Outcome Predictive Value of Serum Ferritin in ICU Patients with Long ICU Stay

Background and Objectives: The simplified interpretation of serum ferritin levels, according to which low ferritin levels indicate iron deficiency and high levels indicate hemochromatosis is obsolete, as in the presence of inflammation serum ferritin levels, no longer correlate with iron stores. However, further data are needed to interpret serum ferritin levels correctly in patients with ongoing inflammation. Our study aimed to assess serum iron and ferritin dynamics in patients with long ICU stay and the possible correlations with organ dysfunction progression and outcome. Materials and Methods: We conducted a prospective study in a university hospital intensive care unit (ICU) over six months. All patients with an ICU length-of-stay of more than seven days were enrolled. Collected data included: demographics, Sequential Organ Failure Assessment (SOFA) score, admission, weekly serum iron and ferritin levels, ICU length-of-stay and outcome. Interactions between organ dysfunction progression and serum iron and ferritin levels changes were investigated. Outcome predictive value of serum ferritin was assessed. Results: Seventy-two patients with a mean ICU length-of-stay of 15 (4.4) days were enrolled in the study. The average age of patients was 62 (16.8) years. There were no significant differences between survivors (39 patients, 54%) and nonsurvivors (33 patients, 46%) regarding demographics, serum iron and ferritin levels and SOFA score on ICU admission. Over time, serum iron levels remained normal or low, while serum ferritin levels statedly increased in all patients. Serum ferritin increase was higher in nonsurvivors than survivors. There was a significant positive correlation between SOFA score and serum ferritin (r = 0.7, 95%CI for r = 0.64 to 0.76, p < 0.01). The predictive outcome accuracy of serum ferritin was similar to the SOFA score. Conclusions: In patients with prolonged ICU stay, serum ferritin dynamics reflects organ dysfunction progression and parallels SOFA score in terms of outcome predictive accuracy.

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Prediction Algorithm for ICU Mortality and Length of Stay Using Machine Learning

10.21203/rs.3.rs-992995/v1 ◽

2021 ◽

Author(s):

Shinya IWASE ◽

Taka-aki Nakada ◽

Tadanaga Shimada ◽

Takehiko Oami ◽

Takashi Shimazui ◽

...

Keyword(s):

Machine Learning ◽

Risk Factors ◽

Length Of Stay ◽

Predictive Value ◽

Predictive Accuracy ◽

Supervised Machine Learning ◽

Icu Patients ◽

Icu Stay ◽

Precise Prediction ◽

Length Of Icu Stay

Abstract Background: Machine learning can predict outcomes and determine variables contributing to precise prediction, and can thus classify patients with different risk factors of outcomes. This study aimed to investigate the predictive accuracy for mortality and length of stay in intensive care unit (ICU) patients using machine learning, and to identify the variables contributing to the precise prediction or classification of patients.Methods: Patients (n=12,747) admitted to the ICU at Chiba University Hospital were randomly assigned to the training and test cohorts. After learning using the variables on admission in the training cohort, the area under the curve (AUC) was analyzed in the test cohort to evaluate the predictive accuracy of the supervised machine learning classifiers, including random forest (RF) for outcomes (primary outcome, mortality; secondary outcome, and length of ICU stay). The rank of the variables that contributed to the machine learning prediction was confirmed, and cluster analysis of the patients with risk factors of mortality was performed to identify the important variables associated with patient outcomes.Results: Machine learning using RF revealed a high predictive value for mortality, with an AUC of 0.945. In addition, RF showed high predictive value for short and long ICU stays, with AUCs of 0.881 and 0.889, respectively. Lactate dehydrogenase (LDH) was identified as a variable contributing to the precise prediction in machine learning for both mortality and length of ICU stay. LDH was also identified as a contributing variable to classify patients into sub-populations based on different risk factors of mortality.Conclusion: The machine learning algorithm could predict mortality and length of stay in ICU patients with high accuracy. LDH was identified as a contributing variable in mortality and length of ICU stay prediction and could be used to classify patients based on mortality risk.

