High APACHE Score Research Articles

Predictors of Treatment Failure and Mortality among Patients with Septic Shock Treated with Meropenem in the Intensive Care Unit.

The aim of the study was to determine the predictors of meropenem treatment failure and mortality in the Intensive Care Unit (ICU). This was a retrospective study, involving sepsis and septic shock patients who were admitted to the ICU and received intravenous meropenem. Treatment failure is defined as evidence of non-resolved fever, non-reduced total white cell (TWC), non-reduced C-reactive protein (CRP), subsequent culture negative and death in ICU. An Acute Physiology and Chronic Health Evaluation II (APACHE II) and duration of antibiotic treatment less than 5 days were associated with treatment failure with adjusted OR = 1.24 (95% CI: 1.15, 1.33; P < 0.001), OR = 65.43 (95% CI: 21.70, 197.23; P < 0.001). A higher risk of mortality was observed with higher APACHE and Sequential Organ Failure Assessment (SOFA) scores, initiating antibiotics > 72 h of sepsis, duration of antibiotic treatment less than 5 days and meropenem with renal adjustment dose with an adjusted OR = 1.21 (95% CI: 1.12, 1.30; P < 0.001), adjusted OR = 1.23 (95% CI: 1.08, 1.41; P < 0.001), adjusted OR = 6.38 (95% CI: 1.67, 24.50; P = 0.007), adjusted OR = 0.03 (95% CI: 0.01, 0.14; P < 0.001), adjusted OR = 0.30 (95% CI: 0.14, 0.64; P = 0.002). A total of 50 (14.12%) patients had a treatment failure with meropenem with 120 (48.02%) ICU mortality. The predictors of meropenem failure are higher APACHE score and shorter duration of meropenem treatment. The high APACHE, high SOFA score, initiating antibiotics more than 72 h of sepsis, shorter duration of treatment and meropenem with renal adjustment dose were predictors of mortality.

Prognostic and risk factor analysis of cancer patients after unplanned ICU admission: a real-world multicenter study

To investigate the occurrence and 90-day mortality of cancer patients following unplanned admission to the intensive care unit (ICU), as well as to develop a risk prediction model for their 90-day prognosis. We prospectively analyzed data from cancer patients who were admitted to the ICU without prior planning within the past 7 days, specifically between May 12, 2021, and July 12, 2021. The patients were grouped based on their 90-day survival status, and the aim was to identify the risk factors influencing their survival status. A total of 1488 cases were included in the study, with an average age of 63.2 ± 12.4 years. The most common reason for ICU admission was sepsis (n = 940, 63.2%). During their ICU stay, 29.7% of patients required vasoactive drug support (n = 442), 39.8% needed invasive mechanical ventilation support (n = 592), and 82 patients (5.5%) received renal replacement therapy. We conducted a multivariate COX proportional hazards model analysis, which revealed that BMI and a history of hypertension were protective factors. On the other hand, antitumor treatment within the 3 months prior to admission, transfer from the emergency department, general ward, or external hospital, high APACHE score, diagnosis of shock and respiratory failure, receiving invasive ventilation, and experiencing acute kidney injury (AKI) were identified as risk factors for poor prognosis within 90 days after ICU admission. The average length of stay in the ICU was 4 days, while the hospital stay duration was 18 days. A total of 415 patients died within 90 days after ICU admission, resulting in a mortality rate of 27.9%. We selected 8 indicators to construct the predictive model, which demonstrated good discrimination and calibration. The prognosis of cancer patients who are unplanned transferred to the ICU is generally poor. Assessing the risk factors and developing a risk prediction model for these patients can play a significant role in evaluating their prognosis.

Predictors of Non-invasive Ventilation Failure and Associated Factors Among the COVID-19 Patients Admitted to Intensive Care Unit.

Non-invasive ventilation (NIV) is a method of oxygenation supply that eliminates the need for an endotracheal airway. Non-invasive ventilation failure is defined as the necessity for endotracheal intubation or death during the NIV trial. This study aimed to identify the predictors and associated factors of NIV failure in coronavirus disease 2019 (COVID-19) patients admitted to an intensive care unit (ICU). This retrospective, longitudinal cohort study utilized electronic medical records of COVID-19 patients admitted to the ICU. A total of 150 patients were included in the study. Patient demographics, medical history, laboratory tests, partial pressure of carbon dioxide (PCO2), oxygen saturation (SpO2), heart rate, acidosis, consciousness, oxygenation, and respiratory rate (HACOR score), and the ratio of oxygen saturation (ROX) index (the SpO2/fraction of inspired oxygen [FIO2] to respiratory rate [SF] ratio) were recorded. Non-invasive ventilation failure was determined based on the need for endotracheal intubation or cardiac-respiratory arrest while on NIV. Of 150 patients, 55.3% were male (mean age: 55.9 years), with an NIV failure rate of 67.3%, a mortality rate of 66.7%, and 3.3% of patients requiring tracheostomy after NIV failure. The ROX index consistently decreased over time, and an increase in the HACOR score and PCO2 after 6 hours of commencing NIV were the predictors of NIV failure. Additionally, higher levels of lactate dehydrogenase, lower SF ratios, and higher APACHE scores upon ICU admission were significantly associated with NIV failure. Notably, the erythrocyte sedimentation rate (ESR) as an inflammatory index, SF ratio upon ICU admission, HACOR score, ROX index, and PCO2 after 12 hours were significant predictors of in-hospital mortality in patients receiving NIV. The ROX index, HACOR scale, and PCO2 are significant predictors of both NIV failure and in-hospital mortality.

