scholarly journals Norepinephrine Dosage Is Associated With Lactate Clearance After Resuscitation in Patients With Septic Shock

2021 ◽  
Vol 8 ◽  
Author(s):  
Chao Yu ◽  
Wenjing Fan ◽  
Min Shao
Keyword(s):  
Septic Shock ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Mortality Rate ◽  
Logistic Regression Analysis ◽  
Oxygen Metabolism ◽  
Lactate Clearance ◽  
Apache Ii Score ◽  
High Dose ◽  
Central Venous

Background: Some septic shock patients have persistent hyperlactacidemia despite a normal systemic hemodynamics after resuscitation. Central venous oxygen saturation (ScvO2), mean arterial pressure (MAP), and central venous pressure (CVP) cannot be target in subsequent hemodynamic treatments. Vasoplegia is considered to be one of the main causes of oxygen metabolism abnormalities in septic shock patients, and norepinephrine (NE) is the first-line vasopressor in septic shock treatment; its dosage represents the severity of vasoplegia. This study was performed to determine whether vasoplegia, as assessed by NE dosage, can indicate patients' lactate clearance after the completion of resuscitation.Methods: A retrospective study was performed, and 106 patients with septic shock in an intensive care unit were analyzed. Laboratory values and hemodynamic variables were obtained upon completion of resuscitation (H 0) and 6 h after (H 6). Lactate clearance was defined as the percent decrease in lactate from H 0 to H 6. Student's t-test, Mann-Whitney U-test, Chi-square or Fisher's exact tests, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were performed for statistical analysis.Results: Patients with a mean age of 63.7 ± 13.8 years, baseline APACHE II score of 21.0 ± 5.1, and SOFA score of 12.7 ± 2.7 were enrolled. The study found that after 6-h of resuscitation, lactate clearance (LC) was <10% in 33 patients (31.1%). Patients with 6-h LC <10% compared with 6-h LC ≥ 10% had a higher NE dose (μg·kg−1·min−1) (0.55 [0.36–0.84] vs. 0.25 [0.18–0.41], p < 0.001). Multivariate logistic regression analysis of statistically significant univariate variables showed that NE dose had a significant inverse relationship with 6-h LC < 10%. The cutoff for NE was ≥ 0.32 μg·kg−1·min−1 for predicting 6-h lactate clearance after resuscitation, with a sensitivity of 75.76% and a specificity of 70.00%. Septic shock patients with an NE dose ≥ 0.32 μg·kg−1·min−1, relative to patients with an NE dose < 0.32 μg·kg−1·min−1, had a greater 30-day mortality rate (69.8% vs. 26.4% p < 0.001).Conclusion: Some patients with septic shock had persistent oxygen metabolism disorders after hemodynamic resuscitation. NE dose may indicate vasoplegia and oxygen metabolism disorder. After resuscitation, septic shock patients with high-dose NE have lower lactate clearance and a greater 30-day mortality rate than those with low-dose NE.

scholarly journals Predicting Burn Mortality Using a Simple Novel Prediction Model

2021 ◽  
Author(s):  
Sneha Sharma ◽  
Raman Tandon
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Prediction Model ◽  
Receiver Operating Characteristic ◽  
Logistic Regression Analysis ◽  
Operating Characteristic ◽  
Binary Logistic Regression ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Binary Logistic Regression Analysis

Abstract Background Prediction of outcome for burn patients allows appropriate allocation of resources and prognostication. There is a paucity of simple to use burn-specific mortality prediction models which consider both endogenous and exogenous factors. Our objective was to create such a model. Methods A prospective observational study was performed on consecutive eligible consenting burns patients. Demographic data, total burn surface area (TBSA), results of complete blood count, kidney function test, and arterial blood gas analysis were collected. The quantitative variables were compared using the unpaired student t-test/nonparametric Mann Whitney U-test. Qualitative variables were compared using the ⊠2-test/Fischer exact test. Binary logistic regression analysis was done and a logit score was derived and simplified. The discrimination of these models was tested using the receiver operating characteristic curve; calibration was checked using the Hosmer—Lemeshow goodness of fit statistic, and the probability of death calculated. Validation was done using the bootstrapping technique in 5,000 samples. A p-value of <0.05 was considered significant. Results On univariate analysis TBSA (p <0.001) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p = 0.004) were found to be independent predictors of mortality. TBSA (odds ratio [OR] 1.094, 95% confidence interval [CI] 1.037–1.155, p = 0.001) and APACHE II (OR 1.166, 95% CI 1.034–1.313, p = 0.012) retained significance on binary logistic regression analysis. The prediction model devised performed well (area under the receiver operating characteristic 0.778, 95% CI 0.681–0.875). Conclusion The prediction of mortality can be done accurately at the bedside using TBSA and APACHE II score.

