scholarly journals Faktor-Faktor yang Berhubungan dengan Mortalitas 30 Hari pada Pasien Sakit Kritis dengan Kandidiasis Invasif yang Dirawat di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSCM)

2017 ◽  
Vol 4 (1) ◽  
pp. 11
Author(s):  
Ardi Ardian ◽  
Ceva W Pitoyo ◽  
Dita Adhitianingsih ◽  
Widayat Djoko Santoso ◽  
Siti Setiati
Keyword(s):  
Risk Factors ◽  
Severe Sepsis ◽  
Mortality Rate ◽  
Critically Ill ◽  
Candida Tropicalis ◽  
Invasive Candidiasis ◽  
Critically Ill Patients ◽  
Candida Parapsilosis ◽  
Charlson Index ◽  
Mortality Factors

Pendahuluan. Tingkat mortalitas kandidiasis invasif mencapai 30-70%. Setiap studi menunjukkan tingkat mortalitas yang berbeda pada studi dan sampel yang berbeda. Belum ada data mengenai profil dan analisis faktor mortalitas kandidiasis invasif pada pasien sakit kritis. Studi ini bertujuan untuk memberikan informasi profil kandidiasis invasif pada pasien sakit kritis beserta faktor faktor yang berpengaruh terhadap mortalitas sebagai upaya untuk meningkatkan kualitas tata laksana pasien sakit kritis dengan kandidiasis invasif.Metode. Desain penelitian adalah potong lintang, mengumpulkan data dari rekam medis pada seratus dua pasien sakit kritis dengan kandidiasis invasif. Pasien kandidiasis invasif adalah pasien dengan hasil kultur darah dan atau kultur cairan tubuh normal steril positif jamur spesies Candida. Data yang dikumpulkan meliputi data usia, spesies jamur candida penyebab, faktor risiko kandidiasis invasif, serta data faktor yang berpengaruh terhadap mortalitas yang meliputi ada tidaknya kondisi sepsis, nilai APACHE, ada tidaknya kondisi gagal napas,ada tidaknya gagal ginjal, waktu pemberian terapi antijamur,Charlson Index, dan tempat perawatan (ICU atau Non ICU). Uji analisis bivariat dengan uji chi square dilakukan terhadap masing masing faktor, yang dilanjutkan dengan uji multivariat regresi logistik untuk menilai faktor yang paling berhubungan terhadap mortalitas 30 hari.Hasil. Dari 102 sampel penelitian didapatkan laki laki 52,9% dan perempuan 47,1%. Median usia 53 tahun dengan angka mortalitas 68,6%. Spesies candida penyebab terbanyak adalah Candida tropicalis (34,3%) dan Candida parapsilosis (29,4%), tiga faktor risiko kandidiasis invasif terkait penyakit dasar adalah sepsis (78,9%), keganasan (42,15%), diabetes melitus ( 29,4%) sedangkan yang terkait terapi atau tata laksana adalah penggunaan antibiotik spektrum luas (99%), kateter vena sentral (77,5%), serta pemberian nutrisi parenteral (70,6%). Pada analisis multivariat regresi logistik, faktor yang paling berpengaruh terhadap mortalitas adalah sepsis berat ( p 0,001, OR 7,7, IK95% 2,4 – 24,7), Charlson Index ≥ 3 ( p 0,022, OR 3,5, IK95% 1,2 – 10,2), dan gagal napas (p 0,066, OR 2,733 IK95% 0,9 – 8,0).Simpulan. Pada pasien sakit kritis dengan kandidiasis invasif yang dirawat di RSCM, laki laki lebih banyak dari pada perempuan, dengan median usia 53 tahun, dan angka mortalitas 68,6%. Spesies candida terbanyak penyebab infeksi adalah Candida tropicalis dan Candida parapsilosis. Faktor risiko kandidiasis invasif terbanyak terkait penyakit dasar adalah sepsis sedangkan terkait terapi atau tata laksana adalah penggunaan antibiotik spektrum luas. Faktor faktor yang berhubungan dengan mortalitas 30 hari adalah kondisi sepsis berat dan Charlson index ≥3.Kata Kunci: faktor mortalitas, kandidiasis invasif, sakit kritis Factors Related to 30 day Mortality in Critically Ill Patients with Invasive Candidiasis in Cipto Mangunkusumo HospitalIntroduction. Mortality rate of invasive candidiasis is still high, approximately 30-70%. Every study has a variety mortality rate depend on study design and sample. There is no data in Indonesia about profile and mortality factors analysis in critically ill patients with invasive candidiasis. Methods. The Study design was cross sectional. We studied 102 hospitalized critically ill patients with invasive candidiasis. The demographic, clinical and laboratory data, the risk factors for invasive candidiasis and the outcome of each patient in 30 days were recorded. An analysis bivariate with chi square or Fisher’s test was carried out to analyse some factors such as age > 60 years old, severe sepsis, APACHE score > 20, respiratory failure, renal failure, delayed antifungal treatment > 72 hours after positive culture, Charlson index score, and ICU or non ICU patients. The logistic regression of multivariate analysis was carried out to identify the most influence of all mortality factors. Results. Among 102 identified sample, the majority was male (52.9%), the median age was 53 years old and the mortality rate was 68,6%. Laboratory candida findings came from blood sample (candidemia) (98.03%), liquor cerebrospinal (1.5%) and retina exudate (1.5%). The most common candida species were candida non albicans especially Candida tropicalis (34.3%) and Candida parapsilosis (34.3%). The risk factors for invasive candidiasis from this study related to underlying disease were sepsis (78.9%), malignancy (42.15%), diabetes mellitus (29.4%) and related to therapy or treatment were the usage of broad spectrum antibiotic (99%), central vein catheter (77.5%), and parenteral nutrition (70.6%). The result from multivariate analysis, severe sepsis (p 0.001, OR 7.7, IK95% 2.4 – 24.7), Ch arlson Index ≥3 (p 0.022, OR 3.5, IK95% 1.2–10.2), and respiratory failure (p 0.066, OR 2.7 IK95% 0.9 – 8.0) were independently associated with mortality. Conclusions. In Cipto Mangunkusumo hospital, most critically ill patients with invasive candidiasis was male, median age was 53 years old, and mortality rate was 68,6%. The most species candida caused infection were Candida tropicalis and Candida parapsilosis. The most risk factors of invasive candidiasis from underlying disease was sepsis and from the treatment was the usage of broad spectrum antibiotic. Severe sepsis, and Charlson index ≥3 were associated with a 30 day mortality in critically ill patients with invasive candidiasis.

