scholarly journals Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Jie Zhao ◽  
Lei-qing Li ◽  
Ning-xin Zhen ◽  
Lin-lin Du ◽  
Hui Shan ◽  
...  
Keyword(s):  
Burkholderia Cepacia ◽  
Invasive Mechanical Ventilation ◽  
Attributable Mortality ◽  
Prolonged Length ◽  
Observational Cohort ◽  
Microbial Etiology ◽  
Hospital Stays ◽  
Institutionalized Patients ◽  
Gcs Score ◽  
Serum Crp

Background: The attributable mortality and microbial etiology of stroke-associated pneumonia (SAP) vary among different studies and were inconsistent.Purpose: To determine the microbiology and outcomes of SAP in the lower respiratory tract (LRT) for patients with invasive mechanical ventilation (MV).Methods: In this observational study, included patients were divided into SAP and non-SAP based on a comprehensive analysis of symptom, imaging, and laboratory results. Baseline characteristics, clinical characteristics, microbiology, and outcomes were recorded and evaluated.Results: Of 200 patients, 42.5% developed SAP after the onset of stroke, and they had a lower proportion of non-smokers (p = 0.002), lower GCS score (p < 0.001), higher serum CRP (p < 0.001) at ICU admission, and a higher proportion of males (p < 0.001) and hypertension (p = 0.039) than patients with non-SAP. Gram-negative aerobic bacilli were the predominant organisms isolated (78.8%), followed by Gram-positive aerobic cocci (29.4%). The main pathogens included K. pneumoniae, S. aureus, H. influenzae, A. baumannii, P. aeruginosa, E. aerogenes, Serratia marcescens, and Burkholderia cepacia. SAP prolonged length of MV (p < 0.001), duration of ICU stay (p < 0.001) and hospital stay (p = 0.027), shortened MV-free days by 28 (p < 0.001), and caused elevated vasopressor application (p = 0.001) and 60-day mortality (p = 0.001). Logistic regression analysis suggested that patients with coma (p < 0.001) have a higher risk of developing SAP.Conclusion: The microbiology of SAP is similar to early phase of HAP and VAP. SAP prolongs the duration of MV and length of ICU and hospital stays, but also markedly increases 60-day mortality.

scholarly journals Microbiology and Outcomes of Institutionalized Patients with Stroke-associated Pneumonia: A Prospective Observational Study

2021 ◽  
Author(s):  
Jie Zhao ◽  
Lei-qing Li ◽  
Ning-xin Zhen ◽  
Lin-lin Du ◽  
Hui Shan ◽  
...  
Keyword(s):  
Observational Study ◽  
Burkholderia Cepacia ◽  
Prospective Observational Study ◽  
Invasive Mechanical Ventilation ◽  
Attributable Mortality ◽  
Baseline Characteristic ◽  
Prolonged Length ◽  
Institutionalized Patients ◽  
Gcs Score ◽  
Serum Crp

Abstract Background: The attributable mortality and microbial etiology of stroke-associated pneumonia (SAP) vary among different studies. We intednd to determine the microbiology and outcomes of SAP in lower respiratory tract (LRT) for patients with invasive mechanical ventilation (MV).Methods: In this prospective observational study, included patients were divided into SAP and non-SAP based on comprehensive analysis of symptom, imaging and laboratory results. Baseline characteristic, clinical characteristic, microbiology and outcomes were recorded and evaluated.Results: Of 185 patients, 41.6% developed SAP after onset of stroke, and they had lower proportion of non-smoker (p=0.016), lower GCS score (p<0.001), higher serum CRP score (p<0.001) at ICU admission, and higher proportion of males (p<0.001) and hypertension (p=0.018) than patients with non-SAP. Gram-negative aerobic bacilli were the predominant organisms isolated (78%), followed by Gram-positive aerobic cocci (29.9%). Out of 19 isolated pathogens, main pathogens included K. pneumoniae, S. aureus, H. influenzae, A. baumannii, P. aeruginosa, E. aerogens, Serratia marcescens, and Burkholderia cepacia. SAP significantly prolonged length of MV (p<0.001) and duration of ICU stays (p<0.001), shorten MV-free days by 28 (p<0.001), caused elevated vasopressor application (p=0.002) and 60-day mortality (p=0.001).Conclusion: Microbiology of SAP is similar to early-phase HAP and VAP. SAP significantly prolongs duration of MV and lengths of ICU stays, but also markedly increase 60-day mortality.Trial registration: ChiCTR2000028849; http://www.chictr.org.cn/index.aspx, Registered 05 January 2020.