Abstract 19103: Prognostic Factor for Cardiac Dysfunction in Severe Patients With Heat Stroke

Introduction: Heat stroke is defined by failure of thermoregulation and central nervous abnormalities as a result of high core body temperature from exposure to high temperatures or hard exercise. The cardiovascular system is one of the most vital targets with heat stroke, and the early prediction for cardiovascular dysfunction is very important. Hypothesis: We aimed to investigate the prognostic value of numerous factors and scoring system for predicting cardiac function in emergency patients with heat stroke. Methods: We analyzed the data and clinical outcomes of the patients with heat stroke who were admitted from 2017 to 2021. Glasgow Coma Scale (GCS) was measured based on the patient's level of consciousness and responsiveness, and the APACHE (Acute Physiology and Chronic Health Evaluation) score was calculated by vital signs, GCS, and laboratory data on admission. Clinical variables including echocardiogram were compared according to the median, and receiver operating characteristic (ROC) curve for predicting critical outcomes such as death, ventilator, and dialysis were analyzed. Results: We enrolled 67 patients (60 ± 21year-old, 52 males). The median of APACHE score and GCS were 16.3 and 11, and the patients were classified into two groups (high and low) by median respectively. In the low GCS group, left ventricle ejection fraction (LVEF) was lower and the proportion with wall motion abnormalities was higher ( p =0.008; 0.020). Also, LVEF was lower in the high-APACHE score group ( p= 0.046). ROC curve analysis for predicting critical outcomes showed that GCS and APACHE score had the highest area under the curve value of 0.744 and 0.734 ( p =0.001; 0.001). Conclusions: Echocardiography should be recommended earlier for evaluating LV function in severe patients of heat stroke with lower GCS and higher APACHE score.

Predictors of Acute Kidney Injury in Critically Ill Patient at Intensive Cardiac Care Unit

Background: Acute kidney injury (AKI) occurs frequently in the intensive cardiac care unit and recognized as a heterogeneous syndrome with variable etiology and clinical presentation that affects acute morbidity and mortality. AKI needs to be identified early and underlying causes must be treated&#x0D; Aim: The aim of this study is to identify the risk factors of AKI in critically ill patients at ICCU Sardjito General Hospital.&#x0D; Method: We performed a retrospective analysis of patient registry from Sardjito Cardiovascular Intensive Care (SCIENCE) between January 2021 and December 2021. This registry provided demographic data, risk factors, comorbidities, laboratory findings and survival outcomes. The KDIGO criteria were used to define AKI characterized by an increase in serum creatinine more or equal to 0.3 mg/dL in 48 hours, or an increase in serum creatinine more or equal to 1.5 times than previous value, or urine volume less than 0.5 mL/kg BW/hour for 6 hours. Univariate and multivariate data analyses were carried out.&#x0D; Results: This study included 428 patients with an incidence of AKI was 14,3 %. Univariate analysis showed that AKI was related to diabetes, acute heart failure, sepsis, APACHE score, SAPS, Sardjito score, MCARS, hemoglobin, leukocyte, and plasma albumin concentration. Furthermore, we did multivariate analysis and showed the independent predictor of AKI at ICCU admission is acute heart failure (OR 3.90; 95% CI 1.95–7.77; p &lt;0.001), sepsis (OR 3.02; 95% CI 1.03-8.90; p 0.045) and high APACHE II score (OR 0.33; 95% CI 0.13-0.80; p 0.015).&#x0D; Conclusions: Acute heart failure, sepsis and high APACHE score at admission is independent predictors of AKI among critically ill in ICCU Sardjito General Hospital. The results of this study may contribute to the implementation of targeted therapies.&#x0D;

The role of nutritional risk evaluation in predicting adverse outcomes among patients with severe COVID-19 in Vietnam.

