Intensive Care Unit Mortality Research Articles

Ten-Year Evaluation of Ventilator-Associated Pneumonia (VAP) According to Initial Empiric Treatment: A Retrospective Analysis Using Real-World Data

Background/Objectives: Ventilator-associated pneumonia (VAP) is the main nosocomial infection in intensive care units (ICUs) that causes the highest morbidity and mortality. The aim of our study is to investigate variations in crude ICU mortality among patients with VAP over the past decade. We also wish to identify associated risk factors, evaluate changes in the etiology, and assess the incidence and impact of inappropriate empirical antibiotic treatment (IEAT). Methods: We conducted a retrospective, observational, single-center study over a 10-year period (2014–2024), including critically ill patients who developed VAP. The population was divided into three periods: (P1) from 2014 to 2018 (pre-COVID-19); (P2) from 2019 to 2021 (COVID-19); and (P3) from 2022 to 2024 (post-COVID-19). Binary logistic regression was used to identify which variables were independently associated with ICU mortality. Results: A total of 220 patients were included in the study (P1 = 47, P2 = 96, and P3 = 77 patients). The most prevalent microorganisms identified were P. aeruginosa, Klebsiella spp., and S. aureus. Significant variations in etiology were not observed over the years. The incidence of IEAT was 4.5%, with no observed differences between the study periods. Crude ICU mortality was 33.6%, with higher rates observed in IEAT (40% vs. 33.3%, p = 0.73). In patients with appropriate empiric antibiotic treatment (AEAT), there was a significant decrease in crude mortality over the years from 42.2% in P1 to 22.2% in P3 (p < 0.001). Age (OR = 1.04; 95% CI = 1.01–1.08) and P2 (OR = 2.8; 95% CI = 1.1–7.4) were found to be independently associated with an increased risk of mortality. Conversely, a lower risk of death was associated with mean arterial pressure (OR = 0.94; 95% CI = 0.69–0.99) and the use of syndromic respiratory panel (OR = 0.23; 95% CI = 0.07–0.68). Conclusions: A reduction in crude VAP mortality over the years was observed, with no change in the etiology or rate of IEAT. The implementation of protocols using respiratory syndromic panels could be a measure to implement to reduce VAP mortality.

Ventilator-Associated Pneumonia in Intensive Care Units: A Comparison of Pre-Pandemic and COVID-19 Periods

Background/Objectives: The COVID-19 pandemic has significantly increased the burden of ventilator-associated pneumonia (VAP) in intensive care units (ICUs) globally. However, epidemiological data on VAP in Slovak ICUs, particularly in the context of the pandemic, remain limited. This study aimed to evaluate the incidence, microbial profiles, and risk factors of VAP in Slovak ICU settings, particularly during the COVID-19 pandemic. Methods: A retrospective analysis of VAP data was conducted for respiratory intensive care unit (ICU) patients in a Slovak university hospital, comparing data from the pre-pandemic and pandemic periods. The CDC/NHSN definitions for VAP were applied, and statistical analyses were performed using STATISTICA 13.1. Results: A total of 803 patients were analyzed, representing 8385 bed days and 5836 mechanical ventilator days. VAP rates increased significantly during the pandemic by 111%, from 8.46 to 17.86 events per 1000 MV days (p < 0.001). VAP rates in non-COVID-19 patients increased by 86% during the pandemic compared to pre-pandemic levels. Pandemic conditions also increased ICU mortality from 25.66% to 40.52% (p < 0.001). VAP was identified as a critical determinant of ICU mortality, contributing to a 21.62% higher mortality rate among patients during the pandemic. Younger age, prolonged mechanical ventilation, and medical (vs. surgical) hospitalizations were associated with higher VAP incidence. Gram-negative bacteria dominated the pathogen profiles, with significant increases observed in Pseudomonas aeruginosa (183%), Klebsiella pneumoniae (150%), and Acinetobacter spp. (100%). Conclusions: The COVID-19 pandemic has significantly affected the incidence and epidemiology of VAP in Slovak ICUs, highlighting systemic vulnerabilities in HAI surveillance and IPC practices.

L-shaped association of body mass index with prognosis in individuals with sepsis: a multicenter cohort study

