Mortality In Intensive Care Unit Patients Research Articles

Heart rate/temperature ratio: A practical prognostic indicator for critically ill patients with sepsis

BackgroundWe hypothesize that the heart rate/temperature ratio can predict intensive care unit (ICU) mortality in critical ill patients with sepsis. We aimed to explore the association between the heart rate/temperature ratio and ICU mortality in patients with sepsis. MethodsWe conducted this study utilizing a comprehensive critical care medicine database. The primary endpoint assessed was ICU mortality. A multivariable logistic regression model was employed to determine the independent impact of the heart rate to temperature ratio on ICU mortality. ResultsThe study included 12,321 patients. A nonlinear relationship was observed between the heart rate/temperature ratio and ICU mortality, with an inflection point identified at 2.22. The results from the Multivariable logistic regression analysis revealed that the heart rate/temperature ratio independently contributed to the risk of ICU mortality. In model II, there was a 55 % higher ICU mortality rate with a heart rate/temperature ratio greater than 2.22 than with that less than 2.22 (odds ratio [OR] = 1.55, 95 % confidence interval [CI] 1.35–1.77). Moreover, an elevated heart rate/temperature ratio as a continuous variable showed a positive association with ICU mortality (OR = 2.14; 95 % CI: 1.87–2.45). The impact of the heart rate/temperature ratio on ICU mortality remained consistent across all subgroup variables. The sensitivity analysis results consistently supported the primary outcome, with an E value of 2.47. This suggests that the influence of unmeasured confounders on the observed outcomes was minimal, thereby confirming the robustness of the findings. ConclusionsThe heart rate/temperature ratio is a readily available and convenient indicator in a clinical setting. Elevated heart rate/temperature ratios, particularly those exceeding 2.22, are strongly linked to a high ICU mortality rate among critically ill sepsis patients.

Independent Predictors of Mortality in ICU Patients with COVID-19

Objective: Early identification of Coronavirus disease 2019 (COVID-19) patients at high mortality risk can improve patient care and prevent deaths. To identify prognostic predictors that increase COVID-19 patient mortality risk in the Intensive Care Unit (ICU).
 Methods: Retrospective analysis of clinical characteristics and serological biomarkers of ICU-COVID-19 patients was performed in a tertiary hospital from 24 March 2020 to 20 December 2020. Analysis was conducted on two groups of study participants: survivors and deceased. Multivariate logistic regression was used to determine mortality risk. In order to determine prognostic predictors, the ANOVA test was used to compare the data of serological biomarkers on the day of patients' admission to the ICU and on the 5th day of follow-up.
 Results: A total of 335 patients (54.65%) were in the deceased group, and 278 (45.35%) were in the survivors group. A statistically significant difference was found between the deceased and survivor groups regarding mean age (p

Evaluation of the FAST HUG implementation effect on the mortality and length of stay in admitted patient in Intensive Care Unit (ICU) of a hospital

Objective: We aimed to determine new version of the FAST HUG implementation effect on the mortality and length of stay in admittedpatient in Intensive Care Unit (ICU) of a hospital. Methods: We conducted a prospective cohort study on 406 patients who admitted in medical and surgical ICU of Imam Hossein Hospitalof Tehran province in Iran from July 1, 2022, to September 30, 2022. We identified predictors of ICU mortality by logistic regression model,predictors of 28-day mortality/re-hospitalization/recovery by generalized ordered logit model, predictors of length of stay (LOS) by linearregression, predictors of mechanical ventilation by generalized ordered logit and predictors of SOFA score by hurdle model. Results: This mnemonic had protective impact (OR = 0.56, P-value = 0.01) on the 28-days mortality. One unit increase in mean of FAST HUGscore had a preventive effect on the outcome of death (OR = 0.21). Surgical admission type (Coefficient = –3.24, P-value = 0.00) and FASTHUG implementation (Coefficient =1.58, P-value= 0.0) were strongest factors on the LOS. Conclusion: Our study results approved the importance of the FAST HUG implementation on the decrease of patient mortality in ICU and28 days after discharge. Additionally, this checklist had a statistically significant role in declining SOFA scores in ICU patients.

