Evaluation of Usefulness of Mannheim Peritonitis Index and APACHE II Score in Predicting Mortality and Morbidity in Patients with Peritonitis- A Prospective Diagnostic Test Study

Introduction: Peritonitis, defined as inflammation of the peritoneal cavity can be of various causes, and is one of the most common surgical emergencies. This continues to be a challenge to diagnose and treat. Early intervention is essential to select patients who will need intensive care which brings out better outcome for the patients. This also helps us use the resources optimally. Over years, many scoring systems have been developed and studied to predict outcomes in patients with peritonitis. Aim: To evaluate the ability of Mannheim Peritonitis Index (MPI) and APACHE II (Acute Physiology And Chronic Health Evaluation II) scores in predicting mortality and morbidity in patients with peritonitis. Materials and Methods: A prospective, observational study was conducted at Christian Medical College and Hospital, Vellore, Tamil Nadu, India, for a period of two years from September 2014 to August 2016. A total of 78 patients were recruited for this study. These patients were scored with MPI and APACHE II scores. The primary outcome studied was in hospital death or discharge. The secondary outcome studied was morbidity in terms of local and systemic complications. The risk factors associated with mortality in patients with peritonitis were also studied. The best cut-off value for MPI and APACHE II from the data was calculated using Yuden index. The sensitivity, specificity and likelihood ratios were calculated and presented with 95% Confidence Interval(CI). The sub-group analysis was done for risk factors and complications. Results: There were more males than females. Age ≥48 years (p=0.002) and serum creatinine ≥1.3 g/dL (p=0.012) were found to be significant risk factors for mortality. The sensitivity and specificity of MPI ≥27 in predicting mortality was found to be 90% and 57% respectively. The sensitivity and specificity of APACHE II score ≥10 in predicting mortality was found to be 40% and 78%, respectively. MPI scores ≥27 were strongly associated with morbidity like prolonged ICU stay (p=0.004), mechanical ventilation requirement (p=0.001) and need for dialysis (p=0.035). Conclusion: Present study showed MPI to be a better predictor of mortality than APACHE II, though APACHE II showed better specificity. MPI score also was helpful in predicting morbidity such as prolonged ICU stay, mechanical ventilation requirement postoperatively and need for dialysis postoperatively. MPI was easier to use as it contained lesser variables. MPI could be of use in rural areas with no facility for laboratory investigations and blood gas analysis.

Download Full-text

Clinical Characteristics in Patients with Hospital-Acquired Pneumonia Caused by Extensively Drug-Resistant Acinetobacter baumannii, A Multicenter Retrospective Study

10.21203/rs.3.rs-116166/v1 ◽

2020 ◽

Author(s):

Yujun Li ◽

Xiaomei Huang ◽

Yuyao Wang ◽

Chuzhi Pan ◽

Zexun Mo ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Hospital Mortality ◽

