Intensive Care Unit Admission Research Articles

Associations between obesity and severity of coronavirus disease 2019 in Brazilian inpatients: A 2021 secondary data analysis.

In the backdrop of the global obesity pandemic, recognized as a notable risk factor for coronavirus disease 2019 (COVID-19) complications, the study aims to explore clinical and epidemiological attributes of hospitalized COVID-19 patients throughout 2021 in Brazil. Focused on four distinct age cohorts, the investigation scrutinizes parameters such as intensive care unit (ICU) admission frequency, invasive mechanical ventilation (IMV) usage, and in-hospital mortality among individuals with and without obesity. Using a comprehensive cross-sectional study methodology, encompassing adult COVID-19 cases, data sourced from the Influenza Epidemiological Surveillance Information System comprises 329 206 hospitalized patients. Of these individuals, 26.3% were affected by obesity. Analysis reveals elevated rates of ICU admissions, increased dependence on IMV, and heightened in-hospital mortality among the individuals with obesity across all age groups (p < .001). Logistic regression, adjusting for confounding variables, underscores a progressively rising odds ratio for mortality in younger age brackets: 1.2 (95%CI 1.1-1.3) for those under 50 years, 1.1 (95%CI 1.0-1.2) for the 50-59 age group, and 1.1 (95%CI 1.0-1.2) for the 60-69 age group. Conversely, no significant mortality difference is observed for patients over 70 years (OR: 0.972, 95%CI 0.9-1.1). In summary, hospitalized COVID-19 patients with obesity, particularly in younger age groups, exhibit elevated rates of ICU admission, IMV requirement, and in-hospital mortality compared with the control group. Notably, the 'obesity paradox' is not evident among hospitalized COVID-19 patients in 2021.

Association of Resolved Low-Lying Placentation With Risk of Postpartum Hemorrhage

OBJECTIVE: To evaluate whether individuals who have a placenta previa or low-lying placenta that resolves before delivery are at increased risk of postpartum hemorrhage and postpartum hemorrhage–related morbidity. METHODS: This was a prospective, multicenter, 1:3 matched cohort study of pregnant individuals with singleton gestations diagnosed with low placentation by transvaginal scan at 19 to 23 weeks of gestation between January 2021 and December 2023 at nine academic maternity centers (exposed participants). Unexposed participants were those with a normally located placenta, matched in a 1:3 ratio according to parity. Resolution of low placentation was diagnosed when placenta was at 20 mm or more from the internal os. Individuals with fetal anomalies, hematologic disorders, therapeutic anticoagulation, placenta accreta spectrum disorder, vasa previa, persistent low placentation at birth, and delivery at a nonenrolling center were excluded. Primary outcome was postpartum hemorrhage of 1,000 mL or more. Secondary outcomes included postpartum hemorrhage of 1,500 mL or more, use of second-line uterotonic drugs, blood transfusions, additional procedures to control bleeding, intensive care unit admission, and hospital stay for more than 7 days. Multivariable logistic regression adjusted for confounders was used to estimate independent associations with outcomes. RESULTS: The study population included 182 exposed and 589 unexposed participants. Individuals with resolved low placentation had higher rates of smoking (P=.024), prior dilation and curettage (P=.012), posterior placenta (P&lt;.001), and induction of labor (P=.038). Multivariate logistic regression analysis adjusted for confounders showed that exposed people had higher odds of postpartum hemorrhage of 1,000 mL or more (13.2% vs 4.1%, adjusted odds ratio [aOR] 3.1) compared with unexposed people and of use of second-line uterotonic drugs (28.0% vs 12.4%, aOR 2.69) and tranexamic acid (16.5% vs 7.5%, aOR 2.19), as well as hospital stay longer than 7 days (11.5% vs 3.4%, aOR 2.63). CONCLUSION: Individuals with resolved low placentation are at increased risk of postpartum hemorrhage and related complications compared with those who always had a normally located placenta.

The association between acute kidney injury and dysglycaemia in critically ill patients with and without diabetes mellitus: a retrospective single-center study.