The association between serum chloride and mortality in ICU patients with heart failure: The impact of bicarbonate

ObjectiveTo assess whether serum chloride predicts risk of death in intensive care unit (ICU) patients with heart failure (HF) and the effect of bicarbonate on the efficacy of serum chloride in predicting risk of death in ICU patients. MethodsA total of 9364 HF patients hospitalized in the ICU were enrolled. Patients were divided into hypochloremia (< 96 mEq/L), normal chloride (96–108 mEq/L), and hyperchloremia (> 108 mEq/L) groups. Similarly, we divided the serum bicarbonate level into three groups: low bicarbonate (< 22 mEq/L), medium bicarbonate (22–26 mEq/L), and high bicarbonate (> 26 mEq/L). The outcome of this study was in-hospital mortality. Then, we analyzed the association between abnormal serum chloride and mortality according to the category of serum bicarbonate and assessed the interaction effect. Restricted cubic spline (RCS) was used to show possible nonlinear associations. ResultsIn the overall study population, hypochloremia was associated with a higher risk of in-hospital mortality than normal chloride (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.26–1.86, P < 0.001), hyperchloremia was not significantly related to in-hospital mortality (OR 1.00, 95% CI 0.85–1.19, P = 0.962). However, a linear association between serum chloride and in-hospital mortality was found in the low and normal bicarbonate groups (all P for nonlinear >0.05). ConclusionsHypochloremia is associated with in-hospital mortality and longer hospital stay in critically ill patients with HF. In addition, risk of death in the low and medium serum bicarbonate groups decreased with increasing serum chloride level.

The Relationship of ABO and Rh Blood Group Types With Severe COVID-19 Disease Mortality in ICU Patients: Insights From a Single-Center Experience in Southern Saudi Arabia.

Introduction The global COVID-19 pandemic has triggered an unprecedented public health crisis, emphasizing the need to understand factors influencing disease outcomes. This study explores the role of genetic variations in blood group antigens, particularly ABO and RhD, in shaping mortality rates among critically ill COVID-19 patients in the southern region of Saudi Arabia. Methods Utilizing a retrospective, noninterventional approach, we analyzed medical records of 594 COVID-19 patients admitted to the intensive care unit (ICU) at Aseer Central Hospital from August 2020 to April 2021. The cohort, with a mean age of 60.5 years, consisted of a predominantly male population. Results The study encompassed a diverse age range of 18 to 103 years, with a mean age of 60.5 ± 17.3 years. Of the 594 patients, 398 (67%) were male, and only 5 (0.8%) had a history of smoking. Blood group distribution revealed 275 (48.4%) with O-, 189 (33.3%) with A+, and 51 (9%) with AB- types. Predominant chronic conditions included diabetes mellitus (35.5%). Tragically, 320 patients (54.6%) experienced mortality, with a 100% mortality rate for the B+ blood group and 92.9% for O- blood group. Conclusion This analysis establishes significant statistical links, underscoring the pivotal role of blood type, particularly the Rh factor, in influencing mortality risk among critically ill COVID-19 patients. These findings contribute valuable insights into risk stratification and personalized care for severe cases, emphasizing the importance of genetic considerations in understanding disease outcomes.

Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units.

Intensive care units (ICUs) are expert hospital areas that provide treatment and 24 h care for people who are very sick. Sepsis represents a serious, severe condition and it can lead to septic shock and multiple organ dysfunction syndromes and is one of the most common reasons for patients' hospitalization in ICUs. We wanted to explore the prognostic values of interleukin (IL) 33, soluble suppression of tumorigenicity 2 (sST2), IL 27, and galectin 3 in critically-ill patients. We assumed that these parameters in combination or alone could predict mortality in ICU patients. This research represents a clinical non-randomized prospective study, performed at the Medical Military Academy, a tertiary care hospital in Belgrade, Serbia. The patients were divided in four groups: patients with sepsis (peritonitis, pancreatitis, trauma) and patients without sepsis (trauma). Total number of patients enrolled in the study was 151 and average years of patients were 56.48. The values greater than the cut-off were the predictors of mortality. The IL-33, IL-27 as well as galectin-3 can successfully predict the outcome of critically-ill patients in ICUs. The sST2, cannot predict death in critically-ill patients as a single prognostic factor. However, the combination of at least two biomarkers: IL-33, sST2, IL-27, and galectin-3, gives very significant results in predicting the outcome in patients admitted to ICUs.