As sufficient nutrition helps alleviate catabolic stress and modulate the systemic inflammatory response of the body, it plays an indispensable role in the good prognosis of critically ill patients. Thus, this study aimed to investigate the malnutrition of patients with severe COVID-19 and its association with adverse treatment outcomes. We conducted a retrospective cross-sectional study in two provincial hospitals in Hanoi from February to April 2022. Participants were patients with severe COVID-19 admitted to the Intensive Care Unit (ICU). Malnutrition risk were evaluated by Nutritional Risk Screening-2002 (NRS), Global Leadership Initiative on Malnutrition (GLIM), Prognostic Nutritional Index (PNI), and the adverse prognosis was assessed by Acute Physiology and Chronic Health Evaluation II (APACHE II). The multivariate receiver-operating characteristic (ROC) curve was applied to estimate the predictive ability of those criteria regarding worse treatment results. The percentages of malnutrition measured by NRS, GLIM, PNI, and BMI were 62.6, 51.5, 42.9, and 16.6%, respectively. Patients with more severe malnutrition assessed by GLIM, PNI, and having above target fasting blood glucose (FBG) (≥10.0 mmol/L) were more likely to have higher APACHE scores. PNI had a better diagnostic performance than NRS and BMI (AUC = 0.84, 0.81, and 0.82, respectively). In addition, FBG revealed a good prognostic implication (AUC = 0.84). A relatively high percentage of patients experienced moderate and severe malnutrition regardless of screening tools. Individuals at higher risk of malnutrition and high FBG were predicted to have more adverse treatment outcomes. It is recommended that nutritional screening should be conducted regularly, and personalizing nutritional care strategies is necessary to meet patients' nutrient demands and prevent other nutrition-related complications.

Mean Platelet Volume as a Prognostic Marker in Sepsis in ICU

Abstract Background Sepsis is defined as a systemic inflammatory response to confirmed or suspected infection. It is a major cause of morbidity and mortality, and the incidence is rising, probably due to the growing elderly population, antibiotic resistance, immunosuppressive medication and, invasive surgery. Pneumonia is the most common infection leading to sepsis, followed by urinary tract infections and abdominal infections. These infections are usually localized and controlled by the immune system, but they can sometimes spread and cause sepsis. Objective To correlate between the mean platelet volume in patients with sepsis with C-reactive protein as a prognostic markers. Patients and Methods This is a prospective study conducted on 80 adult critically ill patients of both sexes with sepsis and sever sepsis who admitted to the units of Critical Care Medicine Ain Shams University Hospitals. The samples were collected during the period from 1st October 2019 to 31st March 2020, MPV results were correlated to CRP, SOFA score and APACHE score. Results The results of the present study revealed: 55.8 % were male and 44.2 % were females. Sex did not affect mortality, no statistical significance found. In this study, MPV was a significant parameter in septic patients. The cut off value for MPV was 10.5 fl which was found to be significant and of a magnitude considered to be clinically useful, with sensitivity 57.1%, specificity 80.8%, p value (0.003) and accuracy 72.5% in predicting mortality. A correlation was found between high MPV, CRP, SOFA and APACHE scores. Therefore, MPV may be used as an auxiliary test in the prognosis of sepsis. Conclusion Initial values of MPV were significantly correlated with CRP, APACHE and SOFA scores and with the estimated rate of mortality.

The Incidence of Acute Kidney Injury (AKI) in Critically Ill COVID-19 Patients: A Single-Center Retrospective Cohort Study at a Tertiary Level Hospital in Oman.

