Acute Physiology And Chronic Health Evaluation Research Articles

Effects of closed- versus open-system intensive care units on mortality rates in patients with cancer requiring emergent surgical intervention for acute abdominal complications: a single-center retrospective study in Korea.

In this study, we aimed to compare the in-hospital mortality of patients with cancer who experienced acute abdominal complications that required emergent surgery in open (treatment decisions made by the primary attending physician of the patient's admission department) versus closed (treatment decisions made by intensive care unit [ICU] intensivists) ICUs. This retrospective, single-center study enrolled patients with cancer admitted to the ICU before or after emergency surgery between November 2020 and September 2023. Univariate and logistic regression analyses were conducted to explore the associations between patient characteristics in the open and closed ICUs and in-hospital mortality. Among the 100 patients (open ICU, 49; closed ICU, 51), 23 died during hospitalization. The closed ICU group had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, vasopressor use, mechanical ventilation, and preoperative lactate levels and a shorter duration from diagnosis to ICU admission, surgery, and antibiotic administration than the open ICU group. Univariate analysis linked in-hospital mortality and APACHE II score, postoperative lactate levels, continuous renal replacement therapy (CRRT), and mechanical ventilation. Multivariate analysis revealed that in-hospital mortality rate increased with CRRT use and was lower in the closed ICU. Compared to an open ICU, a closed ICU was an independent factor in reducing in-hospital mortality through prompt and appropriate treatment.

DySurv: dynamic deep learning model for survival analysis with conditional variational inference.

Machine learning applications for longitudinal electronic health records often forecast the risk of events at fixed time points, whereas survival analysis achieves dynamic risk prediction by estimating time-to-event distributions. Here, we propose a novel conditional variational autoencoder-based method, DySurv, which uses a combination of static and longitudinal measurements from electronic health records to estimate the individual risk of death dynamically. DySurv directly estimates the cumulative risk incidence function without making any parametric assumptions on the underlying stochastic process of the time-to-event. We evaluate DySurv on 6 time-to-event benchmark datasets in healthcare, as well as 2 real-world intensive care unit (ICU) electronic health records (EHR) datasets extracted from the eICU Collaborative Research (eICU) and the Medical Information Mart for Intensive Care database (MIMIC-IV). DySurv outperforms other existing statistical and deep learning approaches to time-to-event analysis across concordance and other metrics. It achieves time-dependent concordance of over 60% in the eICU case. It is also over 12% more accurate and 22% more sensitive than in-use ICU scores like Acute Physiology and Chronic Health Evaluation (APACHE) and Sequential Organ Failure Assessment (SOFA) scores. The predictive capacity of DySurv is consistent and the survival estimates remain disentangled across different datasets. Our interdisciplinary framework successfully incorporates deep learning, survival analysis, and intensive care to create a novel method for time-to-event prediction from longitudinal health records. We test our method on several held-out test sets from a variety of healthcare datasets and compare it to existing in-use clinical risk scoring benchmarks. While our method leverages non-parametric extensions to deep learning-guided estimations of the survival distribution, further deep learning paradigms could be explored.

Comparing short-term mortality between people with and without HIV admitted to the intensive care unit: A single-centre matched cohort study (2000-2019).

The survival rate of people with HIV admitted to intensive care units (ICUs) is approaching that of people without HIV. We conducted a matched-cohort study of people with and without HIV admitted to ICU at a large hospital to compare short-term mortality, during 2000-2019. People with HIV were matched to people without HIV (1:2) on age, sex, admission year and Acute Physiology and Chronic Health Evaluation (APACHE)-II score. Applying logistic regression models fitted using independence estimating equations, we describe population-averaged associations of HIV with short-term (in-ICU, in-hospital) mortality during a patient's first admission to ICU, and explore whether these varied by year. A total of 177 people with HIV were matched to 354 people without HIV (71.2% vs. 71.2% male; median age: 47 vs. 48 years, median APACHE-II: 18 vs. 17, median admission year: 2013 vs. 2013). Among people with HIV, 73.4% were on antiretroviral therapy, 51.2% had HIV-RNA ≤50 copies/mL and median CD4 T-cell count was 132 cells/ L. People with HIV had higher in-ICU (24.3% vs. 15.3%) and in-hospital (31.6% vs. 20.1%) mortality. People with HIV had 1.69-fold higher odds (95% confidence interval: 1.03-2.76) of in-ICU mortality and 1.86 (1.19-2.91) higher odds of in-hospital mortality than people without HIV, adjusted for age, sex, year and APACHE-II. There was no evidence that these associations varied by year (p-interaction-in-ICU = 0.90; p-interaction-in-hospital = 0.46). Our findings suggest that although outcomes have improved over time, people with HIV continue to have higher short-term in-ICU and in-hospital mortality following ICU admission compared with people without HIV with similar characteristics.