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Vitamin C, Thiamine, and Hydrocortisone in the Treatment of Sepsis: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Journal of Intensive Care Medicine ◽

10.1177/0885066620987809 ◽

2021 ◽

pp. 088506662098780

Author(s):

Yazan Zayed ◽

Bashar N. Alzghoul ◽

Momen Banifadel ◽

Hima Venigandla ◽

Ryan Hyde ◽

...

Keyword(s):

Septic Shock ◽

Length Of Stay ◽

Vitamin C ◽

Sofa Score ◽

Sequential Analysis ◽

Trial Sequential Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Icu Length Of Stay ◽

Significant Difference

Background: There is a conflicting body of evidence regarding the benefit of vitamin C, thiamine, and hydrocortisone in combination as an adjunctive therapy for sepsis with or without septic shock. We aimed to assess the efficacy of this treatment among predefined populations. Methods: A literature review of major electronic databases was performed to include randomized controlled trials (RCTs) evaluating vitamin C, thiamine, and hydrocortisone in the treatment of patients with sepsis with or without septic shock in comparison to the control group. Results: Seven studies met our inclusion criteria, and 6 studies were included in the final analysis totaling 839 patients (mean age 64.2 ± 18; SOFA score 8.7 ± 3.3; 46.6% female). There was no significant difference between both groups in long term mortality (Risk Ratio (RR) 1.05; 95% CI 0.85-1.30; P = 0.64), ICU mortality (RR 1.03; 95% CI 0.73-1.44; P = 0.87), or incidence of acute kidney injury (RR 1.05; 95% CI 0.80-1.37; P = 0.75). Furthermore, there was no significant difference in hospital length of stay, ICU length of stay, and ICU free days on day 28 between the intervention and control groups. There was, however, a significant difference in the reduction of SOFA score on day 3 from baseline (MD −0.92; 95% CI −1.43 to −.41; P < 0.05). In a trial sequential analysis for mortality outcomes, our results are inconclusive for excluding lack of benefit of this therapy. Conclusion: Among patients with sepsis with or without septic shock, treatment with vitamin C, thiamine, and hydrocortisone was not associated with a significant reduction in mortality, incidence of AKI, hospital and ICU length of stay, or ICU free days on day 28. There was a significant reduction of SOFA score on day 3 post-randomization. Further studies with a larger number of patients are needed to provide further evidence on the efficacy or lack of efficacy of this treatment.

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Predictive Factors for the Need of Tracheostomy in Patients With Large Vessel Occlusion Stroke Being Treated With Mechanical Thrombectomy

Frontiers in Neurology ◽

10.3389/fneur.2021.728624 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ilko L. Maier ◽

Katarina Schramm ◽

Mathias Bähr ◽

Daniel Behme ◽

Marios-Nikos Psychogios ◽

...

Keyword(s):

Logistic Regression ◽

Length Of Stay ◽

Mechanical Thrombectomy ◽

Multivariate Logistic Regression Analysis ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Icu Stay ◽

Icu Length Of Stay ◽

Symptomatic Intracerebral Hemorrhage

Background: Patients with large vessel occlusion stroke (LVOS) eligible for mechanical thrombectomy (MT) are at risk for stroke- and non-stroke-related complications resulting in the need for tracheostomy (TS). Risk factors for TS have not yet been systematically investigated in this subgroup of stroke patients.Methods: Prospectively derived data from patients with LVOS and MT being treated in a large, academic neurological ICU (neuro-ICU) between 2014 and 2019 were analyzed in this single-center study. Predictive value of peri- and post-interventional factors, stroke imaging, and pre-stroke medical history were investigated for their potential to predict tracheostomy during ICU stay using logistic regression models.Results: From 635 LVOS-patients treated with MT, 40 (6.3%) underwent tracheostomy during their neuro-ICU stay. Patients receiving tracheostomy were younger [71 (62–75) vs. 77 (66–83), p < 0.001], had a higher National Institute of Health Stroke Scale (NIHSS) at baseline [18 (15–20) vs. 15 (10–19), p = 0.009] as well as higher rates of hospital acquired pneumonia (HAP) [39 (97.5%) vs. 224 (37.6%), p < 0.001], failed extubation [15 (37.5%) vs. 19 (3.2%), p < 0.001], sepsis [11 (27.5%) vs. 16 (2.7%), p < 0.001], symptomatic intracerebral hemorrhage [5 (12.5%) vs. 22 (3.9%), p = 0.026] and decompressive hemicraniectomy (DH) [19 (51.4%) vs. 21 (3.8%), p < 0.001]. In multivariate logistic regression analysis, HAP (OR 21.26 (CI 2.76–163.56), p = 0.003], Sepsis [OR 5.39 (1.71–16.91), p = 0.004], failed extubation [OR 8.41 (3.09–22.93), p < 0.001] and DH [OR 9.94 (3.92–25.21), p < 0.001] remained as strongest predictors for TS. Patients with longer periods from admission to TS had longer ICU length of stay (r = 0.384, p = 0.03). There was no association between the time from admission to TS and clinical outcome (NIHSS at discharge: r = 0.125, p = 0.461; mRS at 90 days: r = −0.179, p = 0.403).Conclusions: Patients with LVOS undergoing MT are at high risk to require TS if extubation after the intervention fails, DH is needed, and severe infectious complications occur in the acute phase after ischemic stroke. These factors are likely to be useful for the indication and timing of TS to reduce overall sedation and shorten ICU length of stay.