Acute kidney injury (AKI) is associated with adverse outcomes in critically ill patients. Coronavirus disease 2019 (COVID-19) affects the renal system frequently and leads to AKI. This study aims to determine the incidence of AKI, risk factors including hyperglycemia, and the requirement for renal dialysis. A retrospectively observational study was done at Sultan Qaboos University Hospital between March 2020 and September 2021. A total of 286 adult patients with laboratory-confirmed COVID-19 infection admitted to the intensive care unit (ICU) were included in the study. The patient's medical records were reviewed. Patients' baseline demographic characteristics, APACHE score on admission, clinical data including length of stay, oxygenation parameters, ventilator days, shock, AKI (KIDIGO guideline), dialysis, medications, lab on admission as well as during the ICU stay, and the outcome (mortality) were recorded in detail. Follow-up was done till discharge from ICU. The study population included 68.5% (196/286) males. The median age was 56 years (interquartile range, IQR: 43-66.25). The incidence of AKI was 55.2% (158/286) overall. Out of those who had AKI, 27.2% (43/158), 31.6% (50/158), and 41.1% (65/158) developed AKI stages 1, 2, and 3, respectively. Univariate analysis for the development of AKI showed the following significant variables: age (p=0.005; odds ratio, OR 1.024; 95% confidence interval, CI 1.007-1.041), creatinine level on admission (p=0.012; OR 1.005; 95%CI 1.001-1.008), APACHE score on admission (p<0.001; OR 1.049; 95%CI 1.021-1.077), P/F ratio (p<0.001; OR 0.991; 95%CI 0.987-0.995), nephrotoxic agent (p<0.001; OR 8.556; 95%CI 4.733-15.467), shock (p<0.001; OR 8.690; 95%CI 5.087-14.843), days on the ventilator (p<0.001; OR 1.085; 95%CI 1.043-1.129), and length of stay in ICU (p<0.001; OR 1.082; 95%CI 1.047-1.119). The multivariate analysis confirmed only shock (p=0.004; OR 5.893; 95%CI 1.766-19.664). A total of 41.7% (66/158) of patients received dialysis. Hyperglycemia was not associated with the development of AKI. For patients with AKI, those having high APACHE score (p<0.001), shock (p=0.56; OR 2.326; 95%CI 1.036-5.223), ischemic heart disease (IHD) (p=0.002; OR 9.000; 95%CI 1.923-42.130), and hypertension (p=0.023; OR 2.145; 95%CI 11.125-4.090) were significantly associated with the requirement of dialysis. The mortality was found to be 59.1% (169/286) overall whereas it was 83.5% (132/158) for AKI versus 28.9% (37/158) for non-AKI cases. A high incidence of AKI for critically ill COVID-19 cases was foundin this study. The shock was the only significant predictor for the development of AKI. AKI is associated with high mortality in these patients.

Post-intensive care syndrome in out-of-hospital cardiac arrest patients: A prospective observational cohort study.

IntroductionIntensive care unit patients are at risk for post-intensive care syndrome (PICS), which includes psychological, physical and/or cognitive sequelae after their hospital stay. Our aim was to investigate PICS in adult patients with out-of-hospital cardiac arrest (OHCA).MethodsIn this prospective observational cohort study, we assessed risks for PICS at 3 and 12-month follow-up within the following domains: a) physical impairment (EuroQol [EQ-5D-3L]), b) cognitive functioning (Cerebral Performance Category [CPC] score >1, modified Rankin Scale [mRS] >2) and c) psychological burden (Hospital Anxiety and Depression Scale [HADS], Impact of Event Scale-Revised [IES-R]).ResultsAt 3 months, 69/139 patients (50%) met the definition of PICS including 37% in the physical domain, 25% in the cognitive domain and 13% in the psychological domain. Intubation (OR 2.3, 95%CI 1.1 to 5,0 p = 0.03), sedatives (OR 3.4, 95%CI 1 to 11, p = 0.045), mRS at discharge (OR 4.3, 95%CI 1.70 to 11.01, p = 0.002), CPC at discharge (OR 3.3, 95%CI 1.4 to 7.6, p = 0.005) and post-discharge work loss (OR 13.4, 95%CI 1.7 to 107.5, p = 0.014) were significantly associated with PICS. At 12 months, 52/110 (47%) patients had PICS, which was associated with prolonged duration of rehabilitation, higher APACHE scores, and higher mRS and CPC scores at hospital discharge.ConclusionsNearly half of long-term OHCA survivors show PICS after 3 and 12 months. These high numbers call for more emphasis on appropriate screening and treatment in this patient population. Future studies should evaluate whether early identification of these patients enables preventive strategies and treatment options.

Can PCO2 be a mortality predictor in COVID-19 patients?

Aim: The clinical course of Corona Virus Disease 2019 (COVID-19) infection is ranging from asymptomatic to moderate and severe disease with low survival rates. Therefore, reliable prediction of COVID-19 mortality and identification of contributing factors would allow targeted therapies for high-risk individuals. We aimed to determine whether partial carbon dioxide (PCO2) concentrations could predict mortality in patients treated in the intensive care unit (ICU).&#x0D; Material and Method: Acute Physiology and Chronic Health Evaluation (APACHE -2) scores, ferritin, lymphocyte count, neutrophil lymphocyte ratio (NLR), PCO2, partial oxygen concentration to inspired oxygen fraction (P/F) ratio were retrospectively determined and were compared between survivors and non-survivors. &#x0D; Results: The mean APACHE-2 value was higher in Group Non-survivors than in Group Survivors. Patients in Group Non-survivors were significantly older than those in Group Survivors (p=0,012). From day 7, low baseline lymphocyte counts were significant for mortality (p=0,046). NLR was also high at ICU admission, and it was significant for mortality from the 7th day (p=0.022). From day 10, PCO2 and ferritin levels increased in Group Non-survivors. The P/F ratio increased with treatment in both groups during the first 10 days, and after day 13, the increase continued in Group Survivors, whereas the values decreased in Group Non-survivors. We found that PCO2 concentrations in patients at ICU admission were as expected and that the increase in PCO2 could predict mortality along with increased ferritin levels, older age, high APACHE scores, low lymphocyte count, elevated NLR and high P/F ratio. &#x0D; Conclusion: This study showed that in patients with COVID -19, an increase in PCO2 concentration can predict mortality along with increased ferritin levels, older age, high APACHE scores, low lymphocyte count, elevated NLR and high P/F ratio.