Investigating the Relationship between Red Cell Width Distribution (RDW) and Outcome in Ventilator-Associated Pneumonia: A Prospective Cross-Sectional Study

Background: Ventilator-associated pneumonia (VAP) is a consequence of mechanical ventilation, which can be fatal. Several markers are available to predict outcomes related to VAP. Choosing a predictor that is inexpensive, affordable, and accurate is advantageous. This study aimed to examine red cell distribution width (RDW) as a predictor of mortality in patients with VAP.&#x0D; Methods: This prospective cohort study was conducted among 49 patients in the intensive care unit (ICU) of Valiasr Hospital in Tehran. A researcher-made checklist was used to collect RDW and other marker data, as well as mortality outcomes and length of stay (LOS) in the ICU. The Pearson correlation coefficient in the SPSS software and the regression model in the Eviews software were used to examine the relationship between markers and different outcomes.&#x0D; Results: Of a total of 49 patients (57.1% male; mean age = 54 ± 16), the length of ICU stays ranged from 7 to 14 days. According to the Pearson correlation coefficient, a significant association between RDW and mortality (P =.009) was noted. But no significant relationship between RDW and length of stay in the ICU (P =.81) was noted. Additionally, the regression model showed a positive relationship between RDW and white blood cells (WBC), lactate, and sequential organ failure assessment (SOFA).&#x0D; Conclusion: Our study showed a positive but weak correlation between RDW and ICU mortality in patients with VAP. Due to its availability and low cost of measurement, RDW is an appropriate option for predicting mortality risk in patients who are admitted to the ICU and develop VAP.

Prognostic value of oxygen saturation index trajectory phenotypes on ICU mortality in mechanically ventilated patients: a multi-database retrospective cohort study

BackgroundHeterogeneity among critically ill patients undergoing invasive mechanical ventilation (IMV) treatment could result in high mortality rates. Currently, there are no well-established indicators to help identify patients with a poor prognosis in advance, which limits physicians’ ability to provide personalized treatment. This study aimed to investigate the association of oxygen saturation index (OSI) trajectory phenotypes with intensive care unit (ICU) mortality and ventilation-free days (VFDs) from a dynamic and longitudinal perspective.MethodsA group-based trajectory model was used to identify the OSI-trajectory phenotypes. Associations between the OSI-trajectory phenotypes and ICU mortality were analyzed using doubly robust analyses. Then, a predictive model was constructed to distinguish patients with poor prognosis phenotypes.ResultsFour OSI-trajectory phenotypes were identified in 3378 patients: low-level stable, ascending, descending, and high-level stable. Patients with the high-level stable phenotype had the highest mortality and fewest VFDs. The doubly robust estimation, after adjusting for unbalanced covariates in a model using the XGBoost method for generating propensity scores, revealed that both high-level stable and ascending phenotypes were associated with higher mortality rates (odds ratio [OR]: 1.422, 95% confidence interval [CI] 1.246–1.623; OR: 1.097, 95% CI 1.027–1.172, respectively), while the descending phenotype showed similar ICU mortality rates to the low-level stable phenotype (odds ratio [OR] 0.986, 95% confidence interval [CI] 0.940–1.035). The predictive model could help identify patients with ascending or high-level stable phenotypes at an early stage (area under the curve [AUC] in the training dataset: 0.851 [0.827–0.875]; AUC in the validation dataset: 0.743 [0.709–0.777]).ConclusionsDynamic OSI-trajectory phenotypes were closely related to the mortality of ICU patients requiring IMV treatment and might be a useful prognostic indicator in critically ill patients.