ObjectiveThe relationship between body mass index (BMI) and sepsis prognosis remains highly controversial and uncertain. This study investigated the association between BMI and prognosis in patients with sepsis.MethodsThis retrospective observational cohort study included adult patients admitted to the intensive care unit (ICU) with sepsis from Medical Information Mart for Intensive Care-IV version 2.2 (MIMIC-IV V2.2) and eICU Collaborative Research Database (eICU-CRD). The cut-off value of BMI was identified by the restricted cubic spline (RCS) curve and included patients were categorized into two groups: the low BMI group (< 28 kg/m2) and the high BMI group (≥ 28 kg/m2). The primary outcome was ICU mortality, and secondary outcomes were in-hospital and 28-day mortality. We performed the log-rank test to detect whether there is a difference in prognosis among different groups in two different cohorts. Multiple distinct models were used to validate the robustness of the results.ResultsThere were 18,385 and 38,713 patients in the MIMIC-IV 2.2 and eICU-CRD cohorts, respectively. An L-shaped relationship was observed between BMI and ICU mortality in the primary analysis from MIMIC-IV 2.2. Similar relationships were found in eICU-CRD. When BMI was less than the cut-point, the risk of ICU mortality increased rapidly with decreasing BMI. When BMI was greater than the cut-point, the risk of ICU mortality levelled off as BMI increased. Sepsis patients with higher BMI values exhibited decreased ICU all-cause mortality rates (MIMIC-IV cohort: HR: 0.81, 95% CI 0.75–0.88, p < 0.001; eICU-CRD cohort: HR: 0.75, 95% CI 0.71–0.80, p < 0.001). Consistent trends were observed for both in-hospital mortality and 28-day mortality rates. The results remained robust in multiple distinct models and subgroup analyses.ConclusionAn L-shaped relationship was observed between BMI and prognosis in septic patients, indicating that lower BMI values are significantly linked to increased mortality. Targeted nutritional interventions and close monitoring for patients with low BMI could potentially enhance their prognosis. Therefore, BMI can also be utilized to categorize the risk levels of patients with sepsis and effectively predict their prognosis.

Comparative analysis of malnutrition screening tools in predicting mortality in critically ill patients: SGA, GLIM, and mNutric Score.

Introduction: Malnutrition is prevalent among critically ill patients and is associated with increased mortality, prolonged hospital stays, and higher rates of complications. Several malnutrition screening tools are available, including the Subjective Global Assessment (SGA), the Global Leadership Initiative on Malnutrition (GLIM), and the modified Nutrition Risk in Critically Ill (mNutric) Score. This study aims to compare the predictive ability of these three tools in determining mortality among critically ill patients. Methods: A retrospective cohort study was conducted in the Intensive Care Unit (ICU) of RSUP Dr. Wahidin Sudirohusodo from April 2022 to March 2023. Patients aged 18 years and older were included. Nutritional status was assessed using SGA, GLIM, and mNutric Score. The primary outcome was mortality. Result: A total of 1,106 patients were included in the analysis. The overall ICU mortality rate was 23.1%. The mNutric Score was a significant independent predictor of mortality (OR = 6.601, 95% CI: 4.183–10.416, p &lt; 0.001), while neither SGA nor GLIM were significant after adjustment for confounders. Conclusion: The mNutric Score is a superior tool for predicting mortality in critically ill patients compared to SGA and GLIM. Its use should be considered in ICU settings to identify patients at nutritional risk and guide timely interventions.

Comparative outcomes of corticosteroids, neuromuscular blocking agents, and inhaled nitric oxide in ARDS: a systematic review and network meta-analysis

ObjectivesAcute respiratory distress syndrome (ARDS) is associated with high rates of morbidity and mortality. However, the evidence regarding the effectiveness of commonly used treatments, including corticosteroids, neuromuscular blocking agents (NMBAs), and inhaled nitric oxide (iNO), remains uncertain. Therefore, this study aimed to compare and rank these three treatments to identify the most effective option.Data sourcesWe searched PubMed, Embase, Cochrane Library, and Web of Science for clinical trials from the earliest records to 1 May 2024.Study selection and data extractionClinical trials evaluating three interventions compared with the control group for ARDS were included, with restrictions on any language. Data were extracted by two independent reviewers. Frequentist network meta-analysis (NMA) was performed to identify the most effective intervention, and treatments were ranked using the surface under the cumulative ranking (SUCRA) curve. The primary outcome was 28-day mortality, while secondary outcomes included ventilator-free days up to 28 days, ICU mortality, in-hospital mortality, and the incidence of new infection events.Data synthesisData from 26 clinical trials encompassing 5,071 patients were analyzed. Vecuronium bromide was the most effective strategy for reducing 28-day mortality compared to conventional treatment, iNO, methylprednisolone, and placebo (OR 0.38, 95% CI 0.15–1.00, and OR 0.30, 95% CI 0.10–0.85 and OR 0.25, 95% CI 0.08–0.74 and OR 0.23, 95% CI 0.08–0.65; SUCRA: 96.6%). Dexamethasone was identified as the most effective treatment option for increasing ventilator-free days at 28 days compared to conventional therapy and cisatracurium (MD 3.60, 95% CI 1.77–5.43, and MD 3.40, 95% CI 0.87–5.92; SUCRA: 93.2%). Methylprednisolone demonstrated the highest effectiveness for preventing ICU mortality (SUCRA: 88.5%). Although dexamethasone, cisatracurium, conventional therapy, methylprednisolone, and iNO treatment did not show significant superiority in reducing in-hospital mortality, dexamethasone showed the highest probability of being the most effective treatment option (SUCRA: 79.7%). Furthermore, dexamethasone treatment showed the highest safety in reducing the incidence of new infection events compared with placebo and iNO (OR 0.61, 95% CI 0.42–0.88, and OR 0.33, 95% CI 0.19–0.58; SUCRA: 91.8%).ConclusionThis NMA suggests that corticosteroids may provide benefits to patients with ARDS. While the application of NMBAs may reduce 28-day mortality, iNO did not demonstrate a significant beneficial effect as a therapeutic measure.Systematic review registrationPROSPERO, CRD42022333165 https://www.crd.york.ac.uk/PROSPERO/.

