Impact of serial measurements of lysophosphatidylcholine on 28-day mortality prediction in patients admitted to the intensive care unit with severe sepsis or septic shock

Purpose

The purpose of this study is to investigate the effect of serial lysophosphatidylcholine (LPC) measurement on 28-day mortality prediction in patients with severe sepsis or septic shock admitted to the medical intensive care unit (ICU).

Methods

This is a prospective observational study of 74 ICU patients in a tertiary hospital. Serum LPC, white blood cell, C-reactive protein, and procalcitonin (PCT) levels were measured at baseline (day 1 of enrollment) and day 7. The LPC concentrations were compared with inflammatory markers using their absolute levels and relative changes.

Results

The LPC concentration on day 7 was significantly lower in nonsurvivors than in survivors (68.45 ± 42.36 μmol/L and 99.76 ± 73.65 μmol/L; P = .04). A decreased LPC concentration on day 7 to its baseline as well as a sustained high concentration of PCT on day 7 at more than 50% of its baseline value was useful for predicting the 28-day mortality. Prognostic utility was substantially improved when combined LPC and PCT criteria were applied to 28-day mortality outcome predictions. Furthermore, LPC concentrations increased over time in patients with appropriate antibiotics but not in those with inappropriate antibiotics.

Conclusions

Serial measurements of LPC help in the prediction of 28-day mortality in ICU patients with severe sepsis or septic shock.     

Incidence and mortality of severe sepsis in surgical intensive care patients: the influence of patient gender on disease process and outcome

Objective: Laboratory studies demonstrated significant detrimental effects of male sex-steroids (testosterone) on immune functions following hemorrhagic shock and soft-tissue trauma. Moreover, better survival of female mice subjected to severe sepsis was observed when compared to male animals. The aims of the present study were to evaluate whether or not gender differences regarding incidence and mortality of severe sepsis do exist in surgical intensive care patients and to elucidate the influence of patient age on incidence and mortality of severe sepsis/septic shock.¶Design: Data base review of prospectively collected data from surgical intensive care patients.¶Setting: Surgical intensive care unit of the department of surgery of a university hospital.¶Patients: Prospectively collected data of 4218 intensive care patients (2709 male, 1509 female).¶Results: Significantly fewer female patients were referred to the intensive care unit (6.6 % vs 10.8 % of all patients; P < 0.05) leading to a significantly smaller proportion of female intensive care patients (35.8 % vs 64.2 %). No gender differences regarding number of failing organs or surgical procedure (exception vascular surgery) were observed in patients with and without severe sepsis/septic shock, indicating that the patients studied are comparable regarding general health prior to admission to SICU. Among all female patients referred to SICU only 7.6 % developed severe sepsis/septic shock, while 10.4 % of all male patients suffered from severe sepsis or septic shock (P < 0.05). This gender difference results from a significantly lower incidence of severe sepsis/septic shock in female patients between 60 and 79 years. No gender difference regarding mortality rates of severe sepsis/septic shock was observed (men 64.9 %, women 65.5 %).¶Conclusions: Our results indicate a significantly smaller number of female patients requiring intensive care as well as a significantly lower incidence of severe sepsis/septic shock in female intensive care patients. Mortality from severe sepsis/septic shock, however, is not affected by gender.     

Predicting mortality in intensive care unit patients infected with Klebsiella pneumoniae: A retrospective cohort study

IntroductionAlthough several models to predict intensive care unit (ICU) mortality are available, their performance decreases in certain subpopulations because specific factors are not included. Moreover, these models often involve complex techniques and are not applicable in low-resource settings. We developed a prediction model and simplified risk score to predict 14-day mortality in ICU patients infected with Klebsiella pneumoniae.MethodologyA retrospective cohort study was conducted using data of ICU patients infected with Klebsiella pneumoniae at the largest tertiary hospital in Northern Vietnam during 2016–2018. Logistic regression was used to develop our prediction model. Model performance was assessed by calibration (area under the receiver operating characteristic curve-AUC) and discrimination (Hosmer-Lemeshow goodness-of-fit test). A simplified risk score was also constructed.ResultsTwo hundred forty-nine patients were included, with an overall 14-day mortality of 28.9%. The final prediction model comprised six predictors: age, referral route, SOFA score, central venous catheter, intracerebral haemorrhage surgery and absence of adjunctive therapy. The model showed high predictive accuracy (AUC = 0.83; p-value Hosmer-Lemeshow test = 0.92). The risk score has a range of 0–12 corresponding to mortality risk 0–100%, which produced similar predictive performance as the original model.ConclusionsThe developed prediction model and risk score provide an objective quantitative estimation of individual 14-day mortality in ICU patients infected with Klebsiella pneumoniae. The tool is highly applicable in practice to help facilitate patient stratification and management, evaluation of further interventions and allocation of resources and care, especially in low-resource settings where electronic systems to support complex models are missing.     

