scholarly journals Fungal Infections in COVID-19 Intensive Care Patients

2021 ◽  
Vol 70 (3) ◽  
pp. 395-400
Author(s):  
AYŞENUR SÜMER COŞKUN ◽  
ŞENAY ÖZTÜRK DURMAZ
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Mortality Rate ◽  
Opportunistic Infections ◽  
Fungal Infections ◽  
Tracheal Aspirate ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Period Increase ◽  
Intensive Care Patients

Opportunistic fungal infections increase morbidity and mortality in COVID-19 patients monitored in intensive care units (ICU). As patients’ hospitalization days in the ICU and intubation period increase, opportunistic infections also increase, which prolongs hospital stay days and elevates costs. The study aimed to describe the profile of fungal infections and identify the risk factors associated with mortality in COVID-19 intensive care patients. The records of 627 patients hospitalized in ICU with the diagnosis of COVID-19 were investigated from electronic health records and hospitalization files. The demographic characteristics (age, gender), the number of ICU hospitalization days and mortality rates, APACHE II scores, accompanying diseases, antibiotic-steroid treatments taken during hospitalization, and microbiological results (blood, urine, tracheal aspirate samples) of the patients were recorded. Opportunistic fungal infection was detected in 32 patients (5.10%) of 627 patients monitored in ICU with a COVID-19 diagnosis. The average APACHE II score of the patients was 28 ± 6. While 25 of the patients (78.12%) died, seven (21.87%) were discharged from the ICU. Candida parapsilosis (43.7%) was the opportunistic fungal agent isolated from most blood samples taken from COVID-19 positive patients. The mortality rate of COVID-19 positive patients with candidemia was 80%. While two out of the three patients (66.6%) for whom fungi were grown from their tracheal aspirate died, one patient (33.3%) was transferred to the ward. Opportunistic fungal infections increase the mortality rate of COVID-19-positive patients. In addition to the risk factors that we cannot change, invasive procedures should be avoided, constant blood sugar regulation should be applied, and unnecessary antibiotics use should be avoided.

scholarly journals Analysis of the Incidence of Euthyroid Sick Syndrome in Comprehensive Intensive Care Units and Related Risk Factors

2021 ◽  
Vol 12 ◽  
Author(s):  
Jianying Guo ◽  
Yanyan Hong ◽  
Zhiyong Wang ◽  
Yukun Li
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Mortality Rate ◽  
Intensive Care Units ◽  
White Blood Cells ◽  
Apache Ii ◽  
Prognostic Indicators ◽  
Apache Ii Score ◽  
Euthyroid Sick Syndrome ◽  
The Relationship

ObjectiveA low concentration of plasma triiodothyronine (T3) indicates euthyroid sick syndrome (ESS), which could be associated with a poor outcome in patients in intensive care units (ICUs). This study evaluated the relationship between ESS and prognostic indicators in patients admitted to an ICU and examined the free T3 (FT3) cut-off points that could be associated with 28-day mortality.MethodsThis prospective observational study included patients admitted to the ICU of The Third Hospital of Hebei Medical University between February and November 2018. Baseline variables and data on the occurrence of low FT3 were collected. The patients were divided into ESS (FT3 < 3.28 pmol/L) and non-ESS groups. The relationship between ESS and prognostic indicators in patients admitted to the ICU was evaluated, and the FT3 cut-off points that could be associated with 28-day mortality were examined.ResultsOut of a total of 305 patients, 118 (38.7%) were in the ESS group. Levels of FT3 (P < 0.001) and FT4 (P = 0.001) were lower, while the 28-day mortality rate (P < 0.001) and hospitalization expenses in the ICU (P = 0.001) were higher in the ESS group. A univariable analysis identified ESS, FT3, free thyroxine (FT4)/FT3, the APACHE II score, the sequential organ failure (SOFA) score, the duration of mechanical ventilation, creatinine (CREA) levels, the oxygenation index (HGB), white blood cells, albumin (ALB) levels, age, and brain natriuretic peptide (BNP) levels as factors associated with 28-day mortality (all P < 0.05). The cut-off value of FT3 for 28-day mortality was 2.88 pmol/L, and the 28-day mortality rate and hospitalization expenses in the ICU were higher in patients with ESS. The syndrome was confirmed to be independently associated with 28-day mortality.ConclusionThis study determined the incidence of ESS in the comprehensive ICU to be 38.7%. APACHE II, SOFA, BNP, APTT, HGB, PLT, CREA, ALB, FT4, SBP, and DBP are closely related to ESS, while BNP, PLT, and ALB are independent risk factors for the syndrome.

