Independent Predictor Of Intensive Care Unit Mortality Research Articles

Prevalence, Risk Factors, and Mortality of New-Onset Atrial Fibrillation in Mechanically Ventilated Critically Ill Patients.

Background/Objectives: Critically ill patients admitted to the intensive care unit (ICU) frequently develop new-onset atrial fibrillation (NOAF) due to numerous risk factors. While NOAF has been associated with increased mortality, it remains unclear whether it serves merely as a marker of illness severity or directly contributes to adverse outcome. This study aimed to determine the incidence and risk factors for NOAF in a homogenized population of mechanically ventilated patients at ICU admission, excluding well-established predisposing factors. Additionally, we examined the impact of NOAF on mortality in this context. Methods: We prospectively studied consecutive patients over a 3-year period to identify triggers for NOAF. Factors associated with 30-day mortality during the ICU stay were recorded. Demographic data, medical history, laboratory findings, and the severity of illness at admission were compared between patients who developed NOAF and those remaining in sinus rhythm. In NOAF patients, the course of atrial fibrillation (resolution, persistence, or recurrence) was evaluated during the 30-day ICU stay. Results: Of the 1330 patients screened, 685 were eligible for analysis, with 110 (16.1%) developing NOAF. Septic episodes occurred more frequently in the NOAF group compared to the no-NOAF group (92.7% vs. 58.1%, p < 0.001). Notably, 80% of NOAF patients developed a septic episode concurrently with the atrial fibrillation, often stemming from secondary infections, and 85.3% presented with septic shock. When focusing on patients with at least one septic episode during the 30-day ICU stay, 23.4% of them developed NOAF. Additionally, patients with NOAF were older and had a higher prevalence of hypertension; disease severity at admission was not a triggering factor. Mainly sepsis, but also advanced age, and a history of hypertension remained independent factors associated with its occurrence. Sepsis, primarily, along with advanced age and a history of hypertension, was identified as independent factors associated with the occurrence of NOAF. Mortality was higher in the NOAF group compared to the control group (39 patients (35.5%) vs. 138 patients (24%), p = 0.01). NOAF occurrence, sepsis, disease severity at admission, and age were associated with increased ICU mortality; however, NOAF was not found to be an independent predictor of ICU mortality in multivariate analysis. Instead, sepsis, age, and disease severity at admission remained independent predictors of 30-day mortality. Sinus rhythm was restored in 60.9% of NOAF patients within 48 h, with the improvement or stabilization of sepsis being crucial for rhythm restoration. Conclusions: NOAF is a common complication in intubated ICU patients and is independently associated with sepsis, advanced age, and hypertension. While NOAF is linked to increased ICU mortality, it is more likely a marker of disease severity than a direct cause of death. Sepsis improvement appears critical for restoring and maintaining sinus rhythm.

Comparison of lactate/albumin ratio and established scoring systems for predicting mortality in critically ill cirrhotic patients.

critically ill cirrhotic patients may present a serious clinical condition defined as acute-on-chronic liver failure with high mortality. While established scoring systems like Child-Pugh and Model for End-stage Liver Disease (MELD) offer prognostic insights, their limitations warrant exploration of alternative markers. The lactate/albumin ratio (LAR) serves as a potential prognostic indicator in critical care settings, yet its utility in cirrhotic patients remains underexplored. one hundred and seventy-five critically ill cirrhotic patients were assessed in this retrospective cohort study. Clinical severity scores, including Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Chronic Liver Failure-Organ Failure Score (CLIF-OF) were compared with LAR along with traditional liver failure scoring systems. Logistic regression and receiver operating characteristic (ROC) curve analysis were used to evaluate prognostic performance. Intensive Care Unit (ICU) nonsurvivors had significantly higher scores in all liver failure and clinical severity scores compared to survivors (p < 0.001). Median LAR was significantly higher in nonsurvivors (p < 0.001). ROC analysis revealed comparable prognostic accuracy between LAR, APACHE II, SOFA, and CLIF-OF scores in predicting ICU mortality. Logistic regression identified SOFA score at 48th hour, LAR, and requirement of mechanical ventilation as independent predictors of ICU mortality. LAR demonstrates promising prognostic utility in predicting ICU mortality among critically ill cirrhotic patients, complementing established scoring systems. Early reassessment using SOFA score at 48th hour may guide therapeutic interventions and improve patient outcomes. Further prospective studies are warranted to validate these findings and optimize clinical management strategies.

Clinical usefulness of presepsin and monocyte distribution width (MDW) kinetic for predicting mortality in critically ill patients in intensive care unit.

