Frequency Of ICU Admission Research Articles

Laboratory predictors of sickle cell disease severity: a cross-sectional study.

Sickle cell disease (SCD) is the most common monogenic disorder, although the diversity and heterogenicity of clinical presentations render estimations of disease severity unpredictable. This cross-sectional study aimed to determine if laboratory markers could serve as indicators of SCD severity. We enrolled 90 adult patients with SCD with a mean age of 32.33 ± 11.84 years from the eastern province of Saudi Arabia, where SCD is more common than in other regions. Our study revealed a positive significant association between the number of hospitalizations and emergency visits with white blood cells (WBC) (R = 0.241, R = 0.207), respectively. Similarly, positive significant associations were found between the number of hospitalizations and emergency visits with platelets (R = 0.393, R = 0.276), respectively. Conversely, negative significant relationships were found between the number of hospitalizations and emergency visits (ER) with hemoglobin (Hb) F (R = -0.268, R = -0.263), respectively. Additionally, significant negative relationships were found between Hb F (R = -0.223) and the frequency of ICU admission. Only the number of hospitalizations and emergency visits annually were significantly predicted with P values of 0.021 and 0.038, respectively. Moreover, an increase in WBC was found to significantly increase the chance of undergoing splenectomy by 23.02%. SCD is a multisystemic disease with heterogeneous clinical presentations and disease severity. Inflammatory markers are valuable tools for better risk stratification and could be translated into developing new therapeutic strategies and modifying the treatment paradigm.

Emergency laparotomy and perioperative COVID-19: a single-center retrospective cohort study.

Concerning the perioperative outcomes of patients diagnosed with COVID-19 who underwent emergency laparotomy, more data must be collected. Because COVID-19 can affect multiple organs, cause various complications, and act as a risk factor for surgery, in this study, we aimed to compare the outcomes of emergency laparotomy between SARS-CoV-2 infected and uninfected patients. This retrospective cohort study was conducted on patients who underwent emergency laparotomy from December 2021 to December 2022. Postoperative outcomes were compared between patients with and without confirmed perioperative SARS-CoV-2 infection. The primary outcome was 30-day mortality. Secondary outcomes were postoperative intensive care unit admission, hospital length of stay, re-operation, and postoperative complications. Data were analyzed by SPSS statistic version 27. In this study, 50 patients in the COVID-19 group and 91 patients in the non-COVID-19 group were assessed. The 30-day mortality in the COVID-19 group was significantly higher than in the non-COVID-19 group (34% vs. 12.1%, respectively, P = 0.004). Postoperative complications were significantly higher in the COVID-19 group (64% vs. 26.4%, P < 0.001). The frequency of ICU admission and need for re-operation were significantly higher in the COVID-19 group (P = 0.003 and P = 0.039, respectively). Length of hospital stay was significantly lower in the non-COVID-19 group (P = 0.021). In patients with confirmed COVID-19, emergency laparotomy is associated with increased postoperative morbidity and mortality. Additionally, emergency laparotomy is associated with increasing postoperative complications, length of hospital stay, intensive care admission, and additional surgery requirement.

Elevated interleukin (IL)-6 as a predictor of disease severity among Covid-19 patients: a prospective cohort study

