1
|
Muñoz Fernandez SS, Garcez FB, Alencar JCGD, Cederholm T, Aprahamian I, Morley JE, de Souza HP, Avelino da Silva TJ, Ribeiro SML. Applicability of the GLIM criteria for the diagnosis of malnutrition in older adults in the emergency ward: A pilot validation study. Clin Nutr 2021; 40:5447-5456. [PMID: 34653825 DOI: 10.1016/j.clnu.2021.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Acutely ill older adults are at higher risk of malnutrition. This study aimed to explore the applicability and accuracy of the GLIM criteria to diagnose malnutrition in acutely ill older adults in the emergency ward (EW). METHODS We performed a retrospective secondary analysis, of an ongoing cohort study, in 165 participants over 65 years of age admitted to the EW of a Brazilian university hospital. Nutrition assessment included anthropometry, the Simplified Nutritional Assessment Questionnaire (SNAQ), the Malnutrition Screening Tool (MST), and the Mini-Nutritional Assessment (MNA). We diagnosed malnutrition using GLIM criteria, defined by the parallel presence of at least one phenotypic [nonvolitional weight loss (WL), low BMI, low muscle mass (MM)] and one etiologic criterion [reduced food intake or assimilation (RFI), disease burden/inflammation]. We used the receiver operating characteristic (ROC) curves and Cox and logistic regression for data analyses. RESULTS GLIM criteria, following the MNA-SF screening, classified 50.3% of participants as malnourished, 29.1% of them in a severe stage. Validation of the diagnosis using MNA-FF as a reference showed good accuracy (AUC = 0.84), and moderate sensitivity (76%) and specificity (75.1%). All phenotypic criteria combined with RFI showed the best metrics. Malnutrition showed a trend for an increased risk of transference to intensive care unit (OR = 2.08, 95% CI 0.99, 4.35), and severe malnutrition for in-hospital mortality (HR = 4.23, 95% CI 1.2, 14.9). CONCLUSION GLIM criteria, following MNA-SF screening, appear to be a feasible approach to diagnose malnutrition in acutely ill older adults in the EW. Nonvolitional WL combined with RFI or acute inflammation were the best components identified and are easily accessible, allowing their potential use in clinical practice.
Collapse
Affiliation(s)
| | - Flavia Barreto Garcez
- Geriatrics Division, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Julio César García de Alencar
- Disciplina de Emergencias Clínicas, Departamento de Clínica Médica, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Karolinska University Hospital, Stockholm, Sweden
| | - Ivan Aprahamian
- Geriatrics Division, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - John Edward Morley
- Division of Geriatric Medicine, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Heraldo Possolo de Souza
- Disciplina de Emergencias Clínicas, Departamento de Clínica Médica, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | | | - Sandra Maria Lima Ribeiro
- Nutrition Department, School of Public Health, University of Sao Paulo, São Paulo, Brazil; School of Arts, Science, and Humanity, University of Sao Paulo, São Paulo, Brazil
| |
Collapse
|
2
|
Vizoso FJ, Fernández-Francos S, Eiro N. Mesenchymal Stem/Stromal Cells and Their Derivates in Acute Diseases: Emergency in the Post-COVID-19 Times. Int J Mol Sci 2021; 22:ijms22168395. [PMID: 34445102 PMCID: PMC8395045 DOI: 10.3390/ijms22168395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 12/19/2022] Open
Abstract
The current coronavirus disease-19 (COVID-19) pandemic has strongly revived the pressing need to incorporate new therapeutic alternatives to deal with medical situations that result in a dramatic breakdown in the body's normal homeostasis [...].
Collapse
Affiliation(s)
- Francisco J. Vizoso
- Research Unit, Fundación Hospital de Jove, Av. Eduardo Castro, 161, 33290 Gijón, Spain; (S.F.-F.); (N.E.)
- Department of Surgery, Fundación Hospital de Jove, Av. Eduardo Castro, 161, 33290 Gijón, Spain
- Correspondence: ; Tel.: +34-985320050 (ext. 84216)
| | - Silvia Fernández-Francos
- Research Unit, Fundación Hospital de Jove, Av. Eduardo Castro, 161, 33290 Gijón, Spain; (S.F.-F.); (N.E.)
- Department of Anesthesiology, Fundación Hospital de Jove, Av. Eduardo Castro, 161, 33290 Gijón, Spain
| | - Noemi Eiro
- Research Unit, Fundación Hospital de Jove, Av. Eduardo Castro, 161, 33290 Gijón, Spain; (S.F.-F.); (N.E.)
| |
Collapse
|
3
|
Zhao X, Zhang R, Jiang H, Liu K, Ma C, Bai M, An T, Yao Y, Wang X, Wang M, Li Y, Zhang Y, Zhang J. Combined use of low T3 syndrome and NT-proBNP as predictors for death in patients with acute decompensated heart failure. BMC Endocr Disord 2021; 21:140. [PMID: 34215247 PMCID: PMC8252209 DOI: 10.1186/s12902-021-00801-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In patients with established HF, low triiodothyronine syndrome (LT3S) is commonly present, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful marker for predicting death. This study was aimed to evaluate the prognostic value of LT3S in combination with NT-proBNP for risk of death in patients with heart failure (HF). METHODS A total of 594 euthyroid patients hospitalized with acute decompensated HF were enrolled by design. Of these patients, 27 patients died during hospitalization and 100 deaths were identified in patients discharged alive during one year follow-up. Patients were divided into 2 groups on the base of the reference ranges of free T3 (FT3) levels: LT3S group (FT3 < 2.3pg/mL, n = 168) and non-LT3S group (FT3 ≥ 2.3pg/mL, n = 426). RESULTS In multivariable Cox regression, LT3S was significantly associated with 1 year all-cause mortality (adjusted hazard ratio, 1.85; 95 % confidence interval [CI], 1.21 to 2.82; P = 0.005), but not significant for in-hospital mortality (adjusted hazard ratio, 1.58; 95 % CI, 1.58 to 2.82; P = 0.290) after adjustment for clinical variables and NT-proBNP. Addition of LT3S and NT-proBNP to the prediction model with clinical variables significantly improved the C statistic for predicting 1 year all-cause mortality. CONCLUSIONS In patients with acute decompensated HF, the combination of LT3S and NT-proBNP improved prediction for 1 year all-cause mortality beyond established risk factors, but was not strong enough for in-hospital mortality.
Collapse
Affiliation(s)
- Xinke Zhao
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, 100037, Beijing, China
| | - Rongcheng Zhang
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, 100037, Beijing, China
| | - Hugang Jiang
- Department of Cardiology, Affiliated Hospital of Gansu University of Chinese Medicine, 732 Jiyuguanxi Road, 730000, Lanzhou, China
| | - Kai Liu
- Department of Cardiology, Affiliated Hospital of Gansu University of Chinese Medicine, 732 Jiyuguanxi Road, 730000, Lanzhou, China
| | - Chengxu Ma
- Department of Cardiology, Affiliated Hospital of Gansu University of Chinese Medicine, 732 Jiyuguanxi Road, 730000, Lanzhou, China
| | - Ming Bai
- Department of Cardiology, The First Hospital of Lanzhou University, 730000, Lanzhou, China
| | - Tao An
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, 100037, Beijing, China
| | - Younan Yao
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, 100037, Beijing, China
| | - Xinqiang Wang
- Department of Cardiology, Affiliated Hospital of Gansu University of Chinese Medicine, 732 Jiyuguanxi Road, 730000, Lanzhou, China
| | - Ming Wang
- Department of Cardiology, Affiliated Hospital of Gansu University of Chinese Medicine, 732 Jiyuguanxi Road, 730000, Lanzhou, China
| | - Yingdong Li
- Department of Cardiology, Affiliated Hospital of Gansu University of Chinese Medicine, 732 Jiyuguanxi Road, 730000, Lanzhou, China.
| | - Yuhui Zhang
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, 100037, Beijing, China.
| | - Jian Zhang
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, 100037, Beijing, China.
| |
Collapse
|
4
|
Dong CT, Liveris A, Lewis ER, Mascharak S, Chao E, Reddy SH, Teperman SH, McNelis J, Stone ME. Do surgical emergencies stay at home? Observations from the first United States Coronavirus epicenter. J Trauma Acute Care Surg 2021; 91:241-246. [PMID: 34144567 PMCID: PMC8218982 DOI: 10.1097/ta.0000000000003202] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/06/2021] [Accepted: 02/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND During the coronavirus disease 2019 pandemic, New York instituted a statewide stay-at-home mandate to lower viral transmission. While public health guidelines advised continued provision of timely care for patients, disruption of safety-net health care and public fear have been proposed to be related to indirect deaths because of delays in presentation. We hypothesized that admissions for emergency general surgery (EGS) diagnoses would decrease during the pandemic and that mortality for these patients would increase. METHODS A multicenter observational study comparing EGS admissions from January to May 2020 to 2018 and 2019 across 11 NYC hospitals in the largest public health care system in the United States was performed. Emergency general surgery diagnoses were defined using International Classification Diseases, Tenth Revision, codes and grouped into seven common diagnosis categories: appendicitis, cholecystitis, small/large bowel, peptic ulcer disease, groin hernia, ventral hernia, and necrotizing soft tissue infection. Baseline demographics were compared including age, race/ethnicity, and payor status. Outcomes included coronavirus disease (COVID) status and mortality. RESULTS A total of 1,376 patients were admitted for EGS diagnoses from January to May 2020, a decrease compared with both 2018 (1,789) and 2019 (1,668) (p < 0.0001). This drop was most notable after the stay-at-home mandate (March 22, 2020; week 12). From March to May 2020, 3.3%, 19.2%, and 6.0% of EGS admissions were incidentally COVID positive, respectively. Mortality increased in March to May 2020 compared with 2019 (2.2% vs. 0.7%); this difference was statistically significant between April 2020 and April 2019 (4.1% vs. 0.9%, p = 0.045). CONCLUSION Supporting our hypothesis, the coronavirus disease 2019 pandemic and subsequent stay-at-home mandate resulted in decreased EGS admissions between March and May 2020 compared with prior years. During this time, there was also a statistically significant increase in mortality, which peaked at the height of COVID infection rates in our population. LEVEL OF EVIDENCE Epidemiological, level IV.
Collapse
|
5
|
Liao Y, Yang C, Bakeer B. Prognostic value of red blood cell distribution width in patients with acute pulmonary embolism: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25571. [PMID: 33950932 PMCID: PMC8104284 DOI: 10.1097/md.0000000000025571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prior reports have suggested that the red blood cell distribution width (RDW) parameter could be measured as a prognostic indicator in pulmonary embolism (PE) patients, thereby helping to guide their care. However, no systematic analyses on this topic have been completed to date, and the exact relationship between RDW and PE remains to be fully clarified. We will therefore conduct a systematic literature review with the goal of defining the correlation between RDW and mortality in acute PE cases. METHODS The EMBASE, Web of Knowledge, PubMed, ClinicalTrials.gov, and Cochrane Library databases will be searched for all relevant studies published from inception through March 2021 using the following search strategy: ("red blood cell distribution width") AND ("pulmonary embolism"). Two authors will independently identify eligible studies and extract data. The Q and I2 statistics will be used to judge heterogeneity among studies. RESULTS This study will establish the relative efficacy of RDW as a metric for predicting PE patient mortality. CONCLUSIONS This study will offer a reliable, evidence-based foundation for the clinical utilization of RDW as a tool for gauging mortality risk in acute PE patients. ETHICS AND DISSEMINATION As this is a protocol for a systematic review of previously published data, no ethical approval is required. Electronic dissemination of study results will be done through a peer-review publication or represented at a related conference.
Collapse
Affiliation(s)
- Ye Liao
- Medical Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Chunsheng Yang
- Department of Rehabilitation Medicine, The First Affiliation Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Banu Bakeer
- Department of Rehabilitation Medicine, The First Affiliation Hospital of Xinjiang Medical University, Urumqi, PR China
| |
Collapse
|
6
|
Martín-Rodríguez F, López-Izquierdo R, del Pozo Vegas C, Delgado-Benito JF, Ortega GJ, Castro Villamor MA, Sanz-García A. Association of Prehospital Oxygen Saturation to Inspired Oxygen Ratio With 1-, 2-, and 7-Day Mortality. JAMA Netw Open 2021; 4:e215700. [PMID: 33847751 PMCID: PMC8044733 DOI: 10.1001/jamanetworkopen.2021.5700] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE The early identification of patients at high risk of clinical deterioration represents one of the greatest challenges for emergency medical services (EMS). OBJECTIVE To assess whether use of the ratio of prehospital oxygen saturation measured by pulse oximetry (Spo2) to fraction of inspired oxygen (Fio2) measured during initial contact by EMS with the patient (ie, the first Spo2 to Fio2 ratio) and 5 minutes before the patient's arrival at the hospital (ie, the second Spo2 to Fio2 ratio) can predict the risk of early in-hospital deterioration. DESIGN, SETTING, AND PARTICIPANTS A prospective, derivation-validation prognostic cohort study of 3606 adults with acute diseases referred to 5 tertiary care hospitals in Spain was conducted between October 26, 2018, and June 30, 2020. Eligible patients were recruited from among all telephone requests for EMS assistance for adults who were later evacuated with priority in advanced life support units to the referral hospitals during the study period. MAIN OUTCOMES AND MEASURES The primary outcome was hospital mortality from any cause within the first, second, third, or seventh day after EMS transport to the hospital. The main measure was the Spo2 to Fio2 ratio. RESULTS A total of 3606 participants comprised 2 separate cohorts: the derivation cohort (3081 patients) and the validation cohort (525 patients). The median age was 69 years (interquartile range, 54-81 years), and 2122 patients (58.8%) were men. The overall mortality rate of the patients in the study cohort ranged from 3.6% for 1-day mortality (131 patients) to 7.1% for 7-day mortality (256 patients). The best model performance was for 2-day mortality with the second Spo2 to Fio2 ratio with an area under the curve of 0.890 (95% CI, 0.829-0.950; P < .001), although the other outcomes also presented good results. In addition, a risk-stratification model was generated. The optimal cutoff resulted in the following ranges of Spo2 to Fio2 ratios: 50 to 100 for high risk of mortality, 101 to 426 for intermediate risk, and 427 to 476 for low risk. CONCLUSIONS AND RELEVANCE This study suggests that use of the prehospital Spo2 to Fio2 ratio was associated with improved management of patients with acute disease because it accurately predicts short-term mortality.