Apache Ii ◽

Apache Ii Score ◽

Drug Resistant ◽

Central Venous ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired ◽

Lactamase Inhibitor

Abstract Background Extremely drug-resistant (XDR) Acinetobacter baumannii （A. baumannii）has been of a great concern. The relationship between XDR and patient outcomes remains unclear. We investigated the clinical features, risk factors, and outcomes of Hospital-acquired pneumonia (HAP)caused by XDR A. baumannii. Methods A multicenter retrospective case-control study was performed to determine factors associated with XDR A. baumannii pneumonia from 5 teaching hospitals in Guangzhou, China. Results 76 patients were enrolled in the study. XDR A. baumannii pneumonia patients were tend to be smoker (11.9% vs 3.9%, P = 0.130) and older (76.5±11.2 vs 70.3±16.4, P = 0.007) and had more comorbid diseases including chronic obstructive pulmonary disease (COPD) (48.7% vs 21.1%, P = 0.001) and renal failure (21.1% vs 3.9%, P = 0.002) and had higher APACHE II score (65.8% vs 47.4%, P = 0.033). Invasive procedures including insertion of urinary catheter, nasogastric tube, central venous/arterial catheter, bronchoscopy and mechanical ventilation along with using β-lactam/β-lactamase inhibitor and carbapenem were also risk factors for XDR A. baumannii pneumonia. Multivariate analysis showed the APACHE II score >=20 (OR, 2.1; 95% CI: 1.1–4.1, P = 0.023), COPD (OR, 9.6; 95% CI: 2.0–45.5, P = 0.004), central venous/arterial catheter placement (OR,11.5; 95% CI: 1.1-117.8, P = 0.040), low albumin levels (OR, 1.2; 95% CI: 1.1-1.4, P = 0.001) and using β-lactam/β-lactamase inhibitor (OR,15.9; 95% CI: 2.7-94.2, P = 0.002) were independent risk factors for XDR A. baumannii pneumonia. Compared with the non-XDR A. baumannii patients, the XDR A. baumannii pneumonia increased length of mechanical ventilation (11.1±12.3 vs 5.1±5.6, P = 0.000), hospital stay (42.2±24.3 vs 34.8±18.0, P = 0.036) and ICU (Intensive Care Unit) stay (27.5±19.0 vs 20.0±20.5, P = 0.020), but it did not increase in-hospital mortality (47.4% vs 32.9%, P = 0.137). Conclusions XDR A. baumannii pneumonia was strongly related to systemic illnesses, invasive procedure, low albumin levels and the APACHE II score and increasing the length of mechanical ventilation and hospital stay. But it did not increase in-hospital mortality.

Download Full-text

Risk Factors for the Development of Nosocomial Pneumonia and Its Clinical Impact in Cardiac Surgery

10.21203/rs.3.rs-882631/v1 ◽

2021 ◽

Author(s):

Ferdinand Jr Rivera Gerod ◽

Edgar Ongjoco ◽

Rod Castro ◽

Armin Masbang ◽

Elmer Casley Repotente ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Cardiac Surgery ◽

Hospital Mortality ◽

Nosocomial Pneumonia ◽

Clinical Impact ◽

Adult Patients ◽

Mortality And Morbidity ◽

Factors Associated ◽

Prolonged Icu Stay

Abstract BackgroundThe development of nosocomial pneumonia after cardiac surgery is a significant post-operative complication that may lead to increased morbidity, mortality, and hospital cost. We aimed to identify risk factors associated with it and to determine its clinical impact in terms of in-hospital mortality and morbidity.MethodsThis is a retrospective cohort study conducted among all adult patients who underwent cardiac surgery from 2014-2019 in St. Luke’s Medical Center, Quezon City, Philippines. Baseline characteristics and possible risk factors for pneumonia were retrieved from medical records. Nosocomial pneumonia was based on the Centers for Disease Control and Prevention criteria. Clinical outcomes include in-hospital mortality and morbidity. Odds ratios from logistic regression was computed to determine risk factors associated with pneumonia using STATA 15.0.ResultsOut of 373 patients included in this study, 104 (28%) patients acquired pneumonia. Most surgeries were coronary artery bypass graft (CABG) (71.58%), followed by valve repair/replacement (29.76%). Neither age, sex, BMI, diabetes, LV dysfunction, renal dysfunction, COPD/asthma, urgency of surgery, surgical time, nor smoking showed association in the development of pneumonia. However, preoperative stay of >2 days was associated with 92.3% (95%CI 18–213%) increased odds of having pneumonia (p=.009). Also, every additional hour on mechanical ventilation conferred 0.8% (95%CI, 0.3–1%) greater odds of acquiring pneumonia (p=.003).Patients who developed pneumonia had 3.9 times odds of mortality (95%CI 1.51–9.89, p=.005), 3.8 times odds of prolonged hospitalization (95%CI 1.81–7.90,p<.001), 6.4 times odds of prolonged ICU stay (95%CI 3.59–11.35,p<.001), and 9.5 times odds of postoperative reintubation (95%CI 3.01–29.76,p<.001). ConclusionAmong adult patients undergoing cardiac surgeries, prolonged preoperative hospital stay and prolonged mechanical ventilation were both associated with an increased risk for nosocomial pneumonia. Those who developed pneumonia had worse outcomes with significantly increased in-hospital mortality, prolonged hospitalization, prolonged ICU stay, and increased postoperative re-intubation. Clinicians should therefore minimize delays in surgery to avoid unnecessary exposure to pathogenic organisms. Also, timely liberation from mechanical ventilation after surgery should be encouraged.

