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Background: The stress hyperglycemia ratio (SHR) has emerged as a potential prognostic indicator for various critical illnesses. However, its role in determining outcomes in patients with atrial fibrillation (AF) within the intensive care unit (ICU) remains unclear. This study aimed to elucidate the association between SHR and all-cause mortality in this clinical setting. Methods: We conducted a retrospective cohort study utilizing data from a large, retrospective database. Critically ill patients with documented AF were stratified based on quartiles of SHR. The primary outcome was 365-day all-cause mortality, with secondary outcomes including 90-day and 28-day mortality. COX proportional hazards models adjusted for confounders and Kaplan-Meier curve analyses were used to explore the relationship between SHR and mortality. Results: 2,679 patients with critical AF were enrolled in the final study. Among the patients studied, those in the highest SHR quartiles exhibited an increased risk of 365-day all-cause mortality (HR:1.32, 95%CI=1.06-1.65). Notably, in subgroup analyses, the prognostic value of SHR was particularly pronounced in patients with hypertension. Sensitivity analyses confirmed the persistence of these findings after excluding cohorts with malignant tumors, and heart failure. Conclusions: Our research discerns a positive association between SHR and all-cause mortality in critically ill patients with AF, highlighting the significance of acute glycemic dysregulation on patient outcomes. Longer follow-up is still needed in the future to study the association between SHR and all-cause mortality in critically ill patients with AF.

Asunto(s)

Fibrilación Atrial , Enfermedad Crítica , Hiperglucemia , Humanos , Fibrilación Atrial/mortalidad , Fibrilación Atrial/sangre , Enfermedad Crítica/mortalidad , Masculino , Femenino , Anciano , Estudios Retrospectivos , Hiperglucemia/mortalidad , Hiperglucemia/sangre , Persona de Mediana Edad , Pronóstico , Glucemia/análisis , Glucemia/metabolismo , Unidades de Cuidados Intensivos/estadística & datos numéricos , Anciano de 80 o más Años

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BACKGROUND: The role of the geriatric nutritional risk index (GNRI) as a prognostic factor in intensive care unit (ICU) patients with acute kidney injury (AKI) remains uncertain. OBJECTIVES: The aim of this study was to investigate the impact of the GNRI on mortality outcomes in critically ill patients with AKI. METHODS: For this retrospective study, we included 12,058 patients who were diagnosed with AKI based on ICD-9 codes from the eICU Collaborative Research Database. Based on the values of GNRI, nutrition-related risks were categorized into four groups: major risk (GNRI < 82), moderate risk (82 ≤ GNRI < 92), low risk (92 ≤ GNRI < 98), and no risk (GNRI ≥ 98). Multivariate analysis was used to evaluate the relationship between GNRI and outcomes. RESULTS: Patients with higher nutrition-related risk tended to be older, female, had lower blood pressure, lower body mass index, and more comorbidities. Multivariate analysis showed GNRI scores were associated with in-hospital mortality. (Major risk vs. No risk: OR, 95% CI: 1.90, 1.54-2.33, P < 0.001, P for trend < 0.001). Moreover, increased nutrition-related risk was negatively associated with the length of hospital stay (Coefficient: -0.033; P < 0.001) and the length of ICU stay (Coefficient: -0.108; P < 0.001). The association between GNRI scores and the risks of in-hospital mortality was consistent in all subgroups. CONCLUSIONS: GNRI serves as a significant nutrition assessment tool that is pivotal to predicting the prognosis of critically ill patients with AKI.

Asunto(s)

Lesión Renal Aguda , Enfermedad Crítica , Mortalidad Hospitalaria , Evaluación Nutricional , Humanos , Femenino , Lesión Renal Aguda/mortalidad , Masculino , Enfermedad Crítica/mortalidad , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Evaluación Geriátrica/métodos , Estado Nutricional , Anciano de 80 o más Años , Unidades de Cuidados Intensivos , Medición de Riesgo/métodos , Factores de Riesgo