Mortality and Prognostic Factors of Adult Patients with Acute Leukemia Admitted to the ICU: A Systematic Review

Introduction: Acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) are the most aggressive group of hematologic malignancies (Pulte et al, 2020) and will be responsible for approximately 12,700 deaths in the U.S. during 2023(Seiger et al,2023). Improved overall survival (OS) has been observed in the past decades in both diseases, but high mortality in the Intensive Care Unit (ICU) persists, which may prevent ICU admission of those patients. We aimed to review the literature on mortality data and survival predictors of patients with acute leukemia (AL) admitted to the ICU. Methods: Embase, Pubmed and Cochrane databases were searched for articles published from January of 2005 to December of 2020. Due to OS improvement of patients with AML, we only included studies published as of 2005 (Percival et al, 2015). Editorials, case reports and small case series were excluded. Results: Initial search revealed 1,015 manuscripts from database and references, 650 were screened and 115 were fully assessed, for which 24 met eligibility criteria (Figure 1). A total of 13,350 patients were included in the review. Median age was 54.8 years and 57.3% of patients were male. AML represented the majority of diagnoses (98.2%).Two studies included only newly diagnosed patients, 1 study only included patients with relapsed disease and the rest (N=21) included subjects regardless of the AL status. Only 0.7% of patients had a history of hematopoietic stem cell transplantation . 81.9% of patients required mechanical ventilation, 25.3% needed renal replacement therapy, and 65.9% used vasopressors in studies data was available. Median SOFA score in the first 24h of ICU admission was 10.85 . Pooled ICU mortality and hospital mortality were 45.0% and 43.1%, respectively; 58.2% of patients were deceased at 90-day mark (Table 1). The 12 months OS was 37.3%. Higher SOFA score, need for mechanical ventilation, sepsis, vasopressor use, and age greater than 60 years were the most common predictors of ICU, hospital and 90-day mortality. Relapsed or refractory status of underlying AL was the most significant risk factor for long-term mortality. Conclusions: Our systemic review showed that ICU mortality in patients with AL was 45.0%, which represents a survival improvement compared to prior studies on patients with hematological malignancies, where ICU mortality could be as high as 69% (Ashkenazi et al, 1986). Predictors of ICU mortality were closely related to the severity of acute illness rather than malignancy status. We acknowledge that our patient population was mostly comprised of AML cases and the majority of the original studies included a small number of patients with AL with exception of one large study (Halpern et al, 2017).

Infection control: dental extractions in ICU patients and their relation to the exams

Through dental extraction, dentists are able to eliminate infectious foci that can lead to systemic problems in patients during their admission to the Intensive Care Unit (ICU). Therefore, the objective of this study was to analyze the influence of dental extraction on laboratory exams of ICU patients, identify the profile of patients undergoing dental extraction in the ICU, and assess the safety of performing this procedure in critically ill patients. A retrospective analysis of medical records was conducted for patients admitted to the ICUs of two public hospitals, both before and after the dental extraction procedure. The following tests were examined: daily laboratory glucose levels and daily leukocyte counts for a period of ten days. The profile of patients requiring dental extractions in the ICU, in order, includes those admitted for respiratory diseases, sepsis, heart disease, and kidney problems. There were no statistically significant differences in blood glucose and leukocyte values after the dental extractions. Therefore, this study suggests that when dental extractions are properly indicated, they are a safe procedure as they do not cause significant worsening in leukocyte counts or glycemia, and they do not increase mortality in ICU patients.