Backgroundaccompanied to the spreading of coronavirus disease 2019 (Covid-19) in the world, identifying factors related to the severity of the disease is one of the interests of physician and medical researchers. We hypothesized that interleukin 6 serum level is associated with severe outcome.MethodsIn this longitudinal prospective cohort study we enrolled 208 confirmed COVID-19 patients who were admitted to the Tohid Hospital (Sanandaj, Iran). Patients were classified into two groups based on IL-6 value in the first day of admission, elevated (n = 107) or not elevated/normal (n = 101), and followed until the occurrence of final outcome (death or discharge from the hospital). Data were analyzed using univariate methods, Chi-squared and independent two sample T test. The relationship between the independent variables and our interesting outcomes were investigated by multiple linear and penalized logistic regression modeling.ResultsA total of 208 patients, 51% female and mean age 53.6 ± 16.3 years, including 107 elevated and 101 non-elevated IL-6 patients, were followed. No significant difference was observed between the two groups in demographic and clinical characteristics. Although not significant, logistic regression results showed that the chance of death occurrence among patients with elevated IL-6 are 3.91 times higher. According to the multiple linear regression modeling, elevated IL-6 significantly increased the duration of hospital stay (P = 0.02). Frequency of ICU admission (P = 0.04) and mean of ICU stay (P = 0.8) are also higher in elevated IL-6 group.ConclusionThis study revealed that elevated IL-6 is significantly related to prolongation of hospital stay in Covid-19 patients. Although not significant, the occurrence of death among patients who had increased IL-6 in the time of admission was higher than patients with normal or lower serum levels of IL-6.

Comparison of Mortality between Health Workers and General Population Infected with Covid-19

Objective: The main purpose of this study is to compare the mortality between health workers and general population infected with coronavirus disease. Study Design: Comparative/Retrospective study Place and Duration: Study was conducted at Medicine and Gastroenterology department of Ayub Teaching Hospital, Abbottabad for duration of six months from 1st January 2021 to ¬¬¬¬¬¬30th June 2021. Methods: In this study 250 patients of both genders with coronavirus infection were presented. Age of the patients was between 18-70 years. Informed written consent was taken from all the cases for baseline details including age, sex, body mass index, socio-economic status and residency. Included patients were both symptomatic and asymptomatic to disease. Among 250 cases 125 patients were in the general population included in group I while other 125 cases were health workers included in group II. Patients were admitted to the hospital and examined for recovery. Outcomes among both groups were assessed and compared in terms of ICU admission, ventilation requirement and rate of mortality. We used the SPSS 25.0 version to analyze complete data. Results: In group I, 65 (52%) patients were males and 60 (48%) cases were females with mean age 47.66±8.87 years and in group II, 70 (56%) were males and 55 (45%) females with mean age 27.66±8.87. Mean BMI in group I was 25.11±8.33 kg/m2 and in group II, body mass index was 22.32±7.54 kg/m2. Majority of the patients i.e 73 (58.4%) in group I had poor socio economic status but in group II 50 (40%) cases had poor economic status. Majority of the cases among both groups were from urban areas 75 (60%) and 85 (64%). 48 (38.4%) were symptomatic in group I and 53 (42.4%) were in group II. Hypertension, diabetes mellitus and heart disease were the most common comorbidities. Frequency of ICU admission, ventilation requirement and mortality was significantly higher in general population 19 (15.2%), 24 (19.2%), 14 (11.2%) as compared to health workers 6 (4.8%), 7 (5.6%) and 5 (4%) with p value &lt; 0.05. Conclusion: We concluded in this study that the severity of pandemic disease among general population was higher because of less use of preventive measures as compared to health workers and frequency of deaths, ICU admission and use of invasive ventilation in general population were also very high. Keywords: Mortality, ICU, Ventilation, General Population, Health workers, Coronavirus

Healthcare Use during the Last Six Months of Life in Patients with Advanced Breast Cancer.