scholarly journals Obesity and smoking as risk factors for invasive mechanical ventilation in COVID-19: A retrospective, observational cohort study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0238552
Author(s):  
Ana C. Monteiro ◽  
Rajat Suri ◽  
Iheanacho O. Emeruwa ◽  
Robert J. Stretch ◽  
Roxana Y. Cortes-Lopez ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Smoking Status ◽  
Univariate Analysis ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Observational Cohort Study ◽  
Smoking History ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Purpose To describe the trajectory of respiratory failure in COVID-19 and explore factors associated with risk of invasive mechanical ventilation (IMV). Materials and methods A retrospective, observational cohort study of 112 inpatient adults diagnosed with COVID-19 between March 12 and April 16, 2020. Data were manually extracted from electronic medical records. Multivariable and Univariable regression were used to evaluate association between baseline characteristics, initial serum markers and the outcome of IMV. Results Our cohort had median age of 61 (IQR 45–74) and was 66% male. In-hospital mortality was 6% (7/112). ICU mortality was 12.8% (6/47), and 18% (5/28) for those requiring IMV. Obesity (OR 5.82, CI 1.74–19.48), former (OR 8.06, CI 1.51–43.06) and current smoking status (OR 10.33, CI 1.43–74.67) were associated with IMV after adjusting for age, sex, and high prevalence comorbidities by multivariable analysis. Initial absolute lymphocyte count (OR 0.33, CI 0.11–0.96), procalcitonin (OR 1.27, CI 1.02–1.57), IL-6 (OR 1.17, CI 1.03–1.33), ferritin (OR 1.05, CI 1.005–1.11), LDH (OR 1.57, 95% CI 1.13–2.17) and CRP (OR 1.13, CI 1.06–1.21), were associated with IMV by univariate analysis. Conclusions Obesity, smoking history, and elevated inflammatory markers were associated with increased need for IMV in patients with COVID-19.

scholarly journals Making the Case: Intra-arterial Therapy for Less Common Metastases

2017 ◽  
Vol 34 (02) ◽  
pp. 132-139 ◽  
Author(s):  
Andrew Gordon ◽  
Omar Uddin ◽  
Ahsun Riaz ◽  
Riad Salem ◽  
Robert Lewandowski
Keyword(s):  
Soft Tissue Sarcomas ◽  
Outpatient Setting ◽  
Prospective Data ◽  
Tumor Bed ◽  
Dominant Disease ◽  
Observational Cohort ◽  
Hospital Stays ◽  
High Antitumor Activity ◽  
Nonsurgical Patients ◽  
Hepatic Malignancies

AbstractIntra-arterial therapies have high antitumor activity for both primary and secondary hepatic malignancies. Selective infusions allow increased delivery of cytoreductive therapy to the tumor bed while sparing the normal hepatic parenchyma. These therapies are now often applied in the outpatient setting or with short overnight hospital stays and have a growing role in the treatment of liver-dominant disease from metastatic colorectal cancer and from neuroendocrine tumors. Less commonly, intra-arterial therapies are applied to treat secondary hepatic malignancies from breast cancer, melanoma, pancreatic adenocarcinoma, and soft-tissue sarcomas. The available data are limited and generally retrospective observational cohort series of single institutions. The purpose of this article is to summarize the recent literature on outcomes for intra-arterial therapy in nonsurgical patients. Multi-institutional registries and prospective data are greatly needed, as intra-arterial therapies are increasingly applied in these patients to stop progression of chemorefractory tumors.

scholarly journals Serum C-reactive protein levels predict neurological outcome after aneurysmal subarachnoid hemorrhage

2012 ◽  
Vol 70 (3) ◽  
pp. 202-205 ◽  
Author(s):  
Flávio Ramalho Romero ◽  
Eduardo de Freitas Bertolini ◽  
Eberval G. Figueiredo ◽  
Manoel Jacobsen Teixeira
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
C Reactive Protein ◽  
Clinical Prognosis ◽  
Protein Levels ◽  
Reactive Protein ◽  
Fisher Grade ◽  
Serial Serum ◽  
Gcs Score ◽  
Serum Crp

OBJECTIVES: Our aim was to evaluate the relationship between serum C-reactive protein (CRP) levels and the neurological prognosis and development of vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS: Eighty-two adult patients with aSAH diagnoses were prospectively evaluated. Glasgow Coma Scale (GCS) score, Hunt and Hess grade, Fisher grade, cranial CT scans, digital subtraction angiography studies and daily neurological examinations were recorded. Serial serum CRP measurements were obtained daily between admission and the tenth day. Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRS) were used to assess the prognosis. RESULTS: Serum CRP levels were related to severity of aSAH. Patients with lower GCS scores and higher Hunt and Hess and Fisher grades presented statistically significant higher serum CRP levels. Patients with higher serum CRP levels had a less favorable prognosis. CONCLUSIONS: Increased serum CRP levels were strongly associated with worse clinical prognosis in this study.

