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Lawson CM, Jones C, Herman M, Kim C, Mannino E, Omer E, Venegas C. Does Ileus Represent the Forgotten End Organ Failure in Critical Illness? Curr Gastroenterol Rep 2024; 26:166-171. [PMID: 38558135 DOI: 10.1007/s11894-023-00910-8] [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] [Accepted: 12/12/2023] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW This review evaluates the current literature on ileus, impaired gastrointestinal transit (IGT), and acute gastrointestinal injury (AGI) and its impact on multiple organ dysfunction syndrome. RECENT FINDINGS Ileus is often under recognized in critically ill patients and is associated with significant morbidity and is potentially a marker of disease severity as seen in other organs like kidneys (ATN).
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Affiliation(s)
- Christy M Lawson
- Department of Trauma Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
| | - Chris Jones
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Michael Herman
- Department of Gastroenterology, Borland Groover Clinic, Fleming Island, FL, USA
| | - Cecilia Kim
- Department of Trauma Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Elizabeth Mannino
- Department of Trauma Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Endashaw Omer
- Department of Gastroenterology, University of Louisville, Louisville, KY, USA
| | - Carlas Venegas
- Department of Neurology, Mayo Clinc, Jacksonville, FL, USA
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Chang ZY, Gao WX, Zhang Y, Chen P, Zhao W, Wu D, Chen ZD, Gao YH, Liang WQ, Chen L, Xi HQ. Development and validation of a nomogram to predict postsurgical intra-abdominal infection in blunt abdominal trauma patients: A multicenter retrospective study. Surgery 2024; 175:1424-1431. [PMID: 38402039 DOI: 10.1016/j.surg.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/23/2023] [Accepted: 01/13/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Intra-abdominal infection is a common complication of blunt abdominal trauma. Early detection and intervention can reduce the incidence of intra-abdominal infection and improve patients' prognoses. This study aims to construct a clinical model predicting postsurgical intra-abdominal infection after blunt abdominal trauma. METHODS This study is a retrospective analysis of 553 patients with blunt abdominal trauma from the Department of General Surgery of 7 medical centers (2011-2021). A 7:3 ratio was used to assign patients to the derivation and validation cohorts. Patients were divided into 2 groups based on whether intra-abdominal infection occurred after blunt abdominal trauma. Multivariate logistic regression and least absolute shrinkage and selection operator regression were used to select variables to establish a nomogram. The nomogram was evaluated, and the validity of the model was further evaluated by the validation cohort. RESULTS A total of 113 were diagnosed with intra-abdominal infection (20.4%). Age, prehospital time, C-reactive protein, injury severity score, operation duration, intestinal injury, neutrophils, and antibiotic use were independent risk factors for intra-abdominal infection in blunt abdominal trauma patients (P < .05). The area under the receiver operating curve (area under the curve) of derivation cohort and validation cohort was 0.852 (95% confidence interval, 0.784-0.912) and 0.814 (95% confidence interval, 0.751-0.902). The P value for the Hosmer-Lemeshow test was .135 and .891 in the 2 cohorts. The calibration curve demonstrated that the nomogram had a high consistency between prediction and practical observation. The decision curve analysis also showed that the nomogram had a better potential for clinical application. To facilitate clinical application, we have developed an online at https://nomogramcgz.shinyapps.io/IAIrisk/. CONCLUSION The nomogram is helpful in predicting the risk of postoperative intra-abdominal infection in patients with blunt abdominal trauma and provides guidance for clinical decision-making and treatment.
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Affiliation(s)
- Zheng Y Chang
- Medical School of Chinese PLA, Beijing, China; Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wen X Gao
- Medical School of Chinese PLA, Beijing, China; Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yue Zhang
- Medical School of Chinese PLA, Beijing, China; Department of Endocrinology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peng Chen
- Medical School of Chinese PLA, Beijing, China; Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wen Zhao
- Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China; School of Medicine, Nankai University, Tianjin, China
| | - Di Wu
- Medical School of Chinese PLA, Beijing, China; Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhi D Chen
- Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yun H Gao
- Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wen Q Liang
- Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lin Chen
- Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Hong Q Xi
- Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
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Palmowski L, Nowak H, Witowski A, Koos B, Wolf A, Weber M, Kleefisch D, Unterberg M, Haberl H, von Busch A, Ertmer C, Zarbock A, Bode C, Putensen C, Limper U, Wappler F, Köhler T, Henzler D, Oswald D, Ellger B, Ehrentraut SF, Bergmann L, Rump K, Ziehe D, Babel N, Sitek B, Marcus K, Frey UH, Thoral PJ, Adamzik M, Eisenacher M, Rahmel T. Assessing SOFA score trajectories in sepsis using machine learning: A pragmatic approach to improve the accuracy of mortality prediction. PLoS One 2024; 19:e0300739. [PMID: 38547245 PMCID: PMC10977876 DOI: 10.1371/journal.pone.0300739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/04/2024] [Indexed: 04/01/2024] Open
Abstract
INTRODUCTION An increasing amount of longitudinal health data is available on critically ill septic patients in the age of digital medicine, including daily sequential organ failure assessment (SOFA) score measurements. Thus, the assessment in sepsis focuses increasingly on the evaluation of the individual disease's trajectory. Machine learning (ML) algorithms may provide a promising approach here to improve the evaluation of daily SOFA score dynamics. We tested whether ML algorithms can outperform the conventional ΔSOFA score regarding the accuracy of 30-day mortality prediction. METHODS We used the multicentric SepsisDataNet.NRW study cohort that prospectively enrolled 252 sepsis patients between 03/2018 and 09/2019 for training ML algorithms, i.e. support vector machine (SVM) with polynomial kernel and artificial neural network (aNN). We used the Amsterdam UMC database covering 1,790 sepsis patients for external and independent validation. RESULTS Both SVM (AUC 0.84; 95% CI: 0.71-0.96) and aNN (AUC 0.82; 95% CI: 0.69-0.95) assessing the SOFA scores of the first seven days led to a more accurate prognosis of 30-day mortality compared to the ΔSOFA score between day 1 and 7 (AUC 0.73; 95% CI: 0.65-0.80; p = 0.02 and p = 0.05, respectively). These differences were even more prominent the shorter the time interval considered. Using the SOFA scores of day 1 to 3 SVM (AUC 0.82; 95% CI: 0.68 0.95) and aNN (AUC 0.80; 95% CI: 0.660.93) led to a more accurate prognosis of 30-day mortality compared to the ΔSOFA score (AUC 0.66; 95% CI: 0.58-0.74; p < 0.01 and p < 0.01, respectively). Strikingly, all these findings could be confirmed in the independent external validation cohort. CONCLUSIONS The ML-based algorithms using daily SOFA scores markedly improved the accuracy of mortality compared to the conventional ΔSOFA score. Therefore, this approach could provide a promising and automated approach to assess the individual disease trajectory in sepsis. These findings reflect the potential of incorporating ML algorithms as robust and generalizable support tools on intensive care units.
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Affiliation(s)
- Lars Palmowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum, Germany
| | - Hartmuth Nowak
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum, Germany
- Zentrum für Künstliche Intelligenz, Medizininformatik und Datenwissenschaften, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Andrea Witowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum, Germany
| | - Björn Koos
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum, Germany
| | - Alexander Wolf
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum, Germany
| | - Maike Weber
- Medizinische Fakultät, Medizinisches Proteom-Center, Ruhr Universität Bochum, Bochum, Germany
- Zentrum für Proteindiagnostik (PRODI), Ruhr Universität Bochum, Bochum, Germany
| | - Daniel Kleefisch
- Medizinische Fakultät, Medizinisches Proteom-Center, Ruhr Universität Bochum, Bochum, Germany
- Zentrum für Proteindiagnostik (PRODI), Ruhr Universität Bochum, Bochum, Germany
| | - Matthias Unterberg
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum, Germany
| | - Helge Haberl
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum, Germany
| | - Alexander von Busch
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum, Germany
| | - Christian Ertmer
- Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Germany
| | - Alexander Zarbock
- Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Germany
| | - Christian Bode
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Christian Putensen
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Ulrich Limper
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universität Witten/Herdecke, Krankenhaus Köln-Merheim, Köln, Germany
| | - Frank Wappler
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universität Witten/Herdecke, Krankenhaus Köln-Merheim, Köln, Germany
| | - Thomas Köhler
- Klinik für Anästhesiologie und Operative Intensiv-, Rettungsmedizin und Schmerztherapie, Klinikum Herford, Herford, Germany
- Klinik für Anästhesiologie und Intensivmedizin, AMEOS-Klinikum Halberstadt, Halberstadt, Germany
| | - Dietrich Henzler
- Klinik für Anästhesiologie und Operative Intensiv-, Rettungsmedizin und Schmerztherapie, Klinikum Herford, Herford, Germany
| | - Daniel Oswald
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum Westfalen, Dortmund, Germany
| | - Björn Ellger
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum Westfalen, Dortmund, Germany
| | - Stefan F. Ehrentraut
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Lars Bergmann
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum, Germany
| | - Katharina Rump
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum, Germany
| | - Dominik Ziehe
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum, Germany
| | - Nina Babel
- Centrum für Translationale Medizin, Medizinische Klinik I, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Herne, Germany
| | - Barbara Sitek
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum, Germany
- Medizinische Fakultät, Medizinisches Proteom-Center, Ruhr Universität Bochum, Bochum, Germany
| | - Katrin Marcus
- Medizinische Fakultät, Medizinisches Proteom-Center, Ruhr Universität Bochum, Bochum, Germany
| | - Ulrich H. Frey
- Klinik für Anästhesiologie, Operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Germany
| | - Patrick J. Thoral
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Cardiovascular Science (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michael Adamzik
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum, Germany
| | - Martin Eisenacher
- Medizinische Fakultät, Medizinisches Proteom-Center, Ruhr Universität Bochum, Bochum, Germany
- Zentrum für Proteindiagnostik (PRODI), Ruhr Universität Bochum, Bochum, Germany
| | - Tim Rahmel
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr Universität Bochum, Bochum, Germany
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Kikuchi K, Kazuma S, Masuda Y. Improvement in ICU Mortality From Sepsis Associated With Recuperation From Septic Multiple-Organ Failure: A Retrospective, Single-Center, Cohort Study. Cureus 2024; 16:e57118. [PMID: 38681321 PMCID: PMC11055621 DOI: 10.7759/cureus.57118] [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: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Although mortality due to sepsis has decreased in recent decades, there are few studies on the timing of death during ICU stay. Characteristics of patients related to changes over the years of ICU death and changes in the timing of ICU death will provide new insights for future sepsis management. METHODS This was a single-center, retrospective study. Patients admitted to the ICU for sepsis between 2005 and 2019 were included in the study. The study period was divided into three five-year intervals, and the timing of death in the ICU was divided into early-stage (1-3 ICU days), mid-stage (4-14 ICU days), and late-stage (15 or more ICU days). Patient characteristics related to ICU death at three five-year intervals and the timing of death were evaluated. RESULTS ICU mortality for sepsis has decreased over time (2005-2009, 30.2%; 2010-2014, 21.0%; 2015-2019, 12.1%; p<0.01). In the timing of death, only mid-stage mortality decreased. Multiple-organ failure (OR, 4.53; 95% CI, 2.79-7.48) and hematological malignancies (OR, 2.48; 95% CI, 1.19-5.07) were associated with ICU mortality over entire study periods. Only multiple-organ failure was associated with ICU mortality at the five-year intervals (OR, 5.94; 95% CI, 2.73-13.7 for 2005-2009; OR, 4.01; 95% CI, 1.82-9.31 for 2010-2014; OR, 2.58; 95% CI, 1.05-6.59 for 2015-2019). Mid-stage mortality of multiple-organ failure decreased (2005-2009, 12.8%; 2010-2014, 7.6%; 2015-2019, 1.6%; p=0.02). However, early- and late-stage mortality of multiple-organ failure did not change. CONCLUSIONS Improvement in mid-stage mortality in septic patients with multiple-organ failure can contribute to the improvement of overall ICU mortality in patients with sepsis.