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HUBUNGAN SKOR SOFA DENGAN LAMA RAWAT INAP PASIEN SEPSIS PASCA LAPARATOMI DI ICU PERIODE JULI 2012 – SEPTEMBER 2013

e-CliniC ◽

10.35790/ecl.2.2.2014.5051 ◽

2014 ◽

Vol 2 (2) ◽

Author(s):

Tifany Tewuh ◽

Diana Lalenoh ◽

Lucky Kumaat

Keyword(s):

Length Of Stay ◽

Organ Failure ◽

Organ Dysfunction ◽

Sofa Score ◽

Spearman Correlation ◽

Short Period ◽

Collection Data ◽

Spearman Correlation Test ◽

Relationship Of ◽

The Relationship

Abstract: Sofa score is one of the assessments used in ICU. Sofa score can help to see organ dysfunction or organ failure during treatment and can be used to predict the prognosis of patients treated in ICU. Aim: To determine the relationship of sofa score with length of stay patients septic post laparatomy in ICU. Methods: This study is a retrospective analytic study with collection data of sofa score patients septic post laparatomy in ICU RSUP Prof. R D. Kandou period July 2012-September 2013.Data were evaluated and analyzed to see the relationship with length of stay. Result: These results by using the spearman correlation test showed significance value p=0,557 (p>0,05). Conclusions: No relationship between the sofa score with length of stay patients septic post laparatomy in ICU because of less number of samples and a short period study. Keywords: sofa score, length of stay, septic post laparatomy. Abstrak: Skor Sofa adalah salah satu penilaian yang digunakan di ICU. Skor Sofa dapat membantu untuk melihat disfungsi organ atau gagal organ selama perawatan dan dapat digunakan untuk memprediksikan prognosis dari pasien yang dirawat di ICU. Tujuan: Mengetahui hubungan Skor Sofa dengan lama rawat inap pasien sepsis post laparatomi di ICU. Metode: Penelitian ini merupakan penelitian analitik retrospektif dengan pengumpulan data skor sofa pasien sepsis post laparatomi yang dirawat di ICU RSUP Prof. DR. R. D. Kandou periode Juli 2012 – September 2013. Data dievaluasi dan dianalisis untuk melihat hubungannya dengan lama rawat inap. Hasil: Hasil penelitian ini dengan menggunakan uji korelasi spearman menunjukkan nilai signifikasi p=0,557 (p>0,05). Simpulan: Tidak didapatkan hubungan antara skor sofa dengan lama rawat inap pasien sepsis post laparatomi di ICU karena jumlah sampel yang kurang dan periode penelitian yang singkat. Kata Kunci: skor sofa, lama rawat inap, sepsis post laparatomi.