Mechanical Ventilation Outcomes in Patients With Pulmonary Hypertension in the United States: A National Retrospective Cohort Analysis

2016 ◽  
Vol 32 (10) ◽  
pp. 588-592 ◽  
Author(s):  
Barret Rush ◽  
Bradly J. Biagioni ◽  
Landon Berger ◽  
Robert McDermid
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Cohort Analysis ◽  
Invasive Mechanical Ventilation ◽  
The United States ◽  
Retrospective Cohort Analysis ◽  
Hospital Stays ◽  
Pulmonary Arterial ◽  
Future Work ◽  
Overall Mortality

Objective: The outcome of patients with pulmonary arterial hypertension (PAH) who undergo mechanical ventilation is not well known. Methods: The Nationwide Inpatient Sample for 2006 to 2012 was used to isolate patients with a diagnosis of PAH who also underwent invasive (MV) and noninvasive (NIMV) mechanical ventilation. The primary outcome was in-hospital mortality. Results: The hospital records of 55 208 382 patients were studied, and there were 21 070 patients with PAH, of whom 1646 (7.8%) received MV and 834 (4.0%) received NIMV. Those receiving MV had higher mortality (39.1% vs 12.6%, P < .001) and longer hospital stays (11.9 days, interquartile range [IQR] 6.1-22.2 vs 6.7 days, IQR 3.4-11.9, P < .001) than those undergoing NIMV. Of the patients treated with MV, 4.4% also used home oxygen therapy and had similar overall mortality to those who did not use home oxygen (35.3% vs 39.1%, P = .46). Similarly, there was no relationship between home oxygen use and mortality in patients treated with NIMV (10.6% vs 12.6%, P = .48). Notably, more patients treated with NIMV used home oxygen than those treated with MV (14.4% vs 4.4%, P < .001). Conclusion: Patients with PAH who undergo invasive mechanical ventilation have an in-hospital mortality of 39.1%. Future work may help identify the types of patients who benefit most from advanced respiratory support in a critical care setting.

scholarly journals Absence of fear of dying predicts new organ failure: Results of a multicenter prospective observational cohort study

2021 ◽  
Author(s):  
Aurélien Mazeraud ◽  
Guillaume Turc ◽  
Sivanthiny Sivanandamoorthy ◽  
Raphaël Porcher ◽  
Annabelle Stoclin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Organ Failure ◽  
Invasive Mechanical Ventilation ◽  
Observational Cohort Study ◽  
Prospective Observational Cohort Study ◽  
State Trait Anxiety Inventory ◽  
Saps Ii ◽  
Item Questionnaire ◽  
Observational Cohort ◽  
Acute Anxiety

Abstract Rationale: Intensity of anxiety at admission in intensive care unit (ICU) is associated with subsequent deterioration.Objective: The primary aim of this study was to assess predictive value of stressful fears and feelings to predict new organ failure within the first seven days after ICU admission.Methods: We conducted a prospective three-center cohort study of non-comatose patients without delirium or invasive mechanical ventilation. A twelve-item questionnaire was developed to assess stressful fears and feelings. Illness severity was assessed using SAPS-II and SOFA scores. Intensity of chronic and acute anxiety was assessed with the ‘Trait’ and ‘State’ forms of the State-Trait Anxiety Inventory (STAI). Patients were followed-up for seven days. Results: From April 2014 to December 2017, 373 patients (median age, 63y.o. [49-74]; 159 [40.7%] women; SAPS-II 28 [19-37]) were included. Feeling of vulnerability and fear of dying was reported in 209 (54.4%) and 178 (46.4%) patients, respectively. STAI was equal or above 40 in 192 (51.5%) patients. Ninety-four (25.2%) patients developed a new organ failure. Feeling of vulnerability (OR=1.96, 95%CI:1.12-3.43], p=0.01) and absence of fear of dying (OR=2.38, 95%CI:1.37-4.17], p=0.002) were associated with occurrence of a new organ failure after adjustment on STAI ≥40, SAPS-II and SOFA. Conclusion: Absence of fear of dying is associated with occurrence of new organ failure within the seven post-ICU admission days. We hypothesize that fear of dying might be protective for subsequent deterioration by mobilizing patient’s homeostatic resources. Trial registration: NCT02355626

scholarly journals In-hospital and one-year mortality among patients with acute kidney injury and hematological malignancies

