Odds Of Intensive Care Unit Admission Research Articles

Epidemiology of injuries among patients admitted to Imam Khomeini Hospital, Urmia, affiliated with the national trauma registry of Iran

Objective: Trauma is one of the major causes of mortality and morbidity globally. The current study aimed to improve the understanding of characteristics, severity of injuries and outcomes of trauma patients admitted to Imam Khomeini Hospital, Urmia, Iran.
 Methods: Data were obtained from the trauma registry of Imam Khomeini Hospital, a level 1 trauma referral center, for all patients admitted to the center from 17 september 2016 to 21 January 2023. Patients’ demographics, injury mechanisms, and patients' outcomes were analyzed.
 Results: The emergency department attended to 5555 trauma patients. The gender distribution was with 3998 (71.9%) males and 1557 (29.1%) females. Patients' age ranged from 1 to 101 years, with a mean±standard deviation (SD) of 33.1 (±20.7) years. Road traffic accidents followed by falls were the most common causes of traumas reported in 2138 (38.5%) and 1298 (23.4%) trauma patients, respectively. The in-hospital mortality rate was 0.9% (53 patients). The mean (±SD) age of death was 43.5 (±22.4) years. 569 (10.2%) patients were admitted to the intensive care unit (ICU). The univariable logistic regression models showed that there were significant associations between age (P<0.001), Glasgow coma scale (GCS) (P<0.001), injury severity score (ISS) (P<0.001), and mechanical ventilation (P<0.001) as independent variables and death outcome. The univariable and multiple logistic regression analyses showed statistically significant associations between age, cause of trauma, ISS, GCS and body site injury with ICU admission. The odds of ICU admission in patients after being adjusted for age, ISS, GCS, cause of trauma and type of transportation was 1.73 times higher in head, face, and neck injuries compared to limb injuries. (adjusted OR: 1.73, [95% CI: 1.23,2.42]; P<0.01).
 Conclusion: Older age, low GCS, higher ISS and mechanical ventilation were associated with higher mortality. Older age, higher ISS, lower GCS, body site injury, type of transportation, and cause of trauma were all significant independent predictors of ICU admission.

Racial difference in mortality among COVID-19 hospitalizations in California

In the US, racial disparities in hospital outcomes are well documented. We explored whether race was associated with all-cause in-hospital mortality and intensive care unit (ICU) admission among COVID-19 patients in California. This was a retrospective analysis of California State Inpatient Database during 2020. Hospitalizations ≥ 18 years of age for COVID-19 were included. Cox proportional hazards with mixed effects were used for associations between race and in-hospital mortality. Logistic regression was used for the association between race and ICU admission. Among 87,934 COVID-19 hospitalizations, majority were Hispanics (56.5%), followed by White (27.3%), Asian, Pacific Islander, Native American (9.9%), and Black (6.3%). Cox regression showed higher mortality risk among Hispanics, compared to Whites (hazard ratio, 0.91; 95% CI 0.87–0.96), Blacks (hazard ratio, 0.87; 95% CI 0.79–0.94), and Asian, Pacific Islander, Native American (hazard ratio, 0.89; 95% CI 0.83–0.95). Logistic regression showed that the odds of ICU admission were significantly higher among Hispanics, compared to Whites (OR, 1.70; 95% CI 1.67–1.74), Blacks (OR, 1.70; 95% CI 1.64–1.78), and Asian, Pacific Islander, Native American (OR, 1.82; 95% CI 1.76–1.89). We found significant disparities in mortality among COVID-19 hospitalizations in California. Hispanics were the worst affected with the highest mortality and ICU admission rates.

