Organ Dysfunction Score Research Articles

Therapeutic Plasma Exchange in Children With Acute and Acuteon-Chronic Liver Failure: A Single-Center Experience.

Acute liver failure is a life-threatening condition that may result in death if liver transplant is not performed. The aim of our study was to evaluate patients with acute liver failure or acute-on-chronic liver failure who were followed and treated with therapeutic plasma exchange in a pediatric intensive care unit until they achieved clinical recovery or underwent liver transplant. In this retrospective, singlecenter study, we included patients with acute liver failure or acute-on-chronic liver failure who received therapeutic plasma exchange between April 2020 and December 2021. Clinical findings, laboratory findings, extracorporeal therapies, Pediatric Risk of Mortality III and liver injury unit scores and pretherapy and posttherapy hepatic encephalopathy scores, Model for End-Stage Liver Disease score, and Pediatric End-Stage Liver Disease score were retrospectively analyzed. Nineteen patients were included in the study. One patient was excluded because of positivity for COVID-19. The mean age of children was 62.06 months, ranging from 5 months to 16 years (12 boys, 6 girls). Thirteen patients (72.2%) had acute liver failure, and 5 patients (27.8%) had acute-on-chronic liver failure. No significant difference was shown for mean liver injury unit score (P = .673) and Pediatric Logistic Organ Dysfunction score (P = .168) between patients who died and patients who received treatment at the inpatient clinic and transplant center. However, Pediatric Risk of Mortality score and the mean Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease scores before therapeutic plasma exchange and after therapeutic plasma exchange (after 3 consecutive days of treatment) were statistically significant (P = .001 and P = .004). Therapeutic plasma exchange may assist bridge to liver transplant or assist with spontaneous recovery of liver failure in pediatric patients with acute liver failure or acute-on-chronic liver failure.

To Study Correlation between MOD Score and Biomarker Values for Early Prediction of MODS in Suspected Cases of Sepsis Cases in Hospital

Background: Utility of biomarkers in early prediction of multiple organ dysfunction syndrome (MODS) in suspected cases of sepsis presenting to the Emergency Department (ED). Aim and Objectives: To correlate the biomarker values (Pro-calcitonin (PCT), C-reactive protein (CRP), NT-pro BNP and Neutrophil gelatinase associated lipocalin (NGAL) with multiple organ dysfunction (MOD) score and to evaluate their role in early prediction of MODS in suspected sepsis patients presenting to ED. Methods: This is a prospective observational study conducted on 65 patients with suspected sepsis. Patients of 18-65 years presented in the ED with triage complaints of fever, respiratory, urinary and abdominal infections, who were sepsis screen positive on arrival and admitted, were enrolled in the study. They were categorized into two groups: Group 1 (MODS score Positive at 48 or 72 hours) and Group 2 (MOD score Negative). Biomarker values in both the groups and its correlation with MOD score was analyzed. Results: At 48 hours, 40 (61.5%) patients were MODS positive with PCT (Sensitivity 100%, OR-12.6, CI-0.6-255.04, p=0.098), CRP (Sensitivity 100%, OR-27.0, CI-1.44-504.0, p=0.027), NTpro BNP (Sensitivity 82.5%, OR-7.07, CI-2.55-22.16, p=0.0008) and NGAL (Sensitivity 77.5%, OR-82.9, CI-9.7-698.16, p=0.0001) with PPV of NGAL (96.88%) and NT-pro BNP (76.74%) and 100% NPV for PCT and CRP. Conclusion: This study established a good correlation of NT-pro BNP and NGAL with positive MODS score suggestive of and highly predictive of developing MODS in suspected cases of sepsis. The normal value of PCT and CRP on arrival in patients with suspected sepsis rules out MODS even at 72 hours during their hospital stay.

