Intensive Care Mortality Research Articles

COVID-19 Nedeni ile Yatarak Tedavi Görenlerde Aşıların ve Hatırlatma Dozlarının Hastalık Sürecine ve Mortaliteye Etkisi

Objective: As of the first months of 2020, vaccination is the most effective method to combat the COVID-19 pandemic, which has become a part of our lives. This study aims to describe the vaccination status of inpatients, the effectiveness of booster vaccine protocols, and the risk factors for intensive care unit (ICU) and mortality of COVID-19 patients.
 Materials and Methods: Our study included 247 patients hospitalized in a tertiary care hospital due to COVID-19. Patients hospitalized for non-COVID-19 reasons were excluded from the study even if the PCR test was positive. Socio-demographic data, clinical and laboratory findings of the participants were recorded using the hospital database and a questionnaire. Patients were divided into groups as mild-moderate-severe disease in terms of disease severity, ward and ICU in terms of hospitalization clinic. According to vaccination status, they were categorized as unvaccinated, Sinovac-based protocols, BioNTech-based protocols and others. 
 Results: Of the 247 patients in the study, 55.1% were male and the mean age was 60 ± 17.26 years. 38.5% of the patients were admitted to the ICU and 9.3% died. It was observed that 38.8% of those admitted to the ICU and 56.5% of those who died were not vaccinated. Being over 65 years of age (p=0.008), being hospitalized for more than 7 days (p=0.003), having a severe illness (p=0.002), having a nervous system disease (p=0.005) and having other comorbidities (p=0.000), were significant for ICU admission, whereas disease severity (p=0.000) and comorbidities such as hypertension (p=0.000), diabetes mellitus (p=0.020) and cardiovascular diseases (p=0.000) were found to be risk factors for mortality.
 Conclusion: The addition of reminder doses, especially the fourth dose, to vaccination protocols may be more beneficial in preventing the need for ICU follow-up, which increases mortality in COVID-19.

Association Between Levels of Intensive Care and In-Hospital Mortality in Patients Hospitalized for Sepsis Stratified by Sequential Organ Failure Assessment Scores.

To assess the association between levels of intensive care and in-hospital mortality in patients hospitalized for sepsis, stratified by Sequential Organ Failure Assessment (SOFA) score at admission. A nationwide, propensity score-matched, retrospective cohort study. A Japanese national inpatient database with data on 70-75% of all ICU and high-dependency care unit (HDU) beds in Japan. Adult patients hospitalized for sepsis with SOFA scores greater than or equal to 2 on their day of admission between April 1, 2018, and March 31, 2021, were recruited. Propensity score matching was performed to compare in-hospital mortality, and patients were stratified into 10 groups according to SOFA scores. Two exposure and control groups according to treatment unit on day of admission: 1) ICU + HDU versus general ward and 2) ICU versus HDU. Of 97,070 patients, 19,770 (20.4%), 23,066 (23.8%), and 54,234 (55.9%) were treated in ICU, HDU, and general ward, respectively. After propensity score matching, the ICU + HDU group had significantly lower in-hospital mortality than the general ward group, among cohorts with SOFA scores greater than or equal to 6. There were no significant differences in in-hospital mortality among cohorts with SOFA scores 3-5. The ICU + HDU group had significantly higher in-hospital mortality than the general ward among cohorts with SOFA scores of 2. The ICU group had lower in-hospital mortality than the HDU group among cohorts with SOFA scores greater than or equal to 12. There were no significant differences in in-hospital mortality among cohorts with SOFA scores 5-11. The ICU group had significantly higher in-hospital mortality than the general ward group among cohorts with SOFA scores less than or equal to 4. Patients hospitalized for sepsis with SOFA scores greater than or equal to 6 in the ICU or HDU had lower in-hospital mortality than those in the general ward, as did those with SOFA scores greater than or equal to 12 in the ICU versus HDU.

