ICU Admission Rate Research Articles

63 Neuronal Death-associated Proteins S100B, Tau and Neuron Specific Enolase Association to Sepsis-related Organ Dysfunction and Death in the Elderly: A Prospective Single Center Cohort Study

Sepsis is a highly prevalent condition in the emergency department (ED) with high mortality, ICU admission and tracheal intubation rates. Its physiopathology is not fully understood, and how neuronal death-related cell markers relate is partially unknown. Our aim was to assess whether these markers are positively associated with worse outcomes in elderly septic patients.

Clinical comparison of omicron and delta variants in older COVID-19 patients and the effect of vaccination status

Aim: It was aimed to investigate the clinical course of the Omicron vand Delta variant among the SARS-CoV-2 vaccinated and unvaccinated COVID-19 patients over 65 years old and to compare their effects on patients.
 Material and Method: The study was conducted on 567 COVID-19 patients over 65 years old. All patients’ gender, age, medical history, COVID-19 PCR test results, blood test results, thorax CT images, vaccination status, hospitalization status, and treatment results were recorded. When evaluating the chest CT images, a semiquantitative scoring system was used. The patients were divided into the Omicron and Delta variant subgroups, and vaccinated and unvaccinated groups. Comparisons were made between the Delta variant and Omicron variant groups, the vaccinated and unvaccinated patient groups,and SARS-CoV-2 mRNA vaccinated and inactivated SARS-CoV-2 vaccinated patient groups.
 Results: A total of 519 patients were included in the study.337 patients were in the Omicron variant group, 182 were in the Delta variant group.The hospitalization rate, ICU admission rate, mortality rate, rate of symptomatic patients,and the median thorax CT severity score was significantly higher in the Delta variant group than the Omicron variant group.The hospitalization rate, ICU admission rate, mortality rate, median thorax CT score and the rate of asymptomatic patients was significantly higher in the unvaccinated patient group than in the vaccinated group.There was no significant difference in the mortality rates and in the ICU admission rates between the inactivated SARS-CoV-2 vaccinated group and the SARS-CoV-2 mRNA vaccinated group.
 Conclusion: The SARS-CoV-2 Omicron variant compared to the Delta variant and the SARS-CoV-2 vaccinated patients compared to the unvaccinated patients had a milder clinical course and less mortality in COVID-19 patients over 65 years old.

Trauma Team Activation: improved care of major trauma patients.

To assess whether Trauma Team Activation (TTA) at Christchurch Hospital is associated with reduced mortality or improves in-hospital care for major trauma patients, and review differences in the two-tier activation system (Trauma Call versus Trauma Standby). A retrospective observational study of major trauma patients presenting to Christchurch Emergency Department (ED) 2018-2019. Univariate analyses were undertaken followed by multivariate analyses controlling for age and injury severity score (ISS). Major trauma patients with a TTA had a higher mean ISS (p<0.001) compared to patients without TTA. After controlling for age and ISS, TTA was associated with decreased time to CT (p<0.001), and shorter ED length of stay (LOS) (p<0.001). Despite an increased rate of surgery (OR 1.9, 95%CI:1.2-3.0) and admission to ICU (OR 4.1, 95%CI:2.0-8.5), with longer total hospital LOS (p<0.001). When compared to those with a Trauma Standby, patients with a full Trauma Call had a higher mortality (OR 1.5, 95%CI:0.3-8.4), increased rates of surgery (OR 2.7, 95%CI:1.4-5.2) and ICU admission (OR 17.9, 95%CI:4.2-77.4), with a longer hospital LOS (p=0.006). TTA was associated with decreased time to diagnostic imaging and definitive management in major trauma patients. Whilst causation cannot be inferred, these trends were apparent after controlling for age and ISS.

