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1.
Giles N. Cattermole S.K. Paulina Mak C.H. Elizabeth Liow Man Fung Ho Kin Yee Grace Hung Kai Man Keung Hoi Man Li Colin A. Graham Timothy H. Rainer 《Resuscitation》2009,80(9):1000-1005
Introduction
Several prognostic scores exist for critically ill patients, including APACHE II, Revised Trauma Score (RTS), Rapid Emergency Medicine Score (REMS) and Modified Early Warning Score (MEWS). However, there is no widely used score specifically designed to predict the likelihood of early intensive care unit (ICU) admission or death in undifferentiated emergency department (ED) resuscitation room patients. We aimed to derive such a score and compare it with other similar scores.Methods
This was a single centre study of consecutive adult resuscitation room patients over one month. Physiological and blood test variables were compared according to the composite primary outcome: admission to ICU or death within 7 days of attendance. Multivariate logistic regression was used to derive a prediction score which was compared with other scores using ROC (receiver operating characteristic) analysis.Results
330 patients were included in the study, of whom 77 were admitted to ICU or died within 7 days. A prediction score was derived using the following parameters: systolic blood pressure; Glasgow coma score; blood glucose; bicarbonate; white cell count; and a history of metastates. This score significantly out-performed APACHE II, RTS, REMS and MEWS with an area under the ROC curve of 0.909 (95% CI 0.872–0.938).Conclusion
The Prince of Wales Emergency Department Score (PEDS) is a new prognostic score to predict the likelihood of early ICU admission or death in undifferentiated resuscitation room patients. Further studies are needed to validate and refine this potentially useful tool. 相似文献2.
Antoine G. Schneider Miklós Lipcsey Michael Bailey David V. Pilcher Rinaldo Bellomo 《Journal of critical care》2013
Purpose
Comparison of illness severity for intensive care unit populations assessed according to different scoring systems should increase our ability to compare and meta-analyze past and future trials but is currently not possible. Accordingly, we aimed to establish a methodology to translate illness severity scores obtained from one system into another.Materials and methods
Using the Australian and New-Zealand intensive care adult patient database, we obtained simultaneous admission Acute Physiology and Chronic Health Evaluation (APACHE) II and APACHE III scores and Simplified Acute Physiology Score (SAPS) II in 634 428 patients admitted to 153 units between 2001 and 2010. We applied linear regression analyses to create models enabling translation of one score into another. Sensitivity analyses were performed after removal of diagnostic categories excluded from the original APACHE database, after matching for similar risk of death, after splitting data according to country of origin (Australia or New Zealand) and after splitting admissions occurring before or after 2006.Results
The translational models were APACHE III = 3.08 × APACHE II + 5.75; APACHE III = 1.47 × SAPS II + 8.6; and APACHE II = 0.36 × SAPS II + 4.4. The area under the receiver operating curve for mortality prediction was 0.853 (95% confidence interval, 0.851-0.855) for the “APACHE II derived APACHE III” score and 0.854 (0.852-0.855) for the “SAPS II derived APACHE III” vs 0.854 (0.852-0.855) for the original APACHE III score. Similarly, it was 0.841 (0.839-0.843) for the “SAPS II derived APACHE II score” vs 0.842 (0.840-0.843) for the original APACHE II score. Correlation coefficients as well as intercepts remained very similar in all subgroups analyses.Conclusions
Simple and robust translational formulas can be developed to allow clinicians to compare illness severity between studies involving critically ill patients. Further studies in other countries and health care systems are needed to confirm the generalizability of these results. 相似文献3.
Jrme Fichet MD Emmanuelle Mercier MD Olivier Gene MD Denis Garot MD Annick Legras MD Pierre-Franois Dequin MD PhD Dominique Perrotin MD 《Journal of critical care》2009,24(3):364-370
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. 相似文献4.