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INTRODUCTION: The proportion of very elderly patients in the intensive care unit (ICU) is expected to rise. Furthermore, patients are likely more prone to suffer a cardiac arrest (CA) event within the ICU. The occurrence of intensive care unit cardiac arrest (ICU-CA) is associated with high mortality. To date, the incidence of ICU-CA and its clinical impact on outcome in the very old (≥ 90 years) patients treated is unknown. METHODS: Retrospective analysis of all consecutive critically ill patients ≥ 90 years admitted to the ICU of a tertiary care university hospital in Hamburg (Germany). All patients suffering ICU-CA were included and CA characteristics and functional outcome was assessed. Clinical course and outcome were assessed and compared between the subgroups of patients with and without ICU-CA. RESULTS: 1,108 critically ill patients aged ≥ 90 years were admitted during the study period. The median age was 92.3 (91.0-94.2) years and 67% (n = 747) were female. 2% (n = 25) of this cohort suffered ICU-CA after a median duration 0.5 (0.2-3.2) days of ICU admission. The presumed cause of ICU-CA was cardiac in 64% (n = 16). The median resuscitation time was 10 (2-15) minutes and the initial rhythm was shockable in 20% (n = 5). Return of spontaneous circulation (ROSC) could be achieved in 68% (n = 17). The cause of ICU admission was primarily medical in the total cohort (ICU-CA: 48% vs. No ICU-CA: 34%, p = 0.13), surgical - planned (ICU-CA: 32% vs. No ICU-CA: 37%, p = 0.61) and surgical - unplanned/emergency (ICU-CA: 43% vs. No ICU-CA: 28%, p = 0.34). The median Charlson Comorbidity Index (CCI) was 2 (1-3) points for patients with ICU-CA and 1 (0-2) for patients without ICU-CA (p = 0.54). Patients with ICU-CA had a higher disease severity according to SAPS II (ICU-CA: 54 vs. No ICU-CA: 36 points, p < 0.001). Patients with ICU-CA had a higher rate of mechanically ventilation (ICU-CA: 64% vs. No ICU-CA: 34%, p < 0.01) and required vasopressor therapy more often (ICU-CA: 88% vs. No ICU-CA: 41%, p < 0.001). The ICU and in-hospital mortality was 88% (n = 22) and 100% (n = 25) in patients with ICU-CA compared to 17% (n = 179) and 28% (n = 306) in patients without ICU-CA. The mortality rate for patients with ICU-CA was observed to be 88% (n = 22) in the ICU and 100% (n = 25) in-hospital. In contrast, patients without ICU-CA had an in-ICU mortality rate of 17% (n = 179) and an in-hospital mortality rate of 28% (n = 306) (both p < 0.001). CONCLUSION: The occurrence of ICU-CA in very elderly patients is rare but associated with high mortality. Providing CPR in this cohort did not lead to long-term survival at our centre. Very elderly patients admitted to the ICU likely benefit from supportive care only and should probably not be resuscitated due to poor chance of survival and ethical considerations. Providing personalized assurances that care will remain appropriate and in accordance with the patient's and family's wishes can optimise compassionate care while avoiding futile life-sustaining interventions.

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Reanimación Cardiopulmonar , Enfermedad Crítica , Paro Cardíaco , Unidades de Cuidados Intensivos , Humanos , Femenino , Masculino , Paro Cardíaco/terapia , Paro Cardíaco/mortalidad , Estudios Retrospectivos , Anciano de 80 o más Años , Reanimación Cardiopulmonar/métodos , Enfermedad Crítica/terapia , Enfermedad Crítica/mortalidad , Alemania/epidemiología , Mortalidad Hospitalaria/tendencias , Incidencia

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BACKGROUND: Too high or too low patient volumes and work amounts may overwhelm health care professionals and obstruct processes or lead to inadequate personnel routine and process flow. We sought to evaluate, whether an association between current caseload, current workload, and outcomes exists in intensive care units (ICU). METHODS: Retrospective cohort analysis of data from an Austrian ICU registry. Data on patients aged ≥ 18 years admitted to 144 Austrian ICUs between 2013 and 2022 were included. A Cox proportional hazards model with ICU mortality as the outcome of interest adjusted with patients' respective SAPS 3, current ICU caseload (measured by ICU occupancy rates), and current ICU workload (measured by median TISS-28 per ICU) as time-dependent covariables was constructed. Subgroup analyses were performed for types of ICUs, hospital care level, and pre-COVID or intra-COVID period. RESULTS: 415 584 patient admissions to 144 ICUs were analysed. Compared to ICU caseloads of 76 to 100%, there was no significant relationship between overuse of ICU capacity and risk of death [HR (95% CI) 1.06 (0.99-1.15), p = 0.110 for > 100%], but for lower utilisation [1.09 (1.02-1.16), p = 0.008 for ≤ 50% and 1.10 (1.05-1.15), p < 0.0001 for 51-75%]. Exceptions were significant associations for caseloads > 100% between 2020 and 2022 [1.18 (1.06-1.30), p = 0.001], i.e., the intra-COVID period. Compared to the reference category of median TISS-28 21-30, lower [0.88 (0.78-0.99), p = 0.049 for ≤ 20], but not higher workloads were significantly associated with risk of death. High workload may be associated with higher mortality in local hospitals [1.09 (1.01-1.19), p = 0.035 for 31-40, 1.28 (1.02-1.60), p = 0.033 for > 40]. CONCLUSIONS: In a system with comparably high intensive care resources and mandatory staffing levels, patients' survival chances are generally not affected by high intensive care unit caseload and workload. However, extraordinary circumstances, such as the COVID-19 pandemic, may lead to higher risk of death, if planned capacities are exceeded. High workload in ICUs in smaller hospitals with lower staffing levels may be associated with increased risk of death.

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COVID-19 , Enfermedad Crítica , Unidades de Cuidados Intensivos , Sistema de Registros , Carga de Trabajo , Humanos , Carga de Trabajo/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Unidades de Cuidados Intensivos/organización & administración , Masculino , Femenino , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Austria/epidemiología , Enfermedad Crítica/terapia , Enfermedad Crítica/epidemiología , Enfermedad Crítica/mortalidad , COVID-19/epidemiología , COVID-19/mortalidad , COVID-19/terapia , Estudios de Cohortes , Mortalidad Hospitalaria/tendencias , Adulto

