusting for confounding factors, differences in primary outcomes between the two groups were not statistically significant (P = 0.167), however, patients in the IVIG group had longer hospital stay periods (P = 0.041). Conclusion Adjuvant therapy with IVIG did not improve in-hospital mortality rates or the need for mechanical ventilation in severe COVID-19 patients. Our study does not support the use of immunoglobulin in patients with severe COVID-19 patients.

scholarly journals Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
pp. 205435812110277
Author(s):  
Tyler Pitre ◽  
Angela (Hong Tian) Dong ◽  
Aaron Jones ◽  
Jessica Kapralik ◽  
Sonya Cui ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Disease Severity ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

scholarly journals The Association of Low Admission Serum Creatinine with the Risk of Respiratory Failure Requiring Mechanical Ventilation: A Retrospective Cohort Study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Charat Thongprayoon ◽  
Wisit Cheungpasitporn ◽  
Api Chewcharat ◽  
Michael A. Mao ◽  
Sorkko Thirunavukkarasu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Respiratory Failure ◽  
Serum Creatinine ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Reference Group ◽  
Hospitalized Patients ◽  
Tertiary Referral Hospital ◽  
Time Of Admission

AbstractTo assess the association between low serum creatinine (SCr) value at admission and the risk of respiratory failure requiring mechanical ventilation in hospitalized patients. A retrospective cohort study was conducted at a tertiary referral hospital. All hospitalized adult patients from 2011 through 2013 who had an admission SCr value were included in this study. Patients who were mechanically ventilated at the time of admission were excluded. Admission creatinine was stratified into 7 groups: ≤0.4, 0.5–0.6, 0.7–0.8, 0.9–1.0, 1.1–1.2, 1.3–1.4, and ≥1.5 mg/dL. The primary outcome was the occurrence of respiratory failure requiring mechanical ventilation during hospitalization. Logistic regression analysis was used to assess the independent risk of respiratory failure based on various admission SCr, using SCr of 0.7–0.8 mg/dL as the reference group in the analysis of all patients and female subgroup and of 0.9–1.0 mg/dL in analysis of male subgroup. A total of 67,045 eligible patients, with the mean admission SCr of 1.0 ± 0.4 mg/dL, were studied. Of these patients, 799 (1.1%) had admission SCr of ≤0.4 mg/dL, and 2886 (4.3%) developed respiratory failure requiring mechanical ventilation during hospitalization. The U-curve relationship between admission SCr and respiratory failure during hospitalization was observed, with the nadir incidence of in-hospital respiratory failure in SCr of 0.7–0.8 mg/dL and increased in-hospital respiratory failure associated with both reduced and elevated admission SCr. After adjustment for confounders, very low admission SCr of ≤0.4 mg/dL was significantly associated with increased in-hospital respiratory failure (OR 3.11; 95% CI 2.33–4.17), exceeding the risk related to markedly elevated admission SCr of ≥1.5 mg/dL (OR 1.61; 95% CI 1.39–1.85). The association remained significant in the subgroup analysis of male and female patients. Low SCr value at admission is independently associated with increased in-hospital respiratory failure requiring mechanical ventilation in hospitalized patients.

scholarly journals Overrepresentation of Injection Drug Use Route of Infection Among Human Immunodeficiency Virus Long-term Nonprogressors: A Nationwide, Retrospective Cohort Study in China, 1989–2016

2019 ◽  
Vol 6 (5) ◽  
Author(s):  
Jing Han ◽  
Zunyou Wu ◽  
Jennifer M McGoogan ◽  
Yurong Mao ◽  
Houlin Tang ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cohort Study ◽  
Drug Use ◽  
Injection Drug Use ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Injection Drug ◽  
Route Of Infection ◽  
Immunodeficiency Virus