Ho Cheol Kim Jun-Wan Yoo So Yeon Lim Gee Young Suh Shin Ok Koh Sungwon Na Chae-Man Lim Younsuck Koh Won-Il Choi Young-Joo Lee Seok Chan Kim Chin Kook Rhee Gyu Rak Chon Je Hyeong Kim Jae Yeol Kim Jaemin Lim Sunghoon Park Jin Hwa Lee Ji Hyun Lee 《Journal of critical care》2013
Purpose
The purpose of this study is to evaluate factors associated with the mortality of patients admitted to intensive care units (ICUs) after in-hospital cardiopulmonary resuscitation (CPR) and the impact of a hospital rapid response system (RRS) on patient mortality in Korea.Materials and Methods
A prospective multicenter cohort study was done in 22 ICUs of 15 centers from July 1, 2010, to January 31, 2011. We only enrolled patients admitted to ICUs after in-hospital CPR and divided eligible patients into 2 groups—survivors and nonsurvivors.Results
Among 4617 patients, 150 patients were admitted post-CPR, 76 died, and 74 survived. At 24 hours, the Sequential Organ Failure Assessment score, Simplified Acute Physiology Score II, and the best Glasgow Coma Scale were significantly lower in the nonsurvivors than in the survivors. In multivariate analysis, the Simplified Acute Physiology Score II and presence of lower respiratory infection were both independently associated with mortality. At the first hour after admission, lowest serum potassium and highest heart rate were associated with mortality. At 24 hours after admission, lowest mean arterial pressure, HCO3 level, and venous oxygen saturation level; highest heart rate; and use of vasoactive drugs were associated with mortality. The mortality of patients in hospitals with an RRS was not significantly different from that of hospitals without an RRS.Conclusion
Various physiologic and laboratory parameters were associated with the mortality of post-CPR ICU admitted patients, and the presence of an RRS did not reduce mortality of these patients in our study. 相似文献5.
Thanh N. Huynh S. Sam Weigt Catherine A. Sugar Shelley Shapiro Eric C. Kleerup 《Journal of critical care》2012
Purpose
Patients with pulmonary hypertension (PH) can decompensate to the point where they require care in the intensive care unit (ICU). Our objective is to examine the outcomes and characteristics of patients with PH admitted to the ICU.Methods
This is a retrospective study of 99 patients with PH who were admitted to the medical ICU of a single tertiary care center. Baseline characteristics, interventions during ICU admission, and ICU and 6-month outcome were documented. Univariate and multivariate logistic regressions were used to evaluate association of patient characteristics with mortality.Results
Intensive care unit mortality was 30%, and 6-month mortality was 40%. Acute Physiology and Chronic Health Evaluation II score, World Health Organization Group 3 PH, and preexisting treatment with a prostacyclin at time of ICU admission were associated with worse outcome. Patients who received cardiopulmonary resuscitation had 100% mortality. The requirement for mechanical ventilation and dialysis was also associated with increased mortality. Pulmonary artery catheter placement was associated with reduced mortality, specifically if it was placed early during ICU admission and if associated with a change in the present management.Conclusions
Mortality is high in critically ill patients with PH. The identification of prognostic baseline characteristics and interventions in the ICU is important and warrants further investigation. 相似文献6.
Marylou Cárdenas-Turanzas Joe Ensor Chris Wakefield Karen Zhang Susannah Kish Wallace Kristen J. Price Joseph L. Nates 《Journal of critical care》2012
Purpose
This study aims to validate the performance of the Sequential Organ Failure Assessment (SOFA) score to predict death of critically ill patients with cancer.Material and methods
We conducted a retrospective observational study including adults admitted to the intensive care unit (ICU) between January 1, 2006, and December 31, 2008. We randomly selected training and validation samples in medical and surgical admissions to predict ICU and in-hospital mortality. By using logistic regression, we calculated the probabilities of death in the training samples and applied them to the validation samples to test the goodness-of-fit of the models, construct receiver operator characteristics curves, and calculate the areas under the curve (AUCs).Results
In predicting mortality at discharge from the unit, the AUC from the validation group of medical admissions was 0.7851 (95% confidence interval [CI], 0.7437-0.8264), and the AUC from the surgical admissions was 0.7847 (95% CI, 0.6319-0.937). The AUCs of the SOFA score to predict mortality in the hospital after ICU admission were 0.7789 (95% CI, 0.74-0.8177) and 0.7572 (95% CI, 0.6719-0.8424) for the medical and surgical validations groups, respectively.Conclusions
The SOFA score had good discrimination to predict ICU and hospital mortality. However, the observed underestimation of ICU deaths and unsatisfactory goodness-of-fit test of the model in surgical patients to indicate calibration of the score to predict ICU mortality is advised in this group. 相似文献7.
