scholarly journals Heart Rate Fluctuation and Mortality in Critically Ill Myocardial Infarction Patients: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Qi Guo ◽  
Hongwei Li ◽  
Huijun Ouyang ◽  
Runlu Sun ◽  
Junjie Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Sensitivity Analyses ◽  
Hazard Ratios

Background: Whether heart rate (HR) fluctuation after admission has an impact on the outcomes of critically ill myocardial infarction (MI) patients in intensive care unit remains unknown.Methods: A total of 2,031 MI patients were enrolled from the Medical Information Mart for Intensive Care (MIMIC-III) database. HR fluctuation was calculated as the maximum HR minus the minimum HR in the initial 24 h after admission. Participants were divided into 3 groups, namely, low HR fluctuation [<30 beats per minute (bpm)], medium HR fluctuation (30–49 bpm), and high HR fluctuation (≥ 50 bpm). The main outcomes were 30–day and 1-year mortality. Cox regression and restricted cubic spline model were used.Results: Each 10-bpm increase in HR fluctuation was associated with a higher risk of 30-day mortality and 1-year mortality, with adjusted hazard ratios of 1.122 (95% CI, 1.083–1.162) and 1.107 (95% CI, 1.074–1.140), respectively. Compared with the low HR fluctuation group, the high HR fluctuation group suffered a significantly higher risk of mortality after adjustment, with hazard ratios of 2.156 (95% CI, 1.483–3.134) for 30-day mortality and 1.796 (95% CI, 1.354–2.381) for 1-year mortality. A typical J-type curve was observed in restricted cubic splines for the association between HR fluctuation and 30-day or 1-year mortality of MI patients, with the lowest risk on the HR fluctuation of 30 bpm. Sensitivity analyses emphasized the robustness of our results.Conclusions: This retrospective cohort study revealed an independent positive association between HR fluctuation and 30-day and 1-year mortality in critically ill MI patients, which warrants further investigation.

scholarly journals Predictors of early postdischarge mortality in critically ill patients: A retrospective cohort study from the California Intensive Care Outcomes project

2011 ◽  
Vol 26 (1) ◽  
pp. 65-75 ◽  
Author(s):  
Eduard E. Vasilevskis ◽  
Michael W. Kuzniewicz ◽  
Brian A. Cason ◽  
Rondall K. Lane ◽  
Mitzi L. Dean ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Care Outcomes

scholarly journals Association of Rosacea With Cardiovascular Disease: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Daein Choi ◽  
Sungjun Choi ◽  
Seulggie Choi ◽  
Sang Min Park ◽  
Hyun‐Sun Yoon
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Cohort Study ◽  
Heart Disease ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Hazard Ratios ◽  
Increased Risk

Background There is emerging evidence that rosacea, a chronic cutaneous inflammatory disease, is associated with various systemic diseases. However, its association with cardiovascular disease (CVD) remains controversial. We aimed to investigate whether patients with rosacea are at increased risk of developing CVD. Methods and Results This retrospective cohort study from the Korean National Health Insurance Service‐Health Screening Cohort included patients with newly diagnosed rosacea (n=2681) and age‐, sex‐, and index year–matched reference populations without rosacea (n=26 810) between 2003 and 2014. The primary outcome was subsequent CVD including coronary heart disease and stroke. Multivariable Cox regression analyses were used to evaluate adjusted hazard ratios for subsequent CVD adjusted for major risk factors of CVD. Compared with the reference population (13 410 women; mean [SD] age, 57.7 [9.2] years), patients with rosacea (1341 women; mean [SD] age, 57.7 [9.2] years) displayed an increased risk for CVD (adjusted hazard ratios, 1.20; 95% CI, 1.03–1.40) and coronary heart disease (adjusted hazard ratios, 1.29; 95% CI, 1.05–1.60). The risk for stroke was not significantly elevated (adjusted hazard ratios, 1.12; 95% CI, 0.91–1.37). Conclusions This study suggests that patients with rosacea are more likely to develop subsequent CVD. Proper education for patients with rosacea to manage other modifiable risk factors of CVD along with rosacea is needed.