Risk factors for severe COVID-19 in the young—before and after ICU admission

BackgroundFactors associated with severe COVID-19 and death among young adults are not fully understood, including differences between the sexes. The aim of this study was to identify factors associated with severe COVID-19 requiring intensive care and 90-day mortality among women and men below 50 years of age.MethodsA register-based study using data from mandatory national registers, where patients with severe COVID-19 admitted to the ICU with need for mechanical ventilation (cases) between March 2020 and June 2021 were matched regarding age, sex, and district of residence with 10 population-based controls. Both the study population and the controls were divided into groups based on age (< 50 years, 50–64, and ≥ 65 years) and sex. Multivariate logistic regression models including socioeconomic factors were used to calculate odds ratios (OR) with 95% confidence intervals (CIs) for associations between severe COVID-19 in the population to compare the magnitude of the risk associations for co-morbidities in the different age categories, and subsequently factors associated with 90-day mortality among patients admitted to ICU.ResultsIn total, 4921 cases and 49,210 controls (median age 63 years, 71% men) were included.The co-morbidities with the strongest associations with severe COVID-19 for the young population compared to older patients were chronic kidney disease (OR 6.80 [3.61–12.83]), type 2 diabetes (OR 6.31 [4.48–8.88]), hypertension (OR 5.09 [3.79–6.84]), rheumatoid arthritis (OR 4.76 [2.29–9.89]), obesity (OR 3.76 [2.88–4.92]), heart failure (OR 3.06 [1.36–6.89]), and asthma (OR 3.04 [2.22–4.16]).When comparing women vs. men < 50 years of age, stronger associations were seen for women regarding type 2 diabetes (OR 11.25 [6.00–21.08] vs OR 4.97 [3.25–7.60]) and hypertension (OR 8.76 [5.10–15.01] vs OR 4.09 [2.86–5.86]).The factors associated with 90-day mortality in the young were previous venous thromboembolism (OR 5.50 [2.13–14.22]), chronic kidney disease (OR 4.40 [1.64–11.78]) and type 2 diabetes (OR 2.71 [1.39–5.29]). These associations with 90-day mortality were foremost driven by the female population.ConclusionChronic kidney failure, type 2 diabetes, hypertension, rheumatoid arthritis, obesity, heart failure, and asthma were the strongest risk factors associated with severe COVID-19 requiring ICU-care in individuals < 50 years compared to the older population. However, after ICU admission, previous thromboembolism, chronic kidney failure, and type 2 diabetes were associated with increased 90-day mortality. The risk associations for co-morbidities were generally stronger among younger individuals compared to older and in women compared to men.

Influence of vaccination on adverse health outcomes after SARS-CoV-2 infection among individuals with alcohol use disorder: a population-based study.

Alcohol use disorders (AUD) have not been included in the priority groups for early vaccine against SARS-CoV-2. We aimed to determine adverse outcomes after SARS-CoV-2 infection among individuals with AUD and how this is modified by vaccination. This was a registry-based cohort study carried out in Denmark, 27 February 2020 to 15 October 2021, comprising 2157 individuals with AUD and 237 541 without AUD who had had a polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection during the study period. The association of AUD with the absolute and relative risk of hospitalization, intensive care and 60-day mortality after SARS-CoV-2 infection and of all-cause mortality throughout the follow-up period were measured. Potential interactions with SARS-CoV-2 vaccination, education and sex were explored in stratified analyses and tested by including interaction terms and using likelihood ratio tests. Individuals with AUD had an increased absolute and relative risk of adverse outcomes, including hospitalization [incidence rate ratio (IRR) = 1.72, 95% confidence interval (CI) = 1.51-1.95], intensive care (IRR = 1.47, 95% CI = 1.07-2.02) and 60-day mortality [mortality rate ratio (MRR) = 2.35, 95% CI = 1.94-2.85] compared with SARS-CoV-2-positive individuals without AUD. Irrespective of AUD, highest risks of these adverse health outcomes were observed for individuals not vaccinated against SARS-CoV-2 infection, for individuals of low educational level and in males. However, for all-cause mortality throughout the follow-up period, SARS-CoV-2 infection showed a lower relative mortality risk increase, whereas being unvaccinated showed a higher relative mortality risk increase, in individuals with AUD than in the reference population without AUD (P of interaction tests < 0.0001). Both alcohol use disorder and being unvaccinated for SARS-CoV-2 appear to be independent risk factors for adverse health outcomes following SARS-CoV-2 infection.

