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Melaku EE, Urgie BM, Dessie F, Seid A, Abebe Z, Tefera AS. Determinants of Mortality of Patients Admitted to the Intensive Care Unit at Debre Berhan Comprehensive Specialized Hospital: A Retrospective Cohort Study. Patient Relat Outcome Meas 2024; 15:61-70. [PMID: 38410832 PMCID: PMC10895994 DOI: 10.2147/prom.s450502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/16/2024] [Indexed: 02/28/2024] Open
Abstract
Background The provision of intensive care services is advancing globally. However, in resource-limited settings, it is lagging far behind and intensive care unit mortality is still higher due to various reasons. This study aimed to assess determinants of mortality among medical patients admitted to the intensive care unit. Methods A five-year facility-based retrospective Cohort Study was conducted. A total of 546 medical patients admitted to the intensive care unit from March 2017 to February 2022 were included. Document review using a structured questionnaire was implemented to collect data. Data entered into Epi Data were analyzed by STATA and summarized using frequency tables and graphs. Binary and multivariate logistic regression analyses were performed to identify determinants of mortality. Results The overall mortality was 35.9%. Approximately half of the deaths were attributed to septic shock, congestive heart failure, severe community-acquired pneumonia, and stroke. The most common immediate cause of death was cardio-respiratory arrest. Source of admission, GCS level at admission, duration of ICU stay, treatment with inotropes, septic shock, and retroviral infection status were found to have a statistically significant association with ICU mortality. Conclusion and Recommendations This study revealed a significantly higher mortality rate among patients admitted to the intensive care unit. Early identification and admission of patients to the intensive care unit are important factors that could decrease mortality. Patient selection is essential since some patients with a high likelihood of mortality might not benefit from intensive care unit admission in an area with high resource limitations.
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Affiliation(s)
- Ermiyas Endewunet Melaku
- Department of Internal Medicine, School of Medicine, Debre Berhan University, Debre Berhan, Ethiopia
| | - Besufekad Mulugeta Urgie
- Department of Internal Medicine, School of Medicine, Debre Berhan University, Debre Berhan, Ethiopia
| | - Firmayie Dessie
- Department of Internal Medicine, School of Medicine, Debre Berhan University, Debre Berhan, Ethiopia
| | - Ali Seid
- Department of Internal Medicine, School of Medicine, Debre Berhan University, Debre Berhan, Ethiopia
| | - Zenebe Abebe
- Department of Biostatistics, School of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
| | - Aklile Semu Tefera
- Department of Epidemiology, School of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
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Deniau B, Boulet N, Pétrier M, Mezzarobba M, Coutrot M, Cattan P, Corté H, Dépret F, Lefrant JY, Plaud B, Boudemaghe T. Epidemiologic features and outcomes associated with caustic ingestion among adults admitted in intensive care unit from 2013 to 2019: a French national observational study. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02392-9. [PMID: 38114647 DOI: 10.1007/s00068-023-02392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/03/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Caustic ingestion is a potential life-threatening condition associated with high morbidity and mortality. Data on patients admitted to Intensive Care Unit (ICU) for severe caustic ingestion are lacking. We aimed to describing epidemiological features and outcomes of patients admitted to ICU for caustic ingestion in France. METHODS In a retrospective, observational, and multicenter study, data from the national French Programme de Médicalisation des Systèmes d'Informations (PMSI) database were analysed from 2013 to 2019. In-hospital mortality rate (primary outcome) and in-ICU complications (secondary outcomes) were reported and analysed. RESULTS 569 patients (289 males (50.8%), with median age of 49 years [interquartile (26-62)] were admitted in 65 French ICU for severe caustic ingestion. Five hundred and thirteen patients (90%) were admitted for intentional caustic ingestion. The median length of stay in ICU was 14.0 [4.0-31.0] days. In-hospital mortality occurred in 56 patients (9.8%). In multivariate analysis, age and simplified acute physiology score II were associated with in-hospital mortality age of 40-59 years [OR = 15.3 (2.0-115.3)], age of 60-79 years [OR = 23.6 (3.1-182.5)], and age > 80 years [OR = 37.0 (4.2-328.6)] and SAPS 2 score [OR = 1.0018 (1.003-1.033), p < 0.001]. During ICU stay, 423 complications (74%) were reported in 505 patients (89%). Infectious (244 (42.9%)), respiratory (207 (36.4%)), surgical 62 (10.9%), haemorrhagic (64 (11.2%)) and thrombo-embolic and (35 (6.2%)) complications were the most frequently reported during ICU stay. CONCLUSION ICU admission for severe caustic ingestion is associated with 9.8% mortality and 74% complications. Age > 40 years and SAPS 2 score were independently associated with mortality.
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Affiliation(s)
- Benjamin Deniau
- Department of Anaesthesiology, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 1 Avenue Claude Vellefaux, 75010, Paris, France.
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université Paris Cité, Paris, France.
- Université Paris Cité, Paris, France.
- FHU PROMICE, Paris, France.
| | - Nicolas Boulet
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France
| | - Melissa Pétrier
- Service de Biostatistique, Epidémiologie Clinique, Santé Publique Innovation et Méthodologie (BESPIM), Pôle Pharmacie, Santé Publique, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Myriam Mezzarobba
- Service de Biostatistique, Epidémiologie Clinique, Santé Publique Innovation et Méthodologie (BESPIM), Pôle Pharmacie, Santé Publique, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Maxime Coutrot
- Department of Anaesthesiology, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Pierre Cattan
- Université Paris Cité, Paris, France
- Service de Chirurgie Viscérale, Cancérologique Et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Helene Corté
- Service de Chirurgie Viscérale, Cancérologique Et Endocrinienne, Hôpital 13 Saint Louis, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - François Dépret
- Department of Anaesthesiology, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 1 Avenue Claude Vellefaux, 75010, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - Jean-Yves Lefrant
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France
| | - Benoit Plaud
- Department of Anaesthesiology, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 1 Avenue Claude Vellefaux, 75010, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- FHU PROMICE, Paris, France
| | - Thierry Boudemaghe
- Service Information Médicale, Méthodes Et Recherche (SIMMER), Pôle Pharmacie, Santé Publique, CHU Nîmes, University of Montpellier, Nîmes, France
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Stevenson P, Marguet M, Regulski M. Biofilm and Hospital-Acquired Infections in Older Adults. Crit Care Nurs Clin North Am 2023; 35:375-391. [PMID: 37838413 DOI: 10.1016/j.cnc.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Biofilm infections are a serious threat to public health, resistant to traditional treatments and host immune defenses. Biofilm infections are often polymicrobial, related to chronic wounds, medical devices (eg, knee replacements, catheters, tubes, contact lenses, or prosthetic valves) and chronic recurring diseases. Biofilms are more complex than nonadhered planktonic bacteria and produce a structure that prevents damage to the bacteria within the biofilm structure. The structure provides a hidden route to feed and nurture the bacteria allowing for ongoing spread of the bacteria.
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Affiliation(s)
- Patricia Stevenson
- Next Science™ LLC, 10550 Deerwood Park Boulevard, Suite 300, Jacksonville, FL 32256, USA.
| | - Melissa Marguet
- Next Science™ LLC, 10550 Deerwood Park Boulevard, Suite 300, Jacksonville, FL 32256, USA
| | - Matthew Regulski
- Next Science™ LLC, 10550 Deerwood Park Boulevard, Suite 300, Jacksonville, FL 32256, USA; The Wound Institute of Ocean County, 54 Bey Lea Road Tom's River, NJ 08759, USA
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Zhai Y, Yao Q, The E, Ao L, Fullerton DA, Meng X. Aging exacerbates cardiac dysfunction and mortality in sepsis through enhancing TLR2 activity. Front Cardiovasc Med 2023; 10:1293866. [PMID: 38094127 PMCID: PMC10716470 DOI: 10.3389/fcvm.2023.1293866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/14/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Sepsis is prevalent in the elderly population with increased incidence and mortality. Currently, the mechanism by which aging increases the susceptibility to sepsis and worsens outcome is unclear. We tested the hypothesis that aging exacerbates cardiac dysfunction in sepsis through a Toll-like receptor 2 (TLR2)-dependent mechanism. Methods Male young adult (4-6 months) and old (18-20 months) wild type (WT) and TLR2 knockout (KO) mice were subject to moderate sepsis by cecal ligation and puncture. Additional groups of young adult and old WT mice were treated with TLR2 agonist Pam3CSK4. Left ventricle (LV) performance was evaluated with a pressure-volume microcatheter. Tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6 and monocyte chemoattractant protein-1 (MCP-1) in the myocardium and plasma were assessed using enzyme-linked immunosorbent assay. Results Sepsis reduced LV ejection fraction and cardiac output in both young adult and old WT mice. However, identical CLP caused more severe cardiac dysfunction and high mortality in old WT mice that were accompanied by greater levels of TNF-α, IL-1β, IL-6 and MCP-1 in the myocardium and plasma. TLR2 KO diminished aging-related difference in myocardial and systemic inflammatory response, resulting in improved cardiac function and decreased mortality in old septic mice. In addition, higher myocardial TLR2 levels in old WT mice resulted in greater myocardial inflammatory response and worse cardiac dysfunction following administration of TLR2 agonist. Conclusion Moderate sepsis results in greater cardiac dysfunction and significant mortality in old mice. Aging elevates TLR2 level/activity to exacerbate the inflammatory response to sepsis, leading to worse cardiac dysfunction and mortality.
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Affiliation(s)
| | | | | | | | | | - Xianzhong Meng
- Department of Surgery, University of Colorado Denver, Aurora, CO, United States
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Sipahioglu H, Ilik HKZ, Ozer NT, Onuk S, Koyuncu S, Kuzuguden S, Elay G. Importance of Asprosin for Changes of M. Rectus Femoris Area during the Acute Phase of Medical Critical Illness: A Prospective Observational Study. Healthcare (Basel) 2023; 11:healthcare11050732. [PMID: 36900737 PMCID: PMC10000515 DOI: 10.3390/healthcare11050732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Asprosin, a new adipokine, is secreted by subcutaneous white adipose tissue and causes rapid glucose release. The skeletal muscle mass gradually diminishes with aging. The combination of decreased skeletal muscle mass and critical illness may cause poor clinical outcomes in critically ill older adults. To determine the relationship between the serum asprosin level, fat-free mass, and nutritional status of critically ill older adult patients, critically ill patients over the age of 65 receiving enteral nutrition via feeding tube were included in the study. The patients' cross-sectional area of the rectus femoris (RF) of the lower extremity quadriceps muscle was evaluated by serial measurements. The mean age of the patients was 72 ± 6 years. The median (IQR) serum asprosin level was 31.8 (27.4-38.1) ng/mL on the first study day and 26.1 (23.4-32.3) ng/mL on the fourth study day. Serum asprosin level was high in 96% of the patients on the first day, and it was high in 74% on the fourth day after initiation of enteral feeding. The patients achieved 65.9 ± 34.1% of the daily energy requirement for four study days. A significant moderate correlation between delta serum asprosin level and delta RF was found (Rho = -0.369, p = 0.013). In critically ill older adult patients, a significant negative correlation was determined between serum asprosin level with energy adequacy and lean muscle mass.
