scholarly journals Neutrophil-Lymphocyte count ratio on admission as a predictor of Bacteremia and In Hospital Mortality among Sepsis and Septic shock In Patients at Rizal Medical Center

2018 ◽  
Vol 9 (3) ◽  
pp. 36-40 ◽  
Author(s):  
Rakesh Kumar Mandal ◽  
Primo B. Valenzuela
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Lymphocyte Count ◽  
Medical Center ◽  
Laboratory Data ◽  
Positive Association ◽  
Cross Sectional ◽  
Clinical Prognosis ◽  
Count Ratio ◽  
Sepsis And Septic Shock

Background: Neutrophil-Lymphocyte count ratio (NLCR), a readily accessible biomarker, has become increasingly useful as predictive and prognostic tools in patients with various medical conditions. NLCR has also been reported to represent disease severity effectively.Aims and Objectives: To investigate NLCR on admission as a prognostic marker of bacteremia and in-hospital mortality in patients diagnosed with Sepsis and Septic Shock.Materials and Methods: This cross-sectional, retrospective study involves one-hundred twenty (120) adult patients with Sepsis and Septic Shock admitted to the IMCU and ICU from January 2015 to December 2016. Laboratory data and clinical outcomes were retrieved and documented from the laboratory and patients’ charts. A cut-off point of >10 was used to be a marker for bacteremia and hence, patients were stratified into two groups based on this cut-off. Out of 120, 78 patients (with mean age of 60) has NLCR of at least 10 while only 42 patients (with mean age of 55) has NCLR of at most 10.Results: A significant, strong and positive association between NLCR and in-hospital mortality was found (P=0.0001) indicating that an increased rate of mortality is observed for patients with persistently high NCLR. Results also indicated that NLCR is a significant predictor (P=0.0002) of in-hospital mortality via a logistic model. The receiver-operating characteristic (ROC) curve for NLCR predicting in-hospital mortality showed an area under the curve (AUC) of 0.8007 which is an indicative of high predictive power. Its sensitivity and specificity is calculated to be 97.37% and 93.18, respectively. Overall, the performance of NCLR as a predictor based on its computed hit rate is found to be approximately 93.33%.Conclusion: Increased NLCR levels were independently associated with unfavorable clinical prognosis in patients with sepsis. A high NLCR (>10) is significantly associated with in- hospital mortality. NCLR predicts in-hospital mortality with high accuracy, high precision and small misclassification.Asian Journal of Medical Sciences Vol.9(3) 2018 6-9

scholarly journals Correlation Between Neutrophil-lymphocyte Count Ratio and Procalcitonin in Sepsis and Septic Shock

2019 ◽  
Vol 51 (3) ◽  
pp. 165-171
Author(s):  
Jonathan Jonathan ◽  
Erwin Pradian ◽  
Ardi Zulfariansyah
Keyword(s):  
Septic Shock ◽  
Lymphocyte Count ◽  
Count Ratio ◽  
Sepsis And Septic Shock

Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock

2021 ◽  
pp. 088506662110614
Author(s):  
Mohinder R. Vindhyal ◽  
Liuqiang (Kelsey) Lu ◽  
Sagar Ranka ◽  
Prakash Acharya ◽  
Zubair Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Congestive Heart Failure ◽  
Hospital Mortality ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Cross Sectional ◽  
Increased Risk ◽  
Icd 10 ◽  
Nationwide Readmission Database

Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings’ mechanisms to improve outcomes in patients with SS and underlying CHF.

Neutrophil-to-lymphocyte count ratio in predicting prognosis of septic shock patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hoda Omar Mahmoud ◽  
Niven Gerges Fahmy ◽  
Mona Ahmed Mohamed Abdelmotaleb Ammar ◽  
Mostafa Mansour Mohamed Elsaid ELryany
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
Lymphocyte Count ◽  
Late Mortality ◽  
Late Death ◽  
Tertiary Referral Center ◽  
Risk Of Death ◽  
Count Ratio ◽  
Significant Difference ◽  
Common Causes

Abstract Background Septic shock is one of the most common causes of admission to the intensive care unit in the world and one of the most common causes of death among intensive care patients. Since the definition of sepsis and septic shock and many studies have been designed to understand everything about sepsis regarding mechanism, pathophysiology, complications, diagnosis, management and all other aspects. Objective To find the association between neutrophil to lymphocyte count ratio and the mortality from septic shock patients. The work aims also to determine if this ratio can be used as a prognostic marker of septic shock patients and to compare this ratio with other sepsis markers as C-reactive protein (CRP) and procalcitonin. Patients and Methods This study was conducted prospectively in critical care unit in Ain Shams Hospital, a university-affiliated, tertiary referral center in Cairo, Egypt. Study subjects included 125 patients between January 2018 to January 2019. The ethics committee of our institution approved the study protocol, and written informed consent was obtained from each patient’s family. Results In our study, the neutrophils count was significantly increased in survived patients compared with early and late mortality patients in day 1 while lymphocytes count was lower in survived patient than early and late mortality patients and the NLCR in our study was higher in survived patients than early and late mortality patients. In day 4, our results revealed significant increase in neutrophils count in patients of late mortality compared with its count in survived patients, while lymphocytes didn't show any significant difference compared with its count in survived patients with significant increase in NLCR in patients of late mortality compared with those of survived patients in day 4. Both CRP and procalcitonin are increased in patients of early and late mortality groups compared with its value in survived patients in day 1 and 4. Conclusion This study demonstrates a real relationship between the NLCR and the risk of death in septic shock patients. Septic shock patients at risk of early death presented a low NLCR at admission, although late death was associated with an increased NLCR during the first 5 days. Early and late death should be distinguished because they may involve different underlying mechanisms, and the NLCR might be considered as a discriminant indicator of early or late death. In addition, our findings provide more insight into biology. The circulating neutrophil and lymphocyte trends observed in this study offer an interesting mechanistic viewpoint. We observed that circulating lymphocytes and the NLCR behave in opposite ways in early- and late death patients, supporting the hypothesis that divergent mechanisms could be involved in these two groups.

