Intensive Care Admission Research Articles

Thyroid profile prognostic value on disease severity and mortality in COVID-19

Background: Precise accurate triage of Coronavirus disease 2019 (COVID-19) patients during hospitalization for early identification of individuals at risk of developing severe disease is essential as Intensive Care Units (ICUs) are overwhelmed by the pandemic burden. The aim of this study was to evaluate thyroid function in patients with COVID-19. Methods: 60 healthy controls and 180 patients were admitted to a cardiothoracic hospital, Minia University, Egypt, between March 2020 and September 2021 without a history of thyroid disease. Patients divided as 60 non-COVID pneumonia patients with a similar degree of severity were included as another control group to find any unique effects of COVID-19 on thyroid function, 120 positive COVID-19 divided according to clinical classifications into moderate (n = 58), severe (n = 21), and critical (n = 41), Critical group were admitted to ICU and classified to survivors (n = 33) and non-survivors (n = 8). COVID patients also were divided into tertiles according to their FT3 levels. Lowes tertile (n = 45), middle tertile (n = 37) and highest tertile (n = 38). All participants underwent routine physical checkups, acute physiology, and chronic health evaluation (APACHE-II) scores. The outcome measure was death during hospitalization; intensive care admission, mechanical ventilation, and length of hospitalization. We analyzed the ability of each parameter to predict mortality in participants. Further, we also evaluated whether the combination of free triiodothyronine (FT3) level with APACHE-II score could improve the mortality prediction. Results: Thyroid Stimulating Hormone (TSH) was lower than normal range in 56.7% (68/120) of patients with COVID-19. TSH and serum-free triiodothyronine (FT3) were significantly lower in COVID-19 patients than healthy control and non-COVID-19 pneumonia patients. TSH and FT3 were lower in severe COVID-19 with statistical significance (p < 0.001) and both positively correlated with the severity. The free thyroxine (FT4) in COVID-19 patients was not significantly different from the control group. Patients in the lowest FT3 tertile had significantly higher rates of mortality (18/40), mechanical ventilation (24/53.3), and intensive care unit admission (20/44.4). In univariate analyses, FT3 remained the most significant independent predictor of death. Conclusion: The changes in serum TSH and FT3 levels may be important manifestations of COVID-19 courses.FT3 levels can serve as a prognostic tool for disease severity in early presentation of COVID-19.

The direct disease burden of COVID-19 in Belgium in 2020 and 2021

BackgroundBurden of disease estimates have become important population health metrics over the past decade to measure losses in health. In Belgium, the disease burden caused by COVID-19 has not yet been estimated, although COVID-19 has emerged as one of the most important diseases. Therefore, the current study aims to estimate the direct COVID-19 burden in Belgium, observed despite policy interventions, during 2020 and 2021, and compare it to the burden from other causes.MethodsDisability-adjusted life years (DALYs) are the sum of Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) due to disease. DALYs allow comparing the burden of disease between countries, diseases, and over time. We used the European Burden of Disease Network consensus disease model for COVID-19 to estimate DALYs related to COVID-19. Estimates of person-years for (a) acute non-fatal disease states were calculated from a compartmental model, using Belgian seroprevalence, social contact, hospital, and intensive care admission data, (b) deaths were sourced from the national COVID-19 mortality surveillance, and (c) chronic post-acute disease states were derived from a Belgian cohort study.ResultsIn 2020, the total number of COVID-19 related DALYs was estimated at 253,577 [252,541 − 254,739], which is higher than in 2021, when it was 139,281 [136,704 − 142,306]. The observed COVID-19 burden was largely borne by the elderly, and over 90% of the burden was attributable to premature mortality (i.e., YLLs). In younger people, morbidity (i.e., YLD) contributed relatively more to the DALYs, especially in 2021, when vaccination was rolled out. Morbidity was mainly attributable to long-lasting post-acute symptoms.ConclusionCOVID-19 had a substantial impact on population health in Belgium, especially in 2020, when COVID-19 would have been the main cause of disease burden if all other causes had maintained their 2019 level.

Physical fitness level and the risk of severe COVID-19: A systematic review.