Evaluating the Efficacy of Inhaled Colistin via Two Nebulizer Types in Ventilator-Associated Pneumonia: Prospective Randomized Trial.

Backgroud: This prospective randomized trial evaluated the clinical efficacy of inhaled colistin administered through two distinct nebulizer types, a vibrating mesh nebulizer (VMN) and a jet nebulizer (JN), in the treatment of ventilator-associated pneumonia caused by multidrug-resistant bacteria. In addition, an in vitro model was used to determine the optimal delivery of colistin. Method: Thirty-two patients prescribed intravenous (IV) colistin inhalation were randomized to receive either a VMN (n = 17) or a JN (n = 15), then compared to the control group (IV alone) over a 7-to 10-day period. The primary endpoint was the clinical pulmonary infection score (CPIS), and the secondary endpoints were the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACE) score, and duration of ventilator use. Results: Results from in vitro testing demonstrated that VMN delivered a significantly higher colistin dose than JN (35.68 ± 3.55% vs. 23.56 ± 3.31%; p < 0.001) when positioned at the humidifier inlet. Compared to the IV alone group, the IV with inhalation group yielded significant improvements in CPIS, SOFA score, and APACHE score on day 7; nevertheless, clinical outcomes between the two nebulizers were statistically indistinguishable. Conclusions: In conclusion, although VMN delivers a higher dose in vitro, both nebulizers yielded comparable clinical outcomes. This study was registered at US Clinical Trial Registration (NCT04633317).

Evaluation of risk factors for 14-day and 30-day mortality among treatment regimens against Pseudomonas aeruginosa resistant to carbapenem but susceptible to traditional antipseudomonal non-carbapenem β-lactam agents.

Pseudomonas aeruginosa associated with hospital-acquired infection is often resistant to various antibiotics and is associated with high mortality worldwide. The appropriate treatment of Pseudomonas aeruginosa resistant to carbapenems but susceptible to traditional antipseudomonal non-carbapenem β-lactam agents (Car-R/NonCar-S P. aeruginosa) remains unclear. This retrospective study evaluated risk factors for 14-day and 30-day mortality among treatment regimens against Car-R/NonCar-S P. aeruginosa. This study enrolled 180 patients with Car-R/NonCar-S P. aeruginosa infection at Phramongkutklao Hospital between January 2019 and December 2023. The 14-day and 30-day mortality rates were 18.3% and 28.9%, respectively. Bloodstream infection (OR 1.97, 95% CI 0.88-4.43), septic shock (OR 3.3, 95% CI 1.30-8.40), Acute Physiology and Chronic Health Evaluation (APACHE) II < 14 (OR 0.13, 95% CI 0.03-0.54), Sequential Organ Failure Assessment (SOFA) <7 (OR 0.25, 95% CI 0.11-0.56), and Pitt bacteremia score <4 (OR 0.16, 95% CI 0.05-0.47) were associated with 14-day mortality. There was a higher 14-day and 30-day mortality in patients treated with piperacillin/tazobactam or aminoglycosides but there was no significant difference among antipseudomonal antimicrobial agents in the treatment of Car-R/NonCar-S P. aeruginosa infection. We supported the use of traditional antipseudomonal β-lactam agents to treat Car-R/NonCar-S P. aeruginosa infections, however the use of piperacillin/tazobactam might be concerned in some cases and further investigations were needed.

Assessment of sestrin 2 as a sepsis marker and predictor of disease severity

Introduction Sestrin 2 is considered a stress-inducible antioxidant protein. This study was aimed to evaluate sestrin 2 in subjects with sepsis, and its correlation with clinical severity and mortality. Methods Sepsis and control group patients were followed from admission to discharge. A blood sample was taken at admission for determination of serum sestrin 2 level. Results Of the total 42 patients with sepsis, there were 25 females and the mean age was 74.9 years. The sestrin 2 levels were significantly higher in the sepsis group. The optimum sestrin 2 cut-off point of ≥3.13 ng/mL had 95.2% sensitivity and 71.4% specificity for sepsis (p < .001). Sestrin 2 levels were higher in patients who needed renal replacement therapy (p = .018), patients who needed vasopressor therapy (p = .001) and patients with organ dysfunction (p = .002). The sestrin 2 level was significantly correlated with Acute Physiology and Chronic Health Evaluation (APACHE) II score, Nutrition Risk in the Critically Ill (NUTRIC) Score, C-reactive protein and albumin. Sestrin 2 levels were not associated with 30 d mortality in sepsis patients. Conclusions Sestrin 2 was significantly higher in the sepsis patients and associated with sepsis related adverse clinical outcomes. These results provided information concerning the clinical utility of sestrin 2.