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Affiliation(s)
- Hilal Sipahioglu
- Department of Intensive Care Unit, Kayseri City Training and Research Hospital, Kayseri 38080, Turkey
- Correspondence: ; Tel.: +90-035223-157700 (Ext. 11056)
| | | | - Nurhayat Tugra Ozer
- Department of Clinical Nutrition, Erciyes School of Medicine, Erciyes University, Kayseri 38080, Turkey
| | - Sevda Onuk
- Department of Intensive Care Unit, Kayseri City Training and Research Hospital, Kayseri 38080, Turkey
| | - Sumeyra Koyuncu
- Department of Nephrology, Kayseri City Training and Research Hospital, Kayseri 38080, Turkey
| | - Sibel Kuzuguden
- Department of Biochemistry, Kayseri City Training and Research Hospital, Kayseri 38080, Turkey
| | - Gulseren Elay
- Department of Intensive Care Unit, Gaziantep University, Gaziantep 27470, Turkey
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Naz H, Korkmaz P, Arslanal E, Mıstanoğlu-Özatağ D, Gürbüz H. Prospective Evaluation of Infections in Geriatric Patients in Intensive Care Units. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2022; 4:268-273. [PMID: 38633716 PMCID: PMC10986692 DOI: 10.36519/idcm.2022.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/15/2022] [Indexed: 04/19/2024]
Abstract
Objective Nosocomial infections (NIs) are major health problems with morbidity and mortality. Geriatric patients require intensive care unit (ICU) admission more frequently, and serious challenges occur during treatment. We aimed to evaluate the risk factors of NI and mortality in geriatric patients admitted to the ICU. Materials and Methods The study was conducted between April 2018 and April 2019 in two hospitals. We prospectively recorded the data on the forms prepared according to daily ICU visits. Results During the study period, 600 patients were hospitalized in the ICUs. Geriatric patients constituted 446 (74.3%) of the total number. The NI rate was 59% in adult patients and 80% in geriatric patients. The most frequent NI in geriatric patients was pneumonia (42%). Furthermore, the need for mechanical ventilation support, prolongation of hospital stay, total parenteral nutrition, and tracheostomy were statistically higher in geriatric patients with NI. The mortality rate in geriatric patients was statistically higher than in non-geriatric. We found the rates of prolonged hospitalization, NI development, malignancy, and cerebrovascular disease diagnosis significantly higher in geriatric patients than in non-geriatric patients. Conclusion NI and mortality rate are higher in geriatrics than in adult patients. Pneumonia is the most common type of NI in the ICU. Identification of risk factors regarding NI and mortality in geriatric patients in ICU will contribute to developing strategies for prevention.
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Affiliation(s)
- Hasan Naz
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Pınar Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Kütahya Health Sciences University School of Medicine, Kütahya, Turkey
| | - Esra Arslanal
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Duru Mıstanoğlu-Özatağ
- Department of Infectious Diseases and Clinical Microbiology, Kütahya Health Sciences University School of Medicine, Kütahya, Turkey
| | - Hande Gürbüz
- Department of Anesthesiology and Reanimation, University of Health Sciences School of Medicine, Derince Training and Research Hospital, Kocaeli, Turkey
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Sipahioglu H, Bahcebası S. The Impact of Sequential Organ Failure Assessment (SOFA) Score on Mortality in Geriatric Patients With Sepsis and Septic Shock in the ICU. Cureus 2022; 14:e30887. [PMID: 36465747 PMCID: PMC9709246 DOI: 10.7759/cureus.30887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 06/17/2023] Open
Abstract
Objective One of the most common causes of mortality and morbidity in elderly patients is sepsis. Malnutrition is widespread in elderly patients, affecting mortality and morbidity. The present study aimed to evaluate the clinical features of patients hospitalized in the tertiary intensive care unit with the diagnosis of sepsis, as well as the effects of the Sequential Organ Failure Assessment (SOFA) score, prealbumin, albumin, and other laboratory parameters on hospital mortality. Methods The patients were divided into two groups according to their survival. The demographic and clinical characteristics of the two groups were compared. Independent risk factors affecting mortality were determined by logistic regression. Results A total of 653 patients admitted to the medical ICU were evaluated out of which 254 geriatric patients with sepsis and septic shock were included. There was in-hospital mortality in 122 (48%) patients. There was no difference in age in both groups (76 (71-84) vs. 76 (70-84), p=0.896). BUN (p=0.013), LDH (p=0.014), LDH/albumin (p<0.001), BUN/albumin (p<0.001), lactate/albumin (p= 0.007), and CRP/albumin (p=0.001) was higher in deceased patients compared to surviving patients. Prealbumin and albumin were lower in non-survivors (p=0.001). When the factors affecting mortality were examined by multivariate analysis, it was determined that none of the laboratory parameters alone predicted mortality. SOFA score was the only independent risk factor indicating mortality in the geriatric patient population with sepsis (OR=1.886 (1.410-2.510), p<0.001). Conclusion In conclusion, we demonstrated that high age and parameters of nutrition indicators did not affect mortality in geriatric patients hospitalized in the intensive care unit due to sepsis. In our study, the SOFA score was an independent risk factor affecting mortality in geriatric patients with sepsis, as in all sepsis cases.
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Affiliation(s)
- Hilal Sipahioglu
- Intensive Care Unit, Kayseri City Training and Research Hospital, Kayseri, TUR
| | - Sami Bahcebası
- Internal Medicine, Kayseri City Training and Research Hospital, Kayseri, TUR
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Heppner HJ, Haitham H. Intensive care of geriatric patients-a thin line between under- and overtreatment. Wien Med Wochenschr 2022; 172:102-108. [PMID: 35006520 PMCID: PMC8744379 DOI: 10.1007/s10354-021-00902-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/30/2021] [Indexed: 11/25/2022]
Abstract
Demographic developments are leading to an ever-increasing proportion of elderly and aged patients in hospitals at all levels of care, and even more patients from these age groups are to be expected in the future. Based on the projected population development, e.g., in Norway, an increase in intensive care beds of between 26 and 37% is expected by 2025. This poses special challenges for the treatment and management of geriatric intensive care patients. The acute illness is not the only decisive factor, but rather the existing multimorbidity and functional limitations of this vulnerable patient group must likewise be taken into account. Age per se is not the sole determinant of prognosis in critical patients, even though mortality increases with age.
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Affiliation(s)
- Hans Jürgen Heppner
- Chair for Geriatrics and Day-Care Hospital, University of Witten/Herdecke, Dr.-Moeller-Str. 15, 58332, Schwelm, Germany.
- Geriatric Clinic, Schwelm, Germany.
- Institute for Biomedicine of Ageing, FAU Erlangen, Nuremberg, Germany.
| | - Hag Haitham
- Chair for Geriatrics and Day-Care Hospital, University of Witten/Herdecke, Dr.-Moeller-Str. 15, 58332, Schwelm, Germany
- Geriatric Clinic, Schwelm, Germany
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Karcıoglu O, Yilmaz S, Kilic M, Suzer NE, Ozbay S, Tatlıparmak AC, Ayan M. Geriatric Sepsis in the COVID-19 Era: Challenges in Diagnosis and Management. INTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND ALLIED SCIENCES 2022. [DOI: 10.51847/leeequplat] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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10
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Application of a 72 h National Early Warning Score and Incorporation with Sequential Organ Failure Assessment for Predicting Sepsis Outcomes and Risk Stratification in an Intensive Care Unit: A Derivation and Validation Cohort Study. J Pers Med 2021; 11:jpm11090910. [PMID: 34575690 PMCID: PMC8465191 DOI: 10.3390/jpm11090910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 12/20/2022] Open
Abstract
We investigated the best timing for using the National Early Warning Score 2 (NEWS2) for predicting sepsis outcomes and whether combining the NEWS2 and the Sequential Organ Failure Assessment (SOFA) was applicable for mortality risk stratification in intensive care unit (ICU) patients with severe sepsis. All adult patients who met the Third International Consensus Definitions for Sepsis and Septic Shock criteria between August 2013 and January 2017 with complete clinical parameters and laboratory data were enrolled as a derivation cohort. The primary outcomes were the 7-, 14-, 21-, and 28-day mortalities. Furthermore, another group of patients under the same setting between January 2020 and March 2020 were also enrolled as a validation cohort. In the derivation cohort, we included 699 consecutive adult patients. The 72 h NEWS2 had good discrimination for predicting 7-, 14-, 21-, and 28-day mortalities (AUC: 0.780, 0.724, 0.700, and 0.667, respectively) and was not inferior to the SOFA (AUC: 0.740, 0.680, 0.684, and 0.677, respectively). With the new combined NESO tool, the hazard ratio was 1.854 (1.203-2.950) for the intermediate-risk group and 6.810 (3.927-11.811) for the high-risk group relative to the low-risk group. This finding was confirmed in the validation cohort using a separated survival curve for 28-day mortality. The 72 h NEWS2 alone was non-inferior to the admission SOFA or day 3 SOFA for predicting sepsis outcomes. The NESO tool was found to be useful for 7-, 14-, 21-, and 28-day mortality risk stratification in patients with severe sepsis.
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Eraslan Doganay G, Cirik MO. Determinants of prognosis in geriatric patients followed in respiratory ICU; either infection or malnutrition. Medicine (Baltimore) 2021; 100:e27159. [PMID: 34516508 PMCID: PMC8428736 DOI: 10.1097/md.0000000000027159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/19/2021] [Indexed: 01/05/2023] Open
Abstract
Severity of illness, age, malnutrition, and infection are the important factors determining intensive care unit (ICU) survival.The aim of the study is to determine the relations between Geriatric Nutritional Risk Index (GNRI), C-reactive protein/albumin (CAR), and prognosis-mortality of geriatric patients (age of ≥65 years) admitted to intensive care unit.The study with 10/15/2020, 697 approval date, and number retrospectively registered. Between January 1, 2018 and December 31, 2019, 413 geriatric patients admitted to ICU. The patients were divided into three groups according to their age.The age group, gender, Charlson comorbidity index, intensive care scores (Acute Physiology And Chronic Health Evaluation II and Sequential Organ Failure Assessment), the infection markers (white blood cell, procalcitonin, CAR levels), malnutrition tools for each patient (body mass index, Nutrition Risk in Critically ill score, and GNRI scores) were analyzed retrospectively. Also length of stay (LOS) ICU, length of stay hospital, and 30-day mortality were recorded.Geriatric patients number of 403 was included in the study. Forty-nine (12.3%) patients had a history of malignancy, 272 (67.5%) patients had Chronic Obstructive Pulmonary Disease comorbidity. There was no difference in mortality between age groups.In patients with mortality, body mass index, had being Chronic Obstructive Pulmonary Disease history, GNRI, length of stay hospital, and albumin were significantly lower; malignancy comorbidity rate, inotrope use, modified Nutrition Risk in Critically ill score, mechanical ventilation duration, LOS ICU, Sequential Organ Failure Assessment, Acute Physiology And Chronic Health Evaluation II, Charlson comorbidity index, C-reactive protein, procalcitonin, and CAR were significantly higher.Both malnutrition and infection affect mortality in geriatric patients in intensive care. The GNRI is better than CAR at predicting mortality.
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Govil D, Pal D. Can We Predict Outcome In Critically Ill Elderly Patients? Indian J Crit Care Med 2021; 25:615-616. [PMID: 34316137 PMCID: PMC8286403 DOI: 10.5005/jp-journals-10071-23886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Govil D, Pal D. Can We Predict Outcome in Critically Ill Elderly Patients? Indian J Crit Care Med 2021;25(6):615-616.