RESUMEN

Pediatric patients with multiple organ failures in the pediatric intensive care unit (PICU) are at a higher risk of mortality. Assessing the mortality risk when patients are admitted to PICU is important to allocate treatment and care properly. The aim of this study was to compare the performance of the PRISM IV score within the first 24 and 72 hours to predict mortality in the PICU. Demographic, clinical, and laboratory data were collected to compute the PRISM IV in the first 24 and 72 hours among critically ill pediatric patients in the PICU at H. Adam Malik General Hospital, Medan, Indonesia, from April 2021 to February 2022. The comparison of the PRISM IV scores and its components within the first 24 and 72 hours was analyzed using the Wilcoxon test, Student's independent t-test or McNemar test. The role of PRISM IV score in predicting mortality was assessed using the receiver operating characteristic (ROC) curve. Out of 35 pediatric patients, 17 (48.6%) of them died. Platelet count (p=0.022), pCO2 (p=0.026), HCO3 (p=0.009), total CO2 (p=0.015), and base excess (p=0.001) were statistically different between 24 and 72 hours groups. The area under curve (AUC) for the first 24 hours using PRISM IV scores was 47.4% with p=0.792 (95%CI, 27.7%-67.1%). Meanwhile, the AUC of 72 hours group was 65.4%, p=0.121 (95%CI, 47.1%-83.6%). This study suggested that PRISM IV scores in the first 24 and 72 hours may not be a reliable screening tool for predicting mortality. However, further studies are suggested to validate these findings.

Asunto(s)

Enfermedad Crítica , Unidades de Cuidado Intensivo Pediátrico , Humanos , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Enfermedad Crítica/mortalidad , Masculino , Femenino , Preescolar , Niño , Indonesia/epidemiología , Lactante , Medición de Riesgo , Curva ROC , Mortalidad Hospitalaria , Factores de Tiempo , Hospitalización/estadística & datos numéricos , Índice de Severidad de la Enfermedad

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BACKGROUND: Mechanical ventilation (MV) is vital for critically ill ICU patients but carries significant mortality risks. This study aims to develop a predictive model to estimate hospital mortality among MV patients, utilizing comprehensive health data to assist ICU physicians with early-stage alerts. METHODS: We developed a Machine Learning (ML) framework to predict hospital mortality in ICU patients receiving MV. Using the MIMIC-III database, we identified 25,202 eligible patients through ICD-9 codes. We employed backward elimination and the Lasso method, selecting 32 features based on clinical insights and literature. Data preprocessing included eliminating columns with over 90% missing data and using mean imputation for the remaining missing values. To address class imbalance, we used the Synthetic Minority Over-sampling Technique (SMOTE). We evaluated several ML models, including CatBoost, XGBoost, Decision Tree, Random Forest, Support Vector Machine (SVM), K-Nearest Neighbors (KNN), and Logistic Regression, using a 70/30 train-test split. The CatBoost model was chosen for its superior performance in terms of accuracy, precision, recall, F1-score, AUROC metrics, and calibration plots. RESULTS: The study involved a cohort of 25,202 patients on MV. The CatBoost model attained an AUROC of 0.862, an increase from an initial AUROC of 0.821, which was the best reported in the literature. It also demonstrated an accuracy of 0.789, an F1-score of 0.747, and better calibration, outperforming other models. These improvements are due to systematic feature selection and the robust gradient boosting architecture of CatBoost. CONCLUSION: The preprocessing methodology significantly reduced the number of relevant features, simplifying computational processes, and identified critical features previously overlooked. Integrating these features and tuning the parameters, our model demonstrated strong generalization to unseen data. This highlights the potential of ML as a crucial tool in ICUs, enhancing resource allocation and providing more personalized interventions for MV patients.

Asunto(s)

Mortalidad Hospitalaria , Unidades de Cuidados Intensivos , Aprendizaje Automático , Respiración Artificial , Humanos , Respiración Artificial/mortalidad , Masculino , Femenino , Persona de Mediana Edad , Anciano , Máquina de Vectores de Soporte , Enfermedad Crítica/mortalidad , Bases de Datos Factuales

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BACKGROUND: Critically ill patients in the intensive care unit (ICU) often experience dysglycaemia. However, studies investigating the link between acute kidney injury (AKI) and dysglycaemia, especially in those with and without diabetes mellitus (DM), are limited. METHODS: We used the Medical Information Mart for Intensive Care IV database to investigate the association between AKI within 7 days of admission and subsequent dysglycaemia. The primary outcome was the occurrence of dysglycaemia (both hypoglycemia and hyperglycemia) after 7 days of ICU admission. Logistic regression analyzed the relationship between AKI and dysglycaemia, while a Cox proportional hazards model estimated the long-term mortality risk linked to the AKI combined with dysglycaemia. RESULTS: A cohort of 20,008 critically ill patients were included. The AKI group demonstrated a higher prevalence of dysglycaemia, compared to the non-AKI group. AKI patients had an increased risk of dysglycaemia (adjusted odds ratio [aOR] 1.53, 95% confidence interval [CI] 1.41-1.65), hypoglycemia (aOR 1.56, 95% CI 1.41-1.73), and hyperglycemia (aOR 1.53, 95% CI 1.41-1.66). In subgroup analysis, compared to DM patients, AKI showed higher risk of dysglycaemia in non-DM patients (aOR: 1.93 vs. 1.33, Pint<0.01). Additionally, the AKI with dysglycaemia group exhibited a higher risk of long-term mortality compared to the non-AKI without dysglycaemia group. Dysglycaemia also mediated the relationship between AKI and long-term mortality. CONCLUSION: AKI was associated with a higher risk of dysglycaemia, especially in non-DM patients, and the combination of AKI and dysglycaemia was linked to higher long-term mortality. Further research is needed to develop optimal glycemic control strategies for AKI patients.

