Characteristics of Sepsis-2 septic shock patients failing to satisfy the Sepsis-3 septic shock definition: an analysis of real-time collected data

Background Baseline characteristics and disease severity of patients with septic shock according to the new Sepsis-3 definition may differ from patients that only comply with the Sepsis-2 definition. We conducted a retrospective cohort study on the ICU of a Belgian tertiary care facility to seek out differences between these two patient groups and to identify variables associated with no longer satisfying the latest definition of septic shock. Results Of 1198 patients with septic shock according to the Sepsis-2 consensus definition, 233 (19.4%) did not have septic shock according to the Sepsis-3 shock definition. These patients more often had medical admission reasons and a respiratory infection as cause for the septic shock. They less often had surgery on admission and were less likely to have chronic liver disease (5.6% vs 16.2%, absolute difference 10.6% (95% CI 6.4–14.1%). Patients with septic shock only according to the old definition had significant lower APACHE II and SOFA scores and lower hospital mortality (31.6% vs 55.3%, p < 0.001). In a multivariate analysis, following variables were associated with Sepsis-2 shock patients no longer being defined as such by the Sepsis-3 definition: respiratory infection (OR 1.485 (95% CI 1.56–2.089), p = 0.023), a medical admission reason (OR 1.977 (95% CI 1.396–2.800) and chronic liver disease (OR 0.345 (95% CI 0.181–0.660), p < 0.001). Conclusions One in five patients with septic shock according to the Sepsis-2 consensus definition is no longer considered as such when the Sepsis-3 shock criteria are applied. A medical admission reason, a respiratory infection and absence of chronic liver disease are independently associated with no longer being identified as having septic shock by the Sepsis-3 criteria.

Elevated level of urea is a good predictor for 30-day all-cause mortality in acutely admitted medical patients

Objective: To assess the correlation between urea and mortality in acutely ill medical patients admitted to hospital. Methods: We included consecutively admitted adult patients from the medical admission unit at a regional Danish hospital. Data on mortality was extracted. The association with 30-day mortality was described using cubic splines, and discriminatory power, crude association and adjusted analyses were performed. Results: We included 5,894 patients, with a 30-day mortality of 5.6%. We found a dose-response relation between urea and 30-day mortality with an increase from 2.7% to 19.5% (p<0.001). Conclusion: Elevated urea is strongly associated with 30-day all-cause mortality in acutely admitted medical patients with acceptable discrimination and good calibration.

Development and validation of automated computer aided-risk score for predicting the risk of in-hospital mortality using first electronically recorded blood test results and vital signs for COVID-19 hospital admissions: a retrospective development and validation study

ObjectivesThere are no established mortality risk equations specifically for unplanned emergency medical admissions which include patients with the novel coronavirus SARS-19 (COVID-19). We aim to develop and validate a computer-aided risk score (CARMc19) for predicting mortality risk by combining COVID-19 status, the first electronically recorded blood test results and latest version of the National Early Warning Score (NEWS2).DesignLogistic regression model development and validation study using a cohort of unplanned emergency medical admissions to hospital.SettingYork Hospital (YH) as model development dataset and Scarborough Hospital (SH) as model validation dataset.ParticipantsUnplanned adult medical admissions discharged over three months (11 March 2020 to 13 June 2020) from two hospitals (YH for model development; SH for external model validation) based on admission NEWS2 electronically recorded within ±24 hours and/or blood test results within ±96 hours of admission. We used logistic regression modelling to predict the risk of in-hospital mortality using two models: 1) CARMc19_N: age + sex + NEWS2 including subcomponents + COVID19; 2) CARMc19_NB: CARMc19_N in conjunction with seven blood test results and acute kidney injury score. Model performance was evaluated according to discrimination (c-statistic), calibration (graphically), and clinical usefulness at NEWS2 thresholds of 4+, 5+, 6+.ResultsThe risk of in-hospital mortality following emergency medical admission was similar in development and validation datasets (8.4% vs 8.2%). The c-statistics for predicting mortality for Model CARMc19_NB is better than CARMc19_N in the validation dataset (CARMc19_NB = 0.88 (95%CI 0.86 to 0.90) vs CARMc19_N = 0.86 (95%CI 0.83 to 0.88)). Both models had good internal and external calibration (CARMc19_NB: 1.01 (95%CI 0.88 vs 1.14) & CARMc19_N: 0.95 (95%CI 0.83 to 1.06)). At all NEWS2 thresholds (4+, 5+, 6+) model CARMc19_NB had better sensitivity and similar specificity.ConclusionsWe have developed a validated CARMc19 score with good performance characteristics for predicting the risk of in-hospital mortality following an emergency medical admission using the patient’s first, electronically recorded vital signs and blood tests results. Since the CARMc19 scores place no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.