In this study, we explored the accuracy of two new sepsis biomarkers, monocyte distribution width (MDW) and presepsin (PSP), compared to traditional ones, C-reactive protein (CRP) and Procalcitonin (PCT), to identify sepsis and predict intra-hospital mortality by analyzing their kinetic at different time points during hospitalization stay. We enrolled 104 patients admitted to the intensive care unit (ICU) of University Hospital "Paolo Giaccone", Palermo. Among these, 30 (29%) had a clinical diagnosis of sepsis. MDW, PCT, CRP, and PSP were evaluated at admission (T0), after 24 h (T24), 48 h (T48), 72 h (T72), at day 5 (T5), and at discharge (TD). Patients with sepsis displayed higher levels of PCT and PSP than patients without sepsis at each timepoint; differently, CRP displayed statistically significant differences only at T0, while MDW only at T0 and T24. Patients with increasing levels of PSP displayed lower median survival time than patients with decreasing levels; differences reached statistical significance only at 48 h (20 vs. 29 days, log rank test, p = 0.046). Interestingly, PSP was an independent predictor of ICU mortality at 48 and 72 h after hospital admission. Also, the kinetic of PSP had prognostic value, with increased values at 48 h after admission being associated with reduced survival. Our findings support the role of PSP and its kinetic as a predictor of ICU mortality.

Characteristics and outcomes of patients admitted to intensive care units in Uganda: a descriptive nationwide multicentre prospective study

Intensive care unit (ICU) mortality rates have decreased over time. However, in low-and lower-middle income countries (LMICs), there remains an excess ICU mortality with limited understanding of patient characteristics, treatments, and outcomes from small single centre studies. We aimed therefore, to describe the characteristics, therapies and outcomes of patients admitted to all intensive care units in Uganda. A nationwide prospective observational study including all patients admitted Uganda’s ICUs with available daily charts was conducted from 8th January 2018 to 1st April 2018. Socio-demographics and clinical characteristics including worst vital signs in the first 24 h of admission were recorded with calculation of the National Early Warning Score (NEWS-2) and quick Sequential Organ Function Assessment (qSOFA) score. ICU interventions were recorded during the ICU stay and patients were followed up to 28 days in ICU. The primary outcome was 28 day ICU mortality. Three-hundred fifty-one patients were analysed with mean age 39 (24.1) years, 205 (58.4%) males with 197 (56%) surgical admissions. The commonest indication for ICU admission was postoperative care (42.9%), 214 (61%) had at least one comorbidity, with hypertension 104 (48.6%) most prevalent and 35 (10%) HIV positive. The 28 day ICU mortality was 90/351 (25.6%) with a median ICU stay of 3 (1–7) days. The highest probability of death occurred during the first 10 days with more non-survivors receiving mechanical ventilation (80% vs 34%; p < 0.001), sedation/paralysis (70% vs 50%; p < 0.001), inotropic/vasopressor support (56.7% vs 22.2%; p < 0.001) and renal replacement therapy (14.4% vs 4.2%; p < 0.001). Independent predictors of ICU mortality included mechanical ventilation (HR 3.34, 95% CI 1.48–7.52), sedation/paralysis (HR 2.68, 95% CI 1.39–5.16), inotropes/vasopressor (HR 3.17,95% CI 1.89–5.29) and an HIV positive status (HR 2.28, 95% CI 1.14–4.56). This study provides a comprehensive description of ICU patient characteristics, treatment patterns, and outcomes in Uganda. It not only adds to the global body of knowledge on ICU care in resource-limited settings but also serves as a foundation for future research and policy initiatives aimed at optimizing ICU care in Sub-Saharan Africa.

Sequential Organ Failure Assessment (SOFA) Score for predicting mortality in patients with sepsis in Vietnamese intensive care units: a multicentre, cross-sectional study

ObjectivesTo compare the accuracy of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) Scores in predicting mortality among intensive care unit (ICU)...

Prognostic Factors and Intensive Care Outcome in Post-Transplant Phase of Hematopoietic Stem Cell Transplantation: Intensive Care Outcome in Hematopoietic Stem Cell Transplantation.

To identify new clinical and biologic parameters associated with short-term survival in allogeneic or autologous hematopoietic stem cell transplantation (HSCT) patients who were admitted to the intensive care unit (ICU) during their post-transplant period. 40 patients who were admitted to the ICU in our center during their post-transplant period were evaluated retrospectively between Jan 2014 - Jun 2021. Baseline patient characteristics before the transplant, reasons for ICU admissions, laboratory and clinical findings, supportive treatment in ICU and short-term survival were analyzed. We found 8.8% ICU admission rate in all patient group (n = 450). Mortality rate of the patients who were admitted to ICU was 75%. Invasive mechanic ventilation, need for vasopressor, heart rate was significantly different between survivor and non-survivor group (p = 0.001, p = 0.001, p = 0.004). Elevated INR was associated with poor survival on ICU (p = 0.033). APACHE II score was an independent predictor of ICU mortality (p = 0.045). Despite the recent advances in transplant conditioning protocols, prophylaxis strategies and improvements of management in ICU, overall survival for HSCT patients in ICU is still poor. In this study INR level was described as a new prognostic factor in ICU for first time in the literature.