2021 ◽  
Vol 35 (1) ◽  
pp. 11-17
Author(s):  
Inês Coelho ◽  
◽  
Teresa Chuva ◽  
Hugo Ferreira ◽  
Ana Paiva ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Hematological Malignancies ◽  
Invasive Mechanical Ventilation ◽  
Kidney Injury ◽  
Hospital Death ◽  
Non Hodgkin Lymphoma ◽  
Hospital Patients ◽  
Observational Cohort ◽  
One Year

Hematological malignancies (HM) confer a high risk of acute kidney injury (AKI), which is associated with elevated morbi-mortality. The aim of this study was to identify the prognostic factors for in-hospital mortality and one-year mortality in this population. We conducted a single center, retrospective, observational cohort study of 101 in-hospital patients with AKI and HM between January 2015 and December 2019. Multiple myeloma was present in 30.7% of the patients, followed by non-Hodgkin lymphoma (NHL) in 27.7%. Renal support therapy (RST) was needed in 60.4% of the cases. Independent predictors for in-hospital mortality were invasive mechanical ventilation (IMV) (OR 49.53; 95% CI:9.17 – 267.57; P<0.001) and infection during in-hospital stay (IDHS) (OR 5.09; 95% CI:1.18 – 21.89; P=0.029). Predictors for one-year mortality were NHL (HR 2.88; 95% CI:1.54 – 5.39; P=0.001), tumor progression (HR 2.36; 95% CI:1.29 – 4.32; P=0.006) and IMV (HR 6.38; 95% CI:3.50 – 11.64; P<0.001). Higher albumin levels at AKI diagnosis conferred a better prognosis (HR 0.57; 95% CI:0.35 – 0.91; P=0.020). Our model showed that patients with HM and AKI who were submitted to IMV and had IDHS had a probability of in-hospital death of 96%. Albumin at the time of AKI influenced one-year mortality.

scholarly journals Refining Prognosis for Intracerebral Hemorrhage by Early Reassessment

2017 ◽  
Vol 43 (3-4) ◽  
pp. 110-116 ◽  
Author(s):  
Matthew B. Maas ◽  
Brandon A. Francis ◽  
Rajbeer S. Sangha ◽  
Bryan D. Lizza ◽  
Eric M. Liotta ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Prognostic Score ◽  
Observational Cohort Study ◽  
Predictors Of Outcome ◽  
Neurologic Injury ◽  
Ordinal Regression Model ◽  
Observational Cohort ◽  
Ich Score ◽  
Gcs Score ◽  
Z Transformation

Background: Prognostic assessments, which are crucial for decision-making in critical illnesses, have shown unsatisfactory reliability. We compared the accuracy of a widely used prognostic score against a model derived from clinical data obtained 5 days after admission for patients with intracerebral hemorrhage (ICH), a condition for which prognostication has proven notoriously challenging and prone to bias. Methods: Patients enrolled in a prospective observational cohort study of spontaneous ICH underwent hourly Glasgow Coma Scale (GCS) assessment. Outcome was measured at 3 months using the modified Rankin Scale (mRS). We analyzed the change in correlation between GCS and 3-month mRS scores from admission through day 5, and compared the performance of a parsimonious set of day 5 clinical variables against the ICH score. Results: Data was collected on 254 subjects. The ICH score and day 5 GCS score were both correlated with 3-month mRS score (p < 0.001), but the correlation was stronger with day 5 GCS score (p < 0.05 by Fisher z-transformation). Premorbid mRS score, intraventricular hemorrhage and day 5 GCS score were independent predictors of outcome (all p < 0.05 in ordinal regression model). While ICH score correctly classified good (mRS 0-3) vs. poor (mRS 4-6) outcome in 73% of cases, the day 5 model correctly classified 83% of cases. Conclusions: A simple reassessment after 5 days of care significantly improves the accuracy of prognosticating outcome in patients with ICH. These data confirm the feasibility and potential utility of early reassessments in refining prognosis for patients who survive early stabilization of a severe neurologic injury.