Critically ill patients in the intensive care unit (ICU) often experience dysglycaemia. However, studies investigating the link between acute kidney injury (AKI) and dysglycaemia, especially in those with and without diabetes mellitus (DM), are limited. We used the Medical Information Mart for Intensive Care IV database to investigate the association between AKI within 7 days of admission and subsequent dysglycaemia. The primary outcome was the occurrence of dysglycaemia (both hypoglycemia and hyperglycemia) after 7 days of ICU admission. Logistic regression analyzed the relationship between AKI and dysglycaemia, while a Cox proportional hazards model estimated the long-term mortality risk linked to the AKI combined with dysglycaemia. A cohort of 20,008 critically ill patients were included. The AKI group demonstrated a higher prevalence of dysglycaemia, compared to the non-AKI group. AKI patients had an increased risk of dysglycaemia (adjusted odds ratio [aOR] 1.53, 95% confidence interval [CI] 1.41-1.65), hypoglycemia (aOR 1.56, 95% CI 1.41-1.73), and hyperglycemia (aOR 1.53, 95% CI 1.41-1.66). In subgroup analysis, compared to DM patients, AKI showed higher risk of dysglycaemia in non-DM patients (aOR: 1.93 vs. 1.33, Pint<0.01). Additionally, the AKI with dysglycaemia group exhibited a higher risk of long-term mortality compared to the non-AKI without dysglycaemia group. Dysglycaemia also mediated the relationship between AKI and long-term mortality. AKI was associated with a higher risk of dysglycaemia, especially in non-DM patients, and the combination of AKI and dysglycaemia was linked to higher long-term mortality. Further research is needed to develop optimal glycemic control strategies for AKI patients.

Planned Home Births in the United States Have Outcomes Comparable to Planned Birth Center Births for Low-Risk Birthing Individuals.

There are lingering concerns in the United States about home birth. We used 2 large (n = 50,043; n = 62,984), national community birth registries to compare maternal and neonatal outcomes for planned home versus planned birth center births. To compare outcomes by intended birth site, we used logistic regressions, controlling for demographic and pregnancy risk variables. Maternal outcomes included intrapartum or postpartum transfer to hospital, hospitalization, cesarean, and hemorrhage; neonatal outcomes included neonatal transfer, hospitalization, neonatal intensive care unit admission, and intrapartum or neonatal death. Analyses were conducted twice, once in each dataset. Individuals who planned home births had a lower incidence of all types of transfers, compared with those who planned birth center births, but in one dataset only, experienced more cesareans [adjusted odds ratio (95% CI): 1.32 (1.02-1.70); 0.95 (0.88-1.03)]. Planned home birth was associated with lower adjusted odds of maternal hospitalization in one dataset but not the other [0.97 (0.54-1.74); 0.85 (0.76-0.95)], and was not associated with hemorrhage. Neonatal outcomes likewise were either not associated with a planned birthplace or suggested home birth was safer: hospitalization [0.77 (0.53-1.11), 0.90 (0.82-0.98)], neonatal intensive care unit admission [0.54 (0.28-1.00), 0.97 (0.86-1.10)]. There was no observable association with intrapartum or neonatal death: 1.07 (0.68-1.67; only calculated once because of small numbers of events). Planned home births are as safe as planned birth center births for low-risk pregnancies. Current guidelines advising against planned home births are not supported by these data.

Mycoplasma pneumoniae incidence, phenotype, and severity in children and adolescents in Denmark before, during, and after the COVID-19 pandemic: a nationwide multicentre population-based cohort study

Mycoplasma pneumoniae infections resurged globally in 2023-2024 after a three-year decline during the COVID-19 pandemic. We explored the incidence and severity of M pneumoniae infections in children and adolescents before, during, and after the pandemic. This nationwide, population-based cohort study included all Danish children and adolescents aged 0-17 years with a positive M pneumoniae PCR test from May 1, 2016, to April 30, 2024. We obtained clinical details for patients hospitalised for 24h or more. Risk ratios for infections, hospitalisations, and disease manifestations in 2023-2024 versus pre-COVID-19 seasons were calculated using Fisher's exact and Pearson's χ2 tests. A season was defined from May 1 to April30. Among the Danish population of 1,152,000 children and adolescents, 14,241 with a positive PCR test for Mpneumoniae were included. In 2023-2024, children and adolescents with a positive PCR rose 2.9-fold (95% CI 2.8-3.1; p<0.0001) compared to the pre-COVID-19 seasons, and hospitalisations rose 2.6-fold (95% CI 2.0-3.3; p<0.0001). Mpneumoniae-induced rash and mucositis increased 5.3-fold (95% CI 1.8-15.3; p=0.0007). In 2023-2024 compared to the pre-COVID-19 seasons, there was no difference in the proportion of hospitalisation (360 [4%] of 8165 versus 230 [4%] of 6009; p=0.09), the median duration of hospital stay (3 days [IQR 2-5] versus 3 days [IQR2-5]; p=0.84), or paediatric intensive care unit admission (14 [4%] of 360 versus 9 [4%] of 230 p=1.00). In Denmark, M pneumoniae infections and hospitalisations increased three-fold in 2023-2024 compared with the pre-COVID-19 seasons, indicating an immunity debt caused by the decline in M pneumoniae during the COVID-19 pandemic. While the severity of M pneumoniae infections did not change in 2023-2024, the five-fold increase in M pneumoniae-induced rash and mucositis in children and adolescents highlights Mpneumoniae as an important pathogen causing mucocutaneous eruptions. Innovation Fund Denmark and Rigshospitalets Forskningsfond.

Risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding

BACKGROUND With the widespread use of hemocoagulase in patients with gastrointestinal bleeding, clinicians have become increasingly concerned about coagulation disorders associated with this medication. Risk factors for hypofibrinogenemia associated with hemocoagulase are poorly understood. AIM To determine risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding. METHODS We performed a retrospective analysis of the medical documentation of hospitalized patients treated with hemocoagulase for gastrointestinal bleeding. Hypofibrinogenemia was defined as a decrease in plasma fibrinogen concentration to less than 2.0 g/L. The included patients were divided into two groups: acquired hypofibrinogenemia group and non-hypofibrinogenemia group. We used logistic regression analysis to identify potential risk factors and established risk assessment criteria by employing a receiver operating characteristic curve. RESULTS There were 36 patients in the acquired hypofibrinogenemia group and 73 patients in the non-hypofibrinogenemia group. The hypofibrinogenemia group showed higher rates of intensive care unit admissions (P = 0.021), more female patients (P = 0.005), higher in-hospital mortality (P = 0.027), larger hemocoagulase doses (P = 0.026), more Packed Red Cells transfusions (P = 0.024), and lower baseline fibrinogen levels (P &lt; 0.000). Binary logistic regression was employed to examine the risk factors associated with acquired hypofibrinogenemia. The analysis revealed that baseline fibrinogen [odds ratio (OR) 0.252, 95%CI: 0.137-0.464, P &lt; 0.000], total hemocoagulase doses (OR 1.074, 95%CI: 1.015-1.137, P = 0.014), and female gender (OR 2.856, 95%CI: 1.015–8.037, P = 0.047) were statistically significant risk factors. CONCLUSION Higher doses of total hemocoagulase, female gender, and a lower baseline fibrinogen level were risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding.

Exploring Risk Factors Associated With Intensive Care Unit Admission in a Retrospective Cohort of 631 Children With Bronchiolitis.

Examine the trends and epidemiological features of acute hospitalized bronchiolitis cases among children aged 28 days to 2 years, both before and after the COVID-19 pandemic. Furthermore, evaluate their need for intensive care unit (ICU) admission and identify primary risk factors associated with severe bronchiolitis. A retrospective analysis was conducted on the medical records of paediatric patients admitted to Meyer Children's Hospital in Florence (Italy) from September 2019 to March 2023, with the diagnosis of bronchiolitis. Between 2019 and 2023, bronchiolitis hospitalizations grew by 76%, going from 131 to 230 cases, after the historical minimum of 14 cases in the 2020-2021 season. Respiratory syncytial virus (RSV) infection emerged as the predominant etiological agent, contributing to 76% of hospitalizations in both 2021-2022 and 2022-2023 seasons. Coinfection cases increased fivefold from 2019 to 2023, accounting for 23% of hospitalizations in 2022-2023. In addition, the ICU admission rate increased from 13% in 2019-2020 to 31% of bronchiolitis hospitalizations in 2022-2023. Univariate and multivariate analysis data show that infants below 2 months of age, preterm births, comorbidities and RSV infections were correlated with a higher risk for ICU admission. The growing trend in ICU admissions for acute bronchiolitis in hospitalized children represents a substantial health challenge. Addressing the bronchiolitis epidemic necessitates a strategic focus on RSV prevention through interventions such as vaccines and monoclonal antibodies. Urgent implementation of preventive initiatives, together with continuous surveillance and the establishment of national databases, is imperative and cannot be further deferred.