Comparison of Vasopressor Duration in Septic Shock Patients With and Without Cirrhosis

2020 ◽  
pp. 106002802098072
Author(s):  
Melissa M. Durst ◽  
Elizabeth A. Eitzen ◽  
Scott T. Benken
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Medical Center ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Treatment Strategies ◽  
Severity Of Illness ◽  
Discharge Disposition ◽  
Increase Risk ◽  
Vasopressor Use

Background Patients with cirrhosis have immune dysfunction, altered inflammatory response, and hemodynamic changes which increase risk of septic shock and potentially prolong management with fluids, vasopressors, and other therapies. Due to limited available guidance, this study aimed to characterize vasopressor use in patients with cirrhosis in relation to patients without cirrhosis in septic shock. Methods This was a retrospective matched cohort analysis of 122 patients admitted to the intensive care unit (ICU) at an academic medical center from January 2015 to November 2017. Patients were grouped based on the presence or absence of cirrhosis and matched based on severity of illness scoring. The primary outcome was vasopressor duration. Secondary comparisons included total vasopressor requirement, length of hospital and ICU stay, in-hospital mortality, change in organ function, and discharge disposition. Results The group with cirrhosis had significantly longer median (interquartile range [IQR]) durations of vasopressor therapy compared with the group without cirrhosis (86.0 [42.0-164.5] vs 39.0 [14.5-82.0] hours; P = 0.003) leading to increased median (IQR) vasopressor exposure (71.7 [15.5-239.5] vs 24.7 [5.3-77.9] mg norepinephrine [NE] equivalents; P = 0.003). No difference was found in in-hospital mortality between groups. However, regression analysis showed vasopressor exposure was associated with in-hospital mortality. Conclusion and Relevance Patients with cirrhosis in septic shock have increased vasopressor durations and overall requirements compared with patients without cirrhosis. Increased durations and requirements is associated with poorer outcomes independent of presence of cirrhosis. Future studies are needed to improve vasopressor treatment strategies and end points utilized in cirrhosis.

scholarly journals Association of Positive Fluid Balance and Mortality in Sepsis and Septic Shock in An Australian Cohort

2017 ◽  
Vol 45 (6) ◽  
pp. 737-743 ◽  
Author(s):  
M. G. Pittard ◽  
S. J. Huang ◽  
A. S. McLean ◽  
S. R. Orde
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Confidence Intervals ◽  
Fluid Balance ◽  
Severity Of Illness ◽  
Primary Outcome Measure ◽  
Published Data ◽  
Positive Fluid Balance ◽  
Retrospective Audit ◽  
Sepsis And Septic Shock

In patients with septic shock, a correlation between positive fluid balance and worsened outcomes has been reported in multiple observational studies worldwide. No published data exists in an Australasian cohort. We set out to explore this association in our institution. We conducted a retrospective audit of patient records from August 2012 to May 2015 in a single-centre, 24-bed surgical and medical intensive care unit (ICU) in Sydney, Australia. All patients with septic shock were included. Exclusion criteria included length of stay less than 24 hours or vasopressors needed for less than six hours. Data was gathered on fluid balance for the first seven days of ICU admission, biochemical data and other clinical indices. The primary outcome measure was survival to hospital discharge. One hundred and eighty-six patients with septic shock were included, with an overall hospital mortality of 23.7%. Seventy-five percent of patients required mechanical ventilation, and 27.4% required haemodialysis. The mean daily fluid balance on the first day of admission was positive 1,424 ml and 1,394 ml for ICU and hospital survivors, respectively. On average, the daily fluid balance for non-survivors was higher than the survivors: ICU non-survivors were 602 (95% confidence intervals 230, 974) ml (P=0.0015) and hospital non-survivors were 530 [95% confidence intervals 197, 863] ml (P=0.0017) higher than the survivors. In line with other recently published data, after adjustment for confounders (severity of illness based on the Acute Physiology and Chronic Health Evaluation score) we found a correlation between positive fluid balance and worsened hospital mortality in critically ill patients with sepsis and septic shock. Further research investigating rational use of fluids in this patient group is needed.