Pamidronate for Hypercalcemia in Critically Ill Surgical Patients.

Hypercalcemia in critically ill patients is associated with an increased severity of illness and mortality that becomes worse as the levels rise. Pamidronate was evaluated for the treatment of hypercalcemia in critically ill surgical patients. This retrospective study evaluated 30 critically ill surgical patients who developed hypercalcemia (ionized calcium (iCa)≥1.25 mmol/L) while in the surgical ICUs over three years. Patients were case-matched 1:1 for age and severity of illness. In the 30 patients with an overall Acute Physiology and Chronic Health Evaluation (APACHE)II of 22±9, mechanical ventilation was required in 27/30 (90%) and hemodialysis in 11/30 (37%).Within four days of pamidronate, iCa declined from a mean of 1.46±0.14 to 1.15±0.14 mmol/L, p=0.004; however, the blood urea nitrogen (BUN) and serum creatinine (SCr) increased significantly in patients with renal impairment.An iCa≥1.35 mmol/L increased mortality from 0% to 26%. Hypercalcemia in critically ill surgical patients is associated with increased severity of illness. Over a period of four days, pamidronate reduced iCa levels at ~0.08 mmol/L/day and corrected 80% of the hypercalcemic patients; however, it may cause further renal dysfunction.

Receptor-Interacting Protein Kinase 3 as a Serological Biomarker in Relation to Disease Severity and Delirium After Acute Pancreatitis: A Prospective Cohort Study.

Delirium is a common complication of acute pancreatitis. Receptor-interacting protein kinase 3 (RIP3) is an activator of programmed cell necrosis. This study aimed to determine its ability to predict delirium after acute pancreatitis. In total, 297 patients with acute pancreatitis were prospectively enrolled in this study. Patients were divided into two subgroups (study and validation groups: 197 and 100 cases, respectively). Serum RIP3 levels were measured in all patients and in 100healthy controls. Acute Physiology and Chronic Health Evaluation (APACHE) II, Ranson, and sequential organ failure assessment (SOFA) scores were used for the severity assessment. In-hospital delirium was observed as an outcome variable. Multifactorial analyses were performed to discern severity correlations and outcome associations. Serum RIP3 levels were significantly higher in the patients than in the controls. Serum RIP3 levels had linear relationships under the restricted cubic spline and were independently correlated with APACHE II, Ranson, and SOFA scores. Serum RIP3 levels were linearly correlated with the likelihood of developing in-hospital delirium and exhibited a strong discrimination efficiency under the receiver operating characteristic curve. Serum RIP3 levels, coupled with APACHE II scores, Ranson scores, and SOFA scores, were the four independent predictors of in-hospital delirium. No interactions were revealed regarding its relevance to sex, age, or body mass index in subgroup analysis. These were integrated to form a model graphically represented by a nomogram that showed effective stability, clinical fit, and predictive ability for in-hospital delirium. The model was verified in the validation group. An incremental trend in serum RIP3 levels was notable after acute pancreatitis. Serum RIP3 levels are independently related to illness severity and occurrence of in-hospital delirium, indicating that serum RIP3 may be a potential biomarker of acute pancreatitis.

The value of coagulation indicators combined with sequential organ failure assessment in assessing disease severity and prognosis of elderly patients with sepsis

To explore the value of coagulation indicators and related critical scores in evaluating the severity and prognosis of elderly sepsis patients. Patients admitted to the intensive care unit (ICU) of General Hospital of Ningxia Medical University aged ≥60 years with a definite diagnosis of sepsis from May 2020 to May 2022 were retrospectively included. General epidemiological data, coagulation indices such as prothrombin time (PT), international normalized ratio (INR), prothrombin activity (PTA), activated partial thromboplastin time (APTT), prothrombin time (TT), fibrinogen (FIB), D-dimer, platelet count (PLT), and other laboratory indices within 24 hours of admission to the ICU, acute physiology and chronic health evaluation (APACHE), sequential organ failure assessment (SOFA), sepsis-related complications, and 28-day prognosis were collected. Patients were divided into shock and non-shock groups according to whether septic shock occurred or not, and into death and survival groups according to 28 days outcomes, and the differences of each index between the groups were compared. Independent risk factors for septic shock and 28-day death were analyzed by using univariate and multivariate Logistic regression, and the receiver operator characteristic curve (ROC curve) were further plotted to assess the value of independent risk factors in predicting the occurrence of septic shock and 28-day death in elderly patients with sepsis. A total of 295 elderly patients with sepsis were included, 192 (65.08%) developed septic shock, and 126 (42.71%) died at 28 days. Multivariate binary Logistic regression analysis showed that SOFA score and PT-INR were independent risk factors for septic shock and 28-day death in elderly patients with sepsis [septic shock: odds ratio (OR) and 95% confidence interval (95%CI) were 1.340 (1.186-1.513) and 1.720 (1.235-2.396), respectively; 28-day death: OR and 95%CI were 1.188 (1.044-1.351) and 4.546 (2.613-7.910), respectively, all P < 0.01]. ROC curve analysis showed that SOFA score and PT-INR had certain predictive values for septic shock occurrence and 28-day death in elderly patients with sepsis, and the area under the curve (AUC) for septic shock occurrence were 0.743 and 0.564, respectively. The AUC of 28-day death was 0.711 and 0.651, respectively. The combined predicted AUC was 0.761 and 0.817, the sensitivity was 78.1% and 65.1%, and the specificity was 63.1% and 85.8%, respectively. PT-INR and SOFA score have potential predictive value in the assessment of the severity and prognosis of elderly patients with sepsis, and their combined prediction accuracy is higher.