scholarly journals Risk factors and mortality rate in Covid-19 critically ill patients in Mexico

2021 ◽  
Vol 46 ◽  
pp. S701
Author(s):  
M. Bejarano ◽  
C.O. Ramos ◽  
E.A. Rosas ◽  
C.E. Madera ◽  
R. Rascón ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Critically Ill ◽  
Critically Ill Patients

Evaluation of the updated “Candida score” with sepsis 3.0 criteria in critically ill patients

2019 ◽  
Author(s):  
Dongkai Li ◽  
Jiahui Zhang ◽  
Wen Han ◽  
Guangxu Bai ◽  
Wei Cheng ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Critically Ill ◽  
Invasive Candidiasis ◽  
Critically Ill Patients ◽  
Clinical Relevance ◽  
Hospital Admissions ◽  
Clinical Importance ◽  
Number Of Patients ◽  
Candida Score ◽  
Score Model

Abstract BackgroundThe Candida score proposed in 2009 was calculated on the definition of “severe sepsis”, which was removed in the Sepsis 3.0 definition. This study investigated the clinical relevance of Candida score with the updated sepsis 3.0 definition (CS-3.0) instead of severe sepsis (CS-2009) in the new admitted critically ill patients.MethodWe performed a retrospective analysis on a single‑center public database. All patients with ICU stay≥72 hours were included in this study. The Candida score was calculated based on the data collected on ICU admission. The incidence of invasive candidiasis was determined and its relationship with the CS-2009 and CS-3.0 was studied.ResultsA total of 17,666 patients were identified after screening 58,976 hospital admissions, and 436 cases (2.5%) were diagnosed with invasive candidiasis. In the infection group, the number of patients who met the Sepsis 3.0 criteria was greater than the number of patients with severe sepsis (81.2% vs. 78.4%, p<0.005). The area under curve of the CS-2009 was 0.789 (95% CI 0.765-0.813) and the CS-3.0 was 0.804 (95% CI 0.782-0.827). ConclusionOur study confirmed the clinical relevance and comparative superiority of the updated Candida score model, using the Sepsis 3.0 definition, compared with the classic sepsis/severe sepsis model, in assessment of critically ill patients. Considering the clinical importance of organ dysfunction in ICI, the sepsis 3.0 should be used as the basis for prediction of invasive candidiasis.