FRI108 Role Of Obesity In Patients With Coronary Artery Dissection

Abstract Disclosure: S. Karki: None. V. Deenadayalan: None. S. Shoura: None. R. Gajjar: None. A. Shahi: None. Background: Coronary artery dissection (CAD) is an established cause of acute coronary syndrome (ACS) in the general population. However, its risk factors and pathophysiology remain poorly understood. We aim to compare the clinical outcomes in patients admitted for CAD with and without obesity. Methods: This was a trend study of the National Inpatient database from 2010 to 2019. Adult patients (age >18) with a principal diagnosis of APE were identified using the International Classification of Diseases code, tenth revision (ICD-10), and were divided into two groups based on a secondary diagnosis of Morbid Obesity (MO). Primary outcomes evaluated were in-patient mortality, Length Of Stay (LOS) and Total Hospitalization Charges (THC). Secondary outcomes included acute severity measures like blood transfusion, Intensive Care Unit (ICU) admission, Cerebrovascular Accidents (CVA), and Acute Kidney Injury (AKI). Multivariate linear and logistic regression were used to adjust for confounders. We estimated trends, inpatient mortality, mean length of hospital stays (LOS) and mean total hospital charges (THC) over the period. Multivariable regression analysis adjusted for age and sex was used to obtain trend statistics on outcomes. Results: Out of 2,440 adult patients admitted with CAD, 440(18%) were found to be obese. The mean age in obese group vs non-obese was 52.8 and 55.9 years respectively. There was a trend towards an increased inpatient mortality among obese patients compared to non-obese with aOR 2.36 (95% CI 0.73-7.59, p=0.148) however, this did not reach statistical significance. Similarly, there was no statistically significant difference in terms of LOS and THC. Among secondary outcomes, the rate of blood transfusion (11.3% vs 4.7%, aOR 1.97, 95% CI 0.77-5.04), AKI (15.9% vs 9.7%, aOR 1.23, 95%CI 0.58-2.65) and CVA (2.2% vs 1.5%, aOR 0.43, 95% CI 0.03-7.58) seemed to be increased in obese group. Odds of ICU admission was similar between both the groups (10.2 % vs 10.5%, aOR 0.75, 95% CI 0.33-1.68). Conclusion: Obesity does not significantly increase the in-patient mortality and other secondary outcomes among patients admitted for CAD which is reassuring. Future studies looking into the pathophysiology behind this phenomenon are needed. Presentation: Friday, June 16, 2023

Comparison of epidemiologic features between upper and lower limb injuries and risk factors for intensive care unit admission in a university hospital affiliated with the National Trauma Registry of Iran

PurposeUpper extremity injuries (UEIs) and lower extremity injuries (LEIs) constitute a considerable component of traumas. However, their epidemiologic differences and short-term in-hospital outcomes are not fully elucidated. This study aims to compare such discrepancies in a large-scale study. MethodsIn this retrospective study, all patients with UEIs and/or LEIs hospitalized from 24th July 2016 to 16th May 2020 in Sina Hospital, Tehran, Iran, and registered at the National Trauma Registry of Iran were enrolled in the study. Relevant demographic and clinical characteristics were extracted from the National Trauma Registry of Iran database. Patients were grouped into either UEI or LEI. For those with concomitant UEIs and LEIs, the more severe one based on the abbreviated injury scale was defined as the principal diagnosis. In addition, cases with the abbreviated injury scale > 3 for both UEI and LEI or concomitant injuries to body areas other than the limbs were excluded. Independent samples t-test, Mann-Whitney U test, Chi-square test, quintile regression models, and logistic regression models with “margins” command were used for statistical analyses, as indicated. ResultsIn this research, 3170 eligible cases were identified. For the LEI group, there was a much higher proportion of male patients (86.7% vs. 82.0%) and higher mean age (years, 42.9 vs. 35.3) compared to the UEI group (both p < 0.001). Patients with an injury severity score (ISS) of 9 – 15 were outnumbered in the LEI group (22.9% vs. 1.6%, p < 0.001), while the proportion of those with an ISS < 9 was higher in the UEI group (98.1% vs. 76.8%, p < 0.001). The multiple logistic regression model showed a statistically significant association between intensive care unit (ICU) admission and ISS (odds ratio (OR) = 4.01 for ISS 9 – 15 vs. ISS <9, 95% confidence interval (CI)|: 3.01 – 5.35; OR = 17.65 for ISS ≥16 vs. ISS < 9, 95% CI: 4.03 – 77.27), age (OR = 1.02, 95% CI: 1.01 – 1.03), cause of injury (OR = 0.27 for blunt trauma vs. road traffic crash, 95% CI: 0.08 – 0.90; OR = 0.49 for cut/stab injuries vs. road traffic crash, 95% CI: 0.28 – 0.84) and body region (OR = 1.65 for lower extremity, 95% CI: 1.19 – 2.29). Having adjusted for other covariates, the odds of ICU admission in patients with LEIs was 1.65 times the odds in patients with UEIs. ConclusionsPatients with LEIs were older and suffered from more severe injuries. In addition, the age- and ISS-adjusted ICU admission and length of hospital stay were significantly higher in LEI patients. The chance of ICU admission was associated with age, cause of injury, ISS, and body region. The findings of this study can aid in the meticulous selection of ICU-candidate patients. In addition, the role of factors other than ISS and age in ICU admission and prolongation of hospitalization should be addressed by prospective studies.