PREDICTORS OF IN-HOSPITAL MORTALITY IN PATIENTS WITH SNAKE BITE IN POPULATION OF KARACHI, PAKISTAN

2019 ◽  
Vol 17 (4) ◽  
pp. 107-111
Author(s):  
Harish Kumar ◽  
Adnan Bashir ◽  
Khadijah Abid ◽  
Nabeel Naeem Baig
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Medical Center ◽  
Kidney Injury ◽  
Hazard Ratio ◽  
Snake Bite ◽  
Rank Test ◽  
Cross Sectional ◽  
Early Management ◽  
Risk Of Death

Background: Snake bite remains major public health problems worldwide. The objective of this study was to determine predictors of in-hospital mortality in patients presenting with snake bite in population of Karachi, Pakistan. Materials & Methods: It was cross-sectional study conducted at Department of General Medicine, Postgraduate Medical Center, Karachi, Pakistan from 11th June 2016 to 10th August 2017. 300 patients with snake bite were selected. Age, gender, acute kidney injury, vomiting and in-hospital mortality were variables. Except age, all variables were nominal and were analyzed by frequency and percentage. Cox-proportional-hazard regression model was applied and hazard ratios were calculated along with 95% confidence intervals (CI) to assess the strength of association between predictors i.e. age, gender, AKI and vomiting and outcome (in-hospital mortality). Kaplan-Meier and time to event plot were used to investigate all patients who were on follow-up for 7 days from admission. Log-rank test was used to identify the predictors of in-hospital mortality for significant independent influence on prognosis at alpha .05. Results: The mean age of the sample was 27.7±14.58 years. Out of a sample of 300 patients, 221 (73.7%) were males and 79 (26.3%) females. The frequency (%) of AKI was 102 (66%), vomiting 122 (40.7%) and of in-hospital mortality 31 (10.3%). The probability of survival at day 7 was 81.8%. Vomiting [hazard ratio 6.86 (95% CI: 2.78-16.93), p=<0.001] and acute kidney injury [hazard ratio 3.85 (95% CI: 1.75-8.45), p=<0.001] were associated with higher risk of death in adjusted analysis. Conclusion: Acute kidney injury and vomiting are strong predictors of mortality among patients with snake bite. These predictors can be helpful for clinicians in assessing prognosis of their patients more accurately and by early management of these factors, mortality & morbidity can be reduced.

scholarly journals Adequate antibiotic therapy prior to ICU admission in patients with severe sepsis and septic shock reduces hospital mortality

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
Author(s):  
José Garnacho-Montero ◽  
Antonio Gutiérrez-Pizarraya ◽  
Ana Escoresca-Ortega ◽  
Esperanza Fernández-Delgado ◽  
José María López-Sánchez
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Antibiotic Therapy ◽  
Icu Admission ◽  
Sepsis And Septic Shock

Impact of New-Onset Left Ventricular Dysfunction on Outcomes in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock

2016 ◽  
Vol 33 (12) ◽  
pp. 680-686 ◽  
Author(s):  
Saraschandra Vallabhajosyula ◽  
Shane M. Gillespie ◽  
David W. Barbara ◽  
Nandan S. Anavekar ◽  
Juan N. Pulido
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Diastolic Dysfunction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Secondary Outcomes ◽  
Sepsis And Septic Shock

Background: Left ventricular systolic dysfunction (LVSD) and LV diastolic dysfunction (LVDD) are commonly seen in severe sepsis and septic shock; however, their role in patients with concurrent invasive mechanical ventilation (IMV) is less well defined. Methods: This was a prospective observational study on all patients admitted to all the intensive care units (ICUs) at Mayo Clinic, Rochester from August 2007 to January 2009. All adult patients with severe sepsis and septic shock and concurrent IMV without prior heart failure underwent transthoracic echocardiography within 24 hours. Patients with active pregnancy, prior congenital or valvular heart disease, and prosthetic cardiac valves were excluded. Left ventricular systolic dysfunction was defined as LV ejection fraction (LVEF) <50% and LVDD as E/e′ >15. Primary outcome was hospital mortality, and secondary outcomes included IMV duration, ICU length of stay (LOS), and total LOS. Two-tailed P value of <.05 was considered statistically significant. Results: In a total of 106 patients, 58 (54.7%) met our inclusion criteria, with 17 (29.3%), 11 (19.0%), and 5 (8.6%) having LVSD, LVDD, and both, respectively. The cohorts with and without LVSD and LVDD did not differ significantly in their baseline characteristics and laboratory and ventilatory parameters. Compared to those without LVSD, patients with LVSD had higher LV end-systolic diameters but were not different in their left atrial diameters or E/e′ ratio. Patients with LVDD had a higher E velocity and E/e′ ratio compared to those without LVDD. Hospital mortality was not different in patients with and without LVSD (8 [47%] vs 21 [51%], P = 1.00) and LVDD (8 [73%] vs 21 [45%], P = .18). Secondary outcomes were not different between the 2 groups. Conclusion: Left ventricular systolic or diastolic dysfunction did not influence in-hospital outcomes in patients with severe sepsis and septic shock and concurrent IMV.

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