scholarly journals Association between comorbid sleep apnoea–hypopnoea syndrome and prognosis of intensive care patients: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048886
Author(s):  
Hongxia Wang ◽  
Guangqiang Shao ◽  
Lei Rong ◽  
Yang Ji ◽  
Keke Zhang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Sleep Apnoea ◽  
Chronic Obstructive ◽  
Comorbid Condition ◽  
Icu Mortality ◽  
Cerebral Disease

ObjectiveIn this study, we investigated the association between comorbid sleep apnoea–hypopnoea syndrome (SAHS) and the prognosis of patients in an intensive care unit (ICU) to determine whether this relationship varies between different disease subgroups.MethodsWe conducted a retrospective cohort study using publicly available information from the critical care database Medical Information Mart for Intensive Care III. Adults (≥18 years of age) who attended the ICU for the first time were enrolled. Demographic information and clinical data were obtained from each patient. The primary outcome was 30-day mortality after ICU admission, and the secondary outcomes were in-hospital and ICU mortality. Multivariate logistic regression and Cox regression analyses were used to examine the associations between SAHS comorbidities and the research outcomes. Propensity score matching was used to adjust for potential confounding variables.ResultsOf the 32 989 patients enrolled, 1918 (5.81%) were diagnosed with SAHS as a comorbid condition. Patients with SAHS had a significantly lower 30-day mortality rate compared with those without SAHS (5.27% vs 13.65%, respectively; p<0.001). The frequency of chronic obstructive pulmonary disease, cerebral disease, cardiovascular disease, hypertension, diabetes mellitus and renal failure was significantly different between the two groups. Patients with SAHS demonstrated significantly longer survival compared with patients without SAHS. Multivariate Cox proportional hazards regression identified a significant relationship between SAHS and mortality within 30 days (adjusted HR=0.610, 95% CI 0.499 to 0.747, p<0.0001).ConclusionSAHS as a comorbid condition decreases the risk of 30-day mortality, in-hospital mortality and ICU mortality among ICU patients.

scholarly journals AST/ALT ratio as a predictor of mortality and future exacerbations of PM/DM-ILD——a retrospective cohort study with 522 cases

2020 ◽  
Author(s):  
Renjiao Li ◽  
Wen-Jun Zhu ◽  
Faping Wang ◽  
Xiaoju Tang ◽  
Fengming Luo
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Low Cost ◽  
Cox Regression Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Hazard Ratios

Abstract ObjectiveTo assess the associations between aspartate transaminase/alanine transaminase ratio (DRR) and mortality in patients with Polymyositis/dermatomyositis associated interstitial lung disease (PM/DM-ILD).Patients and MethodsThis was a retrospective cohort study, which included 522 patients with PM/DM-ILD whose DRR on admission were tested at West China Hospital of Sichuan University during the period from January 1, 2008 to December 31, 2018. Cox regression models were used to estimate hazard ratios for mortality in four predefined DRR strata (≤ 0.91, 0.91–1.26, 1.26–1.73 and > 1.73), after adjusting for age, sex, DRR stratum, diagnosis, overlap syndrome, hemoglobin, platelet count, white blood cell count, the percentage of neutrophils, neutrophil/lymphocyte ratio, albumin, creatine kinase, uric acid/creatinine ratio, triglycerides or low density lipoprotein.ResultsHigher DRR (> 1.73) was an independent predictor of 1-year mortality in multivariate Cox regression analysis (hazard ratio 3.423, 95% CI 1.481–7.911, p = .004). Patients with higher DRR more often required use of mechanical ventilation and readmission for acute exacerbation of PM/DM-ILD at 1-year follow-up.ConclusionHigher DRR on admission for PM/DM-ILD patients are associated with increased mortality, risk of mechanical ventilation and hospitalization in 1-year follow-up. This low-cost, easy-to-obtain, rapidly measured biomarker may be useful in the identification of high-risk PM/DM-ILD patients that could benefit from intensive management.

scholarly journals Admission factors associated with intensive care unit readmission in critically ill oncohematological patients: a retrospective cohort study