Предикторы госпитальной летальности при экстренном хирургическом лечении острейшего расслоения аорты типа А по Стенфорду в условиях искусственного кровообращения: ретроспективное когортное исследование

INTRODUCTION: Acute Stanford type A aortic dissection is one of the most severe cardiovascular diseases with high in-hospital mortality. OBJECTIVE: To establish predictors of in-hospital mortality in the treatment of patients with acute Stanford type A aortic dissection under conditions of artificial circulation and to determine their threshold values. MATERIALS AND METHODS: Study design: retrospective, cohort, single-center. Inclusion criteria: surgical intervention with cardiopulmonary bypass, confirmed diagnosis of acute Stanford type A aortic dissection, age &gt; 18 years. The study included 51 patients: 42 men and 9 women aged from 35 to 77 years, median 59 years [47; 65]. All patients (n = 51) were treated in 2022 and were divided into 2 groups depending on the outcome: group 1 (n = 27) included those who died in the intensive care unit within 30 days, group 2 (n = 24) included survived and discharged patients. The endpoint of trial was 30-day in-hospital mortality. RESULTS: Postoperative Sequential Organ Failure Assessment (SOFA) score &gt; 7, Acute Physiology And Chronic Health Evaluation (APACHE) II score &gt; 19, and Vasoactive-inotropic score (VIS) &gt; 10, cardiopulmonary bypass time &gt; 177 minutes, and total hypothermic circulatory arrest time &gt; 30 minutes were associated with an increased risk of 30-day in-hospital mortality. CONCLUSIONS: Statistically significant predictors of hospital mortality in the treatment of patients with acute Stanford type A aortic dissection under cardiopulmonary bypass are the SOFA index, the APACHE II index and the VIS index after the end of surgery, as well as the time of cardiopulmonary bypass and the time of total hypothermic circulatory arrest.

Reevaluation of prognostic and severity indicators for COVID-19 patients in the emergency department

Aims This study aimed to re-evaluate whether the scoring systems, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were effective in predicting prognosis and severity of COVID-19 patients in the emergency department (ED). Methods COVID-19 patients enrolled in this retrospective study divided into the death (DEA) and survival (SUR) groups, the severe/critical (SC) and non-severe/critical (non-SC) groups. The Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA), National Early Warning Score (NEWS) and CCEDRRN COVID-19 Mortality Score were calculated. The neutrophil, lymphocyte and platelet counts were extracted from the first routine blood examination, and NLR and PLR were calculated accordingly. Receiver Operating Characteristic (ROC) curve and logistic regression were performed. Results All the scoring systems, as well as NLR and PLR, significantly increased in both the DEA and SC groups. The ROC curve showed that the CCEDRRN COVID-19 Mortality Score had the highest predictive value for mortality and severity (AUC 0.779, 0.850, respectively), which outperformed the APACHE II, SOFA and NEWS. NLR presented better predictive ability for severity (AUC 0.741) than death (AUC 0.702). The APACHE II, NEWS and CCEDRRN COVID-19 Mortality Score were positively correlated with both prognosis and severity, whereas NLR only with severity. Conclusion The NEWS and CCEDRRN COVID-19 Mortality Score were reconfirmed for early and rapid predicting the poor prognosis and severity of COVID-19 patients in ED, especially the CCEDRRN COVID-19 Mortality Score with the highest discrimination capacity, and NLR was more appropriate for predicting the severity.

Correlation of Serum Albumin Levels With the Severity of Sepsis Among Intensive Care Unit Patients.