scholarly journals Association between comorbid asthma and prognosis of critically ill patients with severe sepsis: a cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jinju Huang ◽  
Jurong Zhang ◽  
Faxia Wang ◽  
Jiezhu Liang ◽  
Qinchang Chen ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Mortality Rate ◽  
Acute Exacerbation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Primary Study ◽  
Value Analysis ◽  
Kaplan Meier ◽  
Saps Ii Score ◽  
Asthma Patients

AbstractBasic research suggests some contributing mechanisms underlying asthma might at the same time benefit patients with asthma against sepsis, while the potential protective effect of comorbid asthma on prognosis of sepsis has not been well studied in clinical research. The study aimed to assess the association between comorbid asthma and prognosis in a cohort of patients admitted to intensive care unit (ICU) with severe sepsis. Patients with severe sepsis admitted to ICUs were included from the MIMIC-III Critical Care Database, and categorized as patients without asthma, patients with stable asthma, and patients with acute exacerbation asthma. The primary study outcome was 28-day mortality since ICU admission. Difference in survival distributions among groups were evaluated by Kaplan–Meier estimator. Multivariable Cox regression was employed to examine the association between comorbid asthma and prognosis. A total of 2469 patients with severe sepsis were included, of which 2327 (94.25%) were without asthma, 125 (5.06%) with stable asthma, and 17 (0.69%) with acute exacerbation asthma. Compared with patients without asthma, patients with asthma (either stable or not) had a slightly younger age (66.73 ± 16.32 versus 64.77 ± 14.81 years), a lower proportion of male sex (56.81% versus 40.14%), and a lower median SAPS II score (46 versus 43). Patients with acute exacerbation asthma saw the highest 28-day mortality rate (35.29%), but patients with stable asthma had the lowest 28-day mortality rate (21.60%) when compared to that (34.42%) in patients without asthma. Consistent results were observed in Kaplan–Meier curves with a p-value for log-rank test of 0.016. After adjusting for potential confounding, compared to being without asthma, being with stable asthma was associated with a reduced risk of 28-day mortality (hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.44–0.97, p = 0.0335), but being with acute exacerbation asthma was toward an increased risk of 28-day mortality (HR 1.82, 95% 0.80–4.10, p = 0.1513). E-value analysis suggested robustness to unmeasured confounding. These findings suggest comorbid stable asthma is associated with a better prognosis in critically ill patients with severe sepsis, while acute exacerbation asthma is associated with worse prognosis.

scholarly journals Prognostic impact of elevated lactate levels on mortality in critically ill patients with and without preadmission metformin treatment: a Danish registry-based cohort study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Rene A. Posma ◽  
Trine Frøslev ◽  
Bente Jespersen ◽  
Iwan C. C. van der Horst ◽  
Daan J. Touw ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mortality Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Lower Mortality ◽  
Prognostic Impact ◽  
Icu Admission ◽  
Lactate Levels ◽  
Restricted Cubic Splines

Abstract Background Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whether the association between lactate levels around ICU admission and mortality is different in metformin users compared to metformin nonusers. Methods This cohort study included patients admitted to ICUs in northern Denmark between January 2010 and August 2017 with any circulating lactate measured around ICU admission, which was defined as 12 h before until 6 h after admission. The association between the mean of the lactate levels measured during this period and 30-day mortality was determined for metformin users and nonusers by modelling restricted cubic splines obtained from a Cox regression model. Results Of 37,293 included patients, 3183 (9%) used metformin. The median (interquartile range) lactate level was 1.8 (1.2–3.2) in metformin users and 1.6 (1.0–2.7) mmol/L in metformin nonusers. Lactate levels were strongly associated with mortality for both metformin users and nonusers. However, the association of lactate with mortality was different for metformin users, with a lower mortality rate in metformin users than in nonusers when admitted with similar lactate levels. This was observed over the whole range of lactate levels, and consequently, the relation of lactate with mortality was shifted rightwards for metformin users. Conclusion In this large observational cohort of critically ill patients, early lactate levels were strongly associated with mortality. Irrespective of the degree of hyperlactataemia, similar lactate levels were associated with a lower mortality rate in metformin users compared with metformin nonusers. Therefore, lactate levels around ICU admission should be interpreted according to metformin use.

scholarly journals Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yongfang Zhou ◽  
Steven R. Holets ◽  
Man Li ◽  
Gustavo A. Cortes-Puentes ◽  
Todd J. Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
History Of ◽  
Training Background ◽  
The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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