Delivery mode and fetal outcome in attempted vaginal deliveries after previous cesarean section: a nationwide register-based cohort study in Finland

Purpose Even though the risks and advantages of repeat Cesarean sections (CSs) and vaginal births after cesarean section (VBACs) are well studied, there is a scarcity of information on the effects of previous CS on maternal and fetal outcomes during subsequent deliveries. The aim of this study is to evaluate delivery mode and fetal outcomes in a trial of labor after cesarean section (TOLAC). Methods In this nationwide retrospective cohort study, data from the National Medical Birth Register (MBR) were used to evaluate the outcomes of TOLACs. TOLACs were compared to the outcomes of the trial of labor after previous successful vaginal delivery. A multivariable logistic regression model was used to assess the primary outcomes (delivery mode, neonatal intensive care unit, and perinatal/neonatal mortality). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were used for comparison. Results A total of 29 352 (77.0%) women attempted vaginal delivery in the TOLAC group. In the control group, 169 377 (97.2%) women attempted vaginal delivery. The adjusted odds for urgent CS (aOR 13.05, CI 12.59–13.65) and emergency CS (aOR 3.65, CI 3.26–4.08) were notably higher in the TOLAC group when compared to the control group. The odds for neonatal intensive care unit treatment (aOR 2.05, CI 1.98–2.14), perinatal mortality (aOR 2.15, CI 1.79–2.57), and neonatal mortality (aOR 1.75, CI 1.20–2.49) were higher in the TOLAC group. Conclusions The odds for emergency CS were higher among women who underwent TOLAC. The odds for neonatal intensive care and perinatal mortality were also higher, and further research is needed to identify those expecting women who are better suited for TOLAC to minimize the risk for a neonate. The results of this study should be acknowledged by the mother and the clinician when considering the possibility of vaginal births after cesarean section.

Hemoperfusion techniques using Jafron HA330 cartridge combined with BBraun Dialog+ dialysis machine in patient with coronavirus disease 2019 pneumonia and septic shock: a case report

BackgroundThe use of hemoperfusion for cytokine removal and inflammatory mediators is increasingly intense, especially in coronavirus disease 2019 patients who are already known to the general public for having cytokine storms. However, we have known about these cytokine storms for a long time in the critical care world. One of the modalities to remove cytokines is to use filtration and adsorption techniques with continuous renal replacement therapy. The use of continuous renal replacement therapy is usually constrained by its very high cost compared with standard care, especially in Indonesia, where health costs are covered by national health insurance. In this case, we use hemodialysis and hemoperfusion, using a dialysis machine, which is more cost-effective and easy to use.Case presentationWe used the Jafron HA330 cartridge, modified for the BBraun Dialog+ dialysis machine. This case report presents an 84-year-old Asian man with septic shock due to pneumonia, congestive heart failure, and acute chronic kidney disease accompanied by fluid overload. After undergoing hemodialysis and hemoperfusion separately, there was a gradual and significant clinical improvement. Clinical indicators, including the vasopressor inotropic score and infection markers, should all be considered when deciding whether to begin hemodialysis and hemoperfusion.ConclusionIn general, using hemoperfusion to treat septic shock patients can reduce the length of stay in the intensive care unit, and morbidity and mortality.

Systematic review and meta-analysis of the clinical effectiveness of tixagevimab/cilgavimab for prophylaxis of COVID-19 in immunocompromised patients.

Immunocompromised patients, such as those with a haematological malignancy, are at higher risk of SARS-CoV-2 infection, severe outcomes and mortality. Tixagevimab/cilgavimab is a monoclonal antibody combination which binds to the SARS-CoV-2 spike protein. The PROVENT phase III clinical trial reported that tixagevimab/cilgavimab prophylaxis significantly reduced the risk of COVID-19 infection in immunocompromised participants. However, the trial was conducted before the Omicron variant became prevalent. This systematic review and meta-analysis provide an up-to-date summary of the real-world effectiveness of tixagevimab/cilgavimab in immunocompromised patients, including patients with haematological malignancies. Clinical studies from 1 January 2021 to 1 October 2022, which reported breakthrough COVID-19 infections after tixagevimab/cilgavimab, were included. COVID-19-related hospitalisations, intensive care admissions and mortality were also assessed. A meta-analysis was performed to ascertain overall clinical effectiveness. Eighteen studies, with 25 345 immunocompromised participants, including 5438 patients with haematological pathologies, were included in the review. The overall clinical effectiveness of tixagevimab/cilgavimab against COVID-19 breakthrough infection, hospitalisation, intensive care admission and COVID-19-specific mortality was 40.54%, 66.19%, 82.13% and 92.39%, respectively. This review highlights the clinical effectiveness of tixagevimab/cilgavimab at reducing COVID-19 infection and severe outcomes for immunosuppressed individuals, including patients with a haematological malignancy, during the Omicron-predominant era. Real-world studies are important to provide ongoing certainty of the clinical benefit for immunocompromised patients against new SARS-CoV-2 variants.