Effectiveness and safety of an emergency department-based rapid response system

Rapid Response Systems (RRSs) are designed to assist hospitalized patients who become unstable, aiming to address “failure to rescue” and prevent cardiac arrests. Despite global implementation, evidence of RRS effectiveness is controversial. This study evaluates the effectiveness and safety of an RRS at Maggiore Hospital in Lodi, Italy, focusing on the Medical Emergency Team (MET) organization. The RRS at Maggiore Hospital was established in 2017 using the National Early Warning Score (NEWS) for monitoring. The MET, consisting of an emergency physician and one nurse, operates from 8:00 PM to 8:00 AM. Data from 2014-2019, divided into PRE (2014-2016) and POST (2017-2019) periods, were analyzed. The primary outcomes were unplanned ICU transfers and in-hospital mortality. A difference-in-differences (DiD) design compared outcomes in MET and non-MET wards before and after RRS implementation. Hospitalizations were similar in the PRE and POST periods. A significant reduction in Intensive Care Unit (ICU) transfers was observed overall (0.26%, p=0.005), but not in mortality (0.10%, p=0.47). Both MET and non-MET wards showed reduced ICU transfers, but the decrease was statistically significant only in MET wards. DiD analysis showed no significant reductions in either ICU transfer (p=0.77) or mortality rates (p=0.15) between MET and non-MET wards. The RRS at Maggiore Hospital effectively reduced ICU transfers without increasing mortality, demonstrating its safety. The MET organization did not significantly impact ICU transfers compared to non-MET wards. Further studies should explore additional measures of clinical deterioration to fully assess the impact of RRS.

Mortality and patient disposition after ICU tracheostomy for secretion management vs. prolonged ventilation: a retrospective cohort study

BackgroundThere is little research on long-term, patient-centered outcomes in critically ill patients undergoing tracheostomy for secretion management or prolonged ventilation. The goal of this study was to determine and compare hospital and long-term mortality, and incidence of new institutionalization amongst patients who underwent an ICU tracheostomy for these two aforementioned indications.MethodsThis was a single center historic cohort study of all ICU patients who received a tracheostomy for secretion management or prolonged ventilation from 2011 to 2022. We compared hospital and long-term mortality and incidence of new institutionalization between these two groups.ResultsA cohort of 247 patients (133 secretion management, 114 prolonged ventilation) was established. Overall hospital mortality was 86/247 (35%), mortality at 1 year was 106/207 (51%), and at 3 years was 117/167 (70%), with no significant difference between the two indications. Patients with prolonged ventilation indication had a significantly higher ICU mortality [34/114 (30%) vs. 13/133 (10%), P < 0.001]. Amongst hospital survivors, 49/137 (36%) were unable to return home, with significantly more patients tracheostomized for secretion management requiring new institutionalization [37/78 (47%) vs. 12/59 (20%), P = 0.002].ConclusionsTracheostomy indication may be an important determinant of short- and long-term patient-centered outcomes. Patients receiving a tracheostomy for secretion management were twice as likely to be discharged to a new institution compared to prolonged ventilation patients. Patient-centered outcomes should be included in future studies and if confirmed, these outcomes should be incorporated into discussions about tracheostomy decision making.

The relationship between hypomagnesemia and ICU mortality in severe hemorrhagic stroke patients: an observational multicentre study on eICU database