腹部外科脓毒症368例的临床救治

目的探索降低腹部外科脓毒症患者病死率的综合治疗措施。方法整体治疗时,在“炎性介质、细菌、内外毒素、微循环、免疫功能、营养代谢、基础疾病、脏器功能”等方面进行兼顾和并治,相应实施14条具体治疗措施。提出了短程山莨菪碱联用地塞米松为主的综合救治方案;提出并应用“分阶段代谢营养支持”治疗,减少严重并发症的发生率;采用自制的“解毒固本汤”配合治疗,以改善免疫紊乱状态、调控炎性介质等。结果本组腹部外科脓毒症368例患者,总计死亡46例,死亡率为12．50%,死亡46例均为并发MODS的患者。结论腹部外科脓毒症治疗困难,死亡率高,采用综合救治新对策能降低腹部外科脓毒症的死亡率。     

Short-term and long-term mortality in very elderly patients admitted to an intensive care unit

Objective To report short-term and long-term mortality of very elderly ICU patients and to determine independent risk factors for short-term and long-term mortalityDesign and setting Retrospective cohort study in the medical/surgical ICU of a tertiary university teaching hospital.Patients 578 consecutive ICU patients aged 80 years or older.Results Demographic, physiological, and laboratory values derived from the first 24 h after ICU admission. ICU mortality of unplanned surgical (34.0%) and medical patients (37.7%) was higher than that of planned surgical patients (10.6%), as was post-ICU hospital mortality (26.5% and 29.7% vs. 4.4%). Mortality 12 months after hospital discharge, including ICU and hospital mortality, was 62.1% in unplanned surgical and 69.2% in medical patients vs. 21.6% in planned patients. Only median survival of planned surgical patients did not differ from survival in the age- and gender-matched general population. Independent risk factors for ICU mortality were lower Glasgow Coma Scale score, higher SAPS II score, the lowest urine output over 8 h, abnormal body temperature, low plasma bicarbonate levels, and higher oxygen fraction of inspired air. High urea concentrations and admission type were risk factors for hospital mortality, and high creatinine concentration was an independent risk factor for 12-month mortality.Conclusion Mortality in very elderly patients after unplanned surgical or medical ICU admission is higher than after planned admission. The most important factors independently associated with ICU mortality were related to the severity of illness at admission. Long-term mortality was associated with renal function.This article is discussed in the editorial available at:     

Platelet indices are novel predictors of hospital mortality in intensive care unit patients

Background and objective

Platelet volume indices (PVIs) are inexpensive and readily available in intensive care units (ICUs). However, their association with mortality has never been investigated in a critical care setting. Our study aimed to investigate the association of PVI and mortality in unselected ICU patients.

Methods

This was a retrospective study conducted in a mixed 24-bed ICU from September 2010 to December 2012. Platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), platelet count, and plateletcrit were measured on ICU entry. Univariable analyses were performed to screen for variables that were associated with mortality. Variables with P < .1 were incorporated into a regression model to adjust for the odds ratio of platelet indices.

Results

A total of 1556 patients were included during the study period, including 1113 survivors and 443 nonsurvivors (mortality rate: 28.47%). Platelet distribution width and MPV were significantly higher in nonsurvivors than in survivors. Platelet distribution width greater than 17% and MPV greater than 11.3 fL were independent risk factors for mortality (adjusted odds ratio: 1.92 and 1.84, respectively) and survival time (hazards ratio: 1.77 and 1.75, respectively).

Conclusion

Higher MPV and PDW are associated with increased risk of death, whereas the decrease in plateletcrit is associated with increased mortality risk.     