scholarly journals 146. Infective Endocarditis in South Korea: a 12-year Single-Center Experience of 419 Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S100-S101
Author(s):  
Jung Ho Kim ◽  
Hi Jae Lee ◽  
Woon Ji Lee ◽  
Hye Seong ◽  
Jin young Ahn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Infective Endocarditis ◽  
Mortality Rate ◽  
South Korea ◽  
Hospital Mortality ◽  
Incidence Rate ◽  
Logistic Regression Analysis

Abstract Background Infective endocarditis (IE) is a potentially lethal disease that has undergone constant changes in epidemiology and pathogen. Treatment of IE has become more complex with today’s myriad healthcare-associated factors as well as regional differences in causative organisms. Therefore, it is necessary to investigate the overall trends, microbiological features, clinical characteristics and outcomes of IE in South Korea. Methods We performed a retrospective cohort study of patients with the diagnosis of probable or definite IE according to the modified Duke Criteria admitted to a tertiary care center in South Korea between November 2005 and August 2017. Poisson log-linear regression was used to estimate time trends of IE incidence rate and mortality rate. Risk factors for in-hospital mortality were evaluated by multivariate logistic regression analysis including an interaction term. Results There were 419 IE patients (275 male vs. 144 female) during the study period. The median age of the patients was 56 years. The annual incidence rate of IE of our institution was significantly increased. (RR 1.05; 95% CI, 1.02–1.08; P = 0.006) The mortality rate showed trends toward down, but not statistically significant (P = 0.875). IE was related to a prosthetic valve in 15.0% and 21.7% patients developed IE during hospitalization. The mitral valve was the most commonly affected valve (61.3%). Causative microorganisms were identified in 309 patients (73.7%) and included streptococci (34.6%), followed by Staphylococcus aureus (15.8%) and enterococci (7.9%). The in-hospital mortality rate was 14.6%. Logistic regression analysis found aortic valve endocarditis (OR 3.18; P = 0.001), IE caused by staphylococcus aureus (OR 2.32; P = 0.026), a presence of central nervous system embolic complication (OR 1.98; P = 0.031), a high SOFA score (OR 1.22; P = 0.023) and a high Charlson’s comorbidity index (OR 1.11; P = 0.019) as predictors of in-hospital mortality. On the other hand, surgical intervention for IE was found to be a protective factor against mortality. (OR 0.25, P < 0.001) Conclusion Although IE has been increasing, the mortality rate has not yet reduced significantly. Studies on causative organisms of IE and risk factors for mortality are warranted in improving prognosis. Disclosures All authors: No reported disclosures.

scholarly journals Time to Appropriate Antibiotic Therapy is an Independent Indicator of Poor Outcome in Children with Nosocomial Klebsiella Pneumoniae Bloodstream Infection

2020 ◽  
Author(s):  
Jie Cheng ◽  
Qinyuan Li ◽  
Guangli Zhang ◽  
Huiting Xu ◽  
Yuanyuan Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Antibiotic Therapy ◽  
Bloodstream Infection ◽  
Logistic Regression Analysis ◽  
Cutoff Point ◽  
Cart Analysis ◽  
Poor Outcome

