scholarly journals Impact of Fluid Resuscitation Regimes in Relative Risk of Mortality in Burned Patients

2021 ◽  
Vol 5 (2) ◽  
pp. 849-853
Author(s):  
Besnik Faskaj ◽  
Monika Belba
Keyword(s):  
Relative Risk ◽  
Statistical Significance ◽  
Burn Injuries ◽  
University Hospital ◽  
Burn Shock ◽  
Ringer Lactate ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Observational Prospective Cohort Study ◽  
The University

Background; Some studies have supported the opinion that patients who get greater volumes of resuscitation fluids are at a higher chance of edema, complications, and probably bad outcomes. In the results of the International Society of Burn Injuries approximately half (49.5%) added colloid before 24h. This study aims to analyze the relative risk for mortality comparing resuscitation in the first 24 hours with Parkland and resuscitation with the use of Colloids.  Material and Methods; This was an observational prospective cohort study conducted in the Service of Burns of the University Hospital Centre "Mother Teresa" in Tirana (UHCT), Albania. The study includes adult patients with critical burns > 40% TBSA, hospitalized in the Intensive Care Unit of the service during the period 2014 to 2019. Resuscitation in the first 24 hours is done with Ringer Lactate according to Parkland and with Ringer Lactate with the addition of colloids after 12 hours. Results; The data for organ dysfunction and organ insufficiency were the same in the two groups without statistical significance. Mortality in the RL group was 48% (24 deaths of 50 patients) while in the RL + Colloid rehydrated group was 46% (23 deaths of 50 patients). Patients which have 40-60% burns and are rehydrated with RL + Colloids have a risk of death 0.4 times less than those rehydrated with RL. Conclusions; Resuscitation with Ringer lactate and Colloids in the first 24 hours of thermal damage is a rehydration alternative for the treatment of burn shock. This therapy especially helps patients with major burns > 40% TBSA who during rehydration require large amounts of fluids and are associated with severe plasma hypoalbuminemia. Number Need to Treat (NNT benefit) is 10 so 1 in 10 patients can benefit in lowering the risk of death with RL + Colloid rehydration.

scholarly journals Measures of Risk for Sepsis and Mortality in Severe Burned Patients with Stress Induced Hyperglycemia.

2021 ◽  
Vol 5 (2) ◽  
pp. 830-833
Author(s):  
Albana Aleksi ◽  
Monika Belba
Keyword(s):  
Medical Condition ◽  
University Hospital ◽  
Burn Shock ◽  
Burn Treatment ◽  
Risk Of Mortality ◽  
Close Relationship ◽  
Life Threatening ◽  
Burn Disease ◽  
The University ◽  
The Impact

Background; Hyperglycemia as a medical condition due to diabetes or other underlying conditions like Stress-Induced Hyperglycemia and sepsis as a life-threatening medical condition are two of the challenges faced during burn treatment. The purpose of this study was to evaluate the risk for sepsis and mortality for the patients with critical hyperglycemic values during the disease. Material and Methods; This is an observational retrospective cohort study conducted in the Service of Burns of the University Hospital Centre “Mother Teresa” in Tirana (UHCT), Albania from 1st January 2010 to 31st December 2014. Patients were categorized as having euglycemia (mean BG values ranging from 80-120 mg/dl), moderate hyper Sepsis was defined according to the ABA Consensus Panel Publication for Infection and Sepsis glycemia (mean BG values <180 mg/dl) or critical hyperglycemia (mean BG values ≥180 mg/dl). to evaluate the impact of the presence of critical hyperglycemia during the disease in sepsis and mortality, we performed Relative risk, Odds ratio Results; Those who had overall hyperglycemia (Moderate and Critical) had 2.6 times the risk for sepsis compared to those who were in the euglycemia group. Analyzing the risk of mortality in patients with overall hyperglycemia during the disease, we observed that the chance of a bad outcome was 2.7 times more likely to occur if the patient had hyperglycemia (RR=2.7). Conclusions: Glucose values on admission, as one of the derangement features of burn shock, are prognostic factors in critical hyperglycemia during burn disease and have a close relationship with other outcomes (sepsis and mortality).

scholarly journals Impact of Ethnicity and Underlying Comorbidity on COVID-19 Inhospital Mortality: An Observational Study in Abu Dhabi, UAE

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Asma Deeb ◽  
Khulood Khawaja ◽  
Nida Sakrani ◽  
Abdulla AlAkhras ◽  
Ahmed Al Mesabi ◽  
...  
Keyword(s):  
Liver Disease ◽  
Observational Study ◽  
Older Patients ◽  
Statistical Significance ◽  
The Philippines ◽  
Abu Dhabi ◽  
Inhospital Mortality ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
The Impact