Analysis of pathogenic factors on the death rate of sepsis patients

Background The Surviving Sepsis Campaign (SSC) believed that early identification of septic shock, aggressive fluid resuscitation and maintenance of effective perfusion pressure should be carried out. However, some of the current research focused on a single death factor for sepsis patients, based on a limited sample, and the research results of the relationship between comorbidities and sepsis related death also have some controversies. Method Therefore, our study used data from a large sample of 9,544 sepsis patients aged 18–85 obtained from the MIMIC-IV database, to explore the risk factors of death in patients with sepsis. We used the general clinical information, organ dysfunction scores, and comorbidities to analyze the independent risk factors for death of these patients. Results The death group had significantly higher organ dysfunction scores, lower BMI, lower body temperature, faster heart rate and lower urine-output. Among the comorbidities, patients suffering from congestive heart failure and liver disease had a higher mortality rate. Conclusion This study helps to identify sepsis early, based on a comprehensive evaluation of a patient’s basic information, organ dysfunction scores and comorbidities, and this methodology could be used for actual clinical diagnosis in hospitals.

The non-canonical inflammasome activators Caspase-4 and Caspase-5 are differentially regulated during immunosuppression-associated organ damage.

The non-canonical inflammasome, which includes caspase-11 in mice and caspase-4 and caspase-5 in humans, is upregulated during inflammatory processes and activated in response to bacterial infections to carry out pyroptosis. Inadequate activity of the inflammasome has been associated with states of immunosuppression and immunopathological organ damage. However, the regulation of the receptors caspase-4 and caspase-5 during severe states of immunosuppression is largely not understood. We report that CASP4 and CASP5 are differentially regulated during acute-on-chronic liver failure and sepsis-associated immunosuppression, suggesting non-redundant functions in the inflammasome response to infection. While CASP5 remained upregulated and cleaved p20-GSDMD could be detected in sera from critically ill patients, CASP4 was downregulated in critically ill patients who exhibited features of immunosuppression and organ failure. Mechanistically, downregulation of CASP4 correlated with decreased gasdermin D levels and impaired interferon signaling, as reflected by decreased activity of the CASP4 transcriptional activators IRF1 and IRF2. Caspase-4 gene and protein expression inversely correlated with markers of organ dysfunction, including MELD and SOFA scores, and with GSDMD activity, illustrating the association of CASP4 levels with disease severity. Our results document the selective downregulation of the non-canonical inflammasome activator caspase-4 in the context of sepsis-associated immunosuppression and organ damage and provide new insights for the development of biomarkers or novel immunomodulatory therapies for the treatment of severe infections.

Clinico-laboratory outcomes of plasma transfusion in the Egyptian’s pediatric intensive care units—a prospective observational study

BackgroundDespite the paucity of data supporting their indications, plasma transfusions (PT) are regularly administered for critically ill patients (CIP) in pediatric intensive care units (PICU). The aim of this study was to identify the actual indications for PT in the Egyptian’s PICUs and determine to what extent it affects the clinic-laboratory outcomes for CIP.MethodsA prospective observational study was conducted for 6 months on 180 CIP in PICUs of Cairo University Hospital who received plasma for at least one time during their length of stay (LOS). Full history, examination, and investigations were obtained from the medical records.ResultsPlasma was transfused in 64.4% of the studied population to support moderate and severe critical illness identified by multiple organ dysfunction score (MODS). Meanwhile, subjective-based physician conceptions accounted for 12.8% of all indications for plasma transfusion. PT in CIP was associated with a significant reduction in platelet count, prothrombin time, partial thromboplastin time, and international normalized ratio with p-value < 0.001, while there was a significant increase in hemoglobin level with p-value < 0.001. A statistically positive correlation exists between the time interval between admission and 1st PT and LOS with a p-value < 0.001 being shorter with earlier transfusion. Of the 180 patients enrolled in this study, seventy patients (38.9%) died, while 110 patients (61.1%) survived. A statistically significant increase in mechanical ventilation (MV) (p = 0.004), total number of PT (p < 0.001), and MODS score (p < 0.001) were recorded in dead CIP compared with survivors.ConclusionModerate and severe critical illness identified by MODS was the most frequent cause for PT in the Egyptian’s PICUs. Early, precise, and objectively based PT has a strong role in improving the outcomes in CIP.

Pediatric Profound Dengue Shock Syndrome and Use of Point-of-Care Ultrasound During Mechanical Ventilation to Guide Treatment: Single-Center Retrospective Study, 2013-2021.