Prognosis and 1-year mortality of intensive care unit patients with severe hepatic encephalopathy

Purpose

Data regarding outcome of patients with chronic liver disease with severe hepatic encephalopathy in intensive care unit are currently scarce.

Methods

This study is a retrospective observational case series in a medical intensive care unit (ICU) in a university hospital from 1995 to 2005. Patients with hepatic encephalopathy (HE) (admitted with or developing) were identified. Clinical and laboratory parameters were analyzed to determinate predictors of ICU and 1-year mortality.

Results

Seventy-one patients were included (53 male). Median Simplified Acute Physiology Score was 56 with Child-Pugh score 11 ± 2. Seventy-six percent of patients were admitted with coma (Glasgow Coma Scale, 7.7 ± 4). Eighty-two percent of patients required intubation, and 28% vasopressors. Thirty-five percent died during ICU stay. At 1 year, mortality was 54%. Univariate analysis identified arterial hypotension, mechanical ventilation, vasopressors at any time, acute renal failure, Simplified Acute Physiology Score, and sepsis associated with ICU mortality. In multivariate analysis, vasopressor use or acute renal failure was the main independent predictor of ICU death and 1-year mortality. Patients free of these risk factors, even requiring intubation, were identified as isolated HE, with lower mortality rates.

Conclusion

Predictors of outcome were similar to other groups of patients with liver disease admitted for other reasons. Intensive care unit mortality was lower than reported for other groups of patients with similar illness. Patients with severe HE admitted to ICU with no organ dysfunction other than mechanical ventilation had a better outcome and may require ICU admission.     

Plasma apolipoprotein CI correlates with increased survival in patients with severe sepsis

Objective We recently reported that apolipoprotein CI (apoCI) protects against the development of murine bacterial sepsis. We now examined the time course of plasma apoCI levels in survivors and non-survivors of severe sepsis. Design Prospective study in patients meeting predefined criteria for severe sepsis. Setting University hospital intensive care unit. Patients and participants Seventeen patients with severe sepsis. Interventions In each patient, serial blood samples for determination of total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, apoCI, apoAI, apoB, and apoCIII protein as well as clinical outcome data were collected over 30 days. Measurements and results Upon hospitalization, apoCI levels were approximately 5 times lower than normal values in septic patients, i.e. median 1.34 [interquartile range (IQR) 0.82–2.16] mg/dl. ApoCI gradually increased to median values of 5.51 (IQR 3.64–6.97) mg/dl on day 28. At day 0, apoCI levels tended to be lower in non-survivors than in survivors. Remarkably, apoCI levels remained low in non-survivors, whereas apoCI levels gradually increased to normal levels in survivors. This difference was significant and remained so after adjustment for lipoprotein core lipids. No such effect between survivors and non-survivors could be detected for lipoprotein lipids or for apoAI, apoB, and apoCIII after lipid adjustment. Conclusions Plasma apoCI levels are markedly decreased in patients with severe sepsis. ApoCI levels were higher in survivors, even after adjustment for lipid levels, and recovered progressively to normal levels. In contrast, apoCI levels remained low in non-survivors. Therefore, a high plasma apoCI level predicts survival in patients with severe sepsis. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Endotoxin activity levels as a prediction tool for risk of deterioration in patients with sepsis not admitted to the intensive care unit: A pilot observational study

Purpose

The aim of this prospective observational study was to evaluate in patients with sepsis not requiring intensive care unit admission the relationship between the levels of endotoxin activity assay (EAA) early after sepsis recognition and the risk of development of organ dysfunction (OD).

Methods

Endotoxin activity assay levels were drawn immediately after sepsis identification (baseline) and at 6, 24, and 48 hours postbaseline in 50 patients with signs of sepsis of a duration of less than 24 hours. An EAA 0.60 units or greater was considered as highly elevated.

Results

Logistic regression showed independent association between EAA levels at baseline and the appearance of new OD (adjusted odd ratio, 2.41; 95% confidence interval, 1.18-4.90; P < .05). Fifteen patients (30%) who developed new OD after baseline had at least 1 EAA level 0.60 or greater. The adjusted linear regression analysis showed that across the 4 time points, EAA levels were significantly higher in patients who developed new OD (0.11; 95% confidence interval, 0.01-0.20; P < .05).

