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61.
Fahad Faqihi Abdulrahman Alharthy Salman Abdulaziz Abdullah Balhamar Awad Alomari Zohair AlAseri Hani Tamim Saleh A. Alqahtani Demetrios J. Kutsogiannis Peter G. Brindley Dimitrios Karakitsos Ziad A. Memish 《International journal of antimicrobial agents》2021,57(5):106334
Assessment of efficacy of therapeutic plasma exchange (TPE) following life-threatening COVID-19. This was an open-label, randomised clinical trial of ICU patients with life-threatening COVID-19 (positive RT-qPCR plus ARDS, sepsis, organ failure, hyperinflammation). Study was terminated after 87/120 patients enrolled. Standard treatment plus TPE (n = 43) versus standard treatment (n = 44), and stratified by PaO2/FiO2 ratio (>150 vs. ≤150), were compared. Primary outcomes were 35-day mortality and TPE safety. Secondary outcomes were association between TPE and mortality, improvement in SOFA score, change in inflammatory biomarkers, days on mechanical ventilation (MV), and ICU length of stay (LOS). Eighty-seven patients [median age 49 (IQR 34–63) years; 82.8% male] were randomised (44 standard care; 43 standard care plus TPE). Days on MV (P = 0.007) and ICU LOS (P = 0.02) were lower in the TPE group. 35-Day mortality was non-significantly lower in the TPE group (20.9% vs. 34.1%; Kaplan-Meier, P = 0.582). TPE was associated with increased lymphocytes and ADAMTS-13 activity and decreased serum lactate, lactate dehydrogenase, ferritin, d-dimers and interleukin-6. Multivariable regression analysis provided several predictors of 35-day mortality: PaO2/FiO2 ratio (HR, 0.98, 95% CI 0.96–1.00; P = 0.02]; ADAMTS-13 activity (HR, 0.89, 95% CI 0.82–0.98; P = 0.01); pulmonary embolism (HR, 3.57, 95% CI 1.43–8.92; P = 0.007). Post-hoc analysis revealed a significant reduction in SOFA score for TPE patients (P < 0.05). In critically-ill COVID-19 patients, addition of TPE to standard ICU therapy was associated with faster clinical recovery and no increased 35-day mortality. 相似文献
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Ralphe Bou Chebl Hani Tamim Gilbert Abou Dagher Musharaf Sadat Ghassan Ghamdi Abdulrahman Itani Alawi Saeedi Yaseen M. Arabi 《Annals of medicine》2021,53(1):1737
ObjectivesThis study aims to examine the outcome of end-stage renal disease (ESRD) patients admitted with sepsis to the intensive care unit (ICU).DesignSingle centre, retrospective cohort studySettingThe study was conducted in the Intensive Care Department of King Abdulaziz Medical City, Riyadh, Saudi Arabia.ParticipantsData were extracted from a prospectively collected ICU database from 2002 to 2017. Patients were considered to have sepsis based on the sepsis-3 definition and were stratified into 2 groups based on the presence or absence of ESRD.Primary and secondary outcomesThe primary outcome of the study was in-hospital mortality. Secondary outcomes included ICU mortality, ICU and hospital lengths of stay, and mechanical ventilation duration.ResultsA total of 8803 patients were admitted to the ICU with sepsis during the study period. 730 (8.3%) patients had ESRD. 49.04% of ESRD patients with sepsis died within their hospital stay vs. 31.78% of non-ESRD patients. ESRD septic patients had 1.44 greater odds of dying within their hospital stay as compared to septic non-ESRD patients (OR 1.44, 95% CI 1.03–1.53). Finally, the predictors of hospital mortality in septic ESRD patients were found to be mechanical ventilation (OR 3.36; 95% CI 2.27–5.00), a history of chronic liver disease (OR 2.26; 95% CI 1.26–4.07), and use of vasopressors (OR 1.74; 95% CI 1.19–2.54). Among patients with ESRD, hospital mortality was higher in subgroups of patients with chronic cardiac (OR 1.86 (1.36–2.53) vs. 1.19 (0.96–1.47)) and chronic respiratory illnesses (OR 2.20 (1.52–3.20) vs. 1.21 (0.99–1.48)).ConclusionESRD patients admitted to the intensive care unit with sepsis are at greater odds of mortality compared to patients with non-ESRD. This risk is particularly increased if these patients have a concomitant history of chronic cardiac and respiratory illnesses.