scholarly journals Colistin-induced nephrotoxicity and risk factors in intensive care unit: estimating from the routine laboratory findings

2019 ◽  
Vol 6 (9) ◽  
pp. 210-220 ◽  
Author(s):  
Ahmet Ziya Şahin ◽  
Betül Kocamer Şimşek
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Tracheal Aspirate ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Urine Ph ◽  
Laboratory Findings ◽  
Arterial Blood Gas ◽  
Arterial Blood

Objective: In this study we aimed to evaluate the patients treated with colistin in an intensive care unit (ICU) and risk factors emergence of acute renal failure (ARF) after colistine treatment. Materials and Methods: Patients treated with colistine in the ICU between June 2016 and September 2018 were reviewed in this retrospective study. The 37 patients who were received colistine more than 3 days due to detection of Acinetobacter baumannii in culture of tracheal aspirate specimen were included in this study. Sociodemographic and clinical data and also biochemical parameters, glomerular filtration rates (GFR), APACHE-II, RIFLE and AKIN scores were examined. Patients were divided into two groups as ARF-developing and non-ARF-developing. Follow - up parameters were compared between these two groups. Results: The patient group consisted of 26 males and 11 females. The mean age of the patients was 61.0 ± 19.33 years and %45 of the patients developed ARF. Mean APACHE-II score was 20.7±5.6. Mean age was significantly older in ARF patients. Onset day of colistine was significantly lower in patients with ARF. Significant relationships were found with the creatinine, albumin, AST, ALT and BUN parameters between ARF. Conclusion: Older age and early initiation of colistin treatment in the ICU should be considered to be risky for ARF development. Before colistin treatment BUN, creatinine, CRP, albumin and AST levels should be considered to be risky for ARF development. After colistin treatment ALT, BUN, creatinine, urine output, platelet, AST, arterial blood gas base excess levels, urine pH, and protein amount in urine should be followed carefully.

Outcomes of Critically Ill Gynecological Cancer Patients Admitted to Intensive Care Unit

2012 ◽  
Vol 30 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Silvio A. Ñamendys-Silva ◽  
María O. González-Herrera ◽  
Julia Texcocano-Becerra ◽  
Angel Herrera-Gómez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Gynecological Cancer ◽  
Apache Ii ◽  
Apache Ii Score

Purpose: To assess the characteristics of critically ill patients with gynecological cancer, and to evaluate their prognosis. Methods: Fifty-two critically ill patients with gynecological cancer admitted to intensive care unit (ICU) were included. Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality. Results: Thirty-five patients (67.3%) had carcinoma of the cervix uteri and 11 (21.2%) had ovarian cancer. The mortality rate in the ICU was 17.3% (9 of 52) and hospital mortality rate were 23%(12 of 52). In the multivariate analysis, independent prognostic factors for hospital mortality were vasopressor use (odds ratio [OR] = 8.60, 95% confidence interval [CI] 2.05-36; P = .03) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.43, 95% CI 1.01-2.09; P = .048). Conclusions: The independent prognostic factors for hospital mortality were the need for vasopressors and the APACHE II score.

scholarly journals Influence of time elapsed from end of emergency surgery until admission to intensive care unit, on Acute Physiology and Chronic Health Evaluation II (APACHE II) prediction and patient mortality rate

2005 ◽  
Vol 123 (4) ◽  
pp. 167-174 ◽  
Author(s):  
Paulo Antonio Chiavone ◽  
Samir Rasslan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Emergency Surgery ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Death Risk ◽  
Expected Mortality

CONTEXT AND OBJECTIVE: Patients are often admitted to intensive care units with delay in relation to when this service was indicated. The objective was to verify whether this delay influences hospital mortality, length of stay in the unit and hospital, and APACHE II prediction. DESIGN AND SETTING: Prospective and accuracy study, in intensive care unit of Santa Casa de São Paulo, a tertiary university hospital. METHODS: We evaluated all 94 patients admitted following emergency surgery, from August 2002 to July 2003. The variables studied were APACHE II, death risk, length of stay in the unit and hospital, and hospital mortality rate. The patients were divided into two groups according to the time elapsed between end of surgery and admission to the unit: up to 12 hours and over 12 hours. RESULTS: The groups were similar regarding gender, age, diagnosis, APACHE II score and hospital stay. The death risk factors were age, APACHE II and elapsed time (p < 0.02). The mortality rate for the over 12-hour group was higher (54% versus 26.1%; p = 0.018). For the over 12-hour group, observed mortality was higher than expected mortality (p = 0.015). For the up to 12-hour group, observed and expected mortality were similar (p = 0.288). CONCLUSION: APACHE II foresaw the mortality rate among patients that arrived faster to the intensive care unit, while the mortality rate was higher among those patients whose admission to the intensive care unit took longer.