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1443: MODIFIED SHOCK INDEX AS A PREDICTOR OF ICU LENGTH OF STAY, SOFA SCORE, AND MORTALITY

Critical Care Medicine ◽

10.1097/01.ccm.0000510117.17741.aa ◽

2016 ◽

Vol 44 (12) ◽

pp. 436-436

Author(s):

Namita Jayaprakash ◽

Nathan Smischney ◽

Rahul Kashyap ◽

Jenkins Gregory ◽

Ognjen Gajic

Keyword(s):

Length Of Stay ◽

Sofa Score ◽

Shock Index ◽

Icu Length Of Stay

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Incidence and Predictive Value of Thrombocytopenia in Patients with Severe Community Acquired Pneumonia

Acta Chirurgica Latviensis ◽

10.1515/chilat-2016-0007 ◽

2015 ◽

Vol 15 (1) ◽

pp. 35-39 ◽

Cited By ~ 1

Author(s):

Jelena Dunaiceva ◽

Olegs Sabelnikovs

Keyword(s):

Intensive Care ◽

Platelet Count ◽

Hospital Mortality ◽

Sofa Score ◽

Predictive Value ◽

Community Acquired Pneumonia ◽

Icu Patients ◽

Icu Stay ◽

Severe Community Acquired Pneumonia ◽

Clinical Records

SummaryIntroduction. Thrombocytopenia is frequently encountered in intensive care unit (ICU) patients. The cause of thrombocytopenia is multifactorial, it develops as a result of infection, inflammation and depletion of coagulation factors. Therefore, thrombocytopenia could potentially serve as an indicator of severity of the illness and an outcome predictor in patients with severe community-acquired pneumonia (CAP).Aim of the study. To determine incidence and predictive value of thrombocytopenia in ICU patients with severe CAP.Material and methods. We carried out a retrospective study based on clinical records from patients admitted to the Pauls Stradins Clinical University Hospital Intensive Care and Reanimation Unit from 2011 to 2014. Thrombocytopenia was defined as platelet count ≤150×109/L.Results. A total of 98 patients were included in this study, 58 (59%) men and 40 (41%) women. The mean (±SD) age of patients was 61±17.9 years, 54% died and 46% survived. 57 patients (58%) developed thrombocytopenia, in 58% it was present at the admission to ICU, and 42% developed thrombocytopenia during their stay in ICU. The lowest platelet count, in survivors was on fifth day in ICU, while in non-survivors on fourth day in ICU. Platelet count on admission to ICU (ROC AUC: 0.610, p=0.095) had lower discriminative power for ICU mortality than SOFA score (ROC AUC: 0.729, p=0.001) and CURB-65 score (ROC AUC: 0.680, p=0.006). Patients with thrombocytopenia at any point of ICU stay had higher hospital mortality in comparison to patients without thrombocytopenia. (36 (63.1%) vs 17 (41.1%), p=0.041). In thrombocytopenic patients non-resolution of thrombocytopenia during the ICU stay was associated with higher mortality (OR 5.5; 95% CI, 1.6-18.7, p=0.006). After adjusting for age, gender and SOFA score, non-resolution of thrombocytopenia remained to be an independent mortality predictor (OR 8, 95% CI 1.7-37, p=0.008)Conclusions. Thrombocytopenia is frequently encountered in patients with severe CAP. Thrombocytopenia at any point of ICU stay is associated with higher hospital mortality. Resolution of thrombocytopenia is associated with better clinical outcome.

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Early mobilization is associated with decreased mechanical ventilation and ICU length of stay following cardiac surgery

Health & Research Journal ◽

10.12681/healthresj.28161 ◽

2021 ◽

Vol 7 (4) ◽

pp. 184

Author(s):

Vasiliki Raidou ◽

Stavros Dimopoulos ◽

Foteini Chatzivasiloglou ◽

Christos Kourek ◽

Vasiliki Tsagari ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Medical Records ◽