Effect of the COVID-19 vaccination on feto-maternal outcomes: A prospective cohort study among Indian pregnant women

Background &amp; objectives Studies on the effects of COVID-19 vaccination among pregnant women in Asian settings, more specifically in India, are scarce. The present study evaluated the feto-maternal outcomes among Indian pregnant women who received the COVID-19 vaccine. Methods A prospective cohort study was undertaken among 430 pregnant women from two primary health centres (PHC) in Chandigarh, India during 2021-2022. The feto-maternal outcomes evaluated in the study included abortions, live birth/stillbirth, term/pre-term/post-term delivery, mode of delivery (normal vaginal/caesarean section/forceps), birth weight and intrauterine growth retardation. Results Of the 430 study participants, 295 pregnant women received COVID-19 vaccines, with an uptake rate of 68.6 per cent. Majority of vaccinated women (280- who completed the study) were in their second trimester (133, 47.5%), while 92 (32.9%) were in their third, and 55 (19.6%) were in their first trimester when they were enrolled in the study. Neonatal intensive care unit (NICU) admission was significantly lower among the vaccinated pregnant women, while other feto-maternal and neonatal outcomes were similar between vaccinated and unvaccinated pregnant women. Interpretation &amp; conclusions The findings of this study suggest COVID-19 vaccination in pregnant women in India might be safe, in terms of feto-maternal outcomes

Lactate dehydrogenase as a biochemical marker for prediction of maternal and perinatal outcomes in hypertensive disorders in pregnancy

Hypertensive disorder of pregnancy includes new onset hypertension in pregnancy that is gestational hypertension and already existing hypertension that is chronic hypertension and gestational hypertension sometimes worsened by preeclampsia. Preeclampsia can cause complications such as eclampsia, HELLP syndrome, renal failure, pulmonary edema, stroke, and left ventricular failure. We aim to assessthe predictive role ofLactate Dehydrogenase value in Hypertensive disorders in pregnancy.After obtaining the informed consent, pregnant patients who were visiting Tertiary care centre and who were more than 28 weeks period of gestation were enrolled. Patients from both antenatal OPD clinics and from those who were presenting in emergency were included in this study. Serum levels of LDH were tested. Patients were monitored till delivery and 6 weeks following childbirth.The Mean serum levels of lactate dehydrogenase (LDH) in eclamptic group was 1495.000±859.1230, 804.569±224.5519 in severely preeclamptic group and in mild preeclamptic group ,mean LDH levels were 520.062±110.3944. The difference between both the groups was statistically significant (p &amp;#60; 0.001).Women with serum LDH levels &amp;#62; 800 IU/L and LDH levels between 601-800 IU/L, experienced considerably greater complications in preeclamptic-eclamptic group as compared to those with serum LDH levels &amp;#60; 600 IU/L.Thepreeclamptic-eclamptic group of women had increased serum LDH levels. Greater LDH levels were linked to worse outcomes for mothers including placental abruption, hemolysis elevated liver enzymes low platelet count (HELLP syndrome), pulmonary edema and maternal death and they were also linked to fetal complications including intrauterine fetal death (IUFD), intrauterine growth restriction and neonatal intensive care unit (NICU) admission.

Diagnostic comparison of bedside lung ultrasound and chest radiography in the intensive care unit

Bedside lung ultrasound (POCUS) offers advantages over chest X-ray, including better cost-effectiveness for diagnosing certain pulmonary pathologies. This study compares the diagnostic concordance between portable chest X-rays and bedside lung ultrasounds in the intensive care unit (ICU). Adult ICU patients were included. POCUS was performed using the abbreviated BLUE protocol. Diagnostic results from POCUS and chest radiographies were compared using the intensivist clinical diagnosis - based on clinical examinations and lung ultrasounds - as the reference. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the ultrasounds were calculated. A total of 100 patients were included, 71 with pulmonary pathologies. The average time to perform the ultrasound was 308 seconds. Ultrasound identified pathology in 20 patients with a normal chest radiographs. Diagnostic discrepancies occurred in 30 patients, highlighting ultrasound´s superior sensitivity in detecting atelectasis, pleural effusions, and pulmonary edema. Ultrasound demonstrated sensitivity (S) of 85%, specificity (E) of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 55%. Lung point-of-care ultrasound at ICU admission detects more pathologies and does not miss significant abnormalities seen on chest X-rays. It also shows good diagnostic accuracy. These findings suggest that pulmonary POCUS, using an abbreviated protocol, could be a viable alternative to chest radiography for initial evaluation and follow-up of pulmonary pathologies in critically ill patients, potentially improving care quality and management.