Background. The UAE reported its first cluster of COVID 2019 in a group of returned travellers from Wuhan in January 2020. Various comorbidities are associated with worse disease prognosis. Understanding the impact of ethnicity on the disease outcome is an important public health issue but data from our region is lacking. Aim. We aim to identify comorbidities among patients hospitalized for COVID-19 that are associated with inhospital death. Also, to assess if ethnicity is correlated with increased risk of death. Patients and Method. The study is a single-centre, observational study in Shaikh Shakhbout Medical City, Abu Dhabi. Patients admitted with COVID-19, between 1st of March and the end of May, were enrolled. Records were studied for demography, comorbidity, and ethnicity. Ethnicity was divided into Arabs (Gulf, North Africa, and the Levant), South Asia (India, Pakistan, Bangladesh, Nepal, and Afghanistan), Africans, the Philippines, and others. The study was approved by the Department of Health of Abu Dhabi. Results. 1075 patients (972 males) were enrolled. There were 24 nationalities under 5 ethnicity groups. Mean (average) age was 51 years (20–81). 101 (9.4%) died with deceased patients being significantly older. Death risk was not significantly influenced by sex. Duration of hospitalization among survivors was 6.2 days (0.2–40.4) with older patients and men staying longer ( P < 0.01 ). Comorbidities of diabetes, hypertension, cardiovascular disease, chronic renal disease, liver disease, and malignancy were associated with higher risk of mortality univariate, but only liver disease reached statistical significance after adjustment for age. The highest percentage of death was seen in Arab Levant (21.2) followed by the Asian Afghan (18.8); however, differences among ethnicities did not reach statistical significance ( P = 0.086 ). Conclusion. COVID-19 outcome was worse in older people and those with comorbidities. Men and older patients required longer hospitalization. Ethnicity is not seen to impact the risk of mortality.

scholarly journals Postoperative Course After Emergency Colorectal Surgery for Secondary Peritonitis in the Elderly Is Often Complicated by Delirium

2012 ◽  
Vol 97 (2) ◽  
pp. 129-134 ◽  
Author(s):  
Stephan Engelberger ◽  
Manuel Zürcher ◽  
Jochen Schuld ◽  
Carsten Thomas Viehl ◽  
Christoph Kettelhack
Keyword(s):  
Postoperative Delirium ◽  
Statistical Significance ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
University Hospital ◽  
Colorectal Origin ◽  
American Society ◽  
Emergency Colorectal Surgery ◽  
American Society Of Anesthesiologists ◽  
The University

Abstract Postoperative delirium, morbidity, and mortality in our elderly patients with secondary perionitis of colorectal origin is described. This is a chart-based retrospective analysis of 63 patients who were operated on at the University Hospital Basel from April 2001 to May 2004. Postoperative delirium occurred in 33%. Overall morbidity was 71.4%. Surgery-related morbidity was 43.4%. Mortality was 14.4%. There was no statistical significance between delirium, morbidity and mortality (P  =  0.279 and P  =  0.364). There was no statistically significant correlation between the analyzed scores (American Society of Anesthesiologists classification, Mannheimer Peritonitis Index, Acute Physiology and Chronic Health Evaluation score II, physiological and operative surgical severity and enumeration of morbidity and mortality score‚ or short ‚cr-POSSUM’) and postoperative delirium, morbidity or mortality. Postoperative delirium occurred in one-third of the patients, who seem to have a trend to higher morbidity. Even if the different scores already had proven to be predictive in terms of morbidity and mortality, they do not help the risk stratification of postoperative delirium, morbidity, or mortality in our collective population.

scholarly journals Mortality in Patients With Septic Shock by Multidrug Resistant Bacteria

