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Fumagalli RM, Chiarelli M, Cazzaniga M, Bonato C, D'Angelo L, Cavalieri D'Oro L, Cerino M, Terragni S, Lainu E, Lorini C, Scarazzati C, Tazzari SE, Porro F, Aldé S, Burati M, Brambilla W, Nattino S, Locatelli M, Valsecchi D, Spreafico P, Tantardini V, Schiavo G, Zago MP, Fumagalli LAM. Blood cell differential count discretisation modelling to predict survival in adults reporting to the emergency room: a retrospective cohort study. BMJ Open 2023; 13:e071937. [PMID: 37993167 PMCID: PMC10668290 DOI: 10.1136/bmjopen-2023-071937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 10/02/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVES To assess the survival predictivity of baseline blood cell differential count (BCDC), discretised according to two different methods, in adults visiting an emergency room (ER) for illness or trauma over 1 year. DESIGN Retrospective cohort study of hospital records. SETTING Tertiary care public hospital in northern Italy. PARTICIPANTS 11 052 patients aged >18 years, consecutively admitted to the ER in 1 year, and for whom BCDC collection was indicated by ER medical staff at first presentation. PRIMARY OUTCOME Survival was the referral outcome for explorative model development. Automated BCDC analysis at baseline assessed haemoglobin, mean cell volume (MCV), red cell distribution width (RDW), platelet distribution width (PDW), platelet haematocrit (PCT), absolute red blood cells, white blood cells, neutrophils, lymphocytes, monocytes, eosinophils, basophils and platelets. Discretisation cut-offs were defined by benchmark and tailored methods. Benchmark cut-offs were stated based on laboratory reference values (Clinical and Laboratory Standards Institute). Tailored cut-offs for linear, sigmoid-shaped and U-shaped distributed variables were discretised by maximally selected rank statistics and by optimal-equal HR, respectively. Explanatory variables (age, gender, ER admission during SARS-CoV2 surges and in-hospital admission) were analysed using Cox multivariable regression. Receiver operating curves were drawn by summing the Cox-significant variables for each method. RESULTS Of 11 052 patients (median age 67 years, IQR 51-81, 48% female), 59% (n=6489) were discharged and 41% (n=4563) were admitted to the hospital. After a 306-day median follow-up (IQR 208-417 days), 9455 (86%) patients were alive and 1597 (14%) deceased. Increased HRs were associated with age >73 years (HR=4.6, 95% CI=4.0 to 5.2), in-hospital admission (HR=2.2, 95% CI=1.9 to 2.4), ER admission during SARS-CoV2 surges (Wave I: HR=1.7, 95% CI=1.5 to 1.9; Wave II: HR=1.2, 95% CI=1.0 to 1.3). Gender, haemoglobin, MCV, RDW, PDW, neutrophils, lymphocytes and eosinophil counts were significant overall. Benchmark-BCDC model included basophils and platelet count (area under the ROC (AUROC) 0.74). Tailored-BCDC model included monocyte counts and PCT (AUROC 0.79). CONCLUSIONS Baseline discretised BCDC provides meaningful insight regarding ER patients' survival.
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Affiliation(s)
- Riccardo Mario Fumagalli
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
- Klinik für Angiologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Marco Chiarelli
- Dip.Chirurgico, Chirurgia Urgenza, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Massimo Cazzaniga
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Claudio Bonato
- Dipartimento Servizi Clinici, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Luciano D'Angelo
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Luca Cavalieri D'Oro
- UOC Epidemiologia, Agenzia per la Tutela della Salute Brianza, Monza, Lombardia, Italy
| | - Mario Cerino
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Sabina Terragni
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Elisa Lainu
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Cristina Lorini
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Claudio Scarazzati
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Sara Elisabetta Tazzari
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Francesca Porro
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Simone Aldé
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Morena Burati
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - William Brambilla
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Stefano Nattino
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
- Scuola Spec. Medicina Emergenza-Urgenza, Università degli Studi di Milano, Milano, Lombardia, Italy
| | - Matteo Locatelli
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
- Polo formativo, Agenzia per la Tutela della Salute Brianza, Monza, Lombardia, Italy
| | - Daria Valsecchi
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Paolo Spreafico
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Valter Tantardini
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Gianpaolo Schiavo
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Mauro Pietro Zago
- Dip.Chirurgico, Chirurgia Urgenza, Ospedale Alessandro Manzoni, Lecco, LC, Italy
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Zhao X, Wu X, Si Y, Xie J, Wang L, Liu S, Duan C, Wang Q, Wu D, Wang Y, Chen J, Yang J, Hu S, Yin W, Li J. D-DI/PLT can be a prognostic indicator for sepsis. PeerJ 2023; 11:e15910. [PMID: 37692119 PMCID: PMC10487589 DOI: 10.7717/peerj.15910] [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: 03/20/2023] [Accepted: 07/26/2023] [Indexed: 09/12/2023] Open
Abstract
Aims To investigate the indicators affecting the early outcome of patients with sepsis and to explore its prognostic efficacy for sepsis. Methods We collected clinical data from 201 patients with sepsis admitted to the emergency department of Xijing Hospital between June 2019 and June 2022. The patients were categorized into groups (survival or fatality) based on their 28-day prognosis. The clinical characteristics, biochemical indexes, organ function-related indicators, and disease scores of the patients were analyzed for both groups. Risk factor analysis was conducted for the indicators with significant differences. Results Among the indicators with significant differences between the deceased and survival groups, D-dimer (D-DI), Sequential Organ Failure Assessment (SOFA) score, platelet (PLT), international normalized ratio (INR), and D-DI/PLT were identified as independent risk factors affecting the prognosis of sepsis patients. Receiver operating characteristic (ROC) curves showed that D-DI/PLT (area under the curve (AUC) = 93.9), D-DI (AUC = 89.6), PLT (AUC = 81.3), and SOFA (AUC = 78.4) had good judgment efficacy. Further, Kaplan Meier (K-M) survival analysis indicated that the 28-day survival rates of sepsis patients were significantly decreased when they had high levels of D-DI/PLT, D-DI, and SOFA as well as low PLTs. The hazard ratio (HR) of D-DI/PLT between the two groups was the largest (HR = 16.19). Conclusions D-DI/PLT may be an independent risk factor for poor prognosis in sepsis as well as a clinical predictor of patient prognosis.
