scholarly journals Predictors of in-hospital mortality in critically ill Geriatric patients

2021 ◽  
pp. 77
Author(s):  
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Roc Curve ◽  
Total Protein ◽  
Prognostic Model ◽  
Geriatric Patients ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Distribution Width ◽  
Predictors Of Mortality

Objective: To determine the predictors of in-hospital mortality in critically ill older patients. Participants and Methods: A prospective cohort study including 305 critically ill older adults (age ≥60 years) who were admitted to High Dependency Units (HDUs) in a tertiary care university hospital from March 22, 2019 to January 4, 2020. Demographic, clinical and laboratory data of participants were collected thought a review of medical records and clinical observation at HDUs till either death or discharge alive. Statistical analysis included univariate analysis of selected potential predictors such as various comorbidities, C- reactive protein / Albumin ratio (CAR), Neutrophil-lymphocyte ratio (NLR), Red cell distribution width (RDW), Po2/Fio2 ratio (PFR), Simplified acute physiology score II (SAPS II), Charlson comorbidity index (CCI) and multidrug-resistant Gram-negative bacterial (MDR-GNB) infection to ascertain their association with mortality, followed by multivariable logistic regression to derive the final prediction model. The discriminative ability of the model was evaluated by using the receiver operating characteristic (ROC) curve. RESULTS: Overall mortality was 53.1%. Multivariate regression analysis revealed independent predictors of mortality including dementia in clinical history with an odds ratio (OR) of 4.86 (95% CI: 1.28-18.34), total protein with an OR of .53 (95% CI: .30-.95) and the use of mechanical ventilation (MV) and/or intravenous cardiovascular support with an OR of 148.34 (95% CI: 34.28-641.77), formulating a novel prognostic model with an area under the ROC curve of .93 (95% CI: .89-.96, P.000). CONCLUSION: History of dementia, total protein and the use of MV and/or intravenous cardiovascular support are predictors of mortality in critically ill geriatric patients. It provides a novel prognostic model which needs validation in other multicenter prospective studies.

scholarly journals A Retrospective Cohort Study on the Association between Red Cell Distribution Width and All-Cause Mortality of Patients with Cholecystitis at ICU Admission

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Yihua Dong ◽  
Yu Pan ◽  
Wei Zhou ◽  
Yanhuo Xia ◽  
Jingye Pan
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
Regression Models ◽  
Red Cell ◽  
Cell Distribution ◽  
Distribution Width ◽  
Prognostic Effect ◽  
Short And Long Term ◽  
Long Term Mortality

Background. Elevated red cell distribution width (RDW) has been reported to be associated with mortality in some critically ill patient populations. The aim of this article is to investigate the relationship between RDW and in-hospital mortality and short- and long-term mortality of patients with cholecystitis. Method. We conducted a retrospective cohort study in which data from all 702 patients extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database were used. Receiver operating characteristic (ROC) curves were constructed to evaluate the prognostic predictive value of RDW for in-hospital mortality and short- (i.e., 30-day and 90-day) and long-term (i.e., 180-day, 1-year, 3-year, and 5-year) mortality. We converted RDW into a categorical variable according to quintiles as less than or equal to 13.9%, 14.0-14.8%, 14.9-15.8%, and 15.9-17.2% and more than 17.2%. The Kaplan-Meier (K-M) methods and log-rank tests were used to compare survival differences among different groups. The relationships between RDW levels and in-hospital mortality were evaluated by univariate and multivariate binary logistic regression models. Multivariable Cox regression models were built to investigate the association of RDW on the short-term and long-term mortality. Result. After adjusting for potential confounders, RDW was positively associated with in-hospital mortality (OR: 1.187, 95% CI [1.049, 1.343]) and short- (i.e., 30-day: HR: 1.183, 95% CI [1.080, 1.295], 90-day: HR: 1.175, 95% CI [1.089, 1.268]) and long-term (i.e., 1-year: HR:1.162, 95% CI [1.089, 1.240]) mortality in critically ill patients with cholecystitis. Similar results were also shown in the secondary outcomes of 180-day, 3-year, and 5-year mortality. RDW had a significant accurate prognostic effect on different endpoints and could improve the prognostic effect of scoring systems. Conclusion. High level of RDW is associated with an increased risk of in-hospital mortality and short- and long-term mortality in critically ill patients with cholecystitis. RDW can independently predict the prognosis of patients with cholecystitis.