Asunto(s)

Lesión Renal Aguda , Enfermedad Crítica , Hiperglucemia , Hipoglucemia , Unidades de Cuidados Intensivos , Humanos , Lesión Renal Aguda/sangre , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/etiología , Lesión Renal Aguda/epidemiología , Masculino , Estudios Retrospectivos , Femenino , Enfermedad Crítica/mortalidad , Persona de Mediana Edad , Anciano , Hiperglucemia/complicaciones , Hiperglucemia/sangre , Hiperglucemia/epidemiología , Hipoglucemia/complicaciones , Hipoglucemia/sangre , Hipoglucemia/epidemiología , Hipoglucemia/mortalidad , Unidades de Cuidados Intensivos/estadística & datos numéricos , Diabetes Mellitus/epidemiología , Factores de Riesgo , Modelos Logísticos , Modelos de Riesgos Proporcionales , Glucemia/análisis , Prevalencia

RESUMEN

SOURCE CITATION: Dulhunty JM, Brett SJ, De Waele JJ, et al; BLING III Study Investigators. Continuous vs intermittent ß-lactam antibiotic infusions in critically ill patients with sepsis: the BLING III randomized clinical trial. JAMA. 12 June 2024. [Epub ahead of print.] 38864155.

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Antibacterianos , Sepsis , beta-Lactamas , Humanos , Sepsis/tratamiento farmacológico , Sepsis/mortalidad , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , beta-Lactamas/administración & dosificación , beta-Lactamas/uso terapéutico , Infusiones Intravenosas , Enfermedad Crítica/mortalidad , Esquema de Medicación , Persona de Mediana Edad , Masculino , Antibióticos Betalactámicos

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This study delves into the correlation between the triglyceride glucose-body mass index (TyG-BMI) index upon hospital admission and clinical outcomes among this patient population. We investigated the association between TyG-BMI at hospital admission and clinical outcomes in this patient group, and analyzed data from the Medical Information Mart for Intensive Care IV database, identifying acute pancreatitis (AP) patients admitted to ICUs and stratifying them by TyG-BMI quartiles. We assessed the relationship between TyG-BMI and mortality (both in-hospital and ICU) using Cox proportional hazards regression and restricted cubic splines. The cohort included 419 patients, average age 56.34 ± 16.62 years, with a majority being male (61.58%). Hospital and ICU mortality rates were 11.93% and 7.16%, respectively. Higher TyG-BMI was positively correlated with increased all-cause mortality. Patients in the highest TyG-BMI quartile had significantly greater risks of in-hospital and ICU mortality. An S-shaped curve in the spline analysis indicated a threshold effect at a TyG-BMI of 243 for increased in-hospital mortality risk. TyG-BMI is a reliable predictor of both in-hospital and ICU mortality in severely ill AP patients, suggesting its utility in enhancing risk assessment and guiding clinical interventions for this vulnerable population.

Asunto(s)

Glucemia , Índice de Masa Corporal , Enfermedad Crítica , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos , Pancreatitis , Triglicéridos , Humanos , Masculino , Femenino , Pancreatitis/mortalidad , Pancreatitis/sangre , Persona de Mediana Edad , Enfermedad Crítica/mortalidad , Triglicéridos/sangre , Anciano , Glucemia/análisis , Glucemia/metabolismo , Adulto , Modelos de Riesgos Proporcionales

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Sepsis and hypertension pose significant health risks, yet the optimal mean arterial pressure (MAP) target for resuscitation remains uncertain. This study investigates the association between average MAP (a-MAP) within the initial 24 h of intensive care unit admission and clinical outcomes in patients with sepsis and primary hypertension using the Medical Information Mart for Intensive Care (MIMIC) IV database. Multivariable Cox regression assessed the association between a-MAP and 30-day mortality. Kaplan-Meier and log-rank analyses constructed survival curves, while restricted cubic splines (RCS) illustrated the nonlinear relationship between a-MAP and 30-day mortality. Subgroup analyses ensured robustness. The study involved 8,810 patients. Adjusted hazard ratios for 30-day mortality in the T1 group (< 73 mmHg) and T3 group (≥ 80 mmHg) compared to the T2 group (73-80 mmHg) were 1.25 (95% CI 1.09-1.43, P = 0.001) and 1.44 (95% CI 1.25-1.66, P < 0.001), respectively. RCS revealed a U-shaped relationship (non-linearity: P < 0.001). Kaplan-Meier curves demonstrated significant differences (P < 0.0001). Subgroup analysis showed no significant interactions. Maintaining an a-MAP of 73 to 80 mmHg may be associated with a reduction in 30-day mortality. Further validation through prospective randomized controlled trials is warranted.