Effect Of Exogenous Melatonin on the Incidence of Delirium and Its Association with Severity of Illness in Postoperative Surgical ICU Patients

Background: Delirium is common in critically ill intensive care unit (ICU) patients and has been documented in up to 87 percent of patients. Sleep deprivation and delirium have been associated. Alteration of melatonin production has been associated with delirium. Melatonin acts via melatonin receptors present in the suprachiasmatic nuclei (SCN) and promotes sleep by attenuating the wake-promoting signal from the SCN. Objective: To determine the relationship between exogenous melatonin and the incidence of delirium and its association of with severity of illness, measured in term of APACHE II, procalcitonin level at the time of admission and daily SOFA score. Patients and Methods: Design: Randomised placebo-control study. Setting: the study was conducted in critical care setting in a tertiary level ICU. Participants: Postoperative patients age between 20-60 years who are going to be ventilated more than 48 hours without any contraindication to enteral medications. Interventions: Study group received melatonin 5 mg through the enteral route. Main outcome measures: To determine the effect of exogenous melatonin on the incidence of delirium in postoperative patients who require mechanical ventilation for more than 24 hours. The secondary outcome measures are procalcitonin (PCT) value at admission and disease severity scores like APACHE II and SOFA. Results: No statistically significant difference was found in admission incidence of delirium or procalcitonin. Age was higher in those patients that developed delirium (p &lt; 0.05). Conclusions: Although the incidence of delirium is not affected by exogenous melatonin or higher APACHE scores, it had a significant correlation with higher procalcitonin, that in turn indicated an association with delirium and sepsis. It was found that there is increased risk of developing delirium with increasing age.

Incidence, prevalence and prognostic implications of right-sided heart failure in acute respiratory distress syndrome: A prospective observational study

: Acute respiratory distress syndrome is a heterogeneous disease which involves both the alveoli and pulmonary vessels. Acute cor pulmonale was initially considered as a marker of severity but its impact on outcome is still controversial. : This was a prospective observational study conducted over a period of nine months in ICU of a tertiary care center in India. Out of 2028 patient admitted in ICU 64 patients with ARDS (Berlins definition) underwent transthoracic echocardiography within 3 days of admission after diagnosis.: Acute cor pulmonale(ACP) was detected in 23 (36%) patients. Patients with ACP have greater the severity of disease and higher APACHE score as compared to those without ACP.Ph, PCO and P/F ratio appears to be the independent risk factor in patients for ACP in ARDS.Patients with ACP in ARDS had a higher incidence of shock and mortality(43.5%). ACP is quite common in ARDS. Due to its effect on the outcome, it appears to be a major factor in deciding ventilatory strategy in patients with ARDS. Right ventricle protective approach of ventilation keeps lung and heart connected.

Effect of presence of severe thrombocytopenia on prognosis of hepatic patients in intensive care unit

Abstract Background Thrombocytopenia is defined as a platelet count below 150,000/μL.It is the most common hematological complication in patients with chronic liver disease (CLD).The prevalence of thrombocytopenia in chronic liver diseases ranges from 6 % among non-cirrhotic patients with chronic liver disease to 70 % among patients with liver cirrhosis. Objective To investigate the association between thrombocytopenia and the risk of higher mortality incidence in hepatic patients in intensive care unit. Patients and Methods The present prospective cohort study was conducted at Ain Shams University hospitals Intensive care units, from October 2019 to August 2020. After obtaining approval of the study protocol from the local ethical committee, as well as fully informed consents signed by the patient closet relative, 130 hepatic patients admitted at ICU with hepatic coma and patients classified according to platelet count on admission into two equal groups. Group A: included 65 Patients with thrombocytopenia on admission (&amp;lt;100,000/μL). Group B: included 65 Patients with normal platelet count on admission with persistently normal platelet count (≥100,000/μL). Results Our study revealed that patients with lower platelet counts had significantly higher risk of death and ICU stay. In our study we showed that there are two independent risk factors affecting the outcome of hepatic patients in the ICU they were thrombocytopenia and high APACHE score. These observations highlight the potential importance of low platelets count in identifying a group of hepatic patients who are at risk for poorer prognosis. Conclusion Thrombocytopenia is a frequent laboratory finding among hepatic patients, which is generally correlated to the severity of illness. Thrombocytopenia is generally associated with higher APACHE II score when compared to normal platelet count indicating that it is associated with higher degree of morbidity and expected higher mortality rate.