scholarly journals Clinical and Laboratory Predictors of Mortality in Patients With SARS-CoV-2 Infection in A Tertiary Care Center of Central Kerala, India - A Case control Study

2021 ◽  
Vol 6 (4) ◽  
pp. 111-120
Author(s):  
Priyanka Rajmohan ◽  
◽  
Anil Kumar Chellappan pillai Chellappan pillai Rajamma ◽  
Mimtha Ayiravelil Mohanan ◽  
Ponnu Jose ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Serum Creatinine ◽  
Case Control Study ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Case Control ◽  
Hospital Death ◽  
Predictors Of Mortality ◽  
Multivariable Logistic Regression ◽  
Control Study

Background: Since various studies indicate differences in the case fatality rate of SARS-CoV-2 in different settings, it is vital to elucidate the clinical and laboratory parameters. This would be helpful in identifying individuals who are susceptible to adverse outcomes, thereby targeting essential health interventions to resource poor settings. This study aimed to determine the clinical and laboratory predictors of mortality due to COVID-19. Materials & Methods: In this case control study, we included 162 adult inpatients who died due to COVID-19 from May 2020 to February 2021, as cases (n=81) and those discharged as controls (n=81). Demographic, clinical, treatment, and laboratory data was extracted from medical records and electronic database and compared between survivors and non-survivors. Univariate analysis and multivariable logistic regression methods were used to identify the risk factors associated with in-hospital death. Results: Comorbidities were present among 82 (50.6%) participants. Hypertension was the most common comorbidity 99(61.1%) followed by diabetes mellitus 92 (56.8%) and coronary artery disease 55(34%). Multivariable logistic regression model showed that cardiovascular disease (OR=5.80, 95%CI: 1.09–47.55, P=0.011), decreased oxygen saturation (OR=33.68, 95%CI: 2.81–403.80, P=0.006), elevated CRP (OR=1.16, 95%CI: 1.01–1.32, P=0.026), and serum creatinine (OR=3.26, 95%CI: 1.02–11.55, P=0.047) were the significant predictors of mortality. Conclusion: This study found that comorbidities such as CAD, elevated serum creatinine, elevated inflammatory markers, and decreased O2 saturation were independent predictors of mortality among COVID-19 patients.

scholarly journals The predictive value of red blood cell distribution width and platelet-to -lymphocyte ratio for acute kidney injury in critically ill patients

2021 ◽  
Author(s):  
Yan Tang ◽  
Fen Jiang ◽  
Li Zhang ◽  
Jiaxuan Xiang ◽  
Jie Lei ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Blood Cell ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Cell Distribution ◽  
Platelet To Lymphocyte Ratio ◽  
Distribution Width ◽  
Red Blood Cell Distribution

Abstract Background Red blood cell distribution width (RDW) and the platelet-to-lymphocyte ratio (PLR) are associated with different types of prognoses in critically ill patients. But, the value of RDW and PLR in predicting the occurrence of acute kidney injury (AKI) in critically ill patients are unknown. The purpose of the study was to explore the associations of RDW and PLR with AKI incidence. Methods Among 1500 adult patients in the intensive care unit (ICU) between January 2016 and December 2019 were enrolled, we examined the associations of baseline RDW and PLR with the risk of AKI development using logistical analysis. In addition, we explored the value of RDW and PLR in predicting in-hospital mortality. Results The study participants included 951 men and 549 women, aged 60.1±16.14 years. The subjects had a mean RDW of 14.65±2.14% and a mean PLR of 188.16±129.2. Overall, 615 (41%) patients were diagnosed with AKI. There were remarkable differences in RDW and the PLR between the AKI and non-AKI groups (P<0.001). After adjustment, the association of RDW with AKI development risk strengthened (OR: 1.28, 95% CI: 1.19-1.36). Moreover, we divided the groups into two subgroups each; the high-RDW (≥14.045%) group had a high risk of developing AKI (OR=5.189, 95% CI: 4.088-6.588), while the high-PLR(≥172.067)group had a risk of developing AKI (OR=9.11,95% CI:7.09-11.71). The areas under the receiver operating characteristic curves (AUCs) for the prediction of AKI incidence based on RDW and PLR were 0.780 (95% CI: 0.755-0.804) and 0.728 (95% CI:0.702-0.754) (all P< 0.001), with cut-off values of 14.045 and 172.067, respectively. Moreover, a higher RDW was associated with a higher rate of hospital mortality (OR: 2.907, 2.190-3.858), and the risk of in-hospital mortality related to PLR was 1.534 (95%CI: 1.179-1.995). The AUC for in-hospital mortality based on RDW was 0.663 (95%CI:0.628-0.698), while the AUC for in-hospital mortality based on the PLR was 0.552 (0.514-0.589). Conclusions A higher RDW related to a higher risk of the occurrence of AKI and in-hospital mortality in ICU.The PLR also showed predictive value for the occurrence of AKI but did not show any clear prediction value of in-hospital mortality.