To verify systematically the association between the status of physical fitness and the risk of severe Coronavirus disease 2019 (COVID-19). This systematic review is in accordance with the Preferred Reporting Items for Systematic Review and Meta Analyses (PRISMA) statement and the eligibility criteria followed the Population, Intervention, Comparison, Outcomes and Study (PICOS) recommendation. PubMed, Embase, SciELO and Cochrane electronic databases were searched. All studies that explored the relationship between the pattern of physical fitness and COVID-19 adverse outcomes (hospitalization, intensive care unit admission, intubation, or mortality), were selected. The quality of the studies was assessed by the specific scale of the Newcastle-Ottawa Scale. A total of seven observational studies were identified in this systematic review; 13​468 patients were included in one case-control study, two cohort studies, and four cross-sectional studies. All studies reported an inverse association between high physical fitness and severe COVID-19 (hospitalization, intensive care admission, or mortality). Only some studies reported comorbidities, especially obesity and cardiovascular disorders, but the results remained unchanged after controlling for comorbidities. The quality of the seven studies included was moderate according to the Newcastle-Ottawa Quality Assessment Scale. The methodological heterogeneity of the studies included did not allow a meta-analysis of the findings. In conclusion, higher physical fitness levels were associated with lower risk of hospitalization, intensive care admissions, and mortality rates among patients with COVID-19.

The Impact of COVID-19 Vaccination on Bulgarian Patients with Uncomplicated Type 2 Diabetes Mellitus as the Only Chronic Condition

Abstract Objective: This retrospective study aimed to investigate the impact of COVID-19 vaccination on Bulgarian patient cohorts with uncomplicated diabetes mellitus type 2 as the only documented chronic comorbidity. We conducted a comparison of fully vaccinated and non-vaccinated populations, considering gender, age groups and vaccine type, across ambulatory, hospital, and ICU settings. Design: Between March 2020 and June 2022, a comprehensive retrospective analysis was conducted on a national level, utilizing data from the Ministry of Health of the Republic of Bulgaria database obtained after a formal written request. The study included a total of 1,126,946 confirmed COVID-19 patients. Results: Among the 1,126,946 confirmed COVID-19 patients, 3,792 individuals (0.33% of the total confirmed cases) had diabetes mellitus as a single chronic condition. Among the 247,441 hospitalized COVID-19 cases, 1,382 patients (0.56% of the total) had type 2 diabetes mellitus. Notably, the majority of patients requiring hospitalization due to supplemental oxygen requirement were unvaccinated women aged between 60 and 69, accounting for 240 patients. The highest mortality rates were observed in both unvaccinated men and women aged between 70 and 79, with 88 patients in each group. Statistical analysis revealed significant findings in favor of reduced rates of ambulatory care [OR = 0.76 (95% CI 0.6471 to 0.8891); p = 0.0006], intensive care admission [OR = 0.38 (95% CI 0.2698 to 0.5282); p < 0.0001], in-hospital mortality [OR = 0.18 (95% CI 0.0864 to 0.3604); p < 0.0001], and ICU-related mortality [OR = 0.17 (95% CI 0.0893 to 0.3436); p < 0.0001]. The vaccinated cohorts who received BNT162b2 demonstrated the lowest observed death rates, with 9 deaths out of 485 individuals (1.8%) across all age groups. Conclusion: In conclusion, this retrospective analysis indicates reduced mortality in patients with uncomplicated type II diabetes mellitus who received vaccination against SARS-CoV-2. Vaccinated individuals also showed significant reduction in ICU admissions.

Obstructive Shock Pulmonary Embolism: Catheter Directed Thrombolysis

Venous thromboembolism is one of the most frequently encountered condition for which patients need intensive care admission often. Most of the time patients presents with shock and hemodynamic instability if it is massive pulmonary embolism. Incidence of Vte is comparable to western population in India, studies conducted by Ayyapan et all say it around 20/10,000 admission. Studies showed higher mortality of around 50% in high risk (massive) and mortality of around 14% in intermediate risk (sub-massive) PE which necessitating more aggressive approach in high-risk groups. Rapid administration of systemic thrombolytic agents is indicated in massive pulmonary embolism patients who presents with hemodynamic instability but systemic thrombolytic therapy is associated with risk of major bleeding around 20% and haemorrhagic stroke of 2% to 5% . During systemic thrombolysis shunting of thrombolytic agents away from clot into the systemic circulation which makes it failed lysis sometimes along with major bleeding.