Simple SummaryIn the last decades, new treatment options for advanced (breast) cancer have resulted in increased use of health care resources near the end of life. We assessed health care use near the end of life of patients with advanced breast cancer (ABC). In this study, we have shown that ICU admission, and CPR occurred rarely during the last six months of life of ABC patients. However, hospital admissions occurred often, especially in patients who received new chemotherapy within 30 days of end of life. Those patients were also more likely to die in the hospital. However, death was most often due to disease progression. To improve quality of life near the end of life of advanced breast cancer patients, it is vital to develop tools to help clinicians identify those patients who will benefit from chemotherapy at the end of life.New treatment options in cancer have resulted in increased use of health care resources near the end of life. We assessed health care use near the end of life of patients with advanced breast cancer (ABC). From the Southeast Netherlands Breast cancer (SONABRE) registry, we selected all deceased patients diagnosed with ABC in Maastricht University Medical Center between January 2007 and October 2017. Frequency of health care use in the last six months of life was described and predictors for health care use were assessed. Of 203 patients, 76% were admitted during the last six months, 6% to the intensive care unit (ICU) and 2% underwent cardiopulmonary resuscitation (CPR). Death in hospital occurred in 25%. Nine percent of patients received a new line of chemotherapy ≤30 days before death, which was associated with age <65 years and <1 year survival since diagnosis of metastases. In these patients, the hospital admission rate was 95%, of which 79% died in the hospital, mostly due to progressive disease (80%). In conclusion, the frequency of ICU-admission, CPR or a new line of chemotherapy ≤30 days before death was low. Most patients receiving a new line of chemotherapy ≤30 days before death, died in the hospital.

Intensive care admissions and outcomes associated with short-term exposure to ambient air pollution: a time series analysis.

Short-term exposure to outdoor air pollution has been positively associated with numerous measures of acute morbidity and mortality, most consistently as excess cardiorespiratory disease associated with fine particulate matter (PM2.5), particularly in vulnerable populations. It is unknown if the critically ill, a vulnerable population with high levels of cardiorespiratory disease, is affected by air pollution. We performed a time series analysis of emergency cardiorespiratory, stroke and sepsis intensive care (ICU) admissions for the years 2008-2016, using data from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS-APD). Case-crossover analysis was conducted to assess the relationship between air pollution and the frequency and severity of ICU admissions having adjusted for temperature, humidity, public holidays and influenza activity. 46,965 episodes in 87 separate ICUs were analysed. We found no statistically significant associations with admission counts. However, ICU admissions ending in death within 30days were significantly positively associated with short-term exposure to PM2.5 [RR 1.18, 95% confidence interval (CI) 1.02-1.37, per 10µg/m3 increase]. This association was more pronounced in those aged 65 and over (RR 1.33, 95% CI 1.11-1.58, per 10µg/m3). Increased ICU mortality was associated with higher levels of PM2.5. Larger studies are required to determine if the frequency of ICU admissions is positively associated with short-term exposure to air pollution.

Classify the Acute Drug Intoxication Patients with Poisoning Severity Score(PSS) and Calculate the Optimal Cutoff Value of PSS, PSSsum to Predict Poor Prognosis

Purpose: This study examined the Poisoning Severity Score (PSS) from acute poisoning patients, to determine the relationships among the PSS, PSSsum, the primary outcome (prolonged stay at the ER over 24 hours, general ward and ICU admission and the application of intubation and mechanical ventilator, and the administration of inotropes). Methods: A retrospective study was conducted through the EMR for 15 months. The PSS grade was classified according to the evidence of symptoms and signs. The differences in the primary outcomes between the PSS of when a single organ was damaged, and the PSS, PSSsum combined with the grade of when multiple organs were damaged, were studied. The cutoff value was calculated using the receiving operating characteristics (ROC) curve. Results: Of the 284 patients; 85 (29.9%) were men with a mean age of 48.8 years, and their average arrival time to the ER was $4.4{pm}6.7;hours$. The most frequently used drug was hypnotics. The number of patients with PSS grade 0, 1, 2, 3, and 4 was 17, 129, 122, 24, and one, respectively. No ICU admissions, application of intubation and mechanical ventilators, administration of inotropes were observed among the patients with PSS grades 0 and 1 but only on patients with PSS grades 2 to 4. At PSS, when separating the patients according to the number of damaged organs, 17 had no symptoms, 133 had one organ damaged, 75 had two organs damaged, 36 had three organs damaged, and 23 had four organs damaged. Significant differences were observed between increasing number of damaged organs and the primary outcome. Conclusion: Among the acute poisoning patients, the PSS was higher in severity when the grade was higher. The number of damaged organs and the primary outcome showed meaningful statistical differences. This study confirmed that when the patients' PSS&gt;2 and PSSsum&gt;5, the frequency of ICU admission was higher, and they were considered to be severe with an increased prescription risk of application of intubation and mechanical ventilator, and the administration of inotropes.