scholarly journals Predictors of Mortality among Inter-Hospital Transferred Patients in a Middle-Income Country: a Retrospective Cohort Study

2021 ◽  
Vol 73 (5) ◽  
Author(s):  
Parin Rattananon ◽  
Isara Yenyuwadee ◽  
Thanchanok Dheeradilok ◽  
Parichaya Boonsoong ◽  
Nintita Sripaiboonkij Thokanit ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Community Hospital ◽  
Tertiary Care Hospital ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Medication Use ◽  
Care Hospital ◽  
Middle Income ◽  
Vasoactive Medication ◽  
Transferred Patients

Objective: To identify predictors for hospital mortality among inter-hospital transferred patients in low-resource settings of rural hospitals in Thailand.Methods: We conducted a retrospective cohort study of patients transferred from emergency room(ER) of a community hospital to its designated tertiary care hospital in a western province of Thailand. During March 2018 and February 2019, medical records of 412 patients were reviewed and extracted for potential predictor variables and outcomes. We defined deaths within 72 hrs after a transfer as primary outcome and overall hospital mortality as secondary outcome. Multivariate logistic regression analysis was performed to identify predictors of the outcomes adjusted for potential confounders.Results: Out of 412 patients, a total of 37 patients (9.0%) died during the stay in receiving hospital and 18 (4.4%) of them died within 72 hrs after transfer. Top ten primary diagnostic categories included road traffic injuries (19.7%), acute appendicitis (9.7%), and acute myocardial infarction (5.1%). Univariate analysis revealed early mortality (<72 hrs) was associated with NEWS2, Emergency Severity Index (ESI), cardiac arrest prior to transfer, use of vasoactive agents, endotracheal intubation and admitting service. Using multiple logistic regression model  adjusted for  the predictors identified by univariate analysis, we found early mortality was independently associated with NEWS2 ≥ 9 (compared to NEWS2 0-6) with OR= 17.51(95%CI 3.16-97.00)  and vasoactive medication use (OR= 5.46, 95%CI 1.39-21.46). Similarly, overall mortality was also independently associated with NEWS2 ≥ 9(OR= 4.76, 95%CI 1.31–17.36)  and  vasoactive medication use (OR= 7.51,95%CI  2.76–20.45).Conclusion: This study identified predictors of early (<72 hrs) hospital mortality and overall hospital mortality among ER patients transferred from a rural community hospital to its designated tertiary care hospital in Thailand, a middle-income country with universal healthcare coverage. The findings might be helpful to inform decision-making dealing with the inter-hospital transfer of ER patients in resource-poor rural settings with similar case-mix.

scholarly journals Non-COVID Neurological Emergencies: A Silent Killer Going Unnoticed during COVID-19 Pandemic

2021 ◽  
Author(s):  
Nikita Dhar ◽  
Govind Madhaw ◽  
Mritunjai Kumar ◽  
Niraj Kumar ◽  
Ashutosh Tiwari ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Care Center ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Poor Compliance ◽  
Severe Illness ◽  
Local Health ◽  
Significant Delay ◽  
Neurological Emergencies ◽  
The Impact