Collapse
Affiliation(s)
- Francisco Martín-Rodríguez
- Faculty of Medicine, Valladolid University, Valladolid, Spain
- Advanced Life Support, Emergency Medical Services, Valladolid, Spain
| | - Raúl López-Izquierdo
- Faculty of Medicine, Valladolid University, Valladolid, Spain
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Carlos del Pozo Vegas
- Faculty of Medicine, Valladolid University, Valladolid, Spain
- Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Guillermo J. Ortega
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid, Spain
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | | | - Ancor Sanz-García
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid, Spain
| |
Collapse
|
7
|
Mackintosh NJ, Davis RE, Easter A, Rayment-Jones H, Sevdalis N, Wilson S, Adams M, Sandall J. Interventions to increase patient and family involvement in escalation of care for acute life-threatening illness in community health and hospital settings. Cochrane Database Syst Rev 2020; 12:CD012829. [PMID: 33285618 PMCID: PMC8406701 DOI: 10.1002/14651858.cd012829.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is now a rising commitment to acknowledge the role patients and families play in contributing to their safety. This review focuses on one type of involvement in safety - patient and family involvement in escalation of care for serious life-threatening conditions i.e. helping secure a step-up to urgent or emergency care - which has been receiving increasing policy and practice attention. This review was concerned with the negotiation work that patient and family members undertake across the emergency care escalation pathway, once contact has been made with healthcare staff. It includes interventions aiming to improve detection of symptoms, communication of concerns and staff response to these concerns. OBJECTIVES To assess the effects of interventions designed to increase patient and family involvement in escalation of care for acute life-threatening illness on patient and family outcomes, treatment outcomes, clinical outcomes, patient and family experience and adverse events. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP) ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform from 1 Jan 2000 to 24 August 2018. The search was updated on 21 October 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-randomised controlled trials where the intervention focused on patients and families working with healthcare professionals to ensure care received for acute deterioration was timely and appropriate. A key criterion was to include an interactive element of rehearsal, role play, modelling, shared language, group work etc. to the intervention to help patients and families have agency in the process of escalation of care. The interventions included components such as enabling patients and families to detect changes in patients' conditions and to speak up about these changes to staff. We also included studies where the intervention included a component targeted at enabling staff response. DATA COLLECTION AND ANALYSIS Seven of the eight authors were involved in screening; two review authors independently extracted data and assessed the risk of bias of included studies, with any disagreements resolved by discussion to reach consensus. Primary outcomes included patient and family outcomes, treatment outcomes, clinical outcomes, patient and family experience and adverse events. Our advisory group (four users and four providers) ensured that the review was of relevance and could inform policy and practice. MAIN RESULTS We included nine studies involving 436,684 patients and family members and one ongoing study. The published studies focused on patients with specific conditions such as coronary artery disease, ischaemic stroke, and asthma, as well as pregnant women, inpatients on medical surgical wards, older adults and high-risk patients with a history of poor self-management. While all studies tested interventions versus usual care, for four studies the usual care group also received educational or information strategies. Seven of the interventions involved face-to-face, interactional education/coaching sessions aimed at patients/families while two provided multi-component education programmes which included components targeted at staff as well as patients/families. All of the interventions included: (1) an educational component about the acute condition and preparedness for future events such as stroke or change in fetal movements: (2) an engagement element (self-monitoring, action plans); while two additionally focused on shared language or communication skills. We had concerns about risk of bias for all but one of the included studies in respect of one or more criteria, particularly regarding blinding of participants and personnel. Our confidence in results regarding the effectiveness of interventions was moderate to low. Low-certainty evidence suggests that there may be moderate improvement in patients' knowledge of acute life-threatening conditions, danger signs, appropriate care-seeking responses, and preparedness capacity between interactional patient-facing interventions and multi-component programmes and usual care at 12 months (MD 4.20, 95% CI 2.44 to 5.97, 2 studies, 687 participants). Four studies in total assessed knowledge (3,086 participants) but we were unable to include two other studies in the pooled analysis due to differences in the way outcome measures were reported. One found no improvement in knowledge but higher symptom preparedness at 12 months. The other study found an improvement in patients' knowledge about symptoms and appropriate care-seeking responses in the intervention group at 18 months compared with usual care. Low-certainty evidence from two studies, each using a different measure, meant that we were unable to determine the effects of patient-based interventions on self-efficacy. Self-efficacy was higher in the intervention group in one study but there was no difference in the other compared with usual care. We are uncertain whether interactional patient-facing and multi-component programmes improve time from the start of patient symptoms to treatment due to low-certainty evidence for this outcome. We were unable to combine the data due to differences in outcome measures. Three studies found that arrival times or prehospital delay time was no different between groups. One found that delay time was shorter in the intervention group. Moderate-certainty evidence suggests that multi-component interventions probably have little or no impact on mortality rates. Only one study on a pregnant population was eligible for inclusion in the review, which found no difference between groups in rates of stillbirth. In terms of unintended events, we found that interactional patient-facing interventions to increase patient and family involvement in escalation of care probably have few adverse effects on patient's anxiety levels (moderate-certainty evidence). None of the studies measured or reported patient and family perceptions of involvement in escalation of care or patient and family experience of patient care. Reported outcomes related to healthcare professionals were also not reported in any studies. AUTHORS' CONCLUSIONS Our review identified that interactional patient-facing interventions and multi-component programmes (including staff) to increase patient and family involvement in escalation of care for acute life-threatening illness may improve patient and family knowledge about danger signs and care-seeking responses, and probably have few adverse effects on patient's anxiety levels when compared to usual care. Multi-component interventions probably have little impact on mortality rates. Further high-quality trials are required using multi-component interventions and a focus on relational elements of care. Cognitive and behavioural outcomes should be included at patient and staff level.
Collapse
Affiliation(s)
- Nicola J Mackintosh
- SAPPHIRE, Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Rachel E Davis
- Health Service & Population Research Department, King's College London, London, UK
| | - Abigail Easter
- Health Service & Population Research Department, King's College London, London, UK
| | - Hannah Rayment-Jones
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Nick Sevdalis
- Health Service & Population Research Department, King's College London, London, UK
| | - Sophie Wilson
- Health Service & Population Research Department, King's College London, London, UK
| | - Mary Adams
- Health Service & Population Research Department, King's College London, London, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences & Medicine, King's College London, London, UK
| |
Collapse
|
8
|
Abstract
BACKGROUND Although selenium is an essential element for humans, acute toxicity has been reported after high oral exposure. METHODS The published literature on the acute toxicity of oral selenium was gathered and reviewed. RESULTS Reported symptoms and signs include abdominal symptoms, such as vomiting, diarrhea, pain, and nausea, as well as garlic-like odor on the breath. In cases of severe toxicity, cardiac and pulmonary symptoms may develop and ultimately lead to mortality. Mortality has been described after the ingestion of gun bluing solutions, which often contain selenous acid among other potentially toxic substances. Mortality has also been reported after the ingestion of other forms of selenium. Ingested doses associated with mortality are in the range of 1-100 mg Se/kg body weight. Blood levels associated with mortality are above 300 μg Se/L (normal level: 100 μg/L), whereas urinary levels associated with the same endpoint are above170 μg Se/L (normal level: 20-90 μg/L). CONCLUSION The acute toxicity associated with oral selenium ingestion and the blood and urinary levels of selenium in different cases of poisonings were reviewed. Mortality is a risk of acute selenium poisoning. Concentrations of selenium in blood and urine samples in non-fatal cases are close to those observed in fatal cases.
Collapse
Affiliation(s)
- Niels Hadrup
- The National Research Centre For The Working Environment, Lersø Parkallé 105, DK 2100, København Ø, Denmark.
| | - Gitte Ravn-Haren
- National Food Institute, Technical University of Denmark, Kemitorvet, DK 2800 Kgs. Lyngby, Denmark.
| |
Collapse
|
9
|
Kwon JM, Jeon KH, Kim HM, Kim MJ, Lim S, Kim KH, Song PS, Park J, Choi RK, Oh BH. Deep-learning-based risk stratification for mortality of patients with acute myocardial infarction. PLoS One 2019; 14:e0224502. [PMID: 31671144 PMCID: PMC6822714 DOI: 10.1371/journal.pone.0224502] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Conventional risk stratification models for mortality of acute myocardial infarction (AMI) have potential limitations. This study aimed to develop and validate deep-learning-based risk stratification for the mortality of patients with AMI (DAMI). METHODS The data of 22,875 AMI patients from the Korean working group of the myocardial infarction (KorMI) registry were exclusively divided into 12,152 derivation data of 36 hospitals and 10,723 validation data of 23 hospitals. The predictor variables were the initial demographic and laboratory data. The endpoints were in-hospital mortality and 12-months mortality. We compared the DAMI performance with the global registry of acute coronary event (GRACE) score, acute coronary treatment and intervention outcomes network (ACTION) score, and the thrombolysis in myocardial infarction (TIMI) score using the validation data. RESULTS In-hospital mortality for the study subjects was 4.4% and 6-month mortality after survival upon discharge was 2.2%. The areas under the receiver operating characteristic curves (AUCs) of the DAMI were 0.905 [95% confidence interval 0.902-0.909] and 0.870 [0.865-0.876] for the ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI) patients, respectively; these results significantly outperformed those of the GRACE (0.851 [0.846-0.856], 0.810 [0.803-0.819]), ACTION (0.852 [0.847-0.857], 0.806 [0.799-0.814] and TIMI score (0.781 [0.775-0.787], 0.593[0.585-0.603]). DAMI predicted 30.9% of patients more accurately than the GRACE score. As secondary outcome, during the 6-month follow-up, the high risk group, defined by the DAMI, has a significantly higher mortality rate than the low risk group (17.1% vs. 0.5%, p < 0.001). CONCLUSIONS The DAMI predicted in-hospital mortality and 12-month mortality of AMI patients more accurately than the existing risk scores and other machine-learning methods.
Collapse
Affiliation(s)
- Joon-myoung Kwon
- Department of Emergency Medicine, Mediplex Sejong Hospital, Incheon, Korea
- Artificial intelligence and big data center, Sejong medical research institute, Gyeonggi, Korea
| | - Ki-Hyun Jeon
- Artificial intelligence and big data center, Sejong medical research institute, Gyeonggi, Korea
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, Incheon, Korea
- * E-mail:
| | - Hyue Mee Kim
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, Incheon, Korea
| | - Min Jeong Kim
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, Incheon, Korea
| | - Sungmin Lim
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, Incheon, Korea
| | - Kyung-Hee Kim
- Artificial intelligence and big data center, Sejong medical research institute, Gyeonggi, Korea
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, Incheon, Korea
| | - Pil Sang Song
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, Incheon, Korea
| | - Jinsik Park
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, Incheon, Korea
| | - Rak Kyeong Choi
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, Incheon, Korea
| | - Byung-Hee Oh
- Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, Incheon, Korea
| |
Collapse
|
10
|
Ferreira IB, Lima EDNS, da Silva NC, Prestes IV, Pena GDG. Combination of red blood cell distribution width and body mass index (COR-BMI) predicts in-hospital mortality in patients with different diagnoses? PLoS One 2019; 14:e0219549. [PMID: 31306467 PMCID: PMC6629057 DOI: 10.1371/journal.pone.0219549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 06/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background The combination of red blood cell distribution width and body mass index (COR-BMI) is indicated as a new prognostic index of survival in patients with laryngeal cancer. However, the ability of this prediction in other types of cancer or whether its use can be expanded to non-oncological patients is unknown. The aim of this study was to investigate the prediction of prognosis of in-hospital mortality of the COR-BMI in oncological and non-oncological patients. Methods A retrospective study was performed with all hospitalized patients between 2014 and 2016, totaling 2930 patients, 262 oncological and 2668 non-oncological. The COR-BMI was divided into three classes: 0, RDW ≤ 13.1% and BMI ≥ 25 kg/m2; 1, RDW ≤ 13.1% and BMI < 18.5 or ≥ 18.5 but < 25 kg/m2 and RDW > 13.1% and BMI ≥ 18.5 but < 25 or BMI ≥ 25 kg/m2; and 2, RDW > 13.1% and BMI < 18.5 kg/m2. In order to analyze the relationship between COR-BMI and in-hospital mortality in the studied population, the Cox Proportional Hazards Model was used in a multivariate analysis based on a conceptual model. Results The COR-BMI was an independent predictor of in-hospital mortality in non-oncological patients (1 versus 0: HR = 3.34; CI = 1.60–6.96, p = 0.001; 2 versus 0: HR = 3.38; CI = 1.22–9.39, p = 0.019). The survival rate of these patients was lower among those with the highest scores on the COR-BMI. This prediction was not found in oncological patients. Conclusion The present study suggests that the COR-BMI may have its practical use expanded to non-oncological patients as an independent predictor of in-hospital mortality.
