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 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.

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 > 30 predicted a high short-term mortality rate (p= 0.0001). However, age > 65 years, respiratory failure, bacteremia, and a diagnosis of acute leukemia were not significantly associated with a poor short-term survival (p> 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.

scholarly journals Prognostic Value of Thyroid Hormone FT3 in General Patients Admitted to the Intensive Care Unit

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Jianying Guo ◽  
Yanyan Hong ◽  
Zhiyong Wang ◽  
Yukun Li
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Prospective Observational Study ◽  
White Blood Cells ◽  
Oxygenation Index ◽  
Prognostic Indicators ◽  
Nonthyroidal Illness ◽  
Medical University ◽  
The Relationship

Low plasma triiodothyronine (T3) concentration indicates nonthyroidal illness syndrome (NTIS), which might be associated with a poor outcome in patients in the intensive care unit (ICU). This study evaluated the relationship between NTIS and prognostic indicators in patients admitted to the ICU and examined the fT3 cut-off points that could be associated with 28-day mortality. This prospective observational study included patients admitted to the ICU of The Third Hospital of Hebei Medical University from February to November 2018. The baseline variables and the occurrence of low free T3 (FT3) were collected. The patients were divided into the NTIS (FT3<3.28) and non-NTIS groups. Among 305 patients, 118 (38.7%) were in the NTIS group. FT3 (P<0.001) and FT4 (P=0.001) were lower, while the 28-day mortality rate (P<0.001) and hospitalization expenses in ICU (P=0.001) were higher in the NTIS group. The univariable analyses identified NTIS, FT3, free thyroxine/FT3, APACHEII, sequential organ failure score, duration of mechanical ventilation, creatinine, oxygenation index, white blood cells, albumin, age, and brain natriuretic peptide as being associated with 28-day mortality (all P<0.05). The cut-off value of FT3 for 28-day mortality was 2.88 pmol/L. The 28-day mortality rate and hospitalization expenses in the ICU were higher in patients with NTIS. NTIS was independently associated with 28-day mortality.

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 Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

2020 ◽  
Author(s):  
Toshifumi Fujiwara ◽  
Kentaro Tokuda ◽  
Kenta Momii ◽  
Kyohei Shiomoto ◽  
Hidetoshi Tsushima ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Intensive Care Units ◽  
Fatal Outcome ◽  
Laboratory Data ◽  
International Normalized Ratio ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Icu Admission

Abstract Background: Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs). Methods: This was a retrospective observational study. This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and December 2017. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU.Results: Upon admission, the median age was 70 (range, 33–96) years, and RA duration was 10 (range, 0–61) years. The 5-year survival after ICU admission was 47%, and 30-day, 90-day, and 1-year mortality rates were 22%, 27%, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvival was associated with a significantly higher glucocorticoid dose, updated Charlson’s comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. Laboratory data obtained at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. The multivariate Cox proportional hazard model revealed that nonuse of csDMARDs, high updated CCI, increased APACHE II score, and prolonged PT-INR were associated with a higher risk of mortality after ICU admission.Conclusion: Our study demonstrated that the nonuse of csDMARDs, high updated CCI, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU.

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 Factors associated with nursing workload in three intensive care units

2021 ◽  
Vol 55 ◽  
Author(s):  
Diana Isabel Cáceres Rivera ◽  
Claudia Consuelo Torres ◽  
Luis Alberto López Romero
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Diagnostic Category ◽  
Multiple Linear Regression Model ◽  
Apache Ii ◽  
Nursing Workload ◽  
Bivariate Analysis ◽  
Apache Ii Score ◽  
Cross Sectional ◽  
Factors Associated

ABSTRACT Objective: To determine the nursing workload in intensive care units (ICUs) and the factors associated with the Nursing Activities Score (NAS). Method: An analytical cross-sectional study was carried out in three ICUs in Bucaramanga, Colombia, between February 2018 and February 2020. The nursing workload was estimated based on the NAS. A descriptive and bivariate analysis stratified by ICU was performed using a robust multiple linear regression model, and the factors associated with the nursing workload (p < 0.05) were estimated. Results: In this study, 362 records were included. The median NAS was 68.1 points (Q1:47.2–Q3:116.7). APACHE II (β = 3.13, CI: 95% 2.28; 3.98), days of stay in ICU ≥3 (β = 16.78, CI: 95% 6.15; 27.41), surgery provenance service (β = 22.31, CI: 95% 9.76; 34.86), and traumatology and emergencies diagnostic category (β = 33.72, CI 95%: 9.90; 57.53) were associated with high NAS scores. Conclusion: The nursing staff spend approximately 70% of their time on a single patient, and administrative work takes up most of their time. Hospital stays of longer than 3 days, high APACHE II score, coming from the surgery department, and having a diagnosis of trauma and emergency were associated with a high workload.

scholarly journals Comparison of APACHE II scores and mortality with CRP/albumin, neutrophil/lymphocyte and thrombocyte/lymphocyte ratios in patients admitted to internal medicine and anesthesia reanimation intensive care unit

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ahmet Usta ◽  
Emin Gemcioglu ◽  
Salih Baser ◽  
Osman Ersoy ◽  
Yunus Halil Polat ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Exacerbation ◽  
Kidney Injury ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Laboratory Findings ◽  
Reactive Protein ◽  
The Relationship

Abstract Objectives This study aimed to evaluate the relationship between C-reactive protein/albumin (CRP/Alb), neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR) ratios and the Acute Physiology And Chronic Health Evaluation II (APACHE II) score and 28-day mortality among 400 patients admitted to internal medicine and anesthesia reanimation intensive care unit (ICU). Methods This prospective study included a total of 400 patients who were admitted to hospital internal medicine and anesthesia reanimation ICUs. Results The most common reasons for ICU admission were pneumonia (29.3%), gastrointestinal bleeding (10.3%), acute exacerbation of chronic kidney disease (CKD) (10.3%), and acute kidney injury (7.5%). The comparison of the laboratory findings with survival outcomes revealed that among the patients with acute exacerbation of CKD, the median NLR (p=0.043) and median CRP/Alb (p=0.021) were significantly higher in patients who died. For all of the patients, the APACHE II score was positively correlated with CRP (p<0.001) and CRP/Alb (p<0.001), negatively correlated with Alb (p<0.001), positively correlated with the NLR (p<0.001), and positively correlated with the PLR. Conclusions The APACHE II score was significantly correlated with the CRP/Alb ratio, NLR, and PLR. The NLR and CRP/Alb ratio were statistically associated with mortality in patients hospitalized for acute exacerbation of CKD.

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