PIM-COVID study: protocol for a multicentre, longitudinal study measuring the psychological impact of surviving an intensive care admission due to COVID-19 on patients in the UK

IntroductionPsychological distress is common in intensive care unit (ICU) survivors and is anticipated in those who were treated for severe COVID-19 infection. This trainee-led, multicentre, observational, longitudinal study aims to...

Pediatric Sepsis Requiring Intensive Care Admission: Potential Structured Follow-Up Protocols to Identify and Manage New or Exacerbated Medical Conditions.

Pediatric sepsis is a leading cause of morbidity and mortality in children globally. Children who require the pediatric intensive care unit (PICU) are at high risk for new or worsening co-morbidities, as well as readmission. This review describes the current state of protocolized follow-up after pediatric sepsis requiring PICU admission. We searched Medline and EMBASE databases for studies published in English from 2005 to date. Duplicates, review articles, abstracts and poster presentations were excluded; neonatal intensive care unit (NICU) patients were also excluded since neonatal sepsis is variably defined and differs from the pediatric consensus definition. The search yielded 418 studies of which 55 were duplicates; the subsequent 363 studies were screened for inclusion criteria, yielding 31 studies for which full article screening was completed. Subsequently, 23 studies were excluded due to wrong population (9), wrong publication type (10), duplicate data (3) or wrong outcome (1). In total, nine studies were included for which we described study design, setting, population, sample size, outcomes, PICU core outcome domain, and results. There were 4 retrospective cohort studies, 4 prospective cohort studies, 1 retrospective case series and no prospective trials. These studies show the varying trajectories of recovery after discharge, with the common finding that new or worsening morbidities are worse within months of discharge, but may persist. Sepsis survivors may have distinct needs and a different post-PICU trajectory compared to other critically ill children, particularly in quality of life and neurocognitive outcomes. Future research should focus on developing screening protocols and studying protocolized follow-up trials to reduce morbidity after pediatric sepsis.

COVID-19 in congenital heart disease patients: what did we learn?!

COVID-19 pandemic has spread widely at unpreceded pace. Cardiovascular comorbidities are significantly correlated with severe and critical illness. Nevertheless, studies examining the impact of congenital heart disease on COVID-19 severity are scarce and restricted to hospitalized patients. This study aims to explore the course of COVID-19 illness, severity and complications in patients with concomitant congenital heart disease. This study is a cross sectional survey that includes patients with congenital heart disease who are registered at the Children Heart Center at the American University of Beirut Medical Center. The survey was conducted in the pediatric cardiology outpatient clinics or remotely via phone calls. A total of 238 patients participated in the study, of which 47.9% had suspected or confirmed diagnosis of SARS-CoV-2 infection. The majority of patients had mild illness. The symptoms ranged between rhinorrhea (15.6%), cough (15.6%), low-grade fever (11.2%), anosmia (2.7%), ageusia (2.5%), headache (9.8%), high-grade fever (8.5%), gastrointestinal symptoms (7.6%), lethargy (6.3%), muscle aches (5.6%), difficulty breathing (5.4%), joint pain (4.7%), and chills (4.7%). 20% of the surveyed patients required treatment at home. Hospitalization and oxygen therapy was required in 3.5% of cases, while only 1.5% demanded intensive care admission. Only one fatality was encountered. COVID-19 infection in pateints with congenital heart disease exhibits a mild to moderate course, and doesn't necessarily increase risk of complicated disease. No correlation could be found between specific congenital heart lesion and disease severity.

Discrimination of blood metabolomics profiles in neonates with idiopathic polyhydramnios.