Purpose
The aim of the study was to evaluate risk factors for infection and sepsis in surgical patients admitted to the intensive care unit (ICU).Materials and Methods
Data were prospectively collected from a cohort of surgical patients from January 2005 to December 2007. We analyzed the incidence of infection and sepsis and certain other variables from the pre-, intra-, and postoperative periods as risk factors for infection and sepsis.Results
We studied 625 surgical patients. The mortality rate was 18.2%, and the mean age of the subjects was 53.1 ± 18.8 years. The incidences of severe sepsis and septic shock were 5% and 11.5%, respectively. A multivariate analysis showed that the following variables were associated with sepsis in the postoperative period: urgent surgery (odds ratio, 2.63; 95% confidence interval [CI], 1.50-4.63), fluid resuscitation (odds ratio, 1.90; 95% CI, 1.18-3.05), vasoactive drugs (odds ratio, 2.58; 95% CI, 1.61-4.14), and mechanical ventilation (odds ratio, 5.51; 95% CI, 3.07-9.89). A Sequential Organ Failure Assessment was associated with infection or sepsis upon ICU admission (area under the curve, 0.737 ± 0.019; 95% CI, 0.748-0.825).Conclusions
This study showed that sepsis has high incidence and mortality in surgical patients admitted to the ICU. Urgent surgeries, mechanical ventilation, fluid resuscitation, and vasoactive drugs in the postoperative period and Sequential Organ Failure Assessment at ICU admission were risk factors for sepsis. 相似文献8.
Antonio Maria Dell’anna Julia Bini VinottiMarjorie Beumier Diego Orbegozo-CortesKatia Donadello Sabino ScollettaJean-Louis Vincent Fabio Silvio Taccone 《Resuscitation》2014
Aim
Prognostication of outcome after cardiac arrest (CA) is challenging. We assessed the prognostic value of daily blood levels of C-reactive protein (CRP), a cheap and widely available inflammatory biomarker, after CA.Methods
We reviewed the data of all patients admitted to our intensive care unit (ICU) after CA between January 2009 and December 2011 and who survived for at least 24 h. We collected demographic data, CA characteristics (initial rhythm; location of arrest; time to return of spontaneous circulation [ROSC]), occurrence of infection, ICU survival and neurological outcome at three months (good = cerebral performance category [CPC] 1–2; poor = CPC 3–5). CRP levels were measured daily from admission to day 3.Results
A total of 130 patients were admitted after successful resuscitation from CA and survived more than 24 h; 76 patients (58%) developed an infection and overall mortality was 56%. CRP levels increased from admission to day 3. CRP levels were higher in in-hospital than in out-of-hospital CA, especially on admission and day 1 (44.1 vs. 2.1 mg L−1 and 74.5 vs. 29.5 mg L−1, respectively; p < 0.001), and in patients with non-shockable than in those with shockable rhythms. In a logistic regression model, high CRP levels on admission were independently associated with poor neurological outcome at 3 months.Conclusion
CRP levels increase in the days following successful resuscitation of CA. Higher CRP levels in patients with in-hospital CA, non-shockable rhythms and infection, suggest a greater inflammatory response in these patients. High CRP levels on admission may identify patients at high-risk of poor outcome and could be a target for future therapies. 相似文献9.
