scholarly journals Urine Output Is Associated With In-hospital Mortality in Intensive Care Patients With Septic Shock: A Propensity Score Matching Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Tianyang Hu ◽  
Zhao Qiao ◽  
Ying Mei
Keyword(s):  
Septic Shock ◽  
Risk Factor ◽  
Intensive Care ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Scoring System ◽  
Urine Output ◽  
Roc Curves ◽  
Intensive Care Patients

Background: The relationship between urine output (UO) and in-hospital mortality in intensive care patients with septic shock is currently inconclusive.Methods: The baseline data, UO, and in-hospital prognosis of intensive care patients with septic shock were retrieved from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. By drawing receiver operating characteristic (ROC) curves and comparing the areas under the ROC curves (AUC) to determine the predictive value of UO for in-hospital mortality, and by drawing the Kaplan-Meier curves to compare the difference in in-hospital mortality between different groups of UO.Results: Before and after the propensity score matching (PSM) analysis, UO was always a risk factor for in-hospital mortality in patients with septic shock. The AUC of UO was comparable to the Sequential Organ Failure Assessment (SOFA) scoring system, while the AUC of combining UO and SOFA was greater than that of SOFA. The median survival time of the high-UO group (UO > 0.39 ml/kg/h, before PSM; UO > 0.38 ml/kg/h, after PSM) was longer than that of the low-UO group. Compared with the high-UO group, the hazard ratios (HR) of the low-UO group were 2.6857 (before PSM) and 1.7879 (after PSM).Conclusions: UO is an independent risk factor for septic shock. Low levels of UO significantly increase the in-hospital mortality of intensive care patients with septic shock. The predictive value of UO is comparable to the SOFA scoring system, and the combined predictive value of the two surpasses SOFA alone.

scholarly journals Effectiveness of LODS, OASIS, and SAPS II to predict in-hospital mortality for intensive care patients with ST elevation myocardial infarction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Liang Wang ◽  
Zhengwei Zhang ◽  
Tianyang Hu
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Clinical Benefit ◽  
Predictive Value ◽  
Scoring Systems ◽  
Study Cohort ◽  
Intensive Care Patients ◽  
Saps Ii ◽  
Saps Ii Score

AbstractThe relationship between three scoring systems (LODS, OASIS, and SAPS II) and in-hospital mortality of intensive care patients with ST segment elevation myocardial infarction (STEMI) is currently inconclusive. The baseline data, LODS score, OASIS score, SAPS II score, and in-hospital prognosis of intensive care patients with STEMI were retrieved from the Medical Information Mart for Intensive Care IV database. Propensity score matching analysis was performed to reduce bias. Receiver operating characteristic curves (ROC) were drawn for the three scoring systems, and comparisons between the areas under the ROC curves (AUC) were conducted. Decision curve analysis (DCA) was performed to determine the net benefits of the three scoring systems. LODS and SAPS II were independent risk factors for in-hospital mortality. For the study cohort, the AUCs of LODS, OASIS, SAPS II were 0.867, 0.827, and 0.894; after PSM, the AUCs of LODS, OASIS, SAPS II were 0.877, 0.821, and 0.881. A stratified analysis of the patients who underwent percutaneous coronary intervention/coronary artery bypass grafting (PCI/CABG) or not was conducted. In the PCI/CABG group, the AUCs of LODS, OASIS, SAPS II were 0.853, 0.825, and 0.867, while in the non-PCI/CABG group, the AUCs of LODS, OASIS, SAPS II were 0.857, 0.804, and 0.897. The results of the Z test suggest that the predictive value of LODS and SAPS II was not statistically different, but both were higher than OASIS. According to the DCA, the net clinical benefit of LODS was the greatest. LODS and SAPS II have excellent predictive value, and in most cases, both were higher than OASIS. With a more concise composition and greater clinical benefit, LODS may be a better predictor of in-hospital mortality for intensive care patients with STEMI.

Evaluating the Predictive Value of Lactate in Patients With Cancer Having Septic Shock

2018 ◽  
Vol 35 (8) ◽  
pp. 789-796
Author(s):  
Lama H. Nazer ◽  
Dalia Rimawi ◽  
Feras I. Hawari
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Predictive Validity ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Serum Lactate ◽  
Predictive Values ◽  
Patients With Cancer ◽  
Predict Hospital Mortality