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Affiliation(s)
- Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta: The Medicity, Gurugram, Haryana, India
| | - Divya Pal
- Institute of Critical Care and Anesthesia, Medanta: The Medicity, Gurugram, Haryana, India
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Kim SY, Woo SH, Lee WJ, Kim DH, Seol SH, Lee JY, Jeong S, Park S, Cha K, Youn CS. The qSOFA score combined with the initial red cell distribution width as a useful predictor of 30 day mortality among older adults with infection in an emergency department. Aging Clin Exp Res 2021; 33:1619-1625. [PMID: 33124001 PMCID: PMC7595059 DOI: 10.1007/s40520-020-01738-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/27/2020] [Indexed: 11/01/2022]
Abstract
PURPOSE This study aimed to investigate whether the qSOFA and initial red cell distribution width (RDW) in the emergency department (ED) are associated with mortality in older adults with infections who visited the ED. METHODS This was a retrospective study conducted in 5 EDs between November 2016 and February 2017. We recorded age, sex, comorbidities, body temperature, clinical findings, and initial laboratory results, including the RDW. The initial RDW values and the qSOFA criteria were obtained at the time of the ED visit. The primary outcome was 30 day mortality. RESULTS A total of 1,446 patients were finally included in this study, of which 134 (9.3%) died within 30 days and the median (IQR) age was 77 (72, 82) years. In the multivariable analysis, the RDW (14.0-15.4%) and highest RDW (> 15.4%) quartile were shown to be independent risk factors for 30 day mortality (OR 2.12; 95% CI 1.12-4.02; p = 0.021) (OR 3.35; 95% CI 1.83-6.13; p < 0.001). The patients with qSOFA 2 and 3 were shown to have the high odds ratios of 30-day mortality (OR 3.50; 95% CI 2.09-5.84; p < 0.001) (OR 11.30; 95% CI 5.06-25.23; p < 0.001). The qSOFA combined with the RDW quartile for the prediction of 30 day mortality showed an AUROC value of 0.710 (0.686-0.734). CONCLUSION The qSOFA combined with the initial RDW value was associated with 30-day mortality among older adults with infections in the ED. The initial RDW may help emergency physicians predict mortality in older adults with infections visiting the ED.
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Functional outcome in intensive care older survivors. Aging Clin Exp Res 2021; 33:1609-1617. [PMID: 32865758 DOI: 10.1007/s40520-020-01679-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Most of the research focused on mortality and neglected functional outcome in older patients admitted to intensive care unit (ICU). AIMS The aim of this study is evaluating functional outcome in older patients admitted to ICU. METHODS A cross-sectional study of 203 elderly patients admitted to Geriatric ICU in Ain Shams University Hospitals and followed for 90 days after ICU discharge to track their functional level and other adverse outcomes. RESULTS The mean age for the cohort was 72.6 ± 8.8. Seventy-three patients survived after 3 months (36%). Only 42 patients out of 73 survivors maintained the same level of functions (58%). Factors related to functional decline were Charlson Comorbidity Index and infections acquired within 3 months after discharge. ICU scores, like APACHE and SAPS II scores were not effective in predicting functional outcomes. CONCLUSIONS Comorbidity burden and infections acquired within 3 months after discharge are important determinants of long-term functional level after ICU admission.
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Smithard DG, Abdelhameed N, Han T, Pieris A. Age, Frailty, Resuscitation and Intensive Care: With Reference to COVID-19. Geriatrics (Basel) 2021; 6:36. [PMID: 33916039 PMCID: PMC8167565 DOI: 10.3390/geriatrics6020036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022] Open
Abstract
Discussion regarding cardiopulmonary resuscitation and admission to an intensive care unit is frequently fraught in the context of older age. It is complicated by the fact that the presence of multiple comorbidities and frailty adversely impact on prognosis. Cardiopulmonary resuscitation and mechanical ventilation are not appropriate for all. Who decides and how? This paper discusses the issues, biases, and potential harms involved in decision-making. The basis of decision making requires fairness in the distribution of resources/healthcare (distributive justice), yet much of the printed guidance has taken a utilitarian approach (getting the most from the resource provided). The challenge is to provide a balance between justice for the individual and population justice.
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Affiliation(s)
- David G Smithard
- Department Geriatric Medicine, Lewisham and Greenwich NHS Trust, London SE13 6LH, UK
- School of Health Science, University of Greenwich, London SE9 2UG, UK
| | - Nadir Abdelhameed
- Geriatric Medicinet, King’s College Hospital, London SE5 9RS, UK; (N.A.); (T.H.)
| | - Thwe Han
- Geriatric Medicinet, King’s College Hospital, London SE5 9RS, UK; (N.A.); (T.H.)
| | - Angelo Pieris
- Geriatric Medicine, St Thomas’ Hospital, London SE1 7EH, UK;
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Chopra S, Pednekar S, Karnik ND, Londhe C, Pandey D. A Study of the Outcome of Critically Ill Elderly Patients in a Tertiary Care Hospital Using SOFA Score. Indian J Crit Care Med 2021; 25:655-659. [PMID: 34316145 PMCID: PMC8286402 DOI: 10.5005/jp-journals-10071-23883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background With a rapidly rising geriatric population, the magnitude of elderly patients requiring intensive care is a major cause of concern. Data on critically ill geriatric patients is scarce, especially in developing countries. Aim and objective The aim of the study is to identify the etiology, clinical profile, and outcome in elderly patients admitted to the intensive care unit (ICU) and to predict their survival using the sequential organ failure assessment (SOFA) score. Materials and methods A prospective observational study was performed over a period of 18 months with analysis of 100 patients admitted to the ICU, above the age of 60 years, with multi-organ dysfunction. The outcome of discharge or death was studied using the SOFA score on admission, on day 2, and the delta SOFA score. Results In this study of 100 patients, 88% of patients were in the 60–70 years age-group. The number of male and female patients was equal. Seventy percent of patients had comorbidities, of which hypertension was most common. The two most common etiologies were acute febrile illness and pneumonia. The use of mechanical ventilation, inotropic support, and serum creatinine has a significant association with the outcome. The SOFA score at admission did not have a significant association, but the score at 48 hours and delta SOFA score co-related with the outcome of the patients. Sixty-four patients got discharged; thus, there was a survival rate of 64%. Conclusion The SOFA score at 48 hours is the most sensitive predictor of outcome, followed closely by the delta SOFA score, as compared to the SOFA score on admission, for critically ill elderly patients. There is a significant association of use of mechanical ventilation, inotropic support, and serum creatinine with the outcome. How to cite this article Chopra S, Pednekar S, Karnik ND, Londhe C, Pandey D. A Study of the Outcome of Critically Ill Elderly Patients in a Tertiary Care Hospital Using SOFA Score. Indian J Crit Care Med 2021;25(6):655–659.
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Affiliation(s)
- Shivani Chopra
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Sangeeta Pednekar
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Niteen D Karnik
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Charulata Londhe
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Dharmendra Pandey
- Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
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D'Andrea A, Le Peillet D, Fassier T, Prendki V, Trombert V, Reny JL, Roux X. Functional Independence Measure score is associated with mortality in critically ill elderly patients admitted to an intermediate care unit. BMC Geriatr 2020; 20:334. [PMID: 32907534 PMCID: PMC7488031 DOI: 10.1186/s12877-020-01729-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/23/2020] [Indexed: 11/11/2022] Open
Abstract
Background Age alone is not a robust predictor of mortality in critically ill elderly patients. Chronic health status and functional status before admission could be better predictors. This study aimed to determine whether functional status, assessed using the Functional Independence Measure (FIM), could be an independent predictor of mortality in a geriatric population admitted to an intermediate care unit (IMCU). Methods A monocentric, retrospective, observational study of all patients aged ≥75 years old admitted to Geneva University Hospitals’ geriatric IMCU between 01.01.2012 and 31.05.2016. The study’s primary outcome metrics were one-year mortality’s associations with a pre-admission FIM score and other relevant prospectively recorded prognostic variables. Results A total of 345 patients were included (56% female, mean age 85 +/− 6.5 years). Mean FIM score was 66 +/− 26. One-year mortality was 57%. Dichotomized low (≤ 63) and high FIM (> 63) scores were associated with one-year mortalities of 68 and 44%, respectively. Logistic regression calculations found an association between pre-admission FIM score and one-year mortality (p < 0.0001), including variables usually associated with mortality (e.g., age, sex, comorbidities, mini-mental health state score, renal function). Multivariate survival analysis showed a significant difference between groups, with a hazard ratio of 0.29 (95% CI: 0.13–0.65) for patients with high FIM scores. Conclusions In the present study, higher functional status, assessed using the FIM tool before admission to an IMCU, was significantly and independently associated with lower one-year mortality. This opens up perspectives on the potential value of FIM for establishing a finer prognosis and better triage of critically ill older patients.
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Affiliation(s)
- A D'Andrea
- Division of anesthesiology, Département of anesthesiology, Hospital Riviera Chablais, Vaud Valais, Rennaz, Switzerland
| | - D Le Peillet
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - T Fassier
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals & Interprofessionnal Simulation Center, Geneva, Switzerland
| | - V Prendki
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - V Trombert
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - J-L Reny
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - X Roux
- Divison of Internal Medecine of the Aged, Departement of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.
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Age is not a risk factor in survival of severely ill patients with co-morbidities in a medical intensive care unit. Ir J Med Sci 2020; 190:317-324. [PMID: 32623567 DOI: 10.1007/s11845-020-02298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The individuals over 65 years old constitute an important patient population of medical intensive care units (ICUs). AIM To evaluate the risk factors for mortality in a medical ICU consisting a group of patients with a large number of co-morbidities. METHODS This is a retrospective study involving patients who were followed for more than 48 h. The cohort was divided into two groups according to age: (1) young, < 65 years old, and (2) elderly, ≥ 65 years old. RESULTS A total of 693 patients (303 F, 390 M) were included. The median age was 68 years (18-97). There were 279 (40.3%) young and 414 (59.7%) elderly patients. There was no difference between the groups in gender and mortality (p = 0.436, p = 0.932, respectively). Most of the co-morbid diseases were more common in the elderly except solid malignancies which were more common in young patients (p = 0.033). Long ICU stay, long hospital stay before ICU, high APACHE II and Charlson co-morbidity index scores, pneumonia, acute hepatic failure/coma, malignancy, acute hemodialysis, need for vasopressors, and invasive mechanical ventilation were independent predictors of ICU mortality. CONCLUSION Age and gender were not found to be predictors of mortality. There was no survival advantage between young and elderly patients. Co-morbid diseases, apart from malignancy, had no effect on mortality. In developing countries, where patients with terminal illness and multiple co-morbid diseases are treated in the ICU, age should not be a determining factor in patient selection for ICU or in the treatment decisions to be applied to patients.
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Guillon A, Hermetet C, Barker KA, Jouan Y, Gaborit C, Ehrmann S, Le Manach Y, Dequin PF, Grammatico-Guillon L. Long-term survival of elderly patients after intensive care unit admission for acute respiratory infection: a population-based, propensity score-matched cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:384. [PMID: 32600392 PMCID: PMC7325055 DOI: 10.1186/s13054-020-03100-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023]
Abstract
Background Intensive care unit (ICU) hospitalisations of elderly patients with acute respiratory infection have increased, yet the long-term effects of ICU admission among elderly individuals remain unknown. We examined differences over the 2 years after discharge in mortality, healthcare utilisation and frailty score between elderly survivors of ARI in the ICU and an elderly control population. Methods We used 2009–2017 data from 39 hospital discharge databases. Patients ≥ 80 years old discharged alive from ICU hospitalisation for acute respiratory infection were propensity score-matched with controls (cataract surgery) discharged from the hospital at the same time and adjusted for age, sex and comorbidities present before hospitalisation. We reported 2-year mortality and compared healthcare utilisation and frailty scores in the 2-year periods before and after ICU hospitalisation. Results One thousand two hundred and twenty elderly survivors of acute respiratory infection in the ICU were discharged, and 988 were successfully matched with controls. After discharge, patients had a 10.1-fold [95% CI, 6.1–17.3] higher risk of death at 6 months and 3.6-fold [95% CI, 2.9–4.6] higher risk of death at 2 years compared with controls. They also had a 2-fold increase in both healthcare utilisation and frailty score in the 2 years after hospital discharge, whereas healthcare utilisation and frailty scores among controls were stable before and after hospitalisation. Conclusions We observed a substantially increased rate of death in the years following ICU hospitalisation for elderly patients along with elevated healthcare resource use and accelerated age-associated decline as assessed by frailty score. These findings provide data for better informed goals-of-care discussions and may help target post-ICU discharge services.