2016 ◽  
Vol 28 (1) ◽  
Author(s):  
Cinthia Mendes Rodrigues ◽  
Ellen Maria Campos Pires ◽  
Jorge Patrick Oliveira Feliciano ◽  
Jose Mauro Vieira Júnior ◽  
Leandro Utino Taniguchi
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Factors Associated ◽  
Intensive Care Unit Readmission

scholarly journals Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study

BMJ ◽  
2019 ◽  
pp. l1927 ◽  
Author(s):  
Thomas S Valley ◽  
Theodore J Iwashyna ◽  
Colin R Cooke ◽  
Shashank S Sinha ◽  
Andrew M Ryan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
St Elevation Myocardial Infarction ◽  
Icu Admission ◽  
Admission Rates ◽  
Percentage Points ◽  
St Elevation

AbstractObjectiveTo evaluate the effect of intensive care unit (ICU) admission on mortality among patients with ST elevation myocardial infarction (STEMI).DesignRetrospective cohort study.Setting1727 acute care hospitals in the United States.ParticipantsMedicare beneficiaries (aged 65 years or older) admitted with STEMI to either an ICU or a non-ICU unit (general/telemetry ward or intermediate care) between January 2014 and October 2015.Main outcome measure30 day mortality. An instrumental variable analysis was done to account for confounding, using as an instrument the additional distance that a patient with STEMI would need to travel beyond the closest hospital to arrive at a hospital in the top quarter of ICU admission rates for STEMI.ResultsThe analysis included 109 375 patients admitted to hospital with STEMI. Hospitals in the top quarter of ICU admission rates admitted 85% or more of STEMI patients to an ICU. Among patients who received ICU care dependent on their proximity to a hospital in the top quarter of ICU admission rates, ICU admission was associated with lower 30 day mortality than non-ICU admission (absolute decrease 6.1 (95% confidence interval −11.9 to −0.3) percentage points). In a separate analysis among patients with non-STEMI, a group for whom evidence suggests that routine ICU care does not improve outcomes, ICU admission was not associated with differences in mortality (absolute increase 1.3 (−0.9 to 3.4) percentage points).ConclusionsICU care for STEMI is associated with improved mortality among patients who could be treated in an ICU or non-ICU unit. An urgent need exists to identify which patients with STEMI benefit from ICU admission and what about ICU care is beneficial.

scholarly journals HbA1c and hypoglycaemia in intensively treated type 2 diabetes: a retrospective cohort study in primary care

JRSM Open ◽  
2018 ◽  
Vol 9 (7) ◽  
pp. 205427041877366
Author(s):  
Manil Malawana ◽  
Sally Kerry ◽  
Rohini Mathur ◽  
John Robson
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Antidiabetic Medication ◽  
Oral Antidiabetic ◽  
Hazard Ratios ◽  
All Cause Mortality

Objective To establish whether low HbA1c is associated with clinical hypoglycaemia among people with type 2 diabetes prescribed insulins or sulphonylureas. Design Retrospective cohort study using routine electronic GP health records collected between January 2013 and December 2015. Setting Three east London Clinical Commissioning Groups. Participants Two cohorts of adults with type 2 diabetes prescribed either (i) insulins with or without other oral antidiabetic medication (n = 6788, 36.4%) or (ii) sulphonylureas with or without other oral antidiabetic medications excluding insulins (n = 11,840, 63.6%). Main outcome measures First clinically recorded hypoglycaemia and all-cause mortality. Hazard ratios (HR) adjusting for age, ethnicity, renal function and comorbidities were calculated using Cox regression models. Results Compared with an HbA1c of 53–63 mmol/mol, the adjusted HR of hypoglycaemia in those with a low HbA1c, below 53 mmol/mol, in the insulin and sulphonylurea cohorts were 1.26 (95% CI, 0.97 to 1.62) and 1.54 (95% CI, 1.27 to 1.87), respectively. Adjusted HRs of all-cause mortality from low HbA1c in the insulin and sulphonylurea cohorts were 1.54 (95% CI, 1.15 to 2.07) and 1.42 (95% CI, 1.11 to 1.81), respectively. Increasing age and renal impairment were also associated with increased hypoglycaemic risk in both cohorts. Conclusions HbA1c below 53 mmol/mol was associated with episodes of clinical hypoglycaemia among people with type 2 diabetes prescribed sulphonylureas, and all-cause mortality in those prescribed insulins and sulphonylureas. These findings support the need for reviewing glycaemic targets and the intensities of treatment in those with low HbA1c prescribed insulins or sulphonylureas to reduce the risk of hypoglycaemia.

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