Using the Hospital Frailty Risk Score to assess mortality risk in older medical patients admitted to the intensive care unit.

Prognostic information at the time of hospital discharge can help guide goals-of-care discussions for future care. We sought to assess the association between the Hospital Frailty Risk Score (HFRS), which may highlight patients' risk of adverse outcomes at the time of hospital discharge, and in-hospital death among patients admitted to the intensive care unit (ICU) within 12 months of a previous hospital discharge. We conducted a multicentre retrospective cohort study that included patients aged 75 years or older admitted at least twice over a 12-month period to the general medicine service at 7 academic centres and large community-based teaching hospitals in Toronto and Mississauga, Ontario, Canada, from Apr. 1, 2010, to Dec. 31, 2019. The HFRS (categorized as low, moderate or high frailty risk) was calculated at the time of discharge from the first hospital admission. Outcomes included ICU admission and death during the second hospital admission. The cohort included 22 178 patients, of whom 1767 (8.0%) were categorized as having high frailty risk, 9464 (42.7%) as having moderate frailty risk, and 10 947 (49.4%) as having low frailty risk. One hundred patients (5.7%) with high frailty risk were admitted to the ICU, compared to 566 (6.0%) of those with moderate risk and 790 (7.2%) of those with low risk. After adjustment for age, sex, hospital, day of admission, time of admission and Laboratory-based Acute Physiology Score, the odds of ICU admission were not significantly different for patients with high (adjusted odds ratio [OR] 0.99, 95% confidence interval [CI] 0.78 to 1.23) or moderate (adjusted OR 0.97, 95% CI 0.86 to 1.09) frailty risk compared to those with low frailty risk. Among patients admitted to the ICU, 75 (75.0%) of those with high frailty risk died, compared to 317 (56.0%) of those with moderate risk and 416 (52.7%) of those with low risk. After multivariable adjustment, the risk of death after ICU admission was higher for patients with high frailty risk than for those with low frailty risk (adjusted OR 2.86, 95% CI 1.77 to 4.77). Among patients readmitted to hospital within 12 months, patients with high frailty risk were similarly likely as those with lower frailty risk to be admitted to the ICU but were more likely to die if admitted to ICU. The HFRS at hospital discharge can inform prognosis, which can help guide discussions for preferences for ICU care during future hospital stays.

Pregnancy Outcomes Before and After the Emergence of the SARS-CoV-2 B.1.1.529 (Omicron) Variant [ID: 1365953

INTRODUCTION: Starting December 15, 2021, the SARS-CoV-2 B.1.1.529 (Omicron) variant became the predominant strain in the United States. Preliminary data suggest that the Omicron variant causes less severe COVID-19 than earlier variants. We hypothesize that adverse maternal and neonatal outcomes are less likely if infection occurred during the Omicron epoch compared to pre-Omicron. METHODS: This IRB-approved retrospective cohort study was conducted at a major university health system in Maryland from March 2020 to May 2022. We identified patients who were SARS-CoV-2 positive before and after December 15, 2021. Demographics and maternal, obstetric, and neonatal outcomes were collected and compared. Wilcoxon rank-sum and Fisher’s exact tests were used to compare continuous and categorical data, respectively. Adjusted odds ratios (aORs) were calculated using vaccination status. RESULTS: A total of 742 SARS-CoV-2–positive pregnant patients were identified. Of those, 548 (74%) tested positive pre-Omicron and 194 (26%) tested positive during the Omicron wave. Tobacco and illicit drug use were higher among patients in the Omicron epoch. Patients were also older and more likely to have received at least one vaccine dose (3% versus 35%, P&lt;.001). Omicron epoch patients had less severe disease as evidenced by higher rates of asymptomatic infection (72% versus 44%) as well as lower rates of hospital admission due to COVID-19, supplemental oxygenation, and intensive care unit (ICU) admission. However, the odds of ICU admission were not significantly decreased in Omicron epoch patients after adjusting for vaccination (aOR 0.15, 95% CI 0.02–1.14). The odds of preeclampsia and preterm birth less than 34 weeks were lower in Omicron epoch patients after adjusting for vaccination (aOR, 0.61 and 0.38, respectively). Neonatal outcomes were not statistically different between the two groups. CONCLUSION: Pregnant patients infected with SARS-CoV-2 during the Omicron epoch have a less severe disease course than those infected pre-Omicron. Lower ICU admissions during the Omicron epoch may be due to higher vaccination rates.