Conclusions

Endotoxin activity assay levels 0.60 or greater early after sepsis diagnosis in patients not requiring intensive care unit admission predict risk of development of new organ dysfunction. High EAA levels in the first 48 hours of recognition of sepsis are also predictive of risk of deterioration.     

After-hours admissions are not associated with increased risk-adjusted mortality in pediatric intensive care

Objective To examine the influence of time of admission on risk-adjusted mortality and length of stay for nonelective patients admitted to a pediatric intensive care unit (ICU) without 24-h per day in-house intensivist coverage. Design Data analyzed came from a comprehensive, prospectively collected ICU database. Setting A 12-bed pediatric ICU located in a university-affiliated tertiary referral children's hospital. Patients Subjects consisted of 4,456 consecutive nonelective patients admitted over a 10-year period (1997–2006). Interventions None. Measurements and results Patients were categorized according to time of admission to the ICU as either in-hours (0800–1800 Monday–Friday and 0800–1200 on weekends), when an intensivist is present in the ICU, or after-hours (all other times), when intensivists attend only on an as-needed basis. Multivariate logistic regression was used to assess the effect of time of admission on outcome after adjustment for severity of illness using the Paediatric Index of Mortality (PIM). Patients admitted after hours had a lower risk-adjusted mortality than those admitted during normal working hours, with an odds ratio for death of 0.712 (95% confidence interval 0.518–0.980, p = 0.037). Length of stay was also significantly shorter for patients admitted after hours (44.05 h vs. 50.0 h, p = 0.001). Conclusions A lack of in-house intensivist presence is not associated with any increase in mortality or length of stay for patients admitted to our pediatric ICU; on the contrary, after-hours admission in this cohort was associated with a decreased risk-adjusted mortality and a shorter length of stay.     

Serum adiponectin upon admission to the intensive care unit may predict mortality in critically ill patients

Purpose

Adiponectin has been proposed as an important regulator of glucose metabolism influencing obesity and insulin resistance, which are important risk factors for the outcome of critically ill patients. Moreover, experimental models of inflammation suggest protective anti-inflammatory properties of adiponectin. We therefore investigated the potential pathogenic role and prognostic value of circulating adiponectin levels in critical illness.

Materials and methods

One hundred seventy critically ill patients (122 with sepsis and 48 without sepsis) were prospectively studied at admission to the medical intensive care unit (ICU) and compared with 60 healthy controls. Patients' survival was followed for approximately 3 years.

Results

Adiponectin serum concentrations did not differ between healthy controls and critically ill patients, neither in patients with nor in patients without sepsis. However, patients with decompensated liver cirrhosis had significantly elevated serum adiponectin levels. Likewise to non-critically ill subjects, ICU patients with preexisting diabetes or obesity displayed significantly reduced circulating adiponectin. Inflammatory cytokines did not correlate with serum adiponectin. Interestingly, low adiponectin levels at ICU admission were an independent positive predictor of short-term and overall survival.

Conclusions

Although serum concentrations did not differ in critically ill patients from controls, low adiponectin levels at admission to ICU have been identified as an independent predictor of survival.     

重症医学科重度子痫前期产妇围手术期临床路径的应用

目的 评价综合重症医学科(ICU)开展重度子痫前期产妇围手术期临床路径(CP)的效果,并分析其变异情况以促进质量改进.方法 比较福建医科大学附属第二医院ICU内实行CP前1年(2009年1月至12月,14例)和实施CP后1年(2010年1月至12月,22例)收治的重度子痫前期产妇ICU停留时间、住院费用、并发症发生率、病死率以及术后前3 d血压控制的总有效率.结果 与实施CP前1年组比较,实施CP后1年组ICU停留时间(h)明显缩短(65.5±24.9比86.3±28.2,t=2.321,P＜0.05),ICU住院费用(元)明显减少(6 463.6±1 838.2比8 136.5±2 142.8,t=2.496,P＜0.05),并发症发生率有所下降(36.4%比42.8%,x2=0.100,P＞0.05);血压控制的总有效率术后1 d、2 d明显提高(1 d:59.1%比14.3%,2 d:86.4%比50.0%,均P＜0.05),而术后3 d则无明显差异(95.4%比85.7%,P＞0.05).实施CP前1年组死亡1例,实施CP后1年组无死亡.结论 通过对重度子痫前期产妇围手术期实施CP管理,降低了患者的医疗负担,促进了医疗质量持续改进.