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Affiliation(s)
- Antoine Guillon
- CHRU de Tours, Service de Médecine Intensive Réanimation, INSERM U1100, Centre d'Etude des Pathologies Respiratoires, CRICS-TriggerSEP Research Network, Université de Tours, 2 Bd Tonnellé, F-37044, Tours Cedex 9, France.
| | - Coralie Hermetet
- CHRU de Tours, Epidémiologie des Données Cliniques (EpiDcliC), Service d'Information Médicale, d'Épidémiologie et d'Économie de la Santé, Université de Tours, Tours, France.,EA EES, Université de Tours, Tours, France
| | - Kimberly A Barker
- Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Department of Microbiology, Boston University School of Medicine, Boston, MA, USA
| | - Youenn Jouan
- CHRU de Tours, Service de Médecine Intensive Réanimation, INSERM U1100, Centre d'Etude des Pathologies Respiratoires, CRICS-TriggerSEP Research Network, Université de Tours, 2 Bd Tonnellé, F-37044, Tours Cedex 9, France
| | - Christophe Gaborit
- CHRU de Tours, Epidémiologie des Données Cliniques (EpiDcliC), Service d'Information Médicale, d'Épidémiologie et d'Économie de la Santé, Université de Tours, Tours, France.,EA EES, Université de Tours, Tours, France
| | - Stephan Ehrmann
- CHRU de Tours, Service de Médecine Intensive Réanimation, INSERM U1100, Centre d'Etude des Pathologies Respiratoires, CRICS-TriggerSEP Research Network, Université de Tours, 2 Bd Tonnellé, F-37044, Tours Cedex 9, France.,CIC INSERM 1415, Tours, France
| | - Yannick Le Manach
- Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, Michael DeGroote School of Medicine, McMaster University and the Perioperative Research Group, Population Health Research Institute, Hamilton, ON, Canada
| | - Pierre-François Dequin
- CHRU de Tours, Service de Médecine Intensive Réanimation, INSERM U1100, Centre d'Etude des Pathologies Respiratoires, CRICS-TriggerSEP Research Network, Université de Tours, 2 Bd Tonnellé, F-37044, Tours Cedex 9, France
| | - Leslie Grammatico-Guillon
- CHRU de Tours, Epidémiologie des Données Cliniques (EpiDcliC), Service d'Information Médicale, d'Épidémiologie et d'Économie de la Santé, Université de Tours, Tours, France
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Lee YL, Ha SO, Park YS, Yi JH, Hur SB, Lee KH, Hong KY, Sin JY, Kim DH, Cha JK, Kim JH. Baseline and clinical characteristics of older adults admitted to the intensive care unit through the emergency room: Analysis based on age groups. HONG KONG J EMERG ME 2019. [DOI: 10.1177/1024907919880442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: There is currently no consensus on the criteria for admitting older adults to the intensive care unit. Methods: This single-center retrospective study evaluated the baseline and clinical characteristics of older adults admitted to the intensive care unit between January 2017 and June 2017; patients were analyzed according to their age group. Factors associated with in-hospital mortality were specifically determined using logistic regression analysis. Results: Among 582 patients included in the present study, 34.2%, 46.6%, and 19.2% were aged 65–74, 75–84, and over 84 years, respectively. In terms of clinical outcomes, although there were no significant differences in the length of intensive care unit and hospital stay and intensive care unit mortality, significant differences were observed in terms of in-hospital mortality, hospital discharge disposition, and neurologic outcomes at discharge ( p = 0.039, p = 0.005, and p = 0.032, respectively). Predictive factors for in-hospital mortality were age (⩾85 years), initial mental status (stupor to coma), a Korean Triage and Acuity Scale level of 1, underlying diagnosis of cancer, abdominal pain or discomfort, apnea, and a chief compliant of dyspnea. Conclusion: Compared to those aged 65–84 years, in-hospital mortality was 1.96-fold higher in those aged over 84 years. However, the overall mortality in our cohort was not considerably different from that of the younger population. Intensive care unit admission should be considered in selected older adults after evaluating the risk factors for mortality.
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Affiliation(s)
- Ye Lim Lee
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Republic of Korea
| | - Sang Ook Ha
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Republic of Korea
| | - Young Sun Park
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Republic of Korea
| | - Jeong Hyeon Yi
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Republic of Korea
| | - Sun Beom Hur
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Republic of Korea
| | - Ki Ho Lee
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Republic of Korea
| | - Ki Yong Hong
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Republic of Korea
| | - Ju Young Sin
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Republic of Korea
| | - Duk Hwan Kim
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Republic of Korea
| | - Jun Kwon Cha
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Republic of Korea
| | - Jin Hyuck Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Republic of Korea
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Cintra MTG, Belém D, Moraes EN, Botoni FA, Bicalho MAC. The impact of intensive care admission criteria on elderly mortality. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2019; 65:1015-1020. [PMID: 31389516 DOI: 10.1590/1806-9282.65.7.1015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 04/19/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To review systematically the influence of admission criteria on the mortality of elderly patients under intensive therapy. METHODS We performed a search on the PUBMED and BIREME databases by using the MeSH and DeCS terms "intensive care units", "patient admission", and "aged" in Portuguese, English, and Spanish. Only prospective and retrospective cohort studies were included. We analyzed the severity score, type of hospital admission, quality of life, co-morbidities, functionality, and elderly institutionalization. RESULTS Of the 1,276 articles found, thirteen were selected after evaluation of the inclusion and exclusion criteria. It was observed that the severity score, functionality, and co-morbidities had an impact on mortality. It was not possible to determine which severity score was more suitable. CONCLUSION We suggest that analysis of functionality, co-morbidities, and severity scores should be conducted to estimate the elderly mortality in relation to the admission to intensive care units.
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Affiliation(s)
| | - Dinah Belém
- Geriatra. Colaborador do Ambulatório de Geriatria do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brasil
| | - Edgar Nunes Moraes
- Geriatra. Professor Associado do Departamento de Clínica Médica da UFMG, Belo Horizonte, MG, Brasil
| | - Fernando Antônio Botoni
- Intensivista. Professor Adjunto do Departamento de Clínica Médica da UFMG, Belo Horizonte, MG, Brasil
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Kotfis K, Wittebole X, Jaschinski U, Solé-Violán J, Kashyap R, Leone M, Nanchal R, Fontes LE, Sakr Y, Vincent JL. A worldwide perspective of sepsis epidemiology and survival according to age: Observational data from the ICON audit. J Crit Care 2019; 51:122-132. [DOI: 10.1016/j.jcrc.2019.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 02/04/2023]
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Wang PY, Takemura N, Xu X, Cheung DST, Lin CC. Predictors of successful discharge from intensive care units in older adults aged 80 years or older: A population-based study. Int J Nurs Stud 2019; 100:103339. [PMID: 31590116 DOI: 10.1016/j.ijnurstu.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/27/2019] [Accepted: 04/13/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND We determined the long-term outcomes of adult intensive care unit (ICU) patients and investigated the predictors of successful discharge for ≥6 months among older adults aged ≥80 years in Taiwan. OBJECTIVES To identify the predictors of ICU admission in patients aged ≥80 years and the predictors of and optimal cutoff predictive discharge score (PDS) for ICU successful discharge in patients aged ≥80 years. DESIGN A population-based retrospective cohort study. SETTINGS AND PARTICIPANTS Medical records of 282,269 individuals aged ≥80 years collected from the Taiwan National Health Insurance Research Database from 2001 to 2013. METHODS Demographic and clinical parameters, Charlson's comorbidity index (CCI), hospital type, and post-discharge outcomes of ICU patients aged ≥80 years were obtained from their medical records. Multivariable logistic regression was used to analyze and identify the predictors of successful discharge and treatments received by critically ill patients aged ≥80 years admitted to the ICU. The optimal cutoff PDS for successful discharge in older adults were calculated by Youden Index. Results 65,756 ICU admissions were documented, of which 21% (n = 13,825) were for adults aged ≥80 years. The successful discharge rate among ICU patients aged ≥80 years (57.2%) was significantly lower than that among those aged 18-64 and 65-79 years (81.7% and 71.5%, respectively). Multivariable logistic regression analyses revealed the following predictors of successful discharge for ≥6 months after ICU admission in adults aged ≥80 years: younger age (adjusted odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.94-0.96), shorter ICU length of stay (adjusted OR = 0.90, 95% CI = 0.88-0.92), lower CCI (adjusted OR = 0.92, 95% CI = 0.90-0.93), and no life-sustaining treatments received (Cardiopulmonary resuscitation: adjusted OR = 0.75, 95% CI = 0.68-0.84; mechanical ventilation: adjusted OR = 0.63, 95% CI = 0.57-0.71; use of inotropic agents: adjusted OR = 0.37, 95% CI = 0.34-0.41). The optimal cutoff PDS in older adults was 6 (area under the receiver operating characteristic curve = 0.73, 95% CI = 0.72-0.74). CONCLUSION This is the first population-based study investigating the post-discharge outcomes of ICU patients aged ≥80 years. Advanced age was a predictive factor of unsuccessful discharge from the ICU. Nevertheless, more than half of this vulnerable population survived for at least 6 months after discharge. Therefore, age should not be the sole criterion when considering ICU admission and deciding curative treatments for critically ill older adults. Comprehensive assessment and effective communication with patients and their families are also crucial in clinical decision-making for critically ill older adults.
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Affiliation(s)
- Pei-Yi Wang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Naomi Takemura
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Xinyi Xu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong.
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Bautista AF, Lenhardt R, Yang D, Yu C, Heine MF, Mascha EJ, Heine C, Neyer TM, Remmel K, Akca O. Early Prediction of Prognosis in Elderly Acute Stroke Patients. Crit Care Explor 2019; 1:e0007. [PMID: 32166253 PMCID: PMC7063873 DOI: 10.1097/cce.0000000000000007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Acute stroke has a high morbidity and mortality in elderly population. Baseline confounding illnesses, initial clinical examination, and basic laboratory tests may impact prognostics. In this study, we aimed to establish a model for predicting in-hospital mortality based on clinical data available within 12 hours of hospital admission in elderly (≥ 65 age) patients who experienced stroke. DESIGN Retrospective observational cohort study. SETTING Academic comprehensive stroke center. PATIENTS Elderly acute stroke patients-2005-2009 (n = 462), 2010-2012 (n = 122), and 2016-2017 (n = 123). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS After institutional review board approval, we retrospectively queried elderly stroke patients' data from 2005 to 2009 (training dataset) to build a model to predict mortality. We designed a multivariable logistic regression model as a function of baseline severity of illness and laboratory tests, developed a nomogram, and applied it to patients from 2010 to 2012. Due to updated guidelines in 2013, we revalidated our model (2016-2017). The final model included stroke type (intracerebral hemorrhage vs ischemic stroke: odds ratio [95% CI] of 0.92 [0.50-1.68] and subarachnoid hemorrhage vs ischemic stroke: 1.0 [0.40-2.49]), year (1.01 [0.66-1.53]), age (1.78 [1.20-2.65] per 10 yr), smoking (8.0 [2.4-26.7]), mean arterial pressure less than 60 mm Hg (3.08 [1.67-5.67]), Glasgow Coma Scale (0.73 [0.66-0.80] per 1 point increment), WBC less than 11 K (0.31 [0.16-0.60]), creatinine (1.76 [1.17-2.64] for 2 vs 1), congestive heart failure (2.49 [1.06-5.82]), and warfarin (2.29 [1.17-4.47]). In summary, age, smoking, congestive heart failure, warfarin use, Glasgow Coma Scale, mean arterial pressure less than 60 mm Hg, admission WBC, and creatinine levels were independently associated with mortality in our training cohort. The model had internal area under the curve of 0.83 (0.79-0.89) after adjustment for over-fitting, indicating excellent discrimination. When applied to the test data from 2010 to 2012, the nomogram accurately predicted mortality with area under the curve of 0.79 (0.71-0.87) and scaled Brier's score of 0.17. Revalidation of the same model in the recent dataset from 2016 to 2017 confirmed accurate prediction with area under the curve of 0.83 (0.75-0.91) and scaled Brier's score of 0.27. CONCLUSIONS Baseline medical problems, clinical severity, and basic laboratory tests available within the first 12 hours of admission provided strong independent predictors of in-hospital mortality in elderly acute stroke patients. Our nomogram may guide interventions to improve acute care of stroke.