Download Full-text

The Role of Inhaled Corticosteroids and B2 Agonist in Prevention of ARDS in High Risk Patients Admitted to ICU

QJM ◽

10.1093/qjmed/hcaa039.072 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M K Fouad ◽

M H Mohamed ◽

M A M Ammar ◽

A A A S Ahmad

Keyword(s):

Mechanical Ventilation ◽

High Risk ◽

Inhaled Corticosteroids ◽

Diffuse Alveolar Damage ◽

Secondary Outcome ◽

University Hospitals ◽

High Risk Patients ◽

Icu Stay ◽

Risk Patients ◽

Prolonged Icu Stay

Abstract Background Acute respiratory distress syndrome (ARDS) is a life threatening respiratory failure due to lung injury from a variety of precipitants. Pathologically ARDS is characterised by diffuse alveolar damage, alveolar capillary leakage, and protein rich pulmonary oedema leading to the clinical manifestation of poor lung compliance, severe hypoxaemia, and bilateral infiltrates on chest radiograph. Objective The aim of this study is to evaluate the effect of inhaled corticosteroids and B2 agonist in decreasing the incidence of ARDS in high risk patients admitted to ICU. Methodology This prospective study included 100 cases admitted to Ain Shams University hospitals for variable medical problems, and were at risk of ARDS development. There were four drug groups studied in this study according to their role in progression and prevention of ARDS in those hospitalized patients. These drug groups were group C (4ml saline), group S (salbutamol), group F (budesonide), and group M (budesonide and salbutamol). Results ARDS was less likely to develop with the use of salbutamol only or combined with budesonide inhalation in groups S and M respectively. The primary outcome was development of ARDS. The secondary outcome was mechanical ventilation and prolonged ICU stay. Six cases (24%) in each of group C and F developed ARDS, mechanical ventilation and prolonged ICU stay. Just two cases (8%) in each of groups S and M developed ARDS, mechanical ventilation and prolonged ICU stay. The difference between the 4 groups in the incidence of ARDS development was not so far, but it was clearly evident. Conclusion The use of inhaled beta 2 agonists was associated with decreased risk of ARDS, mechanical ventilation and prolonged ICU stay when adjusted for baseline characteristics, predisposing conditions and severity of illness.

Download Full-text

Clinical characteristics and prognosis in patients with urosepsis from intensive care unit in Shanghai, China: a retrospective bi-centre study

BMC Anesthesiology ◽

10.1186/s12871-021-01520-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ying Sheng ◽