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Presión Arterial , Enfermedad Crítica , Hipertensión , Sepsis , Humanos , Masculino , Femenino , Hipertensión/mortalidad , Hipertensión/fisiopatología , Hipertensión/complicaciones , Enfermedad Crítica/mortalidad , Sepsis/mortalidad , Sepsis/fisiopatología , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Unidades de Cuidados Intensivos , Estimación de Kaplan-Meier

RESUMEN

This study was conducted to identify the characteristics and risk factors for early death in critically ill acute promyelocytic leukaemia (APL) patients in the Hemato-oncology ICU (HICU). A total of 44 APL patients from 2017 to 2023 were included. The mortality among APL patients in the HICU was high (27/44, 61.36%). Compared with patients who survived, nonsurvivors had a longer prothrombin time (P = 0.002), lower fibrinogen (P = 0.022), higher white blood cell count (P = 0.004) and higher creatinine (P = 0.037) on hosipital admission. Severe bleeding was the most frequent complication (34 cases, 77.27%), which occurred either preinduction or on Day 5 (IQR 3-7.5 days) of induction. Cerebral bleeding associated with consciousness disturbance was the main reason for HICU admission (18 cases, 40.9%). The leading cause of death was fatal haemorrhage (18/34, 52.94%), which occurred either preinduction or on Day 4 (IQR 3-7 days) of induction. Another common cause of death was sepsis (8/18, 44.44%), which occurred on Day 12 (IQR 9.5-24.75 days) during induction. In conclusion, the main cause of death in APL patients treated in the HICU was primary being attributed to fatal bleeding, followed by sepsis.

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Enfermedad Crítica , Unidades de Cuidados Intensivos , Leucemia Promielocítica Aguda , Humanos , Leucemia Promielocítica Aguda/mortalidad , Leucemia Promielocítica Aguda/complicaciones , Femenino , Masculino , Enfermedad Crítica/mortalidad , Persona de Mediana Edad , Adulto , Factores de Riesgo , Anciano , Hemorragia/mortalidad , Mortalidad Hospitalaria , Estudios Retrospectivos , Sepsis/mortalidad , Sepsis/complicaciones

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Hypophosphatemia (serum phosphate < 2.5 mg/dL) is a major concern when initiating nutritional support. We evaluated which factors contribute to hypophosphatemia development in critically ill patients, as well as the association between hypophosphatemia and mortality. A retrospective cohort study of patients who were ventilated for at least 2 days in a 16-bed mixed ICU. Data collected includes demographics, Acute Physiology & Chronic Health Evaluation 2 (APACHE2) admission score, Sequential Organ Failure Assessment score at 24 h (SOFA24), hourly energy delivery, plasma phosphate levels during the first 2 weeks of admission, ICU length of stay (LOS), length of ventilation (LOV), and mortality (ICU and 90 days). For the hypophosphatemia development model, we considered mortality as a competing risk. For mortality analysis, we used the Cox proportional hazards model considering hypophosphatemia development as a time-varying covariate. 462 patients were used in the analysis. 59.52% of the patients developed hypophosphatemia. Several factors were associated with a decreased risk of hypophosphatemia: age, BMI, pre-admission diabetes diagnosis, APACHE2, SOFA24, first kidney SOFA score, hospital admission time before ICU admission, and admission after liver transplantation. Admission due to trauma was associated with an increased risk of hypophosphatemia. Survival analysis with hypophosphatemia as a time-varying covariate showed a protective effect of hypophosphatemia from mortality (HR 0.447, 95% CI 0.281, 0.712). Age, APACHE2, and SOFA24 score were found to be significantly associated with ICU mortality. Fasting duration in the ICU before nutritional support initiation was not found to be significantly associated with hypophosphatemia. We examined several fasting intervals (12 h, 24 h, 36 h, 48 h, 60 h, 72 h). In each fast interval, we compared the prevalence of hypophosphatemia among patients who fasted the specified length of time, with those who did not fast for the same length of time. In each fasting interval, hypophosphatemia prevalence was lower in the fasting group compared to the non-fasting group. However, this difference was insignificant. BMI, APACHE2, and hospital LOS before ICU admission were inversely associated with hypophosphatemia development. Fasting for up to 72 h in the ICU before starting nutritional support did not affect hypophosphatemia occurrence. Hypophosphatemia was associated with lower mortality.

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Enfermedad Crítica , Hipofosfatemia , Unidades de Cuidados Intensivos , Respiración Artificial , Humanos , Hipofosfatemia/epidemiología , Hipofosfatemia/etiología , Enfermedad Crítica/mortalidad , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Factores de Riesgo , APACHE , Tiempo de Internación , Modelos de Riesgos Proporcionales , Mortalidad Hospitalaria

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Elevated serum corin concentrations in patients with cardiac diseases have been associated with adverse cardiovascular events and progressive renal dysfunction. This study aimed to determine the role of serum corin levels in predicting the incidence of acute kidney injury (AKI) and mortality in critically ill patients admitted to intensive care units (ICUs). We screened 323 patients admitted to the ICU in our institution from May 2018 through December 2019. After excluding patients receiving renal replacement therapy, 288 subjects were enrolled. Cases were divided equally into high (n = 144) and low (n = 144) corin groups according to median serum corin levels, using 910 pg/mL as the cut-off point. Patient characteristics and comorbidities were collected from medical records. The primary outcome was AKI within 48 h after ICU admission, while the secondary outcome was all-cause of mortality within 1 year. Compared with the low corin group, patients in the high corin group had higher prevalence rates of diabetes, cirrhosis, and nephrotoxic agent exposure; higher Sequential Organ Failure Assessment scores, white blood cell counts, proteinuria, and serum N-terminal pro-brain natriuretic peptide levels; but had lower initial estimated glomerular filtration rates. Furthermore, elevated serum corin was associated with higher risks of AKI within 48h of ICU admission (43.1% vs. 18.1%, p < 0.001) and all-cause mortality within one year (63.9% vs. 50.0%, p = 0.024). High corin level showed strongly positive results as an independent predictor of AKI (OR 2.15, 95% CI 1.11-4.19, p = 0.024) but not for the all-cause mortality after adjusting for confounding factors in multivariate analyses. Elevated circulating corin predicted AKI in critically ill patients, but did not predict all-cause mortality within 1 year. As a key enzyme in renin-angiotensin-aldosterone system, corin expression may be regulated through a feedback loop following natriuretic peptide resistance and desensitization of natriuretic peptide receptors in different critically ill status.