Vitamin D supplementation is beneficial in improving the prognosis of patients with acute respiratory failure in the intensive care unit: a retrospective study based on the MIMIC-IV database

BackgroundVitamin D plays a critical role in the regulation of multiple physiological pathways. Vitamin D deficiency may be a risk factor for life-threatening clinical conditions. Several studies have found that vitamin D supplementation in critically ill patients improves prognosis. The purpose of this study was to determine the association between vitamin D and the prognosis of patients with acute respiratory failure (ARF).MethodsIn this retrospective cohort study, we collected clinical information of ARF patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) version 2.0 database. The outcome of this study was in-hospital mortality, intensive care unit (ICU) mortality. Patients were divided into the no-vitamin D and vitamin D groups according to whether they received supplementation or not. The correlation between vitamin D and outcome was examined using Kaplan–Meier (KM) survival curves, Cox proportional risk regression models and subgroup analyses. Propensity-score matching (PSM) was used to ensure the robustness of our findings.ResultsThe study finally included 7,994 patients with ARF, comprising 6,926 and 1,068 in the no-vitamin D and vitamin D groups, respectively. The Kaplan–Meier survival curve indicated a significant difference in survival probability between the two groups. After adjustment for a series of confounders, the multivariate Cox proportional hazards models showed that the hazard ratio (95% confidence interval) values for in-hospital and ICU mortality in the no-vitamin D group were 1.67 (1.45, 1.93) and 1.64 (1.36, 1.98), respectively. The results of propensity score-matched (PSM) analysis were consistent with the original population. In the subgroup analysis, Vitamin D supplementation was associated with lower in-hospital mortality in patients with higher clinical scores (SOFA score ≥ 8, OASIS ≥ 38).ConclusionOur study concluded that Vitamin D supplementation may reduce in-hospital and ICU mortality in patients with ARF in the ICU. There may be a beneficial effect on in-hospital mortality in patients with higher clinical scores. Additional randomized controlled trials are needed to follow up to confirm the relationship between vitamin D supplementation and ARF.

Basophils absence predicts poor prognosis and indicates immunosuppression of patients in intensive care units

Immune cells and immunity are associated with the prognosis of patients with critical illness. Here, medical records retrospectively extracted from the Medical Information Mart for Intensive Care IV were used for screening an immune-related biomarker in intensive care units (ICU) patients and applied for validating the identified indicator in septic patients. In this work, the count of innate immune cells, basophils, harbored a superior role in predicting ICU patients’ prognosis compared with those of other blood immune cells (OR 0.013, 95% CI 0.001, 0.118, P < 0.001). Importantly, basophils absence during ICU stay was positively correlated with the 28-day mortality of ICU patients and served as an independent predictor of ICU patients’ prognosis (OR 3.425, 95% CI 3.717–3.165, P < 0.001). Moreover, the association between critical illness progression, poor outcome, and basophils absence was verified in septic patients. Subsequent investigations revealed the positive relationship between basophils absence and immunosuppression, and suggested the potential of basophils-mediated immunity in predicting the 28-day mortality of ICU patients. Collectively, we identify basophils absence during ICU stay as a novel and unfavorable indicator for evaluating the prognosis of ICU patients and recognizing a branch of ICU patients potentially suitable for intensified treatment and immunoenhancement therapy.

Remimazolam tosylate's long-term sedative properties in ICU patients on mechanical ventilation: effectiveness and safety

ObjectiveThis study compared remimazolam tosylate with propofol or midazolam to assess its safety and effectiveness for long-term sedation of intensive care unit (ICU) patients requiring mechanical ventilation.MethodsAdult patients in the ICU receiving sedation and mechanical ventilation for longer than 24 h were included in this single-center, prospective, observational study. Depending on the sedatives they were given, they were split into two groups (midazolam or propofol group; remimazolam group). ICU mortality was the main result. Laboratory tests, adverse events, and the length of ICU stay were considered secondary outcomes.ResultsA total of 106 patients were involved (46 received propofol or midazolam versus 60 received remimazolam). Age (P = 0.182), gender (P = 0.325), and the amount of time between being admitted to the ICU and receiving medication infusion (P = 0.770) did not substantially differ between the two groups. Multivariate analysis revealed no statistically significant difference in ICU mortality between the two groups. The remimazolam group showed less variability in heart rate (P = 0.0021), pH (P = 0.048), bicarbonate (P = 0.0133), lactate (P = 0.0002), arterial blood gas analyses, liver, and kidney function. The Richmond Agitation and Sedation Scale scores, length of ICU stay, and occurrence of adverse events did not exhibit significant differences between the two groups.ConclusionRemimazolam tosylate did not increase the total inpatient cost, the incidence of adverse events, and ICU mortality in patients with mechanical ventilation. These findings suggest that remimazolam may represent a promising alternative for sedation in the ICU setting.