BackgroundHemorrhagic stroke is a potentially fatal condition with high mortality and morbidity. However, there is a lack of evidence for this relationship in critically ill patients with hemorrhagic stroke. This study aims to explore the relationship between hypomagnesemia and ICU mortality in severe hemorrhagic stroke patients.MethodsThe study included 2,026 severe hemorrhagic stroke patients from the Electronic Intensive Care Unit Collaborative Study database, categorized into hypomagnesemia and non-hypomagnesemia groups based on serum magnesium levels. Primary outcome was ICU mortality. Secondary outcome was mechanical ventilation use. Multivariate Cox proportional hazards regression analyses were used to study the relationship between hypomagnesemia and the outcomes. We also performed a cumulative survival rate analysis by Kaplan–Meier curves.ResultsA total of 2,026 severe hemorrhagic stroke patients, aged over 16 and hospitalized in the ICU for more than 24 h, were enrolled. Among them, 277 (13.7%) died in the ICU, and hypomagnesemia was observed in 489 patients. Multivariable Cox regression analyses demonstrated that hypomagnesemia was related to a 28% increased risk of ICU mortality (HR 1.28, 95% CI [1.02–1.68], p = 0.035) and a 15% increased risk of mechanical ventilation use (HR 1.15, 95% CI [1.04—1.33], p = 0.010) in severe hemorrhagic stroke patients.ConclusionsOur findings suggested that hypomagnesemia is associated with increased risks of ICU mortality and mechanical ventilation use in severe hemorrhagic stroke patients. Future randomized, prospective studies are needed to elucidate the role of hypomagnesemia and explore potential interventions.

Explainable machine learning and online calculators to predict heart failure mortality in intensive care units.

This study aims to develop explainable machine learning models and clinical tools for predicting mortality in patients in the intensive care unit (ICU) with heart failure (HF). Patients diagnosed with HF who experienced their first ICU stay lasting between 24h and 28days were selected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The primary outcome was all-cause mortality within 28days. Data analysis was performed using Python and R, with feature selection conducted via least absolute shrinkage and selection operator (LASSO) regression. Fifteen models were evaluated, and the most effective model was rendered explainable through the Shapley additive explanations (SHAP) approach. A nomogram was developed based on logistic regression to facilitate interpretation. For external validation, the eICU database was utilized. After selection, the study included 2343 records, with 1808 surviving and 535 deceased patients. The median age of the study population was 70.00, with ~3/5 males (60.31%). The median length of stay in the ICU was 6.00days. The median age of the survival group was younger than the non-survival group (69.00 vs. 73.00), and non-survival patients spent longer time in the ICU. Seventy-five features were initially selected, including basic information, vital signs, laboratory tests, haemodynamics and oxygen status. LASSO regression determined the shrinkage parameter α=0.020, and 44 features were chosen for model construction. The linear discriminant analysis (LDA) model showed the best performance, and the accuracy reached 0.8354 in the training cohort and 0.8563 in the testing cohort. It showed satisfying area under the curve (AUC), recall, precision, F1 score, Cohen's kappa score and Matthew's correlation coefficient. The concordance index (c-index) reached 0.7972 in the training cohort and 0.8125 in the testing cohort. In external validation, the LDA model achieved approximately 0.9 in accuracy, precision, recall and F1 score, with an AUC of 0.79. Univariable analysis was performed in the training cohort. Features that differed significantly between the survival and non-survival groups were subjected to multiple logistic regression. The nomogram built on multiple logistic regression included 14 features and demonstrated excellent performance. The AUC of the nomogram is 0.852 in the training cohort, 0.855 in the internal validation cohort and 0.770 in the external validation cohort. The calibration curve showed good consistency. The study developed an LDA and a nomogram model for predicting mortality in HF patients in the ICU. The SHAP approach was employed to elucidate the LDA model, enhancing its utility for clinicians. These models were made accessible online for clinical application.

Association of Lactate Levels and Mortality in Intensive Care Units

Most critically ill patients experience hemodynamic disorders that cause a decrease in blood perfusion, resulting in hypoxia that can increase lactate production. This study will examine the relationship between lactate levels and mortality in intensive care. This study uses a quantitative observational analytical method with a cross-sectional study design and using medical record data. Data analysis was carried out using an Independent T-test to see if there was a significant difference between lactate levels in the blood of dead and living subjects. This study, 154 subjects were obtained, consisting of 96 males (62.3%) and 58 females (37.7%). The average lactate level in the death group was 3.99, and the live group was 2.4 (p=0.004). Subjects with higher lactate levels have higher mortality rates. Lactate levels are one of the indicators of tissue oxygenation in critically ill patients. Hyperlactatemia is common in critically ill patients and can reflect an imbalance between local or systemic oxygen delivery and demand. Hyperlactatemia can cause lactic acidosis or metabolic acidosis and is associated with high mortality outcomes. Increased lactate levels are also associated with the development of Multiple Organ Dysfunction Syndrome (MODS). Subjects with high lactate levels are often associated with a variety of etiologies and poor prognosis, especially critical patients in the Intensive Care Unit (ICU). There was a relationship between blood lactate levels and mortality in ICU patients.

Aerosolized plus intravenous polymyxin B in comparison to intravenous polymyxin B alone for the management of HAP caused by carbapenem-resistant gram-negative bacteria: A prospective multicenter cohort study.

