The Value of Admission Serological Indicators for Predicting 28-Day Mortality in Intensive Care Patients With Acute Heart Failure: Construction and Validation of a Nomogram

Background: Acute heart failure (AHF) is a severe clinical syndrome characterized as rapid onset or worsening of symptoms of chronic heart failure (CHF). Risk stratification for patients with AHF in the intensive care unit (ICU) may help clinicians to predict the 28-day mortality risk in this subpopulation and further raise the quality of care.Methods: We retrospectively reviewed and analyzed the demographic characteristics and serological indicators of patients with AHF in the Medical Information Mart for Intensive Care III (MIMIC III) (version 1.4) between June 2001 and October 2012 and our medical center between January 2019 and April 2021. The chi-squared test and the Fisher's exact test were used for comparison of qualitative variables among the AHF death group and non-death group. The clinical variables were selected by using the least absolute shrinkage and selection operator (LASSO) regression. A clinical nomogram for predicting the 28-day mortality was constructed based on the multivariate Cox proportional hazard regression analysis and further validated by the internal and external cohorts.Results: Age > 65 years [hazard ratio (HR) = 2.47], the high Sequential Organ Failure Assessment (SOFA) score (≥3 and ≤8, HR = 2.21; ≥9 and ≤20, HR = 3.29), lactic acid (Lac) (>2 mmol/l, HR = 1.40), bicarbonate (HCO3-) (>28 mmol/l, HR = 1.59), blood urea nitrogen (BUN) (>21 mg/dl, HR = 1.75), albumin (<3.5 g/dl, HR = 2.02), troponin T (TnT) (>0.04 ng/ml, HR = 4.02), and creatine kinase-MB (CK-MB) (>5 ng/ml, HR = 1.64) were the independent risk factors for predicting 28-day mortality of intensive care patients with AHF (p < 0.05). The novel nomogram was developed and validated with a promising C-index of 0.814 (95% CI: 0.754–0.882), 0.820 (95% CI: 0.721–0.897), and 0.828 (95% CI: 0.743–0.917), respectively.Conclusion: This study provides a new insight in early predicting the risk of 28-day mortality in intensive care patients with AHF. The age, the SOFA score, and serum TnT level are the leading three predictors in evaluating the short-term outcome of intensive care patients with AHF. Based on the nomogram, clinicians could better stratify patients with AHF at high risk and make adequate treatment plans.

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Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients

World Journal of Emergency Surgery ◽

10.1186/s13017-020-00343-y ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Christian Koch ◽

Fabian Edinger ◽

Tobias Fischer ◽

Florian Brenck ◽

Andreas Hecker ◽

...

Keyword(s):

Intensive Care ◽

Sofa Score ◽

Mortality Prediction ◽

Adequate Treatment ◽

Suspected Infection ◽

Intensive Care Patients ◽

Retrospective Data Analysis ◽

Surgical Icu ◽

Qsofa Score ◽

Sirs Criteria

Abstract Background It is crucial to rapidly identify sepsis so that adequate treatment may be initiated. Accordingly, the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) scores are used to evaluate intensive care unit (ICU) and non-ICU patients, respectively. As demand for ICU beds rises, the intermediate care unit (IMCU) carries greater importance as a bridge between the ICU and the regular ward. This study aimed to examine the ability of SOFA and qSOFA scores to predict suspected infection and mortality in IMCU patients. Methods Retrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between January 01, 2012, and September 30, 2018. Patients were screened for suspected infection (i.e., the commencement of broad-spectrum antibiotics) and then evaluated for the SOFA score, qSOFA score, and the 1992 defined systemic inflammatory response syndrome (SIRS) criteria. Results Suspected infection was detected in 1306 (18.3%) of IMCU, 1365 (35.5%) of ICU, and 1734 (62.0%) of IMCU/ICU encounters. Overall, 458 (3.3%) patients died (IMCU 45 [0.6%]; ICU 250 [6.5%]; IMCU/ICU 163 [5.8%]). All investigated scores failed to predict suspected infection independently of the analyzed subgroup. Regarding mortality prediction, the qSOFA score performed sufficiently within the IMCU cohort (AUCROC SIRS 0.72 [0.71–0.72]; SOFA 0.52 [0.51–0.53]; qSOFA 0.82 [0.79–0.84]), while the SOFA score was predictive in patients of the IMCU/ICU cohort (AUCROC SIRS 0.54 [0.53–0.54]; SOFA 0.73 [0.70–0.77]; qSOFA 0.59 [0.58–0.59]). Conclusions None of the assessed scores was sufficiently able to predict suspected infection in surgical ICU or IMCU patients. While the qSOFA score is appropriate for mortality prediction in IMCU patients, SOFA score prediction quality is increased in critically ill patients.