ICU Admission Risk Factors for Latinx COVID-19 Patients at a U.S.-Mexico Border Hospital.

Few studies have examined the impact of coronavirus disease 2019 (COVID-19) on the primarily Latinx community along the U.S.-Mexico border. This study explores the socioeconomic impacts which contribute to strong predictors of severe COVID-19 complications such as intensive care unit (ICU) hospitalization in a primarily Latinx/Hispanic U.S.-Mexico border hospital. A retrospective, observational study of 156 patients (≥ 18years) Latinx/Hispanic patients who were admitted for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at a U.S.-Mexico border hospital from April 10, 2020, to May 30, 2020. Descriptive statistics of sex, age, body mass index (BMI), and comorbidities (coronary artery disease, hypertension, diabetes, cancer/lymphoma, current use of immunosuppressive drug therapy, chronic kidney disease/dialysis, or chronic respiratory disease). Multivariate regression models were produced from the most significant variables and factors for ICU admission. Of the 156 hospitalized Latinx patients, 63.5% were male, 84.6% had respiratory failure, and 45% were admitted to the ICU. The average age was 67.2 (± 12.2). Those with body mass index (BMI) ≥ 25 had a higher frequency of ICU admission. Males had a 4.4 (95% CI 1.58, 12.308) odds of ICU admission (p = 0.0047). Those who developed acute kidney injury (AKI) and BMI 25-29.9 were strong predictors of ICU admission (p < 0.001 and p = 0.0020, respectively). Those with at least one reported comorbidity had 1.98 increased odds (95% CI 1.313, 2.99) of an ICU admission. Findings show that age, AKI, and male sex were the strongest predictors of COVID-19 ICU admissions in the primarily Latinx population at the U.S.-Mexico border. These predictors are also likely driven by socioeconomic inequalities which are most apparent in border hospitals.

Association between mental disorders and COVID-19 outcomes among inpatients in France: A retrospective nationwide population-based study

BackgroundMental disorders are at-risk of severe COVID-19 outcomes. There is limited and heterogeneous national data in hospital settings evaluating the risks associated with any pre-existing mental disorder, and susceptible subgroups. Our study aimed to investigate the association between pre-existing psychiatric disorders and outcomes of adults hospitalised for COVID-19. MethodWe used data obtained from the French national hospital database linked to the state-level psychiatric registry. The primary outcome was 30-days in-hospital mortality. Secondary outcomes were to compare the length of hospital stay, Intensive Care Unit (ICU) admission and ICU length. Propensity score matching analysis was used to control for COVID-19 confounding factors between patients with or without mental disorder and stratified by psychiatric subgroups. ResultsAmong 97 302 adults hospitalised for COVID-19 from March to September 2020, 10 083 (10.3%) had a pre-existing mental disorder, mainly dementia (3581 [35.5%]), mood disorders (1298 [12.9%]), anxiety disorders (995 [9.9%]), psychoactive substance use disorders (960 [9.5%]), and psychotic disorders (866 [8.6%]). In propensity-matched analysis, 30-days in-hospital mortality was increased among those with at least one pre-existing mental disorder (hazard ratio (HR) 1.15, 95% CI 1.08–1.23), psychotic disorder (1.90, 1.24–2.90), and psychoactive substance disorders (1.53, 1.10–2.14). The odds of ICU admission were consistently decreased for patients with any pre-existing mental disorder (OR 0.83, 95% CI 0.76–0.92) and for those with dementia (0.64, 0.53–0.76). ConclusionPre-existing mental disorders were independently associated with in-hospital mortality. These findings underscore the important need for adequate care and targeted interventions for at-risk individuals with severe mental illness.