Purpose: Limited studies evaluated the predictive value of serum lactate (LA) in critically ill patients with cancer. The main objective of this study was to evaluate the predictive validity of LA single measurements as well as LA clearance in predicting mortality in patients with cancer having septic shock. The study also aimed to determine the LA measurement over the first 24 hours with the highest predictability for hospital mortality. Materials and Methods: A retrospective cohort study of adult patients with cancer having septic shock and LA measurements during the first 24 hours. Three receiver–operating characteristic (ROC) curves were constructed to evaluate the predictive validity for hospital mortality of LA at baseline, at 6 hours and at 24 hours after identifying septic shock. The ROC with the largest area under the curve was analyzed to determine LA level with the highest predictability for hospital mortality. In addition, the ability of LA normalization (LA <2 mmol/L at 6 hours and at 24 hours) and the degree of LA elimination (>10% and >20% at 24 hours) to predict hospital mortality were evaluated by determining the predictive values for each clearance end point. Results: The study included 401 patients. LA >2.5 mmol/L at 24 hours showed the largest area under the ROC curve to predict hospital mortality (ROC area: 0.648; 95% confidence interval: 0.585-0.711) with a sensitivity of 58.4% and specificity of 62.8%. The LA normalization, LA clearance >10%, and LA clearance >20% were also predictors of hospital mortality, with the highest sensitivity for LA normalization at 6 hours (74%) and LA normalization at 24 hours (73.4%). Conclusion: In patients with cancer having septic shock, LA >2.5 mmol/L at 24 hours of septic shock had the highest predictability for hospital mortality. The LA normalization and clearance were also predictors of hospital mortality. However, all LA end points were not strong predictors.

Predictive value of thyroxine for prognosis in pediatric septic shock: a prospective observational study

2020 ◽  
Vol 33 (5) ◽  
pp. 653-659
Author(s):  
Jia Song ◽  
Yun Cui ◽  
Chunxia Wang ◽  
Jiaying Dou ◽  
Huijie Miao ◽  
...  
Keyword(s):  
Septic Shock ◽  
Thyroid Hormone ◽  
Observational Study ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Prospective Observational Study ◽  
Threshold Value ◽  
Nonthyroidal Illness ◽  
Hormone Levels ◽  
Thyroid Hormone Levels

AbstractBackgroundThyroid hormone plays an important role in the adaptation of metabolic function to critically ill. The relationship between thyroid hormone levels and the outcomes of septic shock is still unclear. The aim of this study was to assess the predictive value of thyroid hormone for prognosis in pediatric septic shock.MethodsWe performed a prospective observational study in a pediatric intensive care unit (PICU). Patients with septic shock were enrolled from August 2017 to July 2019. Clinical and laboratory indexes were collected, and thyroid hormone levels were measured on PICU admission.ResultsNinety-three patients who fulfilled the inclusion criteria were enrolled in this study. The incidence of nonthyroidal illness syndrome (NTIS) was 87.09% (81/93) in patients with septic shock. Multivariate logistic regression analysis showed that T4 level was independently associated with in-hospital mortality in patients with septic shock (OR: 0.965, 95% CI: 0.937–0.993, p = 0.017). The area under receiver operating characteristic (ROC) curve (AUC) for T4 was 0.762 (95% CI: 0.655–0.869). The cutoff threshold value of 58.71 nmol/L for T4 offered a sensitivity of 61.54% and a specificity of 85.07%, and patients with T4 < 58.71 nmol/L showed high mortality (60.0%). Moreover, T4 levels were negatively associated with the pediatric risk of mortality III scores (PRISM III), lactate (Lac) level in septic shock children.ConclusionsNonthyroidal illness syndrome is common in pediatric septic shock. T4 is an independent predictor for in-hospital mortality, and patients with T4 < 58.71 nmol/L on PICU admission could be with a risk of hospital mortality.

Hospital-acquired pressure ulcers and risk of hospital mortality in intensive care patients on mechanical ventilation

2014 ◽  
Vol 20 (4) ◽  
pp. 362-368 ◽  
Author(s):  
Francisco Manzano ◽  
Ana M. Pérez-Pérez ◽  
Susana Martínez-Ruiz ◽  
Cristina Garrido-Colmenero ◽  
Delphine Roldan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Pressure Ulcers ◽  
Intensive Care Patients ◽  
Hospital Acquired

scholarly journals Relationship between the presence of dedicated doctors in rapid response systems and patient outcome: a multicenter retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hyung-Jun Kim ◽  
Kyeongman Jeon ◽  
Byung Ju Kang ◽  
Jong-Joon Ahn ◽  
Sang-Bum Hong ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Propensity Score ◽  
Intensive Care Unit Admission ◽  
Hazard Ratio ◽  
Rapid Response ◽  
Admission Rates ◽  
Rapid Response Systems ◽  
Response Systems

