Positive fluid balance within the first 72 hours in the intensive care unit is associated with higher mortality in adult patients

Objective: To identify the association between cumulative fluid balance in the first 72 hours of ICU stay and outcomes. Methodology: retrospective observational cohort with data analysis of adult patients hospitalized in an ICU of a tertiary teaching hospital. Results: a total of 86 patients who remained in the ICU for more than 72 hours were evaluated. The fluid balance in the first 72 hours was higher in the subgroup of patients who died in the ICU (5210.3 ± 2787.7 vs. 3017.4 ± 2847.2 mL, p = 0.004). The fluid balance in the first 72 hours was an independent factor directly associated with death in the ICU (OR: 1,000; p = 0.009). The area under the ROC curve was 0.7119 (95% CI: 0.58-0.84, p = 0.005). The optimal cutoff point for the fluid balance in the first 72 hours as a predictor of death in the ICU was + 3.900mL and the relative risk of death among those who presented a fluid balance higher than this value was 1.702 (95% CI: 1, 15-2.53, p = 0.009). Conclusion: an association was identified between the cumulative value in the fluid balance in the first 72 hours of ICU stay and the highest risk of death, which is an independent factor of the patient's severity at admission.

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Incidence and diagnosis of Acute kidney injury in hospitalized adult patients: a retrospective observational study in a tertiary teaching Hospital in Southeast China

BMC Nephrology ◽

10.1186/s12882-017-0622-6 ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 11

Author(s):

Xiaoyan Cheng ◽

Buyun Wu ◽

Yun Liu ◽

Huijuan Mao ◽

Changying Xing

Keyword(s):

Acute Kidney Injury ◽

Observational Study ◽

Teaching Hospital ◽

Kidney Injury ◽

Adult Patients ◽

Retrospective Observational Study ◽

Southeast China ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital

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Prevalence of Delirium and Its Clinical Outcome in Adult Filipino Patients Admitted in The Intensive Care Unit

Journal Of Medicine & Health ◽

10.28932/jmh.v2i4.1106 ◽

2019 ◽

Vol 2 (4) ◽

Author(s):

Abram P Tanuatmadja ◽

Jacqueline R Vea

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Scoring Method ◽

Icu Admission ◽

Icu Stay ◽

Manpower Requirement ◽

Tertiary Teaching ◽

Metro Manila ◽

Tertiary Teaching Hospital ◽

Dsm Iv

Delirium is common in the ICU setting and is associated with increased morbidity, manpower requirement, and costs. This study aims to investigate the prevalence of delirium and its outcome in terms of 14-days mortality and length of ICU stay in ICU patients. The study was done at a 150-bed tertiary teaching hospital, located in Quezon City, Metro Manila, February to September 2016. This is a prospective studyinvolving 136 adults. Screening for delirium was done within 24 hours of ICU admission using both CAM-ICU scoring method and DSM-IV-TR criteria for delirium. Delirium prevalence was found to be 5.15%. The average age was higher in the subjects positive for delirium (70.14 + 21.15 years versus 60.43 + 16.10 years, p=0.1286). At the time of ICU admission, 11.54% of sedated patients were positive for delirium compared to 3.64% of non-sedated patients, p=0.1513 ;OR 3.457. Delirium was associated with higher 14 days mortality (OR 16.8, p=0.0212). Subjects positive for delirium had 2.74 longer days average ICU stay compared to the other group, with p=0.026. We concluded delirium was associated with higher 14-days mortality and longer ICU stay. Keywords : delirium, prevalence, Intensive Care Unit

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Diabetes and Mortality Among 1.6 Million Adult Patients Screened for SARS-CoV-2 in Mexico

10.1101/2020.11.25.20238345 ◽

2020 ◽

Author(s):

Orison O. Woolcott ◽

Juan P. Castilla-Bancayán

Keyword(s):