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Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients

10.21203/rs.3.rs-72795/v2 ◽

2020 ◽

Author(s):

Christian Koch ◽

Fabian Edinger ◽

Tobias Fischer ◽

Florian Brenck ◽

Andreas Hecker ◽

...

Keyword(s):

Intensive Care ◽

Sofa Score ◽

Mortality Prediction ◽

Adequate Treatment ◽

Suspected Infection ◽

Intensive Care Patients ◽

Retrospective Data Analysis ◽

Surgical Icu ◽

Qsofa Score ◽

Sirs Criteria

Abstract Background It is crucial to rapidly identify sepsis so that adequate treatment may be initiated. Accordingly, the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) score are used to evaluate intensive care unit (ICU) and non-ICU patients, respectively. As demand for ICU beds rises, the intermediate care unit (IMCU) carries greater importance as a bridge between the ICU and the regular ward. This study aimed to examine the ability of SOFA and qSOFA scores to predict suspected infection and mortality in IMCU patients.Methods Retrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between 01/01/2012 and 09/30/2018. Patients were screened for suspected infection (i.e., the commencement of broad-spectrum antibiotics) and then evaluated for the SOFA score, qSOFA score, and the 1992 defined systemic inflammatory response syndrome (SIRS) criteria.Results Suspected infection was detected in 1,306 (18.3%) of IMCU, 1,365 (35.5%) of ICU, and 1,734 (62.0%) of IMCU/ICU encounters. Overall, 458 (3.3%) patients died (IMCU: 45 [0.6%]; ICU: 250 [6.5%]; IMCU/ICU: 163 [5.8%]). All investigated scores failed to predict suspected infection independently of the analyzed subgroup. Regarding mortality prediction, the qSOFA score performed sufficiently within the IMCU cohort (AUCROC SIRS: 0.72 [0.71-0.72]; SOFA: 0.52 [0.51-0.53]; qSOFA: 0.82 [0.79-0.84]), while the SOFA score was predictive in patients of the IMCU/ICU cohort (AUCROC SIRS 0.54 [0.53-0.54]; SOFA 0.73 [0.70-0.77]; qSOFA 0.59 [0.58-0.59]).Conclusions None of the assessed scores was sufficiently able to predict suspected infection in surgical ICU or IMCU patients. While the qSOFA score is appropriate for mortality prediction in IMCU patients, SOFA score prediction quality is increased in critically ill patients.

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Comparison of qSOFA Score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients

10.21203/rs.3.rs-65329/v1 ◽

2020 ◽

Author(s):

Christian Koch ◽

Fabian Edinger ◽

Tobias Fischer ◽

Florian Brenck ◽

Andreas Hecker ◽

...

Keyword(s):

Intensive Care ◽

Sofa Score ◽

Mortality Prediction ◽

Adequate Treatment ◽

Suspected Infection ◽

Intensive Care Patients ◽

Retrospective Data Analysis ◽

Surgical Icu ◽

Qsofa Score ◽

Sirs Criteria

Abstract Background It is crucial to rapidly identify sepsis so that adequate treatment may be initiated. Accordingly, the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) score are used to evaluate intensive care unit (ICU) and non-ICU patients, respectively. As demand for ICU beds rises, the intermediate care unit (IMCU) carries greater importance as a bridge between the ICU and the regular ward. This study aimed to examine the ability of SOFA and qSOFA scores to predict sepsis and mortality in IMCU patients. Methods Retrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between 01/01/2012 and 09/30/2018. Patients were screened for suspected infection (i.e., the commencement of broad-spectrum antibiotics) and then evaluated for the SOFA score, qSOFA score, and the 1992 defined systemic inflammatory response syndrome (SIRS) criteria. Results Suspected infection was detected in 1,306 (18.3%) of IMCU, 1,365 (35.5%) of ICU, and 1,734 (62.0%) of IMCU/ICU encounters. Overall, 458 (3.3%) patients died (IMCU: 45 [0.6%]; ICU: 250 [6.5%]; IMCU/ICU: 163 [5.8%]). All investigated scores failed to predict sepsis independently of the analyzed subgroup. Regarding mortality prediction, the qSOFA score performed sufficiently within the IMCU cohort (AUCROC SIRS: 0.72 [0.71-0.72]; SOFA: 0.52 [0.51-0.53]; qSOFA: 0.82 [0.79-0.84]), while the SOFA score was predictive in patients of the IMCU/ICU cohort (AUCROC SIRS 0.54 [0.53-0.54]; SOFA 0.73 [0.70-0.77]; qSOFA 0.59 [0.58-0.59]). Conclusions None of the assessed scores was sufficiently able to predict sepsis in surgical ICU or IMCU patients with suspected infection. While the qSOFA score is appropriate for mortality prediction in IMCU patients, SOFA score prediction quality is increased in critically ill patients.