2017 ◽  
Vol 34 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Stefano Busani ◽  
Giulia Serafini ◽  
Elena Mantovani ◽  
Claudia Venturelli ◽  
Maddalena Giannella ◽  
...  
Keyword(s):  
Septic Shock ◽  
Statistical Significance ◽  
Multidrug Resistant ◽  
Immunoglobulin M ◽  
University Hospital ◽  
Resistant Bacteria ◽  
Sepsis Management ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Background: Patients with septic shock by multidrug resistant (MDR) microorganism maybe considered a specific population of critical patients at very high risk of death in whom the effects of standard sepsis treatment has never been assessed. The objective of this retrospective analysis was to evaluate the risk factors for 30-day mortality and the impact of sepsis management in patients with septic shock caused by MDR bacteria. Methods: Patients with septic shock by MDR bacteria admitted to the mixed intensive care unit (ICU) of Modena University Hospital during a 6-year period were studied. The clinical and microbiological characteristics and sepsis treatments provided were analyzed and compared between survivors (S) and nonsurvivors (NS) at 30 days after septic shock appearance. Results: Ninety-four patients were studied. All therapeutic interventions applied to patients during their ICU stay did not show statistical significance between S and NS groups, except for administration of immunoglobulin M (IgM) preparation which were provided more frequently in S group ( P < .05). At the multivariate adjusted analysis, preexisting cancer (odds ratio [OR] = 2.965) and Acinetobacter baumannii infections (OR = 3.197) were independently correlated with an increased risk of 30-day mortality, whereas treatment with IgM preparation was protective (OR = 0.283). Conclusions: This retrospective study showed that in patients with septic shock caused by MDR bacteria, history of cancer and infection sustained by A baumannii increase the risk of mortality and that standard sepsis treatments do not seem to provide any protective effect. Adjunctive therapy with IgM preparation seems to be beneficial, but further appropriate studies are needed to confirm the results observed.

scholarly journals Opioid Agonist Treatment and Risk of Mortality During an Opioid Overdose Public Health Emergency: A Population-Based Retrospective Cohort Study

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Lindsay A Pearce ◽  
Jeong Eun Min ◽  
Micah Piske ◽  
Haoxuan Zhou ◽  
Fahmida Homayra ◽  
...  
Keyword(s):  
Relative Risk ◽  
Illicit Drug ◽  
Opioid Overdose ◽  
Drug Supply ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Risk Of Death ◽  
Synthetic Opioids ◽  
Risk Of Mortality ◽  
Stopping Treatment

IntroductionOpioid agonist treatment (OAT) is a safe and effective treatment for opioid use disorder (OUD). However, people commonly stop and start OAT and their risk of death is high immediately after stopping. The prevalence of illicitly manufactured fentanyl and other highly potent synthetic opioids have increased in the illicit drug supply globally. Yet, there is limited evidence examining the relationship between OAT and mortality when these contaminants are widely available in the illicit drug supply. Objectives and ApproachWe aimed to compare the risk of mortality on and off OAT in a setting with a high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids in the illicit drug supply. We linked five health administrative datasets in British Columbia, Canada, creating a cohort of 55,347 people with OUD who received OAT during a 23-year period (1996 to 2018). We compared the risk of mortality on and off treatment over time, and according to time since starting or stopping treatment and by medication type. Results7,030 of 55,347 (12.7%) OAT recipients died during follow-up. All-cause SMR was substantially lower on OAT (4.6 [4.4 to 4.8]) compared to off OAT (9.7 [9.5 to 10.0]). In a period of increasing prevalence of fentanyl, the relative risk of mortality off OAT was 2.1 [1.8 to 2.4] times higher than on OAT prior to the introduction of fentanyl, and increased to 3.4 [2.8 to 4.3] at the end of the study period (65% increase in relative risk). Conclusion / ImplicationsThe protective effect of OAT on mortality increased as fentanyl and other synthetic opioids became common in the illicit drug supply, while the risk of mortality remained high off OAT. As fentanyl becomes more widespread globally, these findings highlight the importance of interventions that improve retention on opioid agonist treatment and prevent recipients from stopping treatment.

scholarly journals Investigation of the Role of the Cytomegalovirus as a Respiratory Pathogen in HIV-Infected Patients

1996 ◽  
Vol 3 (4) ◽  
pp. 235-240 ◽  
Author(s):  
Rafael E de la Hoz ◽  
Shizu Hayashi ◽  
Darrel Cook ◽  
Christopher Sherlock ◽  
James C Hogg
Keyword(s):  
Relative Risk ◽  
Hiv Infection ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Pneumocystis Carinii ◽  
Clinical Severity ◽  
University Hospital ◽  
Respiratory Pathogen ◽  
Short Term ◽  
Short Term Mortality

OBJECTIVE:To investigate the occurrence of cytomegalovirus (CMV) pneumonitis in the setting of human immunodeficiency virus (HIV) infection and whether the presence of CMV as copathogen is associated with increased clinical severity or short term mortality in patients withPneumocystis cariniipneumonia.DESIGN:Retrospective cohort study.SETTING:Tertiary care university hospital.PATIENTS:One-hundred and fourteen HIV-infected homosexual men with pneumonia, followed for a minimum of four weeks.MEASUREMENTS:Clinical indicators of severity of pneumonia, microbiology of bronchoalveolar fluid and relative risk of short term mortality.RESULTS:Only two cases of CMV pneumonitis were found, one together withP carinii. However, 45 of the 86 patients withP cariniipneumonia were co-infected with CMV. No difference in clinical severity was detected between patients co-infected withP cariniiand CMV and those withP cariniialone. The relative risk of short term mortality was 3.64 (95% CI 0.82 to 16.18), in patients with co-infection compared with those withP cariniialone. The risk reached statistical significance for patients with earlier stages of HIV infection.CONCLUSIONS:CMV pneumonitis occurs rarely in HIV-infected patients, while CMV co-infection occurs in at least 50% of the cases ofP cariniipneumonia. Although no difference in clinical severity was detected, this study suggests that short term mortality fromP cariniipneumonia may be increased by CMV co-infection, particularly in patients with earlier stages of the disease.