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Affiliation(s)
- Kenichiro Kikuchi
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, JPN
| | - Satoshi Kazuma
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, JPN
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, JPN
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González-Costello J, Pérez-Blanco A, Delgado-Jiménez J, González-Vílchez F, Mirabet S, Sandoval E, Cuenca-Castillo J, Camino M, Segovia-Cubero J, Sánchez-Salado JC, Pérez de la Sota E, Almenar-Bonet L, Farrero M, Zataraín E, García-Cosío MD, Garrido I, Barge-Caballero E, Gómez-Bueno M, de Juan Bagudá J, Manito-Lorite N, López-Granados A, García-Guereta L, Blasco-Peiró T, Sarralde-Aguayo JA, Sobrino-Márquez M, de la Fuente-Galán L, Crespo-Leiro MG, Coll E, Gran-Ipiña F, Díaz-Molina B, Doñate L, Arribas-Leal JM, Sánchez-Vicario F, Atienza F, Rábago Juan-Aracil G, García-Quintana A, Martínez-Alpuente I, Riesgo-Gil F, Hernández-Montfort J, Oliver-Juan E, Sánchez-Rivas J, Padilla-Martínez M, Pérez-Villares JM, Miñambres E, Domínguez-Gil B. Review of the allocation criteria for heart transplant in Spain in 2023. SEC-Heart Failure Association/ONT/SECCE consensus document. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:69-78. [PMID: 37926340 DOI: 10.1016/j.rec.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/26/2023] [Indexed: 11/07/2023]
Abstract
Heart transplant (HT) remains the best therapeutic option for patients with advanced heart failure (HF). The allocation criteria aim to guarantee equitable access to HT and prioritize patients with a worse clinical status. To review the HT allocation criteria, the Heart Failure Association of the Spanish Society of Cardiology (HFA-SEC), the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) and the National Transplant Organization (ONT), organized a consensus conference involving adult and pediatric cardiologists, adult and pediatric cardiac surgeons, transplant coordinators from all over Spain, and physicians and nurses from the ONT. The aims of the consensus conference were as follows: a) to analyze the organization and management of patients with advanced HF and cardiogenic shock in Spain; b) to critically review heart allocation and priority criteria in other transplant organizations; c) to analyze the outcomes of patients listed and transplanted before and after the modification of the heart allocation criteria in 2017; and d) to propose new heart allocation criteria in Spain after an analysis of the available evidence and multidisciplinary discussion. In this article, by the HFA-SEC, SECCE and the ONT we present the results of the analysis performed in the consensus conference and the rationale for the new heart allocation criteria in Spain.
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Affiliation(s)
- José González-Costello
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain.
| | | | - Juan Delgado-Jiménez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Sonia Mirabet
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitari de Sant Pau, Barcelona, Spain
| | - Elena Sandoval
- Servicio de Cirugía Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José Cuenca-Castillo
- Servicio de Cirugía Cardiaca, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Manuela Camino
- Unidad de Trasplante Cardiaco Pediátrico, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
| | - Javier Segovia-Cubero
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
| | - José Carlos Sánchez-Salado
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Luis Almenar-Bonet
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Marta Farrero
- Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
| | - Eduardo Zataraín
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Dolores García-Cosío
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Iris Garrido
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Eduardo Barge-Caballero
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña, A Coruña, Spain; Universidade da Coruña, A Coruña, Spain
| | - Manuel Gómez-Bueno
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia Arana (IDIPHISA), Madrid, Spain
| | - Javier de Juan Bagudá
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Nicolás Manito-Lorite
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Luis García-Guereta
- Servicio de Cardiología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | - Teresa Blasco-Peiró
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Luis de la Fuente-Galán
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - María Generosa Crespo-Leiro
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña, A Coruña, Spain; Universidade da Coruña, A Coruña, Spain
| | | | - Ferrán Gran-Ipiña
- Servicio de Cardiología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Beatriz Díaz-Molina
- Servicio de Cardiología, Hospital Universitario Central de Asturias, ISPA, Oviedo, Asturias, Spain
| | - Lucía Doñate
- Servicio de Cirugía Cardíaca, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - José María Arribas-Leal
- Servicio de Cirugía Cardiovascular, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Felipe Atienza
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Antonio García-Quintana
- Servicio de Cardiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Fernando Riesgo-Gil
- Cardiology Transplant Medicine, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Londres, United Kingdom
| | - Jaime Hernández-Montfort
- Advanced Heart Disease, Recovery and Replacement Programs, Baylor Scott and White Health, Central Texas and Greater Austin, United States
| | - Eva Oliver-Juan
- Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain; Servicio de Medicina Intensiva, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Sánchez-Rivas
- Organización Nacional de Trasplantes, Madrid, Spain; Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | - Eduardo Miñambres
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Roepke RML, Besen BAMP, Daltro-Oliveira R, Guazzelli RM, Bassi E, Salluh JIF, Damous SHB, Utiyama EM, Malbouisson LMS. Predictive Performance for Hospital Mortality of SAPS 3, SOFA, ISS, and New ISS in Critically Ill Trauma Patients: A Validation Cohort Study. J Intensive Care Med 2024; 39:44-51. [PMID: 37448331 DOI: 10.1177/08850666231188051] [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: 07/15/2023]
Abstract
Background: It is not known whether anatomical scores perform better than general critical care scores for trauma patients admitted to the intensive care unit (ICU). We compare the predictive performance for hospital mortality of general critical care scores (SAPS 3 and SOFA) with anatomical injury-based scores (Injury Severity Score [ISS] and New ISS [NISS]). Methods: Retrospective cohort study of patients admitted to a specialized trauma ICU from a tertiary hospital in São Paulo, Brazil between May, 2012 and January, 2016. We retrieved data from the ICU database for critical care scores and calculated ISS and NISS from chart data and whole body computed tomography results. We compared the predictive performance for hospital mortality of each model through discrimination, calibration, and decision-curve analysis. Results: The sample comprised 1053 victims of trauma admitted to the ICU, with 84.2% male patients and mean age of 40 (±18) years. Main injury mechanism was blunt trauma (90.7%). Traumatic brain injury was present in 67.8% of patients; 43.3% with severe TBI. At the time of ICU admission, 846 patients (80.3%) were on mechanical ventilation and 644 (64.3%) on vasoactive drugs. Hospital mortality was 23.8% (251). Median SAPS 3 was 41; median maximum SOFA within 24 h of admission, 7; ISS, 29; and NISS, 41. AUROCs (95% CI) were: SAPS 3 = 0.786 (0.756-0.817), SOFA = 0.807 (0.778-0.837), ISS = 0.616 (0.577-0.656), and NISS = 0.689 (0.649-0.729). In pairwise comparisons, SAPS 3 and SOFA did not differ, while both outperformed the anatomical scores (p < .001). Maximum SOFA within 24 h of admission presented the best calibration and net benefit in decision-curve analysis. Conclusions: Trauma-specific anatomical scores have fair performance in critically ill trauma patients and are outperformed by SAPS 3 and SOFA. Illness severity is best characterized by organ dysfunction and physiological variables than anatomical injuries.
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Affiliation(s)
- Roberta Muriel Longo Roepke
- Trauma and Acute Care Surgery ICU, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Bruno Adler Maccagnan Pinheiro Besen
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo, SP, Brazil
- Medical ICU, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renato Daltro-Oliveira
- Medical ICU, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Estevão Bassi
- Trauma and Acute Care Surgery ICU, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Sérgio Henrique Bastos Damous
- Trauma and Acute Care Surgery ICU, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Edivaldo Massazo Utiyama
- Trauma and Acute Care Surgery ICU, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Marcelo Sá Malbouisson
- Surgical ICU, Anesthesiology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Bozgul SMK, Emecen DA, Akarca FK, Bozkurt D, Aydin O, Koca D, Can O, Unalp OV, Atik T. Association between vitamin D receptor gene FokI polymorphism and mortality in patients with sepsis. Mol Biol Rep 2023; 51:44. [PMID: 38158430 DOI: 10.1007/s11033-023-08971-8] [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: 10/06/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Sepsis is life-threatening organ dysfunction as a result of the host's dysregulated immune response to infection. The vitamin D receptor (VDR) gene FokI polymorphism influences immune cell behavior. In the present study, we aimed to investigate the association between VDR FokI polymorphism and mortality in sepsis and non-sepsis patients in the intensive care unit (ICU). METHODS AND RESULTS This is a prospective observational study involving 96 sepsis and 96 non-sepsis patients admitted to the Ege University ICU. VDR FokI polymorphisms were investigated, as well as the relationship between the identified polymorphisms and mortality. In-hospital mortality was 27.1% in the sepsis group and 8.33% in the non-sepsis group (p = 0.001). The frequencies of VDR FokI TT, TC, and CC genotypes were 8 (8.33%), 48 (50.0%), and 40 (41.7%) in the sepsis group, and 11 (11.5%), 42 (43.8%), and 43 (44.8%) in the non-sepsis group, respectively (p = 0.612). In the sepsis group, the frequencies of Fokl TT, TC, and CC genotypes did not differ significantly between survivors and non-survivors. However, homozygous C allele carriers had lower overall mortality (p = 0.047). CONCLUSION The VDR FokI polymorphism, particularly the CC genotype, appears to be associated with lower mortality in ICU patients.