Background Sepsis is a critical and potentially fatal medical condition characterized by significant illness and death rates. Early recognition and assessment of sepsis severity are vital for its optimal management. Determination of its severity by Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II, is quite a complex process as these score systems require complex and costly investigations. Therefore, this study was designed to determine the predictive capacity of serum albumin levels for the severity of sepsis in intensive care unit (ICU) patients. Methods This cross-sectional study was carried out on 201 ICU-admitted patients with diagnosed sepsis at Benazir Bhutto Hospital (BBH), Rawalpindi, Pakistan from March 2022 to April 2023. Recruitment of patients was performed through consecutive sampling and predefined inclusion and exclusion criteria. Prior to the data collection, ethical approval and informed consent were obtained. Data was gathered via a self-designed proforma. SOFA score was applied for the determination of the severity of sepsis. Patients were categorized into three groups based on sepsis severity (SOFA score). Data analysis was done in the Statistical Package for the Social Sciences (SPSS) version 25. Descriptive and inferential statistics compared study variables. Pearson's correlation and a simple linear regression model were used to assessthe relationship between serum albumin levels and sepsis severity and the predictive capacity of serum albumin levels for sepsis severity respectively. The statistical significance of the p-value was set at less than 0.05. Results Among the 201 patients, 64 (31.84%) had sepsis, 98 (48.75%) had severe sepsis, and 39 (19.41%) had septic shock. Hypoalbuminemia was present among 119 (59.20%) patients while 82 (40.80%) patients had normal albumin levels. Significant differences were found in the total bilirubin, serum creatinine, platelet count, PaO2/FiO2 ratio, mean arterial pressure, Glasgow Coma Scale score, SOFA score, serum albumin level, and the prevalence of normal and low albumin levels across three study groups (p < 0.05). Pearson's correlation analysis showed a strong negative correlation between serum albumin level and SOFA score (correlation coefficient (r) = -0.78, p = 0.001). Linear regression analysis confirmed an inverse relationship between serum albumin levels and SOFA scores (beta coefficient = -2.70, p = 0.002). Conclusions In the present study, serum albumin level was noted as a reliable predictor of sepsis severity in ICU patients. Lower serum albumin levels were associated with higher SOFA scores, indicating more severe sepsis. This study supports the use of serum albumin as a simple and cost-effective biomarker for early identification of sepsis severity, particularly in resource-limited settings.

Prognostic Value of Admission Lactate Levels in Critically Ill Patients: A Comparative Study With Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II Scores.

Introduction Critical illness refers to life-threatening conditions requiring mechanical or pharmacological intervention to maintain organ function. Prognostic models, such as the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores, have been widely used to predict mortality in intensive care unit (ICU) patients. Lactate levels are emerging as a valuable biomarker in this context. This study aims to determine the prognostic value of lactate levels upon admission in critically ill patients and to assess their correlation with SOFA and APACHE II scores. Methods This descriptive cross-sectional study included 200 critically ill patients admitted to the emergency department over one year. Data on patient demographics, clinical findings, and laboratory results were collected, and lactate levels and SOFA and APACHE II scores were measured at the time of admission. Patients were followed throughout their hospital stay, with outcomes classified as survival or mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of lactate, SOFA, and APACHE II scores. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States). Results The mean age of the patients was 56.8±16.9 years; 110 (55%) were men, and 90 (45%) were women. In total, 79 patients (39.5%) were non-survivors, and 121 (60.5%) were survivors. Lactate levels were significantly higher in non-survivors (3.56±1.90 mmol/L) compared to survivors (1.47±0.82 mmol/L) (p<0.001). The SOFA and APACHE II scores were also significantly higher in non-survivors (SOFA: 6.35±3.19; APACHE II: 19.91±8.21) than in survivors (SOFA: 3.14±2.02; APACHE II: 12.45±5.76) (p<0.001). The ROC curve analysis showed that lactate had an area under the curve (AUC) of 0.909, SOFA had an AUC of 0.809, and APACHE II had an AUC of 0.769 for predicting mortality. Conclusions Lactate levels are a highly sensitive predictor of mortality in critically ill patients, with significant correlations to SOFA and APACHE II scores. Lactate, as a single rapid test, provides substantial prognostic information and can aid in early triage and clinical decision-making, particularly in resource-limited settings. A single arterial lactate measurement at admission is an effective tool for predicting patient outcomes in the ICU.

Predictive value of the CURB-65, qSOFA, and APACHE II for in-hospital mortality in patients with acute exacerbation chronic obstructive pulmonary disease.