Incidence and risk factors for stroke in patients with COVID-19 in the Philippines: An analysis of 10,881 cases

BackgroundWhile most large studies on the possible association of COVID-19 and stroke were done in high-income countries, only a few studies consisting of small sample populations have been done in low- to middle-income countries like the Philippines. ObjectivesTo determine the risk factors of stroke among hospitalized COVID19 patients in the Philippines; to determine the possible association between these risk factors and stroke among the same cohort; and to determine if there is an association between mortality and stroke in this same group. MethodologyWe obtained relevant clinical and neurological, including stroke data from the Philippine CORONA study, an observational study involving 10,881 patients with COVID-19 admitted in 37 referral hospitals from all over the Philippines. ResultsThe incidence of stroke among patients with COVID-19 was 3.4% (n = 367). There were more deaths among patients with stroke and COVID-19 than those without stroke and COVID-19 (42.2% vs 14.7%, p < 0.01). In addition, more patients with stroke were admitted in the ICU (43.3% vs 15.0%, p < 0.01) regardless of cause. Smoking (OR: 1.5, 95% CI: 1.3 to 1.7, p < 0.0001), hypertension (OR:1.75, 95% CI:1.53 to 1.97, p < 0.0001), presence of heart failure (OR: 1.4, 95% CI: 1.07 to 1.86, p = 0.01), presence of any neurologic co-morbidities (OR: 1.4, 95% CI:1.11 to 1.46, p = 0.004), and history of stroke (OR:2.3, 95% CI:1.82 to 2.97, p < 0.0001) had direct significant correlation with stroke; while being a health care worker (OR: 0.5, 95% CI: 0.33 to 0.70, p < 0.0004) had an inverse significant association with stroke. ConclusionCOVID-19 stroke patients in the Philippines have a higher mortality and ICU admission rates than patients with COVID-19 alone or COVID-19 stroke patients from developed countries. Our cohort has similar cardiovascular and metabolic risk factors to western patients with stroke, highlighting that COVID-19 may only have a small contribution to stroke incidence.

Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients

BackgroundAcute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement.MethodsThis study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC).ResultsThe median age of the model-derivation cohort was 59 (IQR 47–70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918–0.939) and validation (temporal AUROC 0.927, 95% CI 0.911–0.941; geographic AUROC 0.819, 95% CI 0.792–0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator (https://www.mmcdscore.com/).ConclusionsThe use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation.

Clinical characteristics of patients hospitalized for COVID-19 vaccinated with at least two doses in a tertiary care hospital in Turkey

Background. We aimed to examine the characteristics of Turkish patients hospitalized with COVID-19 despite being fully vaccinated. Method. A retrospective, single-center study was conducted in fully vaccinated patients with inactivated whole virion (CoronaVac) and/or BNT162b2 mRNA (Pfizer-BioNTech) vaccines and admitted to the hospital. We evaluated the hospitalized patients regarding the intensive care unit admission and death. A multivariate binary logistic regression analysis was used to determine the factors for mortality. Results. We conducted the study with 541 patients. The mean age was 70.2, and 52.1% of the patients were women. 73.6% of the patients were 65 years or older. The most common comorbidities were hypertension, diabetes mellitus, and COPD. The rate of the alpha variant was 54.3%, and the delta variant was 29.4%. The mortality rate was 45.8%, and the ICU admission rate was 55.3%. The delta (B.1.617.2) variant had higher ICU admission and mortality rate. Patients vaccinated with two-dose Sinovac-CoronaVac had a higher mortality rate. There was no difference between the time between the last vaccination dose to hospitalization, ICU admission, and mortality. LOS in the hospital was longer in ICU and mortality patients. In multivariate binary logistic analysis; age (odds ratio (OR), 1.06; 95% confidence intervals (95% CI) 1.04-1.08- year increase), male gender (OR, 1.57; 95% CI, 1.04-2.38), presence of comorbid diseases (OR, 4; 95% CI, 2-8) and delta variant (OR, 7.3; 95% CI, 4.4- 12.2) and vaccination with CoronaVac plus BioNTech (OR, 0.21; 95% CI, 0.07-0.62) were associated with death. Conclusion. Our results suggest administering a third and fourth dose of mRNA vaccine to subjects vaccinated primarily with two doses of CoronaVac.