Hyponatraemia as a Predictor of Mortality in Medical Admissions in Ghana: A Comparative Study

Background. Hyponatraemia is the most common electrolyte abnormality in hospital admissions. It occurs in a quarter of medical admissions in Ghana, and it is associated with high mortality. Mortality has been suggested to be due to the underlying medical condition and not necessarily the hyponatraemia. We set out to compare the outcomes of patients with documented hyponatraemia as compared to those with normonatraemia in terms of mortality and length of hospital stay. Methods. We conducted a comparative analysis of patients with hyponatraemia and those with normonatraemia on the medical ward at the Komfo Anokye Teaching Hospital between May 2018 and December 2018. The medical diagnoses, demographics, and laboratory data of the patients were recorded. Participants’ age and gender were matched. Student’s t-test was used to test for differences in continuous variables when parametric and Wilcoxon signed-rank test for nonparametric variables. Multiple logistic regression was used to identify predictors of in-hospital mortality. A p value of <0.05 was considered statistically significant. Results. Within the study period, 846 patients with documented serum sodium were included in the study. The study involved 406 patients with hyponatraemia and 440 patients with normonatraemia. Serum albumin and protein were significantly lower in the hyponatraemia patients as compared to those with normonatraemia. The mortality rate in patients with hyponatraemia was significantly higher than those with normonatraemia (129 (31.8%) vs. 9 (22.3%); OR 1.62 (95% CI: 1.19–2.22), p = 0.002 ). In-hospital stay was longer in patients with hyponatraemia than normonatraemia (7 (4–10) vs. 6 (3–10) days) but not statistically significant p = 0.09 . Multiple logistic regression showed that low serum sodium p < 0.001 and low serum albumin p = 0.009 were the predictors of in-hospital mortality. Conclusion. Hyponatraemia is associated with significantly higher mortality than normonatraemia and predicts worse prognosis in patients on medical admission. Low serum albumin is also a predictor of mortality in medical admission.

Accuracy and Completeness of Medication Histories in Patients in Medical Admission Ward at the University Teaching Hospital

Background: Quality documentation of medication histories at the time of hospitaladmission with regard to accuracy and completeness is not documented at the University Teaching Hospital (UTH), in Zambia. The aim of our study was to assess the accuracy and completeness of medication histories obtained in patients upon hospital admission. Materials and Methods: We conducted a prospective cross-sectional study at the medical admission ward, University Teaching Hospital, over a period of 3months. Our study enrolled 322 patients admitted to this ward who were above 18 years of age and were able to communicate verbally, if not, were accompanied by a caregiver. Clinical records of these patients were screened to review allmedications the patient was taking and patients/caregivers were interviewed to obtain acomplete medication history. All information obtained from patients through interviews was compared with medications recorded in the patient’s clinical records at the time of admission to the hospital. The Statistical Package for Social Sciences(SPSS) version 22 was used for all statistical calculations. Results: Of 287 clinical records, 175 (61%) incidents of inaccurate medication histories at the time of admission were identified and that medication histories in clinical records of patients were incomplete or poorly documented. Conclusion: Our study shows that 61% of medication histories in patients at the time of admission to hospitals are inaccurate. Quality documentation of medication histories in clinical records at the time of hospital admission is poor.