Wen-long Zheng ◽

Qi-fang Shi ◽

Bing-yu Zhang ◽

Guang-yao Yang

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Mechanical Ventilation ◽

Intensive Care ◽

Predictive Value ◽

Clinical Characteristics ◽

Apache Ii ◽

Apache Ii Score ◽

Regional Medical ◽

Underlying Diseases

Abstract Background The purpose of this study was to retrospectively analyze clinical characteristics and prognostic risk factors of urosepsis patients admitted to two intensive care units in Shanghai, China. Methods Clinical data from patients diagnosed with urosepsis were retrospectively retrieved and analyzed from ICU in two regional medical centers from January 2015 to December 2019. Results Two hundred two patients were included in the subsequent analysis eventually, with an average age of 72.02 ± 9.66 years, 79.21% of the patients were female and the mortality rate of 15.84%.The proportion of patients with chronic underlying diseases such as diabetes and hypertension was relatively high (56.44, 49.50%, respectively), and the incidence of shock was also high (41.58%) correspondingly. The most common pathogen isolated was Escherichia coli (79.20%), of which the extended-spectrumβ-lactamases (ESBLs)(+) accounted for 42.57%. In multivariate analysis, the strongest predictors for death were mechanical ventilation (OR 7.260, 95% CI 2.200–23.963; P = 0.001),chronic kidney disease (CKD) (OR 5.140, 95% CI 1.596–16.550; P = 0.006), APACHE II score (OR 1.321, 95% CI 1.184–1.473; P < 0.001) and lactate (OR 1.258, 95% CI 1.037–1.527; P = 0.020). Both APACHE II score and lactate had the ideal predictive value, with the area under the ROC curve (AUC) of 0.858 and 0.805 respectively. Conclusion The patients with urosepsis were characterized by a higher proportion of female, older age, more percentage of comorbidities in this region, and patients with ESBLs (+) Escherichia coli infection were more prone to shock. Mechanical ventilation, comorbidity with CKD, APACHE II score and lactate were independent risk factors for death in urosepsis patient, but lactate level and APACHE II score had better predictive value for prognosis.

Download Full-text

Effect of ROX Index on the Ventilator Free Days in High Flow Nasal Oxygen and Early Invasive Mechanical Ventilation in Adult COVID -19 Patients

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20211126 ◽

2021 ◽

Vol 11 (11) ◽

pp. 203-207

Author(s):

Joslita Rebello ◽

Monisha B. J. Neelankavil ◽

Ananth Srikrishna Somayaji

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Clinical Outcome ◽

Invasive Mechanical Ventilation ◽

High Flow ◽

Apache Ii ◽

Secondary Outcome ◽

Duration Of Stay ◽

Icu Stay ◽

Significant Difference

Background: High flow nasal oxygen (HFNO) is used as an alternative respiratory support in hypoxemic respiratory failure in COVID -19. However the use of HFNO was associated with a lower risk of invasive mechanical ventilation and duration of stay in ICU. This study is aimed at comparing ventilator free days and duration of ICU stay between early mechanical ventilation and HFNO use in COVID -19 to predict the clinical outcome. Methods: We performed a unicentre prospective observational analytical study on subjects with respiratory failure due to COVID -19 comparing effect of ROX index on ventilator free days with use of HFNO therapy and mechanical ventilation on first day of intensive care unit admission. Each group had 20 subjects. Clinical outcome was measured in terms of ventilator free days between two groups. Standard statistical comparisons were used to compare the length of icu stay as secondary outcome. APACHE II and SOFA sores were compared and analysed between two groups. Results: 40 adult subjects critically ill due to COVID -19 were included in the study with 20 in each group. Subjects in HFNO group had higher ventilator free days than those were put on early mechanical ventilation with significant difference. Whereas the duration of icu stay was prolonged in HFNO group but there was no significant statistical difference. Conclusions: In this prospective study HFNO had better clinical outcome in terms of ventilator free days compared to early mechanical ventilation. Duration of stay in ICU had no difference. Key words: Ventilator free days, HFNO, number of days in ICU, ROX index, APACHE II, SOFA score.