Abstract：

Objective To evaluate the effect of implementation of perioperative clinical pathway (CP)for severe preeclampsia patients in intensive care unit (ICU), and to discuss variation factors in order to improve clinical quality. Methods Thirty-six patients treated in ICU in the Second Clinical Hospital of Fujian Medical University were divided into two groups according to time of 1 year before implementation of CP (from January to December in 2009, n = 14) and 1 year after implementation of CP (from January to December in 2010, n = 22). The length of stay in ICU, cost of hospitalization, occurrence of major complications and mortality, as well as the total effective rate of control of blood pressure in the first 3 days after operation were compared. Results Compared with the group of patients of 1 year before implementation of CP, in the group of patients of 1 year after implementation of CP, the length of stay in ICU (hours) was significantly shorter (65. 5 ±24. 9 vs. 86. 3 ±28. 2, t = Z. 321, P＜0. 05), the cost of hospitalization (yuan) was significantly lower (6 463. 6±1 838.2 vs. 8 136. 5±2 142.8, r = 2. 496, P＜ 0. 05), the occurrence rate of major complications was lower (36. 4% vs. 42. 8%, x2 = 0. 100, P＞0. 05), the total effective control rate of blood pressure was significant improved on the 1st and the 2nd postoperative day (1 day: 59. 1 % vs. 14. 3%, 2 days: 86. 4% vs. 50. 0%, both P＜0. 05), but there was no significant change on the 3rd postoperative day (95. 4% vs. 85. 7%, P＞0. 05). One patient died before the application of CP,and none after its application. Conclusion These results suggested that it was beneficial to implement the program in preeclampsia patients to improve medical quality.     

Absolute eosinophils count as a marker of mortality in patients with severe sepsis and septic shock in an intensive care unit

Introduction

Eosinophils in the circulating blood undergo apoptosis during sepsis syndromes induced by the action of certain cytokines.

Objective

The aim of the study was to evaluate the absolute eosinophils count (EC) as a marker of mortality in severe sepsis and septic shock.

Patients and Method

A prospective cohort study of patients with a diagnosis of sepsis or septic shock admitted to the intensive care unit (ICU) of the Dr Gustavo Fricke Hospital between January 2008 and December 2009 was conducted. Daily EC in all patients was analyzed. Receiver operating characteristic curve analysis was used to assess the performance of the diagnostic test.

Results

We studied a total of 240 patients. The median age was 62 years (interquartile range [IQR], 48-72 years), and 67 (27.9%) died. The median EC in patients who died was 43 (IQR, 14-121), whereas in surviving patients, it was 168 (IQR, 98-292) (P < .001). When the EC on the fifth day of hospital stay was assessed, an area under the curve (AUC) of 0.64 (95% confidence interval, 0.55-0.73) was observed. Eosinophils count at intensive care unit discharge showed an area under the curve of 0.81 (95% confidence interval, 0.76-0.87).

Discussion

Eosinophils counts were lower in patients who died of sepsis than in those who survived, but its clinical usefulness seems limited. Their role as an indicator of clinical stability seems to be important.     

Epidemiologic features,risk factors,and outcome of sepsis in stroke patients treated on a neurologic intensive care unit

Purpose

Because of the immune-suppressive effect of cerebral damage, stroke patients are at high risk for infections. These might result in sepsis, which is the major contributor to intensive care unit (ICU) mortality. Although there are numerous studies on infections in stroke patients, the role of sepsis as a poststroke complication is unknown.

Methods

We retrospectively analyzed incidence of and risk factors for sepsis acquisition as well as outcome parameters of 238 patients with ischemic or hemorrhagic strokes consecutively admitted to the neurologic ICU in a tertiary university hospital between January 1, 2009, and December 31, 2010. Basic demographic and clinical data including microbiological parameters as well as factors describing stroke severity (eg, lesion volume and National Institute of Health stroke scale score) were recorded and included into the analysis. The diagnosis of sepsis was based on the criteria of the German Sepsis Society.