Abstract Objectives: To evaluate the effects of time to appropriate therapy (TTAT) on outcomes in children with nosocomial K. pneumoniae bloodstream infection, and to find an optimal time window for empiric antibiotics administration. Methods: Children with nosocomial K. pneumoniae bloodstream infection hospitalized in Children’s Hospital of Chongqing Medical University from April 2014 to December 2019 were enrolled retrospectively. TTAT cutoff point and risk factors were determined and analyzed by Classification and Regression Tree (CART) analysis and Logistic Regression analysis. Results: Overall, sixty-seven patients were enrolled. The incidence of septic shock and mortality was 17.91% (12/67) and 13.43% (9/67), respectively. The CART-derived TTAT cutoff point was 10.7 hours. The multivariate logistic regression analysis indicated delayed therapy (TTAT ≥ 10.7 h), PRISM III scores ≥ 10, early TTP (TTP ≤ 13 h), and need for invasive mechanical ventilation were independent risk factors of septic shock (OR 9.87, 95% CI 1.46-66.59, P = 0.019; OR 9.69, 95% CI 1.15-81.39, P = 0.036; OR 8.28, 95% CI 1.37-50.10, P = 0.021; OR 6.52, 95% CI 1.08-39.51, P = 0.042; respectively) and in-hospital mortality (OR 22.19, 95% CI 1.25-393.94, P = 0.035; OR 40.06, 95% CI 2.32-691.35, P = 0.011; OR 22.60, 95% CI 1.78-287.27, P = 0.016; OR 12.21, 95% CI 1.06-140.67, P = 0.045; respectively). Conclusions: TTAT is an independent predictor of poor outcome in children with nosocomial K. pneumoniae bloodstream infection. Initial appropriate antibiotic therapy should begin within 10.7 hours from the onset of bloodstream infection.

scholarly journals Time to Appropriate Antibiotic Therapy is an Independent Indicator of Poor Outcome in Children with Nosocomial Klebsiella Pneumoniae Bloodstream Infection

2021 ◽  
Author(s):  
Jie Cheng ◽  
Qinyuan Li ◽  
Guangli Zhang ◽  
Huiting Xu ◽  
Yuanyuan Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Antibiotic Therapy ◽  
Bloodstream Infection ◽  
Logistic Regression Analysis ◽  
Cutoff Point ◽  
Cart Analysis ◽  
Poor Outcome

Abstract We aim to evaluate the effects of time to appropriate therapy (TTAT) on outcomes in children with nosocomial K. pneumoniae bloodstream infection, and to find an optimal time window for empiric antibiotics administration. Children with nosocomial K. pneumoniae bloodstream infection hospitalized in Children’s Hospital of Chongqing Medical University from April 2014 to December 2019 were enrolled retrospectively. TTAT cutoff point and risk factors were determined and analyzed by Classification and Regression Tree (CART) analysis and Logistic Regression analysis. Overall, sixty-seven patients were enrolled. The incidence of septic shock and mortality was 17.91% (12/67) and 13.43% (9/67), respectively. The CART-derived TTAT cutoff point was 10.7 hours. The multivariate logistic regression analysis indicated delayed therapy (TTAT ≥ 10.7 h), PRISM III scores ≥ 10, early TTP (TTP ≤ 13 h), and need for invasive mechanical ventilation were independent risk factors of septic shock (OR 9.87, 95% CI 1.46-66.59, P = 0.019; OR 9.69, 95% CI 1.15-81.39, P = 0.036; OR 8.28, 95% CI 1.37-50.10, P = 0.021; OR 6.52, 95% CI 1.08-39.51, P = 0.042; respectively) and in-hospital mortality (OR 22.19, 95% CI 1.25-393.94, P = 0.035; OR 40.06, 95% CI 2.32-691.35, P = 0.011; OR 22.60, 95% CI 1.78-287.27, P = 0.016; OR 12.21, 95% CI 1.06-140.67, P = 0.045; respectively). Conclusions: TTAT is an independent predictor of poor outcome in children with nosocomial K. pneumoniae bloodstream infection. Initial appropriate antibiotic therapy should begin within 10.7 hours from the onset of bloodstream infection.