Download Full-text

Clinical Characteristics in Patients With Hospital-acquired Pneumonia Caused by Extensively Drug-resistant Acinetobacter Baumannii, a Multicenter Retrospective Study

10.21203/rs.3.rs-153820/v1 ◽

2021 ◽

Author(s):

Yujun Li ◽

Xiaomei Huang ◽

Yuyao Wang ◽

Chuzhi Pan ◽

Zexun Mo ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Hospital Mortality ◽

Apache Ii ◽

Apache Ii Score ◽

Drug Resistant ◽

Central Venous ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired ◽

Lactamase Inhibitor

Abstract Background Extremely drug-resistant （XDR） Acinetobacter baumannii （A. baumannii）has been of a great concern. The relationship between XDR and patient outcomes remains unclear. We investigated the clinical features, risk factors, and outcomes of Hospital-acquired pneumonia (HAP)caused by XDR A. baumannii. Methods A multicenter retrospective case-control study was performed to determine factors associated with XDR A. baumannii pneumonia from 5 teaching hospitals in Guangzhou, China. Results 76 patients were enrolled in the study. XDR A. baumannii pneumonia patients were tend to be smoker (11.9% vs 3.9%, P = 0.130) and older (76.5±11.2 vs 70.3±16.4, P = 0.007) and had more comorbid diseases including chronic obstructive pulmonary disease (COPD) (48.7% vs 21.1%, P = 0.001) and renal failure (21.1% vs 3.9%, P = 0.002) and had higher APACHE II score (65.8% vs 47.4%, P = 0.033). Invasive procedures including insertion of urinary catheter, nasogastric tube, central venous/arterial catheter, bronchoscopy and mechanical ventilation along with using β-lactam/β-lactamase inhibitor and carbapenem were also risk factors for XDR A. baumannii pneumonia. Multivariate analysis showed the APACHE II score >=20 (OR, 2.1; 95% CI: 1.1–4.1, P = 0.023), COPD (OR, 9.6; 95% CI: 2.0–45.5, P = 0.004), central venous/arterial catheter placement (OR,11.5; 95% CI: 1.1-117.8, P = 0.040), low albumin levels (OR, 1.2; 95% CI: 1.1-1.4, P = 0.001) and using β-lactam/β-lactamase inhibitor (OR,15.9; 95% CI: 2.7-94.2, P = 0.002) were independent risk factors for XDR A. baumannii pneumonia. Compared with the non-XDR A. baumannii patients, the XDR A. baumannii pneumonia increased length of mechanical ventilation (11.1±12.3 vs 5.1±5.6, P = 0.000), hospital stay (42.2±24.3 vs 34.8±18.0, P = 0.036) and ICU (Intensive Care Unit) stay (27.5±19.0 vs 20.0±20.5, P = 0.020), but it did not increase in-hospital mortality (47.4% vs 32.9%, P = 0.137). Conclusions XDR A. baumannii pneumonia was strongly related to systemic illnesses, invasive procedure, low albumin levels and the APACHE II score and increasing the length of mechanical ventilation and hospital stay. But it did not increase in-hospital mortality.

Download Full-text

Risk factors for severity on admission and the disease progression during hospitalisation in a large cohort of patients with COVID-19 in Japan

BMJ Open ◽

10.1136/bmjopen-2020-047007 ◽

2021 ◽

Vol 11 (6) ◽

pp. e047007

Author(s):

Mari Terada ◽

Hiroshi Ohtsu ◽

Sho Saito ◽

Kayoko Hayakawa ◽

Shinya Tsuzuki ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Chronic Respiratory Disease ◽