314.5: The Difference Between Delta and Omicron Variants in Solid Organ Transplant Recipients

Introduction: Solid Organ Transplant (SOT) recipients are vulnerable to SARS-CoV-2 infection. Delta variant has been reported to have worse outcomes as compared to other variants to date. The Omicron variant has been reported more transmissible but less virulent in general population. However, this phenomenon has not been validated in SOT recipients. Method: This is a retrospective cohort study, conducted in two phases, between July 1st and December 10th, 2021(Delta dominant phase), and January 1st and January 31st, 2022 (Omicron dominant phase) in one of the biggest SOT centers in the United States. Patient demographics including transplanted organ, immunosuppressive medication, vaccination status, and treatment modalities were obtained. We also compared clinical outcomes including hospitalization, ICU admission rate and mortality between two groups. Chi squared or fisher’s exact test were performed for categorical variables, whichever appropriate. For continuous variables, Mann Whitney U-test was performed. Multiple logistic regression model with stepwise backward elimination was developed to identify the risk factors for mortality. We put variables whose p value was less than 0.2. Of note, the institutional treatment protocol has not changed during the study period. Result: We identified 64 and 95 SOT recipients while delta and omicron variants were dominant, respectively. The rate of kidney transplant, age, gender, African American race, and the rate of at least received one dose vaccination were not significantly different between two groups. Of note, the hospital admission rate (68.8% vs 36.2%, p<0.001), ICU admission rate (20.3% vs. 6.3%, p=0.012), and mortality (20.9% vs. 4.2%) were higher during the delta variant versus omicron variant phase. For the risk factor analysis for mortality, we put age, African American race, COVID-19 variant, kidney transplant and vaccination status into multiple logistic regression model. Finally, delta variant was the only statistical significant risk factor for mortality (p<0.001, Odds ratio 9.35, 95% confidence interval 2.52-34.5). Conclusion: This is the first study comparing the outcomes between Delta variant dominant and Omicron variant dominant phase in SOT recipients. Even though there was no treatment protocol changed, the identified risk factor for mortality was delta variant dominant phase. However, still, the hospital admission rate (36.2%) should have been observed while Omicron variant phase and required significant aggressive treatment. Thus, we should prepare and may need to change the treatment protocol based on the variant in the future.

Acute Decompensated Heart Failure in Patients With and Without COVID-19 — The Experience of a Romanian Center

Abstract Objective Our goal was to characterize a cohort of heart failure patients with and without COVID-19 in terms of demographics, comorbid conditions, treatment regimens, lab test results and outcome. Methods We performed a retrospective, unicentric, cohort study on consecutive patients admitted to our department between September and December 2021. Results We enrolled a total of 76 HF patients – 65.3% COVID-19 (+). The median age was 72 years with a female predominance (59.2%). The median length of hospitalization was 13 days, longer for COVID-19 (+). Only 20.7% of all patients were fully vaccinated. COVID-19 (+) patients had higher ICU admission rates and mortality (in-hospital and at follow-up). The most common associated conditions were HTN (78.9%), T2DM (38.2%), cancer (18.4%), CAD (17.1%), late-stage CKD (16.7%), AF (14.5%) and stroke (11.8%). Patients with a history of stroke were more likely to require ICU management. At-home treatment with ACEi/ARB/ARNi made no difference for COVID-19 severity (p = 0.393), mechanical ventilation (p = 0.101) or mortality (in-hospital: p = 0.316; follow-up: p = 0.563); however, ICU admission rates were lower in these patients (p = 0.023). Conclusion Heart failure with preserved ejection fraction and low symptom severity were common findings among COVID-19 positive patients. However, COVID-19 positive patients were hospitalized for longer, required more ICU care and had higher mortality both in-hospital and at follow-up.

Do SARS-CoV-2-Infected Pregnant Women Have Adverse Pregnancy Outcomes as Compared to Non-Infected Pregnant Women?