Abstract Background Rapid response systems (RRSs) improve patients’ safety, but the role of dedicated doctors within these systems remains controversial. We aimed to evaluate patient survival rates and differences in types of interventions performed depending on the presence of dedicated doctors in the RRS. Methods Patients managed by the RRSs of 9 centers in South Korea from January 1, 2016, through December 31, 2017, were included retrospectively. We used propensity score-matched analysis to balance patients according to the presence of dedicated doctors in the RRS. The primary outcome was in-hospital survival. The secondary outcomes were the incidence of interventions performed. A sensitivity analysis was performed with the subgroup of patients diagnosed with sepsis or septic shock. Results After propensity score matching, 2981 patients were included per group according to the presence of dedicated doctors in the RRS. The presence of the dedicated doctors was not associated with patients’ overall likelihood of survival (hazard ratio for death 1.05, 95% confidence interval [CI] 0.93‒1.20). Interventions, such as arterial line insertion (odds ratio [OR] 25.33, 95% CI 15.12‒42.44) and kidney replacement therapy (OR 10.77, 95% CI 6.10‒19.01), were more commonly performed for patients detected using RRS with dedicated doctors. The presence of dedicated doctors in the RRS was associated with better survival of patients with sepsis or septic shock (hazard ratio for death 0.62, 95% CI 0.39‒0.98) and lower intensive care unit admission rates (OR 0.53, 95% CI 0.37‒0.75). Conclusions The presence of dedicated doctors within the RRS was not associated with better survival in the overall population but with better survival and lower intensive care unit admission rates for patients with sepsis or septic shock.

scholarly journals Prompt admission to intensive care is associated with improved survival in patients with severe sepsis and/or septic shock

2018 ◽  
Vol 46 (10) ◽  
pp. 4071-4081 ◽  
Author(s):  
Qiang Li ◽  
Jiajiong Wang ◽  
Guomin Liu ◽  
Meng Xu ◽  
Yanguo Qin ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Multivariable Model ◽  
Icu Admission ◽  
Survival Status ◽  
Healthcare Data ◽  
Multivariable Regression Model ◽  
Multivariable Regression

Objective To investigate the association between time from hospital admission to intensive care unit (ICU) admission (door to ICU time) and hospital mortality in patients with sepsis. Methods This retrospective observational study included routinely collected healthcare data from patients with sepsis. The primary endpoint was hospital mortality, defined as the survival status at hospital discharge. Door to ICU time was calculated and included in a multivariable model to investigate its association with mortality. Results Data from 13 115 patients were included for analyses, comprising 10 309 survivors and 2 806 non-survivors. Door to ICU time was significantly longer for non-survivors than survivors (median, 43.0 h [interquartile range, 12.4, 91.3] versus 26.7 h [7.0, 74.2]). In the multivariable regression model, door to ICU time remained significantly associated with mortality (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.006, 1.017) and there was a significant interaction between age and door to ICU time (OR 0.99, 95% CI 0.99, 1.00). Conclusion A shorter time from hospital door to ICU admission was shown to be independently associated with reduced hospital mortality in patients with severe sepsis and/or septic shock.

scholarly journals Ceftriaxone versus ampicillin/sulbactam for the treatment of aspiration-associated pneumonia in adults

2019 ◽  
Vol 8 (15) ◽  
pp. 1275-1284 ◽  
Author(s):  
Shinya Hasegawa ◽  
Atsushi Shiraishi ◽  
Makito Yaegashi ◽  
Naoto Hosokawa ◽  
Konosuke Morimoto ◽  
...  
Keyword(s):  
Risk Factor ◽  
Propensity Score ◽  
Observational Study ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Risk Difference ◽  
Study Cohort ◽  
Propensity Score Matching Analysis ◽  
Related Risk ◽  
Baseline Characteristics

Aim: To compare hospital mortality in patients with aspiration-associated pneumonia treated with ceftriaxone (CTRX) and in those treated with ampicillin/sulbactam (ABPC/SBT). Methods: From a Japanese multicentre observational study cohort of patients with pneumonia, those diagnosed with pneumonia and having at least one aspiration-related risk factor were selected. Propensity score-matching analysis was used to balance baseline characteristics of the participants and compare hospital mortality of patients treated with CTRX and those treated with ABPC/SBT. Results: Hospital mortality did not significantly differ between patients treated with CTRX and those treated with ABPC/SBT (6.6 vs 10.7%, risk difference -4.0, 95% CI [-9.4, 1.3]; p = 0.143). Conclusion: Further studies are needed to compare CTRX and ABPC/SBT treatments in patients with aspiration-associated pneumonia.

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