Targeted Temperature Management in Postcardiac Arrest Syndrome: A Single-Center Experience with 47 Patients

Our aim in this study is to retrospectively analyze the results of Targeted Temperature Management (TTM) treatment in our intensive care unit. Following the ethics committee's approval, the demographic data, cardiac arrest history, the follow-up process, and the final status of patients who were applied TTM in Sakarya University Training and Research Hospital Anesthesia Intensive Care Unit between January 2017 and December 2019 were recorded. Then, the effect of these parameters on mortality was evaluated using regression analysis. Data of 47 patients who met the study criteria were analyzed. The mean age of the patients was 50 ± 16 and 14 (29.8%) patients were female. The duration of cardiopulmonary resuscitation (CPR) was 22.35 ± 16.08 minutes, 35 (74.5%) patients had a witness to arrest, 25 (53.2%) patients were arrested in the hospital, and 13 (27.7%) patients had shockable rhythm. It was determined that 60% of the patients died, 20% of them were care patients with poor neurological outcomes and 20% of them were discharged outpatient with good neurological outcomes. Age, development of acute renal failure, requiring vasopressor, high APACHE scores, and length of hospital stay were found to be independent risk factors for mortality.

Patients With Idiopathic Pulmonary Fibrosis Admitted to the ICU With Acute Respiratory Failure-A Reevaluation of the Risk Factors and Outcomes.

Idiopathic pulmonary fibrosis (IPF) patients admitted to the ICU with acute respiratory failure (ARF) are known to have a poor prognosis. However, the majority of the studies published to date are older and had small sample sizes. Given the advances in ICU care since the publication of these studies, we sought to reevaluate the outcomes and risk factors associated with mortality in these patients. Retrospective study using a large multi-center ICU database. We identified 411 unique patients with IPF admitted with ARF between 2014-2015. Of all IPF patients admitted to the ICU with ARF, 81.3% required mechanical ventilation (MV): 48.9% invasive and 32.4% non-invasive alone. The hospital mortality rate was 34.5% for all patients; 48.8% in patients requiring invasive MV, 21.8% in those requiring non-invasive MV and 19.5% with no MV. In multiple regression analyses, age, APACHE score, invasive MV, and hyponatremia at admission were associated with increased mortality whereas post-op status was associated with lower mortality. In patients requiring invasive MV, baseline PaO2/FiO2 ratio was also predictive of mortality. Non-pulmonary organ failures were present in less than 20% of the patients. Although the overall mortality rate for IPF patients admitted to the ICU with ARF has improved, the mortality rates for patients requiring invasive MV remains high at approximately 50%. Older age, high APACHE score, and low baseline PaO2/FiO2 ratio are factors predictive of increased mortality in this population.

Incidence, Clinical Characteristics and Outcome of Acute Kidney Injury among Critically Ill patients in Zagazig University Hospitals

Background: There is marked variety in Acute Kidney Injury (AKI) incidence and clinical characteristics as regards independent developmental risk factors and independent risk factors that could affect the outcome especially in critical care setting. Objectives: The aim of the work was to identify incidence and the clinical features of AKI in critical care situation and its impression on outcomes. Patients and Methods: A prospective cohort study in which patients were screened for AKI during the period from October 2018 to September 2019 using the AKIN criteria. Results: Incidence of AKI in critical care setting was 20.3% (63/310). The most independent risk factors for the development of AKI based on multivariate Logistic analysis were sepsis (p value: 0.000, estimated odds ratio: 4.492 and confidence intervals between 2.037 and 9.906) and chronic kidney disease (CKD) (p<0.001, estimated odds ratio: 8,982 and confidence intervals between 3,852 and 20,945). The most independent risk factor for poor AKI outcome was the need for renal replacement therapy (RRT) based on a multivariate logistic analysis (p<0.001, estimated odds Ratio: 3.649 and confidence interval between 1.145 and 4.050). Late nephrologist consultation comes in second place (p=0.002, estimated odds ratio: 4.902 and confidence interval between.463 and 9.316). Mortality in AKI group was 31% (3 patients in stage 2 and 17 patients in stage 3) compared to 42/247 (17%) in patients without AKI. Conclusion: The incidence of AKI in Zagazig University Internal Medicine ICU was 20.3 %. Sepsis was the most independent risk factor for the occurrence of AKI in ICU. The most independent risk factors for poor outcome following AKI development were the need for RRT, Late nephrologist consultation, longer duration of AKI and a high APACHE score.