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Affiliation(s)
- Alexander F. Bautista
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Rainer Lenhardt
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
- Neuroscience ICU, University of Louisville, Hospital, Louisville, KY
| | - Dongsheng Yang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Changhong Yu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Michael F. Heine
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
- Neuroscience ICU, University of Louisville, Hospital, Louisville, KY
| | - Edward J. Mascha
- Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, OH
| | - Cate Heine
- Institute for Data Systems and Society, Centre College, Danville, KY
| | - Thomas M. Neyer
- Department of Anesthesiology, University of Cincinnati, Cincinnati, OH
| | - Kerri Remmel
- Department of Neurology, University of Louisville, Louisville, KY
- Comprehensive Stroke Center, University of Louisville Hospital, Louisville, KY
| | - Ozan Akca
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
- Neuroscience ICU & Comprehensive Stroke Center, UofL Hospital, Louisville, KY
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25
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Martin-Loeches I, Guia MC, Vallecoccia MS, Suarez D, Ibarz M, Irazabal M, Ferrer R, Artigas A. Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study. Ann Intensive Care 2019; 9:26. [PMID: 30715638 PMCID: PMC6362175 DOI: 10.1186/s13613-019-0495-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/16/2019] [Indexed: 12/13/2022] Open
Abstract
Background Age has been traditionally considered a risk factor for mortality in elderly patients admitted to intensive care units. The aim of this prospective, observational, multicenter cohort study is to determine the risk factors for mortality in elderly and very elderly critically ill patients with sepsis. Results A total of 1490 patients with ≥ 65 years of age were included in the study; most of them 1231 (82.6%) had a cardiovascular failure. The mean age (± SD) was 74.5 (± 5.6) years, and 876 (58.8%) were male. The patients were divided into two cohorts: (1) elderly: 65–79 years and (2) very elderly: ≥ 80 years. The overall hospital mortality was 48.8% (n = 727) and was significantly higher in very elderly compared to elderly patients (54.2% vs. 47.4%; p = 0.02). Factors independently associated with mortality were APACHE II score of the disease, patient location at sepsis diagnosis, development of acute kidney injury, and thrombocytopenia in the group of elderly patients. On the other hand, in the group of very elderly patients, predictors of hospital mortality were age, APACHE II score, and prompt adherence of the resuscitation bundle. Conclusion This prospective multicenter study found that patients aged 80 or over had higher hospital mortality compared to patients between 65 and 79 years. Age was found to be an independent risk factor only in the very elderly group, and prompt therapy provided within the first 6 h of resuscitation was associated with a reduction in hospital mortality in the very elderly patients.
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Affiliation(s)
- Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital/Trinity College Dublin TCD, James's St, Ushers, Dublin, D03 VX82, Ireland. .,Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain. .,University of Barcelona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES CB06/06/0028), Barcelona, Spain.
| | - Maria Consuelo Guia
- Critical care Center, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Maria Sole Vallecoccia
- Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital/Trinity College Dublin TCD, James's St, Ushers, Dublin, D03 VX82, Ireland.,Department of Intensive Care and Anaesthesiology, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A.Gemelli, Rome, Italy
| | - David Suarez
- Critical care Center, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Mercedes Ibarz
- Servicio de Medicina Intensiva, Hospitales Universitarios Sagrado Corazon y General de Cataluña, Barcelona, Spain
| | - Marian Irazabal
- Servicio de Medicina Intensiva, Hospitales Universitarios Sagrado Corazon y General de Cataluña, Barcelona, Spain
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Shock Organ Dysfunction and Resuscitation Research Group, Vall d' Hebron Research Institute, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Antonio Artigas
- Critical care Center, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain.,Servicio de Medicina Intensiva, Hospitales Universitarios Sagrado Corazon y General de Cataluña, Barcelona, Spain
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26
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Reijnierse EM, Verlaan S, Pham VK, Lim WK, Meskers CGM, Maier AB. Lower Skeletal Muscle Mass at Admission Independently Predicts Falls and Mortality 3 Months Post-discharge in Hospitalized Older Patients. J Gerontol A Biol Sci Med Sci 2018; 74:1650-1656. [DOI: 10.1093/gerona/gly281] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Indexed: 12/31/2022] Open
Abstract
Abstract
Background
Approximately 10% of older adults are annually admitted to a hospital. Hospitalization is associated with a higher risk of falls and mortality after discharge. This study aimed to identify predictors at admission for falls and mortality 3 months post-discharge in hospitalized older patients.
Methods
The Evaluation of Muscle parameters in a Prospective cohort of Older patients at clinical Wards Exploring Relations with bed rest and malnutrition (EMPOWER) study is an observational, prospective longitudinal inception cohort of 378 patients aged 70 years and older who were subsequently admitted to a tertiary hospital (the Netherlands). Potential predictors for falls and mortality 3 months post-discharge were tested using univariate and multivariate logistic regression analyses and included the following domains: demographic (age, sex, living independently), lifestyle (alcohol, smoking), nutrition (SNAQ score), muscle mass (absolute, relative), physical function (handgrip strength, Katz ADL score), cognition (six-item cognitive impairment test score), and disease (medications, diseases).
Results
The mean age was 79.6 years (standard deviation 6.23) and 50% were male. Within 3 months post-discharge, 19% reported a fall and 13% deceased. Univariate predictors for falls were higher age, lower absolute muscle mass and higher six-item cognitive impairment test score. Lower absolute muscle mass independently predicted falls post-discharge (multivariate). Univariate predictors for mortality were higher age, male sex, no current alcohol use, higher SNAQ score, lower absolute and higher relative muscle mass, higher Katz ADL score and higher number of diseases. Male sex, higher SNAQ score, and lower absolute muscle mass independently predicted mortality post-discharge (multivariate).
Conclusions
In hospitalized older adults, muscle mass should be measured to predict future outcome. Future intervention studies should investigate if increasing muscle mass prevent short-term falls and mortality.
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Affiliation(s)
- Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Sjors Verlaan
- Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Vivien K Pham
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Wen Kwang Lim
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Carel G M Meskers
- Department of Human Movement Sciences, @AgeAmsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
- Department of Human Movement Sciences, @AgeAmsterdam, The Netherlands
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27
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Agrawal S, Luc M, Winkowski F, Lindner K, Agrawal AK, Wozniak M, Sobieszczanska M. Predictors of mortality in older patients admitted to a geriatric hospital. Geriatr Gerontol Int 2018; 19:70-75. [DOI: 10.1111/ggi.13573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 09/03/2018] [Accepted: 10/08/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Siddarth Agrawal
- Department and Clinic of Geriatrics; Wroclaw Medical University; Wroclaw Poland
- Department of Pathology; Wroclaw Medical University; Wroclaw Poland
| | - Mateusz Luc
- Department and Clinic of Geriatrics; Wroclaw Medical University; Wroclaw Poland
- Department of Pathology; Wroclaw Medical University; Wroclaw Poland
| | - Filip Winkowski
- Department and Clinic of Geriatrics; Wroclaw Medical University; Wroclaw Poland
| | - Karolina Lindner
- Department and Clinic of Geriatrics; Wroclaw Medical University; Wroclaw Poland
| | - Anil Kumar Agrawal
- 2nd Department of General and Oncological Surgery; Wroclaw Medical University; Wroclaw Poland
| | - Marta Wozniak
- Department of Pathology; Wroclaw Medical University; Wroclaw Poland
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Haas LEM, van Beusekom I, van Dijk D, Hamaker ME, Bakhshi-Raiez F, de Lange DW, de Keizer NF. Healthcare-related costs in very elderly intensive care patients. Intensive Care Med 2018; 44:1896-1903. [PMID: 30255319 DOI: 10.1007/s00134-018-5381-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/19/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The long-term outcome of "very old intensive care unit patients" (VOPs; ≥ 80 years) is often disappointing. Little is known about the healthcare costs of these VOPs in comparison to younger ICU patients and the very elderly in the general population not admitted to the ICU. METHODS Data from a national health insurance claims database and a national quality registry for ICUs were combined. Costs of VOPs admitted to the ICU in 2013 were compared with costs of younger ICU patients (two groups, respectively 18-65 and 65-80 years old) and a matched control group of very elderly subjects who were not admitted to the ICU. We compared median costs and median costs per day alive in the year before ICU admission (2012), the year of ICU admission (2013) and the year after ICU admission (2014). RESULTS A total of 9272 VOPs were included and compared to three equally sized study groups. Median costs for VOPs in 2012, 2013 and 2014 (€5944, €35,653 and €12,565) are higher compared to the ICU 18-65 population (€3022, €30,223 and €5052, all p < 0.001) and the very elderly control population (€3590, €4238 and €4723, all p < 0.001). Compared to the ICU 65-80 population, costs of VOPs are higher in the year before and after ICU admission (€4323 and €6750, both p < 0.001), but not in the year of ICU admission (€34,448, p = 0.950). The median healthcare costs per day alive in the year before, the year of and the year after ICU admission are all higher for VOPs than for the other groups (p < 0.001). CONCLUSIONS VOPs required more healthcare resources in the year before, the year of and the year after ICU admission compared to younger ICU patients and the very elderly control population, except compared to the ICU 65-80 population in the year of ICU admission. Healthcare costs per day alive, however, are substantially higher for VOPs than for all other study groups in all three studied years.
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Affiliation(s)
- L E M Haas
- Department of Intensive Care Medicine, Diakonessenhuis Utrecht, PO box 80250, 3508 TG, Utrecht, The Netherlands.
| | - Ilse van Beusekom
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands
| | - Diederik van Dijk
- Department of Intensive Care Medicine, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Marije E Hamaker
- Department of Geriatrics, Diakonessenhuis, Utrecht, The Netherlands
| | - Ferishta Bakhshi-Raiez
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands
| | - Dylan W de Lange
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands
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Outcome of older persons admitted to intensive care unit, mortality, prognosis factors, dependency scores and ability trajectory within 1 year: a prospective cohort study. Aging Clin Exp Res 2018; 30:1041-1051. [PMID: 29214518 DOI: 10.1007/s40520-017-0871-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/28/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The outcome and functional trajectory of older persons admitted to intensive care (ICU) unit remain a true question for critical care physicians and geriatricians, due to the heterogeneity of geriatric population, heterogeneity of practices and absence of guidelines. AIM To describe the 1-year outcome, prognosis factors and functional trajectory for older people admitted to ICU. METHODS In a prospective 1-year cohort study, all patients aged 75 years and over admitted to our ICU were included according to a global comprehensive geriatric assessment. Follow-up was conducted for 1 year survivors, in particular, ability scores and living conditions. RESULTS Of 188 patients included [aged 82.3 ± 4.7 years, 46% of admissions, median SAPS II 53.5 (43-74), ADL of Katz's score 4.2 ± 1.6, median Barthel's index 71 (55-90), AGGIR scale 4.5 ± 1.5], the ICU, hospital and 1-year mortality were, respectively, 34, 42.5 and 65.5%. Prognosis factors were: SAPS 2, mechanical ventilation, comorbidity (Lee's and Mc Cabe's scores), disability scores (ADL of Katz's score, Barthel's index and AGGIR scale), admission creatinin, hypoalbuminemia, malignant haemopathy, cognitive impairment. One-year survivors lived in their own home for 83%, with a preserved physical ability, without significant variation of the three ability assessed scores compared to prior ICU admission. CONCLUSION The mortality of older people admitted to ICU is high, with a significant impact of disabilty scores, and preserved 1-year survivor independency. Other studies, including a better comprehensive geriatric assessment, seem necessary to determine a predictive "phenotype" of survival with a "satisfactory" level of autonomy.