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Affiliation(s)
| | - Durdugul Ayyildiz Emecen
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Genetics, Ege University, Izmir, Turkey
| | - Funda Karbek Akarca
- Faculty of Medicine, Department of Emergency Medicine, Ege University, 35100, Bornova, Izmır, Turkey.
| | - Devrim Bozkurt
- Faculty of Medicine, Department of Internal Medicine, Ege University, Izmir, Turkey
| | - Ozgur Aydin
- Faculty of Medicine, Department of Internal Medicine, Ege University, Izmir, Turkey
| | - Didem Koca
- Faculty of Medicine, Department of Internal Medicine, Ege University, Izmir, Turkey
| | - Ozge Can
- Faculty of Medicine, Department of Emergency Medicine, Ege University, 35100, Bornova, Izmır, Turkey
| | - Omer Vedat Unalp
- Department of General Surgeon, KTO Karatay University, Konya, Turkey
| | - Tahir Atik
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Genetics, Ege University, Izmir, Turkey
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8
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Xu Y, Xu K, Guo J, Fang M, Wang Z. Association between dynamic fluctuations in triiodothyronine levels and prognosis among critically ill patients within comprehensive intensive care units. Front Endocrinol (Lausanne) 2023; 14:1282547. [PMID: 38093954 PMCID: PMC10716294 DOI: 10.3389/fendo.2023.1282547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Objective Decrease in free thyroid hormone T3 (FT3) can be used as an independent prognostic indicator for the risk of death in ICUs. However, FT3 as a predictive marker is hindered by its accuracy. The study introduces the concept of dynamic FT3 data as a means to bolster the value of FT3 as a prognostic tool. Therefore, the aim of this study is to investigate the prognostic value of dynamic FT3 evolution in a comprehensive ICU setting, analyze the consistency between dynamic FT3 changes and variations in disease severity, and explore the feasibility of FT3 as an objective indicator for real-time clinical treatment feedback. Methods Employing a single-center prospective observational study, FT3 measurements were taken on multiple days following enrollment, corresponding clinical data were collected. To investigated the pattern of dynamic changes of FT3,its prognostic significance in forecasting the risk of 28-day mortality, the alignment between dynamic FT3 changes and variations in the Sequential Organ Failure Assessment (SOFA) score. Results The survival group exhibited higher last FT3 levels compared to the lowest point (p<0.05), while the death group did not show statistically significant differences (p>0.05). The study also identifies the optimal correlation between FT3 and SOFA score at day 5 (optimal correlation coefficient -0.546).The ROC curve for FT3 at day 5 yielded an optimal AUC of 0.88, outperforming the SOFA score. The study categorizes FT3 curve patterns,Kaplan-Meier survival analysis of these patterns highlighted that the descending-type curve was significantly associated with increased risk of death (P<0.001). Additionally, the research explores the consistency between changes in FT3 and SOFA scores. While overall consistency rates were modest, subgroup analyses unveiled that greater disease severity led to higher consistency rates. Conclusions This study introduces the concept of dynamic FT3 changes to augment its prognostic utility in comprehensive ICU settings. The research identifies day 5 as the optimal time point for predictive efficacy, the descending FT3 curve as indicative of poor prognosis. While overall consistency with SOFA scores is modest, the correlation strengthens with greater disease severity.
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Affiliation(s)
- Yu Xu
- Department of Critical Care Medicine, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Kang Xu
- Department of Critical Care Medicine, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Jianying Guo
- Department of Critical Care Medicine, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Mingxing Fang
- Department of Critical Care Medicine, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Zhiyong Wang
- Department of Critical Care Medicine, Hebei Medical University Third Hospital, Shijiazhuang, China
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Zhao L, Su F, Zhang N, Wu H, Shen Y, Liu H, Li X, Li Y, Xie K. The impact of the new acute respiratory distress syndrome (ARDS) criteria on Berlin criteria ARDS patients: a multicenter cohort study. BMC Med 2023; 21:456. [PMID: 37996902 PMCID: PMC10666384 DOI: 10.1186/s12916-023-03144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE The European Society of Intensive Care Medicine (ESICM) recently recommended changes to the criteria of acute respiratory distress syndrome (ARDS), patients with high-flow oxygen were included, however, the effect of these changes remains unclear. Our objectives were to evaluate the performance of these new criteria and to compare the outcomes of patients meeting the new ARDS criteria with those meeting the Berlin ARDS criteria. METHODS This was a retrospective cohort. The patients admitted to the intensive care unit (ICU) were diagnosed with ARDS. Patients were classified as meeting Berlin criteria ARDS (n = 4279), high-flow nasal oxygen (HFNO) criteria ARDS (n = 559), or new criteria ARDS (n = 4838). RESULTS In comparison with HFNO criteria ARDS and new criteria ARDS, patients with Berlin criteria ARDS demonstrated lower blood oxygen levels assessed by PaO2/FiO2, SpO2/FiO2, and ROX (SpO2/FiO2/respiratory rate) (p < 0.001); and higher severity of illness assessed by the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology And Chronic Health Evaluations (APACHE II), Simplified Acute Physiology Score (SAPS II) (p < 0.001), (p < 0.001), and longer ICU and hospital stays (p < 0.001). In comparison with the HFNO criteria, patients meeting Berlin criteria ARDS had higher hospital mortality (10.6% vs. 16.9%; p = 0.0082), 28-day mortality (10.6% vs. 16.5%; p = 0.0079), and 90-day mortality (10.7% vs. 17.1%; p = 0.0083). ARDS patients with HFNO did not have severe ARDS; Berlin criteria ARDS patients with severe ARDS had the highest mortality rate (approximately 33%). PaO2/FiO2, SpO2/FiO2, and ROX negatively correlated with the SOFA and APACHE II scores. The SOFA and APACHE II scores had high specificity and sensitivity for prognosis in patients with new criteria ARDS. CONCLUSION The new criteria of ARDS reduced the severity of illness, length of stay in the ICU, length of hospital stays, and overall mortality. SOFA and APACHE II scores remain important in assessing the prognosis of patients with new criteria ARDS. TRIAL REGISTRATION Registration number: ChiCTR2200067084.
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Affiliation(s)
- Lina Zhao
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Fuhong Su
- Experimental Laboratory of Intensive Care, Université Libre de Bruxelles, 1000, Brussels, Belgium
| | - Nannan Zhang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Hening Wu
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yuehao Shen
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Haiying Liu
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xuguang Li
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yun Li
- Department of Anesthesiology, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.
| | - Keliang Xie
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, China.
- Department of Anesthesiology, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.
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10
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Gaudette S, Smart L, Woodward AP, Sharp CR, Hughes D, Bailey SR, Dandrieux JRS, Santos L, Boller M. Biomarkers of endothelial activation and inflammation in dogs with organ dysfunction secondary to sepsis. Front Vet Sci 2023; 10:1127099. [PMID: 37520007 PMCID: PMC10372490 DOI: 10.3389/fvets.2023.1127099] [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] [Received: 12/19/2022] [Accepted: 06/09/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Alteration in endothelial function during sepsis is thought to play a key role in the progression of organ failure. We herein compared plasma concentrations of endothelial activation biomarkers vascular endothelial growth factor (VEGF), hyaluronan (HA), plasminogen activator inhibitor-1 (PAI-1) and von Willebrand factor (vWF), as well as inflammatory mediator concentrations (IL-6, IL-8, IL-10, C-reactive protein and monocyte chemoattractant protein-1) in dogs with sepsis to healthy dogs. Methods This study was a multicenter observational clinical trial conducted at two university teaching hospitals from February 2016 until July 2017. The study included 18 client-owned dogs hospitalized with sepsis and at least one distant organ dysfunction, as well as 20 healthy dogs. Plasma biomarker concentrations were measured using ELISA. Severity of illness in dogs with sepsis was calculated using the 5-variable acute physiologic and laboratory evaluation (APPLEFAST) score. Biomarker concentrations were compared between septic and healthy dogs using linear models. Results Septic peritonitis was the most frequent source of sepsis (11/18; 61%), followed by pneumonia (4/18; 22%). Ten dogs (56%) had only 1 organ dysfunction, whereas 3 dogs (17%) had 2, 3 (17%) had 3, 1 (6%) had 4 and 1 (6%) had 5 organ dysfunctions. The median APPLEFAST score in the septic dogs was 28.5 (Q1-Q3, 24-31). Mean plasma concentrations of all endothelial and inflammatory biomarkers, except vWF, were higher in the sepsis cohort than in controls. The mean endothelial biomarker concentrations in the septic cohort ranged from ~2.7-fold higher for HA (difference in means; 118.2 ng/mL, 95% credible limit; 44.5-221.7) to ~150-fold for VEGF (difference in means; 76.6 pg./mL, 95% credible limit; 33.0-143.4), compared to the healthy cohort. Fifteen dogs with sepsis (83%) died; 7 (46%) were euthanized and 8 (53%) died during hospitalization. Conclusion Dogs with naturally occurring sepsis and organ dysfunction had higher mean concentrations of biomarkers of endothelial activation and inflammation compared to healthy dogs, broadening our understanding of the pathophysiology of sepsis secondary to endothelial dysfunction.
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Affiliation(s)
- Sarah Gaudette
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Lisa Smart
- School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
- Small Animal Specialist Hospital, Tuggerah, NSW, Australia
| | - Andrew P. Woodward
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Claire R. Sharp
- School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
- Center for Terrestrial Ecosystem Science and Sustainability, Harry Butler Institute, Murdoch University, Murdoch, WA, Australia
| | - Dez Hughes
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Simon R. Bailey
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Julien R. S. Dandrieux
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Leilani Santos
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Manuel Boller
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, VIC, Australia
- VCA Canada Central Victoria Veterinary Hospital, Victoria, BC, Canada
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Jaworska N, Soo A, Stelfox HT, Burry LD, Fiest KM. Impacts of antipsychotic medication prescribing practices in critically ill adult patients on health resource utilization and new psychoactive medication prescriptions. PLoS One 2023; 18:e0287929. [PMID: 37384760 PMCID: PMC10310007 DOI: 10.1371/journal.pone.0287929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Antipsychotic medications are commonly prescribed to critically ill adult patients and initiation of new antipsychotic prescriptions in the intensive care unit (ICU) increases the proportion of patients discharged home on antipsychotics. Critically ill adult patients are also frequently exposed to multiple psychoactive medications during ICU admission and hospitalization including benzodiazepines and opioid medications which may increase the risk of psychoactive polypharmacy following hospital discharge. The associated impact on health resource utilization and risk of new benzodiazepine and opioid prescriptions is unknown. RESEARCH QUESTION What is the burden of health resource utilization and odds of new prescriptions of benzodiazepines and opioids up to 1-year post-hospital discharge in critically ill patients with new antipsychotic prescriptions at hospital discharge? STUDY DESIGN & METHODS We completed a multi-center, propensity-score matched retrospective cohort study of critically ill adult patients. The primary exposure was administration of ≥1 dose of an antipsychotic while the patient was admitted in the ICU and ward with continuation at hospital discharge and a filled outpatient prescription within 1-year following hospital discharge. The control group was defined as no doses of antipsychotics administered in the ICU and hospital ward and no filled outpatient prescriptions for antipsychotics within 1-year following hospital discharge. The primary outcome was health resource utilization (72-hour ICU readmission, 30-day hospital readmission, 30-day emergency room visitation, 30-day mortality). Secondary outcomes were administration of benzodiazepines and/or opioids in-hospital and following hospital discharge in patients receiving antipsychotics. RESULTS 1,388 propensity-score matched patients were included who did and did not receive antipsychotics in ICU and survived to hospital discharge. New antipsychotic prescriptions were not associated with increased health resource utilization or 30-day mortality following hospital discharge. There was increased odds of new prescriptions of benzodiazepines (adjusted odds ratio [aOR] 1.61 [95%CI 1.19-2.19]) and opioids (aOR 1.82 [95%CI 1.38-2.40]) up to 1-year following hospital discharge in patients continuing antipsychotics at hospital discharge. INTERPRETATION New antipsychotic prescriptions at hospital discharge are significantly associated with additional prescriptions of benzodiazepines and opioids in-hospital and up to 1-year following hospital discharge.