This study aimed to evaluate the efficacy of Quick Sequential Organ Failure Assessment, Confusion, Urea, Respiratory Rate, Blood Pressure, and Age Above or Below 65 Years (CURB-65), and Acute Physiology and Chronic Health Evaluation (APACHE) II in predicting the in-hospital mortality of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This retrospective study was conducted on 1583 hospitalized patients diagnosed with AECOPD from 2017 to 2019. Appropriate clinical data were retrieved from medical records from the time of admission up until the patients were discharged. The patients' most severe physiological condition and laboratory data within the first 24 hours of admission were used to determine CURB-65, Quick Sequential Organ Failure Assessment, and APACHE II scores. The accuracy of these 3 instruments in predicting the in-hospital mortality of patients with AECOPD was compared. It was observed that patients who had died had significantly higher APACHE II and CURB-65 scores (P < .05). Binary logistic regression analysis confirmed their significant association with mortality. The APACHE II score had a sensitivity of 91.6% and a specificity of 89.2%, while CURB-65 had a sensitivity of 94% and a specificity of 67.2%. The receiver operating characteristic curves for APACHE II and CURB-65 showed high predictive accuracy (area under the curve, 0.965 and 0.882, P < .001), respectively. Mortality rates substantially increased with higher scores (P < .001), reaching 38.2% for APACHE II scores ≥16 and 15.8% for CURB-65 scores ≥2. Our findings reveal a clear link between higher mortality rates and higher APACHE II and CURB-65 scores. The receiver operating characteristic curves' strong predictive ability highlights the dependability of these scoring systems in assessing the risk of in-hospital mortality, making them useful tools for predicting the outcomes in critical care.

Elevated Cardiac Troponin Levels as a Predictor of Increased Mortality Risk in Non-Cardiac Critically Ill Patients Admitted to a Medical Intensive Care Unit.

Background: Cardiac troponin I (TnI) is a specific marker of myocardial damage used in the diagnosis of acute coronary syndrome (ACS). TnI levels can also be elevated in patients without ACS, which is linked to a worse prognosis and mortality. We evaluated the clinical implications and prognostic significance of serum TnI levels in critically ill non-cardiac patients admitted to the intensive care unit (ICU) at a tertiary-level hospital. Materials and Methods: A three-year retrospective study including the years 2017-2020 was conducted to evaluate in-hospital mortality during ICU stay and mortality rates at 28 and 90 days, as well as one and two years after admission, in 557 patients admitted to the medical ICU for non-cardiac causes. Results: TnI levels were elevated in 206 (36.9%) patients. Patients with elevated TnI levels were significantly older and had higher rates of comorbidities, including chronic heart failure, coronary heart disease, and chronic kidney disease (p < 0.05 for all). Patients with elevated TnI levels required more invasive mechanical ventilation, vasopressor infusion, and dialysis in the ICU and experienced more shock within the first 72 h (p = 0.001 for all). High TnI levels were associated with higher Acute Physiological and Chronic Health Evaluation (APACHE) II (27.6 vs. 20.3, p = 0.001) and Sequential Organ Failure assessment (8.8 vs. 5.26, p = 0.001) scores. Elevated TnI levels were associated with higher mortality rates at 28 days (58.3% vs. 19.4%), 90 days (69.9% vs. 35.0%), one year (78.6% vs. 46.2%), and two years (82.5% vs. 55.6%) (p < 0.001 for all). Univariate logistic regression analysis revealed that high TnI levels were a strong independent predictor of mortality at all time points: 28 days (OR = 1.2, 95% CI: 1.108-1.3, p < 0.001), 90 days (OR = 1.207, 95% CI: 1.095-1.33, p = 0.001), one year (OR = 1.164, 95% CI: 1.059-1.28, p = 0.002), and two year (OR = 1.119, 95% CI: 1.026-1.22, p = 0.011). Multivariate analysis revealed that age, albumin level, APACHE II score, and requirements for dialysis and vasopressor use in the ICU were important predictors of mortality across all timeframes, but elevated TnI levels were not. Conclusions: Elevated TnI levels in critically ill non-cardiac patients are markers of disease severity. While elevated TnI levels were significant predictors of mortality in the univariate analysis, they lost significance in the multivariate model when adjusted for other factors. Patients with elevated TnI levels had higher mortality rates across all timeframes, from 28 days to two years.

6973 Prospective Multicenter Registry-Based Study on Thyroid Storm: The 2016 Guidelines for the Management from the Japan Thyroid Association and Japan Endocrine Society Are Useful