This study is the first to investigate metabolomic profiles in newborns with IPH and examine the correlation between IPH and fetal health. Differential metabolites and pathways may affect amino acid synthesis and the nervous system. Continuous attention to the development of the nervous system in children with IPH is necessary. • There is an increased risk of adverse pregnancy outcomes with IPH, such as perinatal death, neonatal asphyxia, neonatal intensive care admission, cesarean section rates, and postpartum hemorrhage. • Children with a history of IPH have a higher proportion of defects than the general population, particularly central nervous system problems, neuromuscular disorders, and other malformations. • In neonates with IPH, six differential metabolites were identified with significant differences and good AUC values using LC-MS/MS analysis: glutamic acid, serine, asparagine, aspartic acid, homocysteine, and phenylalanine, which were mainly enriched in two metabolic pathways: aminoacyl-tRNA biosynthesis and alanine, aspartate, and glutamate metabolism. • These differential metabolites and pathways may affect amino acid synthesis and development of the nervous system in neonates with IPH.

The Clinical Association between Carbon Monoxide Poisoning and Myocardial Injury as Measured by Elevated Troponin I Levels.

Carbon monoxide (CO) poisoning accounts for over 50,000 estimated emergency room visits and approximately 1200 deaths per year in the US. Despite the high prevalence, there is a paucity of data looking at the association between laboratory biomarkers and clinical outcomes. Our study investigates the association between myocardial injury as assessed by increased troponin levels and its effect on in-hospital outcomes in CO poisoning. A total of 900 sequential charts of patients presenting with CO poisoning between 1 January 2012, and 31 August 2019, at our tertiary center with regional hyperbaric chamber and burn unit, were reviewed. Of the 900, a total of 488 patients had elevated carboxyhemoglobin levels. Of these 488 patients, 119 (24.4%) also had blood troponin levels measured. Patients were stratified based on the presence or absence of myocardial injury as evidenced by highly sensitive serum troponin I (TnI) level > 0.5 ng/mL to determine if a correlation exists relating to myocardial injury and risk of major adverse events. Mean age was 51.2 years, 58.8% were males, 35.3% were non-White, and 10.1% were intentional CO poisonings. Comorbidities included hypertension: 37%, diabetes: 21%, smoking: 21%, hyperlipidemia: 17.6%, coronary artery disease: 11.8%, asthma: 5.9%, heart failure: 5%, atrial fibrillation: 4.2%, and chronic obstructive pulmonary disease: 4.2%. Myocardial injury occurred in 22 patients (18.5%) and was associated with increased likelihood of requiring intensive care admission (54.5% vs. 20.6%, p = 0.002) and intubation (40.9% vs. 14.4%, p = 0.008). TnI elevation was associated with higher in-hospital mortality (p = 0.008, OR 21.3) compared to patients without TnI elevation. Older age was independently associated with increased in-hospital mortality (p = 0.03, OR 1.08). When controlling for age, in-hospital mortality remained statistically significant (p = 0.01, OR 21.37). No significant difference was found with respect to age, comorbidities, gender, race, ethnicity, or hospital length of stay in patients with and without myocardial injury. Myocardial injury induced by CO exposure occurs frequently and adversely affects clinical outcomes. Further research is needed to help guide physicians in the management of CO poisoning and associated myocardial injury to improve patient outcomes.

Impact of Persistent Inflammation, Immunosuppression, and Catabolism Syndrome during Intensive Care Admission on Each Post-Intensive Care Syndrome Component in a PICS Clinic.