Masson R Colas V Parienti JJ Lehoux P Massetti M Charbonneau P Saulnier F Daubin C 《Resuscitation》2012,83(11):1413-1417
Background
The use of extracorporeal life support (ECLS) as a treatment for severe cardiovascular impairment due to poisoning is unclear. Therefore, we conducted a retrospective cohort analysis to compare survival among critically ill poisoned patients treated with or without ECLS.Methods
All consecutive patients admitted into 2 university hospitals in northwestern France over the past decade for persistent cardiac arrest or severe shock following poisoning due to drug intoxication were included. ECLS was preferentially performed in 1 of the 2 centers.Results
Sixty-two patients (39 women, 23 men; mean age 48 ± 17 years) fulfilled inclusion criteria: 10 with persistent cardiac arrest and 42 with severe shock. Fourteen patients were treated with ECLS and 48 patients with conventional therapies. All subjects received vasopressor and fluid loading. Patients treated with or without ECLS at ICU admission had comparable drug ingestion histories, Simplified Acute Physiology Score (SAPS II score) (66 ± 18), Sequential Organ Failure Assessment (SOFA) score (median: 11 [IQR, 9–13]), Glasgow Coma Scale score (median: 3 [IQR, 3–11]), need for ventilator support (n = 56) and extra renal support (n = 23). Thirty-five (56%) patients survived: 12/14 (86%) ECLS patients and 23/48 (48%) non-ECLS patients (p = 0.02, by Fisher exact test). None of the patients with persistent cardiac arrest survived without ECLS support. Based on admission data, beta-blocker intoxication (p = 0.02) was also associated with lower mortality. In multivariate analysis, adjusting for SAPS II and beta-blocker intoxication, ECLS support remained associated with lower mortality [Adjusted Odds Ratio, 0.18; 95% CI, 0.03–0.96; p = 0.04].Conclusion
In the absence of response to conventional therapies, we consider that ECLS may improve survival in critically ill poisoned patients experiencing cardiac arrest and severe shock. 相似文献10.
M. Dustin Boone Leo A. Celi Ben G. Ho Michael Pencina Michael P. Curry Yotam Lior Daniel Talmor Victor Novack 《Journal of critical care》2014
Purpose
Cirrhosis is a common condition that complicates the management of patients who require critical care. There is interest in identifying scoring systems that may be used to predict outcome because of the poor odds for recovery despite high-intensity care. We sought to evaluate how Model for End-Stage Liver Disease (MELD), an organ-specific scoring system, compares with other severity of illness scoring systems in predicting short- and long-term mortality for critically ill cirrhotic patients.Materials and methods
This was a retrospective cohort study involving seven intensive care units (ICUs) in a tertiary care, academic medical center. Adult patients with cirrhosis who were admitted to an ICU between 2001 and 2008 were evaluated. Severity of illness scores (MELD and Sequential Organ Failure Assessment [SOFA]) were calculated on admission and at 24 and 48 hours. The primary end points were 28-day and 1-year all-cause mortality.Results
Of 19 742 ICU hospitalizations, 848 had cirrhosis. Relevant data were available for 521 patients (73%). Of these cases, 353 patients (69.5%) were admitted to medical ICU (MICU), and the other 155 (30.5%), to surgical unit. Alcohol abuse and hepatitis C were the most common reasons for cirrhosis. Patients who died within 28 days were more likely to receive mechanical ventilation, pressors, and renal replacement therapy. Among 353 medical admissions, both MELD and SOFA were found to be significantly associated with both 28-day and 1-year mortality. Among the 155 surgical admissions, both scores were found to be not significant for 28-day mortality but were significant for 1 year.Conclusions
Our results demonstrate that the prognostic ability of a variety of scoring systems strongly depends on the patient population. In the MICU population, each model (MELD + SOFA, MELD, and SOFA) demonstrates excellent discrimination for 28-day and 1-year mortality. However, these scoring systems did not predict 28-day mortality in the surgical ICU group but were significant for 1-year mortality. This suggests that patients admitted to a surgical ICU will behave similarly to their MICU cohort if they survive the perioperative period. 相似文献11.
Shailesh Bihari Sandra L. Peake Michael Bailey David Pilcher Shivesh Prakash Andrew Bersten 《Journal of critical care》2014
Background
Because increased serum osmolarity may be lung protective, we hypothesized that increased mortality associated with increased serum sodium would be ameliorated in critically ill patients with an acute respiratory diagnosis.Methods
Data collected within the first 24 hours of intensive care unit (ICU) admission were accessed using ANZICS CORE database. From January 2000 to December 2010, 436 209 patients were assessed. Predefined subgroups including patients with acute respiratory diagnoses were examined. The effect of serum sodium on ICU mortality was assessed with analysis adjusted for illness severity and year of admission. Results are presented as odds ratio (95% confidence interval) referenced against a serum sodium range of 135 to 144.9 mmol/L.Results
Overall ICU mortality was increased at each extreme of dysnatremia (U-shaped relationship). A similar trend was found in various subgroups, with the exception of patients with respiratory diagnoses where ICU mortality was not influenced by high serum sodium (odds ratio, 1.3 [0.7-1.2]) and was different from other patient groups (P < .01). Any adverse associations with hypernatremia in respiratory patients were confined to those with arterial pressure of oxygen (PaO2)/fraction of inspired oxygen (Fio2) ratios of greater than 200.Conclusion
High admission serum sodium is associated with increased odds for ICU death, except in respiratory patients. 相似文献12.