Collapse
Affiliation(s)
- Isabela Borges Ferreira
- Multiprofessional Residence Program, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | | | - Nayara Cristina da Silva
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | | | - Geórgia das Graças Pena
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
- * E-mail:
| |
Collapse
|
11
|
Childhood Acute Illness and Nutrition Network. Childhood Acute Illness and Nutrition (CHAIN) Network: a protocol for a multi-site prospective cohort study to identify modifiable risk factors for mortality among acutely ill children in Africa and Asia. BMJ Open 2019; 9:e028454. [PMID: 31061058 DOI: 10.1136/bmjopen-2018-028454] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Children admitted to hospitals in resource-poor settings remain at risk of both inpatient and post-discharge mortality. While known risk factors such as young age and nutritional status can identify children at risk, they do not provide clear mechanistic targets for intervention. The Childhood Acute Illness and Nutrition (CHAIN) cohort study aims to characterise the biomedical and social risk factors for mortality in acutely ill children in hospitals and after discharge to identify targeted interventions to reduce mortality. METHODS AND ANALYSIS The CHAIN network is currently undertaking a multi-site, prospective, observational cohort study, enrolling children aged 1 week to 2 years at admission to hospitals at nine sites located in four African and two South Asian countries. The CHAIN Network supports the sites to provide care according to national and international guidelines. Enrolment is stratified by anthropometric status and children are followed throughout hospitalisation and for 6 months after discharge. Detailed clinical, demographic, anthropometric, laboratory and social exposures are assessed. Scheduled visits are conducted at 45, 90 and 180 days after discharge. Blood, stool and rectal swabs are collected at enrolment, hospital discharge and follow-up. The primary outcome is inpatient or post-discharge death. Secondary outcomes include readmission to hospital and nutritional status after discharge. Cohort analysis will identify modifiable risks, children with distinct phenotypes, relationships between factors and mechanisms underlying poor outcomes that may be targets for intervention. A nested case-control study examining infectious, immunological, metabolic, nutritional and other biological factors will be undertaken. ETHICS AND DISSEMINATION This study protocol was reviewed and approved primarily by the Oxford Tropical Research Ethics Committee, and the institutional review boards of all partner sites. The study is being externally monitored. Results will be published in open access peer-reviewed scientific journals and presented to academic and policy stakeholders. TRIAL REGISTRATION NUMBER NCT03208725.
Collapse
|
12
|
Chioncel O, Collins SP, Ambrosy AP, Pang PS, Antohi EL, Iliescu VA, Maggioni AP, Butler J, Mebazaa A. Improving Postdischarge Outcomes in Acute Heart Failure. Am J Ther 2019; 25:e475-e486. [PMID: 29985826 PMCID: PMC6114135 DOI: 10.1097/mjt.0000000000000791] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Ovidiu Chioncel
- University of Medicine Carol Davila, Bucharest; Emergency Institute
for Cardiovascular Diseases-“Prof. C.C. Iliescu”, Bucharest,
Romania
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University, Nashville,
TN, USA
| | - Andrew P Ambrosy
- Division of Cardiology, Duke University Medical Center, Durham, NC,
USA Duke Clinical Research Institute, Durham, NC, USA
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of
Medicine, Indiana USA
| | - Elena-Laura Antohi
- University of Medicine Carol Davila, Bucharest; Emergency Institute
for Cardiovascular Diseases-“Prof. C.C. Iliescu”, Bucharest,
Romania
| | - Vlad Anton Iliescu
- University of Medicine Carol Davila, Bucharest; Emergency Institute
for Cardiovascular Diseases-“Prof. C.C. Iliescu”, Bucharest,
Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Florence, Italy; EORP-European Society of
Cardiology, Sophia Antipolis, France
| | - Javed Butler
- Department of Medicine, University of Mississippi School of
Medicine, Jackson, MI, USA
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care, APHP – Saint
Louis Lariboisière University Hospitals, University Paris Diderot and INSERM
UMR-S 942, Paris, France
| |
Collapse
|
13
|
Abstract
In the following article, we present the key trends in emergency surgical care in the Russian Federation between 2000 and 2017. The study used data from federal statistical observations and a survey of state medical institutions in 80 regions encompassing 99.3% of the country's population. We discovered a change in the correlation between acute abdominal diseases, particularly a significant reduction in the occurrence of acute appendicitis and perforated peptic ulcer. Reduction in the number of emergency surgeries by 27.8% annually was also observed. Mortality rate decreased in cases of strangulated hernia, acute cholecystitis and acute pancreatitis, while it is stable for bowel obstruction and acute appendicitis and increasing in perforated peptic ulcer cases. The total annual number of lethal outcomes due to acute abdominal diseases was decreased by 1900 cases. Significant changes were observed in mortality rate and minimally invasive surgeries proportions between federal districts and individual regions of the country. The range of administrative measures was proposed.
Collapse
Affiliation(s)
- A Sh Revishvili
- Vishnevsky National medical research center of surgery of Ministry of Health of Russia, Moscow, Russia
| | - A V Fedorov
- Vishnevsky National medical research center of surgery of Ministry of Health of Russia, Moscow, Russia
| | - V P Sazhin
- Pavlov Ryazan State Medical University of Ministry of Health of Russia, Ryazan, Russia
| | - V E Olovyannyi
- Vishnevsky National medical research center of surgery of Ministry of Health of Russia, Moscow, Russia
| |
Collapse
|
14
|
Faisal M, Scally AJ, Jackson N, Richardson D, Beatson K, Howes R, Speed K, Menon M, Daws J, Dyson J, Marsh C, Mohammed MA. Development and validation of a novel computer-aided score to predict the risk of in-hospital mortality for acutely ill medical admissions in two acute hospitals using their first electronically recorded blood test results and vital signs: a cross-sectional study. BMJ Open 2018; 8:e022939. [PMID: 30530474 PMCID: PMC6286481 DOI: 10.1136/bmjopen-2018-022939] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES There are no established mortality risk equations specifically for emergency medical patients who are admitted to a general hospital ward. Such risk equations may be useful in supporting the clinical decision-making process. We aim to develop and externally validate a computer-aided risk of mortality (CARM) score by combining the first electronically recorded vital signs and blood test results for emergency medical admissions. DESIGN Logistic regression model development and external validation study. SETTING Two acute hospitals (Northern Lincolnshire and Goole NHS Foundation Trust Hospital (NH)-model development data; York Hospital (YH)-external validation data). PARTICIPANTS Adult (aged ≥16 years) medical admissions discharged over a 24-month period with electronic National Early Warning Score(s) and blood test results recorded on admission. RESULTS The risk of in-hospital mortality following emergency medical admission was 5.7% (NH: 1766/30 996) and 6.5% (YH: 1703/26 247). The C-statistic for the CARM score in NH was 0.87 (95% CI 0.86 to 0.88) and was similar in an external hospital setting YH (0.86, 95% CI 0.85 to 0.87) and the calibration slope included 1 (0.97, 95% CI 0.94 to 1.00). CONCLUSIONS We have developed a novel, externally validated CARM score with good performance characteristics for estimating the risk of in-hospital mortality following an emergency medical admission using the patient's first, electronically recorded, vital signs and blood test results. Since the CARM score places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.
Collapse
Affiliation(s)
- Muhammad Faisal
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Bradford Institute for Health Research, Bradford, UK
| | - Andrew J Scally
- School of Clinical Therapies, University College Cork, Cork, Ireland
| | | | - Donald Richardson
- Department of Renal Medicine, York Teaching Hospital NHS Foundation Trust Hospital, York, UK
| | - Kevin Beatson
- Department of Renal Medicine, York Teaching Hospital NHS Foundation Trust Hospital, York, UK
- York Teaching Hospital NHS Foundation Trust Hospital, York, UK
| | - Robin Howes
- Department of Strategy and Planning, Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, UK
| | - Kevin Speed
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, UK
| | - Madhav Menon
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, UK
| | - Jeremey Daws
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, UK
| | - Judith Dyson
- School of Health and Social Work, University Of Hull, Hull, UK
| | - Claire Marsh
- Bradford Institute for Health Research, Bradford, UK
| | - Mohammed A Mohammed
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Bradford Institute for Health Research, Bradford, UK
| |
Collapse
|
15
|
Yoo JJ, Chang Y, Cho EJ, Moon JE, Kim SG, Kim YS, Lee YB, Lee JH, Yu SJ, Kim YJ, Yoon JH. Timing of upper gastrointestinal endoscopy does not influence short-term outcomes in patients with acute variceal bleeding. World J Gastroenterol 2018; 24:5025-5033. [PMID: 30510377 PMCID: PMC6262253 DOI: 10.3748/wjg.v24.i44.5025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/15/2018] [Accepted: 11/13/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To examine the association between the timing of endoscopy and the short-term outcomes of acute variceal bleeding in cirrhotic patients.
METHODS This retrospective study included 274 consecutive patients admitted with acute esophageal variceal bleeding of two tertiary hospitals in Korea. We adjusted confounding factors using the Cox proportional hazards model and the inverse probability weighting (IPW) method. The primary outcome was the mortality of patients within 6 wk.
RESULTS A total of 173 patients received urgent endoscopy (i.e., ≤ 12 h after admission), and 101 patients received non-urgent endoscopy (> 12 h after admission). The 6-wk mortality rate was 22.5% in the urgent endoscopy group and 29.7% in the non-urgent endoscopy group, and there was no significant difference between the two groups before (P = 0.266) and after IPW (P = 0.639). The length of hospital stay was statistically different between the urgent group and non-urgent group (P = 0.033); however, there was no significant difference in the in-hospital mortality rate between the two groups (8.1% vs 7.9%, P = 0.960). In multivariate analyses, timing of endoscopy was not associated with 6-wk mortality (hazard ratio, 1.297; 95% confidence interval, 0.806-2.089; P = 0.284).
CONCLUSION In cirrhotic patients with acute variceal bleeding, the timing of endoscopy may be independent of short-term mortality.
Collapse
Affiliation(s)
- Jeong-Ju Yoo
- Department of Gastroenterology and Hepatology, Soonchunhyang University school of Medicine, Bucheon 14584, South Korea
| | - Young Chang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Ji Eun Moon
- Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - Sang Gyune Kim
- Department of Gastroenterology and Hepatology, Soonchunhyang University school of Medicine, Bucheon 14584, South Korea
| | - Young Seok Kim
- Department of Gastroenterology and Hepatology, Soonchunhyang University school of Medicine, Bucheon 14584, South Korea
| | - Yun Bin Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea
| |
Collapse
|
16
|
Zurbrigg K, van Dreumel T, Rothschild MF, Alves D, Friendship R, O'Sullivan TL. Rapid Communication: Postmortem lesions and heart weights of in-transit-loss market pigs in Ontario. J Anim Sci 2018; 95:5532-5536. [PMID: 29293772 DOI: 10.2527/jas2017.2089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In-transit losses (ITL) of market-weight pigs are defined as pigs that die or pigs that become nonambulatory during loading and shipping from the farm to the abattoir. The low proportion of ITL in market pigs implies that individual pig factors may influence ITL, in addition to commonly considered environmental or transport factors. Postmortem examinations of in-transit-loss pigs ( = 85) from 1 Ontario, Canada, abattoir indicated the cause of death to be acute heart failure as a result of cardiac lesions that developed prior to transport. The presence of preexisting cardiac lesions may explain why no or only a few pigs die in a trailer even when the entire load is exposed to extreme temperatures and other common transport risk factors.