ABC-GOALScl score predicts admission to the intensive care unit and mortality of COVID-19 patients over 60 years of age

BackgroundOne of the risk factors for getting seriously ill from COVID-19 and reaching high mortality rates is older age. Older age is also associated with comorbidities, which are risk factors for severe COVID-19 infection. Among the tools that have been evaluated to predict intensive care unit (ICU) admission and mortality is ABC-GOALScl.AimIn the present study we validated the utility of ABC-GOALScl to predict in-hospital mortality in subjects over 60 years of age who were positive for SARS-CoV-2 virus at the moment of admission with the purpose of optimizing sanitary resources and offering personalized treatment for these patients.MethodsThis was an observational, descriptive, transversal, non-interventional and retrospective study of subjects (≥ 60 years of age), hospitalized due to COVID-19 infection at a general hospital in northeastern Mexico. A logistical regression model was used for data analysis.ResultsTwo hundred forty-three subjects were included in the study, whom 145 (59.7%) passed away, while 98 (40.3%) were discharged. Average age was 71, and 57.6% were male. The prediction model ABC-GOALScl included sex, body mass index, Charlson comorbidity index, dyspnea, arterial pressure, respiratory frequency, SpFi coefficient (Saturation of oxygen/Fraction of inspired oxygen ratio), serum levels of glucose, albumin, and lactate dehydrogenase; all were measured at the moment of admission. The area under the curve for the scale with respect to the variable of discharge due to death was 0.73 (IC 95% = 0.662—0.792).ConclusionThe ABC-GOALScl scale to predict ICU admission in COVID-19 patients is also useful to predict in-hospital death in COVID-19 patients ≥ 60 years old.

EARLY PREDICTIVE VALUE OF PRESEPSIN FOR SECONDARY SEPSIS AND MORTALITY IN INTENSIVE CARE UNIT PATIENTS WITH SEVERE ACUTE PANCREATITIS.

Purpose : Sepsis is the leading cause of death in patients with severe acute pancreatitis (SAP) in the intensive care unit (ICU). Early prediction of sepsis secondary to SAP developed in the late phase and of related mortality can enable appropriate treatment and improve outcomes. This study was conducted to evaluate the predictive value of presepsin in ICU patients with SAP at the early stage and compared it with established blood markers and scoring systems. Methods : This retrospective study enrolled 48 septic patients and 53 nonseptic patients admitted to ICU with SAP. Presepsin and other blood markers (procalcitonin, C-reactive protein, IL-6, white blood cell, and serum creatinine) on days 1, 3, and 7 after enrollment as well as scoring systems were assessed to predict secondary sepsis. Outcomes were evaluated at ICU discharge and on days 28 and 90. Results : Presepsin levels (on days 1, 3, and 7) were significantly higher in septic patients than in nonseptic patients. Presepsin levels showed an increasing trend over time in both sepsis and nonsepsis groups, but concentrations increased more rapidly in the sepsis group than in the nonsepsis group. Among the analyzed biomarkers, presepsin was the only blood marker independently associated with sepsis secondary to SAP on days 3 and 7, and presepsin on day 3 was independently associated with mortality at ICU discharge and on days 28 and 90. It showed similar or even better predictive accuracy for both secondary sepsis and mortality than procalcitonin and Sequential Organ Failure Assessment score. Conclusion : Presepsin could be a valuable early predictor of secondary sepsis and mortality in patients admitted to the ICU with SAP and may serve as an indicator for early risk stratification.

Rural-Urban Disparities in Adverse Maternal Outcomes in the United States, 2016-2019.