This study aimed to evaluate the clinical effectiveness of combined aerosolized (AER) and intravenous (IV) polymyxin B in managing patients with hospital-acquired pneumonia (HAP) caused by carbapenem-resistant gram-negative organism (CRO). This multicenter prospective cohort study was conducted across six intensive care units in municipal and above-municipal hospitals in Shaanxi, China, from January 1, 2021 to December 31, 2022. Patients with CRO pneumonia were categorized into the intravenous group (IV polymyxin B alone) and the combination group (AER plus IV polymyxin B). Primary outcomes included ICU mortality, 28-day mortality and bacterial clearance, while secondary outcomes included the duration of mechanical ventilation and length of ICU stay. A total of 64 patients were included in the study, with 29 receiving AER plus IV polymyxin B and 35 receiving IV polymyxin B alone. On the seventh day of treatment, the combination group showed a significant reduction in the APACHE II score (17.86 ± 5.03 vs. 19.17 ± 11.02, P = 0.041) and procalcitonin levels (1.27 ± 0.20 vs. 3.18 ± 0.69, P < 0.001) compared to the intravenous group. Additionally, the combination group exhibited a higher bacterial eradication rate (62.1% vs. 42.9%), lower ICU mortality (27.6% vs. 37.1%), shorter duration of mechanical ventilation (371.39 ± 68.97 h vs. 563.94 ± 100.25 h), and reduced ICU stay (34.41 ± 17.87 d vs. 35.03 ± 21.66 d), although the differences were not statistically significant. In patients with CRO pneumonia, combination therapy resulted in significant reductions in APACHE II scores and procalcitonin, but did not lead to statistically significant improvements in clinical outcomes, compared to IV polymyxin B alone.

The effectiveness of probiotics or synbiotics in the prevention and treatment of diarrhea among critically ill adults: a systematic review and meta-analysis

Diarrhea is one of the most common complications among patients in the Intensive Care Unit (ICU). Alongside common medical products for managing diarrhea, attention has been directed toward natural approaches, such as the use of probiotics or synbiotics supplements. The purpose of this review is to evaluate the effectiveness of probiotics or synbiotics in the prevention and treatment of diarrhea, mortality, and length of ICU stay. In adherence to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) statement, a systematic review and meta-analysis was conducted. Relevant articles were identified by searching PubMed, SpringerLink, and ScienceDirect databases. Quality assessment was done using Cochrane Collaboration's tool for randomized-controlled trials (ROB2). 6,305 articles were identified, of which 14 papers were included. Probiotics reduced the risk of diarrhea by 10%; however, the result was not statistically significant [Risk Ratio (RR) = 0.90; 95% Confidence Interval (CI): 0.77 to 1.05; P = 0.16; I2 = 29%; 13 studies]. No statistical significance was found among studies regarding reducing the duration of diarrhea, with considerable heterogeneity [RR = - 0.53; 95% CI: -1.46 to 0.41; P = 0.27; I2 = 71%, 5 studies]. Neither the length of ICU stays nor the mortality rate was affected by the use of probiotics or synbiotics. Probiotics or synbiotics appear to slightly reduce the incidence of diarrhea among ICU patients. However, this effect is considered statistically significant only after conducting sensitivity and subgroup analyses. Further high-quality clinical trials are required to evaluate the potential of probiotics or synbiotics in the treatment of diarrhea among critically ill patients.

High vs low protein intake in chronic critical illness: A systematic review and meta-analysis.

Patients with persistent organ dysfunction after the first week of intensive care unit (ICU) admission are considered to have chronic critical illness (CCI). Acquired muscle weakness is a common feature of CCI that is accompanied by loss of muscle mass and electromyographic features of myopathy. Optimizing protein intake may help prevent acquired muscle weakness and/or promote muscle recovery, however, the optimal level of protein intake in CCI is uncertain and there is a lack of consensus in published nutritional guidelines. This systematic review focuses on the impact of high versus low protein intake as part of a nutritional strategy for patients with CCI. The terms "protein intake" and "critically ill" were systematically searched in PUBMED, CENTRAL (Cochrane Central Register of Controlled Trials), and WEB OF SCIENCE on 06/01/2023. We included studies that (1) enrolled critically ill adults (aged 18 years or over) who were in the ICU for more than 7 days and that compared (2) protein intake above and below 1.3 gr/kg administered by any route (enteral and/or parenteral), (3) had an intervention period that occurred primarily after the first 7 days of critical illness and (4) reported clinical outcomes including length of ICU and hospital stay, duration of invasive mechanical ventilation (IMV), mortality, ICU acquired infections, muscle mass and physical function. Studies pertaining to elective surgery, those with intervention periods shorter than 7 days or occurring primarily within the first 7 days of critical illness, those measuring only laboratory parameters as outcomes, and safety and feasibility studies were excluded. Four studies were included (N=1730) in the meta-analysis and systematic review. Higher (>1.3g/kg/d) versus lower protein intake was associated with a decrease in early mortality (defined as ICU or 28-day mortality) hazard ratio (HR) 0.42 (95% confidence interval (CI): 0.26-0.70, P<0.001), but had no impact on late mortality (defined as the latest mortality timepoint in each study): HR 0.93 (95% CI 0.76-1.15, P=0.51). There was no significant difference between intervention and control groups with respect to duration of IMV, duration of ICU or hospital stay, muscle mass, or the incidence of ICU-acquired infections. One study reported improvements in physical function at 3 and 6 months in the intervention group. After the first week of critical illness, increasing protein intake to >1.3g/kg/d may improve early mortality but not late mortality or other clinical outcomes. The small number of relevant studies and the heterogeneity of outcomes assessed, weaken these conclusions. Further studies are warranted to discern whether higher protein intake is beneficial in chronic critical illness. PROSPERO registration number: CRD42023403554; PROSPERO registration name: "The effect of higher than 1,3g/kg of protein versus lower intake in chronic critically ill patients".