Background
There are few data comparing outcome and the utility of severity of illness scoring systems following intensive care after out-of-hospital (OHCA), in-hospital (IHCA) and intensive care unit (ICUCA) cardiac arrest. We investigated survival, factors associated with survival and the correlation and accuracy of general and specific scoring systems, including the Apache III score and the OHCA score in OHCA, IHCA and ICUCA patients.Material and methods
Prospective analysis of data on all cardiac arrest patients treated in a tertiary hospital between August 1st 2008 and July 30th 2010. Collected data included resuscitation and post-resuscitation care data as defined by the Utstein Guidelines, Apache III on admission and the OHCA score on admission in OHCA and IHCA patients and after the arrest in ICUCA patients. Statistical methods were used to identify factors associated with outcome and the predictive ability and correlation of the aforementioned scores.Results
Of a total of 3931 patients treated in the ICU, 51 were admitted following OHCA, 50 following IHCA and 22 suffered an ICUCA and had sustained return of spontaneous circulation (ROSC). Survival at 30 days was highest among ICUCAs (67%) followed by IHCAs (38%) and OHCAs (29%). Using multivariate analysis delay ROSC was the only independent predictor of survival. The OHCA score performed with moderate accuracy for predicting 30-day mortality (area under the curve 0.77 [0.69–0.86] and was slightly better than the Apache III score 0.71 (0.61–0.80). Using multiple logistic regression the Apache III and the OHCA score were both independent predictors of hospital survival and correlation between these two scores was weak (correlation coefficient of 0.244).Conclusions
Latency to ROSC seems to be the most important determinant of survival in patients following ICU care after a cardiac arrest in this single center trial. The OHCA score and the Apache III score offer moderate predictive accuracy in ICU cardiac arrest patients but correlated weakly with each other. Illness severity adjustment for cardiac arrest patients in ICU should include features of both these scoring systems. 相似文献13.
Background
Score systems for severity of illness and organ dysfunction have been validated and used as tools to predict the risk of death in intensive care unit (ICU) patients, but their usefulness in patients with suspected infection in the emergency department (ED) or hospital ward is unclear.Objectives
The objective of this systematic review was to establish the accuracy of score systems in the prediction of mortality in patients with suspected infection in hospital settings compared to the ICU.Methods
Three researchers independently performed a systematic search and a review of related articles and their references using the PubMed database. The articles were selected by consensus, based on previously defined inclusion and exclusion criteria.Results
In total, 21 studies were included, 19 of which were carried out in the ED. The researchers found that the operative characteristics to evaluate the accuracy (calibration and discrimination) of the different scores were insufficiently assessed in most studies. Only two studies evaluated the calibration, using the Hosmer-Lemeshow goodness-of-fit test, and less than half of the studies evaluated the discrimination, using the area under the receiver operator characteristics curve.Conclusions
The reviewed literature did not provide enough information to assess the accuracy of the prognostic models in patients with suspected infection admitted to the ED and hospital ward. Some reports suggest a better accuracy with new scores like the MEDS (Mortality in Emergency Department Sepsis score), but the results are not consistent. 相似文献14.
Deven Juneja DNB Palepu B. Gopal MD FRCA Dharmesh Kapoor MD DM Ravichandra Raya MD Mohan Sathyanarayanan MD FRCA Parveen Malhotra MD 《Journal of critical care》2009,24(3):387-393
Purpose
The study aimed to describe the clinical outcome of patients with liver cirrhosis admitted to intensive care unit (ICU) and to compare the performance of Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) in predicting mortality.Methods
In this prospective study of patients with cirrhosis admitted to the ICU, demographic data, APACHE II score, SOFA score, presence of acute renal failure (ARF), need for organ support, and mortality were collected.Results
The observed mortality in ICU and at 30 days among 104 patients was 42.3% (95% confidence interval [CI], 32.7%-52.0%) and 56.7% (95% CI, 47.0%-66.4%), respectively. Area under the receiver operating characteristic curve for first-day APACHE II in predicting 30-day mortality was 0.90 (95% CI, 0.83-0.96) and 0.93 (95% CI, 0.88-0.98) for SOFA score (P = .24). On multivariate analysis, ARF (adjusted odds ratio, 7.7; 95% CI, 1.09-54.64) and mechanical ventilation (adjusted odds ratio, 277.6; 95% CI, 12.83-6004.94) were significantly associated with mortality.Conclusions
Presence of ARF and need for mechanical ventilation are associated with high mortality in patients with liver cirrhosis admitted to the ICU. Acute Physiology and Chronic Health Evaluation II and SOFA are good prognostic models in predicting 30-day mortality and do not differ in performance. 相似文献15.