A novel web-based calculator to predict 30-day all-cause in-hospital mortality for 7,202 elderly patients with heart failure in ICUs: a multicenter retrospective cohort study in the United States.

Heart failure (HF) is a significant cause of in-hospital mortality, especially for the elderly admitted to intensive care units (ICUs). This study aimed to develop a web-based calculator to predict 30-day in-hospital mortality for elderly patients with HF in the ICU and found a relationship between risk factors and the predicted probability of death. Data (N = 4450) from the MIMIC-III/IV database were used for model training and internal testing. Data (N = 2,752) from the eICU-CRD database were used for external validation. The Brier score and area under the curve (AUC) were employed for the assessment of the proposed nomogram. Restrictive cubic splines (RCSs) found the cutoff values of variables. The smooth curve showed the relationship between the variables and the predicted probability of death. A total of 7,202 elderly patients with HF were included in the study, of which 1,212 died. Multivariate logistic regression analysis showed that 30-day mortality of HF patients in ICU was significantly associated with heart rate (HR), 24-h urine output (24h UOP), serum calcium, blood urea nitrogen (BUN), NT-proBNP, SpO2, systolic blood pressure (SBP), and temperature (P < 0.01). The AUC and Brier score of the nomogram were 0.71 (0.67, 0.75) and 0.12 (0.11, 0.15) in the testing set and 0.73 (0.70, 0.75), 0.13 (0.12, 0.15), 0.65 (0.62, 0.68), and 0.13 (0.12, 0.13) in the external validation set, respectively. The RCS plot showed that the cutoff values of variables were HR of 96 bmp, 24h UOP of 1.2 L, serum calcium of 8.7 mg/dL, BUN of 30 mg/dL, NT-pro-BNP of 5121 pg/mL, SpO2 of 93%, SBP of 137 mmHg, and a temperature of 36.4°C. Decreased temperature, decreased SpO2, decreased 24h UOP, increased NT-proBNP, increased serum BUN, increased or decreased SBP, fast HR, and increased or decreased serum calcium increase the predicted probability of death. The web-based nomogram developed in this study showed good performance in predicting 30-day in-hospital mortality for elderly HF patients in the ICU.

Prognostic value of Doppler waveform analysis of common femoral vein in septic patients: a prospective cohort study.

To assess whether there is an association between abnormal common femoral vein (CFV) Doppler waveform and intensive care unit (ICU) mortality in patients with sepsis. Patients admitted to the ICU with sepsis were included. Pulsed-wave Doppler was performed by examining the CFV in the short axis without angle correction and in the long axis with angle correction. An abnormal CFV Doppler waveform was determined by a retrograde velocity peak (RVP) > 10cm/s in the long axis or RVP > 50% of the antegrade velocity peak in the short axis. TAPSE < 17mm was defined as right ventricular (RV) dysfunction. The primary outcome was ICU mortality. One hundred and ten patients were included. There was no association between abnormal CFV Doppler waveforms in the long (p = 0.709) and short axes (p = 0.171) and ICU mortality. TAPSE measurements were performed in 16 patients. RV dysfunction was identified in 8 (50.0%) patients. There was no association between the diagnosis of RV dysfunction based on TAPSE measurement and the identification of abnormal CFV Doppler waveforms in the long axis (p = 1.000) and in the short axis (p = 1.000). Abnormal CFV Doppler waveforms were not associated with ICU mortality in patients with sepsis. Furthermore, in the exploratory analysis, these alterations were not useful in identifying RV dysfunction in these patients.