Results

We identified 30 patients (12.6%) with sepsis within the first 7 days from stroke onset. The lungs were the most frequent source of infection (93.3%), and gram-positive organisms were dominating the microbiologic spectrum (52.4%). Comorbidities (chronic obstructive pulmonary disease and immunosuppressive disorders) and Simplified Acute Physiology Score II but none of the factors describing stroke severity were independent predictors of sepsis acquisition. Sepsis was associated with a significantly worse prognosis, leading to a 2-fold increased mortality rate during in-hospital care (36.7% vs 18.8%) and after 3 months (56.5% vs 28.5%), but only in the subgroup of supratentorial hemorrhages, it was an independent predictor of in-hospital and 3-month mortality. Other factors significantly associated with death in a multivariate analysis were chronic obstructive pulmonary disease, malignancies (in-hospital mortality only), and Simplified Acute Physiology Score II (3-month mortality only) for ischemia and heart failure (in-hospital mortality only), National Institute of Health stroke scale score (in-hospital mortality only), and stroke volume for hemorrhages, respectively.

Conclusions

Sepsis seems to be a frequent complication of stroke patients requiring neurologic ICU treatment. Predictors of sepsis acquisition in our study were comorbidities and severity of deterioration of physiological status, but not stroke severity. A better understanding of risk factors is important for prevention and early recognition, whereas knowledge of outcome may help in prognosis prediction. Further studies are needed to clarify the optimal preventive treatment for these patients.     

Nursing care of patients with severe acute respiratory syndrome in the intensive care unit: case reports in Hong Kong

Severe acute respiratory syndrome (SARS) was diagnosed in more than 8437 patients in 25 countries between February and July 2003. During this period the World Health Organisation issued a global alert about SARS and together with the Centre for Disease Control have coordinated their efforts to investigate its pathogenesis and treatment. The outbreak in Hong Kong has been dramatic due to its geographical proximity with Guangdong province, China where the first case of SARS was reported. SARS has been described as a rapidly progressive, sometimes fatal pneumonia with a case fatality rate of 7.6% requiring intensive care. The four case reports illustrate a number of important points concerning the recognition, treatment, management and prevention of SARS, and highlights the importance of considering vigilant assessment and monitoring of patients with SARS. The purpose of this paper is to share our experiences in caring for critically ill patients with SARS in the intensive care unit to nurses globally in order to reduce SARS' morbidity and mortality as well as to protect nurses and other healthcare workers from this disease that is so far threatening the community at large.     

Tc-99m HMPAO labelled WBCs in the detection of occult sepsis in the intensive care unit

In a retrospective study involving 25 patients with occult sepsis in the ICU of Taichung Veterans General Hospital, the sensitivity and specificity of the new diagnostic method, Tc-99m HMPAO labelled white blood cells (WBCs) scan, were compared with other evaluating methods including clinical information, radiograph, ultrasound, bacterial culture, operative findings and pathological report. It was found that Tc-99m HMPAO labelled WBCs scans gave a sensitivity of 96.0%, a specificity of 84.4% and an overall accuracy of 87.3%, as well as the probable causes of false positive and false negative diagnoses were discussed. In conclusion, Tc-99m HMPAO labelled WBCs scans provide a reliable method for imaging of occult sepsis in the ICU.     

Impact of secondary sepsis on mortality in adult intensive care unit patients

RationaleSeptic patients admitted to the intensive care unit (ICU) suffer from immune dysregulation, potentially leading to a secondary sepsis episode. This study aims to (i) assess the secondary sepsis rate, (ii) compare the second with the first episodes in terms of demographics, clinical and laboratory characteristics, and outcomes, and iii) evaluate the outcome of secondary sepsis.MethodsA single-center, retrospective study (2014–2017) was conducted in a Greek ICU, including consecutive cases of adult patients admitted to the ICU for at least 48 h with a principal admission diagnosis of sepsis and stayed for at least 48 h. We searched for a secondary episode of sepsis following the primary-one. We performed survival analyses with Cox proportional hazard, Fine-Gray, and multistate models.ResultsIn this study, 121 patients that fulfilled the eligibility criteria were included. The secondary sepsis group included 28 (23.1 %) patients, with episode onset, median (interquartile range), 9.5 (7.7–16.2) days after ICU admission, who had less frequently had a medical admission diagnosis, a microbiologically confirmed first episode, and the C-reactive protein was lower. The overall ICU mortality of the cohort was 44.6 %. The group that developed secondary sepsis had higher mortality, but significance was lost in Cox regression [Hazard ratio (95 % CI) 0.59(0.31–1.16)]. However, after multistate modeling adjustment, the attributable mortality was estimated at 43.9 % (95 %CI ± 14.8 %).ConclusionSecondary sepsis was evident in a quarter of the study participants and may be associated with an increased risk of death.     