Daniel B. Knox Michael J. Lanspa Cristina M. Pratt Kathryn G. Kuttler Jason P. Jones Samuel M. Brown 《Journal of critical care》2014
Objective
The Sequential Organ Failure Assessment (SOFA) score, a measure of multiple-organ dysfunction syndrome, is used to predict mortality in critically ill patients by assigning equally weighted scores across 6 different organ systems. We hypothesized that specific organ systems would have a greater association with mortality than others.Design
We retrospectively studied patients admitted over a period of 4.2 years to a mixed-profile intensive care unit (ICU). We recorded age and comorbidities, and calculated SOFA organ scores. The primary outcome was 30-day all-cause mortality. We determined which organ subscores of the SOFA score were most associated with mortality using multiple analytic methods: random forests, conditional inference trees, distanced-based clustering techniques, and logistic regression.Setting
A 24-bed mixed-profile adult ICU that cares for medical, surgical, and trauma (level 1) patients at an academic referral center.Patients
All patients' first admission to the study ICU during the study period.Measurements and Main Results
We identified 9120 first admissions during the study period. Overall 30-day mortality was 12%. Multiple analytical methods all demonstrated that the best initial prediction variables were age and the central nervous system SOFA subscore, which is determined solely by Glasgow Coma Scale score.Conclusions
In a mixed population of critically ill patients, the Glasgow Coma Scale score dominates the association between admission SOFA score and 30-day mortality. Future research into outcomes from multiple-organ dysfunction may benefit from new models for measuring organ dysfunction with special attention to neurologic dysfunction. 相似文献16.
Stéphane Gaudry MD Jean-Damien Ricard Clément Leclaire Cédric Rafat Jonathan Messika Alexandre BedetDavid Hajage MD Didier Dreyfuss 《Journal of critical care》2014
Purpose
Renal replacement therapy (RRT) is a major supportive treatment of acute kidney injury (AKI) in intensive care unit (ICU), but the timing of its initiation remains open to debate.Materials and methods
We retrospectively analyzed ICU patients who had AKI associated with at least one usual RRT criteria: serum creatinine concentration greater than 300 μmol/L, serum urea concentration greater than 25 mmol/L, serum potassium concentration greater than 6.5 mmol/L, severe metabolic acidosis (arterial blood pH < 7.2), oliguria (urine output < 135 mL/8 hours or < 400 mL/24 hours), overload pulmonary edema. To estimate the risk of death associated with RRT adjusted for risk factors, we performed a marginal structural Cox model with inverse-probability-of-treatment-weighted estimator.Results
Among 4173 patients admitted to the ICU, 203 patients fulfilled potential RRT criteria. Ninety-one patients (44.8%) received RRT and 112 (55.2%) did not. Non-RRT and RRT patients differed in terms of severity of illness: Simplified Acute Physiology Score II (55 ± 17 vs 60 ± 19, respectively; P < .05) and Sequential Organ Failure Assessment score (8 [5-10] vs 9 [7-11], respectively; P = .01).Crude analysis indicated a lower ICU mortality for non-RRT compared with RRT patients (18% vs 45%; P < .001). In the marginal structural Cox model, RRT was associated with increased mortality (P < .01).Conclusion
A conservative approach of AKI was not associated with increased mortality. 相似文献17.