Severe COVID-19 outcomes among patients with autoimmune rheumatic diseases or transplantation: a population-based matched cohort study

ObjectivesTo assess the risk of severe COVID-19 outcomes in patients with autoimmune rheumatic diseases (ARDs) and transplant recipients compared with matched general population comparators.DesignPopulation-based matched cohort study using administrative health...

181-LB: Hyperglycemia at Hospital Presentation Associated with Severity and Mortality in COVID-19 Patients without Type 2 Diabetes

There is a bidirectional association between hyperglycemia (HG) and COVID-19 severity. We conducted a retrospective cohort study in COVID-19 patients aged ≥18 years hospitalized at the Boston Medical Center during March 1 - August 4, 2020 with the aim to determine the relationships among HG, presence of type 2 diabetes (T2D) and outcomes of COVID-19. Blood glucose levels (BG) measured on admission were extracted from the hospital database. HG was defined as BG &amp;gt;200 mg/dL. Patients with type 1 diabetes or BG &amp;lt;70 mg/dL were excluded. Outcomes were in-hospital death and intensive care unit (ICU) admission. Multivariate analysis was used to determine the associations between exposures and outcomes. A total of 1,434 patients were included in the analysis. The mean ± SD age was 56 ± 17 years, 642 (45%) were female and 458 (32%) had a history of T2D. HG occurred in 193 patients with T2D (42%) and 42 patients without T2D (4%). The rates of death and ICU admission were 9% and 19%, respectively. Among patients without T2D, after adjusting for age, sex, body mass index, race and comorbidities, patients with HG had a significantly higher odds of death (aOR 4.5, 95%CI 1.8 - 11.2) and ICU admission (aOR 3.7, 95%CI 1.8 - 7.5) than patients without HG. Among patients with T2D, patients with HG had a significantly higher odds of ICU admission (aOR 1.7, 95%CI 1.0 - 2.8) and tended to have a higher odds of death (aOR 1.6, 95%CI 0.8-3.0) than patients without HG after adjusting for potential confounders. Among the 235 patients with HG, the odds of death and ICU admission were higher in the 42 HG patients without T2D than the 193 patients with T2D (death: aOR 5.1, 95%CI 1.3 - 19.0; ICU admission: aOR 2.7, 95%CI 1.1 - 6.7) after adjusting for potential confounders including BG. HG in the subset of patients without T2D could be a marker of high inflammatory burden leading to higher mortality or undiagnosed diabetes leading to increased severity of COVID-19 due to metabolic dysfunction. Disclosure N. Charoenngam: None. M. F. Holick: Consultant; Self; Biogena Inc, Ontometrics Inc, Other Relationship; Self; Quest Diagnostics, Speaker’s Bureau; Self; Abbott. C. Apovian: Board Member; Self; Abbott, Allergan plc, Gelesis, Novo Nordisk, Nutrisystem, Tivity Health, Xeno Bioscience, Zafgen, Inc. Funding National Institutes of Health (2T32DK7201-42 to N.C.), (P30DK046200 to C.A.)

Maternal Intensive Care Unit Admission as an Indicator of Severe Acute Maternal Morbidity: A Population-Based Study.

Severe acute maternal morbidity (SAMM) accounts for any life-threatening complication during pregnancy or after delivery. Measuring and monitoring SAMM seem critical to assessing the quality of maternal health care. The objectives were to explore the validity of intensive care unit (ICU) admission as an indicator of SAMM by characterizing the profile of women admitted to an ICU and of their ICU stay, according to the association with other SAMM criterion. We performed a secondary analysis of the 2540 women with SAMM included in the epidemiology of severe acute maternal morbidity (EPIMOMS) multiregional prospective population-based study (2012-2013, n = 182,309 deliveries). The EPIMOMS definition of SAMM, based on national experts' consensus, is a combination of diagnosis, organ dysfunctions, and intervention criteria, including ICU admission. Among women with SAMM, we identified characteristics associated with maternal ICU admission with or with no other SAMM criterion compared with ICU admission, by using multivariable multinomial logistic regression models. Overall, 511 women were admitted to an ICU during or up to 42 days after pregnancy, for a population-based rate of 2.8 of 1000 deliveries (511/182,309; 95% confidence interval [CI], 2.6-3.1); 15.5% of them (79/511; 95% CI, 12.4-18.9) had no other SAMM criterion compared with ICU admission. Among women with SAMM, the odds of ICU admission with no other morbidity criterion were increased in women with preexisting medical conditions (adjusted odds ratio (aOR), 2.13; 95% CI, 1.17-3.86) and cesarean before labor (aOR, 3.12; 95% CI, 1.47-6.64). Women admitted to ICU with no other SAMM criterion had more often decompensation of a preexisting condition, no interventions for organ support, and a shorter length of stay than women admitted with other SAMM criteria. Among women with SAMM, 1 in 5 is admitted to an ICU; 15.5% of those admitted in ICU have no other SAMM criterion and a less acute condition. These results challenge the use of ICU admission as a criterion of SAMM.

Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study.

Background:The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population.Objective:To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI.Design:Retrospective cohort study from a registry of patients with COVID-19.Setting:Three community and 3 academic hospitals.Patients:A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021.Measurements:Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality.Methods:We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality.Results:Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]).Limitations:Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences.Conclusions:Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification.Trial registration:The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

Clinical Outcomes of COVID-19 Patients with Type 2 Diabetes: A Population-Based Study in Korea.

BackgroundThe aim of this study was to evaluate clinical outcomes in coronavirus disease 2019 (COVID-19) positive patients with type 2 diabetes compared to those without diabetes in Korea.MethodsWe extracted claims data for patients diagnosed with COVID-19 from the National Health Insurance Service database in Korea from January 20, 2020 to March 31, 2020. We followed up this cohort until death from COVID-19 or discharge from hospital.ResultsA total of 5,473 patients diagnosed with COVID-19 were analyzed, including 495 with type 2 diabetes and 4,978 without diabetes. Patients with type 2 diabetes were more likely to be treated in the intensive care unit (ICU) (P<0.0001). The incidence of in-hospital mortality was higher in patients with type 2 diabetes (P<0.0001). After adjustment for age, sex, insurance status, and comorbidities, odds of ICU admission (adjusted odds ratio [OR], 1.59; 95% confidence interval [CI], 1.02 to 2.49; P=0.0416) and in-hospital mortality (adjusted OR, 1.90; 95% CI, 1.13 to 3.21; P=0.0161) among patients with COVID-19 infection were significantly higher in those with type 2 diabetes. However, there was no significant difference between patients with and without type 2 diabetes in ventilator, oxygen therapy, antibiotics, antiviral drugs, antipyretics, and the incidence of pneumonia after adjustment.ConclusionCOVID-19 positive patients with type 2 diabetes had poorer clinical outcomes with higher risk of ICU admission and in-hospital mortality than those without diabetes. Therefore, medical providers need to consider this more serious clinical course when planning and delivering care to type 2 diabetes patients with COVID-19 infection.

Factors associated with intensive care admission in patients with lung cancer: a population-based observational study of 26, 731 patients

BackgroundLung cancer is the most common cause of cancer related death worldwide and survival is poor. Patients with lung cancer may develop a critical illness, but it is unclear what features are associated with an Intensive Care Unit (ICU) admission.MethodsThis retrospective, observational, population-based study of linked cancer registration, ICU, hospital discharge and mortality data described the factors associated with ICU admission in patients with lung cancer. The cohort comprised all incident cases of adult lung cancer diagnosed between 1st January 2000 and 31st December 2009 in the West of Scotland, UK, who were subsequently admitted to an ICU within 2 years of cancer diagnosis. Multiple logistic regression was used to determine factors associated with admission.Results26,731 incident cases of lung cancer were diagnosed with 398 (1.5%) patients admitted to an ICU. Patients were most commonly admitted with respiratory conditions and there was a high rate of invasive mechanical ventilation. ICU, in-hospital and six-month survival were 58.5, 42.0 and 31.2%, respectively. Surgical treatment of lung cancer increased the odds of ICU admission (OR 7.23 (5.14–10.2)). Odds of admission to ICU were reduced with older age (75-80 years OR 0.69 (0.49–0.94), > 80 years OR 0.21 (0.12–0.37)), female gender (OR 0.73 (0.59–0.90)) and radiotherapy (OR 0.54 (0.39–0.73)) or chemotherapy treatment (OR 0.52 (0.38–0.70)).Conclusion1.5% of patients diagnosed with lung cancer are admitted to an ICU but both short term and long term survival was poor. Factors associated with ICU admission included age < 75 years, male gender and surgical treatment of cancer

Associations of Intensive Care Unit Capacity Strain with Disposition and Outcomes of Patients with Sepsis Presenting to the Emergency Department.