Patient-Specific Risk Factors Associated With the Development of Hyperchloremia in a Neurocritical Care Intensive Care Unit

2021 ◽  
pp. 089719002110268
Author(s):  
Leslie A. Hamilton ◽  
Michael L. Behal ◽  
Ashley R. Carter ◽  
A. Shaun Rowe
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Neurocritical Care ◽  
Kidney Injury ◽  
Serum Osmolality ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Factors Associated

Background: Hypertonic sodium chloride (HTS) is used in intensive care unit (ICU) settings to manage cerebral edema, intracranial hypertension, and for the treatment of severe hyponatremia. It has been associated with an increased incidence of hyperchloremia; however, there is limited literature focusing on hyperchloremic risk in neurologically injured patients. Objective: The primary objective of this study was to determine risk factors associated with development of hyperchloremia in a neurocritical care (NCC) ICU population. Methods: This was a retrospective case-control study performed in an adult NCC ICU and included patients receiving HTS. The primary outcome was to evaluate patient characteristics and treatments associated with hyperchloremia. Secondary outcomes included acute kidney injury and mortality. Results: Overall, 133 patients were identified; patients who were hyperchloremic were considered cases (n = 100) and patients without hyperchloremia were considered controls (n = 33). Characteristics and treatments were evaluated with univariate analysis and a logistic regression model. In the multivariate model, APACHE II Score, initial serum osmolality, total 3% saline volume, and total 23.4% saline volume were significant predictors for hyperchloremia. In addition, patients with a serum chloride greater than 113.5 mEq/L were found to have a higher risk of acute kidney injury (AKI) (adjusted OR 3.15; 95% CI 1.10-9.04). Conclusions: This study demonstrated APACHE II Score, initial serum osmolality, and total 3% and 23.4% saline volumes were associated with developing hyperchloremia in the NCC ICU. In addition, hyperchloremia is associated with an increased risk of AKI.

scholarly journals Atrial Fibrillation in a Tertiary Care Multidisciplinary Intensive Care Unit—Incidence and Risk Factors

2007 ◽  
Vol 35 (5) ◽  
pp. 707-713 ◽  
Author(s):  
S. Arora ◽  
I. Lang ◽  
V. Nayyar ◽  
E. Stachowski ◽  
D. L. Ross
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Confidence Interval ◽  
Tertiary Care ◽  
Multivariate Logistic Regression Analysis ◽  
Apache Ii ◽  
Resource Utilisation ◽  
Apache Ii Score

Atrial fibrillation is a common arrhythmia in an intensive care unit. We performed a prospective observational study over a period of three months, to study the incidence, risk factors and outcome of patients who develop atrial fibrillation in a multidisciplinary intensive care unit. All patients above the age of 50 years were eligible. Exclusion criteria were: cardiac or oesophageal surgery during current hospitalisation, atrial fibrillation at admission, implanted pacemaker and expected intensive care unit stay of less than 24 hours. Sixty-one patients were included in the study. Eighteen patients (29.5%, confidence interval 18-40) developed atrial fibrillation. Incidence of atrial fibrillation was 4.02 episodes per 100 patient days. Patients who developed atrial fibrillation had higher age (71.3 years vs. 63.2 years, P=0.001), severity of illness (APACHE II 25.4 vs. 20.0, P=0.005) and sepsis at admission (9/18 vs. 9/43, P=0.01). They also had higher in-hospital mortality (Risk ratio 2.7, 95% confidence interval 1.3-5.4). Standardised mortality ratio was higher in patients who developed atrial fibrillation (1.08 vs. 0.63). Patients who developed atrial fibrillation required a longer period of mechanical ventilation and inotropic support. Multivariate logistic regression analysis showed age > 75 years, APACHE II score >20 and sepsis at admission were independent predictors for development of atrial fibrillation in critically ill patients. Although atrial fibrillation by itself is unlikely to be the cause of higher mortality, it is likely to be a marker for increased mortality and resource utilisation in the intensive care unit.