PurposeTo determine the feto-maternal outcome in pregnant women infected with SARS-CoV-2 in comparison to non-infected pregnant women and plan management strategies.Patients and MethodsA retrospective review of case records in the Department of Obstetrics and Gynecology for 1 year was conducted. A total of 6468 case files fulfilling the inclusion criteria were enrolled in the study. Patients who tested positive for SARS CoV-2 and fulfilled inclusion criteria were labeled as cases, whereas patients who tested negative were labeled as controls. Outcome measures including lower segment cesarean section (LSCS) rate, maternal and neonatal intensive care admission and feto-maternal mortality were compared between the two groups.ResultsOur hospital was not an exclusive COVID-19 designated center, and 117 patients infected with SARS-CoV-2 fulfilling the inclusion criteria were enrolled in the study. Fever (67.52%), cough (56.41%), and altered smell (45.29%) were the frequently reported symptoms. Pneumonia affected 16.23% of the cases. LSCS rate was significantly higher in the COVID-19-infected patients (72.41%; OR 2.19; 95% CI 1.46–3.34; p<0.001). The rate of maternal ICU admission in COVID-19-infected pregnant women was 11.96% as compared to 0.8% in the non-infected women (OR 16.76; 95% CI 8.72–30.77; p<0.001). We observed a significantly higher maternal mortality in COVID-19-infected women (2.56%) [OR 41.61; 95% CI 7.65–203.5; p<0.001]. Viral RNA was detected in cord blood and nasopharyngeal swab of one neonate. The neonatal death ratio was high in infected mothers (2.6%) [OR 8.6; 95% CI 1.99–27.23; p<0.001].ConclusionSignificant maternal morbidity, mortality, and neonatal mortality were observed in COVID-19-positive patients.

Obstetric Patients Requiring Intensive Care: Prevalence, Clinical Characteristics and Outcome in a Tertiary Care Institute in Nigeria

Maternal mortality is a major health problem in developing countries. Critical care of the obstetric patient has been recognized as a useful tool in the reduction of maternal morbidity and mortality. The study is a five year retrospective review of the clinical characteristics and outcome of all obstetric admissions into the ICU. Data collected and analyzed included demographics, diagnosis at admission, mode of delivery, ante natal booking status, duration of admission into the ICU, mechanical ventilatory support, duration of stay on the ventilator and outcome of ICU admission. There were 170 obstetric admissions accounting for 25.3% of total ICU admissions during the period of review. The mean age of patients was 30.2±29.2 years. Hypertensive disorders of pregnancy accounted for the highest cause of obstetric admission diagnosis 51.7%. Majority of the patients 94.7% were admitted postpartum. The mean length of ICU stay was 2.7 ± 2.8days. Mortality was 26.5% with a significantly higher percentage of deaths in unbooked/referred patients (66.7%). There is a high rate of ICU admission of obstetric patients in our hospital. Mortality is also high especially among unbooked late referrals. Timely referrals and early recourse to ICU care by booked patients may provide some improvement in the standard of care received in the ICU with a subsequent lower mortality.

Risk for severe outcomes of COVID-19 and PIMS-TS in children with SARS-CoV-2 infection in Germany

Although children and adolescents have a lower burden of SARS-CoV-2-associated disease compared to adults, assessing the risk for severe outcomes among SARS-CoV-2-infected children remains difficult due to a high rate of undetected cases. We combine data from three data sources — a national seroprevalence study (the SARS-CoV-2 KIDS study), the nationwide, state-based reporting system for PCR-confirmed SARS-CoV-2 infections in Germany, and a nationwide registry on children and adolescents hospitalized with either SARS-CoV-2 or pediatric inflammatory multisystem syndrome (PIMS-TS, also known as MIS-C) — in order to provide estimates on the risk of hospitalization for COVID-19-related treatment, intensive care admission, and death due to COVID-19 and PIMS-TS in children. The rate of hospitalization for COVID-19-related treatment among all SARS-CoV-2 seropositive children was 7.13 per 10,000, ICU admission 2.21 per 10,000, and case fatality was 0.09 per 10,000. In children without comorbidities, the corresponding rates for severe or fatal disease courses were substantially lower. The lowest risk for the need of COVID-19-specific treatment was observed in children aged 5–11 without comorbidities. In this group, the ICU admission rate was 0.37 per 10,000, and case fatality could not be calculated due to the absence of cases. The overall PIMS-TS rate was 2.47 per 10,000 SARS-CoV-2 infections, the majority being children without comorbidities.Conclusion: Overall, the SARS-CoV-2-associated burden of a severe disease course or death in children and adolescents is low. This seems particularly the case for 5–11-year-old children without comorbidities. By contrast, PIMS-TS plays a major role in the overall disease burden among all pediatric age groups.What is Known:• SARS-CoV-2-associated burden of disease in children is considered to be low, but accurate risk estimates accounting for clinically undiagnosed infections are lacking.• Asymptomatic SARS-CoV-2 infections are common in children.What is New:• We provide risk estimates for hospitalization for COVID-19-related treatment, ICU admission, death from COVID-19, and PIMS-TS for children with SARS-CoV-2 infections by pooling different data sources.• The risk for PIMS-TS exceeds the risk for severe COVID-19 in all age groups; the risk for severe COVID-19 is the lowest in 5–11 years old.