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30
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Cheng HH, Chen FC, Change MW, Kung CT, Cheng CY, Tsai TC, Hsiao SY, Su CM. Difference between elderly and non-elderly patients in using serum lactate level to predict mortality caused by sepsis in the emergency department. Medicine (Baltimore) 2018; 97:e0209. [PMID: 29595662 PMCID: PMC5895436 DOI: 10.1097/md.0000000000010209] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Elderly people are more susceptible to sepsis and experience more comorbidities and complications than young adults. Serum lactate is a useful biomarker to predict mortality in patients with sepsis. Lactate production is affected by the severity of sepsis, organ dysfunction, and adrenergic stimulation. Whether the predictive ability of serum lactate will be different between non-elderly and elderly patients is unknown.A retrospective cohort study was conducted to compare the prognostic value of hyperlactatemia in predicting the mortality between elderly (≥65 years) and non-elderly (<65 years) patients with sepsis.This is a single-center retrospective observational cohort study conducted from January 2007 to December 2013 in southern Taiwan. All patients with sepsis, who used antibiotics, with blood culture collected, and with available serum lactate levels in the emergency department, were included in the analysis. We evaluated the difference in serum lactate level between the elderly and non-elderly septic patients by using multiple regression models.A total of 7087 patients were enrolled in the study. Elderly and non-elderly patients accounted for 62.3% (4414) and 40.2% (2673) of all patients, respectively. Statistically significant difference of serum lactate levels was not observed between elderly and non-elderly survivors (2.9 vs 3.0 mmol/L; P = .57); however, elderly patients had lower lactate levels than those within the 28-day in-hospital mortality (5.5 vs 6.6 mmol/L, P < .01). Multiple logistic regression revealed higher adjusted mortality risk in elderly and non-elderly patients with lactate levels of ≥4.0 mmol/L (odds ratio [OR], 4.98 and 5.82; P < .01, respectively), and lactate level between 2 and 4 mmol/L (OR, 1.57 and 1.99; P < .01, respectively) compared to that in the reference group with lactate levels of <2.0 mmol/L in each group. In receiver operating characteristic curve analysis, sensitivity rates for predicting mortality were 0.80 and 0.77 for non-elderly and elderly patients, respectively, by using serum lactate levels higher than 2.0 mmol/L.Septic elderly non-survivors had 1 mmol/L lower serum lactate level than those of the non-elderly non-survivors. Lactate >2 mmol/L still could provide enough sensitivity in predicting sepsis mortality in elder patients.
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Affiliation(s)
- Hsien-Hung Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
- School of Medicine, Chung Shan Medical University, Kaohsiung, Taiwan
| | - Fu-Cheng Chen
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Meng-Wei Change
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chi-Yung Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Tsung-Cheng Tsai
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Sheng-Yuan Hsiao
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chih-Min Su
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
- School of Medicine, Chung Shan Medical University, Kaohsiung, Taiwan
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Lee SY, Kim JJ, Jang JH, Hwang IC. Prognostic Factors in Septic Shock Patients on Arrival at Emergency Department. Ann Geriatr Med Res 2017. [DOI: 10.4235/agmr.2017.21.4.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Seong Yeob Lee
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jin Joo Kim
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jae Ho Jang
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - In Cheol Hwang
- Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea
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Francischetti IMB, Szymanski J, Rodriguez D, Heo M, Wolgast LR. Laboratory and clinical predictors of 30-day survival for patients on Extracorporeal Membrane Oxygenation (ECMO): 8-Year experience at Albert Einstein College of Medicine, Montefiore Medical Center. J Crit Care 2017; 40:136-144. [PMID: 28399414 DOI: 10.1016/j.jcrc.2017.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/21/2017] [Accepted: 03/29/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE Survival of patients on ECMO has remained stable in every population. Laboratory values predictors of survival are required to improve patient care. MATERIALS AND METHODS Clinical Looking Glass software was used to assess Electronic Medical Records (EMRs) of patients at Albert Einstein College of Medicine, Montefiore Medical Center (2007-2014). RESULTS Our population comprises of 166 adults and was divided in survivors and non-survivors, within 30days. Indications for ECMO were cardiac (65%), respiratory (25%) and infectious diseases (<10%). Eighty six patients (51.8%) survived the procedure. Gender, body weight, ejection fraction, diastolic blood pressure, and socio-economic status did not differ among survivors and non-survivors. In contrast, younger patients (45yo vs 55yo, p=0.0001) and higher systolic blood pressure (115mmHg vs 103mmHg, p=0.025) have favorable outcome. Univariate analysis shows that pre-cannulation values for creatinine (p=0.0003), chloride (p=0.009), bicarbonate (p=0.015) and pH (p=0.03) have prognostic value. Post-cannulation aPTT, pH, platelet and lymphocyte counts also have discriminative power. Notably, multiple logistic regressions for Multivariate Analysis identified chloride (OR 1.07; 95% CI 1.02-1.13; p=0.004), pH (OR 3.35; 95% CI 1.89-5.9; p<0.0001) and aPTT (OR 0.98; 95% CI 0.976-0.998; p=0.024) as independent risk factors for 30-day mortality. These results imply that pre-existing renal conditions and hemostatic dysregulation contribute to poor outcome. Finally, patients on VV-ECMO have increase odds of survival (OR 1.88; 95% CI 1.06-3.34; p=0.029). CONCLUSIONS Laboratory markers identified herein may guide the management of patients on ECMO.
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Affiliation(s)
- Ivo M B Francischetti
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States.
| | - James Szymanski
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States
| | - Daniel Rodriguez
- Pediatric Perfusion Service, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States
| | - Moonseong Heo
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States
| | - Lucia R Wolgast
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States
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Martín S, Pérez A, Aldecoa C. Sepsis and Immunosenescence in the Elderly Patient: A Review. Front Med (Lausanne) 2017; 4:20. [PMID: 28293557 PMCID: PMC5329014 DOI: 10.3389/fmed.2017.00020] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/15/2017] [Indexed: 12/27/2022] Open
Abstract
Sepsis is a prevalent, serious medical condition with substantial mortality and a significant consumption of health-care resources. Its incidence has increased around 9% annually in general population over the last years and specially in aged patients group. Several risk factors such as comorbidities, preadmission status, malnutrition, frailty, and an impared function in the immune system called immunosenescence are involved in the higher predisposition to sepsis in the elderly patients. Immunosenescence status consists in a functional impairment in both cell-mediated immunity and humoral immune responses and increases not only the risk for develop sepsis but also lead to more severe presentation of infection and may be is also related with a higher mortality. There is a also a concern about to admit patients in the intensive care units taking into account that the outcome of elderly patients is poorer compared to younger people. Nevertheless, the management of septic elderly patients does not differ substantially from younger people. In addition, the quality of life in septic elderly survivors is also lower than in younger people. But age, as alone factor, should not be used to determine treatment options because the poorer outcomes is thought to be due to the increased comorbidities and frailty in this group of patients.
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Affiliation(s)
- Silvia Martín
- Anaesthesia and Surgical Critical Care, Hospital Universitario rio Hortega , Valladolid , Spain
| | - Alba Pérez
- Anaesthesia and Surgical Critical Care, Hospital Universitario rio Hortega , Valladolid , Spain
| | - Cesar Aldecoa
- Anaesthesia and Surgical Critical Care, Hospital Universitario rio Hortega, Valladolid, Spain; University of Valladolid Medical School, Valladolid, Spain
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Baradari AG, Firouzian A, Davanlou A, Aarabi M, Daneshiyan M, Kiakolaye YT. COMPARISON OF PATIENTS' ADMISSION, MEAN AND HIGHEST SOFA SCORES IN PREDICTION OF ICU MORTALITY: A PROSPECTIVE OBSERVATIONAL STUDY. Mater Sociomed 2016; 28:343-347. [PMID: 27999481 PMCID: PMC5149442 DOI: 10.5455/msm.2016.28.343-347] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/05/2016] [Indexed: 01/31/2023] Open
Abstract
Background: Use of valid criteria for evaluation of patients admitted to intensive care unit (ICU) is essential to assess the quality of services provided. This study was conducted to evaluate admission, mean and the highest Sequential Organ Failure Assessment (SOFA) scores in predicting mortality and outcome of patients admitted to the ICU. Methods: This prospective observational study was conducted on 300 patients admitted to the ICU of Imam Khomeini Hospital, Sari, Iran, in 2015. The SOFA tool was applied at the beginning of the admission of patients in the ICU and then every 24 hours. Functions of six vital organs were recorded on a daily basis for scoring with SOFA. Demographic profile, the main diagnosis leading to hospitalization in the ICU, previous interventions, complications and hospital outcomes were recorded for each patient. The patients’ admission, mean and highest SOFA scores were also evaluated and recorded during the study period. These scores were compared between deceased and survived patients. ROC curve determined the best cut-off point of score calculated. Results: Among all 300 patients who were enrolled in the study, 189 (63%) cases were males. Trauma was the most common cause of hospitalization and mortality. Thirty point seven percent of 92 deceased patients needed to intubation. Mean length of ICU and hospital stay were significantly longer for deceased patients than the survivors (P <0.001). The admission, mean and highest SOFA scores were 11.72, 16.38 and 16.45 in deceased patients, as well as 6.52, 5.82 and 6.5 in survived patients, respectively. The area under the curve (AUC) for the admission, mean and highest SOFA scores were 0.875, 0.988 and 0982, respectively. All three models were able to predict the outcome of patients significantly (P <0.0001). The cut-off point of 10.6 for the mean SOFA had the highest sensitivity and specificity in predicting mortality. Conclusion: The results of this study showed that the mean SOFA score had the highest sensitivity and specificity in prediction of ICU mortality. Therefore, this criterion is a valuable indicator to better predictions of mortality and morbidity rate in the ICU patients, which can lead to appropriate health care and therapeutic interventions in these patients.
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Affiliation(s)
- Afshin Gholipour Baradari
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abolfazl Firouzian
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Davanlou
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohsen Aarabi
- Department of Epidemiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Daneshiyan
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Kim J, Choi SM, Park YS, Lee CH, Lee SM, Yim JJ, Yoo CG, Kim YW, Han SK, Lee J. Factors influencing the initiation of intensive care in elderly patients and their families: A retrospective cohort study. Palliat Med 2016; 30:789-99. [PMID: 26934945 DOI: 10.1177/0269216316634241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The number of elderly patients admitted to the intensive care unit is constantly growing. However, a decision regarding intensive care in these populations remains a challenge. AIM To identify factors that influences the decision of elderly patients and their families about whether to initiate intensive care in case of an acute event. DESIGN/PARTICIPANTS Medical records of patients (>80 years), who were admitted to general wards and referred for intensive care, were retrospectively reviewed. Patients who received intensive care were compared with those not agreeing to the initiation of intensive care. RESULTS Among the 125 patients, 45 agreed to receiving intensive care. Baseline characteristics at the time of intensive care unit referral were similar between the intensive care and non-intensive care groups. Only one patient had advance directives before the intensive care unit referral. Lower economic status (odds ratio = 0.27, 95% confidence interval = 0.08-0.94) and cognitive impairment (odds ratio = 0.20, 95% confidence interval = 0.07-0.56) were found associated with a lower likelihood of agreeing to intensive care, while a large number of participants involved in the decision-making process were associated with a higher likelihood of intensive care unit use (odds ratio = 1.82, 95% confidence interval = 1.08-3.09). Mean duration of hospital stay was longer for the intensive care group as compared with the non-intensive care group (28.8 days and 19.8 days, respectively, p = 0.03). However, there was no significant difference in the survival rate. CONCLUSION The initiation of intensive care in elderly patients was influenced not only by medical conditions but also by the patient's economic status and the number of family members involved in the decision-making process.