Key Messages
- Sepsis and bacterial infections are very common in ESRD patients and following cardiovascular disease; sepsis is the second leading cause of death in patients with ESRD.
- This study aims to examine the outcome of patients with end-stage renal disease (ESRD) patients admitted with sepsis to the intensive care unit (ICU).
- The results of this study have shown that end-stage renal disease is associated with greater odds of ICU and hospital mortality among septic patients admitted to an intensive care unit.
- ESRD patients were also more likely to be started on vasopressors and mechanical ventilation.
65.
Ralphe Bou Chebl Hani Tamim Musharaf Sadat Saad Qahtani Tarek Dabbagh Yaseen M. Arabi 《Medicine》2021,100(46)
The aim of this study is to examine the outcome of septic patients with cirrhosis admitted to the intensive care unit (ICU) and predictors of mortality.Single center, retrospective cohort study.The study was conducted in Intensive care Department of King Abdulaziz Medical City, Riyadh, Saudi Arabia.Data was extracted from a prospectively collected ICU database managed by a full time data collector. All patients with an admission diagnosis of sepsis according to the sepsis-3 definition were included from 2002 to 2017. Patients were categorized into 2 groups based on the presence or absence of cirrhosis.The primary outcome of the study was in-hospital mortality. Secondary outcomes included ICU mortality, ICU and hospital lengths of stay and mechanical ventilation duration.A total of 7906 patients were admitted to the ICU with sepsis during the study period, of whom 497 (6.29%) patients had cirrhosis. 64.78% of cirrhotic patients died during their hospital stay compared to 31.54% of non-cirrhotic. On multivariate analysis, cirrhosis patients were at greater odds of dying within their hospital stay as compared to non-cirrhosis patients (Odds ratio {OR} 2.53; 95% confidence interval {CI} 2.04 – 3.15) independent of co-morbidities, organ dysfunction or hemodynamic status. Among cirrhosis patients, elevated international normalization ratio (INR) (OR 1.69; 95% CI 1.29-2.23), hemodialysis (OR 3.09; 95% CI 1.76-5.42) and mechanical ventilation (OR 2.61; 95% CI 1.60–4.28) were the independent predictors of mortality.Septic cirrhosis patients admitted to the intensive care unit have greater odds of dying during their hospital stay. Among septic cirrhosis patients, elevated INR and the need for hemodialysis and mechanical ventilation were associated with increased mortality. 相似文献
66.
Ralphe Bou Chebl Mirabelle Geha Mohamad Assaf Nadim Kattouf Saadeddine Haidar Karim Abdeldaem Nour Halawi Mohamed Khamis Maha Makki Hani Tamim Gilbert Abou Dagher 《Annals of medicine》2021,53(1):2268
ObjectivesLactate/albumin (L/A) ratio is a biomarker in sepsis that has been shown to outperform lactate. This prospective study aims to validate the superior prognostic value of the L/A ratio to lactate in sepsis and septic shock.MethodsProspective cohort conducted from September 2018 till February 2021 on adult patients presenting to the Emergency Department (ED) at a tertiary care centre with sepsis or septic shock. The primary outcome was the prognostic value of the L/A ratio compared to lactate with regards to mortality.ResultsA total of 939 septic patients were included throughout the study period. A total of 236 patients developed septic shock. The AUC value of the L/A ratio in septic patients was 0.65 (95% CI 0.61–0.70) and was higher than that of lactate alone 0.60 (95% CI 0.55–0.64) with a p < .0001. The optimal L/A ratio cut-off threshold that separated survivors from non-survivors was found to be 0.115 for all septic patients. The AUC of the L/A ratio was significantly higher for patients with a lactate ≥2 mmol/L: 0.69 (95% CI 0.64–0.74) versus 0.60 (95% CI 0.54–0.66) with a p < .0001 as well as for patients with an albumin level less than 30 g/L (AUC = 0.69 95% CI= 0.62–0.75 vs AUC= 0.66 95% CI= 0.59–0.73, p = .04). Among septic shock patients there was no statically significant difference in the AUC value of the L/A ratio compared to lactate (0.53 95% CI 0.45–0.61 vs 0.50 95% CI 0.43–0.58 respectively with a p-value = .11).ConclusionsThe L/A ratio is a better predictor of in-patient mortality than lactate in sepsis patients. This superiority was not found in the septic shock subgroup. Our results encourage the use of the ratio early in the ED as a superior prognostic tool in sepsis patients.