Pediatric Acute Respiratory Distress Syndrome (PARDS) in Children With Pulmonary Contusion

2019 ◽  
Vol 36 (1) ◽  
pp. 107-114 ◽  
Author(s):  
Shivanand S. Medar ◽  
Sindy Villacres ◽  
Shubhi Kaushik ◽  
Ruth Eisenberg ◽  
Melvin E. Stone
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Injury Severity ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Pulmonary Contusion ◽  
Lower Oxygen ◽  
Gcs Score ◽  
Level 1 Trauma Center

Objective: There is paucity of data about prevalence of pediatric acute respiratory distress syndrome (PARDS) in children with pulmonary contusion (PC). We intend to evaluate PC in children with chest trauma and the association between PC and PARDS. Design: Retrospective review of Institutional Trauma Registry for patients with trauma. Setting: Level 1 trauma center. Patients: Age 18 years and younger with a diagnosis of PC. Interventions: None. Measurements and Main Results: Of the 1916 children with trauma, 50 (2.6%) had PC. Patients with PC and PARDS had lower Glasgow Coma Scale (GCS) score (7 [3-15] vs 15 [15-15], P = .0003), higher Injury Severity Scale (ISS) score (29 [22-34] vs 19 [14-22], P = .004), lower oxygen saturations (96 [93-99] days vs 99 [98-100] days, P = .0009), higher FiO2 (1 [1-1] vs 0.21 [0.21-0.40], P < .0001), lower oxygen saturation/FiO2 (S/F) ratios (97 [90-99] vs 457 [280-471], P < .0001), need for invasive mechanical ventilation (IMV; 86% vs 23%, P < .0001), and mortality (28% vs 0%, P = .006) compared to those without PARDS. Forty-two percent (21/50) of patients needed IMV, of these 61% (13/21) had PARDS. Patients who needed IMV had significantly lower GCS score (8 [3-11] vs 15 [15-15], P < .0001), higher ISS score (27 [22-34] vs 18 [14-22], P = .002), longer length of stay (LOS; 7.5 [4-14] days vs 3.3 [2-5] days, P = .003), longer hospital LOS (18 [7.0-25] vs 5 [4-11], P = .008), higher PARDS rate (62% vs 7%, P < .0001), and lower S/F ratios (99 [94-190] vs 461 [353-471], P < .0001) compared to those who did not require IMV. Lower GCS score was independently associated with both PARDS and need for IMV. Conclusions: Pediatric ARDS in children with PC is independently associated with lower GCS score, and its presence significantly increased morbidity and mortality. Further larger studies are needed to explore association of lower GCS and higher injury score in children with PARDS and PC.

scholarly journals Features of patients that died for COVID-19 in a hospital in the south of Mexico: A observational cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0245394
Author(s):  
Jesús Arturo Ruíz-Quiñonez ◽  
Crystell Guadalupe Guzmán-Priego ◽  
Germán Alberto Nolasco-Rosales ◽  
Carlos Alfonso Tovilla-Zarate ◽  
Oscar Israel Flores-Barrientos ◽  
...  
Keyword(s):  
Metabolic Diseases ◽  
Numerical Data ◽  
The South ◽  
Male Predominance ◽  
Venn Diagrams ◽  
Risk Of Death ◽  
Observational Cohort ◽  
Hospital Stays ◽  
The Mean ◽  
Metabolic Comorbidities

Background Due to the wide spread of SARS-CoV2 around the world, the risk of death in individuals with metabolic comorbidities has dangerously increased. Mexico has a high number of infected individuals and deaths by COVID-19 as well as an important burden of metabolic diseases; nevertheless, reports about features of Mexican individuals with COVID-19 are scarce. The aim of this study was to evaluate demographic features, clinical characteristics and the pharmacological treatment of individuals who died by COVID-19 in the south of Mexico. Methods We performed an observational study including the information of 185 deceased individuals with confirmed diagnoses of COVID-19. Data were retrieved from medical records. Categorical data were expressed as proportions (%) and numerical data were expressed as mean ± standard deviation. Comorbidities and overlapping symptoms were plotted as Venn diagrams. Drug clusters were plotted as dendrograms. Results The mean age was 59.53 years. There was a male predominance (60.1%). The mean hospital stay was 4.75 ± 4.43 days. The most frequent symptoms were dyspnea (88.77%), fever (71.42%) and dry cough (64.28%). Present comorbidities included diabetes (60.63%), hypertension (59.57%) and obesity (43.61%). The main drugs used for treating COVID-19 were azithromycin (60.6%), hydroxychloroquine (53.0%) and oseltamivir (27.3%). Conclusions Mexican individuals who died of COVID-19 had shorter hospital stays, higher frequency of shortness of breath, and higher prevalence of diabetes than individuals from other countries. Also, there was a high frequency of off-label use of drugs for their treatment.

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