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The association between serum albumin and LOS of patients with acute heart failure: a retrospective study based on the MIMIV-IV database

10.21203/rs.3.rs-850487/v1 ◽

2021 ◽

Author(s):

Tao Liu ◽

haochen xuan ◽

lili wang ◽

xiaoqun li ◽

zhihao lu ◽

...

Keyword(s):

Heart Failure ◽

Intensive Care ◽

Serum Albumin ◽

Acute Heart Failure ◽

Medical Information ◽

Interactive Effect ◽

Albumin Level ◽

Outcome Variable ◽

Trend Test ◽

Exposure Variable

Abstract Objective: To assess the relationship between serum albumin and length of stay (LOS) of the intensive care unit (ICU).Design and Participants: we retrospectively analyze 2280 patients with acute heart failure(AHF) from the medical information mart for intensive care IV (the MIMIC-IV ) database. Materials and Methods: The exposure variable of the present study was serum albumin. The outcome variable was LOS. The final models were established by multivariate linear regression, and subgroup analysis was performed. Trend test and smooth fitting curves were used to evaluate the association between serum albumin and LOS. Results: When the value of serum albumin was less than 5.1g/dl, the analysis of 2280 patients showed that the linear relationship between albumin and LOS. LOS was gradually shortened with the albumin increasing (β: -0.636; 95%CI: -0.819, -0.453; P <0.001). In subgroup, sepsis and serum albumininitial had an interactive effect on LOS (P=0.036), and there was significantly different between AHF patients with sepsis (β:-1.927; 95%CI:-3.823, -0.030) and without sepsis(β: -1.412; 95%CI:-1.737, -1.087) .Conclusion: When serum albumin was less than 5.1g/dl, the negative association was presented between serum albumin level and LOS among patients with AHF, and this association is even closer in patients with sepsis.

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Comparison of qSOFA score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients

10.21203/rs.3.rs-72795/v1 ◽

2020 ◽

Author(s):

Christian Koch ◽

Fabian Edinger ◽

Tobias Fischer ◽

Florian Brenck ◽

Andreas Hecker ◽

...

Keyword(s):

Intensive Care ◽

Sofa Score ◽

Mortality Prediction ◽

Adequate Treatment ◽

Suspected Infection ◽

Intensive Care Patients ◽

Retrospective Data Analysis ◽

Surgical Icu ◽

Qsofa Score ◽

Sirs Criteria

Abstract Background It is crucial to rapidly identify sepsis so that adequate treatment may be initiated. Accordingly, the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) score are used to evaluate intensive care unit (ICU) and non-ICU patients, respectively. As demand for ICU beds rises, the intermediate care unit (IMCU) carries greater importance as a bridge between the ICU and the regular ward. This study aimed to examine the ability of SOFA and qSOFA scores to predict sepsis and mortality in IMCU patients. Methods Retrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between 01/01/2012 and 09/30/2018. Patients were screened for suspected infection (i.e., the commencement of broad-spectrum antibiotics) and then evaluated for the SOFA score, qSOFA score, and the 1992 defined systemic inflammatory response syndrome (SIRS) criteria. Results Suspected infection was detected in 1,306 (18.3%) of IMCU, 1,365 (35.5%) of ICU, and 1,734 (62.0%) of IMCU/ICU encounters. Overall, 458 (3.3%) patients died (IMCU: 45 [0.6%]; ICU: 250 [6.5%]; IMCU/ICU: 163 [5.8%]). All investigated scores failed to predict sepsis independently of the analyzed subgroup. Regarding mortality prediction, the qSOFA score performed sufficiently within the IMCU cohort (AUCROC SIRS: 0.72 [0.71-0.72]; SOFA: 0.52 [0.51-0.53]; qSOFA: 0.82 [0.79-0.84]), while the SOFA score was predictive in patients of the IMCU/ICU cohort (AUCROC SIRS 0.54 [0.53-0.54]; SOFA 0.73 [0.70-0.77]; qSOFA 0.59 [0.58-0.59]). Conclusions None of the assessed scores was sufficiently able to predict sepsis in surgical ICU or IMCU patients with suspected infection. While the qSOFA score is appropriate for mortality prediction in IMCU patients, SOFA score prediction quality is increased in critically ill patients.

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