Collapse
|
17
|
Chicaiza-Ayala W, Henríquez-Trujillo AR, Ortiz-Prado E, Douce RW, Coral-Almeida M. The burden of acute respiratory infections in Ecuador 2011-2015. PLoS One 2018; 13:e0196650. [PMID: 29715314 PMCID: PMC5929540 DOI: 10.1371/journal.pone.0196650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/17/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Burden of disease studies intend to improve public health decision-making and to measure social and economic impact in population. The objective of this study was to describe the burden of acute respiratory infections (ARI) in Ecuador between 2011 and 2015. METHODS Five-year period morbidity and mortality data available from national agencies of statistics was analyzed to estimate the burden of disease attributable to acute respiratory infections. Cases and deaths registered were grouped according to their ICD-10 code into three diagnostic groups: Acute upper respiratory infections (J00-J06), Influenza and pneumonia (J09-J18), and Bronchitis and other acute lower respiratory infections (J20-J22, J85, J86). Disability-adjusted life years stratified by diagnostic and age group were calculated using the "DALY" package for R. The productivity loss in monetary terms was estimated using the human capital method. RESULTS Over the 5-year period studied there were a total of 14.84 million cases of acute respiratory infections, with 17 757 deaths reported (0.12%). The yearly burden of disease ranged between 98 944 to 118 651 disability-adjusted life years, with an estimated average loss of productivity of US$152.16 million (±19.6) per year. Approximately 99% of the burden can be attributed to years life lost due to premature mortality in population under 5 years old and over 60 years-old. CONCLUSIONS The burden of acute respiratory infections remained steady during the analyzed period. Evidence-based prevention and control policies to tackle acute respiratory infections in Ecuador should focus on the population at extreme ages of life.
Collapse
Affiliation(s)
- Wilson Chicaiza-Ayala
- OneHealth Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
| | | | - Esteban Ortiz-Prado
- OneHealth Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
- Department of Medicine and Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York, United States of America
| | - Richard W. Douce
- Department of Internal Medicine, Lakeland Health Care, St. Joseph, Michigan, United States of America
| | - Marco Coral-Almeida
- OneHealth Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
| |
Collapse
|
18
|
Harris S, Singer M, Sanderson C, Grieve R, Harrison D, Rowan K. Impact on mortality of prompt admission to critical care for deteriorating ward patients: an instrumental variable analysis using critical care bed strain. Intensive Care Med 2018; 44:606-615. [PMID: 29736785 PMCID: PMC6006241 DOI: 10.1007/s00134-018-5148-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/21/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE To estimate the effect of prompt admission to critical care on mortality for deteriorating ward patients. METHODS We performed a prospective cohort study of consecutive ward patients assessed for critical care. Prompt admissions (within 4 h of assessment) were compared to a 'watchful waiting' cohort. We used critical care strain (bed occupancy) as a natural randomisation event that would predict prompt transfer to critical care. Strain was classified as low, medium or high (2+, 1 or 0 empty beds). This instrumental variable (IV) analysis was repeated for the subgroup of referrals with a recommendation for critical care once assessed. Risk-adjusted 90-day survival models were also constructed. RESULTS A total of 12,380 patients from 48 hospitals were available for analysis. There were 2411 (19%) prompt admissions (median delay 1 h, IQR 1-2) and 9969 (81%) controls; 1990 (20%) controls were admitted later (median delay 11 h, IQR 6-26). Prompt admissions were less frequent (p < 0.0001) as strain increased from low (22%), to medium (15%) to high (9%); the median delay to admission was 3, 4 and 5 h respectively. In the IV analysis, prompt admission reduced 90-day mortality by 7.4% (95% CI 1.7-18.5%, p = 0.117) overall, and 16.2% (95% CI 1.1-31.3%, p = 0.036) for those recommended for critical care. In the risk-adjust survival model, 90-day mortality was similar. CONCLUSION After allowing for unobserved prognostic differences between the groups, we find that prompt admission to critical care leads to lower 90-day mortality for patients assessed and recommended to critical care.
Collapse
Affiliation(s)
- Steve Harris
- Critical Care Department, University College Hospital London, 235 Euston Road, London, NW1 2BU, UK.
| | - Mervyn Singer
- Wolfson Institute for Biomedical Research, University College London, The Cruciform Building, Gower Street, London, WC1E 6B, UK
| | - Colin Sanderson
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - David Harrison
- Intensive Care National Audit and Research Centre, Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - Kathryn Rowan
- Intensive Care National Audit and Research Centre, Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| |
Collapse
|
19
|
Opio MO, Namujwiga T, Nakitende I, Kellett J, Brabrand M. The prediction of in-hospital mortality by mid-upper arm circumference: a prospective observational study of the association between mid-upper arm circumference and the outcome of acutely ill medical patients admitted to a resource-poor hospital in sub-Saharan Africa. Clin Med (Lond) 2018; 18:123-127. [PMID: 29626015 PMCID: PMC6303455 DOI: 10.7861/clinmedicine.18-2-123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
There are few reports of the association of nutritional status with in-hospital mortality of acutely ill medical patients in sub-Saharan Africa. This is a prospective observational study comparing the predictive value of mid-upper arm circumference (MUAC) of 899 acutely ill medical patients admitted to a resource-poor sub-Saharan hospital with mental alertness, mobility and vital signs. Mid-upper arm circumference ranged from 15 cm to 42 cm, and 12 (24%) of the 50 patients with a MUAC less than 20 cm died (OR 4.84, 95% CI 2.23-10.37). Of the 237 patients with a MUAC more than 28 cm only six (2.5%) died (OR 0.27, 95% CI 0.10-0.67). On logistic regression, the National Early Warning Score (NEWS), alertness, mobility and MUAC were independent predictors of in-hospital mortality. Mid-upper arm circumference is an independent predictor of the in-hospital mortality of acutely ill medical patients in a resource-poor hospital in sub-Saharan Africa.
Collapse
Affiliation(s)
| | | | | | | | - Mikkel Brabrand
- Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - on behalf of the Kitovu Hospital Study Group
- Kitovu Hospital, Masaka, Uganda
- Kitovu Hospital, Masaka, Uganda
- Kitovu Hospital, Masaka, Uganda
- University of Southern Denmark, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Denmark
| |
Collapse
|
20
|
Self WH, Semler MW, Wanderer JP, Wang L, Byrne DW, Collins SP, Slovis CM, Lindsell CJ, Ehrenfeld JM, Siew ED, Shaw AD, Bernard GR, Rice TW. Balanced Crystalloids versus Saline in Noncritically Ill Adults. N Engl J Med 2018; 378:819-828. [PMID: 29485926 PMCID: PMC5846618 DOI: 10.1056/nejmoa1711586] [Citation(s) in RCA: 370] [Impact Index Per Article: 61.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Comparative clinical effects of balanced crystalloids and saline are uncertain, particularly in noncritically ill patients cared for outside an intensive care unit (ICU). METHODS We conducted a single-center, pragmatic, multiple-crossover trial comparing balanced crystalloids (lactated Ringer's solution or Plasma-Lyte A) with saline among adults who were treated with intravenous crystalloids in the emergency department and were subsequently hospitalized outside an ICU. The type of crystalloid that was administered in the emergency department was assigned to each patient on the basis of calendar month, with the entire emergency department crossing over between balanced crystalloids and saline monthly during the 16-month trial. The primary outcome was hospital-free days (days alive after discharge before day 28). Secondary outcomes included major adverse kidney events within 30 days - a composite of death from any cause, new renal-replacement therapy, or persistent renal dysfunction (defined as an elevation of the creatinine level to ≥200% of baseline) - all censored at hospital discharge or 30 days, whichever occurred first. RESULTS A total of 13,347 patients were enrolled, with a median crystalloid volume administered in the emergency department of 1079 ml and 88.3% of the patients exclusively receiving the assigned crystalloid. The number of hospital-free days did not differ between the balanced-crystalloids and saline groups (median, 25 days in each group; adjusted odds ratio with balanced crystalloids, 0.98; 95% confidence interval [CI], 0.92 to 1.04; P=0.41). Balanced crystalloids resulted in a lower incidence of major adverse kidney events within 30 days than saline (4.7% vs. 5.6%; adjusted odds ratio, 0.82; 95% CI, 0.70 to 0.95; P=0.01). CONCLUSIONS Among noncritically ill adults treated with intravenous fluids in the emergency department, there was no difference in hospital-free days between treatment with balanced crystalloids and treatment with saline. (Funded by the Vanderbilt Institute for Clinical and Translational Research and others; SALT-ED ClinicalTrials.gov number, NCT02614040 .).
Collapse
Affiliation(s)
- Wesley H Self
- From the Departments of Emergency Medicine (W.H.S., S.P.C., C.M.S.), Anesthesiology (J.P.W., J.M.E., A.D.S.), Biomedical Informatics (J.P.W., J.M.E.), and Biostatistics (L.W., D.W.B., C.J.L.), the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine (M.W.S., G.R.B., T.W.R.), and the Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research (E.D.S.), Vanderbilt University Medical Center, Nashville
| | - Matthew W Semler
- From the Departments of Emergency Medicine (W.H.S., S.P.C., C.M.S.), Anesthesiology (J.P.W., J.M.E., A.D.S.), Biomedical Informatics (J.P.W., J.M.E.), and Biostatistics (L.W., D.W.B., C.J.L.), the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine (M.W.S., G.R.B., T.W.R.), and the Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research (E.D.S.), Vanderbilt University Medical Center, Nashville
| | - Jonathan P Wanderer
- From the Departments of Emergency Medicine (W.H.S., S.P.C., C.M.S.), Anesthesiology (J.P.W., J.M.E., A.D.S.), Biomedical Informatics (J.P.W., J.M.E.), and Biostatistics (L.W., D.W.B., C.J.L.), the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine (M.W.S., G.R.B., T.W.R.), and the Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research (E.D.S.), Vanderbilt University Medical Center, Nashville
| | - Li Wang
- From the Departments of Emergency Medicine (W.H.S., S.P.C., C.M.S.), Anesthesiology (J.P.W., J.M.E., A.D.S.), Biomedical Informatics (J.P.W., J.M.E.), and Biostatistics (L.W., D.W.B., C.J.L.), the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine (M.W.S., G.R.B., T.W.R.), and the Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research (E.D.S.), Vanderbilt University Medical Center, Nashville
| | - Daniel W Byrne
- From the Departments of Emergency Medicine (W.H.S., S.P.C., C.M.S.), Anesthesiology (J.P.W., J.M.E., A.D.S.), Biomedical Informatics (J.P.W., J.M.E.), and Biostatistics (L.W., D.W.B., C.J.L.), the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine (M.W.S., G.R.B., T.W.R.), and the Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research (E.D.S.), Vanderbilt University Medical Center, Nashville
| | - Sean P Collins
- From the Departments of Emergency Medicine (W.H.S., S.P.C., C.M.S.), Anesthesiology (J.P.W., J.M.E., A.D.S.), Biomedical Informatics (J.P.W., J.M.E.), and Biostatistics (L.W., D.W.B., C.J.L.), the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine (M.W.S., G.R.B., T.W.R.), and the Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research (E.D.S.), Vanderbilt University Medical Center, Nashville
| | - Corey M Slovis
- From the Departments of Emergency Medicine (W.H.S., S.P.C., C.M.S.), Anesthesiology (J.P.W., J.M.E., A.D.S.), Biomedical Informatics (J.P.W., J.M.E.), and Biostatistics (L.W., D.W.B., C.J.L.), the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine (M.W.S., G.R.B., T.W.R.), and the Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research (E.D.S.), Vanderbilt University Medical Center, Nashville
| | - Christopher J Lindsell
- From the Departments of Emergency Medicine (W.H.S., S.P.C., C.M.S.), Anesthesiology (J.P.W., J.M.E., A.D.S.), Biomedical Informatics (J.P.W., J.M.E.), and Biostatistics (L.W., D.W.B., C.J.L.), the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine (M.W.S., G.R.B., T.W.R.), and the Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research (E.D.S.), Vanderbilt University Medical Center, Nashville
| | - Jesse M Ehrenfeld
- From the Departments of Emergency Medicine (W.H.S., S.P.C., C.M.S.), Anesthesiology (J.P.W., J.M.E., A.D.S.), Biomedical Informatics (J.P.W., J.M.E.), and Biostatistics (L.W., D.W.B., C.J.L.), the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine (M.W.S., G.R.B., T.W.R.), and the Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research (E.D.S.), Vanderbilt University Medical Center, Nashville
| | - Edward D Siew
- From the Departments of Emergency Medicine (W.H.S., S.P.C., C.M.S.), Anesthesiology (J.P.W., J.M.E., A.D.S.), Biomedical Informatics (J.P.W., J.M.E.), and Biostatistics (L.W., D.W.B., C.J.L.), the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine (M.W.S., G.R.B., T.W.R.), and the Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research (E.D.S.), Vanderbilt University Medical Center, Nashville
| | - Andrew D Shaw
- From the Departments of Emergency Medicine (W.H.S., S.P.C., C.M.S.), Anesthesiology (J.P.W., J.M.E., A.D.S.), Biomedical Informatics (J.P.W., J.M.E.), and Biostatistics (L.W., D.W.B., C.J.L.), the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine (M.W.S., G.R.B., T.W.R.), and the Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research (E.D.S.), Vanderbilt University Medical Center, Nashville
| | - Gordon R Bernard
- From the Departments of Emergency Medicine (W.H.S., S.P.C., C.M.S.), Anesthesiology (J.P.W., J.M.E., A.D.S.), Biomedical Informatics (J.P.W., J.M.E.), and Biostatistics (L.W., D.W.B., C.J.L.), the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine (M.W.S., G.R.B., T.W.R.), and the Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research (E.D.S.), Vanderbilt University Medical Center, Nashville
| | - Todd W Rice
- From the Departments of Emergency Medicine (W.H.S., S.P.C., C.M.S.), Anesthesiology (J.P.W., J.M.E., A.D.S.), Biomedical Informatics (J.P.W., J.M.E.), and Biostatistics (L.W., D.W.B., C.J.L.), the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine (M.W.S., G.R.B., T.W.R.), and the Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research (E.D.S.), Vanderbilt University Medical Center, Nashville
| |
Collapse
|
21
|
Belayachi J, El Khattate A, Bizrane M, Madani N, Abouqal R. Pre-admission quality of life as predictor of outcome after acute care: the role of emotional well-being. QJM 2018; 111:111-115. [PMID: 29088410 DOI: 10.1093/qjmed/hcx209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Indexed: 11/14/2022] Open
Abstract
PURPOSE We sought to investigate whether pre-admission quality of life could act as a predictor of mortality among acutely ill patients, and which dimension of QOL has the greater impact on outcomes. METHODS Prospective cohort study including patients admitted to an acute medical unit of Rabat Ibn Sina University Hospital, Morocco, between June and September 2014. Characteristics of patients were recorded at admission. The primary exposure was pre-admission quality of life recorded using Euroqol five dimensions three level (EQ-5 D-3 L) and the primary outcome was 90-day mortality. We fit a Cox proportional hazards model to assess their association. We constructed six prediction models; each model included either EQ5D index or one of the five dimensions. We allowed all continuous variables to have a non-linear relationship with the primary outcome using restricted cubic spline with three knots. RESULTS We included 251 patients. The mean EQ5D index was 0.46 ± 0.5. The design of each prediction model was based on the significant findings of the univariate analysis including; bedside EQ5D index or one of the five dimensions of the EQ5D; age, history of chronic disease, Charlson Comorbidity Index and hemoglobinemia. Multi-variate Cox proportional adjusted hazard ratio (HR) derived from the six models, identified that EQ5D index was independently associated with 90-day mortality (HR: 0.48; 95% CI: 0.25; 0.91, P = 0.02), and that anxiety and depression dimension has the greater impact on outcome (HR: 2.97; 95% CI: 1.38; 6.41, P = 0.005). CONCLUSIONS This study revealed that pre-admission health-related quality of life (HRQoL), and particularly pre-admission psychological HRQoL was associated with outcome of acutely ill patients 90 days after discharge.