Intensive care unit (ICU) capacity strain refers to the potential limits placed on an ICU's ability to provide high-quality care for all patients who may need it at a given time. Few studies have investigated how fluctuations in ICU capacity strain might influence care outside the ICU. To determine whether ICU capacity strain is associated with initial level of inpatient care and outcomes for emergency department (ED) patients hospitalized for sepsis. We performed a retrospective cohort study of patients with sepsis admitted from the ED to a medical ward or ICU at three hospitals within the University of Pennsylvania Health System between 2012 and 2015. Patients were excluded if they required life support therapies, defined as invasive or noninvasive ventilatory support or vasopressors, at the time of admission. The exposures were four measures of ICU capacity strain at the time of the ED disposition decision: ICU occupancy, ICU turnover, ICU census acuity, and ward occupancy. The primary outcome was the decision to admit to a ward or to an ICU. Secondary analyses assessed the association of ICU capacity strain with in-hospital outcomes, including mortality. Among 77,142 hospital admissions from the ED, 3,067 patients met the study's eligibility criteria. The ICU capacity strain metrics varied between and within study hospitals over time. In unadjusted analyses, ICU occupancy, ICU turnover, ICU census acuity, and ward occupancy were all negatively associated with ICU admission. In the fully adjusted model including patient-level covariates, only ICU occupancy remained associated with ICU admission (odds ratio, 0.87; 95% confidence interval, 0.79-0.96; P = 0.005), such that a 10% increase in ICU occupancy (e.g., one additional patient in a 10-bed ICU) was associated with a 13% decrease in the odds of ICU admission. Among the subset of patients admitted initially from the ED to a medical ward, ICU occupancy at the time of admission was associated with increased odds of hospital mortality (odds ratio, 1.61; 95% confidence interval, 1.21-2.14; P = 0.001). The odds that patients in the ED with sepsis who do not require life support therapies will be admitted to the ICU are reduced when those ICUs experience high occupancy but not high levels of other previously explored measures of capacity strain. Patients with sepsis admitted to the wards during times of high ICU occupancy had increased odds of hospital mortality.

Quality of End-of-Life Care for the Myelodysplastic Syndromes: Findings from a Large National Database

Background: End-of-life (EOL) care has been shown to be more intensive for blood cancers compared to solid tumors (e.g. Hui, Cancer, 2014); however, data are sparse regarding predictors of intensive care unit (ICU) use in the last 30 days of life and hospice enrollment among patients with specific hematologic malignancies. Moreover, little is known about EOL care specifically for the myelodysplastic syndromes (MDS), which are distinguished among the blood cancers by their relative indolence in many patients and high rate of transfusion dependence.Methods: We conducted a retrospective analysis using the Surveillance Epidemiology and End Results (SEER)-Medicare database. Patients ≥ 65 years of age who had a primary diagnosis of MDS between 2006 and 2011, lived for at least 30 days after their diagnosis, and died prior to December 31, 2012 were eligible for inclusion. Outcomes were two well-established quality measures for EOL care in oncology (Earle, JCO, 2003; Keating, Cancer, 2010): ICU admission within the last 30 days of life (an indicator of poor quality), and enrollment in hospice for any length of time (an indicator of good quality). After determining their overall prevalence, we fit multivariable logistic regression models to investigate sociodemographic and clinical associations (see table) with each outcome.Results: A total of 6,955 MDS patients were eligible. Overall, 28% were admitted to the ICU in the last month of life, and 49% had enrolled in hospice. In multivariable analyses, transfusion-dependent patients were more likely to be admitted to the ICU and less likely to enroll in hospice (both p<0.001). There was no significant association with marital status or time from diagnosis to death for either outcome. Patients who died in later years had a higher prevalence of ICU admissions (p=0.05) and were more likely to enroll in hospice (p<0.001). Additional multivariable associations are shown below.*Adjusted for all variables listed as well as marital status and time from diagnosis to deathConclusions: Only about half of the MDS patients in our cohort were enrolled in hospice; however, the odds of enrollment increased over time. Interestingly, the odds of ICU admission within the last 30 days of life also increased over time, a trend that has been seen in solid tumors (e.g. Wright, JCO, 2014). As bone marrow failure in MDS can lead to reversible sepsis and the need for temporary blood pressure support, it is difficult to determine if this trend truly represents a worsening in quality of EOL care. Finally, our finding that transfusion-dependent MDS patients were less likely to receive hospice suggests that one reason for suboptimal enrollment is that the current hospice model-which largely disallows transfusions-is not meeting the specific palliative needs of this population. [Display omitted] DisclosuresGore:Celgene: Consultancy, Honoraria, Research Funding. Davidoff:Celgene: Consultancy, Research Funding. Steensma:Incyte: Consultancy; Amgen: Consultancy; Celgene: Consultancy; Onconova: Consultancy.