Inhaled Albuterol Use and Impaired Lactate Clearance in Patients With Sepsis: A Retrospective Cohort Study

2020 ◽  
pp. 088506661990109 ◽  
Author(s):  
Tetsuro Maeda ◽  
Janvi Paralkar ◽  
Toshiki Kuno ◽  
Paru Patrawalla
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Logistic Regression Analysis ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Multivariate Logistic Regression Analysis ◽  
Lactate Clearance ◽  
Multivariate Logistic Regression

Background: Lactate clearance has become important in the management of sepsis. However, factors unrelated to sepsis-induced hyperlactatemia, including β-2 adrenergic agonists, can interfere with lactate clearance. Objectives: To investigate the association of inhaled albuterol with lactate clearance in patients with sepsis. Methods: This was a single-center retrospective cohort study. Adult patients with sepsis diagnosed in the emergency department from May 2015 to May 2016 with initial lactate levels >2 mmol/L and serial lactate measurements 2 to 6 hours apart were included. Patients were divided into 2 groups based on whether they received inhaled albuterol between lactate measurements. The primary end point was lactate clearance of 10%. Secondary end points included intensive care unit (ICU) consultation and in-hospital mortality. A multivariate logistic regression analysis was performed to assess the effect of inhaled albuterol on lactate clearance. Results: Of 269 patients included, 58 (22%) received inhaled albuterol between lactate measurements. This group had a significantly higher prevalence of pulmonary disease and a lower initial lactate compared to those who did not receive inhaled albuterol. They had a significantly lower rate of lactate clearance (45% vs 77%, P < .001); however, ICU consultation (71% vs 57%, P = .066) and in-hospital mortality (19% vs 22%, P = .64) were not significantly different. A multivariate logistic regression analysis adjusting for age, sex, chronic kidney disease, cirrhosis, cancer, septic shock or severe sepsis, and the amount of intravenous fluids received showed that inhaled albuterol was independently associated with impaired lactate clearance (adjusted odds ratio: 0.26, 95% confidence interval: 0.14-0.50, P < .001). Conclusions: Inhaled albuterol in patients with sepsis was associated with impaired lactate clearance without an increase in ICU consultation or in-hospital mortality. Impaired lactate clearance in patients with sepsis who receive inhaled albuterol should be interpreted with caution.

Effects of a High Dose of the Contrast Medium Iodixanol on Renal Function in Patients Following Percutaneous Coronary Intervention

Angiology ◽  
2020 ◽  
pp. 000331972095304
Author(s):  
Ning Zhao ◽  
Zaiyan Chen ◽  
Yinpin Zhou ◽  
Qiang Xu ◽  
Zhonglin Xu ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Logistic Regression ◽  
Renal Function ◽  
Regression Analysis ◽  
High Risk ◽  
Logistic Regression Analysis ◽  
Coronary Intervention ◽  
High Dose ◽  
Percutaneous Coronary ◽  
Very High

Iodixanol is associated with lower rates of contrast-induced acute kidney injury (CI-AKI). However, the effects of high volumes of iodixanol on renal function after percutaneous coronary intervention (PCI) have not been fully elucidated. This study evaluates the effects of high-dose (>300 mL) iodixanol on renal function within 72 hours of PCI. We retrospectively reviewed 676 consecutive patients who received high-dose (>300 mL) iodixanol during PCI between October 2015 and December 2017 in 4 centers. Logistic regression analysis was used to identify significant independent predictors for CI-AKI. The incidence of CI-AKI was 3.5% (23/651). In patients administered 300 to 500 mL and >500 mL iodixanol, the incidence of CI-AKI was 3.9% and 1.7%, respectively. In patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, the incidence of CI-AKI was 2.6%. In high-risk and very high-risk patients, stratified by the Mehran risk score, the incidence of CI-AKI was 3.3% and 4.3%, respectively. In patients received high-dose iodixanol (>300 mL), logistic regression analysis demonstrated that female sex, chronic kidney disease, and eGFR were independent risk factors for CI-AKI, but contrast volume was not. The administration of high (300-500 mL) and very high (>500 mL) dose of iodixanol is associated with low rates of CI-AKI.

scholarly journals Clinical significance of lactate clearance in patients with cardiogenic shock: results from the RESCUE registry

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ik Hyun Park ◽  
Jeong Hoon Yang ◽  
Woo Jin Jang ◽  
Woo Jung Chun ◽  
Ju Hyeon Oh ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Clinical Significance ◽  
Logistic Regression Analysis ◽  
Lactate Clearance ◽  
Serum Lactate ◽  
Left Ventricular