Fluoroquinolone prophylaxis in autologous hematopoietic stem cell transplant recipients.

Although fluoroquinolone prophylaxis is frequently utilized in autologous hematopoietic stem cell transplant (AHSCT) patients, its impact on morbidity and mortality is uncertain. This study investigates the role of quinolone prophylaxis after AHSCT in recent years. We conducted a retrospective review of 291 consecutive adult patients who underwent AHSCT for malignant disorders, between June 2013 and January 2015. Outcomes were compared between patients who received norfloxacin prophylaxis and those who did not. The endpoints were mortality during prophylaxis and at 100days after transplant, frequency of ICU admissions, and incidence and type of bacteremia. Of 291 patients, 252 patients received norfloxacin prophylaxis and 39 patients did not. The mortality during prophylaxis and at 100days as well as the median number of days of hospitalization following AHSCT did not differ between the two groups. No differences were noted in the frequency of ICU admission, incidence of septic shock, and duration of ICU stay. Patients who did not receive prophylaxis had a significantly higher rate of neutropenic fever (97%) than patients who received prophylaxis (77%) (p=0.005). The patients with prophylaxis demonstrated a significantly higher rate of gram-positive bacteremia as compared to those without prophylaxis (p=0.002). Frequency of Clostridium difficile infection was similar during and post-prophylaxis. More antibiotic use was noted among patients without prophylaxis [97%; median 9 (range, 5-24) days] compared to patients with prophylaxis [79%; median 7 (range, 3-36) days, p=0.04]. Although fluoroquinolone prophylaxis reduced the incidence of neutropenic fever and antibiotic use in AHSCT, it did not alter mortality or morbidity.

29: Does a postpartum hemorrhage patient safety program result in sustained changes in management and outcomes?

29: Does a postpartum hemorrhage patient safety program result in sustained changes in management and outcomes?

Clinical and Economic Comparison of Laparoscopic to Open Liver Resections Using a 2-to-1 Matched Pair Analysis: An Institutional Experience

Surgical resection of hepatic lesions is associated with intraoperative and postoperative morbidity and mortality. Our center has introduced a laparoscopic liver resection (LLR) program over the past 3 years. Our objective is to describe the initial clinical experience with LLR, including a detailed cost analysis. We evaluated all LLRs from 2006 to 2010. Each was matched to 2 open cases for number of segments removed, patient age, and background liver histology. Model for End-Stage Liver Disease (MELD) and the Charlson comorbidity index were calculated retrospectively. Nonparametric statistical analysis was used to compare surgical and economic outcomes. Analyses were performed including and excluding converted cases. Fifty-seven patients underwent attempted LLR. Demographic characteristics were similar between groups. Estimated blood loss was lower in the LLR vs the open liver resection (OLR) group, at 250 mL and 500 mL, respectively (p < 0.001). Median operating room times were 240 minutes and 270 minutes in the LLR and OLR groups, respectively (p = 0.14). Eight cases were converted to open (14%): 2 for bleeding, 2 for anatomic uncertainty, 1 for tumor size, 1 for margins, 1 for inability to localize the tumor, and 1 for adhesions. Median length of stay was lower for LLR at 5 days vs 6 days for OLR (p < 0.001). There was no difference in frequency of ICU admission, reoperation, 30-day emergency room visit, or 30-day readmission rates. Median overall cost for LLR was lower at $11,376 vs $12,523 for OLR (p = 0.077). Our experience suggests that LLR confers the clinical advantages of reduced operating room time, estimated blood loss, and length of stay while decreasing overall cost. LLR, therefore, appears to be a clinically and fiscally advantageous approach in properly selected patients.