Major Effect ◽

Secondary Outcome ◽

Healthcare Facilities ◽

Wide Range ◽

Registration Number ◽

Using Data ◽

Obesity Hypertension

ObjectivesTo investigate the risk factors contributing to severity on admission. Additionally, risk factors of worst severity and fatality were studied. Moreover, factors were compared based on three points: early severity, worst severity and fatality.DesignAn observational cohort study using data entered in a Japan nationwide COVID-19 inpatient registry, COVIREGI-JP.SettingAs of 28 September 2020, 10480 cases from 802 facilities have been registered. Participating facilities cover a wide range of hospitals where patients with COVID-19 are admitted in Japan.ParticipantsParticipants who had a positive test result on any applicable SARS-CoV-2 diagnostic tests were admitted to participating healthcare facilities. A total of 3829 cases were identified from 16 January to 31 May 2020, of which 3376 cases were included in this study.Primary and secondary outcome measuresPrimary outcome was severe or nonsevere on admission, determined by the requirement of mechanical ventilation or oxygen therapy, SpO2 or respiratory rate. Secondary outcome was the worst severity during hospitalisation, judged by the requirement of oxygen and/orinvasive mechanical ventilation/extracorporeal membrane oxygenation.ResultsRisk factors for severity on admission were older age, men, cardiovascular disease, chronic respiratory disease, diabetes, obesity and hypertension. Cerebrovascular disease, liver disease, renal disease or dialysis, solid tumour and hyperlipidaemia did not influence severity on admission; however, it influenced worst severity. Fatality rates for obesity, hypertension and hyperlipidaemia were relatively lower.ConclusionsThis study segregated the comorbidities influencing severity and death. It is possible that risk factors for severity on admission, worst severity and fatality are not consistent and may be propelled by different factors. Specifically, while hypertension, hyperlipidaemia and obesity had major effect on worst severity, their impact was mild on fatality in the Japanese population. Some studies contradict our results; therefore, detailed analyses, considering in-hospital treatments, are needed for validation.Trial registration numberUMIN000039873. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045453

Download Full-text

Augmented renal clearance: a retrospective, cohort study of urinary creatinine clearance in critically ill patients in the United Kingdom

Journal of International Medical Research ◽

10.1177/03000605211015573 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110155

Author(s):

Brian W Johnston ◽

David Perry ◽

Martyn Habgood ◽

Miland Joshi ◽

Anton Krige

Keyword(s):

Risk Factors ◽

United Kingdom ◽

Creatinine Clearance ◽

Renal Clearance ◽

Repeated Measures ◽

Apache Ii ◽

Apache Ii Score ◽

Augmented Renal Clearance ◽

Urinary Creatinine ◽

The United Kingdom

Objective Augmented renal clearance (ARC) is associated with sub-therapeutic antibiotic, anti-epileptic, and anticoagulant serum concentrations leading to adverse patient outcomes. We aimed to describe the prevalence and associated risk factors for ARC development in a large, single-centre cohort in the United Kingdom. Methods We conducted a retrospective observational study of critically unwell patients admitted to intensive care between 2014 and 2016. Urinary creatinine clearance was used to determine the ARC prevalence during the first 7 days of admission. Repeated measures logistic regression was used to determine risk factors for ARC development. Results The ARC prevalence was 47.0% (95% confidence interval [95%CI]: 44.3%–49.7%). Age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and sepsis diagnosis were significantly associated with ARC. ARC was more prevalent in younger vs. older (odds ratio [OR] 0.95 [95%CI: 0.94–0.96]), male vs. female (OR 0.32 [95%CI: 0.26–0.40]) patients with lower vs. higher APACHE II scores (OR 0.94 [95%CI: 0.92–0.96]). Conclusions This patient group probably remains unknown to many clinicians because measuring urinary creatinine clearance is not usually indicated in this group. Clinicians should be aware of the ARC risk in this group and consider measurement of urinary creatinine clearance.

Download Full-text

Patients With Perforated Peptic Ulcers: Risk Factors for Morbidity and Mortality

International Surgery ◽

10.9738/intsurg-d-15-00180.1 ◽

2019 ◽

Vol 103 (11-12) ◽

pp. 578-584

Author(s):

Fatih Ciftci ◽

Fazilet Erözgen

Keyword(s):