Epidemiology of Clostridium difficile infection: results of a hospital-based study in Krakow, Poland

2015 ◽  
Vol 143 (15) ◽  
pp. 3235-3243 ◽  
Author(s):  
J. CZEPIEL ◽  
J. KĘDZIERSKA ◽  
G. BIESIADA ◽  
M. BIRCZYŃSKA ◽  
W. PERUCKI ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Fold Increase ◽  
Time Span ◽  
University Hospital ◽  
Posterior Stabilization ◽  
The Past ◽  
Risk Of Mortality ◽  
Crude Mortality ◽  
Medical Wards ◽  
The University

SUMMARYOver the past two decades Clostridium difficile infection (CDI) has appeared as a major public health threat. We performed a retrospective study based on the records of patients hospitalized for CDI at the University Hospital in Krakow, Poland, between 2008 and 2014. In the study period, CDI occurred in 1009 individuals. There were 790 (78%) individuals who developed infection only once, whereas 219 (22%) developed infection more than once. The percentage of deaths within 14 days of CDI confirmation was 2·4%, with a mean age of 74·2 ± 15·9 years. Crude mortality was 12·9% in medical wards, 5·6% for surgical wards and 27·7% in the ICU setting. The time span between diagnosis and death was 5·1 days on average. Between 2008 and 2012 a 6·5-fold increase of CDI frequency with a posterior stabilization and even reduction in 2013 and 2014 was observed. According to the data analysed, 2/3 patients in our population developed CDI during their hospitalization even though they were admitted for different reasons. Medical wards pose a significantly higher risk of CDI than the surgical ones. Age is a risk factor for CDI recurrence. In the case of patients who died, death occurred shortly after diagnosis. The first CDI episode poses much higher risk of mortality than the consecutive ones.

scholarly journals Lack of Evidence for an Association between Previous HEV Genotype-3 Exposure and Glomerulonephritis in General

Pathogens ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 18
Author(s):  
Sven Pischke ◽  
Sarah Tamanaei ◽  
Maria Mader ◽  
Julian Schulze zur Wiesch ◽  
Christine Petersen-Benz ◽  
...  
Keyword(s):  
Blood Donors ◽  
Statistical Significance ◽  
University Hospital ◽  
Genotype 3 ◽  
Seropositivity Rate ◽  
Future Studies ◽  
Age Related ◽  
Immune Mediated ◽  
The University ◽  
Age And Sex

Among numerous other immune-mediated diseases, glomerulonephritis has also been suspected to be an extrahepatic manifestation of HEV infection. In this prospective study, we tested 108 patients with glomerulonephritis and 108 age- and sex-matched healthy controls at the University Hospital Hamburg Eppendorf, Hamburg, Germany, for anti-HEV IgG (Wantai test) as a marker for previous HEV exposure. A total of 24 patients (22%) tested positive for anti-HEV IgG. Males tended to be more frequently anti-HEV IgG positive (29%) in comparison to females (16%). However, this does not reach statistical significance (p = 0.07). Anti-HEV IgG positive patients were older in comparison to negative patients (mean 53 vs. 45 years, p = 0.05). The kidney function seems to be slightly decreased in anti-HEV IgG positive patients in comparison to and anti-HEV IgG negative patients basing on creatinine (p = 0.04) and glomerular filtration rate (GFR) (p = 0.05). Slightly higher values of bilirubin could be found in IgG positive patients (p = 0.04). Anti-HEV-IgG seropositivity rate (22%) in glomerulonephritis patients, did not differ significantly in comparison to an age- and sex-matched control cohort of healthy blood donors (31/108 positive, 29%). A total of 2/2 patients with membranoproliferative glomerulonephritis (MPGN) tested anti-HEV IgG positive (p = 0.002 in comparison to glomerulonephritis patients with other subtypes).In conclusion, our findings indicate that previous HEV exposure in a region where GT3 is endemic is not associated with glomerulonephritis in general. However, the subgroup of MPGN patients should be investigated in future studies. Furthermore, future studies are needed to investigate whether the observed association between anti-HEV IgG positivity and reduced GFR in glomerulonephritis patients is HEV associated or is an age-related effect.