Samuel M. Brown Quinn Tate Jason P. Jones Daniel B. Knox Kathryn G. Kuttler Michael Lanspa Matthew T. Rondina Colin K. Grissom Subhasis Behera V.J. Mathews Alan Morris 《Journal of critical care》2013
Introduction
Heart rate variability (HRV) reflects autonomic nervous system tone as well as the overall health of the baroreflex system. We hypothesized that loss of complexity in HRV upon intensive care unit (ICU) admission would be associated with unsuccessful early resuscitation of sepsis.Methods
We prospectively enrolled patients admitted to ICUs with severe sepsis or septic shock from 2009 to 2011. We studied 30 minutes of electrocardiogram, sampled at 500 Hz, at ICU admission and calculated heart rate complexity via detrended fluctuation analysis. Primary outcome was vasopressor independence at 24 hours after ICU admission. Secondary outcome was 28-day mortality.Results
We studied 48 patients, of whom 60% were vasopressor independent at 24 hours. Five (10%) died within 28 days. The ratio of fractal alpha parameters was associated with both vasopressor independence and 28-day mortality (P = .04) after controlling for mean heart rate. In the optimal model, Sequential Organ Failure Assessment score and the long-term fractal α parameter were associated with vasopressor independence.Conclusions
Loss of complexity in HRV is associated with worse outcome early in severe sepsis and septic shock. Further work should evaluate whether complexity of HRV could guide treatment in sepsis. 相似文献18.
Tiruvoipati R Chiezey B Lewis D Ong K Villanueva E Haji K Botha J 《Journal of critical care》2012,27(2):153-158
Background
Stress hyperglycemia (SH) is commonly seen in critically ill patients. It has been shown to be associated with adverse outcomes in some groups of patients. The effects of SH on critically ill patients with sepsis have not been well studied. We aimed to evaluate the effects of SH in critically ill patients with sepsis.Methods
In this retrospective study, patients with sepsis admitted to intensive care unit (ICU) over a 5-year period were included.Results
Of 297 patients, 204 (68.7%) had SH during the study period. The mean blood glucose level in patients with SH was 8.7 mmol/L compared with 5.9 mmol/L in those without SH (P < .05). There were no statistically significant differences in age; sex; sepsis severity; cardiovascular, respiratory, and renal comorbidities; requirement of mechanical ventilation; inotropes; and Acute Physiology, Age, and Chronic Health Evaluation III and Simplified Acute Physiology 2 scores on ICU admission. Intensive care unit mortality was significantly lower in patients who had SH. The median duration of ICU and hospital length of stay was longer in patients with SH. On logistic regression analysis, the presence of SH was associated with reduced ICU mortality. Subgroup analysis revealed SH to be protective in patients with septic shock.Conclusion
Stress hyperglycemia may not be harmful in critically ill patients with sepsis. Patients with SH had lower ICU mortality. 相似文献19.
Objectives
Although EDs are responsible for the initial care of critically ill patients and the amount of critical care provided in the ED is increasing, there are few data examining mechanical ventilation (MV) in the ED. In addition, characteristics of ED-based ventilation may affect planning for ventilator shortages during pandemic influenza or bioterrorist events. The study examined the epidemiology of MV in US EDs, including demographic, clinical, and hospital characteristics; indications for MV; ED length of stay (LOS); and in-hospital mortality.Methods
This study was a retrospective review of the 1993 to 2007 National Hospital Ambulatory Medical Care Survey ED data sets. Ventilated patients were compared with ED patients admitted to the intensive care unit (ICU) and to all other ED visits.Results
There were 3.6 million ED MV visits (95% confidence interval [CI], 3.2-4.0 million) over the study period. Sex, age, race, and payment source were similar for mechanically ventilated and ICU patients (P > .05 for all). Approximately 12.5% of ventilated patients underwent cardiopulmonary resuscitation compared with 1.7% of ICU admissions and 0.2% of all other ED visits (P < .0001). Accordingly, in-hospital mortality was significantly higher for ventilated patients (24%; 95% CI, 13.1%-34.9%) than both comparison groups (9.3% and 2.5%, respectively). Median LOS for ventilated patients was 197 minutes (interquartile range, 112-313 minutes) compared with 224 minutes for ICU admissions and 140 minutes for all other ED visits.Conclusions
Patients undergoing ED MV have particularly high in-hospital mortality rates, but their ED LOS is sufficient for implementation of evidence-based ventilator interventions. 相似文献20.
Chang Dong Yeo MD Jin Woo Kim Seok Chan Kim Young Kyoon Kim Kwan Hyoung Kim Hee Je Kim Seok LeeChin Kook Rhee MD 《Journal of critical care》2012