Relevant SARS-CoV-2 viremia is associated with COVID-19 severity: Prospective cohort study and validation cohort.

Early kinetics of SARS‐CoV‐2 viral load (VL) in plasma determined by quantitative reverse‐transcription polymerase chain reaction (RT‐PCR) was evaluated as a predictor of poor clinical outcome in a prospective study and assessed in a retrospective validation cohort. Prospective observational single‐center study including consecutive adult patients hospitalized with COVID‐19 between November 2020 and January 2021. Serial plasma samples were obtained until discharge. Quantitative RT‐PCR was performed to assess SARS‐CoV‐2 VL. The main outcomes were in‐hospital mortality, admission to the Intensive Care Unit (ICU), and their combination (Poor Outcome). Relevant viremia (RV), established in the prospective study, was assessed in a retrospective cohort including hospitalized COVID‐19 patients from April 2021 to May 2022, in which plasma samples were collected according to clinical criteria. Prospective cohort: 57 patients were included. RV was defined as at least a twofold increase in VL within ≤2 days or a VL > 300 copies/ml, in the first week. Patients with RV (N = 14; 24.6%) were more likely to die than those without RV (35.7% vs. 0%), needed ICU admission (57% vs. 0%) or had Poor Outcome (71.4% vs. 0%), (p < 0.001 for the three variables). Retrospective cohort: 326 patients were included, 18.7% presented RV. Patients with RV compared with patients without RV had higher rates of ICU‐admission (odds ratio [OR]: 5.6 [95% confidence interval [CI]: 2.1–15.1); p = 0.001), mortality (OR: 13.5 [95% CI: 6.3–28.7]; p < 0.0001) and Poor Outcome (OR: 11.2 [95% CI: 5.8–22]; p < 0.0001). Relevant SARS‐CoV‐2 viremia in the first week of hospitalization was associated with higher in‐hospital mortality, ICU admission, and Poor Outcome. Findings observed in the prospective cohort were confirmed in a larger validation cohort.

Gender differences in esophageal variceal bleeding in the United States

Background and Aims Esophageal variceal bleeding is a common reason for hospitalization in patients with cirrhosis. The main objective of this study was to analyze the effects of gender differences on outcomes in hospitalizations related to Esophageal variceal bleeding in the United States. Methods A retrospective observational cohort study was performed using the National Inpatient Sample (NIS) database for all hospitalizations with a discharge diagnosis of esophageal varices with hemorrhage from 2016 to 2019. The primary outcome was in-hospital mortality, while secondary outcomes included rate of early endoscopy (defined as less than 1 day), AKI, blood transfusion, sepsis, ICU admission and TIPS (Transjugular Intrahepatic Portosystemic Shunt). We also compared the length of stay and total hospitalization charges. Results We identified a total of 166,760 patients with variceal bleeding of which 32.7% were females. In-hospital mortality was higher in males, 9.91%, compared to females, 8.31% (adjusted odds ratio (aOR): 0.88, p-value=.008, when adjusted for confounding factors). The odds of undergoing an EGD, length of stay, or total hospitalization charges did not differ between the two groups. Compared to men, women had lower odds of receiving TIPS (aOR = 0.83, p-value=.002). Conclusion Women hospitalised with esophageal variceal bleeding are at a lower risk of death compared to males. Further research is needed to elucidate the factors associated with this lower risk.

Early thoracentesis correlated with survival benefit in patients with spontaneous bacterial empyema.