Key messages
- We aimed to assess the prognostic usefulness of the Lactate/Albumin ratio compared to lactate alone in septic and septic shock patients.
- The L/A ratio proved to be a better predictor of in-patient mortality than lactate alone in sepsis patients. This pattern also applies across various subgroups in our study (malignancy, diabetics, age above 65, lactate level less than 2 mmol/L, albumin less than 30 g/L). Our results favour the use of the L/A ratio over lactate alone in patients with sepsis and the previously mentioned subgroups.
- Our results do not favour the use of the ratio instead of lactate in septic shock patients as there was no statistically significant difference between the AUCs of the ratio and lactate alone.
67.
Limited research has been conducted in the United Arab Emirates in relation to postpartum depression. The purpose of this
study was to investigate the risk and protective factors of postpartum depression in women in Sharjah, United Arab Emirates.
We carried out a prospective study in which we followed women from the second trimester of pregnancy until 4 months postpartum.
Data were collected during the second and third trimesters and then at 2- and 4- months postpartum. The risk/protective factors
that were investigated included: depression and anxiety during pregnancy, stressful life events, breastfeeding, employment
status following delivery, religiosity, and socio-demographic variables. The Edinburgh Postnatal Depression Scale (screening)
and the Mini International Neuropsychiatric Inventory (diagnostic) were used as outcome variables. Using the Mini International
Neuropsychiatric Inventory (diagnostic), 10% of the 137 participants in the study were diagnosed with postpartum depression.
The following variables were found to be predictive of postpartum depression: depression during pregnancy in both the second
and third trimesters: number of children, religion, and use of formula for feeding. Several factors were of borderline significance
including educational level of mother, lack of breastfeeding, personal stressful life events, and employment status following
delivery. These risk factors are important as they indicate potential areas for early identification. Screening of pregnant
women during pregnancy and in the postpartum phase would be important. This study forms the foundation for further research
and development related to prevention and intervention for postpartum depression in this Arab context. 相似文献
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Musharrafieh U Tamim HM Rahi AC El-Hajj MA Al-Sahab B El-Asmar K Tamim HM 《International journal of public health》2008,53(4):208-213
BACKGROUND: Studies to assess the patterns of physical exercise among University students in Lebanon are lacking. The current study looks at the prevalence of physical exercise among university students in Beirut and predictors of performing physical exercise. METHODS: In a cross-sectional study, a proportionate random sample of university students selected from five major universities were asked to complete a self-administered questionnaire related to physical exercise, demographic, scholastic, and health risk behavioral characteristics. Physical exercise was divided into: "No" (<0.5 h) and "Yes" (>0.5 h) per week. Chisquare tests and binary regression were conducted to determine the predictors of performing physical exercise. RESULTS: Of 2,013 students, only 26.4 % engaged in physical exercise. Predictors of performing physical exercise for males, were adoption of exercise as the method of weight control, while for females, they were living abroad, drinking excessive alcohol, and adopting exercise for weight control. CONCLUSION: The prevalence of physical exercise among Lebanese university students is low. Weight control remains the most important predictor of physical activity in males and females. 相似文献
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