Persistent inflammation, immunosuppression, and catabolism syndrome (PIICS) is known as a prolonged immunodeficiency that occurs after severe infection. Few studies have demonstrated a direct relationship between PIICS and physical dysfunction in post-intensive care syndrome (PICS). We herein investigated how each component of PICS was affected by the diagnosis of PIICS during hospitalization and examined the relationship between PIICS and PICS using PICS assessments performed at the Hitachi General Hospital PICS Clinic. The 273 patients who visited the PICS clinic at one month after discharge from the ICU at Hitachi General Hospital were included in the study. We used the diagnostic criteria for PIICS described in previous studies. At least two of the following blood test values on day 14 of hospitalization had to be met for a diagnosis of PIICS: C-reactive protein (CRP) > 2.0 mg/dL, albumin (Alb) < 3.0 g/dL, and lymphocytes (Lym) < 800/μL. Blood test values closest to day 14 out of 11-17 days of hospitalization were used. The primary outcome was a Barthel Index (BI) < 90, while secondary outcomes were the results of various PICS assessments, including mental and cognitive impairments, performed at the PICS clinic. We supplemented missing data with multiple imputations by chained equations. We performed a nominal logistic regression analysis with age, sex, BMI, SOFA, and the presence of PIICS as variables for BI < 90. Forty-three out of two hundred seventy-three PICS outpatients met the diagnostic criteria for PIICS during hospitalization. In comparisons with non-PIICS patients, significantly higher severity scores for APACHE II and SOFA and a longer hospital stay were observed in PIICS patients, suggesting a higher clinical severity. The primary outcome, BI, was lower in the PIICS group (97.5 (58.5, 100) vs. 100 (95, 100), p = 0.008), as were the secondary outcomes (FSS-ICU: 35 (31, 35) vs. 35 (35, 35), MRC score: 55 (50.25, 58) vs. 58 (53, 60), grip strength: 16.45 (9.2, 25.47) vs. 20.4 (15.3, 27.7)). No significant differences were noted in mental or cognitive function assessments, such as HADS, IES-R, and SMQ. A multivariable analysis supplemented with missing data revealed that PIICS (odds ratio: 1.23 (1.08-1.40 p = 0.001) and age (odds ratio: 1.007 (1.004-1.01), p < 0.001) correlated with BI < 90, independent of clinical severity such as sequential organ failure assessment (SOFA). Similar results were obtained in the sensitivity analysis excluding missing data. The present study revealed a strong relationship between PIICS and post-discharge PICS physical dysfunction in patients requiring intensive care.

FTP5.9 A review of post-operative outcomes following Cholecystectomy - Emergency vs Elective

Abstract Aim NICE (CG188) 2014 recommends index cholecystectomy (IC) for patients admitted with gallstone disease, particularly “acute cholecystitis”, within one week of diagnosis. Conversely, elective cholecystectomy (EC) patients are pooled via various pathways, from elective to emergency. Safety of ICs is well-established. A study was conducted to investigate difference in outcomes between IC and EC. Methods Retrospective study of prospective database of cholecystectomies performed as primary procedure was carried out between February 2021 and July 2022 in our trust. The primary outcome was hospital readmission, while secondary outcomes included postoperative complications graded by Clavien-Dindo classification (CDC), length of stay (LoS) and intensive care (ICU) admission. Categorical and continuous data were analysed using Chi-Square and Mann-Whitney-U tests respectively. P-value &amp;lt;0.05 was statistically significant. Results 202 patients underwent cholecystectomy. There were similar numbers in the studied groups; IC-49.8% (n=100/202) and EC-50.2% (n=102/202). Hospital readmission rates were higher in the IC – 11/100(11%) vs EC – 3/102(2.9%), p=0.02. Postoperative interventions (grade-3-CDC) (IC-11.0%, n=11 vs EC-2.9%, n=3, p=0.02) and ICU admission rates (IC-7.0%, n=7 vs EC-1.0%, n=1, p=0.03) were higher in IC compared to EC. Uncomplicated recovery (grade-1-CDC) was significantly higher in EC (p&amp;lt;0.0001). Postoperative LoS was significantly longer in IC (p&amp;lt;0.0001). There was no recorded mortality in either group. Conclusion Study confirms that IC is safe. However, postoperative procedural interventions were more common in IC, which is highly indicative of complex pathology (perforated/necrotic gallbladder/inflamed hepatocystic triangle) and may be contributed by timing of procedure. Further studies to assess underlying factors contributing to these outcomes are warranted.

SP1.1 Comparison of major abdominal emergency surgery outcomes across different organisational models of emergency surgical care: analysis of the UK NELA national database