Spontaneous bacterial empyema (SBEM) is a rare complication of hepatic hydrothorax characterized by hydrothorax infection in the absence of pneumonia. We conducted this study to compare clinical outcomes in SBEM patients who underwent early thoracentesis (ET) (≤ 24h from presentation) versus those who underwent delayed thoracentesis (DT). All patients diagnosed with SBEM at Mayo Clinic Rochester, Minnesota from January 1st 1999 to December 31st 2020 were reviewed. Demographics, pleural fluid studies, laboratory results and clinical outcomes were analyzed. A total of 54 SBEM patients (27 ET and 27 DT) were identified with 38 (70.4%) of patients presenting with right-sided effusions. Both groups had similar baseline characteristics. The rate of ICU admission was significantly higher in the DT group (15 (55.6%) vs. 7 (25.9%) patients, P=0.027). Patients with DT had similar rate of AKI (11 (40.7%) vs. 6 (22.2%) patients, P=0.074). In-hospital mortality (11 (40.7%) vs. 2 (7.4%) patients, P=0.004), 3-month mortality (16 (59.3%) vs. 2 (7.4%) patients, P<0.001) and 1-year mortality rate (21 (77.8%) vs. 6 (22.2%) patients, P<0.001) were higher in the DT group. Patients with SBEM who underwent thoracentesis after 24h from presentation (DT) had higher rates of mortality and ICU admission compared to patients who received early thoracentesis. Thoracentesis should be performed early in patients with suspected SBEM since it may improve survival.

The Impact of SSRI Use on the Clinical Outcome and Prognosis of COVID-19 Patients: A Single-Center Prospective Study

Background: Recent studies have found a link between the usage of selective serotonin reuptake inhibitors (SSRIs) and a lower mortality rate in COVID-19 cases. Objective: The goal of current research was evaluating the effectiveness of SSRI drugs on improvement of COVID-19 patients. Methods: This prospective case-control study, compared SSRI-treated patients with matched control patients not treated with SSRIs at Masih Daneshvari Hospital on a population of 350 patients diagnosed with COVID-19 from March 15th 2021 to March 16th 2022. Results: ICU admission rates were significantly more in the control group than in the case group (44.8% vs. 25.9%; p-value=0.0002; Odds Ratio (OR)= 2.32). Intubation was reported for more cases in the control group than the case group (26.7% vs. 11.4%; p-value=0.0002; OR=2.84). Mortality rate was found to be significantly more in the control group than the case group (23.0% vs. 10.8%; p-value=0.0002; OR=2.46). Furthermore, the subgroup analyses on Fluvoxamine and Sertraline showed that Hospitalization period, ICU admission rates, and intubation were all reported to be significantly smaller in each case subgroups as against the control group. Conclusion: Our assessments underlined the potential efficacy of SSRIs in improving COVID-19 patients’ prognosis, since the use of SSRIs were shown to be associated with shorter hospital stay and ICU stay, lower ICU admission rates and intubation rates, and ultimately decreased mortality rates.

Differential surgical outcome in Federal Medical Centre Owerri, Nigeria

Background: Global understanding of surgical outcome is still limited, with data lacking in some areas of the world. Global studies most times are dominated by data sourced from high income and developed countries. Aim: This study is aimed at evaluating the differential surgical outcomes in a Health Institution in Nigeria, to help understand how patients develop postoperative complications and the severity of such complications. Methods: We recruited 200 patients that were booked for elective or emergency in-hospital or day case surgery. The patients were followed up for maximum of 30 days postoperatively. Perioperative outcomes were evaluated. Results: The majority of the participants were in ASA II class (46%), while the others were in class ASA III (31%), ASA I (20%) and ASA IV (3%). There were 35% participants that had intraoperative complication, while 29% had postoperative complication. The rate of ICU admission was 5%, while the duration of postoperative ICU and hospital stay were 1.7±0.90 days and 13.28±2.97 days respectively. Surgical related mortality rate was 3%. Conclusion: The findings show that despite the high intraoperative complication rate of 35%, postoperative complication rate of 29% and critical care admission rate of 5%, mortality rate (3%) was the same with other global studies.