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Affiliation(s)
- Natalia Jaworska
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Leslie Dan Faculty of Pharmacy, O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lisa D. Burry
- Departments of Pharmacy and Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Kirsten M. Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Leslie Dan Faculty of Pharmacy, O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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12
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Kalogianni L, Polizopoulou ZS, Kazakos G, Kontopoulou K, Triantafyllou E, Siarkou VI, Ceron JJ, Chaintoutis SC, Dovas CI, Tamvakis A, Theodoridis A, Savvas I, Diakou A, Soubasis N. The role of the sequential organ failure assessment score in evaluating the outcome in dogs with parvoviral enteritis. Res Vet Sci 2022; 150:44-51. [DOI: 10.1016/j.rvsc.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/28/2022] [Accepted: 05/09/2022] [Indexed: 11/27/2022]
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Lavalley‐Morelle A, Timsit J, Mentré F, Mullaert J. Joint modeling under competing risks: Application to survival prediction in patients admitted in Intensive Care Unit for sepsis with daily Sequential Organ Failure Assessment score assessments. CPT Pharmacometrics Syst Pharmacol 2022; 11:1472-1484. [PMID: 36201150 PMCID: PMC9662207 DOI: 10.1002/psp4.12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/23/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
Joint models of longitudinal process and time-to-event data have recently gained attention, notably to provide individualized dynamic predictions. In the presence of competing risks, models published mostly involve cause-specific hazard functions jointly estimated with a linear or generalized linear model. Here we propose to extend the modeling to full parametric joint estimation of a nonlinear mixed-effects model and a subdistribution hazard model. We apply this approach on 6046 patients admitted in intensive care unit (ICU) for sepsis with daily Sequential Organ Failure Assessment (SOFA) score measurements. The joint model is built on a randomly selected training set of two thirds of patients and links the current predicted SOFA measurement to the instantaneous risks of ICU death and discharge from ICU, both adjusted on the patient age. Stochastic Approximation Expectation Maximization algorithm in Monolix is used for estimation. SOFA evolution is significantly associated with both risks: 0.37, 95% confidence interval (CI) = [0.35, 0.39] for the risk of death and -0.38, 95% CI = [-0.39, -0.36] for the risk of discharge. A simulation study, inspired from the real data, shows the good estimation properties of the parameters. We assess on the validation set the added value of modeling the longitudinal SOFA follow-up for the prediction of death compared with a model that includes only SOFA at baseline. Time-dependent receiver operating characteristic area under the curve and Brier scores show that when enough longitudinal individual information is available, joint modeling provides better predictions. The methodology can easily be applied to other clinical applications because of the general form of the model.
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Affiliation(s)
| | - Jean‐François Timsit
- Université Paris Cité, IAME, INSERMParisFrance,Service de Réanimation Médicale et InfectieuseAP‐HP, Hôpital BichatParisFrance
| | - France Mentré
- Université Paris Cité, IAME, INSERMParisFrance,Département Epidémiologie Biostatistiques et Recherche CliniqueAP‐HP, Hôpital BichatParisFrance
| | - Jimmy Mullaert
- Université Paris Cité, IAME, INSERMParisFrance,Département Epidémiologie Biostatistiques et Recherche CliniqueAP‐HP, Hôpital BichatParisFrance
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14
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Chang HH, Chiang JH, Wang CS, Chiu PF, Abdel-Kader K, Chen H, Siew ED, Yabes J, Murugan R, Clermont G, Palevsky PM, Jhamb M. Predicting Mortality Using Machine Learning Algorithms in Patients Who Require Renal Replacement Therapy in the Critical Care Unit. J Clin Med 2022; 11:5289. [PMID: 36142936 PMCID: PMC9500742 DOI: 10.3390/jcm11185289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 01/13/2023] Open
Abstract
Background: General severity of illness scores are not well calibrated to predict mortality among patients receiving renal replacement therapy (RRT) for acute kidney injury (AKI). We developed machine learning models to make mortality prediction and compared their performance to that of the Sequential Organ Failure Assessment (SOFA) and HEpatic failure, LactatE, NorepInephrine, medical Condition, and Creatinine (HELENICC) scores. Methods: We extracted routinely collected clinical data for AKI patients requiring RRT in the MIMIC and eICU databases. The development models were trained in 80% of the pooled dataset and tested in the rest of the pooled dataset. We compared the area under the receiver operating characteristic curves (AUCs) of four machine learning models (multilayer perceptron [MLP], logistic regression, XGBoost, and random forest [RF]) to that of the SOFA, nonrenal SOFA, and HELENICC scores and assessed calibration, sensitivity, specificity, positive (PPV) and negative (NPV) predicted values, and accuracy. Results: The mortality AUC of machine learning models was highest for XGBoost (0.823; 95% confidence interval [CI], 0.791−0.854) in the testing dataset, and it had the highest accuracy (0.758). The XGBoost model showed no evidence of lack of fit with the Hosmer−Lemeshow test (p > 0.05). Conclusion: XGBoost provided the highest performance of mortality prediction for patients with AKI requiring RRT compared with previous scoring systems.
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Affiliation(s)
- Hsin-Hsiung Chang
- Division of Nephrology, Department of Internal Medicine, Antai Medical Care Corporation Antai Tian-Sheng Memorial Hospital, Donggang 928, Taiwan
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan 701, Taiwan
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jung-Hsien Chiang
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan 701, Taiwan
| | - Chi-Shiang Wang
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan 701, Taiwan
| | - Ping-Fang Chiu
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan
- Department of Hospitality Management, MingDao University, Changhua 500, Taiwan
| | - Khaled Abdel-Kader
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN 37011, USA
- Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, TN 37011, USA
| | - Huiwen Chen
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Edward D. Siew
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN 37011, USA
- Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, TN 37011, USA
- Tennessee Valley Health Systems (TVHS), Veteran’s Health Administration, Nashville, TN 37212, USA
| | - Jonathan Yabes
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Raghavan Murugan
- Program for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Gilles Clermont
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Paul M. Palevsky
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Kidney Medicine Section, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA
| | - Manisha Jhamb
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Liu X, Dumontier C, Hu P, Liu C, Yeung W, Mao Z, Ho V, Pj T, Kuo PC, Hu J, Li D, Cao D, Mark RG, Zhou FH, Zhang Z, Celi LA. Clinically Interpretable Machine Learning Models for Early Prediction of Mortality in Older Patients with Multiple Organ Dysfunction Syndrome (MODS): An International Multicenter Retrospective Study. J Gerontol A Biol Sci Med Sci 2022; 78:718-726. [PMID: 35657011 DOI: 10.1093/gerona/glac107] [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: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Multiple organ dysfunction syndrome (MODS) is associated with a high risk of mortality among older patients. Current severity scores are limited in their ability to assist clinicians with triage and management decisions. We aim to develop mortality prediction models for older patients with MODS admitted to the ICU. METHODS The study analyzed older patients from 197 hospitals in the US and one hospital in the Netherlands. The cohort was divided into the young-old (65-80 years) and old-old (≥80 years), which were separately used to develop and evaluate models including internal, external and temporal validation. Demographic characteristics, comorbidities, vital signs, laboratory measurements, and treatments were used as predictors. We used the XGBoost algorithm to train models, and the SHAP method to interpret predictions. RESULTS 34,497 young-old (11.3% mortality) and 21,330 old-old (15.7% mortality) patients were analyzed. Discrimination AUROC of internal validation models in 9,046 U.S. patients was as follows: 0.87 and 0.82, respectively; Discrimination of external validation models in 1,905 EUR patients was as follows: 0.86 and 0.85, respectively; and of temporal validation models in 8,690 U.S. patients: 0.85 and 0.78, respectively. These models outperformed standard clinical scores like SOFA and APSIII. The GCS, Charlson Comorbidity Index, and Code Status emerged as top predictors of mortality. CONCLUSIONS Our models integrate data spanning physiologic and geriatric-relevant variables that outperform existing scores used in older adults with MODS, which represents a proof of concept of how machine learning can streamline data analysis for busy ICU clinicians to potentially optimize prognostication and decision making.
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Affiliation(s)
- Xiaoli Liu
- School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China.,Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, 02139, Massachusetts, USA.,Center for Artificial Intelligence in Medicine, The General Hospital of PLA, 100853, Beijing, China
| | - Clark Dumontier
- New England, GRECC (Geriatrics Research, Education and Clinical Center), VA Boston Healthcare System, 02130, Massachusetts, USA.,Division of Aging, Brigham and Women's Hospital, Boston, 02115, Massachusetts, USA
| | - Pan Hu
- Department of anesthesiology, The 920 Hospital of Joint Logistic Support Force of Chinese PLA, 650032, Kunming Yunnan, China.,Department of Critical Care Medicine, The First Medical Center, The General Hospital of PLA, 100853, Beijing, China
| | - Chao Liu
- Department of Critical Care Medicine, The First Medical Center, The General Hospital of PLA, 100853, Beijing, China
| | - Wesley Yeung
- Department of Medicine, National University Hospital, 119228, Singapore.,Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, 02139, Massachusetts, USA
| | - Zhi Mao
- Department of Critical Care Medicine, The First Medical Center, The General Hospital of PLA, 100853, Beijing, China
| | - Vanda Ho
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, 119074, Singapore
| | - Thoral Pj
- Department of Intensive Care Medicine, Amsterdam UMC, 22660, Amsterdam, The Netherlands
| | - Po-Chih Kuo
- Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, 02139, Massachusetts, USA.,Department of Computer Science, National Tsing Hua University, 300044, Hsinchu, Taiwan
| | - Jie Hu
- Department of Critical Care Medicine, The First Medical Center, The General Hospital of PLA, 100853, Beijing, China
| | - Deyu Li
- School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
| | - Desen Cao
- Department of Biomedical Engineering, The General Hospital of PLA, 100853, Beijing, China
| | - Roger G Mark
- Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, 02139, Massachusetts, USA
| | - Fei Hu Zhou
- Department of Critical Care Medicine, The First Medical Center, The General Hospital of PLA, 100853, Beijing, China.,Elderly Center, The General Hospital of PLA, 100853, Beijing, China
| | - Zhengbo Zhang
- School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China.,Center for Artificial Intelligence in Medicine, The General Hospital of PLA, 100853, Beijing, China
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, 02139, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, 02215, Massachusetts, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, 02115, Massachusetts, USA
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16
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Lopez-Delgado JC, Grau-Carmona T, Trujillano-Cabello J, García-Fuentes C, Mor-Marco E, Bordeje-Laguna ML, Portugal-Rodriguez E, Lorencio-Cardenas C, Vera-Artazcoz P, Macaya-Redin L, Martinez-Carmona JF, Mateu-Campos L, Gero-Escapa M, Gastaldo-Simeon R, Vila-García B, Flordelis-Lasierra JL, Montejo-Gonzalez JC, Servia-Goixart L. The Effect of Enteral Immunonutrition in the Intensive Care Unit: Does It Impact on Outcomes? Nutrients 2022; 14:1904. [PMID: 35565870 PMCID: PMC9103218 DOI: 10.3390/nu14091904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The present research aimed to evaluate the effect on outcomes of immunonutrition (IMN) enteral formulas during the intensive care unit (ICU) stay. Methods: A multicenter prospective observational study was performed. Patient characteristics, disease severity, nutritional status, type of nutritional therapy and outcomes, and laboratory parameters were collected in a database. Statistical differences were analyzed according to the administration of IMN or other types of enteral formulas. Results: In total, 406 patients were included in the analysis, of whom 15.02% (61) received IMN. Univariate analysis showed that patients treated with IMN formulas received higher mean caloric and protein intake, and better 28-day survival (85.2% vs. 73.3%; p = 0.014. Unadjusted Hazard Ratio (HR): 0.15; 95% CI (Confidence Interval): 0.06−0.36; p < 0.001). Once adjusted for confounding factors, multivariate analysis showed a lower need for vasopressor support (OR: 0.49; 95% CI: 0.26−0.91; p = 0.023) and continuous renal replacement therapies (OR: 0.13; 95% CI: 0.01−0.65; p = 0.049) in those patients who received IMN formulas, independently of the severity of the disease. IMN use was also associated with higher protein intake during the administration of nutritional therapy (OR: 6.23; 95% CI: 2.59−15.54; p < 0.001), regardless of the type of patient. No differences were found in the laboratory parameters, except for a trend toward lower triglyceride levels (HR: 0.97; 95% CI: 0.95−0.99; p = 0.045). Conclusion: The use of IMN formulas may be associated with better outcomes (i.e., lower need for vasopressors and continuous renal replacement), together with a trend toward higher protein enteral delivery during the ICU stay. These findings may ultimately be related to their modulating effect on the inflammatory response in the critically ill. NCT Registry: 03634943.