Correlation of Clinical Frailty Scale Assessment and in-Hospital Mortality in Elderly Critically Ill Patients Admitted to Intensive Care Units of Private Sector Tertiary Care Hospital

Frailty is a complex geriatric condition marked by increased vulnerability to adverse health events. In intensive care unit patients, there is a clear correlation between the Clinical Frailty Scale and higher short- and long-term mortality rates. Objectives: To evaluate the prognostic importance of frailty, measure the risk of death in the Intensive Care Unit for all Clinical Frailty Scale scores, and methodically evaluate the association between frailty and Intensive Care Unit mortality. Methods: This cross-sectional study was conducted over 1 year (Jan 2023 to July 2023) at the Department of Medical Intensive Care Unit of Ziauddin University Hospital, Karachi Pakistan. Irrespective of gender, all patients of age more than 60 years admitted to the Medical Intensive Care Unit were included. In this study, individuals ≥60 years of age had their pre-admission frailty and hospital mortality compared using the Clinical Frailty Scale. Results: The median age was 75 years. The overall mortality rate was 9.9%. The Clinical Frailty Scale score indicated that 29.7% of patients were classified as non-fragile, 18.7% as vulnerable or pre-fragile, and 51.6% as frail. A significant association of Clinical Frailty Scale assessment was observed with gender, age, outcome, Acute Physiology and Chronic Health Evaluation score and invasive (mechanical ventilation). According to multivariate logistic regression, patients on mechanical ventilators have a higher mortality rate. Conclusions: It was concluded that the findings demonstrated a strong correlation between mortality and the Clinical Frailty Scale among critically sick patients admitted to the intensive care unit.

Does the SOFA Score Have the Ability to Predict Length of Stay and Mortality as well as Other Scorings?

Background: In the intensive care unit (ICU), critically sick pneumonia has a high mortality rate, so forecasting the prognosis is crucial for making decisions. Early detection of clinical deterioration and the implementation of early intervention and care can be achieved through the use of scoring systems. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system is a better system in predicting mortality in critically ill patients. However, in this study, we aim to observed the use of the Sequential Organ Failure Assessment (SOFA) score as a predictor of mortality and length of stay (LOS). Methods: From April to August 2023, we treated 125 critically sick pneumonia patients in the ICU as part of a prospective observational research. An integrated ICU mortality calculator was used to assess the performance of the APACHE II, Simplified Acute Physiology Score II (SAPS II), and SOFA scores. Descriptive statistics will be used for data analysis, and the Fisher exact test and Chi-square test will be used for testing. logistic regression and linear regression methods are used in multivariate analysis. If the p-value is less than 0.05, it will be statistically significant. Results: APACHE II, SAPS II, and SOFA scores were significant in predicting the outcome of critically ill pneumonia patients (cut-off of ≥14.5, ≥34.5, and ≥3.5, respectively). The Spearman rank correlation for LOS shows that APACHE II, SOFA, and SAPS II scores have a very weak relationship with the p-values are 0.121, 0.766, and 0.436, respectively. Conclusion: The SOFA score is a good mortality predictor in critically ill pneumonia patients yet is simpler and easier to use in all settings in the hospital.

Mean Platelet Volume-to-Platelet Count Ratio (MPR) in Acute Exacerbations of Idiopathic Pulmonary Fibrosis: A Novel Biomarker for ICU Mortality

Mean Platelet Volume-to-Platelet Count Ratio (MPR) in Acute Exacerbations of Idiopathic Pulmonary Fibrosis: A Novel Biomarker for ICU Mortality

The effects of blood lactate level on mortality in patients developing sepsis in intensive care unit