Prenatal homelessness, food insecurity, and unemployment and adverse infant outcomes in a California cohort, 2007-2020.

Characterize the relationship between infant outcomes and prenatal homelessness, food insecurity and unemployment. California live births between 22- and 44-weeks' gestation comprised 6,089,327 pregnancies (2007-2020). Data were collected from linked Vital Statistics and hospital discharge records. Prenatal homelessness, food insecurity, and unemployment were classified as health-related social needs (HRSN) using International Classification of Disease codes in delivery records. Risk ratios for preterm birth, low birthweight, small for gestational age, neonatal intensive care unit admission, emergency department admission, rehospitalization, and death were estimated using log-linear Poisson regression adjusted for birthing person race, payer, and education. 65.7 per 100,000 births had HRSN. These infants had a higher risk of preterm birth (aRR 2.7), low birthweight (aRR 2.7), SGA (aRR 1.5), NICU admission (aRR 3.5), and death (aRR 3.0). HRSN increase the risk of infant morbidity and mortality but remain underreported in administrative records, making definitive conclusions difficult.

Feasibility, safety, and clinical outcomes of modified laparoscopic cervicoisthmic cerclage for refractory cervical insufficiency: A single-arm clinical trial-Part 1.

To assess the feasibility, safety, and outcomes of modified laparoscopic transabdominal cerclage in patients with refractory cervical insufficiency. This single-arm clinical trial examined women with refractory cervical insufficiency who underwent modified laparoscopic transabdominal cerclage at a specialized center in Japan between December 2017 and May 2022. Various parameters related to patient demographics, surgical techniques, outcomes, and complications were evaluated. The study enrolled 30 women with a median age of 36 years. The modified laparoscopic transabdominal cerclage was technically successful in all cases. The delivery rate and fetal survival rate at 28 days in the third trimester were both 93%. Surgical complication involving small bowel injury occurred in one case and was promptly repaired. No fetal complications or pregnancy losses occurred within 28 days of the procedure. Perinatal outcomes included a cesarean section rate of 93%, a neonatal intensive care unit admission rate of 30%, and an overall fetal survival rate of 93%. Additionally, no absence or reversal of end-diastolic flow in the uterine artery was identified at the time of cerclage in any of the cases. This study demonstrated the feasibility and safety of modified laparoscopic transabdominal cerclage for refractory cervical insufficiency. The procedure achieved a high delivery rate in the third trimester and a good overall fetal survival rate. The study findings highlight the importance of anatomical precision during thread placement in modified laparoscopic transabdominal cerclage. This technique is promising for treating refractory cervical insufficiency and potentially preventing second-trimester losses and extreme preterm births.

Intensive care unit admissions following enhanced recovery video-assisted thoracoscopic surgery lobectomy.

Video-assisted thoracoscopic surgery (VATS) lobectomy combined with enhanced recovery after surgery (ERAS) protocols has improved postoperative outcomes, yet concerns persist regarding complications and readmissions. Limited research has explored intensive care unit (ICU) admissions and outcomes within this context. This study aimed to analyze ICU admissions following VATS lobectomy within an established ERAS protocol. Consecutive patients who underwent VATS lobectomy between 2018-2023 were included. Patient data were obtained from our prospective institutional database, while ICU data were extracted from electronic patients' records. Of 2099 patients included, 48 (2.3%) required ICU admission. Median-age was 70 (IQR : 64-76), with ICU patients being older and predominantly male (73%). Overall 30-day-mortality was 1.0% with an ICU mortality of 31%. Multiple logistic regression revealed significant associations between ICU admission and male gender (p = <0.001), diabetes mellitus (p = 0.026), heart failure (p = 0.040), DLCO%(0.013). Median time to ICU admission was 4 days (IQR : 2-10). Respiratory failure was the primary reason for ICU admission (60%). Severe surgical complications accounted for 8.3% of all ICU-admissions. In an ERAS setting, the incidence of ICU admission following VATS lobectomy was 2.3%, with a mortality rate of 31%. Respiratory failure was the leading cause of ICU admission.