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Affiliation(s)
- Juan Carlos Lopez-Delgado
- Intensive Care Department, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Spain
- IDIBELL (Institut d’Investigació Biomèdica Bellvitge, Biomedical Investigation Institute of Bellvitge), Av. de la Gran Via, 199, 08908 L’Hospitalet de Llobregat, Spain
| | - Teodoro Grau-Carmona
- Intensive Care Department, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, 28041 Madrid, Spain; (T.G.-C.); (C.G.-F.); (J.L.F.-L.); (J.C.M.-G.)
- i+12 (Instituto de Investigación Sanitaria Hospital 12 de Octubre, Research Institute Hospital 12 de Octubre), Av. de Córdoba s/n, 28041 Madrid, Spain
| | - Javier Trujillano-Cabello
- Intensive Care Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain; (J.T.-C.); (L.S.-G.)
- IRBLLeida (Institut de Recerca Biomèdica de Lleida Fundació Doctor PiFarré, Lleida Biomedical Research Institute’s Doctor PiFarré Foundation), Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain
| | - Carlos García-Fuentes
- Intensive Care Department, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, 28041 Madrid, Spain; (T.G.-C.); (C.G.-F.); (J.L.F.-L.); (J.C.M.-G.)
- i+12 (Instituto de Investigación Sanitaria Hospital 12 de Octubre, Research Institute Hospital 12 de Octubre), Av. de Córdoba s/n, 28041 Madrid, Spain
| | - Esther Mor-Marco
- Intensive Care Department, Hospital Universitario Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Spain; (E.M.-M.); (M.L.B.-L.)
| | - Maria Luisa Bordeje-Laguna
- Intensive Care Department, Hospital Universitario Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Spain; (E.M.-M.); (M.L.B.-L.)
| | - Esther Portugal-Rodriguez
- Intensive Care Department, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain;
| | - Carol Lorencio-Cardenas
- Intensive Care Department, Hospital Universitari Josep Trueta, Av. de França, s/n, 17007 Girona, Spain;
| | - Paula Vera-Artazcoz
- Intensive Care Department, Hospital de la Santa Creu i Sant Pau, C/Sant Quintí, 89, 08041 Barcelona, Spain;
| | - Laura Macaya-Redin
- Intensive Care Department, Complejo Hospitalario de Navarra, C/Irunlarrea, E, 31008 Pamplona, Spain;
| | | | - Lidón Mateu-Campos
- Intensive Care Department, Hospital General Universitario de Castellón, Avda. de Benicàssim, 128, 12004 Castelló de la Plana, Spain;
| | - Maria Gero-Escapa
- Intensive Care Department, Hospital Universitario de Burgos, Av. Islas Baleares, 3, 09006 Burgos, Spain;
| | - Rosa Gastaldo-Simeon
- Intensive Care Department, Hospital de Manacor, Carretera Manacor-Alcudia, s/n, 07500 Manacor, Spain;
| | - Belen Vila-García
- Intensive Care Department, Hospital Universitario Infanta Cristina, Av. 9 de Junio, 2, 28981 Parla, Spain;
| | - José Luis Flordelis-Lasierra
- Intensive Care Department, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, 28041 Madrid, Spain; (T.G.-C.); (C.G.-F.); (J.L.F.-L.); (J.C.M.-G.)
- i+12 (Instituto de Investigación Sanitaria Hospital 12 de Octubre, Research Institute Hospital 12 de Octubre), Av. de Córdoba s/n, 28041 Madrid, Spain
| | - Juan Carlos Montejo-Gonzalez
- Intensive Care Department, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, 28041 Madrid, Spain; (T.G.-C.); (C.G.-F.); (J.L.F.-L.); (J.C.M.-G.)
- i+12 (Instituto de Investigación Sanitaria Hospital 12 de Octubre, Research Institute Hospital 12 de Octubre), Av. de Córdoba s/n, 28041 Madrid, Spain
| | - Lluís Servia-Goixart
- Intensive Care Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain; (J.T.-C.); (L.S.-G.)
- IRBLLeida (Institut de Recerca Biomèdica de Lleida Fundació Doctor PiFarré, Lleida Biomedical Research Institute’s Doctor PiFarré Foundation), Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain
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Chao HY, Wu CC, Singh A, Shedd A, Wolfshohl J, Chou EH, Huang YC, Chen KF. Using Machine Learning to Develop and Validate an In-Hospital Mortality Prediction Model for Patients with Suspected Sepsis. Biomedicines 2022; 10:biomedicines10040802. [PMID: 35453552 PMCID: PMC9030924 DOI: 10.3390/biomedicines10040802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Early recognition of sepsis and the prediction of mortality in patients with infection are important. This multi-center, ED-based study aimed to develop and validate a 28-day mortality prediction model for patients with infection using various machine learning (ML) algorithms. Methods: Patients with acute infection requiring intravenous antibiotic treatment during the first 24 h of admission were prospectively recruited. Patient demographics, comorbidities, clinical signs and symptoms, laboratory test data, selected sepsis-related novel biomarkers, and 28-day mortality were collected and divided into training (70%) and testing (30%) datasets. Logistic regression and seven ML algorithms were used to develop the prediction models. The area under the receiver operating characteristic curve (AUROC) was used to compare different models. Results: A total of 555 patients were recruited with a full panel of biomarker tests. Among them, 18% fulfilled Sepsis-3 criteria, with a 28-day mortality rate of 8%. The wrapper algorithm selected 30 features, including disease severity scores, biochemical parameters, and conventional and few sepsis-related biomarkers. Random forest outperformed other ML models (AUROC: 0.96; 95% confidence interval: 0.93–0.98) and SOFA and early warning scores (AUROC: 0.64–0.84) in the prediction of 28-day mortality in patients with infection. Additionally, random forest remained the best-performing model, with an AUROC of 0.95 (95% CI: 0.91–0.98, p = 0.725) after removing five sepsis-related novel biomarkers. Conclusions: Our results demonstrated that ML models provide a more accurate prediction of 28-day mortality with an enhanced ability in dealing with multi-dimensional data than the logistic regression model.
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Affiliation(s)
- Hsiao-Yun Chao
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Shin Street, Gueishan Village, Taoyuan 333423, Taiwan;
| | - Chin-Chieh Wu
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Avichandra Singh
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
| | - Andrew Shedd
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, TX 76104, USA; (A.S.); (J.W.); (E.H.C.)
| | - Jon Wolfshohl
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, TX 76104, USA; (A.S.); (J.W.); (E.H.C.)
| | - Eric H. Chou
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, TX 76104, USA; (A.S.); (J.W.); (E.H.C.)
- Department of Emergency Medicine, Baylor University Medical Center, Dallas, TX 76104, USA
| | - Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Shin Street, Gueishan Village, Taoyuan 333423, Taiwan;
| | - Kuan-Fu Chen
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Shin Street, Gueishan Village, Taoyuan 333423, Taiwan;
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan 33302, Taiwan;
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan
- Correspondence: ; Tel.: +886-3-328-1200 (ext. 2505)
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18
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Preintubation Sequential Organ Failure Assessment Score for Predicting COVID-19 Mortality: External Validation Using Electronic Health Record From 86 U.S. Healthcare Systems to Appraise Current Ventilator Triage Algorithms. Crit Care Med 2022; 50:1051-1062. [PMID: 35302957 PMCID: PMC9196924 DOI: 10.1097/ccm.0000000000005534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES: Prior research has hypothesized the Sequential Organ Failure Assessment (SOFA) score to be a poor predictor of mortality in mechanically ventilated patients with COVID-19. Yet, several U.S. states have proposed SOFA-based algorithms for ventilator triage during crisis standards of care. Using a large cohort of mechanically ventilated patients with COVID-19, we externally validated the predictive capacity of the preintubation SOFA score for mortality prediction with and without other commonly used algorithm elements. DESIGN: Multicenter, retrospective cohort study using electronic health record data. SETTING: Eighty-six U.S. health systems. PATIENTS: Patients with COVID-19 hospitalized between January 1, 2020, and February 14, 2021, and subsequently initiated on mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 15,122 mechanically ventilated patients with COVID-19, SOFA score alone demonstrated poor discriminant accuracy for inhospital mortality in mechanically ventilated patients using the validation cohort (area under the receiver operating characteristic curve [AUC], 0.66; 95% CI, 0.65–0.67). Discriminant accuracy was even poorer using SOFA score categories (AUC, 0.54; 95% CI, 0.54–0.55). Age alone demonstrated greater discriminant accuracy for inhospital mortality than SOFA score (AUC, 0.71; 95% CI, 0.69–0.72). Discriminant accuracy for mortality improved upon addition of age to the continuous SOFA score (AUC, 0.74; 95% CI, 0.73–0.76) and categorized SOFA score (AUC, 0.72; 95% CI, 0.71–0.73) models, respectively. The addition of comorbidities did not substantially increase model discrimination. Of 36 U.S. states with crisis standards of care guidelines containing ventilator triage algorithms, 31 (86%) feature the SOFA score. Of these, 25 (81%) rely heavily on the SOFA score (12 exclusively propose SOFA; 13 place highest weight on SOFA or propose SOFA with one other variable). CONCLUSIONS: In a U.S. cohort of over 15,000 ventilated patients with COVID-19, the SOFA score displayed poor predictive accuracy for short-term mortality. Our findings warrant reappraisal of the SOFA score’s implementation and weightage in existing ventilator triage pathways in current U.S. crisis standards of care guidelines.