Risk Factors ◽

Peptic Ulcer ◽

Postoperative Period ◽

Perforated Peptic Ulcer ◽

Apache Ii ◽

Morbidity And Mortality ◽

Apache Ii Score ◽

Peptic Ulcers ◽

Presentation Time ◽

Independent Risk Factors

Perforated peptic ulcers continue to be an important problem in surgical practice. In this study, risk factors for peptic ulcer perforation-associated mortality and morbidity were evaluated. This is a retrospective study of patients surgically treated for perforated peptic ulcer over a decade (March 1999–December 2014). Patient age, sex, complaints at presentation, time lapse between onset of complaints and presentation to the hospital, physical findings, comorbidities, laboratory and imaging findings, length of hospitalization, morbidity, and mortality were recorded. The Mannheim peritonitis index (MPI) and Acute Physiology and Chronic Health Evaluation (APACHE) II score were calculated and recorded for each patient on admission to the hospital. Of the 149 patients, mean age was 50.6 ± 19 years (range: 17–86). Of these, 129 (86.5%) were males and 20 (13.4%) females. At least 1 comorbidity was found in 42 (28.1%) of the patients. Complications developed in 36 (24.1%) of the patients during the postoperative period. The most frequent complication was wound site infection. There was mortality in 26 (17.4%) patients and the most frequent cause of mortality was sepsis. Variables that were found to have statistically significant effects on morbidity included age older than 60 years, presence of comorbidities, and MPI (P = 0.029, 0.013, and 0.013, respectively). In a multivariate analysis, age older than 60 years, presence of comorbidities, and MPI were independent risk factors that affected morbidity. In the multivariate logistic regression analysis, age older than 60 years [P = 0.006, odds ratio (OR) = 5.99, confidence interval (CI) = 0.95] and comorbidities (OR = 2.73, CI = 0.95) were independent risk factors that affected morbidity. MPI and APACHE II scoring were both predictive of mortality. Age older than 60, presentation time, and MPI were independent risk factors for mortality. Undelayed diagnosis and appropriate treatment are of the utmost importance when presenting with a perforated peptic ulcer. We believe close observation of high-risk patients during the postoperative period may decrease morbidity and mortality rates.

Download Full-text

Risk factors for mortality in critically ill patients with COVID-19: a multicenter retrospective case-control study

BMC Infectious Diseases ◽

10.1186/s12879-021-06300-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jinghua Gao ◽

Li Zhong ◽

Ming Wu ◽

Jingjing Ji ◽

Zheying Liu ◽

...

Keyword(s):

Risk Factors ◽

Organ Failure ◽

Critically Ill ◽

Sofa Score ◽

Lymphocyte Count ◽

Cox Regression ◽

Survival Curve ◽

Apache Ii ◽

Apache Ii Score ◽

Hospital Death

Abstract Background Coronavirus disease 2019 (COVID-19) has spread around the world, until now, the number of positive and death cases is still increasing. Therefore, it remains important to identify risk factors for death in critically patients. Methods We collected demographic and clinical data on all severe inpatients with COVID-19. We used univariable and multivariable Cox regression methods to determine the independent risk factors related to likelihood of 28-day and 60-day survival, performing survival curve analysis. Results Of 325 patients enrolled in the study, Multi-factor Cox analysis showed increasing odds of in-hospital death associated with basic illness (hazard ratio [HR] 6.455, 95% Confidence Interval [CI] 1.658–25.139, P = 0.007), lymphopenia (HR 0.373, 95% CI 0.148–0.944, P = 0.037), higher Sequential Organ Failure Assessment (SOFA) score on admission (HR 1.171, 95% CI 1.013–1.354, P = 0.033) and being critically ill (HR 0.191, 95% CI 0.053–0.687, P = 0.011). Increasing 28-day and 60-day mortality, declining survival time and more serious inflammation and organ failure were associated with lymphocyte count < 0.8 × 109/L, SOFA score > 3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 7, PaO2/FiO2 < 200 mmHg, IL-6 > 120 pg/ml, and CRP > 52 mg/L. Conclusions Being critically ill and lymphocyte count, SOFA score, APACHE II score, PaO2/FiO2, IL-6, and CRP on admission were associated with poor prognosis in COVID-19 patients.

Download Full-text