Impact of AIS 2015 versus 1998 on injury severity scoring and mortality prediction - single centre retrospective comparison study

BackgroundA key component of trauma system evaluation is the Injury Severity Score (ISS). The ISS is dependent on the AIS, and as AIS versions are updated this effects the number of patients within a health system which are considered severely injured (ISS >15). This study aims to analyse the changes comparing AIS1998 and AIS2015, and its impact on injury severity scoring and survival prediction model in a major trauma centre. MethodsThis retrospective study reviewed all blunt trauma admissions from 1 January 2020 to 31 December 2020 from the trauma registry of Prince of Wales Hospital, Hong Kong. Patients were manually double coded with AIS1998 and AIS2015 by the same experienced trauma nurse who have completed both AIS 1998 and AIS 2015 Courses. AIS patterns and Injury Severity Scores (ISS) derived from AIS 1998 and 2015 were compared using the Wilcoxon Signed Rank Test. The area under the receiving operator curve (AUROC) was compared based on the Trauma and Injury Severity Score (TRISS) model using AIS 1998 and AIS 2015. Results739 patients were included. There were 34 deaths within 30 days (30-day mortality rate 4.6%). Patients coded with AIS2015 compared with AIS1998 had significant reductions in the classification of serious, severe and critical categories of AIS, with a substantial increase in the mild and moderate categories. The largest reduction was observed in the head and neck region (Z = −11.018, p < 0.001), followed by the chest (Z = −6.110, p < 0.001), abdomen (Z = −4.221, p < 0.001) and extremity regions (Z = −4.252, p < 0.001). There was a 27% reduction in number of cases with ISS >15 in AIS2015 compared with AIS1998. Rates of 30-day mortality, ICU admission, emergency operation and trauma team activation of ISS > 15 using AIS 1998 were similar to the cut off for New Injury Severity Score (NISS) >12 using AIS 2015. The AUROC from the TRISS (AIS2015) was 0.942, and not different from the AUROC for TRISS (AIS1998) of 0.936. The sensitivity and specificity were 93.9% and 82.1% for TRISS (AIS2015), and 93.9% and 76.0% for TRISS (AIS1998). ConclusionTrauma centres should be aware of the impact of the AIS2015 update on the benchmarking of trauma care, and consider the need for updating the ISS cut off for major trauma definitions.

Association of multiple sclerosis with mortality in sepsis: a population-level analysis

BackgroundMultiple sclerosis (MS) is associated with increased risk of sepsis and higher sepsis-related mortality, compared to the general population. However, the evidence on the prognostic impact of MS in sepsis has been scarce. We aimed to evaluate the population-level association of MS with short-term mortality in sepsis.MethodsWe performed a retrospective population-based cohort study using a statewide data set to identify hospitalizations aged ≥ 18 years in Texas with sepsis, with and without MS during 2010–2017. Multilevel logistic models were fit to estimate the association of MS with short-term mortality among all sepsis hospitalizations, and for sensitivity analyses among hospitalizations with septic shock and those admitted to ICU.ResultsAmong 283,025 sepsis hospitalizations, 1687 (0.6%) had MS. Compared to sepsis hospitalizations without MS, those with MS were younger (aged ≥ 65 years 35.0% vs 56.8%), less commonly racial/ethnic minority (36.2% vs 48.1%), and had lower mean Deyo comorbidity index (1.6 vs 2.7). The rates of septic shock and ICU admission were similar for sepsis hospitalizations with and without MS (58.7% vs 59.6% and 46.7% vs 46.0%, respectively). The unadjusted short-term mortality among sepsis hospitalizations with and without MS for the whole cohort, among those with septic shock, and among ICU admissions were 20.2% vs 31.3%, 25.6% vs 40.0%, and 24.0% vs 34.8%, respectively. On adjusted analyses, MS was associated with 17% lower odds of short-term mortality (adjusted odds ratio [aOR] 0.828 [95% CI 0.723–0.947]). Similar findings were observed on sensitivity analyses of patients with septic shock (aOR 0.764 [95% CI 0.651–0.896]), but MS was not associated with mortality among sepsis hospitalizations admitted to ICU (aOR 0.914 [95% CI 0.759–1.101]).ConclusionsMS was associated with lower short-term mortality among septic patients, with findings consistent among the subset with septic shock. Among septic patients admitted to ICU, MS was not associated with mortality.

Cefiderocol use in Gram negative infections with limited therapeutic options: Is combination therapy the key?