Triglyceride-glucose index is associated with the occurrence and prognosis of cardiac arrest: a multicenter retrospective observational study

BackgroundTriglyceride-glucose (TyG) index is an efficient indicator of insulin resistance and is proven to be a valuable marker in several cardiovascular diseases. However, the relationship between TyG index and cardiac arrest (CA) remains unclear. The present study aimed to investigate the association of the TyG index with the occurrence and clinical outcomes of CA.MethodsIn this retrospective, multicenter, observational study, critically ill patients, including patients post-CA, were identified from the eICU Collaborative Research Database and evaluated. The TyG index for each patient was calculated using values of triglycerides and glucose recorded within 24 h of intensive care unit (ICU) admission. In-hospital mortality and ICU mortality were the primary clinical outcomes. Logistic regression, restricted cubic spline (RCS), and correlation analyses were performed to explore the relationship between the TyG index and clinical outcomes. Propensity score matching (PSM), overlap weighting (OW), and inverse probability of treatment weighting (IPTW) were adopted to balance the baseline characteristics of patients and minimize selection bias to confirm the robustness of the results. Subgroup analysis based on different modifiers was also performed.ResultsOverall, 24,689 critically ill patients, including 1021 patients post-CA, were enrolled. The TyG index was significantly higher in patients post-CA than in those without CA (9.20 (8.72–9.69) vs. 8.89 (8.45–9.41)), and the TyG index had a moderate discrimination ability to identify patients with CA from the overall population (area under the curve = 0.625). Multivariate logistic regression indicated that the TyG index was an independent risk factor for in-hospital mortality (OR = 1.28, 95% CI: 1.03–1.58) and ICU mortality (OR = 1.27, 95% CI: 1.02–1.58) in patients post-CA. RCS curves revealed that an increased TyG index was linearly related to higher risks of in-hospital and ICU mortality (P for nonlinear: 0.225 and 0.271, respectively). Even after adjusting by PSM, IPTW, and OW, the TyG index remained a risk factor for in-hospital mortality and ICU mortality in patients experiencing CA, which was independent of age, BMI, sex, etc. Correlation analyses revealed that TyG index was negatively correlated with the neurological status of patients post-CA.ConclusionElevated TyG index is significantly associated with the occurrence of CA and higher mortality risk in patients post-CA. Our findings extend the landscape of TyG index in cardiovascular diseases, which requires further prospective cohort study.

THE RELATIONSHIP BETWEEN THE APACHE II SCORE AND THE NUMBER OF DAYS OF HOSPITALIZATION IN THE INTENSIVE CARE UNIT (ICU) AT HARAPAN INSAN HOSPITAL, SENDAWAR WEST KUTAI

The APACHE II score is a method for determining disease severity and assessing patient mortality in ICU. The result of measuring the patient's condition was obtained in the first 24 hours of admission to the ICU. Scoring is used to estimate prognostic risk factors for patients who can leave the ICU room in recovering or dying conditions. The length of hospitalization for patients in the Intensive Care Unit (ICU) is on average more than 5 days. The purpose of this study was to determine the relationship between the APACHE II score and the range of days in the Intensive Care Unit (ICU) at RSUD Harapan Insan Sendawar West Kutai. The design of this study was cross-sectional. The sampling technique in this study used accidental sampling, and the research samplers were 30 respondents. The test instrument used the APACHE II Observation sheet. The results of the statistical analysis of the bivariate test using Chi-Square obtained a p-value of 0.757, which is greater than the alpha value, it means that there is no relationship between the APACHE II score and the range of days of hospitalization in the Intensive Care Unit (ICU) at Harapan Insan Hospital, Sendawar, West Kutai. The Odds Ratio (OR) value was obtained at 0.786, which means that patients who have an APACHE II score were in a low category, and they have an opportunity of 0.786 times to have a range of days of hospitalization in the category of short hospital days. There is no relationship between the APACHE II score and the range of days of hospitalization in the Intensive Care Unit (ICU) at Harapan Insan Hospital, Sendawar, West Kutai. The suggestions for hospital management to add beds in the ICU and the results of the research are expected to be guidelines for patient care in the ICU by using the APACHE II score and improving services in the ICU

Association of lactate-to-albumin ratio with in-hospital and intensive care unit mortality in patients with intracerebral hemorrhage.