Early Mobilization ◽

Icu Stay ◽

Icu Length Of Stay ◽

Icu Discharge

Background: Early mobilization of the Intensive Care Unit (ICU) patients improves muscle strength and functional capacity. It has been demonstrated that prevents Intensive Care Unit Acquired Weakness (ICUAW) and accelerates ICU discharge. However, data on mobilization early after cardiac surgery are inadequate. This study aimed to record early mobilization and investigates the association with ICU findings in cardiac surgery patients.Material and Methods: In this observational study, 165 patients after cardiac surgery were enrolled. Of these, 159 were assessed for early mobilization and mobilization status during ICU stay. Mobilization practices were recorded from 1st post ICU admission and every 48 h until 7th day. The duration of mechanical ventilation (MV) support, ICU length of stay and clinical outcome were recorded from medical records registration. Results: Early mobilization consisted of active and passive limb mobilization, sitting in bed and transferring from bed to chair. The proportion of patients mobilized, was 18% (n = 29/159) on day 1, 53% (n = 46/87) on day 3, 54% (n = 22/41) on day 5 and 62% (n = 15/24) on day 7. ICU length of stay was reduced for mobilized patients (n = 29) on day 1 compared to non-mobilized ones (24 ± 10 vs 47 ± 73 h respectively, P = 0.001). The duration of MV was shorter in mobilized patients on day 3 (n =46) compared to bedridden, (18 ± 9 vs 23 ± 30 h respectively, P = 0.01).Conclusions: Early mobilization after cardiac surgery was found to be low with a significant trend to increase over ICU stay. It is also associated with a reduced duration of MV and ICU length of stay.

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Clinching the diagnosis: 1. iron deficiency and iron overload: serum ferritin and serum iron in clinical medicine

Pathology ◽

10.3109/00313028309085180 ◽

1983 ◽

Vol 15 (4) ◽

pp. 497-503 ◽

Cited By ~ 6

Author(s):

Richard J. Kimber ◽

Z. Rudzki ◽

R.W. Blunden

Keyword(s):

Iron Deficiency ◽

Iron Overload ◽

Serum Ferritin ◽

Serum Iron ◽

Clinical Medicine

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IMPACT probability of poor outcome and plasma cytokine concentrations are associated with multiple organ dysfunction syndrome following traumatic brain injury

Journal of Neurosurgery ◽

10.3171/2018.8.jns18676 ◽

2019 ◽

Vol 131 (6) ◽

pp. 1931-1937 ◽

Cited By ~ 2

Author(s):

Sungho Lee ◽

Hyunsoo Hwang ◽

Jose-Miguel Yamal ◽

J. Clay Goodman ◽

Imoigele P. Aisiku ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Sofa Score ◽

Plasma Concentrations ◽

Multiple Organ ◽

Multiple Organ Dysfunction ◽

Poor Outcome ◽

Initial Plasma

OBJECTIVETraumatic brain injury (TBI) is a major cause of morbidity and mortality. Multiple organ dysfunction syndrome (MODS) occurs frequently after TBI and independently worsens outcome. The present study aimed to identify potential admission characteristics associated with post-TBI MODS.METHODSThe authors performed a secondary analysis of a recent randomized clinical trial studying the effects of erythropoietin and blood transfusion threshold on neurological recovery after TBI. Admission clinical, demographic, laboratory, and imaging parameters were used in a multivariable Cox regression analysis to identify independent risk factors for MODS following TBI, defined as maximum total Sequential Organ Failure Assessment (SOFA) score > 7 within 10 days of TBI.RESULTSTwo hundred patients were initially recruited and 166 were included in the final analysis. Respiratory dysfunction was the most common nonneurological organ system dysfunction, occurring in 62% of the patients. International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) probability of poor outcome at admission was significantly associated with MODS following TBI (odds ratio [OR] 8.88, 95% confidence interval [CI] 1.94–42.68, p < 0.05). However, more commonly used measures of TBI severity, such as the Glasgow Coma Scale, Injury Severity Scale, and Marshall classification, were not associated with post-TBI MODS. In addition, initial plasma concentrations of interleukin (IL)–6, IL-8, and IL-10 were significantly associated with the development of MODS (OR 1.47, 95% CI 1.20–1.80, p < 0.001 for IL-6; OR 1.26, 95% CI 1.01–1.58, p = 0.042 for IL-8; OR 1.77, 95% CI 1.24–2.53, p = 0.002 for IL-10) as well as individual organ dysfunction (SOFA component score ≥ 1). Finally, MODS following TBI was significantly associated with mortality (OR 5.95, 95% CI 2.18–19.14, p = 0.001), and SOFA score was significantly associated with poor outcome at 6 months (Glasgow Outcome Scale score < 4) when analyzed as a continuous variable (OR 1.21, 95% CI 1.06–1.40, p = 0.006).CONCLUSIONSAdmission IMPACT probability of poor outcome and initial plasma concentrations of IL-6, IL-8, and IL-10 were associated with MODS following TBI.

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