The value of NSE to predict ICU mortality in patients with septic shock: A prospective observational study.

To investigate the predictive value of neuron-specific enolase (NSE) on intensive care unit (ICU) mortality in patients with septic shock.Seventy-five patients with septic shock hospitalized in the emergency intensive care unit (EICU) of Hebei General Hospital from March 2020 to September 2021 were included, and the patients’ baseline characteristics and laboratory findings were collected. NSE levels on the first and fourth days after admission were retrieved. NSE% [(NSEday1 – NSEday4)/NSEday1 × 100%] and δNSE (NSEday1 – NSEday4) were calculated. The outcome indicator was ICU mortality. The patients were divided into the survivors group (n = 57) and the nonsurvivors group (n = 18). Multivariate analysis was performed to assess the relationship between NSE and ICU mortality. The predictive value of NSE was evaluated using receiver operating characteristic (ROC) curve.There were no significant differences in age, gender, systolic blood pressure (SBP), heart rate (HR), acute physiology and chronic health evaluation II score (APACHE II score), source of infection, and comorbidities between the 2 groups (all P > .05). Interleukin-6 (IL-6), NSE (day1), and NSE (day4) were significantly higher in patients in the nonsurvivors group (all P < .05), and there were no statistical differences in other laboratory tests between the 2 groups (all P > .05). APACHE II score, IL-6, lactate (Lac), total bilirubin (TBil), NSE (day1), and NSE (day4) showed a weak positive correlation with ICU mortality in patients with septic shock (all P < .05). Multivariate logistic regression analysis demonstrated that APACHE II score (odds ratio [OR] = 1.166, 95% confidence interval [95% confidence interval [CI]] 1.005–1.352, P = .042), IL-6 (OR = 1.001, 95% CI 1.000–1.001, P = .003) and NSE (day4) (OR = 1.099, 95% CI 1.027–1.176, P = .006) were independently associated with the ICU mortality of sepsis shock patients. The area under the curve (AUCs) of APACHE II score, IL-6, NSE (day1), and NSE (day4) for predicting prognosis were 0.650, 0.694, 0.758 and 0.770, respectively (all P < .05). NSE(day4) displayed good sensitivity and specificity (Sn = 61.11%, Sp = 91.23%) for predicting ICU mortality with a cutoff value of 25.94 ug/L.High-level NSE (day4) is an independent predictor of ICU mortality in sepsis shock patients, which may become a good alternate option for evaluating sepsis severity. More extensive studies are needed in the future to demonstrate the prognosis value of NSE.

Atrial fibrillation in COVID-19 patients admitted to an intensive care unit: prevalence and prognosis

Abstract Background The association between atrial fibrillation (AF) and prognosis has been studied in non-COVID-19 patients, but few studies reflect the reality of critically ill COVID-19 patients admitted to a general intensive care unit (ICU). Purpose This study sought to investigate the relationship between previous and new-onset AF in COVID-19 patients admitted to an ICU and prognosis. Methods We retrospectively analyzed patients consecutively admitted to an ICU with COVID-19 and followed them for a median period of 7 months. Patients admitted due to trauma or emergent surgery were excluded from the analysis. Three groups were identified: without AF (G1), with prior history of AF (G2), and with new-onset AF (G3). Groups were compared, with special interest regarding ICU mortality, duration of mechanical ventilation, length of hospitalization, major adverse cardiac events (MACE), and re-hospitalization. MACE was defined as all-cause ICU mortality, new-onset heart failure, acute coronary syndrome, ventricular arrhythmias, pulmonary embolism, myocarditis, and stroke (ischemic or hemorrhagic). Results A total of 297 patients was included in the analysis: without AF (248 patients, 83.5%), with prior history of AF (15 patients, 5.1%), and with new-onset AF (34 patients, 11.4%). Median age was 62 (IQR 17) years, and most patients were male (198 patients, 66.7%). Patients with a prior history of AF were older [median (IQR), G1 60 (16), G2 71 (12), G3 67 (15) years, p=0.001], were more likely to have a history of coronary artery disease (G1 4.9%, G2 26.7%, G3 11.8%, p=0.002), and history of heart failure (G1 6.5%, G2 33.3%, G3 17.6%, p&amp;lt;0.001). Patients with new-onset AF had a longer duration of mechanical ventilation [median (IQR), G1 9 (13), G2 11 (16), G3 18 (12) days, p&amp;lt;0.001), longer ICU length of stay [median (IQR), G1 12 (10), G2 13 (12), G3 19 (15), p=0.001], higher ICU mortality rate (G1 27.0%, G2 33.3%, G3 58.8%, p=0.001), and higher rate of MACE (G1 31.9%, G2 33.3%, G3 70.6%, p&amp;lt;0.001), compared to the other groups. There were no differences regarding sex distribution, other baseline comorbidities, need for invasive mechanical ventilation, vasopressor use, and re-hospitalization rates among groups. Most AF patients were treated with beta-blockers (39.6%) and amiodarone (77.1%), but only 68.8% of patients received anticoagulation (G2 92.9%, G3 58.8%), which may reflect that physicians underestimate the prognosis of new-onset AF. In multivariate analysis, new-onset AF (OR 3.07, 95% CI 1.42–6.67, p=0.005) and older age (OR 1.07, 95% CI 1.04–1.09, p&amp;lt;0.001) remained independent predictors of ICU mortality. Main results are presented in Table 1. Kaplan-Meier survival curves are presented in Figure 1. Conclusion(s) This study shows that critically ill COVID-19 patients with AF present a worse prognosis compared to patients without AF, and new-onset AF is an independent predictor of ICU mortality and MACE. Funding Acknowledgement Type of funding sources: None.