Clinical Predictors of Severe Complicated Clostridium Difficile Infection

Purpose:Clostridium Difficile infection (CDI) can be severe, and associated with complications and mortality. Treatment recommendations are stratified based on severity. However, there are no robust models to predict severe complicated CDI. The objective of this study was to create a clinically useful model to predict severe complicated CDI. Methods: The microbiology laboratory database and patient medical records were queried to identify cases of CDI from June 1, 2007 - May 31, 2010. Severe complicated CDI was defined as need for ICU admission or colectomy, or death within 30 days of CDI diagnosis. Variables including patient demographics, Charlson Co-morbidity index, temperature, peripheral leukocyte count, serum albumin, and change in serum creatinine were obtained. Univariate and multiple variable logistic regression models were used to assess the association of these variables with complications of CDI. Only patients who had data for each variable of interest were included in the multiple variable analyses. Results: The cohort included 1400 patients with CDI (50% female, median age at CDI diagnosis was 63.1 years [range 1.2-100.1]), and 357 (25.5%) were severe complicated CDI cases. The frequency of ICU admission, colectomy, and death within 30 days of diagnosis was 19.3%, 2.3%, and 7.3%, respectively. In univariate analysis, increasing age (OR 1.15, 95% CI 1.08-1.23, p<0.0001), increasing peripheral leukocyte count (OR 1.05, 95% CI 1.03-1.06, p<0.0001), change in serum creatinine >1.5 fold (OR 2.61, 95% CI 2.04-3.34, p<0.0001), serum albumin (OR 0.48, 95% CI 0.35-0.66, p<0.0001), temperature (OR 1.36, 95% CI 1.35-1.59, p=0.0002), and Charlson Co-morbidity index (OR 1.09, 95% CI 1.03-1.15, p=0.001) were associated with severe complicated CDI. Serum albumin and temperature were not included in the multiple variable model due to missing data. In the multiple variable model (adjusting for referral distance), increasing age (OR 1.1, 95% CI 1.03-1.18, p=0.0072), increasing peripheral leukocyte count (OR 1.04, 95% CI 1.03-1.05, p<0.0001) and change in serum creatinine greater than 1.5-fold (OR 2.3, 95% CI 1.75-2.98, p<0.0001) were independent predictors of severe complicated CDI, but Charlson Comorbidity index score was not. Conclusion: Older age, higher peripheral leukocyte count, and rising serum creatinine independently predicted severe complicated CDI. Temperature and low serum albumin were also associated with severe complicated CDI by univariate analysis. An appreciation of these variables could be pivotal in identifying patients at increased risk of CDI complications. It is conceivable that early aggressive monitoring and intervention in these patients could have beneficial effects.

Emergency Traumatologists as Partners in Trauma Care: The Future Is Now

Decreasing manpower available to care for trauma patients both in and out of the ICU has led to a number of proposed solutions, including increasing involvement of emergency medicine-trained physicians in the care of these patients. We performed a descriptive comparative study in an effort to define the role of fellowship-trained emergency medicine physicians as full-time traumatologists. We performed a retrospective review of concurrent and prospectively collected data comparing process of care and outcomes for the resuscitative phase of trauma patients cared for by full-time fellowship-trained trauma surgeons (TS), a fellowship-trained emergency medicine physician (ET), and a first-year fellowship-trained trauma surgeon (TS1). Patient age, Revised Trauma Score, and Injury Severity Score were similar between groups. Process of care, defined by transfusion of uncrossmatched blood, prevalence of hypotension in patients receiving uncrossmatched blood, time spent in the emergency department, frequency of ICU admission, severity of injury for ICU admission, and time between emergency department and operating room for patients requiring surgery, was equivalent between groups. Outcomes evaluated by mortality and length of stay in the hospital and ICU did not differ between groups, and provider group was not predictive of mortality in stepwise logistic regression. These data suggest that emergency traumatologists can provide trauma care effectively within a defined scope of practice and may provide an effective solution to manpower issues confronting trauma centers.