Profound dengue shock syndrome (DSS) complicated by severe respiratory failure necessitating mechanical ventilation (MV) accounts for high case fatality rates among PICU-admitted patients. A major challenge to management is the assessment of intravascular volume, which can be hampered by severe plasma leakage and the use of MV. Retrospective cohort, from 2013 to 2021. Sixty-seven children with profound DSS supported by MV, some of whom underwent bedside point-of-care ultrasound (POCUS) for assessment and monitoring of hemodynamics and fluid administration. PICU of the tertiary Children's Hospital No. 2 in Vietnam. None. We analyzed data clinical and laboratory data during PICU stay. In particular, during use of MV (i.e., at times 0-, 6-, and 24-hr after commencement) and fluid resuscitation. The primary study outcome was 28-day in-hospital mortality, and the secondary outcomes were associations with changes in hemodynamics, blood lactate, and vasoactive-inotrope score (VIS). Patients had a median age of 7 years (interquartile range, 4-9). Use of POCUS during fluid management (39/67), as opposed to not using (28/67), was associated with lower mortality (6/39 [15%] vs. 18/28 [64%]; difference 49 % [95% CI, 28-70%], p < 0.001). Use of POCUS was associated with lower odds of death (adjusted odds ratio 0.17 [95% CI, 0.04-0.76], p = 0.02). The utilization of POCUS, versus not, was associated with greater use of resuscitation fluid, and reductions in VIS and pediatric logistic organ dysfunction (PELOD-2) score at 24 hours after MV and PICU discharge. In our experience of pediatric patients with profound DSS and undergoing MV (2013-2021), POCUS use was associated with lower odds of death, a higher volume of resuscitation fluid, and improvements in the blood lactate levels, VIS, and PELOD-2 score.

Accuracy of different scoring systems in cardiogenic shock patients treated with micro-axial percutaneous left ventricular assist device

Abstract Background Cardiogenic shock (CS) is the most severe form of acute heart failure characterized by high mortality. Micro-axial percutaneous left ventricular assist devices (pLVAD) might improve outcome. The utilization of these devices increased lately but is associated with high material and personnel costs and unknown impact on prognosis. Therefore, a precise assessment of prognosis is of immanent interest to determine upfront, who might benefit from the device. For this purpose, different scoring systems were developed. Purpose In the current study, we investigated accuracy of 9 different scoring systems predicting all-cause mortality at 30 days. Methods Data were collected from our ongoing Impella registry including more than 740 patients treated for different indications since 2014. Among them, 434 patients received a micro-axial pLVAD in CS. Acute Physiology and Chronic Health Evaluation (APACHE) II score (APA), Simplified Acute Physiology Score II (SAPS), Multiple Organ Dysfunction Score (MODS), Sequential Organ Failure Assessment (SOFA), Logistic Organ Dysfunction System (LODS) score, Organ Dysfunctions or Infection score (ODIN), ENCOURAGE score, CardShock score, and IABP-SHOCK II risk score were calculated. All-cause mortality was characterized with the use of Kaplan-Meier plots. A receiver operating characteristic (ROC) curve was generated, and the area under the curve (AUC) was estimated to determine the predictive value of the different scores for 30-day-mortality. Subgroup analyses were performed for CS caused by acute myocardial infarction (AMI), CS caused not by AMI, and cardiopulmonary resuscitation (CPR). Results Patients were 68±1 years old with predominance of male gender (73.5% [n=319]). CS was mainly caused by AMI (55.8% [n=242]). A CPR before pLVAD was performed in 49.5% [n=215] with a mean duration of 36±3 minutes. Initial serum lactate was 7.5±0.3 mmol/l. Further baseline characteristics are shown in Table 1. All-cause mortality at 30 days was 65.0±2.3% (Figure 1A). Survivors’ mean stay at hospital was 18±3 days. ROC analyses revealed a positive prediction of 30-day-mortality of all scores (Figure 1B). The SAPS showed the best, ODIN and IABP-SHOCK II risk score the lowest accuracies (ROC AUC [95% CI] SAPS 0.757 [0.704-0.810; p&amp;lt;0.001], ODIN 0.647 [0.585-0.708; p&amp;lt;0.001], IABP SHOCK II 0.649 [0.588-0.709; p&amp;lt;0.001]). In the subgroup analyses, comparable results were reached except for patients receiving a CPR. Among those patients, only SAPS, LODS and ENCOURAGE score significantly predicted 30-day-mortality, but accuracies were low (Figure 1C). Conclusion In CS patients treated with pLVAD, the examined scoring systems significantly predicted 30-day-mortality with relevant differences in accuracy. The best prediction was revealed by SAPS. None of the scores showed an acceptable prediction in patients receiving a CPR indicating a specific patient cohort in need for better prognostic tools.Table 1Figure 1