Relative Risk ◽

Chronic Renal Disease ◽

Smoking Habit ◽

Case Series ◽

Hazard Ratio ◽

Adult Patients ◽

Epidemiological Surveillance ◽

Risk Of Death ◽

Case Series Study ◽

Relative Risk Of Death

ABSTRACTBackgroundWhether diabetes is associated with COVID-19-related mortality remains unclear.MethodsIn this retrospective case-series study we examined the risk of death associated with self-reported diabetes in symptomatic adult patients with laboratory-confirmed COVID-19 who were identified through the System of Epidemiological Surveillance of Viral Respiratory Disease in Mexico from January 1 through November 4, 2020. Survival time was right-censored at 28 days of follow-up.ResultsAmong 757,210 patients with COVID-19 included in the study, 120,476 (16%) had diabetes and 80,616 died. Patients with diabetes had a 49% higher relative risk of death than those without diabetes (Cox proportional-hazard ratio; 1.49 (95% confidence interval [CI], 1.47-1.52), adjusting for age, sex, smoking habit, obesity, hypertension, immunodeficiency, and cardiovascular, pulmonary, and chronic renal disease. The relative risk of death associated with diabetes decreased with age (P=0.004). The hazard ratios were 1.66 (1.58-1.74) in outpatients and 1.14 (1.12-1.16) in hospitalized patients. The 28-day survival for inpatients with and without diabetes was, respectively, 73.5% and 85.2% for patients 20-39 years of age; 66.6% and 75.9% for patients 40-49 years of age; 59.4% and 66.5% for patients 50-59 years of age; 50.1% and 54.6% for patients 60-69 years of age; 42.7% and 44.6% for patients 70-79 years of age; and 38.4% and 39.0% for patients 80 years of age or older. In patients without COVID-19 (878,840), the adjusted hazard ratio for mortality was 1.78 (1.73-1.84).ConclusionIn symptomatic adult patients with COVID-19 in Mexico, diabetes was associated with higher mortality. This association decreased with age.

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Decline in mortality among hospitalised covid-19 patients in Sweden: a nationwide observational study

10.1101/2020.10.27.20220061 ◽

2020 ◽

Author(s):

Kristoffer Strålin ◽

Erik Wahlström ◽

Sten Walther ◽

Anna M Bennet-Bark ◽

Mona Heurgren ◽

...

Keyword(s):

Relative Risk ◽

Severity Of Illness ◽

Future Research ◽

Adjusted Relative Risk ◽

National Board ◽

Risk Of Death ◽

Hospitalised Patients ◽

Observational Cohort ◽

Relative Risk Of Death ◽

Nationwide Observational Study

ABSTRACTOBJECTIVEIt is important to know if mortality among hospitalised covid-19 patients has changed as the pandemic has progressed. The aim of this study was to describe the dynamics of mortality among patients hospitalised for covid-19 in a nationwide study.DESIGNNationwide observational cohort study of all patients hospitalised in Sweden 1 March to 30 June 2020 with SARS-CoV-2 RNA positivity 14 days before to 5 days after admission, and a discharge code for covid-19.SETTINGAll hospitals in Sweden.PARTICIPANTS15 761 hospitalised patients with covid-19, with data compiled by the Swedish National Board of Health and Welfare.MAIN OUTCOME MEASURESOutcome was 60-day all-cause mortality. Patients were stratified according to month of hospital admission. Poisson regression was used to estimate the relative risk of death by month of admission, adjusting for pre-existing conditions, age, sex, care dependency, and severity of illness (Simplified Acute Physiology, version 3), for patients in intensive care units (ICU).RESULTSThe overall 60-day mortality was 17.8% (95% confidence interval (CI), 17.2% to 18.4%), and it decreased from 24.7% (95% CI, 23.0% to 26.5%) in March to 13.3% (95% CI, 12.1% to 14.7%) in June. Adjusted relative risk (RR) of death was 0.56 (95% CI, 0.51 to 0.63) for June, using March as reference. Corresponding RR for patients not admitted to ICU and those admitted to ICU were 0.60 (95% CI, 0.53 to 0.67) and 0.61 (95% CI, 0.48 to 0.79), respectively. The proportion of patients admitted to ICU decreased from 19.5% (95% CI, 17.9% to 21.0%) in the March cohort to 11.0% (95% CI, 9.9% to 12.2%) in the June cohort.CONCLUSIONSThere was a gradual decline in mortality from March to June 2020 in Swedish hospitalised covid-19 patients, which was independent of pre-existing conditions, age, and sex. Future research is needed to explain the reasons for this decline. The changing covid-19 mortality should be taken into account when management and results of studies from the first pandemic wave are evaluated.