scholarly journals Predictive Performance of two Measures of Prognostic Mortality of Cancer Patients in Intensive Care Unit in Jordan: A Comparative Single-Centre Study

2020 ◽  
Vol 14 (1) ◽  
pp. 168-173
Author(s):  
Issa M. Almansour ◽  
Mohammad K. Aldalaykeh ◽  
Zyad T. Saleh ◽  
Khalil M. Yousef ◽  
Mohammad M. Alnaeem
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Cancer Patients ◽  
Predictive Performance ◽  
Mortality Rates ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Actual Mortality ◽  
Apache Iv

Background: Information is presently insufficient about using Acute Physiology and Chronic Health Evaluation (APACHE) mortality predicting models for cancer patients in intensive care unit (ICU). Objective: To evaluates the performance of APACHE II and IV in predicting mortality for cancer patients in ICU. Interventions/Methods: This was a retrospective study including adult patients admitted to an ICU in a medical center in Jordan. Actual mortality rate was determined and compared with mortality rates predicted by APACHE II and IV models. Receiver operating characteristic (ROC) analysis was used to assess the sensitivity, specificity and predictive performance of both scores. Binary logistic regression analysis was used to determine the effect that APACHE II, APACHE IV and other sample characteristics have on predicting mortality. Results: 251 patients (survived=80; none-survived=171) were included in the study with an actual mortality rate of 68.1%. APACHE II and APACHE IV scores demonstrated similar predicted mortality rates (43.3% vs. 43.0%), sensitivity (52.6% vs. 52.0%), and specificity (76.3%, 76.2%), respectively. The area under (AUC), the ROC curve for APACHE II score was 0.714 (95% confidence interval [CI] 0.645–0.783), and AUC for APACHE IV score was 0.665 (95% CI 0.595–0.734). Conclusions: As APACHE ӀӀ and ӀV mortality models demonstrate insufficient predicting performance, there is no need to consider APACHE IV in our ICU instead of using APACHE ӀӀ as it has more variables and need longer data extraction time. Implications for Practice: We suggest that other approaches in addition to the available models should be attempted to improve the accuracy of cancer prognosis in ICU. Further, it is also required to adjust the available models.

scholarly journals Clinical characteristics and prognosis in patients with urosepsis from intensive care unit in Shanghai, China: a retrospective bi-centre study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying Sheng ◽  
Wen-long Zheng ◽  
Qi-fang Shi ◽  
Bing-yu Zhang ◽  
Guang-yao Yang
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Predictive Value ◽  
Clinical Characteristics ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Regional Medical ◽  
Underlying Diseases

Abstract Background The purpose of this study was to retrospectively analyze clinical characteristics and prognostic risk factors of urosepsis patients admitted to two intensive care units in Shanghai, China. Methods Clinical data from patients diagnosed with urosepsis were retrospectively retrieved and analyzed from ICU in two regional medical centers from January 2015 to December 2019. Results Two hundred two patients were included in the subsequent analysis eventually, with an average age of 72.02 ± 9.66 years, 79.21% of the patients were female and the mortality rate of 15.84%.The proportion of patients with chronic underlying diseases such as diabetes and hypertension was relatively high (56.44, 49.50%, respectively), and the incidence of shock was also high (41.58%) correspondingly. The most common pathogen isolated was Escherichia coli (79.20%), of which the extended-spectrumβ-lactamases (ESBLs)(+) accounted for 42.57%. In multivariate analysis, the strongest predictors for death were mechanical ventilation (OR 7.260, 95% CI 2.200–23.963; P = 0.001),chronic kidney disease (CKD) (OR 5.140, 95% CI 1.596–16.550; P = 0.006), APACHE II score (OR 1.321, 95% CI 1.184–1.473; P < 0.001) and lactate (OR 1.258, 95% CI 1.037–1.527; P = 0.020). Both APACHE II score and lactate had the ideal predictive value, with the area under the ROC curve (AUC) of 0.858 and 0.805 respectively. Conclusion The patients with urosepsis were characterized by a higher proportion of female, older age, more percentage of comorbidities in this region, and patients with ESBLs (+) Escherichia coli infection were more prone to shock. Mechanical ventilation, comorbidity with CKD, APACHE II score and lactate were independent risk factors for death in urosepsis patient, but lactate level and APACHE II score had better predictive value for prognosis.

scholarly journals Impact of Body Mass Index on the Mortality of Critically Ill Patients Admitted to the Intensive Care Unit: An Observational Study