Aortic Steal Correlates with Acute Organ Dysfunction and Short-Term Outcomes in Neonates with Vein of Galen Malformation

Plain Language SummaryVein of Galen malformation is a rare, congenital intracerebral arteriovenous malformation with high morbidity and mortality in neonatal manifestation despite modern interdisciplinary strategies. Currently, there is no valid, noninvasive parameter for early prediction of clinical progression at the bedside. A typical finding of hemodynamically relevant vein of Galen malformation is flow reversal in the descending aorta (aortic steal). Therefore, we developed a new ultrasound method to quantify the percentage of reflux in the preductal aortic isthmus and integrated the measurement method into routine clinical practice. In this study, we retrospectively investigated the association between percentage of aortic steal, organ dysfunction parameters, mortality, and brain injury on magnetic resonance imaging (MRI) at baseline and follow-up in 12 neonates with vein of Galen malformation admitted between January 2021 and June 2022. Statistical analyses showed that the severity of organ dysfunction, mortality, and brain damage on MRI increased with increasing percentage of aortic steal. These correlations and associations showed a linear relationship between percentage reflux in the aortic isthmus and all outcome parameters. The potential of sonographically determined aortic steal to predict clinical progression and short- and long-term outcomes needs to be investigated in larger, prospective cohorts. If this marker proves as promising as the data from this study suggest, it could become an important diagnostic component for management and decision-making in critically ill neonates with vein of Galen malformation.

PREDICTIVE FACTORS AND CLINICAL AND PARACLINICAL FEATURES OF URINARY TRACT DYSFUNCTION IN PRETERM INFANTS

PREDICTIVE FACTORS AND CLINICAL AND PARACLINICAL FEATURES OF URINARY TRACT DYSFUNCTION IN PRETERM INFANTS

Restricted versusUsual/LiberalMaintenance FluidStrategy in Mechanically Ventilated Children: An Open-Label Randomized Trial (ReLiSCh Trial).

To assess the impact of restricted vs. usual/liberal maintenance fluidstrategy on fluid overload (FO) among mechanically ventilated children. This open-label randomized controlled trial was conducted over a period of 1 y (October 2020-September 2021) in a Pediatric intensive care unit (PICU)in North India. Hemodynamically stable mechanically ventilated children were randomized to 40% (restricted group, n=50) and 70-80% (usual/liberal group, n=50) of maintenance fluids. The primary outcome was cumulative fluid overload percentage (FO%) on day 7. Secondary outcomes were FO% >10%; vasoactive inotropic score, sequential organ failure assessment score, pediatric logistic organ dysfunction score and oxygenation index from day 1-7; ventilation free days (VFDs) and PICU free days (PFDs) through day 28; and mortality. The restrictedgroup had statistically non-significant trend towards lower cumulative FO% at day 7 [7.6 vs. 9.5, p=0.40]; and proportion of children with FO% >10% (12% vs. 26%, p=0.21) as compared to usual/liberal group. The increase in FO% from day 1-7 was significant in usual/liberal group as compared to restricted group (p<0.001 and p=0.134, respectively). Restricted group received significantly lower amount of fluid in the first 5 d; had significantly higher VFDs (23 vs. 17 d, p=0.008) and PFDs (19 vs. 15 d, p=0.007); and trend towards lower mortality (8% vs. 16%, p=0.21). Restricted as compared to usual/liberal maintenance fluid strategy among mechanically ventilated children was associated with a trend towards lower rate and severity of FO and mortality; and significantly lower fluid volume received, and higher VFDs and PFDs.