Analysis of six consecutive waves of ICU-admitted COVID-19 patients: key findings and insights from a Portuguese population.

Identifying high-risk patients, particularly in intensive care units (ICUs), enhances treatment and reduces severe outcomes. Since the pandemic, numerous studies have examined COVID-19 patient profiles and factors linked to increased mortality. Despite six pandemic waves, to the best of our knowledge, there is no extensive comparative analysis of patients' characteristics across these waves in Portugal. Thus, we aimed to analyze the demographic and clinical features of 1041 COVID-19 patients admitted to an ICU and their relationship with the different SARS-Cov-2 variants in Portugal. Additionally, we conducted an in-depth examination of factors contributing to early and late mortality by analyzing clinical data and laboratory results from the first 72h of ICU admission. Our findings revealed a notable decline in ICU admissions due to COVID-19, with the highest mortality rates observed during the second and third waves. Furthermore, immunization could have significantly contributed to the reduction in the median age of ICU-admitted patients and the severity of their conditions. The factors contributing to early and late mortality differed. Age, wave number, D-dimers, and procalcitonin were independently associated with the risk of early death. As a measure of discriminative power for the derived multivariable model, an AUC of 0.825 (p < 0.001; 95% CI, 0.719-0.931) was obtained. For late mortality, amodel incorporating age, wave number, hematologic cancer, C-reactive protein, lactate dehydrogenase, and platelet counts resulted in an AUC of 0.795 (p < 0.001; 95% CI, 0.759-0.831). These findings underscore the importance of conducting comprehensive analyses across pandemic waves to better understand the dynamics of COVID-19.

Superiority of Frailty Over Age in Predicting Outcomes Among Clostridium Difficile Patients: Evidence from National Data.

Clostridium difficile infection (CDI) has become a significant healthcare issue with increasing morbidity and mortality in the US and Europe. Frailty, characterized by reduced physical reserves and resistance to stressors, is linked to poor outcomes but its impact on CDI patients remains underexplored. This study seeks to address this gap through a nationwide analysis. Using the National Readmission Database from 2016 to 2020, we employed the International Classification of Diseases, 10th revision, Clinical Modifications codes to identify adult patients admitted with CDI. We further stratified CDI hospitalizations based on frailty. Utilizing a regression model, we assessed the impact of frailty on CDI outcomes. We included 144,611 CDI patients of whom 98,167 (67.88%) were frail. Multivariate analysis showed that frail CDI patients had significantly higher mortality (adjusted odds ratio (aOR) 4.87), acute kidney injury requiring dialysis (aOR 9.50), septic shock (aOR 14.23), and intensive care unit admission (aOR 6.80). CDI-specific complications were more likely in frail patients, including toxic megacolon (aOR 10.22), intestinal perforation (aOR 2.30), need for colectomy (aOR 3.90) and CDI recurrence (aOR 3.65). Resource utilization, indicated by hospitalization charges, length of stay, and 30-day readmission rates, was greater among frail patients. Our study underscores the significant association between frailty and various critical endpoints of CDI, including its incidence, mortality, and recurrence. Additionally, frailty independently predicts higher resource utilization and elevated 30-day readmission. Recognizing frailty as a determinant of CDI outcomes can aid clinicians in risk stratification and guide tailored interventions for this population.

Implantable cardioverter defibrillators in people dying with cancer: A SEER-Medicare analysis of ICD prevalence and association with aggressive end-of-life care.

The shared risk profiles for cancer and heart disease suggest many individuals with cancer may have an implantable cardioverter defibrillator (ICD). ICDs can have dramatic cancer end-of-life care implications including painful and distressing shocks. ICD prevalence and association with aggressive end-of-life care among individuals with breast, colorectal, and pancreatic cancer was evaluated using the Surveillance, Epidemiology, and End Results-Medicare dataset. A total of 37,306 Medicare beneficiaries aged ≥66 years with stage 3 or 4 cancer who died between 2005 and 2016 were identified. ICD prevalence, ICD-related care utilization that might present opportunities to discuss end-of-life implications and association with aggressive end-of-life care (>1 emergency department visit, intensive care unit admission, >1 hospitalization, terminal hospitalization, chemotherapy, and invasive or life-extending procedures) in the last month of life was assessed using multivariable logistic regression. Among cancer decedents, 6% had an ICD. More individuals with an ICD (31%) died in the hospital than individuals without an ICD (25%; p<.001). Half (46%) of individuals with an ICD had device programming or interrogation visits that could be an opportunity for device discussion. In adjusted models, ICD presence was associated with higher odds of every indicator of aggressive end-of-life care other than chemotherapy. Many older cancer decedents in the United States had an ICD, and those with ICDs received more aggressive care at the end of life. Results suggest there are opportunities to discuss ICD and goals of care, raise awareness and encourage shared decision-making for this population to ensure goal-concordant care, and improve end-of-life care quality.