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Lesión Renal Aguda , Enfermedad Crítica , Unidades de Cuidados Intensivos , Humanos , Masculino , Lesión Renal Aguda/sangre , Lesión Renal Aguda/mortalidad , Femenino , Enfermedad Crítica/mortalidad , Anciano , Persona de Mediana Edad , Serina Endopeptidasas/sangre , Biomarcadores/sangre , Factores de Riesgo , Pronóstico

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INTRODUCTION: Sepsis is a life-threatening condition that poses a globally high mortality rate. Identifying risk factors is crucial. Insulin resistance and the TYG index, associated with metabolic disorders, may play a role. This study explores their correlation with mortality in non-diabetic septic patients. METHODS: This retrospective cohort study used data from the MIMIC-IV (version 2.1) database, which includes over 50,000 ICU admissions from 2008 to 2019 at Beth Israel Deaconess Medical Center in Boston. We included adult patients with sepsis who were admitted to the intensive care unit in the study. The primary outcome was to evaluate the ability of TYG to predict death at 28-day of hospital admission in patients with sepsis. RESULTS: The study included 2213 patients with sepsis, among whom 549 (24.8%) died within 28 days of hospital admission. We observed a non-linear association between TYG and the risk of mortality. Compared to the reference group (lower TYG subgroup), the 28-day mortality increased in the higher TYG subgroup, with a fully adjusted hazard ratio of 2.68 (95% CI: 2.14 to 3.36). The area under the curve (AUC) for TYG was 67.7%, higher than for triglycerides alone (AUC = 64.1%), blood glucose (AUC = 62.4%), and GCS (AUC = 63.6%), and comparable to SOFA (AUC = 69.3%). The final subgroup analysis showed no significant interaction between TYG and each subgroup except for the COPD subgroup (interaction P-values: 0.076-0.548). CONCLUSION: In our study, TYG can be used as an independent predictor for all-cause mortality due to sepsis within 28 days of hospitalization.

Asunto(s)

Glucemia , Enfermedad Crítica , Unidades de Cuidados Intensivos , Sepsis , Triglicéridos , Humanos , Sepsis/mortalidad , Sepsis/sangre , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Enfermedad Crítica/mortalidad , Anciano , Triglicéridos/sangre , Glucemia/análisis , Unidades de Cuidados Intensivos/estadística & datos numéricos , Factores de Riesgo , Anciano de 80 o más Años , Mortalidad Hospitalaria

RESUMEN

Importance: The effectiveness of daily sedation interruption (DSI, defined as temporary interruption of sedation) has yet to be demonstrated in critically ill pediatric patients. Objective: To compare the clinical outcomes of DSI vs continuous intravenous (IV) sedation in patients receiving invasive mechanical ventilation (MV) support in the pediatric intensive care unit (PICU). Data Sources: A systematic search for studies was conducted using predefined keywords and Medical Subject Headings in 5 major databases (PubMed, Embase, Web of Science, CINAHL [Cumulated Index to Nursing and Allied Health Literature], and Cochrane Central Register of Controlled Trials) from database inception to October 31, 2023. Study Selection: Retrospective and prospective observational studies, randomized clinical trials (RCTs), and systematic reviews were assessed for inclusion. Studies were eligible if they compared DSI to continuous IV sedation in patients aged 18 years or younger requiring MV in the PICU. Data Extraction and Synthesis: Study characteristics, including the types of sedation, sedation protocols, and clinical outcomes, were extracted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline was followed. A random-effects model was used to pool results from articles for the meta-analysis. Main Outcomes and Measures: The primary outcomes of interest were duration of MV and length of PICU stay. Secondary outcomes included total sedative dose requirement, adverse events (eg, complications associated with MV, withdrawal, and delirium), and mortality. Results: A total of 6 RCTs with 2810 pediatric patients (1569 males [55.8%]; mean age, 26.5 [95% CI, 15.0-37.9] months) were included in the final analysis; patients had a mean PRISM (Pediatric Risk of Mortality) score of 13.68 (95% CI, 10.75-16.61). Compared with continuous IV sedation, DSI was associated with a reduction in length of PICU stay (5 studies, n = 2770; mean difference [MD], -1.45 [95% CI, -2.75 to -0.15] days; P = .03]. There was no difference in MV duration (5 studies, n = 2750; MD, -0.93 [95% CI, -1.89 to 0.04] days; P = .06), total doses of midazolam (3 studies, n = 191; MD, -1.66 [95% CI, -3.95 to 0.63] mg/kg) and morphine used (2 studies, n = 189; MD, -2.63 [95% CI, -7.01 to 1.75] mg/kg), or adverse events (risk ratio [RR], 1.03 [95% CI, 0.74-1.42]; P = .88). There was no difference in mortality between patients exposed vs not exposed to DSI (RR, 0.89 [95% CI, 0.55-1.46]; P = .65). Conclusions and Relevance: This systematic review and meta-analysis found that use of DSI in pediatric patients was associated with reduced length of PICU stay with no increase in adverse events. Further research is needed to ascertain whether this strategy is associated with improved neurodevelopmental outcomes in PICU survivors.