Unified severity and organ dysfunction scoring system in pediatric intensive care unit: A pressing priority

Unified severity and organ dysfunction scoring system in pediatric intensive care unit: A pressing priority

Comparison of Three Different Multiple Organ Dysfunction Scores for Predicting Mortality after Neonatal Cardiac Surgery.

Infants who undergo cardiac surgery frequently have complications that may advance to multiple organ failure and result in mortality. This study aims to compare three different multiple organ dysfunction scoring systems: the Neonatal Multiple Organ Dysfunction (NEOMOD) score, the modified NEOMOD score, and the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score in predicting postoperative 30-day mortality in neonates undergoing cardiac surgery. This retrospective cohort study was conducted between January 2019 and February 2021 in a single unit on neonates operated on due to congenital heart disease in the first 28 days of life. Patients who underwent off-pump surgeries were excluded from the study. The NEOMOD, modified NEOMOD, and PELOD-2 scores were calculated for each of the first 3 days following surgery. A total of 138 patients were included. All scores had satisfactory goodness-of-fit and at least good discriminative ability on each day. The modified NEOMOD score consistently demonstrated the best prediction among these three scores after the first day, reaching its peak performance on day 2 (area under curve: 0.824, CI: 0.75-0.89). Our findings suggest that NEOMOD and modified NEOMOD scores in the first 72 h could potentially serve as a predictor of mortality in this population.

Prostration and the prognosis of death in African children with severe malaria

ObjectivesMalaria is still one of the main reasons for hospitalization in children living in sub-Saharan Africa. Rapid risk stratification at admission is essential for optimal medical care and improved prognosis. Whereas coma, deep breathing, and, to a lesser degree, severe anemia are established predictors of malaria-related death, the value of assessing prostration for risk stratification is less certain. MethodsHere we used a retrospective multi-center analysis comprising over 33,000 hospitalized children from four large studies, including two observational studies from the Severe Malaria in African Children network, a randomized controlled treatment study, and the phase-3-clinical RTS,S-malaria vaccine trial, to evaluate known risk factors of mortality and with a specific emphasis on the role of prostration. ResultsDespite comparable age profiles of the participants, we found significant inter- and intra-study variation in the incidence of fatal malaria as well as in the derived risk ratios associated with the four risk factors: coma, deep breathing, anemia, and prostration. Despite pronounced variations, prostration was significantly associated with an increased risk of mortality (P <0.001) and its consideration resulted in improved predictive performance, both in a multivariate model and a univariate model based on the Lambaréné Organ Dysfunction Score. ConclusionProstration is an important clinical criterion to determine severe pediatric malaria with possible fatal outcomes.

Characterization of multiple organ failure after ruptured abdominal aortic aneurysm repair