CORRELATION OF RADIOGRAPHIC ASSESSMENT OF THE QUANTITY OF LUNG EDEMA (RALE) SCORES AND ARDS SEVERITY

SESSION TITLE: ARDS: Fine-tuning Details in Management SESSION TYPE: Original Investigations PRESENTED ON: 10/21/2019 1:30 PM - 2:30 PM PURPOSE: Our primary outcome was to determine if a correlation exists between RALE scores and ARDS severity as measured by the time to decreased FiO2 requirement less than 0.4. We also evaluated if RALE scores were correlated with brain natriuretic peptide (BNP), Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) score, and in-hospital mortality. METHODS: We performed a retrospective chart review of all admissions to a 16-bed medical intensive care unit (MICU) in an urban community-academic hospital from May 2016 to January 2018. We identified 47 patients intubated for acute hypoxic respiratory failure, and who met ARDS criteria based on chest x-ray findings and pulse oximetric saturation Spo2/Fio2 (SF) ratio. Data collected for these patients included: Ventilator settings, BNP, APACHE score, time to decreased FiO2 RESULTS: 36/47 (76.5%) of the patients had a high RALE score (>23). In pts with RALE score >23, the average time to decrease FiO2 23 patients had a high apache score (>23) and 13/32 (40%) had a high BNP (>583). The death rate in patients with higher RALE Score was 17/36 (47%); of these 7/17 (41%) were associated to an elevated BNP and 6/17 (35%) had a higher APACHE. Only 3/17 (17.6%) deaths had both elevated BNP and APACHE score. Contrarily, 11/47 (23.5%) of our ARDS patients had a low RALE score (23) and 1/6 (16.7%) had a high BNP (>583). The death rate in patients with lower RALE Score was 6/11 (54.5%); of these 1/6 (16.7%) were associated to an elevated BNP and 6/6 (100%) had a higher APACHE. Only 1/6 (16.7) deaths had both elevated BNP and APACHE score. CONCLUSIONS: Higher RALE scores did not correlate with worse clinical outcomes in our patient population compared to those with a lower RALE score. Lower RALE scores seem to correlate with worse characteristics and clinical outcomes including higher BNP, APACHE and death rates. These finding suggest that RALE score alone does not determine ARDS severity. Given our ARDS population also had elevated BNPs it would be worthwhile extending the study to include the role of diuresis in these patients. CLINICAL IMPLICATIONS: Though effective in creating an objective measure for ARDS severity, the RALE score alone doesn’t correlate with acuity of patients with ARDS and their clinical outcomes. A larger patient population would be needed to further analyze the relation between RALE scores and other patient characteristics that increase ARDS severity. DISCLOSURES: No relevant relationships by John Kileci, source=Web Response No relevant relationships by Young Im Lee, source=Web Response No relevant relationships by Natalie Marte, source=Web Response No relevant relationships by Martha Catalina Morales Alvarez, source=Web Response No relevant relationships by Risako Shirane, source=Web Response No relevant relationships by M. Faisal Siddiqi, source=Web Response

SUN-136 Know Your Patients: Our Experience with DKA in the Suburbs

Background: A variety of precipitating factors and clinical presentations have been identified for Diabetic Ketoacidosis (DKA). Most of the available data is from inner city hospitals which cater to a specific demographic much different from suburban medical centers. This study was performed at a suburban community hospital to analyze disease and demographic characteristics of patients admitted with DKA. Methods: Data was retrospectively collected from electronic medical record review for patients admitted with DKA between January 1, 2017 and January 1, 2018. Data included demographics, medical history, hemoglobin A1C, ancillary laboratory tests and length of hospital stay. Patients who left against medical advice were excluded. For patients with multiple DKA admissions, only the first admission was analyzed. Per hospital policy, all DKA patients were admitted to the medical intensive care unit. Results: 55 hospitalizations met the inclusion criteria involving 50 patients. 5 out of 55 patients had readmissions for DKA. The mean age was 47(range 17-85) years. 52% (n=26) of the population were males. The patient population comprised of 52% (n=26) African Americans, 48 % (n=24) Caucasians and 2%(n=1) other ethnic groups. The most common presenting symptom was nausea/vomiting reported by 48% (n=24) of the study subjects. Lethargy/fatigue, abdominal pain was the second and third most common reported symptom by 30% (n=15) and 26% (n=13) subjects respectively. Other presenting symptoms were polyuria 20%(n=10), polydipsia 18%(n=9), confusion 18%(n=9), weakness 12%(n=6), headache 4%(n=2) and blurring of vision 2%(n=1). The above reported symptoms were not mutually exclusive. The most common precipitant for DKA was medication noncompliance 44%(n=22) which was comparable in African American (11/26) and Caucasian (11/24) subgroups. This was followed by infectious etiologies in 36%(n=18) of the cases. DKA was the first presentation of undiagnosed DM in 10%(n=5) of the subjects. Steroid use was implicated in 4%(n=2) patients. Insulin pump failure was implicated in one subject. No definite cause was identified in 4%(n=2) of the patients. Mean hemoglobin A1C was 12.5% (range 8.2-12.5). The mean acute physiology and chronic health evaluation score (APACHE II) at admission was 15 (range 3-28). There was no mortality in the study population. The average length of hospital stay was found to be 3.7 days. Conclusions: (1) Suburban patients with DKA have subtle differences in characteristics as compared to inner city residents and more studies are required to explore these characteristics. (2) Elevated hemoglobin A1C reflects the need for better long-term glycemic control even in patients reporting good compliance. (3) Medication noncompliance rates appear to be independent of ethnicity. (4) Despite high APACHE scores, DKA remains a low mortality condition.