Impact of Individual Characteristics on Hospital Outcomes in Exacerbated COPD in a Biomass-Exposed Turkish Population

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally, and factors such as biomass exposure, demographic characteristics, and comorbidities significantly influence patient outcomes during exacerbations. Aim: This study aims to clarify the impact of patient characteristics on key hospital outcomes, including ICU admissions, hospital length of stay, and in-hospital mortality, focusing on the contextual role of biomass exposure rather than its direct impact. Methods: Using a multicenter, retrospective cohort design, we analyzed the medical records of patients admitted with COPD exacerbations from January 2021 to December 2023. Eligible patients were over 40 years old with confirmed COPD exacerbation, excluding those with other significant lung conditions, severe organ dysfunction, or incomplete data. The collected data included demographics, smoking history, comorbidities, medications, laboratory results, and clinical outcomes, with smoking status categorized into current, former, or never smokers. Results: Our analysis comprised 334 patients with a mean age of 69 ± 8.8 years, including 52 (15.6%) females. Biomass exposure, observed in 22% of patients, was associated with a higher likelihood of being female (p &lt; 0.001), lower smoking rates (p &lt; 0.001), higher prevalence of diabetes mellitus type 2 (p = 0.020), lower peripheral blood eosinophilia (p = 0.001), increased intensive care unit (ICU) admissions (p = 0.034), and higher in-hospital mortality (p = 0.043). Non-survivors tended to be older and had a higher prevalence of hypertension, a history of childhood pneumonia, longer COPD duration, greater need for non-invasive ventilation (NIV) during hospitalization, and more frequent ICU admissions. Univariate Cox regression analysis revealed no significant associations between characteristics and outcomes. Conclusions: Patients with biomass exposure were more likely to be female and had higher rates of ICU admission and in-hospital mortality.

Comparing gastrointestinal dysfunction score and acute gastrointestinal injury grade for predicting short-term mortality in critically ill patients

BACKGROUND The prognosis of critically ill patients is closely linked to their gastrointestinal (GI) function. The acute GI injury (AGI) grading system, established in 2012, is extensively utilized to evaluate GI dysfunction and forecast outcomes in clinical settings. In 2021, the GI dysfunction score (GIDS) was developed, building on the AGI grading system, to enhance the accuracy of GI dysfunction severity assessment, improve prognostic predictions, reduce subjectivity, and increase reproducibility. AIM To compare the predictive capabilities of GIDS and the AGI grading system for 28-day mortality in critically ill patients. METHODS A retrospective study was conducted at the general intensive care unit (ICU) of a regional university hospital. All data were collected during the first week of ICU admission. The primary outcome was 28-day mortality. Multivariable logistic regression analyzed whether GIDS and AGI grade were independent risk factors for 28-day mortality. The predictive abilities of GIDS and AGI grade were compared using the receiver operating characteristic curve, with DeLong’s test assessing differences between the curves’ areas. RESULTS The incidence of AGI in the first week of ICU admission was 92.13%. There were 85 deaths (47.75%) within 28 days of ICU admission. There was no initial 24-hour difference in GIDS between the non-survival and survival groups. Both GIDS (OR 2.01, 95%CI: 1.25-3.24; P = 0.004) and AGI grade (OR 1.94, 95%CI: 1.12-3.38; P = 0.019) were independent predictors of 28-day mortality. No significant difference was found between the predictive accuracy of GIDS and AGI grade for 28-day mortality during the first week of ICU admission (Z = -0.26, P = 0.794). CONCLUSION GIDS within the first 24 hours was an unreliable predictor of 28-day mortality. The predictive accuracy for 28-day mortality from both systems during the first week was comparable.