Abstract Background Limited data are available on the clinical significance of lactate clearance (LC) in patients with cardiogenic shock (CS). This study investigated the prognostic role of LC in CS patients. Methods We analyzed data from 628 patients in the RESCUE registry, a multicenter, observational cohort enrolled between January 2014 and December 2018. Univariable logistic regression analysis was performed to determine the prognostic implications of 24 h LC, and then patients were divided into two groups according to the cut-off value of 24 h LC (high lactate clearance [HLC] group vs. low lactate clearance [LLC] group). The primary outcome was in-hospital mortality. We also assessed all-cause mortality at 12 month follow-up and compared the prognostic performance of 24 h LC according to initial serum lactate level. Results In the univariable logistic regression analysis, 24 h LC was associated with in-hospital mortality (odds ratio 0.989, 95% confidence interval [CI] 0.985–0.993, p < 0.001), and the cut-off value for the LC of the study population was 64%. The HLC group (initial 24 h LC ≥ 64%, n = 333) had a significantly lower incidence of in-hospital death than the LLC group (n = 295) (25.5% in the HLC group vs. 42.7% in the LLC group, p < 0.001). During 12 months of follow-up, the cumulative incidence of all-cause death was significantly lower in the HLC group than in the LLC group (33.0% vs. 48.8%; hazard ratio 0.55; 95% CI 0.42–0.70; p < 0.001). In subgroup analysis, 24 h LC predicted in-hospital mortality better in patients with initial serum lactate > 5 mmol/L than in those with serum lactate ≤ 5 mmol/L (c-statistics of initial serum lactate > 5 mmol/L = 0.782 vs. c-statistics of initial serum lactate ≤ 5 mmol/L = 0.660, p = 0.011). Conclusions Higher LC during the early phase of CS was associated with reduced risk of in-hospital and 12 month all-cause mortalities. Patients with LC ≥ 64% during the 24 h after CS onset could expect a favorable prognosis, especially those with an initial serum lactate > 5 mmol/L. Trial registration: RESCUE (REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock), NCT02985008, Registered December 5, 2016—retrospectively and prospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT02985008

scholarly journals An Evaluation of Environmental and Cultural Factors Affecting Under-Five Mortality in Kebbi State, Nigeria

2021 ◽  
Vol 4 (3) ◽  
pp. 71-92
Author(s):  
Azaki J.B. ◽  
Mundi R. ◽  
Dakyes S.P.
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Mortality Rate ◽  
Logistic Regression Analysis ◽  
Cultural Factors ◽  
Sub Saharan Africa ◽  
P Value ◽  
Water Type ◽  
Factors Affecting ◽  
Under Five

Over the years, Nigeria at all levels of government has formulated and implemented health policies and programmes to reduce under-five mortality; and despite that, it is still among Sub-Saharan Africa countries with high under-five mortality rate. This study aimed at evaluating environmental and cultural factors affecting under-five mortality in Kebbi State, Nigeria. Multi-stage sampling technique was used to sample respondents. Structured questionnaires were administered to 625 women aged 15-49 years and 603 were retrieved, giving the response rate of 96.5%. Descriptive statistics such as frequencies and percentages were employed to analyse the characteristics of the respondents and distribution of under-five mortality experienced by women based on the environmental and cultural factors. Logistic regression analysis was applied to determine the environmental and cultural factors affecting under-five mortality in the study area. The results of the Logistic regression analysis revealed that at P-value <0.05, source of water, frequency of washing water container, water treatment, method of disposing waste water, type of toilet, shared toilet, frequency of washing toilet, method of disposing child’s stool, type of cooling appliance, number of persons per room, use of mosquito net, refuse disposal method and type of cooking fuel were found to be the environmental factors significantly affecting under-five mortality; while ethnicity, religion, practice of food taboo, belief in traditional medicine, belief about disease causation, mother’s autonomy on child’s health and family’s decision on child’s health were found to be the cultural factors significantly affecting under-five mortality in the study area. The study therefore concluded that environmental and cultural factors affect under-five mortality in Kebbi state. To reduce under-five mortality rate, it was recommended that government at all levels should step up efforts in providing adequate infrastructure for public use. Government and cultural organizations should mount advocacy programmes aimed at improving women’s participation in child’s health decision-making in the family.

Sign in / Sign up

Export Citation Format

Share Document