Abstract Disclosure: Y. Furukawa: None. K. Tanaka: None. O. Isozaki: None. A. Suzuki: None. T. Iburi: None. K. Tsuboi: None. M. Iguchi: None. N. Kanamoto: None. K. Minamitani: None. S. Wakino: None. T. Satoh: None. S. Teramukai: None. E. Kimura: None. Y. Miyake: None. T. Akamizu: None. Context: The mortality rate in thyroid storm (TS) has been reported to be higher than 10%. Even when patients survive, some have irreversible damages. In order to improve the prognosis of patients with TS, appropriate management as well as prompt and accurate diagnosis are needed. We created the diagnostic criteria in 2012 and established guidelines for the management of TS in 2016. Objective: We aimed to evaluate the effectiveness of the 2016 guidelines for the management of TS proposed by the Japan Thyroid Association and Japan Endocrine Society. Design: Prospective registry-based study through a secure web platform. Setting: Prospective multicenter registry. Patients and Measurements: Patients with new-onset TS were registered in the Research Electronic Data Capture (REDCap) from May 1, 2018 to April 30, 2022, over four years. On day 30 after admission, clinical information and prognosis of each patient were added to the platform. On day 180, the prognosis was described. The questionnaire consisted of 176 items totally. Results: This study included 110 patients with TS (93 definite and 17 suspected). The median of Acute Physiology and Chronic Health Evaluation (APACHE) II score was 13, higher than the score in the previous nationwide survey, 10 (p=0.001). Nonetheless, the mortality rate at day 30 was 5.5%, approximately half compared with 10.7% in the previous nationwide survey (p=0.13). Lower BMI, lower left ventricular ejection fraction (LVEF) and shock were positively associated with poor prognosis at day 30. The lack of fever ≥ 38°C was surprisingly associated to the outcome. Approximately 80% of doctors followed the guidelines. The mortality rate in patients with an APACHE II score ≥ 12 for whom the guidelines were not followed was significantly higher than the rate in patients for whom the guidelines were followed (50% vs. 4.7%) (p=0.01). Conclusions: Prognosis seemed better than in the previous nationwide survey, even though disease severity was higher. The mortality rate was lower when the guidelines were followed. Thus, the guidelines are useful for managing TS. Presentation: 6/2/2024

Circulating T-lymphocyte subsets as promising biomarkers for the identification of sepsis-induced acute kidney injury.

This retrospective study investigated whether disturbances in circulating T-lymphocyte subsets could predict the incidence of acute kidney injury (AKI) and in-hospital mortality in patients with sepsis. Clinical data from patients with sepsis admitted to the intensive care unit were reviewed. Logistic regression analyses were used to identify independent predictors of in-hospital mortality and the development of AKI. Of 81 patients with sepsis, 50 developed AKI. Both non-survivors and patients with septic AKI exhibited dramatically higher Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Non-survivors exhibited more organ damage, with significantly lower levels of peripheral T-lymphocyte subsets, including total circulating lymphocytes, and CD3+, CD3+CD4+, and CD3+CD8+ T-lymphocytes. Patients with septic AKI exhibited fewer total peripheral lymphocytes and fewer CD3+, CD3+CD4+, and CD3+CD8+ T-lymphocytes, with higher serum lactate levels and lower nadir platelet counts. Independent predictors of 30-day hospital mortality included maximum SOFA and APACHE II scores, occurrence of encephalopathy, and peripheral CD3+ and CD3+CD8+ T lymphocyte counts. Moreover, the maximum SOFA score and CD3+ and CD3+CD8+ T-lymphocyte counts demonstrated good predictive power for AKI in receiver operating characteristic curve (ROC) analyses, with an area under the ROC curve of 0.810 (95% confidence interval [CI] 0.712-0.908) for SOFA score, 0.849 (95% CI 0.764-0.934) for CD3+ T-lymphocytes, and 0.856 (95% CI 0.772-0.941) for CD3+CD8+ T-lymphocytes. Patients with sepsis-induced AKI experienced T lymphopenia and increased in-hospital mortality. Higher maximum SOFA scores and reduced peripheral CD3+ and CD3+CD8+ T-lymphocyte levels were associated with in-hospital mortality and the development of AKI in patients with sepsis.

Acute kidney injury developed in the intensive care unit: a population-based prospective cohort study in the Brazilian Amazon

The Brazilian Amazon is a vast area with limited health care resources. To assess the epidemiology of critically ill acute kidney injury (AKI) patients in this area, a prospective cohort study of 1029 adult patients of the three intensive care units (ICUs) of Rio Branco city, the capital of Acre state, were evaluated from February 2014 to February 2016. The incidence of AKI was 53.3%. Risk factors for AKI included higher age, nonsurgical patients, admission to the ICU from the ward, higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores at ICU admission, and positive fluid balance > 1500 ml/24 hours in the days before AKI development in the ICU, with aOR of 1.3 (95% CI 1.03–1.23), 1.47 (95% CI 1.07–2.03), 1.96 (95% CI 1.40–2.74), 1.05 (95% CI 1.03–1.08) for each unit increase, and 1.62 (95% CI 1.16–2.26), respectively. AKI was associated with higher ICU mortality (aOR 2.03, 95% CI 1.29–3.18). AKI mortality was independently associated with higher age, nonsurgical patients, sepsis at ICU admission, presence of shock or use of vasoactive drugs, mechanical ventilation and mean positive fluid balance in the ICU > 1500 ml/24 hours, both during ICU follow-up, with aOR 1.27 (95% CI 1.14–1.43) for each 10-year increase, 1.64 (95% CI 1.07–2.52), 2.35 (95% CI 1.14–4.83), 1.88 (95% CI 1.03–3.44), 6.73 (95% CI 4.08–11.09), 2.31 (95% CI 1.52–3.53), respectively. Adjusted hazard ratios for AKI mortality 30 and 31–180 days after ICU discharge were 3.13 (95% CI 1.84–5.31) and 1.69 (95% CI 0.99–2.90), respectively. AKI incidence was strikingly high among critically ill patients in the Brazilian Amazon. The AKI etiology, risk factors and outcomes were similar to those described in high-income countries, but mortality rates were higher.