The Combined Use of Interleukin-6 with Serum Albumin for Mortality Prediction in Critically Ill Elderly Patients: The Interleukin-6-to-albumin Ratio.

The association between interleukin-6 (IL-6) and serum albumin (ALB) with mortality in critically ill elderly patients, either as stand-alone biomarkers or in combination, has been scarcely reported. We, therefore, aimed to investigate the prognostic value of the IL-6-to-albumin ratio in this special population. This was a cross-sectional study conducted in the mixed intensive care unit (ICU) of two university-affiliated hospitals in Malaysia. Consecutive elderly patients (aged above or equal to 60 years) admitted to the ICU, who underwent simultaneous measurement of plasma IL-6 and serum ALB, were recruited. The prognostic value of the IL-6-to-albumin ratio was assessed by analysis of the receiver-operating characteristic (ROC) curve. A total of 112 critically ill elderly patients were recruited. The outcome of all-cause ICU mortality was 22.3%. The calculated IL-6-to-albumin ratio was significantly higher in the non-survivors compared to the survivors {14.1 [interquartile range (IQR), 6.5-26.7] vs 2.5 [(IQR, 0.6-9.2) pg/mL, p <0.001]}. The area under the curve (AUC) of IL-6-to-albumin ratio for discrimination of ICU mortality was 0.766 [95% confidence interval (CI), 0.667-0.865, p <0.001] which was slightly higher than that of IL-6 and albumin alone. The ideal cut-off value of the IL-6-to-albumin ratio was above 5.7 with a sensitivity of 80.0% and specificity of 64.4%. After adjusting for severity of illness, the IL-6-to-albumin ratio remained as an independent predictor of ICU mortality with an adjusted odd ratio of 0.975 (95% CI, 0.952-0.999, p = 0.039). The IL-6-to-albumin ratio offers a slight improvement in mortality prediction than either of its constituent individual biomarkers and as such, it may be a potential tool to aid in the prognostication of critically ill elderly patients although this requires further validation in a larger prospective study. Lim KY, Shukeri WFWM, Hassan WMNW, Mat-Nor MB, Hanafi MH. The Combined Use of Interleukin-6 with Serum Albumin for Mortality Prediction in Critically Ill Elderly Patients: The Interleukin-6-to-albumin Ratio. Indian J Crit Care Med 2022;26(10):1126-1130.

New-onset atrial fibrillation predicts poor prognosis in critically ill COVID-19 patients

