scholarly journals The Prevalence, Risk Factors, and Outcomes of Sepsis in Critically Ill Patients in China: A Multicenter Prospective Cohort Study

2020 ◽  
Vol 7 ◽  
Author(s):  
Meiping Wang ◽  
Li Jiang ◽  
Bo Zhu ◽  
Wen Li ◽  
Bin Du ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Cohort Study ◽  
Critically Ill ◽  
Fluid Resuscitation ◽  
Low Income ◽  
Critically Ill Patients ◽  
Low Income Countries ◽  
Icu Mortality ◽  
Tertiary Hospitals

Background: Sepsis is a main cause of morbidity and mortality in critically ill patients. The epidemiology of sepsis in high-income countries is well-known, but information on sepsis in middle- or low-income countries is still deficient, especially in China. The purpose of this study was to explore the prevalence, characteristics, risk factors, treatment, and outcomes of sepsis in critically ill patients in tertiary hospitals in China.Methods: A multicenter prospective observational cohort study was performed with consecutively collected data from adults who stayed in any intensive care unit (ICU) for at least 24 h; data were collected from 1 January 2014 to 31 August 2015, and patients were followed until death or discharge from the hospital.Results: A total of 4,910 patients were enrolled in the study. Of these, 2,086 (42.5%) presented with sepsis or septic shock on admission to the ICU or within the first 48 h after admission to the ICU. ICU mortality was higher in patients with sepsis (13.1%) and septic shock (39.0%) and varied according to geographical region. Acinetobacter, Pseudomonas, and Staphylococcus infections were associated with increased ICU mortality. In addition, age, Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores, pre-existing cardiovascular diseases, malignant tumors, renal replacement therapy (RRT), and septic shock were independent risk factors for mortality in patients with sepsis. The prompt administration of antibiotics (OR 0.65, 95% CI 0.46–0.92) and 30 mL/kg of initial fluid resuscitation during the first 3 h (OR 0.43, 95% CI 0.30–0.63) improved the outcome in patients with septic shock.Conclusions: Sepsis was common and was associated with a high mortality rate in critically ill patients in tertiary hospitals in China. The prompt administration of antibiotics and 30 mL/kg fluid resuscitation decreased the risk of mortality.

scholarly journals Higher Incidence of Stroke in Severe COVID-19 Is Not Associated With a Higher Burden of Arrhythmias: Comparison With Other Types of Severe Pneumonia

2021 ◽  
Vol 8 ◽  
Author(s):  
Peter Jirak ◽  
Zornitsa Shomanova ◽  
Robert Larbig ◽  
Daniel Dankl ◽  
Nino Frank ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Severe Pneumonia ◽  
Thromboembolic Events ◽  
Therapeutic Anticoagulation ◽  
Tertiary Hospitals ◽  
Ventricular Tachycardias ◽  
Disease Specific ◽  
Rhythm Monitoring

Aims: Thromboembolic events, including stroke, are typical complications of COVID-19. Whether arrhythmias, frequently described in severe COVID-19, are disease-specific and thus promote strokes is unclear. We investigated the occurrence of arrhythmias and stroke during rhythm monitoring in critically ill patients with COVID-19, compared with severe pneumonia of other origins.Methods and Results: This retrospective study included 120 critically ill patients requiring mechanical ventilation in three European tertiary hospitals, including n =60 COVID-19, matched according to risk factors for the occurrence of arrhythmias in n = 60 patients from a retrospective consecutive cohort of severe pneumonia of other origins. Arrhythmias, mainly atrial fibrillation (AF), were frequent in COVID-19. However, when compared with non-COVID-19, no difference was observed with respect to ventricular tachycardias (VT) and relevant bradyarrhythmias (VT 10.0 vs. 8.4 %, p = ns and asystole 5.0 vs. 3.3%, p = ns) with consequent similar rates of cardiopulmonary resuscitation (6.7 vs. 10.0%, p = ns). AF was even more common in non-COVID-19 (AF 18.3 vs. 43.3%, p = 0.003; newly onset AF 10.0 vs. 30.0%, p = 0.006), which resulted in a higher need for electrical cardioversion (6.7 vs. 20.0%, p = 0.029). Despite these findings and comparable rates of therapeutic anticoagulation (TAC), the incidence of stroke was higher in COVID-19 (6.7.% vs. 0.0, p = 0.042). These events also happened in the absence of AF (50%) and with TAC (50%).Conclusions: Arrhythmias were common in severe COVID-19, consisting mainly of AF, yet less frequent than in matched pneumonia of other origins. A contrasting higher incidence of stroke independent of arrhythmias also observed with TAC, seems to be an arrhythmia-unrelated disease-specific feature of COVID-19.