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Lymphocytopenia as a Predictor of Mortality in Patients with ICU-Acquired Pneumonia

Journal of Clinical Medicine ◽

10.3390/jcm8060843 ◽

2019 ◽

Vol 8 (6) ◽

pp. 843 ◽

Cited By ~ 9

Author(s):

Adrian Ceccato ◽

Meropi Panagiotarakou ◽

Otavio T. Ranzani ◽

Marta Martin-Fernandez ◽

Raquel Almansa-Mora ◽

...

Keyword(s):

Lymphocyte Count ◽

Independent Predictor ◽

Community Acquired Pneumonia ◽

Immunocompromised Patients ◽

Tertiary Teaching ◽

Failure Assessment ◽

Patients At Risk ◽

Observational Cohort ◽

Tertiary Teaching Hospital ◽

The Moment

Background: Intensive care unit-acquired pneumonia (ICU-AP) is a severe complication in patients admitted to the ICU. Lymphocytopenia is a marker of poor prognosis in patients with community-acquired pneumonia, but its impact on ICU-AP prognosis is unknown. We aimed to evaluate whether lymphocytopenia is an independent risk factor for mortality in non-immunocompromised patients with ICU-AP. Methods: Prospective observational cohort study of patients from six ICUs of an 800-bed tertiary teaching hospital (2005 to 2016). Results: Of the 473 patients included, 277 (59%) had ventilator-associated pneumonia (VAP). Receiver operating characteristic (ROC) analysis of the lymphocyte counts at diagnosis showed that 595 cells/mm3 was the best cut-off for discriminating two groups of patients at risk: lymphocytopenic group (lymphocyte count <595 cells/mm3, 141 patients (30%)) and non-lymphocytopenic group (lymphocyte count ≥595 cells/mm3, 332 patients (70%)). Patients with lymphocytopenia presented more comorbidities and a higher sequential organ failure assessment (SOFA) score at the moment of pneumonia diagnosis. Also, 28-day mortality and 90-day mortality were higher in patients with lymphocytopenia (28-day: 38 (27%) versus 59 (18%), 90-day: 74 (53%) versus 111 (34%)). In the multivariable model, <595 cells/mm3 resulted to be an independent predictor for 90-day mortality (Hazard Ratio 1.41; 95% Confidence Interval 1.02 to 1.94). Conclusion: Lymphocytopenia is an independent predictor of 90-day mortality in non-immunocompromised patients with ICU-AP.

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Potential Drug-Drug Interactionsamong Adult Patients Admitted to MedicalWards at a Tertiary Teaching Hospital inEthiopia

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v8i5-s.2056 ◽

2018 ◽

Vol 8 (5-s) ◽

pp. 348-354 ◽

Cited By ~ 2

Author(s):

Samson Kibrom ◽

Zelalem Tilahun ◽

Solomon Assefa Huluka

Keyword(s):

Drug Interaction ◽

Drug Interactions ◽

Teaching Hospital ◽

Adult Patients ◽

Potential Drug ◽

Potential Ddis ◽

Pharmacodynamic Interaction ◽

Cross Sectional ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital

Abstract Introduction: A Drug-drug interaction (DDI) is a decrease or increase in the pharmacological or clinical response to the administration of two or more drugs that are different from the anticipated response they initiate when individually administered. Objectives: To assess the prevalence and factors associated with potential DDIs among adult inpatients admitted to the medical wards of a tertiary teaching Hospital in Ethiopia. Methods: A retrospective cross-sectional study design was employed on adult patients who were admitted to the medical ward in one year period. A total of 384patients’ medical records were checked for a possible DDI using Micromedex DrugReax® drug interaction database and analyzed consecutively using SPSS version 20.0. Results: Among 384 adult patients enrolled in the study, 209 (54.4%) of them had medications with at least one potential DDI in their prescriptions. Of the 209 potential DDI, 26.3% were with a minimum of one major potential DDI. The median number of potential DDI per patient was 2.2. Overall, 296 potential DDI were identified in the current study. Among 296 identified potential drug-drug interactions, most of the interaction (49.7%) had good documentation. The number of medication prescribed per patient showed a significant (p< 0.001) association with the occurrence of potential DDIs. Conclusion: More than half of the patients’ prescription contains potentially interacting medications. This study, additionally, revealed that there is a significant association between potential DDIs and number of medications prescribed per patient. Key words: Drug-drug interactions, pharmacokinetic interaction, pharmacodynamic interaction, internal medicine

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A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpaitents in a tertiary teaching hospital in China

10.21203/rs.3.rs-24682/v2 ◽

2020 ◽

Author(s):

Zhangrui Zeng ◽

Yinhuan Ding ◽

Gang Tian ◽

Kui Yang ◽

Jian Deng ◽

...