BackgroundMultiple organ failure (MOF) is associated with poor outcomes and increased mortality in sepsis and trauma. There are limited data regarding MOF in patients after ruptured abdominal aortic aneurysm (rAAA) repair. We aimed to identify the contemporary prevalence and characteristics of patients with rAAA with MOF. MethodsWe retrospectively reviewed patients with rAAA who underwent repair (2010-2020) at our multihospital institution. Patients who died within the first 2 days after repair were excluded. MOF was quantified by modified (excluding hepatic system) Denver, Sequential Organ Failure Assessment (SOFA) score, and Multiple Organ Dysfunction Score (MODS) for postoperative days 3 to 5 to determine the prevalence of MOF. MOF was defined as a Denver score of >3, dysfunction in two or more organ systems by SOFA score, or a MODS score of >8. Kaplan-Meier curves and log-rank testing were used to evaluate differences in 30-day mortality between multiple organ failure and patients without MOF. Logistic regression was used to assess predictors of MOF. ResultsOf 370 patients with rAAA, 288 survived past two days (mean age, 73±10.1 years; 76.7% male; 44.1% open repair), and 143 had data for MOF calculation recorded. From postoperative days 3 to 5, 41 (14.24%) had MOF by Denver, 26 (9.03%) by SOFA, and 39 (13.54%) by MODS criteria. Among these scoring systems, pulmonary and neurological systems were impacted most commonly. Among patients with MOF, pulmonary derangement occurred in 65.9% (Denver), 57.7% (SOFA), and 56.4% (MODS). Similarly, neurological derangement occurred in 92.3% (SOFA) and 89.7% (MODS), but renal derangement occurred in 26.8% (Denver), 23.1% (SOFA), and 10.3% (MODS). MOF by all three scoring systems was associated with increased 30-day mortality (Denver: 11.3% vs 41.5% [P < .01]; DOFA: 12.6% vs 46.2% [P < .01]; MODS: 12.5% vs 35.9% [P < .01]), as was MOF by any criteria (10.8% vs 35.7 %; P < .01). Patients with MOF were more likely to have a higher body mass index (55.9±26.6 vs 49.0±15.0; P = .011) and to have had a preoperative stroke (17.9% vs 6.0%; P = .016). Patients with MOF were less likely to have undergone endovascular repair (30.4% vs 62.1%; P < .001). Endovascular repair was protective against MOF (any criteria) on multivariate analysis (odds ratio, 0.23; 95% confidence interval, 0.08-0.64; P = .019) after adjusting for age, gender, and presenting systolic blood pressure. ConclusionsMOF occurred in only 9% to 14% of patients after rAAA repair, but was associated with a three-fold increase in mortality. Endovascular repair was associated with a reduced MOF incidence.

Utility of paediatric logistic organ dysfunction score in predicting mortality in children admitted to PICU at a tertiary care centre

Background: Critically ill children are typically characterized by multiple organ dysfunctions. The use of Paediatric logistic organ dysfunction-2 (PELOD-2) scoring systems has recently been replicated in the paediatric population for morbidity and mortality predictions. Objective of the study was to study the PELOD 2 score in predicting mortality in paediatric intensive care unit within 1 hour of admission. Methods: This was prospective observational study conducted at S Nijalingappa Medical College and Hanagal Shri Kumareshwar Hospital, Bagalkot for period of 16 months. Children aged from 1 month to 14 years admitted to PICU were included in the study and patients whose parents refuse to give consent, age less than 1 month or more than 14 years, those discharged against medical advice were excluded from the study. Venous blood sample were collected within one hour of admission and were analyzed for serum creatinine, serum lactate, total leukocyte count and platelet count and arterial blood sample were collected and paO2 and paCO2 were analysed. Results: Total sample size of study was 80, out of which 52 patients had PELOD 2 score of (&lt;4), 14 patients had score of (5-9), 11 patients had score of (10-14) and 3 patients had score &gt;15.Among total 80 patients 66 survived and 14 died (17.5%). Of the 14 deaths, 3 patients had PELOD 2 score of &gt;15 and 9 had score of 10-14. Pelod-2 score &gt;9 had requirement of mechanical ventilation in 68.4%. Conclusions: Higher the PELOD-2 score on day 1of admission has higher the mortality.

Furosemide in the management of acute kidney injury in the pediatric intensive care unit—retrospective cohort study