2020 ◽  
Author(s):  
Ata Mahmoodpoor ◽  
Fahimeh Karrubi ◽  
Mohammad-Salar Hosseini ◽  
Afshin Iranpour ◽  
Sarvin Sanaie
Keyword(s):  
Body Mass Index ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Waist Circumference ◽  
Mortality Rate ◽  
Body Mass ◽  
Apache Ii ◽  
Apache Ii Score ◽  
P Value ◽  
Surgical Trauma

Abstract Background: Obesity, a wide-ranging disorder all around the world, is associated with significant morbidity and mortality in the general population. Regarding the present controversies, this study aims to evaluate the possible association of body mass index (BMI) and mortality in patients admitted to intensive care units.Methods: During this cross-sectional study, all patients admitted to the intensive care unit of two university affiliated hospitals in northwest of Iran from November 2017 to March 2019 were enrolled. The demographic characteristics of patients, length of stay in the intensive care unit and hospital, organ failure, mortality, duration of mechanical ventilation and vasopressor-therapy, type of nutrition, the occurrence of nosocomial infection, type of admission (medical, surgical, trauma) were recorded for all patients. According to the WHO classification of BMI, patients were divided into the six groups, and the data were analyzed accordingly.Results: Of the 502 patients studied, 267 were male (53.2%) and 235 were female (46.8%). The highest mortality rate was observed among the obesity class II patients (35 < BMI < 40) with 28.6%, while the lowest rate was observed in the normal-weight patients (18.5 < BMI < 25) with 3.9%. The highest length of hospital stay was seen in patients with BMI > 30 with 12 days of hospitalizations. APACHE II and waist circumference had a statistically significant relationship with the mortality rate of patients (P-value < 0.001).Conclusion: The current study showed that BMI could be related to mortality, regardless of waist circumference and APACHE II score. However, considering waist circumference and APACHE II score as confounding factors, BMI does not have a significant effect on mortality and only affect the morbidity of patients.

Outcome and Early Prognostic Indicators in Patients with Hematological Disorders Admitted to the Intensive Care Unit for a Life-Threatening Complication.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1329-1329
Author(s):  
Honar Cherif ◽  
Jan Hansen ◽  
Mats Kalin ◽  
Magnus Bjorkholm Prof
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Mortality Rate ◽  
Mortality Rates ◽  
Apache Ii ◽  
Prognostic Indicators ◽  
Apache Ii Score ◽  
Short Term ◽  
Hematological Diseases ◽  
Life Threatening

Abstract Background: Appropriately aggressive treatment of haematological malignancies can be complicated by a variety of life threatening events. Despite high hospital mortality rates for such patients admitted to intensive care units (ICU) it is now generally considered to be appropriate to offer intensive care to selected cases, provided there is a reasonable prospect of cure or at least worthwhile palliation. Aims and Methods: We conducted a retrospective observational study to assess outcome and prognostic indicators in consecutive patients with hematological diseases admitted to the ICU during a 6-year-period. Results: From 1996 through 2001, a total of 95 patients with hematological diseases and a median age of 57 years (range 16–86) were admitted to the ICU. The median duration of ICU stay was 1 day (mean 4.2 days: range 1–67 days). The Mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 20 (± 9). The large majority of patients underwent active treatment of a hematological malignancy (90%) with acute leukaemia (27%), non-Hodgkin lymphoma (24%) and multiple myeloma (10%) dominating. Respiratory failure (46%), sepsis (24%), cardiovascular complications (9%) and bleeding disorders (7%) were the major reasons for ICU admission. A total of 49 patients (51%) had a microbiologically verified infection and 21 (22%) had bacteremia. Crude ICU, 4-week and 6-month mortality rates were 28%, 45%, and 57%, respectively. An APACHE II score &gt; 30 predicted a high short-term mortality rate (p= 0.0001). However, age &gt; 65 years, respiratory failure, bacteremia, and a diagnosis of acute leukemia were not significantly associated with a poor short-term survival (p&gt; 0.05). A total of 30 patients (31%) were alive after a minimum follow up of 3.5 years. Conclusion: The lower mortality rate as compared with most other series is probably explained by a more liberal attitude towards ICU admission. Not withstanding this, for a substantial proportion of critically ill hematological patients a short time care at an ICU is life saving. Patients with life threatening complications of haematological disease should be offered intensive care unless or until it is clear that there is no prospect of recovery from the acute illness or that the underlying malignancy cannot be controlled.

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