Abstract Objective This study assesses the impact of coronavirus disease 2019 (COVID-19) on the pattern of neurological emergencies reaching a tertiary care center. Materials and Methods This is a retrospective and single center study involving 295 patients with neurological emergencies mainly including acute stroke, status epilepticus (SE), and tubercular meningitis visiting emergency department (ED) from January 1 to April 30, 2020 and divided into pre- and during lockdown, the latter starting from March 25 onward. The primary outcome was number of neurological emergencies visiting ED per week in both periods. Secondary outcomes included disease severity at admission, need for mechanical ventilation (MV), delay in hospitalization, in-hospital mortality, and reasons for poor compliance to ongoing treatment multivariate binary logistic regression was used to find independent predictors of in-hospital mortality which included variables with p <0.1 on univariate analysis. Structural break in the time series analysis was done by using Chow test. Results There was 53.8% reduction in number of neurological emergencies visiting ED during lockdown (22.1 visits vs. 10.2 visits per week, p = 0.001), significantly affecting rural population (p = 0.004). Presenting patients had comparatively severe illness with increased requirement of MV (p < 0.001) and significant delay in hospitalization during lockdown (p < 0.001). Poor compliance to ongoing therapy increased from 34.4% in pre-lockdown to 64.7% patients during lockdown (p < 0.001), mostly due to nonavailability of drugs (p < 0.001). Overall, 35 deaths were recorded, with 20 (8.2%) in pre-lockdown and 15 (29.4%) during lockdown (p = 0.001). Lockdown, nonavailability of local health care, delay in hospitalization, severity at admission, and need for MV emerged as independent predictors of poor outcome in stroke and delay in hospitalization in SE. Conclusion COVID-19 pandemic and associated lockdown resulted in marked decline in non-COVID neurological emergencies reporting to ED, with more severe presentations and significant delay from onset of symptoms to hospitalization.

scholarly journals Association Between Red Cell Distribution Width and Hospital Mortality in Patients with Sepsis

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110042
Author(s):  
Yide Li ◽  
Yingfang She ◽  
Le Fu ◽  
Ruitong Zhou ◽  
Wendi Xiang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Regression Model ◽  
Roc Curve ◽  
Prognostic Value ◽  
Logistic Regression Model ◽  
Cell Distribution ◽  
Multiple Logistic Regression ◽  
Distribution Width ◽  
Apache Iv

Objective Sepsis is the leading cause of death in patients admitted to adult intensive care units (ICUs). We aimed to determine the predictive value of red blood cell distribution width (RDW) in patients with sepsis in a large cohort. Methods This retrospective observational study used data from the eICU Collaborative Research Database. The prognostic value of RDW was investigated using the receiver operating characteristic (ROC) curve, multiple logistic regression model, integrated discriminatory index (IDI), and net reclassification index (NRI). Results In total, 9743 patients were included. The area under the ROC curve of the RDW for predicting hospital mortality was 0.631 (95% confidence interval [CI]: 0.616–0.645). Based on the multiple logistic regression model, an RDW of ≥14.5% was correlated with hospital mortality, regardless of Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation IV (APACHE IV) scores (odds ratio [OR]: 1.838, 95% CI: 1.598–2.119). Using SOFA and APACHE IV scores as reference, the IDI and continuous NRI of RDW for hospital mortality was about 0.3 and 0.014, respectively. Conclusions The RDW may be useful in predicting hospital mortality in patients with sepsis, offering extra prognostic value beyond SOFA and APACHE IV scores.

scholarly journals Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Josefine S. Baekgaard ◽  
◽  
Paer-Selim Abback ◽  
Marouane Boubaya ◽  
Jean-Denis Moyer ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Univariate Analysis ◽  
Severe Trauma ◽  
Arterial Oxygen ◽  
Trauma Patients