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Sathe NA, Bhatraju PK, Mikacenic C, Morrell ED, Mabrey FL, Liles WC, Wurfel MM. Relationships Between Age, Soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1), and Mortality Among Critically Ill Adults: A Cohort Study. Shock 2022; 57:205-211. [PMID: 34812186 PMCID: PMC8969235 DOI: 10.1097/shk.0000000000001888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Innate immune dysregulation may contribute to age-related differences in outcomes among critically ill adults. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is an important innate immune marker with prognostic value in sepsis, but age-related differences have not been studied. METHODS This was a prospective cohort from a large tertiary care hospital enrolling adults from both medical and trauma-surgical intensive care units (ICUs). Plasma sTREM-1 was measured in participants within 24 h of ICU admission. We analyzed associations between age (≤50 and >50 years) and sTREM-1 using linear regression. We then examined associations between sTREM-1 and both 28-day mortality and persistent organ dysfunction (defined as need for dialysis, vasopressors, or invasive mechanical ventilation) 7 days following admission using relative risk regression. RESULTS Of 231 critically ill adults, older patients (n = 122) had higher prevalence of chronic disease and sepsis on enrollment than younger patients, but acute illness severity was similar. Age over 50 was associated with 27% higher sTREM-1 concentrations (95% CI 6%-53%), adjusted for sex and Charlson comorbidity index (CCI). Two-fold higher sTREM-1 was associated with 2.42-fold higher risk for mortality (95% CI 1.57, 3.73) and 1.86-fold higher risk for persistent organ dysfunction (95% CI 1.45, 2.39), adjusted for sex, CCI, and age. CONCLUSIONS sTREM-1 was elevated among critically ill older adults, and strongly associated with both death and persistent organ dysfunction. Immune responses associated with sTREM-1 may contribute to age-related differences in ICU outcomes, warranting further study as a potential therapeutic target in older adults.
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Affiliation(s)
- Neha A. Sathe
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Pavan K. Bhatraju
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
- Sepsis Center of Research Excellence-University of Washington (SCORE-UW)
| | - Carmen Mikacenic
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
- Benaroya Research Institute, Seattle, WA
| | - Eric D. Morrell
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
- Sepsis Center of Research Excellence-University of Washington (SCORE-UW)
| | - F. Linzee Mabrey
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - W. Conrad Liles
- Sepsis Center of Research Excellence-University of Washington (SCORE-UW)
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Mark M. Wurfel
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
- Sepsis Center of Research Excellence-University of Washington (SCORE-UW)
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20
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Mezzaroba AL, Larangeira AS, Morakami FK, Junior JJ, Vieira AA, Costa MM, Kaneshima FM, Chiquetti G, Colonheze UE, Brunello GC, Cardoso LT, Matsuo T, Grion CM. Evaluation of time to death after admission to an intensive care unit and factors associated with mortality: A retrospective longitudinal study. Int J Crit Illn Inj Sci 2022; 12:121-126. [PMID: 36506928 PMCID: PMC9728075 DOI: 10.4103/ijciis.ijciis_98_21] [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] [Received: 11/23/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 12/15/2022] Open
Abstract
Background Among nonsurvivors admitted to the intensive care unit (ICU), some present early mortality while other patients, despite having a favorable evolution regarding the initial disease, die later due to complications related to hospitalization. This study aims to identify factors associated with the time until death after admission to an ICU of a university hospital. Methods Retrospective longitudinal study that included adult patients admitted to the ICU between January 1, 2008, and December 31, 2017. Nonsurviving patients were divided into groups according to the length of time from admission to the ICU until death: Early (0-5 days), intermediate (6-28 days), and late (>28 days). Patients were considered septic if they had this diagnosis on admission to the ICU. Simple linear regression analysis was performed to evaluate the association between time to death over the years of the study. Multivariate cox regression was used to assess risk factors for the outcome in the ICU. Results In total, 6596 patients were analyzed. Mortality rate was 32.9% in the ICU. Most deaths occurred in the early (42.8%) and intermediate periods (47.9%). Patients with three or more dysfunctions on admission were more likely to die early (P < 0.001). The diagnosis of sepsis was associated with a higher mortality rate. The multivariate analysis identified age >60 years (hazard ratio [HR] 1.009), male (HR 1.192), mechanical ventilation (HR 1.476), dialysis (HR 2.297), and sequential organ failure assessment >6 (HR 1.319) as risk factors for mortality. Conclusion We found a higher proportion of early and intermediate deaths in the study period. The presence of three or more organ dysfunctions at ICU admission was associated with early death. The diagnosis of sepsis evident on ICU admission was associated with higher mortality.
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Affiliation(s)
- Ana Luiza Mezzaroba
- Department of Clinical Medicine, Universidade Estadual De Londrina, Londrina, Brazil
| | | | - Fernanda K. Morakami
- Department of Clinical Medicine, Universidade Estadual De Londrina, Londrina, Brazil
| | - Jair Jesus Junior
- Department of Clinical Medicine, Universidade Estadual De Londrina, Londrina, Brazil
| | - Amanda A. Vieira
- Department of Clinical Medicine, Universidade Estadual De Londrina, Londrina, Brazil
| | - Marina M. Costa
- Department of Clinical Medicine, Universidade Estadual De Londrina, Londrina, Brazil
| | - Fernanda M. Kaneshima
- Department of Clinical Medicine, Universidade Estadual De Londrina, Londrina, Brazil
| | - Giovana Chiquetti
- Department of Clinical Medicine, Universidade Estadual De Londrina, Londrina, Brazil
| | - Ulisses E. Colonheze
- Department of Clinical Medicine, Universidade Estadual De Londrina, Londrina, Brazil
| | | | - Lucienne T.Q. Cardoso
- Department of Clinical Medicine, Universidade Estadual De Londrina, Londrina, Brazil
| | - Tiemi Matsuo
- Department of Clinical Medicine, Universidade Estadual De Londrina, Londrina, Brazil
| | - Cintia M.C. Grion
- Department of Clinical Medicine, Universidade Estadual De Londrina, Londrina, Brazil,Address for correspondence: Prof. Cintia M. C. Grion, Divisão De Terapia Intensive, Rua Robert Koch 60, Vila Operária, Londrina 86038-440, Paraná, Brazil. E-mail:
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21
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Méndez-Guerrero O, Calle-Rodas DA, Cervantes-Alvarez E, Alatorre-Arenas E, Pérez-Escobar J, Navarro-Alvarez N, Torre A. Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit. Ann Hepatol 2021; 22:100270. [PMID: 33091594 DOI: 10.1016/j.aohep.2020.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Acute on Chronic Liver Failure (ACLF) is characterized by organ failure and high 28-day mortality. Identifying clinical predictors associated with early mortality could have implications for the treatment of patients with ACLF. PATIENTS AND METHODS Patients diagnosed with chronic liver failure that developed ACLF based on the EASL-CLIF Consortium definition admitted to the Intensive care unit of a tertiary hospital between 2012-2018 were included. Bivariate and multivariate Cox regression analyses were performed to identify factors associated with mortality. RESULTS 148 patients (55% female) were diagnosed with ACLF of which 55% (n = 82) had ACLF grade 3, 28% (n = 41) grade 2 and 17% (n = 25) grade 1. The median age was 54 years (41-63). Hepatitis C virus (HCV) was the most frequent etiology in 29.8% (n = 44) of the patients with bacterial infection being the most predominant precipitant factor in 58.1% (n = 86). Ninety-day global cumulative survival was only 18%. When divided by grade, mortality reached to 10% in ACLF 3. Moreover, in the multivariate Cox regression analysis, renal failure (HR 3.26, 95% CI (2.13-4.99), brain failure (HR 1.37, 95% CI 1.09-2.04) and male sex (HR 1.62, 95% CI 1.10-2.40) were independent predictors of 28- and 90-day mortality. CONCLUSIONS ACLF is a frequent syndrome among chronic liver disease patients. Brain and renal failure are significantly associated with higher mortality and are independent predictors of 28 and 90-day mortality.
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Affiliation(s)
- Osvely Méndez-Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico
| | - Daniel A Calle-Rodas
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico
| | - Eduardo Cervantes-Alvarez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico; PECEM, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Elisa Alatorre-Arenas
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico
| | - Juanita Pérez-Escobar
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico
| | - Nalu Navarro-Alvarez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico; Universidad Panamericana School of Medicine, Campus México, Mexico City, Mexico; Department of Surgery, University of Colorado Anschutz Medical Campus, Denver, CO, United States.
| | - Aldo Torre
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico.
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22
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Schenck EJ, Hoffman KL, Oromendia C, Sanchez E, Finkelsztein EJ, Hong KS, Kabariti J, Torres LK, Harrington JS, Siempos II, Choi AMK, Campion TR. A Comparative Analysis of the Respiratory Subscore of the Sequential Organ Failure Assessment Scoring System. Ann Am Thorac Soc 2021; 18:1849-1860. [PMID: 33760709 PMCID: PMC8641830 DOI: 10.1513/annalsats.202004-399oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 03/23/2021] [Indexed: 11/20/2022] Open
Abstract
Rationale: The Sequential Organ Failure Assessment (SOFA) tool is a commonly used measure of illness severity. Calculation of the respiratory subscore of SOFA is frequently limited by missing arterial oxygen pressure (PaO2) data. Although missing PaO2 data are commonly replaced with normal values, the performance of different methods of substituting PaO2 for SOFA calculation is unclear. Objectives: The study objective was to compare the performance of different substitution strategies for missing PaO2 data for SOFA score calculation. Methods: This retrospective cohort study was performed using the Weill Cornell Critical Care Database for Advanced Research from a tertiary care hospital in the United States. All adult patients admitted to an intensive care unit (ICU) from 2011 to 2019 with an available respiratory SOFA score were included. We analyzed the availability of the PaO2/fraction of inspired oxygen (FiO2) ratio on the first day of ICU admission. In those without a PaO2/FiO2 ratio available, the ratio of oxygen saturation as measured by pulse oximetry to FiO2 was used to calculate a respiratory SOFA subscore according to four methods (linear substitution [Rice], nonlinear substitution [Severinghaus], modified respiratory SOFA, and multiple imputation by chained equations [MICE]) as well as the missing-as-normal technique. We then compared how well the different total SOFA scores discriminated in-hospital mortality. We performed several subgroup and sensitivity analyses. Results: We identified 35,260 unique visits, of which 9,172 included predominant respiratory failure. PaO2 data were available for 14,939 (47%). The area under the receiver operating characteristic curve for each substitution technique for discriminating in-hospital mortality was higher than that for the missing-as-normal technique (0.78 [0.77-0.79]) in all analyses (modified, 0.80 [0.79-0.81]; Rice, 0.80 [0.79-0.81]; Severinghaus, 0.80 [0.79-0.81]; and MICE, 0.80 [0.79-0.81]) (P < 0.01). Each substitution method had a higher accuracy for discriminating in-hospital mortality (MICE, 0.67; Rice, 0.67; modified, 0.66; and Severinghaus, 0.66) than the missing-as-normal technique. Model calibration for in-hospital mortality was less precise for the missing-as-normal technique than for the other substitution techniques at the lower range of SOFA and among the subgroups. Conclusions: Using physiologic and statistical substitution methods improved the total SOFA score's ability to discriminate mortality compared with the missing-as-normal technique. Treating missing data as normal may result in underreporting the severity of illness compared with using substitution. The simplicity of a direct oxygen saturation as measured by pulse oximetry/FiO2 ratio-modified SOFA technique makes it an attractive choice for electronic health record-based research. This knowledge can inform comparisons of severity of illness across studies that used different techniques.