Keyword(s):

Risk Factors ◽

Amphotericin B ◽

Candida Species ◽

Antifungal Susceptibility ◽

Fungal Species ◽

Adult Patients ◽

Paediatric Patients ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital ◽

The Mean

Abstract Background: There are no current national estimates of the candidaemia burden in China, and epidemiological candidaemia data from the underdeveloped region of China are lacking. Methods: A 7-year retrospective study was carried out to analyse the prevalence, species distribution, antifungal susceptibility, risk factors and inpatient mortality of candidaemia among paediatric and adult patients in a regional tertiary teaching hospital in China. Results: During the seven-year study period, a total of 201 inpatients with candidaemia were identified. The median age of the patients was 65 years (range, 1 day to 92 years), and 114 of the patients (56.7%) were male. The mean annual incidence of candidaemia was 0.26 cases per 1,000 admissions (0.42 cases per 1,000 paediatric admissions vs 0.24 cases per 1,000 adult admissions, P<0.05). Candida albicans was the most common fungal species (81/201, 40.3%) in all patients, Candida glabrata was the most common fungal species (18/35, 51.4%) in paediatric patients. Most isolates were susceptible to flucytosine (99.0%) and amphotericin B (99.0%), and the activity of antifungal agents against Candida species was no significant difference in satisfaction between paediatric and adult patients(P>0.05). The all-cause mortality rate was 20.4% (paediatric patients: 11.4% vs adult patients:22.3%, P>0.05). Fewer univariate predictors of poor outcomes were identified for paediatric patients than for adult patients (4 vs 11 predictors). Respiratory dysfunction and septic shock were independent predictors of 30-day mortality for all patients. Conclusions: The epidemiological data of candidaemia in paediatric and adult patients are only different in the distributions of Candida species and the mean annual incidence of candidaemia. Flucytosine and amphotericin B can be used as first-choice agents when no antifungal susceptibility test results are available.

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A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpatients in a tertiary teaching hospital in China

10.21203/rs.3.rs-24682/v1 ◽

2020 ◽

Author(s):

Zhangrui Zeng ◽

Yinhuan Ding ◽

Gang Tian ◽

Kui Yang ◽

Jian Deng ◽

...

Keyword(s):

Risk Factors ◽

Amphotericin B ◽

Candida Species ◽

Antifungal Susceptibility ◽

Fungal Species ◽

Adult Patients ◽

Paediatric Patients ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital ◽

The Mean

Abstract Background There are no current national estimates of the candidaemia burden in China, and epidemiological candidaemia data from the underdeveloped region of China are lacking. Methods A 7-year retrospective study was carried out to analyse the prevalence, species distribution, antifungal susceptibility, risk factors and inpatient mortality of candidaemia among paediatric and adult paitents in a regional tertiary teaching hospital in China. Results During the seven-year study period, a total of 201 inpatients with candidaemia were identified. The median age of the patients was 65 years (range, 1 day to 92 years), and 114 of the patients (56.7%) were male; the mean annual incidence was 0.26 cases per 1,000 admissions (0.42 cases per 1,000 paediatric vs 0.24 cases per 1,000 adult admissions, P<0.05). Candida albicans was the most common fungal species (81/201, 40.3%) in all patients, Candida glabrata was the most common fungal species (18/35, 51.4%) in paediatric patients. Most isolates were susceptible to flucytosine (99.0%) and amphotericin B (99.0%), and the activity of antifungal agents against Candida species was no significant difference in satisfaction between paediatric and adult patients(P>0.05). The all-cause mortality rate was 20.4% (paediatric patients: 11.4% vs adult patients:22.3%, P>0.05). The univariate predictors of poor outcomes in paediatric patients were less than that in adult patients (4 vs 11 predictors). Respiratory dysfunction and septic shock were independent predictors of 30-day mortality in all patients. Conclusions The epidemiological data of candidaemia in paediatric and adult patients are only different in the distribution of Candida species and the mean annual incidence of candidaemia. Flucytosine and amphotericin B could be used as the first-choice agent when there is no the result of antifungal susceptibility tests.

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