Aim: Sepsis is a serious condition with high mortality and morbidity in intensive care units (ICUs). Mortality decreases with early and appropriate antimicrobial treatment. We aimed to investigate the relationship between lactate levels and mortality in the ICU of our hospital. Methods: Patient records &gt; 18, hospitalized in the ICU of Meram State Hospital between January 2022 and January 2024, were retrospectively examined. All patients microbiologically confirmed to have positive blood culture results and diagnosed sepsis were included in the study. Age on admission, gender, diagnoses at hospitalization, Apache II, length of stay, and mortality in ICU were obtained from patients’ medical records. In the presence of suspicion of sepsis in a patient hospitalized in intensive care and in the first 72 hours after antibiotic treatment, the lactate level was recorded. Lactate clearance was defined as the percent decrease in lactate from ICU department presentation to hour 72. Mortality rates within the first 28 days were recorded. Lactate levels were compared in patients with and without mortality. The value of lactate in predicting mortality was evaluated statistically. Results: Of 56 patients included in the study, whose diagnoses of sepsis were microbiologically proven, 38 (67.9%) died. The area under a receiver operating characteristic (ROC) curve Area under curve (AUC) of lactate in predicting mortality was 0.738 [95% confidence interval (CI): 0.590 –0.886, (p=0.004)]. Threshold lactate value for mortality was 1.7 mmol/L (sensitivity: 73.7%, specificity: 61.1%). While lactate levels, lactate clearance, length of hospital stay, Acute Physiologic and Chronic Health Evaluation (APACHE II) score were statistically significant between sepsis patients with and without mortality (p=0,004, p = 0.03 p= 0,00 p=0.003). Baseline lactate was in survivors 2.05±1.37 and in nonsurvivors 1.33±0.98 mmol/L. Survivors compared with nonsurvivors had a lactate clearance of 48.2 ± 24.4 vs. 22.06 ± %, respectively (p = 0.007). It showed lactate clearance to have a significant relationship with mortality (p = 0.03). Conclusion: Here, we found that lactate level and, lactate clearance may be a significant place in the early treatment and follow-up of sepsis patients in ICUs.

P-2241. Monocyte Distribution Width (MDW) as a Biomarker to Distinguish Septic Shock with Bacteremia from Cardiogenic Shock

Abstract Background Shock is associated with high mortality in intensive care units with resultant urgency for rapid diagnosis. The monocyte distribution width (MDW) is a biomarker that is elevated in sepsis and septic shock and is readily obtained from routine leukocyte differential testing. It is unknown whether MDW is also elevated in other kinds of shock. The purpose of this study was to evaluate the potential of MDW to discriminate between cardiogenic and septic shock. Boxplot of the MDW values by those with cardiogenic shock vs those with septic shock (A). The receiver operator curves for the prediction of septic shock (B) and cardiogenic shock (C) using MDW cut-off values, resulting in an AUC of 0.892. Methods This study was a single-center retrospective analysis of adult patients admitted between 1/31/2023 and 12/27/2023 with either cardiogenic shock requiring inotropic or mechanical support or septic shock with bacteremia requiring vasopressor support derived from EHR database search for diagnosis codes. All patients required hemodynamic support and were excluded if any confounding immunosuppressive medications or conditions (e.g., advanced HIV infection, transplant, active malignancy on treatment) were present. Patients with cardiogenic shock were excluded if concomitant infection at the time of admission was identified. MDW was collected at the time of initial presentation. Study population demographics and results by shock category. Results 171 patients met inclusion criteria: 81 with septic shock and 90 with cardiogenic shock. 56.7% of patients with cardiogenic shock received empiric antibiotics on admission. The MDW was significantly higher in the septic shock group. Using estimated cut-off values of MDW &amp;gt; 21.53 for septic shock and MDW &amp;lt; 28.99 for cardiogenic shock each produced an AUC (area under the curve) of 0.892. Elevated SOFA score, elevated WBC, and female sex were associated with increased odds of septic shock. Adding the WBC count to MDW in the logistic regression for septic shock only minimally improved the AUC. Conclusion MDW may be a useful tool in stratifying the risk of septic or cardiogenic shock. MDW above 28.99 supports a diagnosis of septic shock with bacteremia while MDW below 21.53 supports a diagnosis of non-septic shock; values from 21.53-28.99 are less predictive. A low MDW in patients with shock may exclude the need for empiric antibiotics and improve stewardship. Further work is needed to better characterize the performance of this assay in other populations and shock phenotypes. Disclosures Ryan C. Maves, MD, AiCuris: Grant/Research Support|Biotest: Grant/Research Support|GeoVax: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria|Sound Pharmaceuticals: Grant/Research Support

P-2213. Lung Microbiome Diversity Associated with Hospital Mortality in Intubated Patients Admitted to the ICU