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction The association between new-onset atrial fibrillation (AF) and prognosis in critically ill non-COVID-19 patients and non-critically ill patients has been studied, but few studies reflect the reality of COVID-19 patients admitted to a general intensive care unit (ICU). Purpose This study sought to investigate the relationship between new-onset AF in COVID-19 patients admitted to an ICU and prognosis. Methods We retrospectively analyzed patients consecutively admitted to an ICU with COVID-19, with a median follow-up of 10 months. Two groups were identified, with new-onset AF and without new-onset AF. Groups were compared, with special interest regarding ICU mortality, duration of mechanical ventilation, in-hospital diagnosis of heart failure, NT-proBNP value in the first 48 hours after admission, and length of hospitalization. Mortality rate and re-hospitalization during follow-up were compared. Results From a total of 219 patients, AF was identified in 17.8% (n=39) of patients, of whom 69.2% (n=27) presented new-onset AF. Patients with new-onset AF were older (66.4 ±9.0 vs 61.5 ±12.2, p &amp;lt;0.001), with no differences regarding sex distribution. During hospitalization, patients with new-onset AF presented more often with new-onset heart failure (33.3% vs 6.3%, p &amp;lt;0.001), had a longer duration of mechanical ventilation (19.5 ±11 vs 9 ±12 days, p &amp;lt;0.001), longer ICU length of stay (20 ±12 vs 12 ±10 days, p&amp;lt;0.001), higher ICU mortality rate (55.6% vs 29.3%, p=0.006), and higher global mortality (55.6% vs 33.0%, p=0.022). Re-hospitalization rates were similar among groups (7.4% vs 6.3%, p=0.686). NT-proBNP in the first 48 hours was not statistically different among groups, although clinically new-onset AF patients presented higher values [median 1372 (IQR 3664) vs 246 (IQR 893), p=0.455). Main results are presented in Table 1. In multivariate logistic regression, after adjustment for age and APACHE II score, new-onset AF was identified as an independent predictor of ICU mortality (OR=2.475, 95% CI 1.05-5.84, p=0.039). Conclusion(s) The present study shows that new-onset AF in critically ill patients is not a trivial phenomenon and is closely related to the risk of death and worse in-hospital outcomes.

Prognostic value of cardiac troponin in critically ill COVID-19 patients

Funding AcknowledgementsType of funding sources: None.Background/IntroductionAmong patients with COVID-19, there is a high prevalence of cardiovascular disease and myocardial injury from the infection, especially in critically ill patients.PurposeThis study sought to investigate the relationship between elevated admission high-sensitive troponin I in COVID-19 patients admitted to an intensive care unit (ICU) and prognosis.MethodsWe retrospectively analyzed patients consecutively admitted to an ICU with COVID-19, with a median follow-up of 10 months. Patients who were diagnosed with acute coronary syndrome, either died or were discharged within 48 hours of admission, and who did not have a cardiac troponin measurement in the first 48 hours, were excluded.Two groups were identified, with normal troponin and with elevated troponin. Groups were compared, with special interest regarding in-hospital mortality, duration of mechanical ventilation, in-hospital diagnosis of heart failure, and length of hospitalization. Global mortality (in-hospital and during follow up) and re-hospitalization were compared. To compare survival, a Kaplan-Meier curve with log rank test was performed.ResultsFrom a total of 219 patients, after applying the exclusion criteria, 100 patients were included in the analysis, mean age was 62.9 ±12.5 years, and 74% were male.Troponin was normal in 77% of patients and elevated in 23%. Median troponin was 11 (IQR=26) ng/L (reference range <34 ng/L).Patients with elevated troponin were older (66.5 ±12.0 vs 61.6 ±12.5 years, p=0.036). Gender, comorbidities, vasopressor use, and APACHE II score were similar among groups. Patients with elevated troponin presented a higher ICU mortality (16.9% vs 47.8%, p=0.002) and higher global mortality (22.1% vs 47.8%, p=0.016). Re-hospitalization rates, ICU length of stay and duration of mechanical ventilation were similar among groups.In multivariate analysis, after adjustment for age and APACHE II score, an elevated troponin remained an independent predictor of ICU mortality (OR=3.40, 95% CI 1.08-10.4, p=0.036), but not an independent predictor of global mortality (OR=2.75, 95% CI 0.86-8.80, p=0.087).Kaplan-Meier analysis (Figures 1 and 2) showed that patients with elevated troponin had higher ICU (p=0.008) and global mortality (p=0.008) when compared to patients with normal admission troponin.Conclusion(s)The present study shows that elevated high-sensitive cardiac troponin I at admission predicts ICU and global mortality in critically ill COVID-19 patients. Cardiac troponin is as easy-to-use tool that may help to identify patients who benefit from tighter monitoring both during hospitalization and after discharge.

The Intensive care outcome of patients with a solid tumor in a tertiary care hospital in Saudi Arabia: Results of a prospective ICU Registry