ObjectiveTo evaluate the effects of furosemide administration in critically ill children on the progression of acute kidney injury (AKI) and its outcomes compared to those not receiving furosemide.MethodA retrospective cohort study involving children aged 1 month (corrected) to 13 years admitted to the pediatric intensive care unit (PICU) and who were diagnosed with AKI within 24 h was screened for enrollment. Those who received furosemide are classified as the furosemide group, and others as no-furosemide group. The primary outcome was the proportion of patients with AKI (risk or injury stage) progressing to a higher stage. The secondary outcomes were kidney replacement therapy (KRT), fluid balance (%FO), urine output, multi-organ dysfunction, kidney recovery, length of mechanical ventilation, hospital stay including PICU, and all-cause mortality (PICU and hospital).ResultsThree hundred sixty-two patients’ data [furosemide group, n = 182; no-furosemide group, n = 180] were enrolled. The median (IQR) pediatric risk of mortality–III score was similar between groups [10, 4–16 vs. 10, 4–16; p = 0.244]. The primary outcome occurred in 51 (28%) in the furosemide and 36 (20%) in the no-furosemide group. The difference was not statistically significant [RR = 1.40, 95% CI 0.96 to 2.04, p = 0.074]. Higher mean (SD) urine output (ml/kg/hr) was noted in the furosemide group [2.3 (0.9) vs. 1.4 (0.6); p = < 0.001). Significantly higher mean (SD) organ dysfunction score [10 (4) vs. 8.3 (4.4); p < 0.001) and increased median (IQR) length of stay in mechanical ventilation [4, 3–6 vs. 3, 2–6 days; p < 0.001] and hospital [8, 5–11 vs. 6, 5–8 days; p < 0.001] and lower kidney recovery at discharge was noted in the furosemide group [n = 86, 47.3% vs. n = 104, 57.8%; RR = 0.80, 95% CI 0.64 to 0.99; p = 0.044]. No difference was noted in all-cause mortality, fluid balance, and KRT requirement.ConclusionFurosemide infusion in AKI management did not reduce the progression to a higher stage of AKI. Nevertheless, it was associated with higher morbidities.

Sepsis Prognostic Scores Accuracy in Predicting Adverse Outcomes in Children With Sepsis Admitted to the Pediatric Intensive Care Unit From the Emergency Department: A 10-Year Single-Center Experience.

To compare the performance of several prognostic scores calculated in the first 24 hours of admission (day 1) in predicting mortality and morbidity among critically ill children with sepsis presenting to the pediatric emergency department (PED) and then admitted to the pediatric intensive care unit (PICU). Single-center, retrospective cohort study in children with a diagnosis of sepsis visiting the PED and then admitted to the PICU from January 1, 2010 to December 31, 2019. Sepsis organ dysfunction scores-pediatric Sequential Organ Failure Assessment (pSOFA) (Schlapbach, Matics, Shime), quickSOFA, quickSOFA-L, Pediatric Logistic Organ Dysfunction (PELOD)-2, quickPELOD-2, and Pediatric Multiple Organ Dysfunction score-were calculated during the first 24 hours of admission (day 1) and their performance compared with systemic inflammatory response syndrome (SIRS) and severe sepsis-International Consensus Conference on Pediatric Sepsis(ICCPS)-derived criteria-using the area under the receiver operating characteristic curve. Primary outcome was PICU mortality. Secondary outcomes were: a composite of death and new disability (ie, change from baseline Pediatric Overall Performance Category score ≥1); prolonged PICU length of stay (>5 d); prolonged invasive mechanical ventilation (MV) (>3 d). Among 60 patients with sepsis, 4 (6.7%) died, 7 (11.7%) developed new disability, 26 (43.3%) experienced prolonged length of stay, and 21 (35%) prolonged invasive MV. The prognostic ability in mortality discrimination was significantly higher for organ dysfunction scores, with PELOD-2 showing the best performance (area under the receiver operating characteristic curve, 0.924; 95% confidence interval, 0.837-1.000), significantly better than SIRS 3 criteria (0.924 vs 0.509, P = 0.009), SIRS 4 criteria (0.924 vs 0.509, P < 0.001), and severe sepsis (0.924 vs 0.527, P < 0.001). Among secondary outcomes, PELOD-2 performed significantly better than SIRS criteria and severe sepsis to predict prolonged duration of invasive MV, whereas better than severe sepsis to predict "poor outcome" (mortality or new disability). Day 1 organ dysfunction scores performed better in predicting mortality and morbidity outcomes than ICCPS-derived criteria. The PELOD-2 was the organ dysfunction score with the best performance for all outcomes.

Noninvasive Ventilation for Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study.