Abstract Background The lung microbiota of healthy individuals tends to remain stable, but dysbiosis disrupts pulmonary homeostasis, impacting respiratory illness severity and mortality rates. Understanding lung microbiome alterations and their impact on clinical outcomes in ICU-admitted patients has been proposed as a crucial point to improve clinical outcomes, yet this area still needs to be explored. Therefore, this study aims to investigate microbial composition in the lower respiratory tract and assess whether microbial diversity in mechanically ventilated ICU patients is linked to mortality.Figure 1. Beta Diversity Comparisons in the Respiratory Microbiomes of BAL Samples from ICU Admitted Patients Stratified by Hospital Mortality.The beta diversity of bronchoalveolar lavage (BAL) samples from ICU-admitted patients is illustrated through a PCoA scatter plot utilizing Bray-Curtis distances, showing a significant albeit modest differentiation between groups (p = 0.029). The variance explained by each principal coordinate is delineated in the axis titles (p = 0.51 for PC1 and p = 0.01 for PC2). Methods Conducted at Clinica Universidad de La Sabana in Colombia from January 2020 to July 2022, this prospective cohort study enrolled ventilated patients within 12 hours of ICU admission. Bronchoalveolar lavage samples were collected on the day of intubation. The operational taxonomic units (OTUs) were identified using 16S ribosomal RNA (rRNA) gene sequencing. Statistical analyses were performed using RStudio.Figure 2. Comparison of Relative Abundance of OTUs Stratified by Hospital Mortality in ICU Admitted Patients.Percent of relative abundance of the top 20 most abundant microbes in the lungs. Student's t-test was used to calculate the p-value. Asterisks denote the level of significance ​observed: * = p ≤ 0.05; ** = p ≤ 0.01; *** = p ≤ 0.001.​ Results The analysis of 141 intubated patients revealed a predominantly male population (65% [91/139]) with a median (IQR) age of 50.0 years (30.5-67.0). Sequencing generated 20808915 reads and identified 18477 OTUs, with an average of 130873 reads and 13 OTUs per bronchoalveolar lavage sample. Subsequent refinement significantly reduced OTUs to 2096. Comparative analysis, employing Bray-Curtis distances, indicated a statistically significant differentiation (p = 0.02) between patients who died during hospitalization and survivors (Fig. 1). The primary components explained 73.2% of the data variance (R^2=0.73). Prevotella, Acinetobacter, Streptococcus, Staphylococcus, and Veillonella were the predominant OTUs identified in terms of relative abundance, although no significant differences were observed between groups (Fig. 2). Conclusion Dysbiosis of the lung microbiome, characterized by a reduction in the beta diversity and increased concentration of Acinetobacter, was associated with increased mortality in patients requiring invasive mechanical ventilation at ICU admission. These findings highlight the importance of comprehending lung microbial alterations in ICU settings and their potential implications for intubated patients. Disclosures All Authors: No reported disclosures

P-298. Treatment of Carbapenem-Resistant Gram Negative Bacteremia based on Polymixin MIC

Abstract Background Recent studies from India have noted increasing resistance against ceftazidime- avibactam in enterobacteriacea and non-fermenters and hence, polymixins are mainstay in the treatment of carbapenem-resistant gram negative (CRGN) infections. There is no susceptible breakpoint for polymixins in view of concerns with clinical outcome and therefore, guidelines recommend combination therapy. However, studies have failed to show the superiority of polymixin combination therapy over monotherapy. Invitro data shows ≥ 90% PK-PD target attainment for isolates with colistin MIC ≤ 0.5 mg/L, but lower success rates in isolates with higher MICs. Aim of the study is to evaluate if the choice of treatment of CRGN infections can be guided by polymixin MIC. Methods We retrospectively evaluated critically-ill patient with CRGN bacteremia with intermediate in vitro susceptibility to colistin (MIC ≤ 2 mg/L; as per CLSI) at a tertiary care hospital in India from January 2022- June 2023. Patients who received treatment for the CRGN bacteremia for &amp;lt;48 h were excluded. Based on polymixin MIC, patients were grouped into two study groups: those that received polymixin monotherapy and those that received polymixin in combination with another agent susceptible in vitro. Chi-square test was used for categorical data and student’s t-test for continuous data. Analysis was performed using SPSS v28 and statistical significance was defined as p &amp;lt; 0.05. Results Of the 114 patients with CRGN bacteremia, 64 (56%) had an MIC of ≤ 0.5 and 50 (44%) had MIC ≥ 1. There was no statistically significant difference in the ICU mortality between monotherapy and combination therapy arms (16% vs 15%; P = 0.9778) for polymixin MIC ≤ 0.5. However, when the MIC was ≥ 1, a higher mortality was observed in the polymixin monotherapy arm (82% vs 39%; P = 0.0029). Conclusion Isolates with MIC ≤ 0.5 can be treated with polymixin monotherapy alone while isolates with MIC ≥ 1 require a combination therapy of polymixin with another antibiotic suseptible invitro. However, this is a single centre retrospective study and further clinical trials are required to ascertain the feasibility of polymixin MIC guided treatment of CRGN infections. Disclosures All Authors: No reported disclosures