Abstract Background Why some persons living with human immunodeficiency virus (HIV) (PLWH) progress quickly and others remain “healthy” for a decade or more without treatment remains a fundamental question of HIV pathology. We aimed to assess the epidemiological characteristics of HIV long-term nonprogressors (LTNPs) based on a cohort of PLWH in China observed between 1989 and 2016. Methods We conducted a nationwide, retrospective cohort study among Chinese PLWH with HIV diagnosed before 1 January 2008. Records were extracted from China’s national HIV/AIDS database on 30 June 2016. LTNPs were defined as those with AIDS-free, antiretroviral therapy–naive survival, with CD4 cell counts consistently ≥500/μL for ≥8 years after diagnosis. Prevalence was calculated, characteristics were described, and determinants were assessed by means of logistic regression. Potential sources of bias were also investigated. Results Our cohort included 89 201 participants, of whom 1749 (2.0%) were categorized as LTNPs. The injection drug use (IDU) route of infection was reported by 70.7% of LTNPs, compared with only 37.1% of non-LTNPs. The odds of LTNP status were greater among those infected via IDU (adjusted odds ratio [95% confidence interval], 2.28 [1.94–2.68]) and with HIV diagnosed in settings with large populations of persons who inject drugs (1.75 [1.51–2.02] for detention centers, 1.61 [1.39–1.87] for Yunnan, 1.94 [1.62–2.31] for Guangdong, and 2.90 [2.09–4.02] for Xinjiang). Conclusions Overrepresentation of the IDU route of infection among LTNPs is a surprising finding worthy of further study, and this newly defined cohort may be particularly well suited to exploration of the molecular biological mechanisms underlying HIV long-term nonprogression.

Prognostic Factors Associated with Hospital Stay in Patients Undergoing Emergency Cholecystectomy: Retrospective Cohort Study

2019 ◽  
Vol 229 (4) ◽  
pp. e124-e125
Author(s):  
Pilar C. Pinillos Navarro ◽  
Jorge A. Martínez Martínez ◽  
Edgar G. Junca ◽  
Andrés F. Patiño ◽  
Juan S. Moyano ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prognostic Factors ◽  
Hospital Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Factors Associated ◽  
Emergency Cholecystectomy

scholarly journals Drug use disorder following early life exposure to tetrachloroethylene (PCE)-contaminated drinking water: a retrospective cohort study

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Ann Aschengrau ◽  
Alexandra Grippo ◽  
Michael R. Winter ◽  
Margaret G. Shea ◽  
Roberta F. White ◽  
...  
Keyword(s):  
Early Childhood ◽  
Drinking Water ◽  
Cohort Study ◽  
Drug Use ◽  
Diagnostic Criteria ◽  
Retrospective Cohort Study ◽  
Early Life ◽  
Retrospective Cohort ◽  
Contaminated Drinking Water ◽  
Drug Use Disorder

Abstract Background Many studies of adults with occupational exposure to solvents such as tetrachloroethylene (PCE) have shown adverse effects on cognition, mood and behavioral problems. Much less is known about neurotoxic effects in early life at lower exposure levels seen in community settings. We recently reported that illicit drug use was more frequent among adults from Cape Cod, Massachusetts who were exposed to PCE-contaminated drinking water during gestation and early childhood than their unexposed counterparts. Using newly collected data from this population-based retrospective cohort study, the current analysis examines whether early life PCE exposure is also associated with drug use disorder over the life course. Methods Three-hundred and sixty-three subjects with prenatal and early childhood PCE exposure and 255 unexposed subjects were studied. These individuals (median age: 40–41 years) completed self-administered questionnaires on the eleven established diagnostic criteria for drug use disorder and confounding variables. A validated leaching and transport model was used to estimate exposure to PCE-contaminated water. Results Overall, 23.3% of subjects reported having at least one criterion for drug use disorder over their lifetime. Early life PCE exposure was associated with a modest increase in the lifetime presence of one or more diagnostic criteria for drug use disorder (adjusted RR: 1.4, 95% CI: 1.0–1.8). Compared to unexposed subjects, PCE-exposed subjects were more likely to report having most diagnostic criteria of drug use disorder, including neglecting major roles due to drug use, physical and psychological problems related to drug use, and giving up activities due to drug use. No dose-response relationships were observed with increasing levels of PCE exposure. Conclusions These results suggest that exposure to PCE-contaminated drinking water during early life modestly increases the risk of developing diagnostic criteria for drug use disorder later in life. Because this study has several limitations, these findings should be confirmed in follow-up investigations of other exposed populations with more diverse racial and socioeconomic characteristics.

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