Objectives. To describe differences in maternal admissions to the intensive care unit (ICU) and mortality in rural versus urban areas in the United States. Methods. We performed a nationwide analysis and calculated age-standardized rates and rate ratios (RRs) of maternal ICU admission and mortality per 100 000 live births between 2016 and 2019 in rural versus urban areas. Results. From 2016 to 2019, there was no significant increase in age-standardized rates of maternal ICU admissions in rural (170.6-192.3) or urban (161.7-172.4) areas, with a significantly higher rate, albeit a relatively small difference, in rural versus urban areas (2019 RR = 1.14; 95% confidence interval [CI] = 1.04, 1.20). Maternal mortality increased in both rural (66.9-81.7 deaths per 100 000 live births) and urban (38.1-42.3) areas and was nearly 2 times higher in rural areas (2019 RR = 1.93; 95% CI = 1.71, 2.17). Conclusions. Pregnant individuals in rural areas are at higher risk for ICU admission and mortality than are their urban counterparts. Significant increases in maternal mortality occurred in rural and urban areas. Public Health Implications. Public health efforts need to focus on resource-limited rural areas to mitigate geographic disparities in maternal morbidity and mortality. (Am J Public Health. 2023;113(2): 224-227.https://doi.org/10.2105/AJPH.2022.307134).

Protective Effect of Vitamin D Supplementation on COVID-19-Related Intensive Care Hospitalization and Mortality: Definitive Evidence from Meta-Analysis and Trial Sequential Analysis.

The COVID-19 pandemic represents one of the world's most important challenges for global public healthcare. Various studies have found an association between severe vitamin D deficiency and COVID-19-related outcomes. Vitamin D plays a crucial role in immune function and inflammation. Recent data have suggested a protective role of vitamin D in COVID-19-related health outcomes. The purpose of this meta-analysis and trial sequential analysis (TSA) was to better explain the strength of the association between the protective role of vitamin D supplementation and the risk of mortality and admission to intensive care units (ICUs) in patients with COVID-19. We searched four databases on 20 September 2022. Two reviewers screened the randomized clinical trials (RCTs) and assessed the risk of bias, independently and in duplicate. The pre-specified outcomes of interest were mortality and ICU admission. We identified 78 bibliographic citations. After the reviewers' screening, only five RCTs were found to be suitable for our analysis. We performed meta-analyses and then TSAs. Vitamin D administration results in a decreased risk of death and ICU admission (standardized mean difference (95% CI): 0.49 (0.34-0.72) and 0.28 (0.20-0.39), respectively). The TSA of the protective role of vitamin D and ICU admission showed that, since the pooling of the studies reached a definite sample size, the positive association is conclusive. The TSA of the protective role of vitamin D in mortality risk showed that the z-curve was inside the alpha boundaries, indicating that the positive results need further studies. The results of the meta-analyses and respective TSAs suggest a definitive association between the protective role of vitamin D and ICU hospitalization.

Predictivity of CRP, Albumin, and CRP to Albumin Ratio on the Development of Intensive Care Requirement, Mortality, and Disease Severity in COVID-19.

The C-reactive protein (CRP) to albumin ratio (CAR) is a new index calculated by dividing CRP by the albumin level. It has been claimed to have predictive value in determining morbidity and mortality in many critical diseases Aim: In this research, we aimed to elucidate the importance of CRP, albumin, and CARas parameters that can predict the clinical course in COVID-19 patients. In this retrospective analysis, the clinical, laboratory, and radiological findings of patients over the age of 18 who were diagnosed with SARS-CoV-2 infection with a positivereverse transcription-polymerase chain reaction (RT-PCR) test were evaluated. Age, gender, laboratory examinations at admission, and CRPand albumin values at the time of diagnosis have been recorded. The relationship of these parameters with the requirement for intensive care, exitus, and serious illness in the clinical follow-up of the patients was investigated. The baseline hospitalization parameters of the patients were compared between the severe and non-severe groups. Individuals with severe disease had a higher rate of additional disease than those with non-severe disease. It was observed that the mean laboratory values ​​of patients with severe disease had a statistically higher level of D-dimer, CRP, aspartate aminotransferase (AST), platelet distribution width(PDW), CRP-albumin ratio, and ferritin, compared to mild to moderate cases (p<0.05). The rate of additional disease in deceasedpatientswas higher than in patients who were alive (p<0.05). The CAR value was found to be moderately predictive in our study revealing the severity of the disease, and the possibility that the severity of the disease might be higher in patients with a CAR value above 21.47. The results of this study revealed that CAR is a potential parameter in distinguishing critically ill COVID-19 patients in need of intensive care. Therefore, one can say that CARis an important biomarker in clinically determining COVID-19.