scholarly journals Parameters of hemodialysis adequacy and patients’ survival depending on treatment modalities

2015 ◽  
Vol 68 (7-8) ◽  
pp. 251-257 ◽  
Author(s):  
Petar Djuric ◽  
Jovan Popovic ◽  
Aleksandar Jankovic ◽  
Jelena Tosic ◽  
Nada Dimkovic
Keyword(s):  
Relative Risk ◽  
Randomized Clinical Trials ◽  
Proportional Hazards Model ◽  
Statistical Significance ◽  
Hazard Ratio ◽  
Cox Proportional Hazards Model ◽  
Treatment Modalities ◽  
High Flux ◽  
Risk Of Mortality ◽  
Dialysis Vintage

Introduction. Retrospective studies showed that hemodiafiltration was associated with a reduced risk of mortality compared with standard hemodialysis in the patients with end-stage renal disease. Recently, a few prospective randomized clinical trials found no advantage in survival with hemodiafiltration as compared with high-flux hemodialysis and low-flux hemodialysis. The aim of this study was to compare the parameters of hemodialysis adequacy and two-year survival of patients depending on the modality of hemodialysis. Material and Methods. A total of 159 hemodialysis patients were divided into 3 groups according to the type of hemodialysis treatment: group A - lowflux hemodialysis, group B - high-flux hemodialysis, and group C - hemodiafiltration. All patients had the same duration of hemodialysis sessions. The analysis included average one-year biochemical parameters, and two-year survival of patients. Results. The patients on hemodiafiltration were significantly younger, they had longer dialysis vintage and higher index of dialysis adequancy as compared with the patients on low-flux hemodialysis and high-flux hemodialysis, but without a difference between the two latter groups. Compared to the patients on low-flux hemodialysis, the patients on hemodiafiltration and high-flux hemodialysis had significantly higher hemoglobin value with less frequent erythropoietin stimulating agent use. According to Kaplan-Meier survival analysis, the patients on hemodiafiltration and high-flux hemodialysis had significantly better two-year survival than the patients on low-flux hemodialysis. Cox proportional hazards model confirmed that high-flux hemodialysis caused a significantly lower relative risk of mortality (56% reduction) compared to low-flux hemodialysis (hazard ratio 0.44; P=0.026), and hemodiafiltration caused a 58% reduction in the relative risk of mortality compared to low-flux dialysis (hazard ratio 0.42; P=0.105), but without a statistical significance. Conclusion. This study has demonstrated two-year survival benefit with high-flux hemodialysis and hemodiafiltration compared with low-flux hemodialysis. There was no difference in survival between high-flux hemodialysis and hemodiafiltration groups.

scholarly journals The Influence of Apparent Temperature on Mortality in the Kintampo Health and Demographic Surveillance Area in the Middle Belt of Ghana: A Retrospective Time-Series Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Kenneth Wiru ◽  
Felix Boakye Oppong ◽  
Oscar Agyei ◽  
Charles Zandoh ◽  
Obed Ernest Nettey ◽  
...  
Keyword(s):  
Relative Risk ◽  
Apparent Temperature ◽  
Extreme Weather Events ◽  
Diurnal Changes ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Lag Period ◽  
Related Mortality

Globally, studies have shown that diurnal changes in weather conditions and extreme weather events have a profound effect on mortality. Here, we assessed the effect of apparent temperature on all-cause mortality and the modifying effect of sex on the apparent temperature-mortality relationship using mortality and weather data archived over an eleven-year period. An overdispersed Poisson regression and distributed lag nonlinear models were used for this analysis. With these models, we analysed the relative risk of mortality at different temperature values over a 10-day lag period. By and large, we observed a nonlinear association between mean daily apparent temperature and all-cause mortality. An assessment of different temperature values over a 10-day lag period showed an increased risk of death at the lowest apparent temperature (18°C) from lag 2 to 4 with the highest relative risk of mortality (RR = 1.61, 95% CI: 1.2, 2.15, p value = 0.001) occurring three days after exposure. The relative risk of death also varied between males (RR = 0.31, 95% CI: 0.10, 0.94) and females (RR = 4.88, 95% CI: 1.40, 16.99) by apparent temperature and lag. On the whole, males are sensitive to both temperature extremes whilst females are more vulnerable to low temperature-related mortality. Accordingly, our findings could inform efforts at reducing temperature-related mortality in this context and other settings with similar environmental and demographic characteristics.

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