Abstract Aims Emergency General Surgery (EGS) admissions are high risk and account for 14000 intensive care admissions costing over £88 million per year. This aim of this study is to understand the impact of the emergency general surgery model of care on outcomes from emergency laparotomies. Methods Data was obtained from the NELA database. Patients were dichotomised into either EGS hospital or non - EGS Hospital. EGS hospital is defined as a hospital where &amp;gt;5 % of the in-hours emergency laparotomy operating is performed by an emergency general surgeon. The primary outcome was in – hospital mortality. Secondary outcomes were ITU length of stay and duration of hospital stay. A propensity score weighting approach was used to reduce confounding and selection bias. Results 115,509 patients were included in the final analysis. Patient characteristics were similar between the 2 groups. Following propensity score weighting, mean SMD reduced from 0.034 to &amp;lt;0.001. In-hospital mortality was similar (10.8% vs 11.1%, p=0.094), with mean length of stay (16.7 vs 16.1 days, p&amp;lt;0.001) and ITU stay (2.8 vs 2.6 days, p&amp;lt;0.001) persistently longer in patients treated in EGS systems. Conclusions There is no significant association between the emergency surgery hospital model of care and in – hospital mortality in emergency laparotomy patients, suggesting the emergency surgery model of care can be utilised effectively without adversely affecting patient outcomes. There is, however, a significant association between the emergency surgery hospital model of care and an increased length of ITU stay and overall hospital stay. Further studies are required to examine the impact of changing models of EGS delivery in the UK.

Bloodstream Infections by Extendedspectrum β-lactamase-producing Klebsiella Species in Children

Infections caused by resistant Gram-negative bacteria are a serious public health problem, with Klebsiella spp. being the most common cause and increasing over the years. There is a striking increase in antibiotic resistance worldwide. The aim of this study was to retrospectively evaluate the characteristics and treatment of bloodstream infections (BSIs) caused by Klebsiella spp. and to identify possible risk factors for extended-spectrum β-lactamase (ESBL) resistance in our hospital between August 2019 and March 2023. Of 250 Klebsiella isolates, 112 (44.8%) were ESBL producers and 138 (55.2%) were ESBL nonproducers. Catheter-related BSIs (CRBSIs) accounted for 49.6% of infections and were more common in the ESBL nonproducer group. Most of the Klebsiella spp. were K. pneumoniae (233/250). Most of the infections were healthcare-associated infections (85.6%). Most patients had an underlying disease, the most common underlying disease in the ESBL-producing group was neurometabolic disease (26.8%), whereas in the ESBL-non-producing group it was malignancy (35.5%). The median age of the ESBL-producing group was 14 months and was younger (p=0.01). Previous antibiotic use in the last 30 days, especially aminoglycosides (p&lt;0.006), β-lactam-β-lactamase inhibitor combinations (p&lt;0.001) and cephalosporins (p&lt;0.001), increased ESBL-resistant infection. Use of β-lactam-β-lactamase inhibitor combinations in the last 30 days increased the risk of ESBL resistance by approximately 7.4 times, and cephalosporins increased the risk by 5 times. In the ESBL-producing group, the median duration of treatment was longer at 14 days (p=0.01), and carbapenems were most commonly used (p&lt;0.001). Thrombocytopenia (p=0.003), elevated C-reactive protein (p&lt;0.001), CRBSI (p=0.009), presence of central venous catheter (p=0.03), urinary catheter (p&lt;0.001), mechanical ventilation (p&lt;0.001), intensive care admission (p=0.005), previous use of carbapenems, aminoglycosides, fluoroquinolones in the last 30 days (p=0.003, p=0.001, p=0.006, respectively) and colistin treatment (p&lt;0.001) increased the risk of mortality. The 28-day mortality rate was 11.6%. Appropriate use of narrow-spectrum antibiotics and reduction of invasive procedures is important in reducing ESBL resistance and BSI-related mortality.

Bloodstream Infections by Extended-spectrum β-lactamase-producing Klebsiella Species in Children