Intracerebral hemorrhage (ICH) is a severe stroke subtype with a high mortality rate; the lactate-to-albumin ratio (LAR) is a new biomarker for predicting clinical outcomes in patients with ICH. However, the relationship between LAR and mortality in patients with ICH treated in the intensive care unit (ICU) remains controversial. Therefore, in this study, we aimed to investigate the association between LAR and in-hospital and ICU mortality in patients with ICH. Patients with ICH were selected from the Medical Information Mart for Intensive Care III (MIMIC-III) database; their clinical information, including baseline characteristics, vital signs, comorbidities, laboratory test results, and scoring systems, was extracted. Univariate and multivariate Cox proportional hazards analyses were used to investigate the association of LAR with in-hospital and ICU mortality. The maximum selection statistical method and subgroup analysis were used to investigate these relationships further. Kaplan-Meier (KM) analysis was used to draw survival curves. This study enrolled 237 patients with ICH whose lactate and albumin levels, with median values of 1.975 and 3.6 mg/dl, respectively, were measured within the first 24 h after ICU admission. LAR had an association with increased risk of in-hospital mortality [unadjusted hazards ratio (HR), 1.79; 95% confidence interval (CI), 1.32-2.42; p < 0.001] and ICU mortality (unadjusted HR, 1.88; 95% CI, 1.38-2.55; p < 0.001). A cut-off value of 0.963 mg/dl was used to classify patients into high LAR (≥0.963) and low LAR (<0.963) groups, and survival curves suggested that those two groups had significant survival differences (p = 0.0058 and 0.0048, respectively). Furthermore, the high LAR group with ICH had a significantly increased risk of in-hospital and ICU mortality compared to the low LAR group. Our study suggests that a high LAR is associated with an increased risk of in-hospital and ICU mortality in patients with ICH. Thus, the LAR is a useful prognostic predictor of clinical outcomes in patients with ICH.

Prediction of mortality in ICU patients: A comparison between the SOFA score and other indicators.

The intensive care unit (ICU) is the most important department for critically ill patients. Different scoring systems are used to assess the severity of the disease and evaluate organ failure during the patient's stay in ICU. Our purpose was to evaluate the C-reactive protein/Albumin (CRP/Alb) ratio and SOFA score as indicators of 28-day mortality in ICU patients. A total of 55 patients were enrolled in this study. CRP and CRP/Alb rates, SOFA scores, and demographic data were used to evaluate 28-day mortality in a referral hospital. Survived and dead patients were significantly different in the CRP, CRP/Alb rates, and SOFA scores. However, in the adjusted model, the SOFA score was the predictor of 28-day mortality in ICU patients. SOFA score was also confirmed as a predictor of mortality in ICU patients. Besides, the role of CRP and CRP/Alb in the prediction of disease prognosis or mortality requires further studies.

Mortality in ICU Patients with COVID-19-Associated Pulmonary Aspergillosis

A review of 38 studies involving 1437 COVID-19 patients admitted to intensive care units (ICUs) with pulmonary aspergillosis (CAPA) was conducted to investigate whether mortality has improved since the pandemic’s onset. The study found that the median ICU mortality was 56.8%, ranging from 30% to 91.8%. These rates were higher for patients admitted during 2020–2021 (61.4%) compared to 2020 (52.3%), and prospective studies found higher ICU mortality (64.7%) than retrospective ones (56.4%). The studies were conducted in various countries and used different criteria to define CAPA. The percentage of patients who received antifungal therapy varied across studies. These results indicate that the mortality rate among CAPA patients is a growing concern, mainly since there has been an overall reduction in mortality among COVID-19 patients. Urgent action is needed to improve prevention and management strategies for CAPA, and additional research is needed to identify optimal treatment strategies to reduce mortality rates among these patients. This study serves as a call to action for healthcare professionals and policymakers to prioritize CAPA, a serious and potentially life-threatening complication of COVID-19.