Asunto(s)

Hipnóticos y Sedantes , Respiración Artificial , Humanos , Respiración Artificial/métodos , Niño , Hipnóticos y Sedantes/administración & dosificación , Unidades de Cuidado Intensivo Pediátrico , Enfermedad Crítica/terapia , Enfermedad Crítica/mortalidad , Preescolar , Lactante , Tiempo de Internación/estadística & datos numéricos , Adolescente , Sedación Consciente/métodos , Masculino

RESUMEN

OBJECTIVE:  To determine the accuracy and reliability of the sequential organ failure assessment (SOFA) score in predicting the risk of mortality in ICU-admitted COVID-19 patients. STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: COVID Intensive Care Unit (ICU), The Aga Khan University Hospital, Karachi, from January to June 2022. METHODOLOGY: A total of 62 patients with a positive RT-PCR for COVID-19, admitted into the intensive care unit (ICU), were included in this descriptive cross-sectional study. Written informed consent was obtained after explaining the risks and benefits of the study to the patients / next of kin. SOFA score at the time of admission and 48 hours after admission was calculated. The outcome variable, i.e., mortality, was assessed in association with the SOFA score.  Results: The study had a predominantly male population of 54.8% (n = 34). The SOFA score >7 at admission and 48 hours after admission was observed in 46.8% (n = 29) patients. Among 62 COVID-19 patients, the majority were found to have a severe nature of the disease, i.e., 69.4% (n = 43), followed by moderate / mild cases 30.6% (n = 19). Depending on the requirement of the patient, 74.2% (n = 46) were invasively ventilated while 77.4% (n = 48) were on non-invasive ventilation. Overall the mortality rate of the present study was 43.5% (n = 27). The scores both at the time of admission and 48 hours after admission for the survivors had a significant difference (p = 0.001) with the non-survivors. CONCLUSION:  The SOFA score on admission and 48 hours after had a significant positive association with the severity of COVID-19 infection and its risk of mortality. KEY WORDS: COVID-19, Mortality prediction, SOFA score.

Asunto(s)

COVID-19 , Enfermedad Crítica , Unidades de Cuidados Intensivos , Puntuaciones en la Disfunción de Órganos , SARS-CoV-2 , Humanos , COVID-19/mortalidad , Masculino , Femenino , Persona de Mediana Edad , Estudios Transversales , Enfermedad Crítica/mortalidad , Unidades de Cuidados Intensivos/estadística & datos numéricos , Pakistán/epidemiología , Adulto , Mortalidad Hospitalaria , Anciano , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Pronóstico

RESUMEN

This study aimed to investigate the association between glucocorticoid administration and outcomes in critically ill patients with ARDS using the Medical Information Mart for Intensive Care (MIMIC)-III database. Data were collected from the MIMIC-III database, which consists of critically ill participants between 2001 and 2012 in the USA. A total of 1831 adult critically ill patients with ARDS were enrolled from the MIMIC-III database. The 60-day and in-hospital mortality, were the primary endpoints. Secondary outcomes included length of stay (LOS) in the hospital and intensive care unit (ICU), 28-day ventilator-free days, ICU mortality, and 28-day mortality. A total of 1831 patients were included in the data analysis. After propensity score (PS) matching, 464 patients diagnosed with ARDS were matched between the glucocorticoid treatment and control groups. Glucocorticoids were associated with increased in-hospital mortality [hazard ratio (HR) 1.32; 95% CI 1.01-1.71; P = .039], longer ICU stay [HR 2.25; 95% CI 0.84-3.65; P = .002], and shorter ventilation-free days at 28 days in all ARDS patients [HR -2.70; 95% CI -4.28--1.13; P = .001]. The 60-day mortality was higher in the glucocorticoid group (44.83% vs 35.34%; P = .154; HR 1.24; 95% CI 0.93-1.66). Excluding the impact of the glucocorticoid initiation time, from day 15 to day 60, mortality was significantly higher in the glucocorticoid group compared to the non-glucocorticoid group (27.16% vs 12.70%; P < .001; HR 1.75; 95% CI 1.32-2.32). Glucocorticoid administration was associated with worse 60-day and in-hospital survival, longer ICU stay, and shorter ventilator-free days on day 28 in patients with ARDS. Our findings suggest careful consideration of glucocorticoids for ARDS.