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Affiliation(s)
- Junghyun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Reyes JCL, Alonso JV, Fonseca J, Santos ML, Jiménez MDLÁRC, Braniff J. Characteristics and mortality of elderly patients admitted to the Intensive Care Unit of a district hospital. Indian J Crit Care Med 2016; 20:391-7. [PMID: 27555692 PMCID: PMC4968060 DOI: 10.4103/0972-5229.186219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM To study all the elderly patients (≥75 years) who were admitted in an Intensive Care Unit (ICU) of a Spanish hospital and identify factors associated with mortality. PATIENTS AND METHODS A retrospective, observational data collected prospectively in patients ≥75 years recruited from the ICU in the period of January 2004 to December 2010. RESULTS During the study period, 1661 patients were admitted to our unit, of whom 553 (33.3%) were older than 75 years. The mean age was 79.9 years, 317 (57.3%) were male, and the overall in-hospital mortality was 94 patients (17% confidence interval 14-20.3%). When comparing patients who survived to those who died, we found significant differences in mean age (P = 0.001), Acute Physiologic Assessment and Chronic Health Evaluation II and Simplified Acute Physiology Scoring II (SAPS II) on admission (P < 0.0001, postoperative patients (P = 0.001), and need for mechanical ventilation (P < 0.0001). Comparing age groups, we found statistically significant differences in SAPS II (P = 0.007), diagnosis of non-ST-segment elevation myocardial infarction (P = 0.014), complicated postoperative period (P = 0.001), and pacemaker (P = 0.034). Mortality between the groups was statistically significant (P = 0.004). The survival between the group of 65 and 74 years and patients >75 years was not significant (P = 0.1390). CONCLUSIONS The percentage of elderly patients in our unit is high, with low mortality rates. The age itself is not the sole determinant for admission to the ICU and other factors should be taken into account.
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Affiliation(s)
- José Carlos Llamas Reyes
- Department of Emergency and Critical Care Medicine, Hospital Comarcal Valle de los Pedroches de Pozoblanco, Cordoba, Spain
| | - Joaquín Valle Alonso
- Department of Accident and Emergency Medicine, Southport and Formby District General Hospital, Merseyside PR8 6PN, UK
| | - Javier Fonseca
- Department of Family Medicine, Centro de Salud Montoro, Cordoba, Spain
| | - Margarita Luque Santos
- Department of Emergency and Critical Care Medicine, Hospital Comarcal Valle de los Pedroches de Pozoblanco, Cordoba, Spain
| | | | - Jay Braniff
- Department of Accident and Emergency Medicine, Southport and Formby District General Hospital, Merseyside PR8 6PN, UK
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Sánchez-Hurtado L, Terán-Godínez C, Herrera-Gómez A, Arredondo-Armenta J, Guevara-García H, García-Guillén F, Meneses-García A, Juárez-Cedillo T, Ñamendys-Silva S. Outcomes of elderly patients admitted to an oncological intensive care unit: A retrospective analysis. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ukkonen M, Karlsson S, Laukkarinen J, Rantanen T, Paajanen H. Severe Sepsis in Elderly Patients Undergoing Gastrointestinal Surgery-a Prospective Multicenter Follow-up Study of Finnish Intensive Care Units. J Gastrointest Surg 2016; 20:1028-33. [PMID: 26768009 DOI: 10.1007/s11605-016-3076-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/04/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND We aimed to evaluate the outcome of elderly patients with severe sepsis after alimentary tract surgery. METHODS A prospective study was conducted in 24 intensive care units (ICU) in Finland. Four thousand five hundred consecutive patients were admitted to ICUs and 470 patients fulfilled the criteria for severe sepsis. All patients who had undergone gastrointestinal surgery were included. The outcomes of elderly (≥65 years) and younger patients were compared. The key factor under analysis was death from any cause during the hospitalization or within 1 year after the surgery. RESULTS A total of 73 elderly patients (and 81 younger patients) were found to have severe alimentary tract surgery-related sepsis. The mean age of the elderly patients was 76.4 years, and 56.2 % were female. The most common indication for surgery was acute cholecystitis (21.9 %), followed by acute diverticulitis (13.7 %), and gastroduodenal ulcer (13.7 %). The anatomic site of the infection was intra-abdominal in 86.3 % of cases, the second most common being pulmonary (13.7 %). In-hospital mortality was 47.9 % and 1-year mortality 64.4 %. Of the discharged patients, 31.6 % died within 1 year. Patients who died were older and more frequently had concomitant conditions. The ICU scoring systems (APACHE, SAPS, and SOFA) and elevated lactate levels were predictive of increased mortality. CONCLUSION Severe sepsis among the elderly is a rare but often-fatal infectious event. In addition to high in-hospital mortality, it is also associated with significant 1-year mortality.
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Affiliation(s)
- Mika Ukkonen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, FIN-33521, Tampere, Finland.
| | - Sari Karlsson
- Department of Intensive Care Medicine, Tampere University Hospital, Tampere, Finland
| | - Johanna Laukkarinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, FIN-33521, Tampere, Finland
| | - Tuomo Rantanen
- Department of Gastrointestinal Surgery, University of Eastern Finland, Kuopio, Finland
| | - Hannu Paajanen
- Department of Gastrointestinal Surgery, University of Eastern Finland, Kuopio, Finland
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Kim J, Lee J, Choi S, Lee J, Park YS, Lee CH, Yim JJ, Yoo CG, Kim YW, Han SK, Lee SM. Trends in the Use of Intensive Care by Very Elderly Patients and Their Clinical Course in a Single Tertiary Hospital in Korea. Korean J Crit Care Med 2016. [DOI: 10.4266/kjccm.2016.31.1.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Junghyun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jungkyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sunmi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Paz Martín D, Aliaño Piña M, Pérez Martín F, Velaz Domínguez S, Vázquez Vicente B, Poza Hernández P, Ávila Sánchez FJ. Hospital mortality in postoperative critically ill patients older than 80 years. Can we predict it at an early stage? ACTA ACUST UNITED AC 2015; 63:313-9. [PMID: 26639789 DOI: 10.1016/j.redar.2015.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 08/10/2015] [Accepted: 08/12/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the incidence of in-hospital mortality throughout the post-surgical period of patients aged 80 or over who were admitted to the post-surgical critical care unit, as well as to assess the predictive capacity of those variables existing in the first 48hours on the in-hospital mortality. MATERIAL AND METHODS An observational retrospective cohort study conducted on postsurgical patients up to 80years old who were admitted to the unit between June 2011 and December 2013. Univariate and multivariate binary logistic regression was used to determine the association between mortality and the independent variables. RESULTS Of the 186 patients included, 9 (4.8%) died in the critical care unit, and 22 (11.8%) died in wards during hospital admission, giving a hospital mortality of 31 (16.7%). Among the 78 patients (42%) that underwent acute surgery, and the 108 who underwent elective surgery, there was a mortality rate of 19 (10.2%) and 12 (6.5%), respectively. As regards the variables analysed during the first 48hours of admission that showed to be hospital mortality risk factor were the need for mechanical ventilation over 48h, with an OR: 7.146 (95%CI: 1.563-32.664, P=.011) and the degree of the severity score on the APACHE II scale in the first 24hours, with an OR: 1.102 (95%CI: 1.005-1.208, P=.039). CONCLUSION The incidence of hospital mortality in very old patients found in our study is comparable to that reported by other authors. Patients who need mechanical ventilation over 48h, and with higher scores in the APACHE II scale could be at a higher risk of in-hospital mortality.
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Affiliation(s)
- D Paz Martín
- Grupo de Trabajo de Cuidados Críticos Perioperatorios (GTCCP) de la Sección de Cuidados Intensivos de la SEDAR Unidad de Reanimación, Servicio de Anestesiología y Reanimación, Complejo Hospitalario de Toledo, Toledo, España.
| | - M Aliaño Piña
- Grupo de Trabajo de Cuidados Críticos Perioperatorios (GTCCP) de la Sección de Cuidados Intensivos de la SEDAR Unidad de Reanimación, Servicio de Anestesiología y Reanimación, Complejo Hospitalario de Toledo, Toledo, España
| | - F Pérez Martín
- Grupo de Trabajo de Cuidados Críticos Perioperatorios (GTCCP) de la Sección de Cuidados Intensivos de la SEDAR Unidad de Reanimación, Servicio de Anestesiología y Reanimación, Complejo Hospitalario de Toledo, Toledo, España
| | - S Velaz Domínguez
- Grupo de Trabajo de Cuidados Críticos Perioperatorios (GTCCP) de la Sección de Cuidados Intensivos de la SEDAR Unidad de Reanimación, Servicio de Anestesiología y Reanimación, Complejo Hospitalario de Toledo, Toledo, España
| | - B Vázquez Vicente
- Grupo de Trabajo de Cuidados Críticos Perioperatorios (GTCCP) de la Sección de Cuidados Intensivos de la SEDAR Unidad de Reanimación, Servicio de Anestesiología y Reanimación, Complejo Hospitalario de Toledo, Toledo, España
| | - P Poza Hernández
- Grupo de Trabajo de Cuidados Críticos Perioperatorios (GTCCP) de la Sección de Cuidados Intensivos de la SEDAR Unidad de Reanimación, Servicio de Anestesiología y Reanimación, Complejo Hospitalario de Toledo, Toledo, España
| | - F J Ávila Sánchez
- Grupo de Trabajo de Cuidados Críticos Perioperatorios (GTCCP) de la Sección de Cuidados Intensivos de la SEDAR Unidad de Reanimación, Servicio de Anestesiología y Reanimación, Complejo Hospitalario de Toledo, Toledo, España
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Hachemi M, Bhageerutty K, Cattenoz M. Évaluation de l’état nutritionnel de la personne âgée en réanimation. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jeitziner MM, Zwakhalen SM, Bürgin R, Hantikainen V, Hamers JP. Changes in health-related quality of life in older patients one year after an intensive care unit stay. J Clin Nurs 2015; 24:3107-17. [PMID: 26248729 DOI: 10.1111/jocn.12904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This study investigates health-related quality of life in older patients, over one year following an intensive care unit stay. BACKGROUND Health-related quality of life is an important outcome when assessing long-term effectiveness of intensive care treatment, and to assist patients, their relatives and healthcare professionals in making treatment decisions. DESIGN Prospective non-randomised longitudinal study. METHODS The Short Form Health Survey 36 was administered 1 week after an intensive care stay (retrospective baseline), and after six months and 12 months to the study population and to an age-matched comparison group at recruitment (baseline), and after six months and 12 months. Demographic data, admission diagnosis, length of stay, severity of illness, pain, anxiety, agitation, and intratracheal suctioning, turning and intubation were recorded. Recruitment period: December 2008 to April 2011. RESULTS Health-related quality of life of the older patients was significantly lower than the comparison group, both before and after the intensive care unit stay, and showed great individual variability. Within group scores, however, were stable over the year. Both physical and mental health scores were lower for the older patients. Renal failure, cardiac surgery and illness severity were associated with lower physical health scores. Cardiovascular illness, intratracheal suctioning and turning were associated with lower mental health scores. CONCLUSIONS Health-related quality of life was lower in older patients than in the age-matched group but remained stable over one year. RELEVANCE TO CLINICAL PRACTICE Older patients with severe illnesses, acute renal failure or who have had cardiac surgery, need additional support after hospital discharge due to functional restrictions. Discharge planning should ensure that this support would be provided. Special attention should be given to develop and use methods to reduce distress during routine intensive care interventions such as intratracheal suctioning or turning.