Collapse
Affiliation(s)
- J Belayachi
- Acute Medical Unit, Ibn Sina University Hospital, 10000, Rabat, Morocco
- Laboratory of Biostatistics, Clincial, and Epidemiological Research, Faculté de Médecineet de Pharmacie - Université Mohamed V Souissi, 10000, Rabat, Morocco
- Faculté de Médecine et de Pharmacie - University Mohammed V, 10000, Rabat, Morocco
| | - A El Khattate
- Acute Medical Unit, Ibn Sina University Hospital, 10000, Rabat, Morocco
| | - M Bizrane
- Acute Medical Unit, Ibn Sina University Hospital, 10000, Rabat, Morocco
| | - N Madani
- Acute Medical Unit, Ibn Sina University Hospital, 10000, Rabat, Morocco
- Laboratory of Biostatistics, Clincial, and Epidemiological Research, Faculté de Médecineet de Pharmacie - Université Mohamed V Souissi, 10000, Rabat, Morocco
- Faculté de Médecine et de Pharmacie - University Mohammed V, 10000, Rabat, Morocco
| | - R Abouqal
- Acute Medical Unit, Ibn Sina University Hospital, 10000, Rabat, Morocco
- Laboratory of Biostatistics, Clincial, and Epidemiological Research, Faculté de Médecineet de Pharmacie - Université Mohamed V Souissi, 10000, Rabat, Morocco
- Faculté de Médecine et de Pharmacie - University Mohammed V, 10000, Rabat, Morocco
| |
Collapse
|
22
|
García AS, de la Puente Martín M, Baztán JJ. External validation of mortality prognostic indices after hospital discharge in older adults. Eur J Intern Med 2018; 48:e25-e27. [PMID: 29208452 DOI: 10.1016/j.ejim.2017.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/30/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Alberto Socorro García
- Department of Geriatrics, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain.
| | | | - Juan J Baztán
- Department of Geriatrics, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain
| |
Collapse
|
23
|
Kellett J, Hojs R. Introduction to the special issue on acutely ill patients. Eur J Intern Med 2017; 45:1. [PMID: 29128236 DOI: 10.1016/j.ejim.2017.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- John Kellett
- Department of Emergency Medicine, Hospital of SouthWest Jutland, Esbjerg, Denmark.
| | - Radovan Hojs
- Clinic for Internal Medicine, Department of Nephrology, University Medical Centre Maribor, Maribor, Slovenia
| |
Collapse
|
24
|
Migone de Amicis M, Chivite D, Corbella X, Cappellini MD, Formiga F. Anemia is a mortality prognostic factor in patients initially hospitalized for acute heart failure. Intern Emerg Med 2017; 12:749-756. [PMID: 28233161 DOI: 10.1007/s11739-017-1637-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/09/2017] [Indexed: 12/30/2022]
Abstract
Anemia is a risk factor related to morbidity and mortality in patients with chronic heart failure (HF). Less is known about its influence in patients in an early stage of HF. Our aim is to investigate the prognostic role of anemia in patients initially hospitalized for acute HF. We reviewed all consecutive patients admitted within a 18-month period with a main diagnosis of acute HF. We collected demographic, clinical and treatment data. Anemia is defined as Hemoglobin <12/13 g/dL upon admission in female/male patients, respectively. 719 patients were included (55.5% female), with a mean age of 78.7 ± 9 years. Anemia was present in 59.6% of patients upon admission, with a mean Hb of 10.4 ± 1.4 g/dL. Multivariate analysis confirms the relationship between the presence of anemia and older age, a previous diagnostic history of diabetes, and the presence of chronic kidney disease. In-hospital mortality is similar for anemic and non-anemic patients (6.8 vs 3.8%, p = n.s.) However, the difference is significant when one-year mortality is evaluated (31% in anemic patients vs 19% in non-anemic patients, p < 0.001). Cox regression analysis confirms the association between anemia and higher risk of one-year mortality, as well as with older age and a higher Charlson comorbidity index. Our study confirms that the presence of anemia is an independent factor for mid-term (1-year) mortality even in patients experiencing a first admission due to acute HF.
Collapse
Affiliation(s)
- Margherita Migone de Amicis
- Scuola di Specializzazione in Medicina Interna, Università degli Studi di Milano, Milan, Italy.
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy.
| | - David Chivite
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Maria Domenica Cappellini
- Scuola di Specializzazione in Medicina Interna, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Francesc Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
25
|
Abstract
OBJECTIVES Readmission and death are frequent after a hospitalisation and difficult to predict. While many predictors have been identified, few studies have focused on functional status. We assessed whether performance-based functional impairment at discharge is associated with readmission and death after an acute medical hospitalisation. DESIGN, SETTING AND PARTICIPANTS We prospectively included patients aged ≥50 years admitted to the Department of General Internal Medicine of a large community hospital. Functional status was assessed shortly before discharge using the Timed Up and Go test performed twice in a standard way by trained physiotherapists and was defined as a test duration ≥15 s. Sensitivity analyses using a cut-off at >10 and >20 s were performed. PRIMARY AND SECONDARY OUTCOME MEASURES The primary and secondary outcome measures were unplanned readmission and death, respectively, within 6 months after discharge. RESULTS Within 6 months after discharge, 107/338 (31.7%) patients had an unplanned readmission and 31/338 (9.2%) died. Functional impairment was associated with higher risk of death (OR 2.44, 95% CI 1.15 to 5.18), but not with unplanned readmission (OR 1.34, 95% CI 0.84 to 2.15). No significant association was found between functional impairment and the total number of unplanned readmissions (adjusted OR 1.59, 95% CI 0.95 to 2.67). CONCLUSIONS Functional impairment at discharge of an acute medical hospitalisation was associated with higher risk of death, but not of unplanned readmission within 6 months after discharge. Simple performance-based assessment may represent a better prognostic measure for mortality than for readmission.
Collapse
Affiliation(s)
- Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Antoine Folly
- Department of General Internal Medicine, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Marco Mancinetti
- Department of General Internal Medicine, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Daniel Hayoz
- Department of General Internal Medicine, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Jacques D Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
26
|
Singer Fisher E, Burns B, Kim J. Acute decompensated heart failure: new strategies for improving outcomes [digest]. Emerg Med Pract 2017; 19:S1-S2. [PMID: 28745846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Acute decompensated heart failure is a common emergency department presentation with significant associated morbidity and mortality. Heart failure accounts for more than 1 million hospitalizations annually, with a steadily increasing incidence as our population ages. This issue reviews recent literature regarding appropriate management of emergency department presentations of acute decompensated heart failure, with special attention to newer medication options. Emergency department management and appropriate interventions are discussed, along with critical decision-making points in resuscitation for both hypertensive and hypotensive patients. [Points & Pearls is a digest of Emergency Medicine Practice].
Collapse
Affiliation(s)
- Emily Singer Fisher
- Assistant Professor, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Boyd Burns
- George Kaiser Foundation Chair in Emergency Medicine, Associate Professor & Program Director, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Jeremy Kim
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
27
|
Singer Fisher E, Burns B. Acute Decompensated Heart Failure: New Strategies for Improving Outcomes. Emerg Med Pract 2017; 19:1-24. [PMID: 28447933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/10/2017] [Indexed: 06/07/2023]
Abstract
Acute decompensated heart failure is a common emergency department presentation with significant associated morbidity and mortality. Heart failure accounts for more than 1 million hospitalizations annually, with a steadily increasing incidence as our population ages. This issue reviews recent literature regarding appropriate management of emergency department presentations of acute decompensated heart failure, with special attention to newer medication options. Emergency department management and appropriate interventions are discussed, along with critical decision-making points in resuscitation for both hypertensive and hypotensive patients.
Collapse
Affiliation(s)
- Emily Singer Fisher
- Assistant Professor, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Boyd Burns
- George Kaiser Foundation Chair in Emergency Medicine, Associate Professor and Program Director, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK
| |
Collapse
|
28
|
Abstract
BACKGROUND Historically, women have lower all-cause mortality than men. It is less understood that sex differences have been converging, particularly among certain subgroups and causes. This has implications for public health and health system planning. Our objective was to analyse contemporary sex differences over a 20-year period. METHODS We analysed data from a population-based death registry, the Ontario Registrar's General Death file, which includes all deaths recorded in Canada's most populous province, from 1992 to 2012 (N=1 710 080 deaths). We calculated absolute and relative mortality sex differences for all-cause and cause-specific mortality, age-adjusted and age-specific, including the following causes: circulatory, cancers, respiratory and injuries. We used negative-binomial regression of mortality on socioeconomic status with direct age adjustment for the overall population. RESULTS In the 20-year period, age-adjusted mortality dropped 39.2% and 29.8%, respectively, among men and women. The age-adjusted male-to-female mortality ratio dropped 41.4%, falling from 1.47 to 1.28. From 2000 onwards, all-cause mortality rates of high-income men were lower than those seen among low-income women. Relative mortality declines were greater among men than women for cancer, respiratory and injury-related deaths. The absolute decline in circulatory deaths was greater among men, although relative deciles were similar to women. The largest absolute mortality gains were seen among men over the age of 85 years. CONCLUSIONS The large decline in mortality sex ratios in a Canadian province with universal healthcare over two decades signals an important population shift. These narrowing trends varied according to cause of death and age. In addition, persistent social inequalities in mortality exist and differentially affect men and women. The observed change in sex ratios has implications for healthcare and social systems.
Collapse
Affiliation(s)
- Laura C Rosella
- Public Health Ontario, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Calzavara
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - John W Frank
- Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Tiffany Fitzpatrick
- Ontario Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit (OSSU), Toronto, Ontario, Canada
| | | | - David Henry
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Ontario Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit (OSSU), Toronto, Ontario, Canada
- Institute of Health Management Policy and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
29
|
Romero-Ortuno R, Wallis S, Biram R, Keevil V. Clinical frailty adds to acute illness severity in predicting mortality in hospitalized older adults: An observational study. Eur J Intern Med 2016; 35:24-34. [PMID: 27596721 DOI: 10.1016/j.ejim.2016.08.033] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/09/2016] [Accepted: 08/29/2016] [Indexed: 01/15/2023]
Abstract
AIM Frail individuals may be at higher risk of death from a given acute illness severity (AIS), but this relationship has not been studied in an English National Health Service (NHS) acute hospital setting. METHODS This was a retrospective observational study in a large university NHS hospital in England. We analyzed all first non-elective inpatient episodes of people aged ≥75years (all specialties) between October 2014 and October 2015. Pre-admission frailty was assessed with the Clinical Frailty Scale (CFS) of the Canadian Study on Health & Aging, and AIS in the Emergency Department was measured with a Modified Early Warning Score (ED-MEWS<4 was considered as low acuity, and ED-MEWS≥4 as high acuity). A survival analysis compared times to 30-day inpatient death between CFS categories (1-4: very fit to vulnerable, 5: mildly frail, 6: moderately frail, and 7-8: severely or very severely frail). RESULTS There were 12,282 non-elective patient episodes (8202 first episodes, of which complete data was available for 5505). In a Cox proportional hazards model controlling for age, gender, Charlson Comorbidity Index, history of dementia, current cognitive concern, and discharging specialty (medical versus surgical), ED-MEWS≥4 (HR=2.87, 95% CI: 2.27-3.62, p<0.001), and CFS 7-8 (compared to CFS 1-4, HR=2.10, 95% CI: 1.52-2.92, p<0.001) were independent predictors of survival time. CONCLUSIONS We found frailty and AIS independently associated with inpatient mortality after adjustment for confounders. Hospitals may find it informative to undertake large scale assessment of frailty (vulnerability), as well as AIS (stressor), in older patients admitted to hospital as emergencies.