Risk Factors Analysis and Prediction Model Establishment for Carbapenem-Resistant Enterobacteriaceae Colonization: A Retrospective Cohort Study.

The objective of this study was to identify the risk factors associated with Carbapenem-resistant Enterobacteriaceae (CRE) colonization in intensive care unit (ICU) patients and to develop a predictive risk model for CRE colonization. In this study, 121 ICU patients from Fujian Provincial Hospital were enrolled between January 2021 and July 2022. Based on bacterial culture results from rectal and throat swabs, patients were categorized into two groups: CRE-colonized (n = 18) and non-CRE-colonized (n = 103). To address class imbalance, Synthetic Minority Over-sampling Technique (SMOTE) was applied. Statistical analyses including T-tests, Chi-square tests, and Mann-Whitney U-tests were employed to compare differences between the groups. Feature selection was performed using Lasso regression and Random Forest algorithms. A Logistic regression model was then developed to predict CRE colonization risk, and the results were presented in a nomogram. After applying SMOTE, the dataset included 198 CRE-colonized patients and 180 non-CRE-colonized patients, ensuring balanced groups. The two groups were comparable in most clinical characteristics except for diabetes, previous emergency department admission, and abdominal infection. Eight independent risk factors for CRE colonization were identified through Random Forest, Lasso regression, and Logistic regression, including Acute Physiology and Chronic Health Evaluation (APACHE) II score > 16, length of hospital stay > 31 days, female gender, previous carbapenem antibiotic exposure, skin infection, multi-site infection, immunosuppressant exposure, and tracheal intubation. The risk prediction model for CRE colonization demonstrated high accuracy (87.83%), recall rate (89.9%), precision (85.6%), and an AUC value of 0.877. Patients were categorized into low-risk (0-90 points), medium-risk (91-160 points), and high-risk (161-381 points) groups, with corresponding CRE colonization rates of 1.82%, 7.14%, and 58.33%, respectively. This study identified independent risk factors for CRE colonization and developed a predictive model for assessing the risk of CRE colonization.

Sepsis-associated acute kidney injury in patients with chronic kidney disease: Patient characteristics, prevalence, timing, trajectory, treatment and associated outcomes.

The features and outcomes of sepsis-associated acute kidney injury (SA-AKI) may be affected by chronic kidney disease (CKD). Accordingly, we aimed to compare SA-AKI in patients with or without CKD. Retrospective cohort study in 12 intensive care units (ICU). We studied the prevalence, patient characteristics, timing, trajectory, treatment and outcomes of SA-AKI with and without CKD. Of 84 240 admissions, 7255 (8.6%) involved patients with CKD. SA-AKI was more common in patients with CKD (21% vs 14%; p < .001). CKD patients were older (70 vs. 60 years; p < .001), had a higher median Charlson co-morbidity index (5 vs. 3; p < .001) and acute physiology and chronic health evaluation (APACHE) III score (78 vs. 60; p < .001) and were more likely to receive renal replacement therapy (RRT) (25% vs. 17%; p < .001). They had less complete return to baseline function at ICU discharge (48% vs. 60%; p < .001), higher major adverse kidney events at day 30 (MAKE-30) (38% vs. 27%; p < .001), and higher hospital and 90-day mortality (21% vs. 13%; p < .001, and 27% vs. 16%; p < .001, respectively). After adjustment for patient characteristics and severity of illness, however, CKD was not an independent risk factor for increased 90-day mortality (OR 0.88; 95% CI 0.76-1.02; p = .08) or MAKE-30 (OR 0.98; 95% CI 0.80-1.09; p = .4). SA-AKI is more common in patients with CKD. Such patients are older, more co-morbid, have higher disease severity, receive different ICU therapies and have different trajectories of renal recovery and greater unadjusted mortality. However, after adjustment day-90 mortality and MAKE-30 risk were not increased by CKD.