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Affiliation(s)
- Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, University Hospital (Inselspital), Bern, Switzerland.,Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Sandra Mg Zwakhalen
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Reto Bürgin
- National Centre of Competence in Research, University of Geneva, Geneva, Switzerland
| | - Virpi Hantikainen
- Institute of Applied Nursing Science, University of Applied Sciences, St. Gallen, Switzerland
| | - Jan Ph Hamers
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Infection, sepsis, and immune function in the older adult receiving critical care. Crit Care Nurs Clin North Am 2015; 26:47-60. [PMID: 24484923 DOI: 10.1016/j.ccell.2013.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The elderly are vulnerable to developing sepsis due to functional and immune changes, and frequent instrumentation and contact with the health care system. Those infected often present with nonspecific complaints and are at risk for underrecognition and undertreatment, with greater likelihood of rapid progression to severe sepsis and septic shock; however, often respond well to early, organized, and aggressive interventions. Survivors may not return to baseline level of function and may require long-term care facilities after discharge from the hospital. Patient and family preferences for goals of care should be explored as early as possible and incorporated into treatment plans.
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Ota H, Kawai H, Sato M, Ito K, Fujishima S, Suzuki H. Effect of early mobilization on discharge disposition of mechanically ventilated patients. J Phys Ther Sci 2015; 27:859-64. [PMID: 25931747 PMCID: PMC4395731 DOI: 10.1589/jpts.27.859] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/07/2014] [Indexed: 01/02/2023] Open
Abstract
[Purpose] The purpose of this study was to clarify the benefits of early mobilization for mechanically ventilated patients for their survival to discharge to home from the hospital. [Subjects and Methods] Medical records were retrospectively analyzed of patients who satisfied the following criteria: age ≥ 18 years; performance status 0-2 and independent living at their home before admission; mechanical ventilation for more than 48 h; and survival after mechanical ventilation. Mechanically ventilated patients in the early mobilization (EM) group (n = 48) received mobilization therapy, limb exercise and chest physiotherapy, whereas those in the control group (n = 60) received bed rest alone. Univariate and multivariate logistic regression analyses were performed to identify clinical variables associated with discharge disposition. [Results] Early mobilization was a positive independent factor and the presence of neurological deficits was a negative factor contributing to discharge to home. Among patients surviving mechanical ventilation without neurological deficits, the rate of discharge to home was significantly higher among patients in the EM group that in the control group (76% vs. 40%). [Conclusion] Early mobilization can improve the rate of discharge to home of patients requiring mechanical ventilation because of non-neurological deficits.
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Affiliation(s)
- Hideki Ota
- Department of Thoracic Surgery, Akita Red Cross Hospital, Japan ; Respiratory Support Team, Akita Red Cross Hospital, Japan
| | - Hideki Kawai
- Department of Thoracic Surgery, Akita Red Cross Hospital, Japan
| | - Makoto Sato
- Respiratory Support Team, Akita Red Cross Hospital, Japan ; Department of Rehabilitation, Akita Red Cross Hospital, Japan
| | - Kazuaki Ito
- Respiratory Support Team, Akita Red Cross Hospital, Japan ; Department of Rehabilitation, Akita Red Cross Hospital, Japan
| | | | - Hiroko Suzuki
- Department of Emergency and Critical Care, Akita Red Cross Hospital, Japan
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Sodhi K, Singla MK, Shrivastava A, Bansal N. Do Intensive Care Unit treatment modalities predict mortality in geriatric patients: An observational study from an Indian Intensive Care Unit. Indian J Crit Care Med 2014; 18:789-95. [PMID: 25538413 PMCID: PMC4271278 DOI: 10.4103/0972-5229.146312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Ageing being a global phenomenon, increasing number of elderly patients are admitted to Intensive Care Units (ICU). Hence, there is a need for continued research on outcomes of ICU treatment in the elderly. Objectives: Examine age-related difference in outcomes of geriatric ICU patients. Analyze ICU treatment modalities predicting mortality in patients >65 years of age. Materials and Methods: A retrospective observational study was conducted in 2317 patients admitted in a multi-specialty ICU of a tertiary care hospital over 2-year study period from January 1, 2011 to December 31, 2012. A clinical database was collected which included age, sex, specialty under which admitted, APACHE-II and SOFA scores, patient outcome, average length of ICU stay, and the treatment modalities used in ICU including mechanical ventilation, inotropes, hemodialysis, and tracheostomy. Patients were divided into two groups: <65 years (Control group) and >65 years (Geriatric age group). Results: The observed overall ICU mortality rate in the study population was 19.6%; no statistical difference was observed between the control and geriatric age group in overall mortality (P > 0.05). Mechanical ventilation (P = 0.003, odds ratio [OR] =0.573, 95% confidence interval [CI] =0.390–0.843) and use of inotropes (P = 0.018, OR = 0.661, 95% CI = 0.456–0.958) were found to be predictors of mortality in elderly population. On multivariate analysis, inotropic support was found to be an independent ICU treatment modality predicting mortality in the geriatric age group (β coefficient = 1.221, P = 0.000). Conclusion: Intensive Care Unit mortality rates increased in the geriatric population requiring mechanical ventilation and inotropes during ICU stay. Only inotropic support could be identified as independent risk factor for mortality.
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Affiliation(s)
- Kanwalpreet Sodhi
- Department of Critical Care, SPS Apollo Hospitals, Ludhiana, Punjab, India
| | - Manender Kumar Singla
- Department of Anaesthesia and Critical Care and Statistician, SPS Apollo Hospitals, Ludhiana, Punjab, India
| | - Anupam Shrivastava
- Department of Anaesthesia and Critical Care and Statistician, SPS Apollo Hospitals, Ludhiana, Punjab, India
| | - Namita Bansal
- Department of Quality Assurance, SPS Apollo Hospitals, Ludhiana, Punjab, India
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Affiliation(s)
- Palepu B Gopal
- Department of Critical Care Medicine, Axon Anaesthesia Associates, Care Hospitals, Hyderabad, Telangana, India
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48
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Conterno LO, Toni SMD, Konkiewitz RG, Guedes ES, Barros RTD, Tiveron MG. Impact of hospital infections on patients outcomes undergoing cardiac surgery at Santa Casa de Misericórdia de Marília. Braz J Cardiovasc Surg 2014; 29:167-76. [PMID: 25140466 PMCID: PMC4389460 DOI: 10.5935/1678-9741.20140037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/17/2013] [Indexed: 11/25/2022] Open
Abstract
Objective this study aimed to determine the incidence of nosocomial infections, the risk
factors and the impact of these infections on mortality among patients undergoing
to cardiac surgery. Methods Retrospective cohort study of 2060 consecutive patients from 2006 to 2012 at the
Santa Casa de Misericórdia de Marília. Results 351 nosocomial infections were diagnosed (17%), 227 non-surgical infections and
124 surgical wound infections. Major infections were mediastinitis (2.0%), urinary
tract infection (2.8%), pneumonia (2.3%), and bloodstream infection (1.7%). The
in-hospital mortality was 6.4%. Independent variables associated with non-surgical
infections were age > 60 years (OR 1.59, 95% CI 1.09 to 2.31), ICU stay > 2
days (OR 5, 49, 95% CI 2.98 to 10, 09), mechanical ventilation > 2 days (OR11,
93, 95% CI 6.1 to 23.08), use of urinary catheter > 3 days (OR 4.85 95% CI 2.95
-7.99). Non-surgical nosocomial infections were more frequent in patients with
surgical wound infection (32.3% versus 7.2%, OR 6.1, 95% CI 4.03 to 9.24).
Independent variables associated with mortality were age greater than 60 years (OR
2.0; 95% CI 1.4 to3.0), use of vasoactive drugs (OR 3.4, 95% CI 1.9 to 6, 0),
insulin use (OR 1.8; 95% CI 1.2 to 2.8), surgical reintervention (OR 4.4; 95% CI
2.1 to 9.0) pneumonia (OR 4.3; 95% CI 2.1 to 8.9) and bloodstream infection (OR =
4.7, 95% CI 2.0 to 11.2). Conclusion Non-surgical hospital infections are common in patients undergoing cardiac
surgery; they increase the chance of surgical wound infection and mortality.
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Affiliation(s)
| | | | | | - Elaine Salla Guedes
- Hospital Infection Control Service, Santa Casa de Misericordia de Marília, Marília, SP, Brazil
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Zampieri FG, Colombari F. The impact of performance status and comorbidities on the short-term prognosis of very elderly patients admitted to the ICU. BMC Anesthesiol 2014; 14:59. [PMID: 25071415 PMCID: PMC4112835 DOI: 10.1186/1471-2253-14-59] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients ≥80 years of age are increasingly being admitted to the intensive care unit (ICU). The impact of relevant variables, such comorbidities and performance status, on short-term outcomes in the very elderly is largely unknown. Few studies address the calibration of illness severity scores (SAPS3 score) within this population. We investigated the risk factors for hospital mortality in critically ill patients ≥80 years old, emphasizing performance status and comorbidities, and assessed the calibration of SAPS3 scores in this population. METHODS 1129 very elderly patients admitted to a tertiary ICU in Brazil during a two-year period were retrospectively included in this study. Demographic features, reasons for admission, illness severity, comorbidities (including the Charlson Comorbidity Index) and a simplified performance status measurement were obtained. After univariate analysis, a multivariate model was created to evaluate the factors that were associated with hospital mortality. Alternatively, a conditional inference tree with recursive partitioning was constructed. Calibration of the SAPS3 scores and the multivariate model were evaluated using the Hosmer-Lemeshow test and a calibration plot. Discrimination was assessed using a receiver operating characteristics curve. RESULTS On multivariate analysis after stepwise regression, only the SAPS3 score (OR 1.08, 95% CI 1.06-1.10), Charlson Index (OR 1.16, 95% CI 1.07-1.27), performance status (OR 1.61, 95% CI 1.05-2.64 for partially dependent patients and OR 2.39, 95% CI 1.38-4.13 for fully dependent patients) and a non-full code status (OR 11.74, 95% CI 6.22-22.160) were associated with increased hospital mortality. Conditional inference tree showed that performance status and Charlson Index had the greatest influence on patients with less severe disease, whereas a non-full code status was prominent in patients with higher illness severity (SAPS3 score >61). The model obtained after logistic regression that included the before mentioned variables demonstrated better calibration and greater discrimination capability (AUC 0.86, 95% CI 0.83-0.89 versus AUC 0.81, 95% CI 0.78-0.84, respectively; p < 0.001) than the SAPS3 score alone. CONCLUSIONS Performance status and comorbidities are important determinants of short-term outcome in critically ill elderly patients ≥80 years old. The addition of simple background information may increase the calibration of the SAPS3 score in this population.
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Affiliation(s)
- Fernando G Zampieri
- Unidade de Terapia Intensiva, Hospital Alemão Oswaldo Cruz, Rua João Julião, 133, São Paulo, São Paulo, Brazil ; Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Fernando Colombari
- Unidade de Terapia Intensiva, Hospital Alemão Oswaldo Cruz, Rua João Julião, 133, São Paulo, São Paulo, Brazil
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Comparison of intensive-care-unit-acquired infections and their outcomes among patients over and under 80 years of age. J Hosp Infect 2014; 87:152-8. [DOI: 10.1016/j.jhin.2014.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 03/27/2014] [Indexed: 11/21/2022]
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