Collapse
Affiliation(s)
- Roman Romero-Ortuno
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, United Kingdom; Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom.
| | - Stephen Wallis
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Richard Biram
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Victoria Keevil
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, United Kingdom; Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| |
Collapse
|
30
|
Perrin HB, Cintas P, Abravanel F, Gérolami R, d'Alteroche L, Raynal JN, Alric L, Dupuis E, Prudhomme L, Vaucher E, Couzigou P, Liversain JM, Bureau C, Vinel JP, Kamar N, Izopet J, Peron JM. Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E. Emerg Infect Dis 2016; 21:1928-34. [PMID: 26490255 PMCID: PMC4622229 DOI: 10.3201/eid2111.141789] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Neurologic disorders, mainly Guillain-Barré syndrome and Parsonage–Turner syndrome (PTS), have been described in patients with hepatitis E virus (HEV) infection in industrialized and developing countries. We report a wider range of neurologic disorders in nonimmunocompromised patients with acute HEV infection. Data from 15 French immunocompetent patients with acute HEV infection and neurologic disorders were retrospectively recorded from January 2006 through June 2013. The disorders could be divided into 4 main entities: mononeuritis multiplex, PTS, meningoradiculitis, and acute demyelinating neuropathy. HEV infection was treated with ribavirin in 3 patients (for PTS or mononeuritis multiplex). One patient was treated with corticosteroids (for mononeuropathy multiplex), and 5 others received intravenous immunoglobulin (for PTS, meningoradiculitis, Guillain-Barré syndrome, or Miller Fisher syndrome). We conclude that pleiotropic neurologic disorders are seen in HEV-infected immunocompetent patients. Patients with acute neurologic manifestations and aminotransferase abnormalities should be screened for HEV infection.
Collapse
|
31
|
Godard-Sebillotte C, Dramé M, Basileu T, Fanon JL, Godaert L. Is self-rated health an independent prognostic factor of six-week mortality in older patients hospitalized for an acute condition? Qual Life Res 2016; 25:2335-40. [PMID: 26919847 DOI: 10.1007/s11136-016-1252-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether self-rated health is a prognostic factor of six-week mortality, independently of other known objective prognostic factors. METHODS The SAFMA study was a prospective cohort, which recruited patients from the University Hospital of Martinique Acute Care for Elders unit (French West Indies) from January to June 2012. Patients aged 75 or older and hospitalized for an acute condition were eligible. The outcome was time to death within the six-week follow-up. The main explanatory variable was self-rated health. Sociodemographic and clinical characteristics were considered as covariates. Cox's proportional hazards model was used. RESULTS The mean age of the 223 patients included was 85.1 ± 5.5 years. Six-week mortality rate was 14.8 %; none were lost to follow-up. In total, 123 claimed "very good to good" health, and 100 "medium to very poor" health. Self-rated health was the only independent prognostic factor associated with 6-week mortality (hazard ratio 2.61; 95 % confidence interval 1.18-5.77; p = .02), when adjusting for known prognostic factors such as age, dimensions of the comprehensive geriatric assessment and comorbidity burden. CONCLUSION The association between self-rated health and short-term mortality could have implications for clinical practice, particularly in helping in the estimation of prognosis in acute care setting.
Collapse
Affiliation(s)
- Claire Godard-Sebillotte
- Department of Family Medicine, McGill University, 5858, Chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada.
| | - Moustapha Dramé
- Faculty of Medicine, University of Reims Champagne-Ardenne, EA 3797, Reims, France
- Department of Research and Innovation, University Hospitals of Reims, Robert Debré Hospitals, 51092, Reims, France
| | - Tatiana Basileu
- Department of Geriatrics, Martinique General Hospital, Fort-De-France, France
| | - Jean-Luc Fanon
- Department of Geriatrics, Martinique General Hospital, Fort-De-France, France
| | - Lidvine Godaert
- Department of Geriatrics, Martinique General Hospital, Fort-De-France, France
| |
Collapse
|
32
|
Socorro García A, de la Puente M, Perdomo B, López Pardo P, Baztán JJ. Functional status and mortality at month and year in nonagenarians hospitalized due to acute medical illness. Eur J Intern Med 2015; 26:705-8. [PMID: 26320014 DOI: 10.1016/j.ejim.2015.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/05/2015] [Accepted: 08/10/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To analyze risk factors associated with short and long-term mortality in nonagenarians hospitalized due to acute medical conditions. DESIGN, SETTING, AND PARTICIPANTS Prospective study of all patients aged 90 years or older admitted in a geriatric unit during 2009 due to medical acute illness. Baseline variables were collected at admission (sex, cause of admission, Charlson index, serum albumin, functional, and mental status), functional loss at admission (as the difference between Barthel index(BI) 2 weeks before admission and BI at admission), and functional loss at discharge(as the difference between BI 2 weeks before admission and BI at discharge). The association of these variables with mortality at 1 month and 1 year after admission was analyzed by multivariate Cox regression analysis. RESULTS Out of all patients admitted, 434 (33%) were 90 years old or older and 76.3% were female. Mortality at 1 month and 1 year after admission was 19% and 57%, respectively. In the month mortality multivariate analysis, being older (HR, 1.11; 95% CI=1.02 to 1.20), a previous Barthel index less than 40 points (HR, 5.87; 95% CI=1.16 to 29.67), and functional loss at admission (HR; 1.13; 95% CI=1.03 to 1.25) were independent risk factors. When patients that died 1 month after admission were excluded, the presence of hypoalbuminemia <3g/dl (HR, 2.70; 95% CI=1.69 to 4.32) and functional loss at discharge (HR-1.08, 95% CI=1.03 to 1.14) were the factors associated with 1 year mortality. CONCLUSIONS In nonagenarians, functional impairment is the most important risk factor associated with short and long-term mortality after hospitalization due to acute medical illness.
Collapse
Affiliation(s)
- Alberto Socorro García
- Department of Geriatrics, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain.
| | - María de la Puente
- Department of Geriatrics, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain
| | - Beatriz Perdomo
- Department of Geriatrics, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain
| | - Patricia López Pardo
- Department of Geriatrics, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain
| | - Juan J Baztán
- Department of Geriatrics, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain
| |
Collapse
|
33
|
Nayak RK, Allingstrup M, Phanareth K, Kofoed-Enevoldsen A. suPAR as a biomarker for risk of readmission and mortality in the acute medical setting. Dan Med J 2015; 62:A5146. [PMID: 26441392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The urokinase-type plasminogen activator receptor (uPAR) and its ligand (suPAR) are involved in numerous physiological and pathological pathways. Previous studies have shown that an elevated plasma suPAR level is associated with disease severity and mortality. The aim of this prospective observational study was to determine if the suPAR level was associated with readmission and mortality in the acute medical setting. METHODS Plasma suPAR levels were measured in 1,036 patients at admission. Follow-up ranged 3-10 months. Cox proportional hazards model was used to assess the relative contribution of different risk factors to mortality and readmission. The ANOVA test and Pearson's chi-squared test were used to compare suPAR tertile level with various variables. RESULTS The highest suPAR tertile level was significantly associated with mortality within 30 days after discharge, with a 6.66 hazard ratio (HR). Similar associations were found with readmission within the maximum observation period (HR = 2.26) and within 30 days (HR = 2.08), although the latter became insignificant when covariates were included. CONCLUSIONS This study confirms previous findings of increased mortality and adds the finding that increased long-term readmission rates are associated with elevated suPAR levels. The present data do, however, not indicate that suPAR may serve as an independent biomarker for increased risk of short-term readmission in the acute medical setting. FUNDING This study was funded by a grant from ViroGates A/S, the company that produces the suPARnostic assay. TRIAL REGISTRATION No: H-B-2009-075.
Collapse
|
34
|
Abstract
BACKGROUND The identification of high-risk patients could form a basis for targetted intervention following an emergency medical admission. METHODS All emergency admissions to our institution over 12 years (2002-13) were included. An Illness Severity method based on admission laboratory parameters, previously developed between 2002 and 2007, was investigated for the 2008-13 cohort. We compared the area under the receiver operating characteristic (AUROC) to predict a 30-day in-hospital death between the original and validating cohorts using logistic multiple variable analyses. We defined six risk subgroups, based on admission laboratory data and examined the frequency of 30-day in-hospital mortality within these subgroups. RESULTS About 66 933 admissions were recorded in 36 271 patients. Between 2002 and 2007, the 30-day in-hospital mortality was 11.3% but between 2008 and 2013 was 6.7% (P < 0.001). This represented an absolute risk reduction (ARR) of 4.6%, a relative risk reduction (RRR) of 41.0%, and a number needed to treat of 21.6. The laboratory model was similarly predictive in both cohorts-for 2002-07, the AUROC was 0.82 (95% CI 0.81, 0.82) and for 2008-13 was 0.82 (95% CI 0.81, 0.83). Two high-risk subgroups were identified within each cohort; for 2002-07, these contained 15.0 and 30.2% of admitted patients but 95.5% of in-hospital deaths. For 2008-13, these two groups contained 15.7 and 31.0% of admitted patients but 97.0% of in-hospital deaths. CONCLUSION A previously described laboratory score method, based on admission biochemistry, identified patients at high risk for an in-hospital death. Risk profiling at admission is feasible for emergency medical admissions and could offer a means to outcome improvement.
Collapse
Affiliation(s)
- R Conway
- From the Department of Internal Medicine, St. James's Hospital, James Street, Dublin 8, Ireland
| | - D Byrne
- From the Department of Internal Medicine, St. James's Hospital, James Street, Dublin 8, Ireland
| | - D O'Riordan
- From the Department of Internal Medicine, St. James's Hospital, James Street, Dublin 8, Ireland
| | - B Silke
- From the Department of Internal Medicine, St. James's Hospital, James Street, Dublin 8, Ireland
| |
Collapse
|
35
|
De Luca E, Perissinotto E, Fabris L, Pengo V, Zurlo A, De Toni P, De Zaiacomo F, Manzato E, Giantin V. Short- and longer-term predictive capacity of the Multidimensional Prognostic Index: The timing of the assessment is of no consequence. Arch Gerontol Geriatr 2015; 61:458-63. [PMID: 26306454 DOI: 10.1016/j.archger.2015.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/13/2015] [Accepted: 07/31/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND Several studies have tested the ability of the Multidimensional Prognostic Index (MPI) to predict mortality for acute elderly patients admitted to hospital. We compared the reliability of MPI scores obtained both on admission to, and at discharge from hospital. We tested MPI performance in predicting short- and longer-term mortality grouped into three risk groups and according to single MPI scores. METHODS A longitudinal prospective study was conducted on 699 elderly patients admitted to the Geriatric Unit at Padua General Hospital. MPI scores were obtained on admission and at discharge. In-hospital and one-year mortality was recorded. Adjusted Cox's regression models were used to assess the prognostic value of the MPI scores. RESULTS 691 were included in the study: 459 (66.4%) women and 232 (33.6%) men, mean age=85.2 ± 7.0 years. Patients were grouped as: low risk MPI 12.5%; moderate risk MPI 28.6%; severe risk MPI 58.9%. The cumulative in-hospital mortality rate was 7.4%. In the adjusted model, only MPI score (not MPI risk group) was significantly associated with in-hospital death ([HR]=1.22, 95%CI 1.07-1.39). 1-Year crude mortality rate: 39.2%. The patients' MPI scores at admission and at discharge were equally predictive of death (adjusted HR of MPI on admission 1.20 [1.15-1.27], p<0.0001; at discharge 1.24 [1.18-1.30], p<0.0001). The performance (AUC) of the MPI score on admission and at discharge proved much the same. CONCLUSIONS This study confirmed the value of the MPI in predicting mortality for acute elderly patients. Grouping MPI scores into risk levels may not be appropriate when applied to hospitalized acute geriatric patients. The prognostic value of MPI scores was confirmed only for MPI value ≥0.68. Judging from our study, the timing of the assessment during a patient's hospital stay (on admission or at discharge) may be irrelevant for longer-term prognostic purposes.