Effects of Age and Comorbidities on Intensive Care and 1-Year Mortality after HeartMate 3 Implantation

Effects of Age and Comorbidities on Intensive Care and 1-Year Mortality after HeartMate 3 Implantation

Evaluation of Necessity for Intensive Care Stay, Mortality, and Morbidity in Poisoning Cases Admitted to the Emergency Department

Evaluation of Necessity for Intensive Care Stay, Mortality, and Morbidity in Poisoning Cases Admitted to the Emergency Department

Effects of intraoperative fluid therapy on intensive care process, morbidity, and mortality after lung transplantation.

This study aims to evaluate the effect of intraoperative fluid therapy on intensive care process and first 90-day morbidity and mortality in patients undergoing lung transplantation. Between March 2013 and December 2020, a total of 77 patients (64 males, 13 females; mean age: 47.6±13.0 years; range, 19 to 67 years) who underwent lung transplantation were retrospectively analyzed. The patients were divided into two groups according to the amount of fluid given intraoperatively: Group 1 (<15 mL/kg-1/h-1) and Group 2 (>15 mL/kg-1/h-1). Demographic, clinical, intra- and postoperative data of the patients were recorded. Less than 15 mL/kg-1/h-1 f luid w as a dministered t o 75.3% (n=58) of the patients (Group 1) and 24.7% (n=19) were administered more than 15 mL/kg-1/h-1 (Group 2). In t erms of native disease, the rate of diagnosis of chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis was higher in Group 1, and the rate of other diagnoses was higher in Group 2 (p<0.01). The ratio of women in Group 2 was higher (p<0.05), while the body mass index values were significantly lower in this group (p<0.01). The erythrocyte, fresh frozen plasma, platelet, crystalloid and total fluid given in Group 2 were significantly higher (p<0.001). Inotropic/vasopressor agent use rates and extracorporeal membrane oxygenation requirement were significantly higher in Group 2 (p<0.01). Primary graft dysfunction, gastrointestinal complications, and mortality rates were also significantly higher in Group 2 (p<0.05). The increased intraoperative fluid volume in lung transplantation is associated with primary graft dysfunction, gastrointestinal complications, and mortality rates.

Association between Admission Blood Glucose Levels and Clinical Outcomes among Diabetic Adults Admitted to a Tertiary Care Hospital in Chennai, India: A Retrospective Study

Introduction: Admission blood glucose levels have an impact on hospitalisation and Length Of Stay (LOS). Uncontrolled blood glucose levels have been found to affect patients’ outcomes. Elevation of the initial blood glucose level during critical diagnosis was identified as an independent risk factor for in-hospital mortality in critical cases. Aim: To examine the association between admission blood glucose levels and clinical outcomes in adult diabetic patients. Materials and Methods: This retrospective study was conducted at a tertiary care hospital in Chennai, Tamil Nadu, India. Data were collected between July 1, 2021, and August 31, 2021, using non-probability convenience sampling from 522 records of adult diabetic patients admitted between January 2019 and March 2020. Capillary random blood glucose levels at the time of admission and their effects on LOS, both in the hospital and Intensive Care Unit (ICU), readmission, and mortality data were collected. Statistical analysis was performed using the Chi-square test. Results: Analysis of the records of 522 adult diabetic patients revealed that the mean and standard deviation (SD) of admission Capillary Blood Glucose (CBG) level were 177.46±49.42 mg/ dL, and the mean LOS in the hospital was 4.54±3.89 days. It was found that 340 (65.1%) patients had an admission duration of ≤4 days. There was a statistically significant association between admission blood glucose levels and LOS in the hospital (p-value=0.01), LOS in the ICU (p-value=0.008), readmission to the hospital (p-value=0.001), and mortality rate (p-value=0.0001). Conclusion: The study demonstrates that admission blood glucose levels are associated with the clinical outcomes of patients. These findings substantiate the need for maintaining normal glycemic levels through patient education and a proactive team approach to improve patient outcomes.

The Effects of Iron Therapy on Blood Transfusion, Length of Intensive Care Stay and Mortality in Patients with Iron Deficiency Anemia in the Intensive Care Unit

The Effects of Iron Therapy on Blood Transfusion, Length of Intensive Care Stay and Mortality in Patients with Iron Deficiency Anemia in the Intensive Care Unit

Risk factors of intensive care admission and mortality in a cohort of 111 Egyptian COVID-19 patients