Objective: There is a paucity of research on the factors predicting mortality and a length of stay in the Intensive Care Unit (ICU) with solid tumor patients. This study will assess the characteristics and predictors of outcomes of patients with solid tumors in medical ICU.&#x0D; Material and Methods: This research has been designed as a retrospective observational study using an ICU database. Patients who have a solid tumor were included in the study (May 2015 to July 2018). Post-surgical and those with a length of stay of more than one day are excluded from the study. We identified the predictors for ICU mortality and ICU long stay (≥21 days).&#x0D; Results: Out of 2883 patients, 364 patients with solid tumors were enrolled. The commonest sites for solid tumors were breast (15.9%), colorectal (11.5%), and lung (9.9%). 158 (43.4%) had metastatic disease, and 264 (72.5%) with progressive disease. The major reasons for ICU admission were a respiratory failure (52.7%) and severe sepsis (52.2%). The ICU and hospital mortality rates were 32.4% and 47%, respectively. Fifty patients (13.7%) had long stayed (≥ 21 days) in ICU. The independent predictors for mortality were Sequential Organ Failure Assessment (SOFA) score (OR, 1.2; 95% CI, 1.1–1.3; P=.000), invasive ventilation (OR, 3.5; 95% CI, 1.5–8.3; P=.004) and vasopressor (OR, 2.6; 95% CI, 1.1–5.9; P=.018), while the independent predictors of long-stay were ICU infections (odds ratio [OR], 18.9; 95% CI, 5.3 – 66.7; P=.0001), SOFA score (OR, 1.5; 95% CI, 1.2–1.8; P=.0001), invasive ventilation (OR, 8.2; 95% CI, 1.6–40.4; P=.009), bilirubin (OR, .5; 95% CI .2–.9; P=.049).&#x0D; Conclusion: Irrespective of the cancer stage, patients had a reasonable survival, and most do not require a long stay in the ICU. Flexibility in admission should be considered as disease progression and metastatic disease were not independent predictors of ICU mortality or long stay in this study.

Serum total triiodothyronine (T3) as a predictor of mortality and morbidity in critically ill patients and its correlation of predictability with acute physiology and chronic health evaluation II score: A prospective observational study.

Background:The aim is to assess the prognostic value of total T3, total T4, and thyroid-stimulating hormone among critically ill patients admitted to the medical intensive care unit (ICU) in association with mortality and its correlation with the acute physiology and chronic health evaluation II (APACHE II) score.METHODS: Our prospective observational study consists of 257 patients without known thyroid diseases admitted to the medical ICU. The baseline characteristics of the patients were recorded, including the APACHE II score and thyroid hormone levels at ICU admission. Based on the primary outcome of mortality, we analyzed the data by appropriate statistical methods. A P < 0.05 was considered significant.Results:Of the 257 patients included in the study, 47 (18.28%) succumbed to their illnesses. A significant difference in T3 levels (P < 0.001), T4 levels (P < 0.001), and APACHE II score (P < 0.001) was found between the survivors and the nonsurvivors. There was negative correlation observed between T3 and APACHE II score (r = −0.448, P < 0.001) and T4 and APACHE II score (r = −0.221, P ≤ 0.001). Multivariate logistic regression analysis determined T3 to be the only independent predictor of ICU mortality among thyroid hormones. The area under the curve (AUC) for T3 (0.811 ± 0.04) was almost equal to that of the APACHE II score (0.858 ± 0.029). The duration of ICU stay and hospital stay in patients with low T3 was significantly higher compared to patients with normal T3.Conclusion:Serum T3 is a good indicator for predicting mortality and morbidity among critically ill patients.

Preoperative thyroid hormone levels predict ICU mortality after cardiopulmonary bypass in congenital heart disease patients younger than 3 months old

BackgroundWe aimed to study the effectiveness of preoperative thyroid hormone levels in predicting intensive care unit (ICU) mortality after cardiopulmonary bypass (CPB) in infants with congenital heart disease (CHD).MethodsWe retrospectively reviewed and analyzed data from 133 patients younger than 3 months old who underwent cardiac surgery with CPB from June 2017 to November 2019. ICU mortality prediction was assessed by multivariate binary logistic regression analysis and area under the curve (AUC) analysis.ResultsNon-survivors were younger (17.46 ± 17.10 days vs. 38.63 ± 26.87 days, P = 0.006), with a higher proportion of neonates (9/13 vs. 41/120, P = 0.017) and a higher proportion of individuals with a Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) score ≥ 4 (8/13 vs. 31/120, P = 0.020). No significant difference was found in CPB and aortic cross-clamping (ACC) time. The levels of free triiodothyronine (FT3) (3.91 ± 0.99 pmol/L vs. 5.11 ± 1.55 pmol/L, P = 0.007) and total triiodothyronine (TT3) (1.55 ± 0.35 nmol/L vs. 1.90 ± 0.57 nmol/L, P = 0.032) were higher in survivors than in non-survivors. In the ICU mortality prediction assessment, FT3 was an independent mortality predictor and showed a high AUC (0.856 ± 0.040).ConclusionsThe preoperative FT3 level was a powerful and independent predictor of ICU mortality after CPB in infants with CHD younger than 3 months old.

Blood Urea Nitrogen to Serum Albumin Ratio Independently Predicts Mortality in Critically Ill Patients With Acute Pulmonary Embolism.