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Affiliation(s)
- Xiaojun Zhao
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Xiuhua Wu
- Department of Respiratory and Clinical Care Medicine, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Yi Si
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Jiangang Xie
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Linxiao Wang
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
- College of Life Sciences, Northwest University, Xi’an, Shaanxi, China
| | - Shanshou Liu
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Chujun Duan
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Qianmei Wang
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Dan Wu
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Yifan Wang
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Jijun Chen
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Jing Yang
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Shanbo Hu
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Wen Yin
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Junjie Li
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
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Kazancioglu S, Bastug A, Ozbay BO, Tezcan H, Buyuktarakci C, Akbay A, Bodur H. The usefulness of hematological parameters and cerebrospinal fluid indexes in the differential diagnosis of acute bacterial from viral meningitis. Diagn Microbiol Infect Dis 2023; 107:116005. [PMID: 37392600 DOI: 10.1016/j.diagmicrobio.2023.116005] [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: 01/30/2022] [Revised: 04/19/2023] [Accepted: 06/07/2023] [Indexed: 07/03/2023]
Abstract
Central nervous system (CNS) infection is a medical emergency with an important cause of mortality worldwide. The 79 patients with confirmed acute CNS infection (48 bacterial and 31 viral meningitis) were evaluated. Bacterial meningitis score, cerebrospinal fluid (CSF)/serum glucose ratio, and CSF/serum albumin ratio had the highest area under the curves (0.873, 0.843, 0.810, respectively) for discriminating bacterial meningitis. Neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte ratio (PLR) and CSF lactate dehydrogenase have a good ability for the differential diagnosis of bacterial meningitis. CSF/serum glucose ratio, NLR (with a cut-off value> 8.87), large unstained cell, total protein, albumin, and procalcitonin levels were found to be predictors for mortality. NLR can be used as a biomarker to differentiate bacterial meningitis from viral meningitis and to predict the prognosis of CNS infection. CSF/serum albumin ratio and CSF lactate dehydrogenase can be used to predict bacterial meningitis as well as CSF/serum glucose ratio.
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Affiliation(s)
- Sumeyye Kazancioglu
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
| | - Aliye Bastug
- Health Science University Turkey, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Bahadir Orkun Ozbay
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Hatice Tezcan
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Cansu Buyuktarakci
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Aysenur Akbay
- Ministry of Health Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Hurrem Bodur
- Health Science University Turkey, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
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Shimoni Z, Froom P, Silke B, Benbassat J. The presence of a urinary catheter is an important predictor of in-hospital mortality in internal medicine patients. J Eval Clin Pract 2022; 28:1113-1118. [PMID: 35510815 DOI: 10.1111/jep.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 12/01/2022]
Abstract
RATIONALE AND OBJECTIVE Mortality rates are used to assess the quality of hospital care after appropriate adjustment for case-mix. Urinary catheters are frequent in hospitalized adults and might be a marker of patient frailty and illness severity. However, we know of no attempts to estimate the predictive value of indwelling catheters for specific patient outcomes. The objective of the present study was to (a) identify the variables associated with the presence of a urinary catheter and (b) determine whether it predicts in-hospital mortality after adjustment for these variables. METHODS The study population included all acutely admitted adult patients in 2020 (exploratory cohort) and January-October 2021 (validation cohort) to internal medicine, cardiology and intensive care departments at the Laniado Hospital, a regional hospital with 400 beds in Israel. There were no exclusion criteria. The predictor variables were the presence of a urinary catheter on admission, age, gender, comorbidities and admission laboratory test results. We used bivariate and multivariate logistic regression to test the associations between the presence of a urinary catheter and mortality after adjustment for the remaining independent variables on admission. RESULTS The presence of a urinary catheter was associated with other independent variables. In 2020, the odds of in-hospital mortality in patients with a urinary catheter before and after adjustment for the remaining predictors were 14.3 (11.6-17.7) and 6.05 (4.78-7.65), respectively. Adding the presence of a urinary catheter to the prediction logistic regression model increased its c-statistic from 0.887 (0.880-0.894) to 0.907 (0.901-0.913). The results of the validation cohort reduplicated those of the exploratory cohort. CONCLUSIONS The presence of a urinary catheter on admission is an important and independent predictor of in-hospital mortality in acutely hospitalized adults in internal medicine departments.
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Affiliation(s)
- Zvi Shimoni
- Department of Internal Medicine B, Laniado Hospital, Netanya, Israel.,Ruth and Bruce Rappaport School of Medicine, Technion University, Haifa, Israel
| | - Paul Froom
- Clinical Utility Department, Sanz Medical Center, Laniado Hospital, Netanya, Israel.,School of Public Health, University of Tel Aviv, Tel Aviv-Yafo, Israel
| | - Bernard Silke
- Division of Internal Medicine, St. James' Hospital, Dublin, Ireland
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