Infections caused by resistant Gram-negative bacteria are a serious public health problem, with Klebsiella spp. being the most common cause and increasing over the years. There is a striking increase in antibiotic resistance worldwide. The aim of this study was to retrospectively evaluate the characteristics and treatment of bloodstream infections (BSIs) caused by Klebsiella spp. and to identify possible risk factors for extended-spectrum β-lactamase (ESBL) resistance in our hospital between August 2019 and March 2023. Of 250 Klebsiella isolates, 112 (44.8%) were ESBL producers and 138 (55.2%) were ESBL nonproducers. Catheter-related BSIs (CRBSIs) accounted for 49.6% of infections and were more common in the ESBL nonproducer group. Most of the Klebsiella spp. were K. pneumoniae (233/250). Most of the infections were healthcare-associated infections (85.6%). Most patients had an underlying disease, the most common underlying disease in the ESBL-producing group was neurometabolic disease (26.8%), whereas in the ESBL-non-producing group it was malignancy (35.5%). The median age of the ESBL-producing group was 14 months and was younger (p=0.01). Previous antibiotic use in the last 30 days, especially aminoglycosides (p&lt;0.006), β-lactam-β-lactamase inhibitor combinations (p&lt;0.001) and cephalosporins (p&lt;0.001), increased ESBL-resistant infection. Use of β-lactam-β-lactamase inhibitor combinations in the last 30 days increased the risk of ESBL resistance by approximately 7.4 times, and cephalosporins increased the risk by 5 times. In the ESBL-producing group, the median duration of treatment was longer at 14 days (p=0.01), and carbapenems were most commonly used (p&lt;0.001). Thrombocytopenia (p=0.003), elevated C-reactive protein (p&lt;0.001), CRBSI (p=0.009), presence of central venous catheter (p=0.03), urinary catheter (p&lt;0.001), mechanical ventilation (p&lt;0.001), intensive care admission (p=0.005), previous use of carbapenems, aminoglycosides, fluoroquinolones in the last 30 days (p=0.003, p=0.001, p=0.006, respectively) and colistin treatment (p&lt;0.001) increased the risk of mortality. The 28-day mortality rate was 11.6%. Appropriate use of narrow-spectrum antibiotics and reduction of invasive procedures is important in reducing ESBL resistance and BSI-related mortality.

The PURPOSe cause of death study in stillbirths and neonatal deaths in India and Pakistan: A review.

The PURPOSe study was a prospective, observational study conducted in India and Pakistan to determine the cause of death for stillbirths and preterm neonatal deaths, using clinical data together with minimally invasive tissue sampling (MITS) and the histologic and polymerase chain reaction (PCR) evaluation of fetal/neonatal tissues and the placenta. After evaluating all available data, an independent panel chose a maternal, a placental and a fetal/neonatal cause of death. Here, we summarise the major results. Among the most important findings were that most stillbirths were caused by fetal asphyxia, often preceded by placental malperfusion, and clinically associated with pre-eclampsia, placental abruption and a small-for-gestational-age fetus. The preterm neonatal deaths were primarily caused by birth asphyxia, followed by various infections. An important finding was that many of the preterm neonatal deaths were caused by a nosocomial infection acquired after neonatal intensive care (NICU) admission; the most common organisms were Acinetobacter baumannii, followed by Klebsiella pneumoniae, Escherichia coli/Shigella and Haemophilus influenzae. Group B streptococcus was less commonly present in the placentas or internal organs of the neonatal deaths.

Using emergency department triage for machine learning-based admission and mortality prediction.

Patient admission is a decision relying on sparsely available data. This study aims to provide prediction models for discharge versus admission for ward observation or intensive care, and 30 day-mortality for patients triaged with the Manchester Triage System. This is a single-centre, observational, retrospective cohort study from data within ten minutes of patient presentation at the interdisciplinary emergency department of the Kepler University Hospital, Linz, Austria. We trained machine learning models including Random Forests and Neural Networks individually to predict discharge versus ward observation or intensive care admission, and 30 day-mortality. For analysis of the features' relevance, we used permutation feature importance. A total of 58323 adult patients between 1 December 2015 and 31 August 2020 were included. Neural Networks and Random Forests predicted admission to ward observation with an AUC-ROC of 0.842 ± 0.00 with the most important features being age and chief complaint. For admission to intensive care, the models had an AUC-ROC of 0.819 ± 0.002 with the most important features being the Manchester Triage category and heart rate, and for the outcome 30 day-mortality an AUC-ROC of 0.925 ± 0.001. The most important features for the prediction of 30 day-mortality were age and general ward admission. Machine learning can provide prediction on discharge versus admission to general wards and intensive care and inform about risk on 30 day-mortality for patients in the emergency department.

The birth center model of care: Staffing, business characteristics, and core clinical outcomes.