A critical analysis of early death after adult liver transplants

The 15% mortality rate of liver transplant recipients at one yr may be viewed as a feat in comparison with the waiting list mortality, yet it nonetheless leaves room for much improvement. Our aim was to critically examine the mortality rates to identify high-risk periods and to incorporate cause of death into the analysis of post-transplant survival. We performed a retrospective analysis on United Network for Organ Sharing data for all adult recipients of liver transplants from January 1, 2002 to October 31, 2011. Our analysis included multivariate logistic regression where the primary outcome measure was patient death of 49,288 recipients. The highest mortality rate by day post-transplant was on day 0 (0.9%). The most significant risk factors were as follows: for one-d mortality from technical failure, intensive care unit admission odds ratio (OR 3.2); for one-d mortality from graft failure, warm ischemia >75 min (OR 5.6); for one-month mortality from infection, a previous transplant (OR 3.3); and for one-month mortality from graft failure, a previous transplant (OR 3.7). We found that the highest mortality rate after liver transplantation is within the first day and the first month post-transplant. Those two high-risk periods have common, as well as different, risk factors for mortality.

Intensity of palliative care and its impact on the aggressiveness of end-of-life care in patients with advanced pancreatic cancer.

9518 Background: Quality indicators have been developed to avoid overly aggressive care in patients with advanced cancer. Specialized palliative care (PC) may reduce overly aggressive care in patients with advanced pancreatic cancer. Our objective was to examine the impact of the intensity of specialized PC (defined as a physician consultation focusing on PC needs, lasting at least 40 minutes) on (a) use of chemotherapy within 14 days of death; (b) more than one emergency department (ED) visit; (c) more than one hospitalization; and (d) at least one intensive care unit (ICU) admission, all within 30 days of death. Methods: A retrospective population-based cohort study using linked administrative databases in Ontario, Canada was conducted with patients diagnosed with advanced pancreatic cancer from Jan 1 2005 to Dec 31 2010. Multivariable logistic regression analyses were performed with the above quality indicators as the outcomes of interest and the intensity of PC visits as the exposure, adjusting for other variables (age, sex, comorbidity, rurality, and health region). Intensity of PC was defined in both absolute numbers (ie 0, 1, 2, 3+ visits) and rate of visits per month. Results: Of 6076 patients with advanced pancreatic cancer, 5381 had died at last followup. 2816 (52%) received a PC consultation, 218 (4%) received chemotherapy near death, 234 (4%) patients went to the ICU near death, 993 (18%) had multiple ED visits near death, and 447 (8%) had multiple hospitalizations near death. 2565 (48%) had 0 PC visits, 513 (10%) had 1, 555 (10%) had 2, and 1748 (32%) had 3 or more. In multivariable analyses, having had one PC consultation was associated with a lower odds of ICU admission near death (odds ratio (OR) 0.25; 95% CI 0.13-0.46), multiple ED visits near death (OR 0.44; 95% CI 0.33-0.58), and multiple hospitalizations near death (OR 0.47; 95% CI 0.33-0.69). Two PC visits were associated with a lower OR for chemotherapy near death (OR 0.26; 95% CI 0.14-0.51). Using the monthly PC visit rate, a higher rate was associated with less aggressive care for each outcome. Conclusions: In patients with advanced pancreatic cancer, more intensive PC involvement is associated with less frequent overly aggressive care.