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Affiliation(s)
- Edward J Schenck
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, New York; and
| | | | | | - Elizabeth Sanchez
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
| | - Eli J Finkelsztein
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
| | - Kyung Sook Hong
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- Department of Surgery and Critical Care Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | | | - Lisa K Torres
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, New York; and
| | - John S Harrington
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, New York; and
| | - Ilias I Siempos
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
| | - Augustine M K Choi
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, New York; and
| | - Thomas R Campion
- Department of Population Health Sciences
- Information Technologies and Services, and
- Clinical and Translational Science Center, Weill Cornell Medicine, Cornell University, New York, New York
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23
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Fiest KM, Soo A, Hee Lee C, Niven DJ, Ely EW, Doig CJ, Stelfox HT. Long-Term Outcomes in ICU Patients with Delirium: A Population-based Cohort Study. Am J Respir Crit Care Med 2021; 204:412-420. [PMID: 33823122 PMCID: PMC8480248 DOI: 10.1164/rccm.202002-0320oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Delirium is common in the ICU and portends worse ICU and hospital outcomes. The effect of delirium in the ICU on post-hospital discharge mortality and health resource use is less well known. Objectives: To estimate mortality and health resource use 2.5 years after hospital discharge in critically ill patients admitted to the ICU. Methods: This was a population-based, propensity score-matched, retrospective cohort study of adult patients admitted to 1 of 14 medical-surgical ICUs from January 1, 2014, to June 30, 2016. Delirium was measured by using the 8-point Intensive Care Delirium Screening Checklist. The primary outcome was mortality. The secondary outcome was a composite measure of subsequent emergency department visits, hospital readmission, or mortality. Measurements and Main Results: There were 5,936 propensity score-matched patients with and without a history of incident delirium who survived to hospital discharge. Delirium was associated with increased mortality 0-30 days after hospital discharge (hazard ratio, 1.44 [95% confidence interval, 1.08-1.92]). There was no significant difference in mortality more than 30 days after hospital discharge (delirium: 3.9%, no delirium: 2.6%). There was a persistent increased risk of emergency department visits, hospital readmissions, or mortality after hospital discharge (hazard ratio, 1.12 [95% confidence interval, 1.07-1.17]) throughout the study period. Conclusions: ICU delirium is associated with increased mortality 0-30 days after hospital discharge.
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Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Department of Community Health Sciences.,O'Brien Institute for Public Health.,Department of Psychiatry, and.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Chel Hee Lee
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Department of Community Health Sciences.,O'Brien Institute for Public Health
| | - E Wesley Ely
- Tennessee Valley Veterans Affairs Geriatric Research Education Clinical Center, Nashville Tennessee; and.,Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Vanderbilt University, Nashville Tennessee
| | - Christopher J Doig
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Department of Community Health Sciences.,O'Brien Institute for Public Health
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Department of Community Health Sciences.,O'Brien Institute for Public Health
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24
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Casault C, Soo A, Lee CH, Couillard P, Niven D, Stelfox T, Fiest K. Sedation strategy and ICU delirium: a multicentre, population-based propensity score-matched cohort study. BMJ Open 2021; 11:e045087. [PMID: 34285003 PMCID: PMC8292822 DOI: 10.1136/bmjopen-2020-045087] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We examined the relationship between dominant sedation strategy, risk of delirium and patient-centred outcomes in adults admitted to intensive care units (ICUs). DESIGN Retrospective propensity-matched cohort study. SETTING Mechanically ventilated adults (≥ 18 years) admitted to four Canadian hospital medical/surgical ICUs from 2014 to 2016 in Calgary, Alberta, Canada. PARTICIPANTS 2837 mechanically ventilated adults (≥ 18 years) requiring admission to a medical/surgical ICU were evaluated for the relationship between sedation strategy and delirium. INTERVENTIONS None. PRIMARY AND SECONDARY OUTCOME MEASURES The primary exposure was dominant sedation strategy, defined as the sedative infusion, including midazolam, propofol or fentanyl, with the longest duration before the first delirium assessment. The primary outcome was 'ever delirium' identified using the Intensive Care Delirium Screening Checklist. Secondary outcomes included mortality, length of stay (LOS), ventilation duration and days with delirium. The cohort was analysed in two propensity score (patient characteristics and therapies received) matched cohorts (propofol vs fentanyl and propofol vs midazolam). RESULTS 2837 patients (60.7% male; median age 57 years (IQR 43-68)) were considered for propensity matching. In propensity score-matched cohorts(propofol vs midazolam, n=712; propofol vs fentanyl, n=1732), the odds of delirium were significantly higher with midazolam (OR 1.46 (95% CI 1.06 to 2.00)) and fentanyl (OR 1.22 (95% CI 1.00 to 1.48)) compared with propofol dominant sedation strategies. Dominant sedation strategy with midazolam and fentanyl were associated with a longer duration of ventilation compared with propofol. Fentanyl was also associated with increased ICU mortality (OR 1.50, 95% CI 1.07 to 2.12)) ICU and hospital LOS compared with a propofol dominant sedation strategy. CONCLUSIONS We identified a novel association between fentanyl dominant sedation strategies and an increased risk of delirium, a composite outcome of delirium or death, duration of mechanical ventilation, ICU LOS and hospital LOS. Midazolam dominant sedation strategies were associated with increased delirium risk and mechanical ventilation duration.
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Affiliation(s)
- Colin Casault
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Chel Hee Lee
- Department of Critical Care, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Philippe Couillard
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Daniel Niven
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Tom Stelfox
- Department of Critical Care, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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25
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Arakawa M, Levy JH, Fujimori K, Kondo K, Iba T. A new SOFA score calculation to improve the predictive performance for mortality in sepsis-associated disseminated intravascular coagulopathy patients. J Crit Care 2021; 64:108-113. [PMID: 33845446 DOI: 10.1016/j.jcrc.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The change in the sequential organ failure assessment (SOFA) score from the entry day, a delta-SOFA (SOFAΔ), has been proposed as a better indicator for predicting mortality, and potentially as an endpoint in clinical trials. However, there are some concerns that the value of the absolute SOFA score has not been considered. The purpose of the study is to examine whether the addition of an absolute SOFA score can increase the predictive performance of SOFAΔ. MATERIALS AND METHODS Data obtained from 297 patients with sepsis-associated disseminated intravascular coagulopathy (DIC) in multiinstitutional post-marketing surveys were analyzed retrospectively. The SOFAComb (SOFAΔ score + absolute SOFA score) and SOFAΔ were calculated, and the performance of each indicator was analyzed in terms of predictive ability for 28-day mortality. RESULTS The area under the receiver operating curve (AUC) for the mortality of SOFAComb on day 2, 4, 7 were significantly greater compared to those of SOFAΔ (P <0.001, =0.002, <0.001, respectively). In addition, the accuracy [(True positive + True negative) / total number at the best cutoff points] of SOFAComb was better than that of SOFAΔ. CONCLUSIONS SOFAComb is simple to calculate and provides better predictive performance compared to SOFAΔ for predicting mortality.
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Affiliation(s)
- Makoto Arakawa
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Jerrold H Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University School of Medicine, Sendai, Japan.
| | - Kenta Kondo
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
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26
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Fortini A, Faraone A, Meini S, Bettucchi M, Longo B, Valoriani B, Forni S. Validity of "Sepsis-3" criteria in identifying patients with community-onset sepsis in Internal Medicine wards; a prospective, multicenter study. Eur J Intern Med 2021; 85:92-97. [PMID: 33451890 DOI: 10.1016/j.ejim.2020.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Few data are available on the validity of "Sepsis-3" criteria in identifying patients with sepsis in internal medicine wards (IMWs). Real-life data about this topic and on the prevalence of sepsis in IMWs could be useful for improving hospital organization. OBJECTIVES To assess the validity of "Sepsis-3" criteria in identifying patients with community-onset sepsis in IMWs. Secondary objectives: to evaluate the prevalence of these patients in IMWs and to compare "Sepsis-3" and "Sepsis-1" criteria. METHODS Multicenter, prospective, observational, cohort study, carried out in 22 IMWs of Tuscany (Italy). All patients admitted to each of the study centers over a period of 21-31 days were evaluated within 48 hours; those with clinical signs of infection were enrolled. The main outcome was in-hospital mortality. RESULTS 2,839 patients were evaluated and 938 (33%) met the inclusion criteria. Patients with sepsis diagnosed according to "Sepsis-3" were 522, representing 55.6% of patients with infection and 18.4% of all patients hospitalized; they were older than those without sepsis (79.4±12.5 vs 74.6±15.2 years, p<0.001). In-hospital mortality was significantly higher in patients with sepsis compared to others (13.8% vs 4.6%; p<0.001). "Sepsis-3" criteria showed greater predictive validity for in-hospital mortality than "Sepsis-1" criteria (AUROC=0.71; 95%CI, 0.66-0.77 vs 0.60; 95%CI 0.54-0.66; p=0.0038). CONCLUSIONS "Sepsis-3" criteria are able to identify patients with community-onset sepsis in IMWs, whose prevalence and in-hospital mortality are remarkably high. Medical departments should adapt their organization to the needs for care of these complex patients.