ABSTRACT Background It is important to understand and identify the different clinical characteristics of COVID-19 patients in order to better understand the disease process and determine the various factors associated with poor prognosis and mortality. Methods Data from 111 COVID-19 patients were collected and retrospectively analyzed. The demographics, comorbidities, and laboratory test results of patients admitted to the intensive care unit (ICU) were compared with those admitted to the ward. Additionally, data obtained from patients who were discharged after treatment were compared with those who died at the hospital. Results Patients admitted to the ICU were older and presented with significantly higher levels of ferritin, lactate dehydrogenase (LDH), IL-6, c-reactive protein, and procalcitonin than those admitted to the ward. IL-6 level was an independent predictor of ICU admission. Likewise, the non-survivors were significantly older and had higher levels of LDH, d-dimer, IL-6, creatinine, blood urea nitrogen (BUN), and procalcitonin, and a higher prevalence of chronic kidney disease than those who were discharged from the hospital; increased age and high BUN levels were the independent predictors of mortality. Conclusion This study identified high IL-6 level as a predictor of ICU admission and older age and high BUN levels as predictors of mortality in patients with COVID-19.

270: IMPACT OF COVID-19 PANDEMIC IN ICU AND HOSPITAL RESOURCE UTILIZATION: A CANCER CENTER EXPERIENCE

Introduction: A recent global study including 81 reports reported a significant drop in healthcare utilization mostly outpatient visits, admissions, diagnostics, therapeutics, and emergency services after the COVID-19 pandemic. Interestingly, these reports seldomly address intensive care utilization or mortality. We hypothesized that the pandemic significantly affected the ICU and hospital utilization rates in a comprehensive cancer center located in Houston, Texas. Methods: We conducted an observational study comparing two periods, pre-pandemic (period-A, from 3/01/2019 to 2/28/2020) and first year of the pandemic (period-B, from 3/01/2020 to 2/28/2021). We reviewed the hospital metrics in our electronic health record (EHR). Results: During the two study periods we found a 22% decrease in the overall number of hospital admissions from 46,725 admissions (period-A) to 36,615 admissions (period-B). Emergency service visits (period-A 28,357 versus period-B 21,229) dropped by 25% in period-B. There was a 15% drop in the absolute number of intensive care unit (ICU) non-COVID admissions from 2,511 (period-A) to 2,147 (ICU admission rate period-B), as well as a 15% drop in surgeries and invasive interventions from 48,687 (period-A) to 41,650 interventions (period-B). However, the ICU admission rate increased from 5.4% (period-A) to 5.9% (period-B) (p=0.001). ICU mean length-of-stay (LOS) (4.14 vs 3.82, p=0.001) and mean intubation days (5.8 vs 4.7, p=0.001) were higher in period-A. The mean hospital LOS was 8 days, the same in both periods. ICU mortality was 14.9% during period-A and 14.2% in period-B (p=0.5). Hospital mortality was 2.6% in both periods. Conclusions: Our results confirmed that overall hospital utilization rates decreased during the first year of the COVID-19 pandemic. However, despite the lower numbers of patients the proportion of ICU admissions increased, the LOS and ventilator days decreased, and mortality remained the same. These findings highlight the complexity of critical care dynamics during the pandemic.

Reduced serum cholinesterase is an independent risk factor for all-cause mortality in the pediatric intensive care unit.

Our aim was to assess the relationship between serum cholinesterase levels at intensive care unit admission and all-cause mortality in the pediatric intensive care unit. We used the pediatric intensive care unit database (a large pediatric intensive care database in China from 2010 to 2018) to conduct a retrospective analysis to evaluate the serum cholinesterase levels at intensive care unit admission of 11,751 critically ill children enrolled to the intensive care unit. We analyzed the association between serum cholinesterase and all-cause mortality. Adjusted smoothing spline plots, subgroup analysis and segmented multivariate logistic regression analysis were conducted to estimate the relative risk between proportional risk between serum cholinesterase and death. Of the 11,751 children, 703 (5.98%) died in hospital. After adjusting for confounders, there was a negative association between serum cholinesterase and the risk of death in pediatric intensive care unit. For every 1,000 U/L increase in serum cholinesterase, the risk of death was reduced by 16% (adjusted OR = 0.84, 95% CI: 0.79, 0.89). The results of sensitivity analysis showed that in different stratified analyses (age, intensive care unit category, albumin, alanine aminotransferase, creatinine, neutrophils), the effect of serum cholinesterase on all-cause mortality remained stable. After adjusting for inflammation, nutrition, and liver function factors, cholinesterase reduction is still an independent risk factor for pediatric intensive care unit all-cause mortality.