ObjectivesTo date limited information about cefiderocol use is provided by real life studies. Our aim is to evaluate characteristics and outcome of patients with Gram-negative infections with limited therapeutic options treated with cefiderocol in combination or monotherapy. MethodsWe retrospectively collected data on demographical, clinical characteristics and clinical cure, in-hospital and 30-days mortality, microbiological failure and Clostridioides difficile infections of all patients ≥ 18 years old treated with cefiderocol for ≥ 48 h. ResultsThere were 18 patients of which 14 (77.8%) treated with cefiderocol in combination and 4 (22.2%) with monotherapy. Median age was 54.5 (IQR 35.25–65.75) vs 70.5 (IQR 57.5–78.25) years old, respectively and ward of admission was the ICU in the 78.57% vs 100% of cases. In the 50% vs 100% of cases infections were VAP with concomitant bloodstream infections. Median SOFA score was 10 (IQR 4.5–12.5) vs 5 (IQR 4–6) and APACHE II score was 13.5 (IQR 7.5–18) vs 16 (IQR 8.5–23.5), respectively. Isolated pathogen was carbapenems-resistant Acinetobacter baumannii in 78.57% vs 100% of cases. Median duration of cefiderocol treatment was 9.5 (IQR 7–13.25) vs 9 days (IQR 5.5–12.5) and in 77.8% patients it was used in combination therapy, of which 57.1% were colistin-spairing regimens. Clinical cure was achieved in 64.29% for combination therapy vs 75% of monotherapy treated patients, 30-days mortality rate was 28.57% vs 25% and 30-day ICU admission rate was 14.29% vs 50%, respectively. No statistically significant differences were observed between combination therapy and monotherapy treated patients. ConclusionsTo date, no differences have been demonstrated between cefiderocol monotherapy or combination. Further studies are required to understand whether cefiderocol combination therapy could provide an advantage in outcome in seriously-ill patients.

COVID-19 and Ventricular Shunt Revisions.

Introduction: COVID-19 patients frequently experience headaches, malaise, and fatigue. For patients with shunted hydrocephalus, these signs and symptoms can often be indicative of shunt failure. Thus, it can be challenging to determine if shunt failure has occurred in this patient population. Therefore, we explored the question of how a diagnosis of COVID-19 in shunted hydrocephalus patients influences the rate of shunt revision.Methods: We used a deidentified database network (TriNetX) to gather information on patients with shunted hydrocephalus and COVID-19 versus no COVID-19 from January 20, 2020, through September 26, 2021. Our primary outcome of interest was shunt revision at 90 days, with secondary outcomes of mortality, hospitalization, ICU admission, mechanical ventilation, tracheostomy, PEG tube placement, fall, seizure, acute kidney injury (AKI), venous thromboembolism (VTE), ischemic stroke (I.S.), myocardial infarction (MI), and sepsis. Cohorts were propensity score-matched for common comorbidities and demographics.Results: After propensity score matching, 10,600 patients with shunted hydrocephalus and COVID-19 (cohort 1) and 10,600 patients with shunted hydrocephalus and no COVID-19 (cohort 2) were identified. Average age was 38.5 years. Eight hundred and thirty-four patients (7.869%) in cohort 1 and 180 (1.698%) patients in cohort 2 underwent shunt revision (p=<0.0001, OR 4.978, 95% CI 4.198, 5.821). Mortality was 4.642% vs. 2.113% (p<0.0001, OR 2.255, 95% CI 1.921, 2.647). Hospitalization rates were 27.72% vs. 10.303% (p<0.0001), and ICU admission rates 11.567% vs. 3.463% (p<0.0001). Ventilator dependence was 3.529% vs. 0.953% (p<0.0001), tracheostomy 1.142% vs. 0.236% (p<0.0001), PEG tube insertion 2.472% vs. 0.585% (p<0.0001), falls 2.321% vs. 1.076% (p<0.0001), seizure 11.369% vs. 5.953% (p<0.0001), AKI 4.416% vs. 1.717% (p<0.0001), VTE 3.538% vs. 1.293% (p<0.0001), sepsis 3.887% vs. 1.179% (p<0.0001), IS 0.585% vs. 0.16% (p<0.0001), and MI 1.34% vs. 0.519% (p<0.0001).Conclusion: COVID-19 infection is associated with an almost five-fold increase in shunt revisions.