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Affiliation(s)
- Alberto Fortini
- Internal Medicine, San Giovanni di Dio Hospital, Via di Torregalli 3, 50143 Firenze, Italy.
| | - Antonio Faraone
- Internal Medicine, San Giovanni di Dio Hospital, Via di Torregalli 3, 50143 Firenze, Italy
| | - Simone Meini
- Internal Medicine, Santa Maria Annunziata Hospital, Via Antella 58, 50012 Bagno a Ripol (Firenze), Italy; Internal Medicine, Felice Lotti Hospital, Via Roma, 147, 56025 Pontedera (Pisa), Italy
| | - Michael Bettucchi
- Internal Medicine, San Giovanni di Dio Hospital, Via di Torregalli 3, 50143 Firenze, Italy
| | - Benedetta Longo
- Internal Medicine, Felice Lotti Hospital, Via Roma, 147, 56025 Pontedera (Pisa), Italy
| | - Beatrice Valoriani
- Internal Medicine, Valdichiana Hospital, Località Nottola, 53045 Montepulciano (Siena), Italy
| | - Silvia Forni
- Regional Health Agency of Tuscany, Via Pietro Dazzi, 1, 50141 Firenze, Italy
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27
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Wirth R, Becker C, Djukic M, Drebenstedt C, Heppner HJ, Jacobs AH, Meisel M, Michels G, Nau R, Pantel J, Bauer JM. [COVID-19 in old age-The geriatric perspective]. Z Gerontol Geriatr 2021; 54:152-160. [PMID: 33595696 PMCID: PMC7887547 DOI: 10.1007/s00391-021-01864-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/02/2021] [Indexed: 01/16/2023]
Abstract
Predominantly the older population is affected by a severe course of COVID-19. The mortality of hospitalized patients with COVID-19 above the age of 80 years is up to 54% in international studies. These observations indicate the necessity to highlight the geriatric perspective on this disease. The diagnostics and treatment of COVID-19 do not differ between younger and older patients but atypical symptoms should be expected more frequently in old age. Older subjects show an increased need for rehabilitation after COVID-19. Paradoxically, increasing rehabilitation demands go along with a reduced availability of geriatric rehabilitation options, the latter being a consequence of closure or downsizing of rehabilitation departments during the pandemic. In general, measures of isolation and quarantine should be diligently balanced as the health and emotional consequences of such measures may be severe in older persons. In light of the poor prognosis of older COVID-19 patients, advanced care planning becomes even more relevant. Caregivers and physicians should be encouraged to compose advanced care directives that also reflect the specific circumstances of COVID-19. Fortunately, current data suggest that the effectiveness of the vaccination with the mRNA-vaccines approved in Germany may be equally high in older compared to younger persons.
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Affiliation(s)
- R Wirth
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland.
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
| | - C Becker
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Deutschland
| | - M Djukic
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Deutschland
- Abteilung für Neuropathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - C Drebenstedt
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Innere Medizin und Geriatrie, St.-Marien-Hospital Friesoythe, Friesoythe, Deutschland
| | - H J Heppner
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie, Helios Klinikum Schwelm, Lehrstuhl für Geriatrie, Universität Witten-Herdecke, Schwelm, Deutschland
| | - A H Jacobs
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie mit Neurologie, Johanniter Krankenhaus Bonn, Bonn, Deutschland
- CIO, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland
- EIMI, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - M Meisel
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Innere Medizin und Geriatrie, Diakonissenkrankenhaus Dessau, Dessau, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | - R Nau
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Deutschland
- Abteilung für Neuropathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - J Pantel
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Institut für Allgemeinmedizin, Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - J M Bauer
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum und Netzwerk Altersmedizin, Agaplesion Bethanien Krankenhaus Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
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28
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Riessen R, Haap M, Marckmann G, Mahling M. [Rational therapeutic decisions in intensive care patients]. Dtsch Med Wochenschr 2020; 145:1470-1475. [PMID: 33022728 DOI: 10.1055/a-1216-7614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Decisions about the initiation, continuation and termination of life-supporting treatments are a permanent challenge in intensive care units (ICUs). Decisions should be based on patient preferences and the medical indication. The medical indication is mainly the result of an assessment of the patient's prognosis and the applicable therapeutic options. Factors influencing the short term prognosis are mostly the severity of the acute leading disease, the number and severity of other organ failures and the response to initial treatment. Long term prognosis is dominated by the severity and number of comorbidities, age and the resulting frailty. Because in many patients all these informations are not available at the time of admission, in these cases a time-limited trial is often justified to gather all this information before a decision is made. These principles of decision making can also applied to situations in which ICU-capacities are limited (e. g. COVID-19 pandemic).
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Affiliation(s)
- Reimer Riessen
- Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Michael Haap
- Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Georg Marckmann
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Moritz Mahling
- Sektion Nieren- und Hochdruckkrankheiten, Medizinische Klinik IV, Diabetologie, Endokrinologie und Nephrologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
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29
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Keith PD, Wells AH, Hodges J, Fast SH, Adams A, Scott LK. The therapeutic efficacy of adjunct therapeutic plasma exchange for septic shock with multiple organ failure: a single-center experience. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:518. [PMID: 32831133 PMCID: PMC7443810 DOI: 10.1186/s13054-020-03241-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/12/2020] [Indexed: 12/26/2022]
Abstract
Background Sepsis remains a common condition with high mortality when multiple organ failure develops. The evidence for therapeutic plasma exchange (TPE) in this setting is promising but inconclusive. Our study aims to evaluate the efficacy of adjunct TPE for septic shock with multiple organ failure compared to standard therapy alone. Methods A retrospective, observational chart review was performed, evaluating outcomes of patients with catecholamine-resistant septic shock and multiple organ failure in intensive care units at a tertiary care hospital in Winston-Salem, NC, from August 2015 to March 2019. Adult patients with catecholamine-resistant septic shock (≥ 2 vasopressors) and evidence of multiple organ failure were included. Patients who received adjunct TPE were identified and compared to patients who received standard care alone. A propensity score using age, gender, chronic co-morbidities (HTN, DM, CKD, COPD), APACHE II score, SOFA score, lactate level, and number of vasopressors was used to match patients, resulting in 40 patients in each arm. Results The mean baseline APACHE II and SOFA scores were 32.5 and 14.3 in TPE patients versus 32.7 and 13.8 in control patients, respectively. The 28-day mortality rate was 40% in the TPE group versus 65% in the standard care group (p = 0.043). Improvements in baseline SOFA scores at 48 h were greater in the TPE group compared to standard care alone (p = 0.001), and patients receiving adjunct TPE had a more favorable fluid balance at 48 h (p = 0.01). Patients receiving adjunct TPE had longer ICU and hospital lengths of stay (p = 0.003 and p = 0.006, respectively). Conclusions Our retrospective, observational study in adult patients with septic shock and multiple organ failure demonstrated improved 28-day survival with adjunct TPE compared to standard care alone. Hemodynamics, organ dysfunction, and fluid balance all improved with adjunct TPE, while lengths of stay were increased in survivors. The study design does not allow for a generalized statement of support for TPE in all cases of sepsis with multiple organ failure but offers valuable information for a prospective, randomized clinical trial.
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Affiliation(s)
- Philip D Keith
- Critical Care Medicine, Lexington Medical Center, 2720 Sunset Boulevard, West Columbia, SC, 29169, USA.
| | - Adam H Wells
- Critical Care Medicine, Novant Health Forsyth Medical Center, 3333 Silas Creek Parkway, Winston-Salem, NC, 27103, USA
| | - Jeremy Hodges
- Clinical Pharmacist, Novant Health Forsyth Medical Center, 3333 Silas Creek Parkway, Winston-Salem, NC, 27103, USA
| | - Stephen H Fast
- Department of Mathematics, Limestone College, 1115 College Drive, Gaffney, SC, 29340, USA
| | - Amber Adams
- Emergency Department Clinical Pharmacist, Cabell Huntington Hospital, 1340 Hal Greer Boulevard, Huntington, WV, 25701, USA
| | - L Keith Scott
- Division of Trauma and Surgical Critical Care, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA
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30
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SOFA and qSOFA usefulness for in-hospital death prediction of elderly patients admitted for suspected infection in internal medicine. Infection 2020; 48:879-887. [PMID: 32767020 DOI: 10.1007/s15010-020-01494-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/29/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE To reduce intensive care unit overcrowding and optimize resources, elderly patients affected by suspected infection with declining clinical conditions could be managed in internal medicine departments with stepdown beds. However, commonly used prognostic scores, as Sequential Organ Failure Assessment (SOFA) or quick SOFA (qSOFA) have never been studied in this specific setting. The aim of this study was to evaluate the role and the accuracy of SOFA and qSOFA as prognostic scores in a population of elderly patients with suspected infection admitted to stepdown beds of two internal medicine departments. METHODS Elderly patients admitted from the emergency department in the stepdown beds of two different internal medicine departments for suspected infection were assessed with SOFA and qSOFA scores at the admission. All patients were treated according to current guidelines. Age, sex, comorbidities, Charlson comorbidity index, SOFA and qSOFA were assessed. In-hospital death and length of hospital admission were also recorded. RESULTS 390 subjects were enrolled. In-hospital death occurred in 144 (36.9%) patients; we observed that both SOFA (HR 1.189; 95% CI 1.128-1.253; p < 0.0001) and qSOFA (HR 1.803; 95% CI 1.503-2.164; p < 0.0001) scores were independently associated with an increased risk of in-hospital death. However, the accuracy of both SOFA (AUC: 0.686; 95% CI 0.637-0.732; p < 0.0001) and qSOFA (AUC: 0.680; 95% CI 0.641-0.735; p < 0.0001) in predicting in-hospital death was low in this population. CONCLUSION Elderly patients admitted to stepdown beds for suspected infection experience a high rate of in-hospital death; both SOFA and qSOFA scores can be useful to identify a group of patients who can benefit from admission to an intermediate care environment, however their accuracy is low.
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Abstract
The prognosis for a patient with multiple organ dysfunction syndrome (MODS)-also known as organ dysfunction or organ failure-is grave, and mortality can be high when three or more organ systems fail. This article reviews ongoing abnormalities of organ-specific parameters and a bedside clinical scoring assessment tool to identify the mortality of MODS, focusing on the management of MODS resulting from cardiogenic shock in ICU patients who require support of failing organs to survive.
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The early change of SOFA score as a prognostic marker of 28-day sepsis mortality: analysis through a derivation and a validation cohort. Crit Care 2019; 23:387. [PMID: 31783881 PMCID: PMC6884794 DOI: 10.1186/s13054-019-2665-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/07/2019] [Indexed: 11/15/2022] Open
Abstract
Background Since the Sepsis-3 criteria, change in Sequential Organ Failure Assessment (SOFA) score has become a key component of sepsis identification. Thus, it could be argued that reversal of this change (ΔSOFA) may reflect sepsis response and could be used as measure of efficacy in interventional trials. We aimed to assess the predictive performance of ΔSOFA for 28-day mortality. Methods Data from two previously published randomized controlled trials were studied: the first reporting on patients with severe Gram-negative infections as a derivation cohort and the second reporting on patients with ventilator-associated pneumonia as a validation cohort. Only patients with sepsis according to the Sepsis-3 definition were included in this analysis. SOFA scores were calculated on days 1, 2, 3, 5, 7, 14, and 28. Results We included 448 patients within the derivation cohort and 199 within the validation cohort. Mean SOFA scores on day 1 were 6.06 ± 4.07 and 7.84 ± 3.39, and 28 day mortality 22.8% and 29.6%, respectively. In the derivation cohort, the earliest time point where ΔSOFA score predicted mortality was day 7 (AUROC (95% CI) 0.84 (0.80–0.89); p < 0.001). The best tradeoff for prediction was found with 25% changes (78% sensitivity, 80% specificity); less than 25% decrease of admission SOFA was associated with increased mortality (odds ratio for death 14.87). This finding was confirmed in the validation cohort. Conclusions ΔSOFA on day 7 is a useful early prognostic marker of 28-day mortality and could serve as an endpoint in future sepsis trials alongside mortality. Trial registration ClinicalTrials.gov numbers NCT01223690 and NCT00297674
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