Collapse
Affiliation(s)
- Elisabetta De Luca
- Geriatric Clinic, Department of Medical Science, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - Egle Perissinotto
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Laura Fabris
- Geriatric Clinic, Department of Medical Science, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Valentina Pengo
- Geriatric Clinic, Department of Medical Science, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Anna Zurlo
- Geriatric Clinic, Department of Medical Science, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Pietro De Toni
- Geriatric Clinic, Department of Medical Science, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Francesca De Zaiacomo
- Geriatric Clinic, Department of Medical Science, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Enzo Manzato
- Geriatric Clinic, Department of Medical Science, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Valter Giantin
- Geriatric Clinic, Department of Medical Science, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| |
Collapse
|
36
|
Peacock WF. How galectin-3 changes acute heart failure decision making in the emergency department. Clin Chem Lab Med 2015; 52:1409-12. [PMID: 24756061 DOI: 10.1515/cclm-2014-0221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/19/2014] [Indexed: 11/15/2022]
Abstract
When considering the appropriate disposition plan in a patient presenting to the emergency department (ED) with acute heart failure (HF), the range of options includes discharge home to intensive care unit (ICU) admission. Unfortunately, there are few objective measures to insure optimal choices, and the currently available science is scant at best. The consequences of a lack of a standardized approach are nowhere more evident than as demonstrated by the worldwide 90-day heart failure rehospitalization rate that exceeds 25%. New strategies to address this important gap in clinical care are sorely needed. The measurement of galectin-3 may represent a new alternative to the historical standard of gestalt-based clinical disposition decisions. Elevated galectin-3 can identify patients at very high risk for short-term adverse outcomes, while low levels identify a population with essentially no 90-day revisits. This prospective objective measure of illness severity may aid in clinical decision making and thus represent a future where rehospitalization after HF is an unusual event.
Collapse
|
37
|
Chamberlain S, Stolz U, Dreifuss B, Nelson SW, Hammerstedt H, Andinda J, Maling S, Bisanzo M. Mortality related to acute illness and injury in rural Uganda: task shifting to improve outcomes. PLoS One 2015; 10:e0122559. [PMID: 25849960 PMCID: PMC4388510 DOI: 10.1371/journal.pone.0122559] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 02/23/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Due to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients. METHODS Nurses participated in a two-year training program to become midlevel providers called Emergency Care Practitioners at a rural district hospital. This is a retrospective analysis of the Emergency Department's quality assurance database, including three-day follow-up data. Case fatality rates (CFRs) are reported as the percentage of cases with a specific diagnosis that died within three days of their Emergency Department visit. FINDINGS Overall, three-day mortality was 2.0%. The most common diagnoses of patients who died were malaria (n=60), pneumonia (n=51), malnutrition (n=21), and trauma (n=18). Overall and under-five CFRs were as follows: malaria, 2.0% and 1.9%; pneumonia, 5.5% and 4.1%; and trauma, 1.2% and 1.6%. Malnutrition-related fatality (all cases <18 years old) was 6.5% overall and 6.8% for under-fives. INTERPRETATION This study describes the outcomes of emergency patients treated by midlevel providers in a resource-limited setting. Our fatality rates are lower than previously published regional rates. These findings suggest this model of task-shifting can be successfully applied to acute care in order to address the shortage of emergency care services in similar settings as part of an integrated approach to health systems strengthening.
Collapse
Affiliation(s)
- Stacey Chamberlain
- Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda
- Department of Emergency Medicine and Center for Global Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Uwe Stolz
- Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Bradley Dreifuss
- Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Sara W. Nelson
- Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda
- Department of Emergency Medicine, Maine Medical Center, Portland, Maine, United States of America
| | - Heather Hammerstedt
- Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda
- Idaho Emergency Physicians, Boise, Idaho, United States of America
| | - Jovita Andinda
- Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda
- Karoli Lwanga Hospital, Nyakibale, Uganda
| | - Samuel Maling
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark Bisanzo
- Global Emergency Care Collaborative, Massachusetts, United States of America and Uganda
- Department of Emergency Medicine, University of Massachusetts, Worcester, Massachusetts, United States of America
| |
Collapse
|
38
|
Smolin B, Levy Y, Sabbach-Cohen E, Levi L, Mashiach T. Predicting mortality of elderly patients acutely admitted to the Department of Internal Medicine. Int J Clin Pract 2015; 69:501-8. [PMID: 25311361 DOI: 10.1111/ijcp.12564] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/01/2014] [Indexed: 11/28/2022] Open
Abstract
AIMS This study addresses the common practice of providing aggressive treatments of limited clinical benefit and cost-effectiveness to seriously ill and frail elderly. We have created a statistical model of 6-month mortality risk prediction following acute hospitalisation admission, and identified a subset of patients with poorest prognosis that requires comfort-focused care. METHODS We have studied electronic medical records of 26,937 patients age 65 years or older, hospitalised in the internal medicine departments of one tertiary-care teaching medical center in Northern Israel from January 1, 2008 through December 31, 2011 and mortality data from the Israeli Internal Ministry Registry. Norton score records were employed for the performance status evaluation. Multivariate logistic regression analysis was used to predict the risk of 6-month mortality. RESULTS Variables associated with an increased risk of 6-month mortality included: metastatic cancer, age above 85 years, decreased values of blood albumin and haemoglobin, increased blood urea nitrogen and decreased physical/mental status and activity. The receiver operating characteristic area for the predicted probability of death was 0.845 and 0.847 in external validation cohort. Using predictive values of the logistic regression analysis, the study cohort was stratified into six groups with various predictive mortality risks. CONCLUSION The majority of deaths that have occurred within 6 months following the acute hospitalisation could be predicted on patient admission based on a few simple and easily obtained parameters. Earlier recognition of patients nearing the end of their lives may lead to better care and more efficient use of available resource.
Collapse
Affiliation(s)
- B Smolin
- Department of Internal Medicince D, Technion Faculty of Medicine, Rambam Health Care Campus, Haifa, Israel
| | | | | | | | | |
Collapse
|
39
|
Cohen C, Moyes J, Tempia S, Groome M, Walaza S, Pretorius M, Dawood H, Chhagan M, Haffejee S, Variava E, Kahn K, von Gottberg A, Wolter N, Cohen AL, Malope-Kgokong B, Venter M, Madhi SA. Mortality amongst patients with influenza-associated severe acute respiratory illness, South Africa, 2009-2013. PLoS One 2015; 10:e0118884. [PMID: 25786103 PMCID: PMC4365037 DOI: 10.1371/journal.pone.0118884] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/13/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Data on the burden and risk groups for influenza-associated mortality from Africa are limited. We aimed to estimate the incidence and risk-factors for in-hospital influenza-associated severe acute respiratory illness (SARI) deaths. METHODS Hospitalised patients with SARI were enrolled prospectively in four provinces of South Africa from 2009-2013. Using polymerase chain reaction, respiratory samples were tested for ten respiratory viruses and blood for pneumococcal DNA. The incidence of influenza-associated SARI deaths was estimated at one urban hospital with a defined catchment population. RESULTS We enrolled 1376 patients with influenza-associated SARI and 3% (41 of 1358 with available outcome data) died. In patients with available HIV-status, the case-fatality proportion (CFP) was higher in HIV-infected (5%, 22/419) than HIV-uninfected individuals (2%, 13/620; p = 0.006). CFPs varied by age group, and generally increased with increasing age amongst individuals >5 years (p<0.001). On multivariable analysis, factors associated with death were age-group 45-64 years (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.01-16.3) and ≥65 years (OR 6.5, 95%CI 1.2-34.3) compared to 1-4 year age-group who had the lowest CFP, HIV-infection (OR 2.9, 95%CI 1.1-7.8), underlying medical conditions other than HIV (OR 2.9, 95%CI 1.2-7.3) and pneumococcal co-infection (OR 4.1, 95%CI 1.5-11.2). The estimated incidence of influenza-associated SARI deaths per 100,000 population was highest in children <1 year (20.1, 95%CI 12.1-31.3) and adults aged 45-64 years (10.4, 95%CI 8.4-12.9). Adjusting for age, the rate of death was 20-fold (95%CI 15.0-27.8) higher in HIV-infected individuals than HIV-uninfected individuals. CONCLUSION Influenza causes substantial mortality in urban South Africa, particularly in infants aged <1 year and HIV-infected individuals. More widespread access to antiretroviral treatment and influenza vaccination may reduce this burden.
Collapse
Affiliation(s)
- Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Programme, Centers for Disease Control and Prevention—South Africa, Pretoria, South Africa
| | - Michelle Groome
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases; University of the Witwatersrand; Johannesburg; South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Marthi Pretorius
- Zoonosis Research Unit, Department of Medical Virology, University of Pretoria
| | - Halima Dawood
- Department of Medicine, Pietermaritzburg Metropolitan Hospital, Pietermaritzburg, South Africa
- Department of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Meera Chhagan
- Department of Paediatrics, University of KwaZulu Natal, Durban, South Africa
| | - Summaya Haffejee
- School of Pathology, University of KwaZulu Natal, Durban, South Africa
| | - Ebrahim Variava
- Department of Medicine, Klerksdorp Tshepong Hospital
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
- INDEPTH Network, Accra, Ghana
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam L. Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Programme, Centers for Disease Control and Prevention—South Africa, Pretoria, South Africa
| | - Babatyi Malope-Kgokong
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Marietjie Venter
- Zoonosis Research Unit, Department of Medical Virology, University of Pretoria
- Global Disease Detection, United States Centers for Disease Control and Prevention—South Africa, Pretoria, South Africa
| | - Shabir A. Madhi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases; University of the Witwatersrand; Johannesburg; South Africa
| |
Collapse
|
40
|
Abstract
Background Efforts to develop effective and regionally-appropriate emergency care systems in sub-Saharan Africa are hindered by a lack of data on both the burden of disease in the region and on the state of existing care delivery mechanisms. This study describes the burden of acute disease presenting to an emergency unit in Mahajanga, Madagascar. Methods and Findings Handwritten patient registries on all emergency department patients presenting between 1 January 2011 and 30 September 2012 were reviewed and data entered into a database. Data included age, sex, diagnosis, and disposition. We classified diagnoses into Clinical Classifications Software (CCS) multi-level categories. The population was 53.5% male, with a median age of 31 years. The five most common presenting conditions were 1) Superficial injury; contusion, 2) Open wounds of head; neck; and trunk, 3) Open wounds of extremities, 4) Intracranial injury, and 5) Unspecified injury and poisoning. Trauma accounted for 48%, Infectious Disease for 15%, Mental Health 6.1%, Noncommunicable 29%, and Neoplasms 1.2%. The acuity seen was high, with an admission rate of 43%. Trauma was the most common reason for admission, representing 19% of admitted patients. Conclusions This study describes the burden of acute disease at a large referral center in northern Madagascar. The Centre Hôpitalier Universitaire de Mahajanga sees a high volume of acutely ill and injured patients. Similar to other reports from the region, trauma is the most common pathology observed, though infectious disease was responsible for the majority of adult mortality. Typhoid fever other intestinal infections were the most lethal CCS-coded pathologies. By utilizing a widely understood classification system, we are able to highlight contrasts between Mahajanga’s acute and overall disease burden as well as make comparisons between this region and the rest of the globe. We hope this study will serve to guide the development of context-appropriate emergency medicine systems in the region.
Collapse
Affiliation(s)
- Vijay C. Kannan
- University of Texas Southwestern, Division of Emergency Medicine, Dallas, Texas, United States of America
- Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona, United States of America
- * E-mail:
| | | | - Teri A. Reynolds
- Muhimbili National Hospital, Emergency Medicine Department, Dar Es Salaam, Tanzania
- University of California San Francisco, Emergency Medicine and Global Health Sciences, San Francisco, California, United States of America
| |
Collapse
|
41
|
Brabrand M, Hallas J, Knudsen T. Nurses and physicians in a medical admission unit can accurately predict mortality of acutely admitted patients: a prospective cohort study. PLoS One 2014; 9:e101739. [PMID: 25019354 PMCID: PMC4096600 DOI: 10.1371/journal.pone.0101739] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There exist several risk stratification systems for predicting mortality of emergency patients. However, some are complex in clinical use and others have been developed using suboptimal methodology. The objective was to evaluate the capability of the staff at a medical admission unit (MAU) to use clinical intuition to predict in-hospital mortality of acutely admitted patients. METHODS This is an observational prospective cohort study of adult patients (15 years or older) admitted to a MAU at a regional teaching hospital. The nursing staff and physicians predicted in-hospital mortality upon the patients' arrival. We calculated discriminatory power as the area under the receiver-operating-characteristic curve (AUROC) and accuracy of prediction (calibration) by Hosmer-Lemeshow goodness-of-fit test. RESULTS We had a total of 2,848 admissions (2,463 patients). 89 (3.1%) died while admitted. The nursing staff assessed 2,404 admissions and predicted mortality in 1,820 (63.9%). AUROC was 0.823 (95% CI: 0.762-0.884) and calibration poor. Physicians assessed 738 admissions and predicted mortality in 734 (25.8% of all admissions). AUROC was 0.761 (95% CI: 0.657-0.864) and calibration poor. AUROC and calibration increased with experience. When nursing staff and physicians were in agreement (±5%), discriminatory power was very high, 0.898 (95% CI: 0.773-1.000), and calibration almost perfect. Combining an objective risk prediction score with staff predictions added very little. CONCLUSIONS Using only clinical intuition, staff in a medical admission unit has a good ability to identify patients at increased risk of dying while admitted. When nursing staff and physicians agreed on their prediction, discriminatory power and calibration were excellent.