Interest in expanding access to the birth center model is growing. The purpose of this research is to describe birth center staffing models and business characteristics and explore relationships to perinatal outcomes. This descriptive analysis includes a convenience sample of all 84 birth center sites that participated in the AABC Site Survey and AABC Perinatal Data Registry between 2012 and 2020. Selected independent variables include staffing model (CNM/CM or CPM/LM), legal entity status, birth volume/year, and hours of midwifery call/week. Perinatal outcomes include rates of induction of labor, cesarean birth, exclusive breastfeeding, birthweight in pounds, low APGAR scores, and neonatal intensive care admission. The birth center model of care is demonstrated to be safe and effective, across a variety of staffing and business models. Outcomes for both CNM/CM and CPM/LM models of care exceed national benchmarks for perinatal quality with low induction, cesarean, NICU admission, and high rates of breastfeeding. Within the sample of medically low-risk multiparas, variations in clinical outcomes were correlated with business characteristics of the birth center, specifically annual birth volume. Increased induction of labor and cesarean birth, with decreased success breastfeeding, were present within practices characterized as high volume (>200 births/year). The research demonstrates decreased access to the birth center model of care for Black and Hispanic populations. Between 2012 and 2020, 84 birth centers across the United States engaged in 90,580 episodes of perinatal care. Continued policy development is necessary to provide risk-appropriate care for populations of healthy, medically low-risk consumers.

Prophylactic Administration of Tranexamic Acid Reduces Blood Products' Transfusion and Intensive Care Admission in Women Undergoing High-Risk Cesarean Sections.

Postpartum hemorrhage (PPH) remains a major cause of maternal mortality. Tranexamic acid (TxA) has shown effectiveness in reducing PPH-related maternal bleeding events and deaths. We conducted a cohort study including parturient women at high risk of bleeding after undergoing a cesarean section (CS). Participants were divided into two groups: the treatment group received prophylactic 1-g TxA before surgery (n = 500), while the comparison group underwent CS without TxA treatment (n = 500). The primary outcome measured increased maternal blood loss following CS, defined as more than a 10% drop in hemoglobin concentration within 24 h post-CS and/or a drop of ≥2 g/dL in maternal hemoglobin concentration. Secondary outcomes included PPH indicators, ICU admission, hospital stay, TxA complications, and neonatal data. TxA administration significantly reduced hemoglobin decrease by more than 10%: there was a 35.4% decrease in the TxA group vs. a 59.4% decrease in the non-TxA group, p < 0.0001 and hemoglobin decreased by ≥2 g/dL (11.4% in the TxA group vs. 25.2% in non-TxA group, p < 0.0001), reduced packed red blood cell transfusion (p = 0.0174), and resulted in lower ICU admission rates (p = 0.034) and shorter hospitalization (p < 0.0001). Complication rates and neonatal outcomes did not differ significantly. In conclusion, prophylactic TxA administration during high-risk CS may effectively reduce blood loss, providing a potential intervention to improve maternal outcomes.

A comparative study of SARS-CoV-2 and common human coronavirus infections among children presenting to tertiary care in Oman

ObjectivesTo compare clinical manifestations, laboratory characteristics, and outcomes of children presenting to tertiary care with SARS-CoV-2 or common human coronavirus (HCoV) infection. MethodsChildren 13 years of age or younger presenting in 2020 with SARS-CoV-2 and those presenting with HCoV between 2017 and 2019 were included. Clinical and laboratory features were compared using appropriate statistical tests. The study was conducted at the two main tertiary hospitals in Muscat, Oman. ResultsThe study included 255 cases (131 SARS-CoV-2 and 124 HCoV). Median age was 1.7 years (interquartile range 0.5-5.6), and 140 patients (55%) were males. Among children with HCoV infection, diarrhea was less common compared to children with SARS-CoV-2 (4% vs 23%, P <0.001), while respiratory symptoms such as cough were more common (74% vs 31%, P <0.001). Intensive care admission was more frequent with SARS-CoV-2 infection compared to HCoV (22% vs 11%, P = 0.039). Three virus-related deaths were recorded, all of which occurred among patients with SARS-CoV-2 and multisystem inflammatory syndrome in children. ConclusionLower respiratory tract disease is more frequent among children with HCoV infection compared to SARS-CoV-2, while gastrointestinal symptoms are more frequent with SARS-CoV-2. Critical illness is more likely with SARS-CoV-2 infection, driven mostly by multisystem inflammatory syndrome in children.