Asunto(s)

Glucocorticoides , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos , Tiempo de Internación , Puntaje de Propensión , Síndrome de Dificultad Respiratoria , Humanos , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Masculino , Femenino , Síndrome de Dificultad Respiratoria/mortalidad , Síndrome de Dificultad Respiratoria/tratamiento farmacológico , Persona de Mediana Edad , Tiempo de Internación/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Anciano , Bases de Datos Factuales , Enfermedad Crítica/mortalidad , Adulto , Respiración Artificial/estadística & datos numéricos , Estados Unidos/epidemiología

RESUMEN

Hemodynamic management is crucial in patients with acute pancreatitis. Central venous pressure (CVP) is widely used to assess volume status. Our aim was to determine the optimal time window for obtaining CVP measurements to prevent adverse outcomes in patients. This study utilized data from the Medical Information Mart for Intensive Care (MIMIC) IV database. The primary outcome under investigation was the 28-day mortality, while secondary outcomes included 90-day mortality and 1-year mortality. To categorize the study population, a CVP waiting time of 12 hours was employed as the grouping criterion, followed by the utilization of Cox regression analysis to compare the outcomes between the 2 groups. Our study included a total of 233 patients, among whom 154 cases (66.1%) underwent CVP measurements within 12 hours after admission to the Intensive Care Unit (ICU). Univariate and multivariate Cox regression analyses revealed a significantly increased risk of 28-day mortality in patients from the delayed CVP monitoring group compared to those who underwent early CVP measurements (HR = 2.87; 95% CI: 1.35-6.13; P = .006). Additionally, consistent results were observed for the risks of 90-day mortality (HR = 1.91; 95% CI: 1.09-3.35; P = .023) and 1-year mortality (HR = 1.84; 95% CI: 1.09-3.10; P = .023). In the ICU, an extended waiting time for CVP measurements in patients with acute pancreatitis was associated with an increased risk of 28-day mortality.

Asunto(s)

Presión Venosa Central , Pancreatitis , Humanos , Masculino , Femenino , Persona de Mediana Edad , Pancreatitis/mortalidad , Pancreatitis/fisiopatología , Presión Venosa Central/fisiología , Estudios Retrospectivos , Factores de Tiempo , Adulto , Anciano , Enfermedad Crítica/mortalidad , Unidades de Cuidados Intensivos/estadística & datos numéricos , Modelos de Riesgos Proporcionales

RESUMEN

BACKGROUND: Pediatric oncology patients have increased risk for critical illness; outcomes are well described in high-income countries (HICs); however, data is limited for low- and middle-income countries (LMICs). METHODS: We systematically searched PubMed, EMBASE, Web of Science, CINAHL and Global Health databases for articles in 6 languages describing mortality in children with cancer admitted to intensive care units (ICUs) in LMICs. Two investigators independently assessed eligibility, data quality, and extracted data. We pooled ICU mortality estimates using random effect models. RESULTS: Of 3641 studies identified, 22 studies were included, covering 4803 ICU admissions. Overall pooled mortality was 30.3 % [95 % Confidence-interval (CI) 21.7-40.6 %]. Mechanical ventilation [odds ratio (OR) 12.2, 95 %CI:6.2-24.0, p-value<0.001] and vasoactive infusions [OR 6.3 95 %CI:3.3-11.9, p-value<0.001] were associated with ICU mortality. CONCLUSIONS: ICU mortality among pediatric oncology patients in LMICs is similar to that in HICs, however, this review likely underestimates true mortality due to underrepresentation of studies from low-income countries.

Asunto(s)

Enfermedad Crítica , Países en Desarrollo , Neoplasias , Humanos , Enfermedad Crítica/mortalidad , Niño , Neoplasias/mortalidad , Neoplasias/terapia , Neoplasias/epidemiología , Países en Desarrollo/estadística & datos numéricos , Costo de Enfermedad , Unidades de Cuidados Intensivos/estadística & datos numéricos

RESUMEN

BACKGROUND: To further identify the association of the triglyceride-glucose (TyG) index with the risk of mortality among critically ill patients admitted to the intensive care unit (ICU). METHODS: The PubMed, Web of Science, and EMBASE databases were searched for relevant studies up to February 2, 2024. The primary outcomes were in-hospital mortality and ICU mortality. The secondary outcomes were 30-day mortality, 90-day mortality, and 1-year mortality. The hazard ratios (HRs) with 95% confidence intervals (CIs) were combined to evaluate the associations between the TyG index and the above endpoints. All the statistical analyses were performed with STATA 15.0 software. RESULTS: Ten studies involving 22,694 patients were included. The pooled results demonstrated that an elevated TyG index indicated an increased risk of in-hospital mortality (HR = 1.76, 95% CI: 1.41-2.18, P < .001), ICU mortality (HR = 1.52, 95% CI: 1.33-1.74, P < .001), 30-day mortality (HR = 1.50, 95% CI: 1.02-2.19, P = .037), 90-day mortality (HR = 1.42, 95% CI: 1.01-2.00, P = .043), and 1-year mortality (HR = 1.19, 95% CI: 1.11-1.28, P < .001). Subgroup analysis for in-hospital mortality and ICU mortality based on sex, age, body mass index and hypertension showed similar results. However, subgroup analysis stratified by diabetes mellitus (DM) revealed that the associations of the TyG index with in-hospital mortality (HR = 2.21, 95% CI: 1.30-3.78, P = .004) and ICU mortality (HR = 1.93, 95% CI: 0.95-3.94, P = .070) were observed only among patients without DM. CONCLUSION: The TyG index was significantly associated with mortality among critically ill patients without DM, and an elevated TyG index predicted an increased risk of mortality.

Asunto(s)

Glucemia , Enfermedad Crítica , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos , Triglicéridos , Humanos , Enfermedad Crítica/mortalidad , Triglicéridos/sangre , Glucemia/análisis , Unidades de Cuidados Intensivos/estadística & datos numéricos , Femenino , Masculino , Factores de Riesgo