Preadmission quality of life can predict mortality in intensive care unit—A prospective cohort study

Purpose

We sought to investigate whether preadmission quality of life could act as a predictor of mortality among patients admitted to the intensive care unit (ICU).

Materials and methods

This is a prospective observational study of all patients above the age of 18 years admitted to the ICU with a length of stay longer than 24 hours. Short form 36 (SF-36) and Acute Physiology and Chronic Health Evaluation II (APACHE II) were used. Mortality was assessed during ICU admission, 30, and 90 days hereafter.

Results

We included 318 patients. No patients were lost to follow-up. Using the physical component summary of short form 12 (SF-12) as a predictor of ICU mortality, the area under the curve (0.70; confidence interval, 0.62-0.77) was comparable with that of APACHE II (0.74; confidence interval, 0.67-0.82). The difference between SF-12 and SF-36 was nonsignificant.

Conclusions

Preadmission quality of life, assessed by SF-36 and SF-12, is as good at predicting ICU, 30-, and 90-day mortality as APACHE II in patients admitted to the ICU for longer than 24 hours. This indicates that estimated preadmission quality of life, potentially available in the pre-ICU setting, could aid decision making regarding ICU admission and deserves more attention by those caring for critically ill patients.     

Hyperglycaemia and mortality in critically ill patients

Objective To describe hyperglycaemia as a possible marker of morbidity and mortality in critically ill medical and surgical patients admitted to a multidisciplinary ICU.Design Prospective cohort study.Setting A 13-bed non-cardiac multidisciplinary ICU in a university hospital.Patients and participants Adult patients consecutively admitted to the ICU in a 6-month period. Patients with fewer than 2 days stay in the ICU and patients with known diabetes were excluded.Measurements and results At admission a registration form was filled in including demographic data, first and second day APACHE II scores, infections and daily maximum blood glucose level. In surgical patients, high maximum blood glucose level during the stay in ICU was correlated with increased mortality, morbidity and frequency of infection. In medical patients, we found a non-significant trend towards a correlation between hyperglycaemia and morbidity and mortality, respectively.Conclusions High blood glucose level during the stay in ICU was a marker of increased morbidity and mortality in critically ill surgical patients. In medical patients the same trend was found, but non-significant. The population of patients in the present study are heterogeneous and the results from surgical critically ill patients should not be generalised to medical patients.     

Clinical profile, intensive care unit course, and outcome of patients admitted in intensive care unit with dengue

Purpose

The purpose of the study was to assess the clinical profile and course of dengue patients admitted to the intensive care unit (ICU) and to identify factors related to poor outcome.

Methods

All patients with dengue admitted to ICU over 2.5 years were included prospectively. Severity of illness was assessed by the Acute Physiology and Chronic Health Evaluation (APACHE) II score, and organ failure was determined by the Sequential Organ Failure Assessment score. Primary outcome measure was 28-day mortality. Logistic regression analysis was performed to identify factors predicting mortality.

Results

Data from 198 patients were analyzed. Mean age was 39.56 ± 17.1 years, and 61.1% were male. The commonest complaints were fever (96%) and rash (37.9%). Mean admission APACHE II and Sequential Organ Failure Assessment scores were 7.52 ± 7.8 and 4.52 ± 3.4, respectively. The commonest organ failure was coagulation (43.4%) followed by respiratory failure (13.1%). Vasopressors were required by 11.6%; and dialysis and mechanical ventilation were required by 7.6% and 9.1%, respectively. Mortality was 12 (6.1%); and on multivariate analysis, APACHE II score (odds ratio, 1.781; 95% confidence interval, 0.967-3.281; P = .048) could independently predict mortality.

Conclusions

Patients with dengue fever may require ICU admission for organ failure. Outcome is good if appropriate aggressive care and organ support are instituted. Admission APACHE II score may predict patients at higher risk of death.