Acute pulmonary embolism (APE) is one of the prominent causes of death in patients with cardiovascular disease. Currently, reliable biomarkers to predict the prognosis of patients with APE are limited. The present study aimed to investigate the association of blood urea nitrogen to serum albumin (B/A) ratio and intensive care unit (ICU) mortality in critically ill patients with APE. A retrospective cohort study was performed using data extracted from a freely accessible critical care database (MIMIC-III). Adult (≥18 years) patients of first ICU admission with a primary diagnosis of APE in the database were enrolled in the study. The primary endpoint was the ICU mortality rate while the 28-day mortality after ICU admission was the secondary endpoint. The data of survivors and non-survivors were compared. A total of 1048 patients with APE were enrolled in this study, of which 131 patients died in ICU and 169 patients died within 28 days after ICU admission. The B/A ratio in the non-survivors group was significantly higher compared to the survivors group (P < 0.001). The multivariate analysis revealed that the B/A ratio was an independent predictor of ICU mortality (odds ratio [OR] 1.10, 95% CI 1.07-1.14, P < 0.001) and all-cause mortality within 28 days after ICU admission (hazard ratio [HR] 1.07, 95% CI 1.05-1.09, P < 0.001) in APE patients. The B/A ratio showed a greater area under the curve (AUC) of ICU mortality prediction (0.80; P < 0.001) than simplified acute physiology score II (SAPSII) (0.79), systemic inflammatory response syndrome score (SIRS) (0.62), acute physiology score III (APSIII) (0.76) and sequential organ failure assessment (SOFA) score (0.71). The B/A ratio could be a simple and useful prognostic tool to predict mortality in critically ill patients with APE.

Shock on Admission as a Potential Marker for ICU Mortality of Cardiac Arrest Patients.

To investigate the association of shock on admission with predicting intensive care unit (ICU) mortality, hospital mortality, and neurological outcomes of post cardiac arrest patients.This was a retrospective study of cardiac arrest (CA) patients admitted to ICU. Student's t test and Chi-square test were performed to compare the difference of non-shock and shock group. Multivariable regression analysis was performed to investigate shock and its association with ICU mortality, hospital mortality, and neurologic outcomes and linear regression analysis to explore its correlation with length of stay in hospital.A total of 374 CA patients were analyzed, with 200 (53.5%) patients in the presence of shock on admission. Shock was significantly associated with higher ICU mortality (OR 2.42, 95% CI 1.60 to 3.68; P < 0.001), hospital mortality (OR 2.33, 95% CI 1.54 to 3.54; P < 0.001), and more unfavorable neurological outcomes (OR 1.98, 95% CI 1.30 to 3.02; P = 0.001). After adjusting for confounding factors, shock was still an independent predictor of ICU mortality (OR 2.40, 95% CI 1.30 to 4.43; P = 0.005).Shock on admission of CA patients was significantly associated with ICU mortality.

PF186 INTENSIVE CARE OF THE LIFE –THREATING COMPLICATION DE NOVO ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) PATIENTS (PTS)

Background:Treatment of ALL pts can be associated with the life‐threating complications requiring intensive care unit (ICU) admission. The long‐term outcomes of ALL pts after discharge from ICU is unknown.Aims:To compare the overall survival (OS) of de novo ALL pts who required and not required ICU admission during induction remission chemotherapy.Methods:All de novo ALL pts (median age 28 yo, 17–60 yo), treated from 2013 to 2017, were enrolled into the study. Pts were divided into 2 groups: pts required ICU admission (ICU group), and pts not required ICU admission (non‐ICU group). Landmark OS was assessed by the Kaplan – Meier method, log rank value p &lt; 0.05 was considered as significant. Landmark was the date of discharge from ICU, and median time of discharge from ICU. Univariate analysis was performed with χ 2 tests or Fisher's exact tests for categorical variables to find an independent ICU mortality predictor.Results:In total, 87 ALL pts were enrolled into the study, 18 (20.6%) of them pts required ICU admission and 69 pts were treated without ICU. Reasons for ICU admissions were: acute respiratory failure (44%), acute neurological events (28%), tumor lysis syndrome (17%), septic shock (SS) (11%). Mechanical ventilation (MV) was required in 28% of pts, vasopressor support ‐ in 28% of pts, and renal replacement therapy ‐ in 22% of pts. ICU survival rate was 89% (2 pts died in ICU due to the SS). Needs for MV and for vasopressors were independent predictors of ICU mortality (p &lt; 0.05). No one pts died in non‐ICU group during induction chemotherapy. Five year OS was 44% and 76% in ICU and non‐ICU group, respectively, (p &lt; 0.05) (figure 1).Summary/Conclusion:Despite high ICU survival rate (89%), 5– years OS was only 44%. I non‐ICU group OS was 76% (p &lt; 0.05). The long‐term prognosis of ALL pts discharged from ICU worse in comparison AML pts discharged from ICU [1,2]. This phenomenon it could be explained by negative selection of ALL pts in ICU.imageReference1. The influence of ICU admission of the patients with de novo AML on the long‐term survival. Bazhenov A., Galstyan G., Parovichnikova E. et al. Intensive care medicine experimental. 2018 (6) supplement 2. P.4422. Prognostic factors for intensive care unit admission, intensive care outcome, and post‐intensive care survival in patients with de novo acute myeloid leukemia: a single center experience. Schellongowski P. Haematologica. 2011. № 2 (96).