Impact of Interhospital Transfer on Outcomes in Acute Pancreatitis: Implications for Healthcare Quality

Background/Objectives: Effective management of acute pancreatitis (AP) hinges on prompt volume resuscitation and is adversely affected by delays in diagnosis. Given diverse clinical settings (tertiary care vs. community hospitals), further investigation is needed to understand the impact of the initial setting to which patients presented on clinical outcomes and quality of care. This study aimed to compare outcomes and quality indicators between AP patients who first presented to the emergency department (ED) of a tertiary care center and AP patients transferred from community hospitals. Methods: This study included AP patients managed at our tertiary care hospital between 2008 and 2018. We compared demographics and outcomes, including length of stay (LOS), intensive care unit (ICU) admission, rates of local and systemic complications, re-admission rates, and one-year mortality in transferred patients and those admitted from the ED. Quality indicators of interest included duration of volume resuscitation, time until advancement to enteral feeding, pain requiring opioid medication [measured in morphine milliequivalent (MME) dosing], and surgical referrals for cholecystectomy. Categorical variables were analyzed by chi-square or Fisher’s exact test; continuous variables were compared using Kruskal–Wallis tests. Regression was performed to assess the impact of transfer status on our outcomes of interest. Results: Our cohort of 882 AP patients comprised 648 patients admitted from the ED and 234 patients transferred from a community hospital. Transferred patients were older (54.6 vs. 51.0 years old, p &lt; 0.01) and had less frequent alcohol use (28% vs. 39%, p &lt; 0.01). Transferred patients had a significantly greater frequency of gallstone AP (40% vs. 23%), but a lower frequency of alcohol AP (16% vs. 22%) and idiopathic AP (29% vs. 41%) (p &lt; 0.001). Regarding clinical outcomes, transferred patients had significantly higher rates of severe AP (revised Atlanta classification) (10% vs. 2% severe, p &lt; 0.001) and ICU admission (8% vs. 2%, p &lt; 0.001) and longer median LOS (5 vs. 4 days, p &lt; 0.001). Regarding quality indicators, there was no significant difference in the number of days of intravenous fluid administration, or days until advancement to enteral feeding, pain requiring opioid pain medication, or rates of surgical referral for cholecystectomy. Conclusions: Though the quality of care was similar in both groups, transferred patients had more severe AP with higher rates of systemic complications and ICU admissions and longer LOS, with no difference in quality indicators between groups.

Abstract 4115399: Comparative Outcomes of Local-Regional Versus General Anesthesia in Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis

Background: Endovascular Aortic Aneurysm Repair (EVAR) has emerged as a less invasive approach to aneurysm repair. However, the optimal anesthesia modality for elective cases—general or local-regional—remains uncertain. This meta-analysis compares the outcomes of local-regional versus general anesthesia (GA) for abdominal EVAR. Methods: We searched MEDLINE, Embase, and Cochrane databases for studies comparing local-regional and general anesthesia for EVAR up to May 2024. Following the PRISMA protocol, 1,796 articles were screened. Endpoints included 30-day mortality, type I endoleaks, length of hospital stay (LHS), and Intensive Care Unit (ICU) admissions. A random-effects model with odds ratios (OR) and 95% confidence intervals (CI) was used for binary endpoints and mean difference (MD) for continuous endpoints. Heterogeneity was assessed using Q and I2 statistics. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach evaluated the quality of evidence. Results: Sixteen cohort studies, encompassing 70,654 patients treated with EVAR after excluding overlapping populations, were included. All groups had similar demographics, American Society of Anesthesiologists physical status, and aneurysm type. The mean age was 73.6 years, and 88.1% were male. Local-regional anesthesia was associated with significantly lower 30-day all-cause mortality (OR 0.74; 95% CI 0.55 to 0.99; p=0.049; I2=0, Figure A), shorter LHS (MD -0.72 days; 95% CI -1.29 to -0.15; p=0.01; I2=87%), and less ICU admissions (OR 0.53; 95% CI 0.31 to 0.93; p=0.027; I2=98%). There was no increase in endoleaks in the local-regional group (OR 0.78; 95% CI 0.55 to 1.09; p=0.143; I2=29%, Figure B). The GRADE rated this evidence as moderate certainty and high importance. Conclusion: Local-regional anesthesia may be preferable to general anesthesia for EVAR, as it reduces 30-day mortality, ICU admissions, and hospital stay length without increasing the risk of type I endoleaks.