Hyponatraemia as a predictor of mortality in medical admissions in Ghana - A case control study

Background Hyponatraemia is the most common electrolyte abnormality in hospital admissions. It occurs in a quarter of medical admissions in Ghana and its associated with high mortality. Mortality has been suggested to be due to the underlying medical condition and not necessarily the hyponatraemia. We set out to compare the outcomes of patients with documented hyponatraemia as compared to those with normonatraemia in terms of mortality and length of hospital stay.Methods We conducted a case control study of patients with hyponatraemia as compared to those with normonatraemia on the medical ward at the Komfo Anokye Teaching hospital between May 2018 to December 2018. The medical diagnoses, demographics and laboratory data of the patients were recorded. Participants’ age and gender were matched. Student t test was used to test for differences in continuous variables when parametric and Wilcoxon Signed Rank test for non-parametric variables. Multiple logistic regression was used to identify predictors of mortality. A p value of <0.05 was considered statistically significant.Results Within the study period there were 846 patients recruited. This included 406 patients with hyponatraemia and 440 patients as controls. Serum albumin and protein were significantly lower in the hyponatraemia patients as compared to those with normal sodium concentration. The mortality rate in patients with hyponatraemia was significantly higher than those with normonatraemia 129 (31.8%) vs 98 (22.3%) [OR 1.62 (CI 1.19-2.22) p=0.002]. In-hospital stay was longer in patients with hyponatraemia than normonatraemia 7 (4-10) vs 6 (3-10) but not statistically significant (p=0.09). Multiple logistic regression showed that low serum sodium concentration (p<0.001) and low serum albumin concentration (p=0.009) were the predictors of in-hospital mortality.Conclusion Hyponatraemia is associated with significantly higher mortality than normonatraemia and predicts worse prognosis in patients on medical admission. Low serum albumin is also a predictor of mortality in medical admission.

Influence of Pre-Medicine Course GPA and National Medical Admission Test on First Year GPA Among College of Medicine Students: A Retrospective Review

Introduction: The admission criteria used by medical schools in the Philippines in selecting future doctors are the same. These include academic ability, insight into medicine, extracurricular activities and interests, personality, motivation, linguistic and communication skills, and the National Medical Admission Test (NMAT). However, the evidence for using these criteria is limited. The Adventist University of the Philippines College of Medicine (AUP-COM), determined the significant predictors of its students’ GPA in their first year in medical school. The first-year GPA of the students was associated with their success in medical schools. Methods: Utilizing the Pre-medical Board Course GPA and NMAT as factors in predicting future performance of the students in the medical field, this retrospective study utilized all students from four batches (N = 153) who were accepted in COM. 11.1% were from Batch 2019, 26% from Batch 2020, 33% from Batch 2021 and 30.1% from 2022. Majority were females (66%) and had pre-medical courses such as Medical Laboratory Science (49.7%), BS Biology (15.55%), and BS Nursing (11.1%). Statistical analysis included mean, standard deviation, percentage, correlation, and regression. Results: The NMAT of the medicine students had an average of 72.01, with a pre-medicine course GPA of 90.69 (B) and first-year GPA of 84.6% (C+). The bivariate correlation revealed significant positive relationship of NMAT and pre-medicine course grade to the GPA of the students in their first year in medical school. However, regression analysis revealed that only pre-medicine course GPA significantly predicted the first year GPA of students. Discussion: This result can be an eye-opener to medical schools on the percentage weight given to NMAT score as one of the major criteria in the selection process of future doctors. Future research may include other predictors of student performance since pre-medicine course GPA contributes only 13.2% of the variance in medicine students’ first year GPA.