Abstract Background Hyperoxemia has been associated with increased mortality in critically ill patients, but little is known about its effect in trauma patients. The objective of this study was to assess the association between early hyperoxemia and in-hospital mortality after severe trauma. We hypothesized that a PaO2 ≥ 150 mmHg on admission was associated with increased in-hospital mortality. Methods Using data issued from a multicenter prospective trauma registry in France, we included trauma patients managed by the emergency medical services between May 2016 and March 2019 and admitted to a level I trauma center. Early hyperoxemia was defined as an arterial oxygen tension (PaO2) above 150 mmHg measured on hospital admission. In-hospital mortality was compared between normoxemic (150 > PaO2 ≥ 60 mmHg) and hyperoxemic patients using a propensity-score model with predetermined variables (gender, age, prehospital heart rate and systolic blood pressure, temperature, hemoglobin and arterial lactate, use of mechanical ventilation, presence of traumatic brain injury (TBI), initial Glasgow Coma Scale score, Injury Severity Score (ISS), American Society of Anesthesiologists physical health class > I, and presence of hemorrhagic shock). Results A total of 5912 patients were analyzed. The median age was 39 [26–55] years and 78% were male. More than half (53%) of the patients had an ISS above 15, and 32% had traumatic brain injury. On univariate analysis, the in-hospital mortality was higher in hyperoxemic patients compared to normoxemic patients (12% versus 9%, p < 0.0001). However, after propensity score matching, we found a significantly lower in-hospital mortality in hyperoxemic patients compared to normoxemic patients (OR 0.59 [0.50–0.70], p < 0.0001). Conclusion In this large observational study, early hyperoxemia in trauma patients was associated with reduced adjusted in-hospital mortality. This result contrasts the unadjusted in-hospital mortality as well as numerous other findings reported in acutely and critically ill patients. The study calls for a randomized clinical trial to further investigate this association.

scholarly journals Invasive Candidiasis in Critically Ill Patients: A Prospective Cohort Study in Two Tertiary Care Centers

2018 ◽  
Vol 35 (6) ◽  
pp. 542-553 ◽  
Author(s):  
Hasan M. Al-Dorzi ◽  
Hussam Sakkijha ◽  
Raymond Khan ◽  
Tarek Aldabbagh ◽  
Aron Toledo ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Antifungal Therapy ◽  
Invasive Candidiasis ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Tertiary Care ◽  
Candida Score ◽  
Tertiary Care Centers

Background: Invasive candidiasis is not uncommon in critically ill patients but has variable epidemiology and outcomes between intensive care units (ICUs). This study evaluated the epidemiology, characteristics, management, and outcomes of patients with invasive candidiasis at 6 ICUs of 2 tertiary care centers. Methods: This was a prospective observational study of all adults admitted to 6 ICUs in 2 different hospitals between August 2012 and May 2016 and diagnosed to have invasive candidiasis by 2 intensivists according to predefined criteria. The epidemiology of isolated Candida and the characteristics, management, and outcomes of affected patients were studied. Multivariable logistic regression analyses were performed to identify the predictors of non-albicans versus albicans infection and hospital mortality. Results: Invasive candidiasis was diagnosed in 162 (age 58.4 ± 18.9 years, 52.2% males, 82.1% medical admissions, and admission Acute Physiology and Chronic Health Evaluation II score 24.1 ± 8.4) patients at a rate of 2.6 cases per 100 ICU admissions. On the diagnosis day, the Candida score was 2.4 ± 0.9 in invasive candidiasis compared with 1.6 ± 0.9 in Candida colonization ( P < .01). The most frequent species were albicans (38.3%), tropicalis (16.7%), glabrata (16%), and parapsilosis (13.6%). In patients with candidemia, antifungal therapy was started on average 1 hour before knowing the culture result (59.6% of therapy initiated after). Resistance to fluconazole, caspofungin, and amphotericin B occurred in 27.9%, 2.9%, and 3.1%, respectively. The hospital mortality was 58.6% with no difference between albicans and non-albicans infections (61.3% and 54.9%, respectively; P = .44). The independent predictors of mortality were renal replacement therapy after invasive candidiasis diagnosis (odds ratio: 5.42; 95% confidence interval: 2.16-13.56) and invasive candidiasis leading/contributing to ICU admission versus occurring during critical illness (odds ratio: 2.87; 95% confidence interval: 1.22-6.74). Conclusions: In critically ill patients with invasive candidiasis, non-albicans was responsible for most cases, and mortality was high (58.6%). Antifungal therapy was initiated after culture results in 60% suggesting low preclinical suspicion. Study registration: NCT01490684; registered in ClinicalTrials.gov on February 11, 2012.

Sign in / Sign up

Export Citation Format

Share Document