Outcomes in patients with infections and augmented renal clearance: A multicenter retrospective study.

Recently, augmented renal clearance (ARC), which accelerates glomerular filtration of renally eliminated drugs thereby reducing the systemic exposure to these drugs, has started to receive attention. However, the clinical features associated with ARC are still not well understood, especially in the Japanese population. This study aimed to evaluate the clinical characteristics and outcomes of ARC patients with infections in Japanese intensive care unit (ICU) settings. We conducted a retrospective observational study from April 2013 to May 2017 at two tertiary level ICUs in Japan, which included 280 patients with infections (median age 74 years; interquartile range, 64–83 years). We evaluated the estimated glomerular filtration rate (eGFR) at ICU admission using the Japanese equation, and ARC was defined as eGFR >130 mL/min/1.73 m2. Multivariable logistic regression analysis was performed to identify the independent risk factors for ARC and to determine if it was a predictor of ICU mortality. In addition, a receiver operating curve (ROC) analysis was performed, and the area under the ROC (AUROC) was determined to examine the significant variables that predict ARC. In total, 19 patients (6.8%) manifested ARC. Multivariable logistic regression analysis identified younger age as an independent risk factor for ARC (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.91–0.96). However, ARC was not found to be a predictor of ICU mortality (OR, 0.57; 95% CI, 0.11–2.92). In addition, the AUROC of age was 0.79 (95% CI, 0.68–0.91), and the optimal cut off age for ARC was ≤63 years (sensitivity, 68.4%; specificity, 78.9%). The incidence of ARC was, therefore, low among patients with infections in the Japanese ICUs. Although younger age was associated with the incidence of ARC, it was not an independent predictor of ICU mortality.

Health insurance status and risk factors of mortality in patients with septic acute kidney injury in Ningbo, China.

ObjectiveTo investigate the relationship between health insurance status and outcomes of septic acute kidney injury (AKI) related hospitalizations in an intensive care unit (ICU) in Ningbo, China.MethodsFor this retrospective study, information was extracted from patients notes and billing records for patients >18 years of age with a diagnosis of AKI admitted to the ICU department, Ningbo First Hospital from April 2013 to March 2018.ResultsOf the 368 patients with sepsis admitted to ICU, 167 (45%) developed AKI; 95 patients were insured and 72 were uninsured. Compared with insured patients, uninsured patients were younger, had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, but had less catheter interventions and received less renal replacement therapy (RRT). Results from a multivariate analysis showed that independent predictors of ICU mortality were age, APACHE II scores, MODS scores, use of RRT and lack of insurance.ConclusionsUninsured patients with septic AKI were younger, stayed a shorter time in ICU, had higher illness severity scores and a higher ICU mortality than insured patients. Importantly a major risk factor for ICU mortality in this group was lack of insurance.

Hyperlactatemia on ICU admission : Comparison between direct admissions and inpatient transfers.

Hyperlactatemia is associated with increased mortality. Possible differences between patients directly admitted via the emergency department to the intensive care unit (ICU) and inpatient transfers to the ICU have not yet been investigated. In this retrospective analysis, characteristics and outcomes between critically ill medical inpatient transfers and direct admissions with hyperlactatemia on ICU admission, defined as ablood lactate >2 mmol/l, were compared. Atotal of 1042 patients were included, with 424 inpatient transfers and 618 direct admissions. The median age of inpatient transfers and direct admissions was 67.0 and 70.5 years, respectively (P = 0.03). The median APACHE II score was 25 for inpatient transfers and 23 for direct admissions (P = 0.01). The median blood lactate on ICU admission for inpatient transfers and direct admissions was similar (3.6 vs. 3.5 mmol/l). Sepsis was more common among inpatient transfers than direct admissions (53.5 vs. 31.6%, P = 0.001). The ICU (39.6 vs. 28.8%, P < 0.001), hospital (56.8 vs. 38.3%, P < 0.001) and 28-day mortality (46.5 vs. 35.4%, P < 0.001) was significantly higher for inpatient transfers than direct admissions. Among the sepsis cohort, inpatient transfer, APACHEII score and elevated blood lactate were independent predictors of ICU mortality. Among medical ICU patients with admission hyperlactatemia, the median blood lactate was not significantly different between direct admissions and inpatient referrals. Inpatients with sepsis may have been referred to the ICU late.