Collapse
Affiliation(s)
- Mikkel Brabrand
- Department of Medicine, Hospital of South West Denmark, Esbjerg, Denmark
- Centre South Western Denmark, Institute of Regional Health Research – University of Southern Denmark, Esbjerg, Denmark
- * E-mail:
| | - Jesper Hallas
- Research Unit of Clinical Pharmacology, University of Southern Denmark, Odense, Denmark
| | - Torben Knudsen
- Department of Medicine, Hospital of South West Denmark, Esbjerg, Denmark
- Centre South Western Denmark, Institute of Regional Health Research – University of Southern Denmark, Esbjerg, Denmark
| |
Collapse
|
42
|
Wilson AH, Kidd AC, Skinner J, Musonda P, Pai Y, Lunt CJ, Butchart C, Soiza RL, Potter JF, Myint PK. A simple 5-point scoring system, NaURSE (Na+, urea, respiratory rate and shock index in the elderly), predicts in-hospital mortality in oldest old. Age Ageing 2014; 43:352-7. [PMID: 24487652 DOI: 10.1093/ageing/afu002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND the mortality is high in acutely ill oldest old patients. Understanding the prognostic factors which influence mortality will help clinicians make appropriate management decisions. METHODS we analysed prospective mortality audit data (November 2008 to January 2009) to identify variables associated with in-patient mortality in oldest old. We selected those with P < 0.10 from univariate analysis and determined at which cut-point they served as the strongest predictor of mortality. Using these cut-off points, we constructed multivariate logistic regression models. A 5-point score was derived from cut-off points which were significantly associated with mortality tested in a smaller independent re-audit sample conducted in October 2011. RESULTS a total of 405 patients (mean 93.5 ± 2.7 years) were included in the study. The mean length of stay was 18.5 ± 42.4 days and 13.8% died as in-patients. Variables (cut-off values) found to be significantly associated with in-patient mortality were admission sodium (>145 mmol/l), urea (≥14 mmol/l), respiratory rate (>20/min) and shock index (>1.0): creating a 5-point score (NaURSE: NaURS in the Elderly). The crude mortality rates were 9.5, 19.9, 34.4, 66.7, and 100% for scores 0, 1, 2, 3 and 4, respectively. Using the cut-off point of ≥2, the NaURSE score has a specificity of 87% (83.1-90.3) and sensitivity of 39% (28.5-50.0), with an AUC value of 0.69 (0.63-0.76). An external independent validation study (n = 121) showed similar results. CONCLUSIONS the NaURSE score may be particularly useful in identifying oldest old who are likely to die in that admission to guide appropriate care.
Collapse
Affiliation(s)
- Alexander H Wilson
- Academic Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Anihovskaia IA, Golyshev IS, Tebloev KI, Iakovlev MI. [Endotoxin aggression in pathogenesis of acute myocardial infarction and its origin]. Fiziol Cheloveka 2014; 40:129-132. [PMID: 25702469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Endotoxin aggression of intestinal origin occurs in 89% of patients with acute myocardial infarction and may be a factor of the induction and/or progression of the disease. Sources of the development of endotoxin aggression often are Escherichia coli, Bacteroicles, Klebsiella, Proteus and Pseudomonas.
Collapse
|
44
|
Abstract
BACKGROUND Air quality degraded by black smoke (particulate matter, PM10), sulphur dioxide (SO2) and nitrogen oxide (NO(x)) affects human health. Improvements following national legislation have lowered death rates. Whether background air pollution levels continue to affect human health remains unclear. AIM To determine impact of air pollutant concentrations (PM10, SO2 and NO(x)) on in-hospital mortality for acute medical admissions to St James's Hospital over a decade (2002-11). DESIGN All emergency admissions (55,596 episodes in n = 32,581 patients) were tracked prospectively and mortality assessed. Daily levels of PM10, SO2 and NO(x) were obtained from monitoring stations in our catchment area. METHODS Univariate and multivariate logistic regression was employed to examine relationships between pollutant concentration and odds ratio (OR) for death following adjustment for other mortality predictors. RESULTS Mortality related to each pollutant variable assessed (as quintiles of increasing atmospheric concentration) was significantly predictive. For PM10 and SO2, mortality in the highest three quintile concentrations (compared with base quintile) was significantly increased (P < 0.001) with univariate ORs of 1.24, 1.36 and 1.25 for PM10 and 1.43, 1.54 and 1.58 for SO2, respectively. Mortality in all quintile concentrations (compared with base quintile) was significantly increased (P < 0.05) for NO(x) with univariate ORs of 1.14, 1.18, 1.28 and 1.35, respectively. Following adjustment for other mortality predictors such as acute illness severity, all three air pollutants were independently predictive of mortality. CONCLUSION Despite improvement to air quality in Dublin, the prevailing background pollutant concentrations continue to affect human health at levels considered safe and below that previously recognized.
Collapse
Affiliation(s)
- J Lyons
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
| | | | | | | |
Collapse
|
45
|
Bay-Nielsen M, Schulze S. [Mortality during admission in a surgical department]. Ugeskr Laeger 2014; 176:V03130182. [PMID: 25096465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A review of patient charts in 322 in-hospital deaths in one surgical unit from July 1 2010 to June 31 2011. Overall mortality was 2.9%, with terminal cancer patients, patients unsolvable at admission and patients declining treatment comprising 35.7% of patients dying. Most fatalities (169/53%) were after acute admission (median age 78 years, 61%, ASA score > 2). Stratification of in-hospital mortality in surgical patients is feasible and meaningful. A measurable reduction in surgical mortality is probably only possible in the group of patients with acute admissions.
Collapse
|
46
|
Conway R, O'Riordan D, Silke B. Consultant experience as a determinant of outcomes in emergency medical admissions. Eur J Intern Med 2014; 25:151-5. [PMID: 24423972 DOI: 10.1016/j.ejim.2013.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/19/2013] [Accepted: 12/27/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND There are little data on the experiential learning of certified consultant specialists and outcomes in acute medicine. We have examined the 30-day in-hospital mortality and hospital length of stay (LOS) in relation to practice duration, using a database of emergency admissions. METHODS All emergency admissions (60,864 episodes in 35,168 patients) over eleven years (January 2002 to December 2012) were evaluated. Consultant staff were categorised by duration of clinical practice as <15 years, 15-20 years, >20≤25 years and >25 years. We used a stepwise logistic regression model to predict 30-day in-hospital death, adjusting risk estimates for major predictor variables. Marginal analysis used adjusted predictions to test for interactions of key predictors, while controlling for other variables. RESULTS Thirty-day in-hospital mortality correlated with time in clinical practice; decreasing from 8.9% and 9.1% with <15 and 15-20 years to 7.7% for each of the categories of >20≤25 years and >25 years. There was a progressive shortening of LOS with extent of clinical practice - from a median 5.0 days (IQR 1.8, 10.3) for consultants within 15 years of registration to 4.6 (IQR 1.7-8.9; p<0.05) at >20≤25 years and 4.4 (IQR 1.7-9.0; p<0.01) with >25 years. Duration of clinical practice predicted mortality in the univariable analysis - odds ratio (OR) 0.85 (95% CI: 0.78, 0.91; p<0.001); when adjusted in a multivariable model, it remained independently predictive--OR 0.87 (95% CI: 0.79, 0.96; p<0.001) for 30-day in-hospital mortality. CONCLUSION Certified specialists appear to continue with experiential learning with evidence of improved outcome after 20 years in clinical practice.
Collapse
Affiliation(s)
- Richard Conway
- Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland
| | - Deirdre O'Riordan
- Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland
| | - Bernard Silke
- Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland.
| |
Collapse
|
47
|
Opio MO, Nansubuga G, Kellett J. In-hospital mortality of acutely ill medical patients admitted to a resource poor hospital in sub-Saharan Africa and to a Canadian regional hospital compared using the abbreviated VitalPAC Early Warning Score. Eur J Intern Med 2014; 25:142-6. [PMID: 24140259 DOI: 10.1016/j.ejim.2013.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 09/14/2013] [Accepted: 09/28/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND the development of validated early warning scores that only require the measurement of vital signs at the bedside has provided for the first time a practical and affordable method of comparing the outcomes of similar patients admitted to hospital in the developed and developing world. METHODS we compared the outcomes of patients with the same abbreviated version of the VitalPAC early warning score at the time of hospital admission in a Canadian and Ugandan hospital. 844 acutely ill medical patients admitted to Kitovu Hospital, Masaka, Uganda and 48,696 patients admitted to the Thunder Bay Regional Health Sciences Centre (TBRHSC), Ontario, Canada were examined. RESULTS apart from those patients with an abbreviated ViEWS value of 10 there was no statistically significant difference in the in-hospital mortality of Kitvou and TBRHSC patients with the same score on admission. Using arbitrary ranges of the abbreviated ViEWS the 30day Kaplan-Meier survival curves of Kitovu patients were either the same or better than those of TBRHSC patients. CONCLUSION the in-hospital mortality of patients with the same abbreviated ViEWS on hospital admission is similar in TBRHSC and Kitovu Hospital.
Collapse
Affiliation(s)
| | | | - John Kellett
- Thunder Bay Regional Health Sciences Center, Thunder Bay, Ontario, Canada.
| |
Collapse
|
48
|
Bateman BT, Mhyre JM, Hernandez-Diaz S, Huybrechts KF, Fischer MA, Creanga AA, Callaghan WM, Gagne JJ. Development of a comorbidity index for use in obstetric patients. Obstet Gynecol 2013; 122:957-965. [PMID: 24104771 PMCID: PMC3829199 DOI: 10.1097/aog.0b013e3182a603bb] [Citation(s) in RCA: 302] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop and validate a maternal comorbidity index to predict severe maternal morbidity, defined as the occurrence of acute maternal end-organ injury, or mortality. METHODS Data were derived from the Medicaid Analytic eXtract for the years 2000-2007. The primary outcome was defined as the occurrence of maternal end-organ injury or death during the delivery hospitalization through 30 days postpartum. The data set was randomly divided into a two-thirds development cohort and a one-third validation cohort. Using the development cohort, a logistic regression model predicting the primary outcome was created using a stepwise selection algorithm that included 24-candidate comorbid conditions and maternal age. Each of the conditions included in the final model was assigned a weight based on its beta coefficient, and these were used to calculate a maternal comorbidity index. RESULTS The cohort included 854,823 completed pregnancies, of which 9,901 (1.2%) were complicated by the primary study outcome. The derived score included 20 maternal conditions and maternal age. For each point increase in the score, the odds ratio for the primary outcome was 1.37 (95% confidence interval [CI] 1.35-1.39). The c-statistic for this model was 0.657 (95% CI 0.647-0.666). The derived score performed significantly better than available comorbidity indices in predicting maternal morbidity and mortality. CONCLUSION This new maternal comorbidity index provides a simple measure for summarizing the burden of maternal illness for use in the conduct of epidemiologic, health services, and comparative effectiveness research. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Brian T. Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jill M. Mhyre
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael A. Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andreea A. Creanga
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William M. Callaghan
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joshua J. Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
49
|
Abstract
Consultant-delivered care has been shown to improve outcomes for acute medical patients. However, the ideal composition of a medical team to support consultant-delivered care is not clear and little is known about the effect of continuing consultant-delivered care until the patient is discharged. Between December 2011 and April 2012, 260 general medical patients requiring inpatient care were managed by a consultant-delivered multidisciplinary team (CD-MDT) and 150 patients by a standard consultant-led team of trainee doctors. The length of hospital stay was significantly lower for patients managed by a CD-MDT than for those managed by a standard team (4-5 days vs 7 days, p<0.001). No difference between the groups was seen for readmission rates, patient safety or mortality. In conclusion, a CD-MDT is a safe and effective model of inpatient medical care and is associated with a shorter length of hospital stay.
Collapse
Affiliation(s)
- R Fielding
- Department of Medicine, University Hospital Southampton, UK.
| | | | | | | |
Collapse
|
50
|
Amarasuriya UK, Myles PR, Sanders RD. Long-term benzodiazepine use and mortality: are we doing the right studies? Curr Drug Saf 2012; 7:367-371. [PMID: 23373552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 09/30/2012] [Accepted: 10/02/2012] [Indexed: 06/01/2023]
Abstract
Benzodiazepines are World Health Organisation essential medicines used in the treatment of alcohol withdrawal, anaesthesia, sedation, anxiolysis, behavioural disturbance, epilepsy, insomnia, palliative care, and muscle spasm. Despite their widespread use concerns remain over their long-term safety through both neuronal and non-neuronal effects. We conducted a systematic review to identify vulnerable populations of patients who may be at increased risk of harm from benzodiazepines. We identified three potentially "at risk" groups of patients, those with renal disease, lung disease and those recently hospitalised. However methodological limitations including selection bias, vague descriptors of benzodiazepine use and inappropriate grouping together of benzodiazepines with other medications, precluded definitive conclusions. Future studies should concentrate on these groups to identify the long-term safety of benzodiazepines in these patient groups.
Collapse
Affiliation(s)
- Umesh Kalum Amarasuriya
- Stockton-on-Tees Adult Learning Disability Service, Tees Esk & Wear Valleys NHS Foundation Trust, UK
| | | | | |
Collapse
|