scholarly journals Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Ignacio Martin-Loeches ◽  
Maria Consuelo Guia ◽  
Maria Sole Vallecoccia ◽  
David Suarez ◽  
Mercedes Ibarz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Very Elderly ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort

scholarly journals Risk Factors forAcinetobacter baumanniiNosocomial Bacteremia in Critically Ill Patients: A Cohort Study

2001 ◽  
Vol 33 (7) ◽  
pp. 939-946 ◽  
Author(s):  
José‐Luis García‐Garmendia ◽  
Carlos Ortiz‐Leyba ◽  
José Garnacho‐Montero ◽  
Francisco‐Javier Jiménez‐Jiménez ◽  
Carmen Pérez‐Paredes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Critically Ill ◽  
Critically Ill Patients

scholarly journals Diabetes and Hemoglobin A1c as Risk Factors for Nosocomial Infections in Critically Ill Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Eirini Tsakiridou ◽  
Demosthenes Makris ◽  
Vasiliki Chatzipantazi ◽  
Odysseas Vlachos ◽  
Grigorios Xidopoulos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Hemoglobin A1c ◽  
District Hospital ◽  
Bloodstream Infections ◽  
Inclusion Criteria ◽  
Icu Mortality ◽  
Independent Risk Factors

Objective. To evaluate whether diabetes mellitus (DM) and hemoglobin A1c (HbA1c) are risk factors for ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) in critically ill patients.Methods. Prospective observational study; patients were recruited from the intensive care unit (ICU) of a general district hospital between 2010 and 2012. Inclusion criteria: ICU hospitalization >72 hours and mechanical ventilation >48 hours. HbA1c was calculated for all participants. DM, HbA1c, and other clinical and laboratory parameters were assessed as risk factors for VAP or BSI in ICU.Results. The overall ICU incidence of VAP and BSI was 26% and 30%, respectively. Enteral feeding OR (95%CI) 6.20 (1.91–20.17;P=0.002) and blood transfusion 3.33 (1.23–9.02;P=0.018) were independent risk factors for VAP. BSI in ICU (P=0.044) and ICU mortality (P=0.038) were significantly increased in diabetics. Independent risk factors for BSI in ICU included BSI on admission 2.45 (1.14–5.29;P=0.022) and stroke on admission2.77 (1.12–6.88;P=0.029). Sepsis 3.34 (1.47–7.58;P=0.004) and parenteral feeding 6.29 (1.59–24.83;P=0.009) were independently associated with ICU mortality. HbA1c ≥ 8.1% presented a significant diagnostic performance in diagnosing repeated BSI in ICU.Conclusion. DM and HbA1c were not associated with increased VAP or BSI frequency. HbA1c was associated with repeated BSI episodes in the ICU.

scholarly journals Prevalence, Risk Factors and Outcomes of Platelet Transfusion Refractoriness in Critically Ill Patients:  A Retrospective Cohort Study

2020 ◽  
Author(s):  
Saeed Arabi ◽  
Abdullah O Almahayni ◽  
Abdulrahman Alomair ◽  
Emad M Masuadi ◽  
Moussab Damlaj ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Platelet Transfusion ◽  
Tertiary Care ◽  
Interquartile Range ◽  
Surgical Icu

Abstract Background: Refractoriness to platelet transfusion is an understudied phenomenon in critically ill patients. Our objective was to evaluate the prevalence, risk factors and clinical outcomes of platelet refractoriness among patients in a tertiary-care intensive care unit (ICU).Methods: A retrospective cohort study included all patients (age >14 years) who were admitted to a tertiary-care medical-surgical ICU between 2011 and 2016 and received ≥2 platelet transfusions during their ICU stay. We calculated platelet increment (PI) and corrected count increment (CCI). Results: A total of 267 patients were enrolled in the study, collectively receiving 1357 transfusions with a median of 3 (interquartile range: 2-6) transfusions per patient. The median pretransfusion platelet count was 31.0 x109/L (interquartile range: 16.0, 50.0) with a median PI of 6 x109/L (interquartile range: -5, 24). The prevalence of platelet transfusion refractoriness was 54.8% based on PI and 57.0% based on CCI. The two methods had excellent concordance in diagnosing refractoriness (kappa coefficient: 0.939). Refractoriness was more common in patients admitted by Hepatology, Liver Transplant, and Hematology services (69.7%, 69.2%, and 55.6%, respectively). On multivariable logistic regression, younger age was the only significant predictor of refractoriness (odds ratio per year increment: 0.975, 95% CI: 0.951-0.999). Finally, refractoriness was associated with increased length of stay in the ICU (p=0.02), but not with mortality.Conclusions: We demonstrated excellent concordance between PI and CCI for the diagnosis of platelet transfusion refractoriness. Platelet transfusion refractoriness was highly (>50%) prevalent in critically ill patients. However, it was not associated with increased mortality.

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