2425. Clinical and Microbiologic Outcomes Among Patients With Monomicrobial Stenotrophomonas maltophilia Infections

Background Stenotrophomonas maltophilia is an opportunistic pathogen observed in nosocomial infections. Due to biofilm production and intrinsic resistance to numerous antimicrobials, organism eradication is difficult and morbidity and mortality remain high. Unfortunately, study outcomes are often confounded by co-infecting organisms. Therefore, clinical and microbiologic outcome data for monomicrobial infections is warranted.MethodsSingle-center, retrospective chart review of adult patients receiving treatment for S. maltophilia between January 2012 and October 2016. Polymicrobial infections and cystic fibrosis patients were excluded. Primary endpoint was clinical cure (CC) at end of therapy. Secondary endpoints included microbiological eradication (ME), 28-day mortality, and resistance selection. An exploratory analysis was performed in patients receiving trimethoprim-sulfamethoxazole (TMP/SMX) or levofloxacin (LVX).ResultsSeventy-six patients were included in the analysis. The population was 60 years of age, predominantly female (62%) with median APACHE score of 16. Infection onset occurred 6 days after admission with 71% located in the ICU. Approximately 2/third of ICU patients were intubated. Primary site of infection was the lung (92%). Treatment strategies included TMP/SMX (45 patients) or LVX (31 patients). Overall, CC, ME, and 28-day mortality was observed in 79%, 82%, and 14%, respectively. Adverse events were uncommon with three patients receiving TMP/SMX requiring alternate therapy. Comparative analysis revealed similar baseline characteristics except higher APACHE scores (18 vs. 14; P = 0.03) and frequency of mechanical ventilation in the TMP/SMX group (64% vs. 30%; P = 0.007). CC was similar between TMP/SMX and LVX (82% vs. 74%, respectively (P = 0.4)). ME was observed in 84% and 77%, respectively (P = 0.5). Resistance selection to primary treatment was observed in 29% (2/7) and 86% (6/7), respectively (P = 0.1).ConclusionUse of TMP/SMX or LVX for S. maltophilia infections resulted in high CC rates. No differences in primary or secondary outcomes were observed; however, a trend toward resistance selection with LVX was identified. Larger studies assessing outcomes and resistance selection are warranted to further delineate treatment.Disclosures K. Klinker, Melinta Therapeutics: Consultant, Speaker honorarium. Nabriva Therapeutics: Scientific Advisor, Consulting fee.

Characteristics and outcome of Emergency Department intubation in geriatric patients.

The number of elderly patients admitted to the Emergency Department (ED) continues to grow due to the natural aging of the population. Consequently, tracheal intubation will be increasingly used in the oldest old. The objective of this retrospective study is to evaluate the characteristics and outcome of patients of 75years and older undergoing an endotracheal intubation in the ED. In a single center, retrospective study we reviewed digital medical files of patients of 75years and older in the period from 1/01/2008 to 31/12/2010, who were admitted to the ED of the Universitair Ziekenhuis Brussel in Brussels, Belgium and underwent endotracheal intubation. Survival served as primary outcome and survival without sequelae as secondary endpoint. In the study period, 88 patients of 75years and older were intubated in the ED. Sixty three (72%) patients died after intubation and 25 (28%) survived until discharge. All 23 patients (26%), who were intubated during cardiopulmonary resuscitation died. A survival rate of 48% was observed in patients, who were intubated for respiratory failure (28%), intracerebral hemorrhage or ischemic stroke (17%), cardiac failure (8%) or other reasons. Non-survivors were significant older, of male sex, had higher APACHE scores and more frequently used cholesterol lowering drugs. Senior adults, aged 75years or older and undergoing endotracheal intubation at the ED, have a high mortality rate. Younger age and female sex at admission were positively correlated with survival. Of those who left the hospital, one-third were able to return home without major sequelae.