The worldwide practice and impact of noninvasive ventilation (NIV) in pediatric acute respiratory distress syndrome (PARDS) is unknown. We sought to describe NIV use and associated clinical outcomes in PARDS. Planned ancillary study to the 2016/2017 prospective Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study. One hundred five international PICUs. Patients with newly diagnosed PARDS admitted during 10 study weeks. None. Children were categorized by their respiratory support at PARDS diagnosis into NIV or invasive mechanical ventilation (IMV) groups. Of 708 subjects with PARDS, 160 patients (23%) received NIV at PARDS diagnosis (NIV group). NIV failure rate (defined as tracheal intubation or death) was 84 of 160 patients (53%). Higher nonrespiratory pediatric logistic organ dysfunction (PELOD-2) score, Pa o2 /F io2 was less than 100 at PARDS diagnosis, immunosuppression, and male sex were independently associated with NIV failure. NIV failure was 100% among patients with nonrespiratory PELOD-2 score greater than 2, Pa o2 /F io2 less than 100, and immunosuppression all present. Among patients with Pa o2 /F io2 greater than 100, children in the NIV group had shorter total duration of NIV and IMV, than the IMV at initial diagnosis group. We failed to identify associations between NIV use and PICU survival in a multivariable Cox regression analysis (hazard ratio 1.04 [95% CI, 0.61-1.80]) or mortality in a propensity score matched analysis ( p = 0.369). Use of NIV at PARDS diagnosis was associated with shorter exposure to IMV in children with mild to moderate hypoxemia. Even though risk of NIV failure was high in some children, we failed to identify greater hazard of mortality in these patients.

Assessment of severity scoring systems for predicting mortality in critically ill patients receiving continuous renal replacement therapy.

The incidence of acute kidney injury (AKI) is increasing every year and many patients with AKI admitted to the intensive care unit (ICU) require continuous renal replacement therapy (CRRT). This study compared and analyzed severity scoring systems to assess their suitability in predicting mortality in critically ill patients receiving CRRT. Data from 612 patients receiving CRRT in four ICUs of the Korea University Medical Center between January 2016 and November 2018 were retrospectively collected. The mean age of all patients was 67.6 ± 14.8 years, and the proportion of males was 59.6%. The endpoints were in-hospital mortality and 7-day mortality from the day of CRRT initiation to the date of death. The Program to Improve Care in Acute Renal Disease (PICARD), Demirjian's, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) 3, Sequential Organ Failure Assessment (SOFA), Multiple Organ Dysfunction Score (MODS), and Liano's scores were used to predict mortality. The in-hospital and 7-day mortality rates in the study population were 72.7% and 45.1%, respectively. The area under the receiver operator characteristic curve (AUROC) revealed the highest discrimination ability for Demirjian's score (0.770), followed by Liano's score (0.728) and APACHE II (0.710). The AUROC curves for the SAPS 3, MODS, and PICARD were 0.671, 0.665, and 0.658, respectively. The AUROC of Demirjian's score was significantly higher than that of the other scores, except for Liano's score. The Hosmer-Lemeshow test on Demirjian's score showed a poor fit in our analysis; however, it was more acceptable than general severity scores. Kidney-specific severity scoring systems showed better performance in predicting mortality in critically ill patients receiving CRRT than general severity scoring systems.

Forecasting ICU Census by Combining Time Series and Survival Models.

Retrospective observational study. We developed the algorithm using data from the Medical-Surgical ICU (MSICU) at University Hospital, London, Canada and validated using data from the Critical Care Trauma Centre (CCTC) at Victoria Hospital, London, Canada. Adult patient admissions (7,434) to the MSICU and (9,075) to the CCTC from 2015 to 2021. None. We developed an Autoregressive integrated moving average time series model that forecasts patients arriving in the ICU and a survival model using MODS, NEMS, and other factors to estimate patient LOS. The models were combined to create an algorithm that forecasts ICU census for planning horizons ranging from 1 to 7 days. We evaluated the algorithm quality using several fit metrics. The root mean squared error ranged from 2.055 to 2.890 beds/d and the mean absolute percentage error from 9.4% to 13.2%. We show that this forecasting algorithm provides a better fit when compared with a moving average or a time series model that directly forecasts ICU census. Additionally, we evaluated the performance of the algorithm using data during the global COVID-19 pandemic and found that the error of the forecasts increased proportionally with the number of COVID-19 patients in the ICU. It is possible to develop accurate tools to forecast ICU census. This type of algorithm may be important to clinicians and managers when planning ICU capacity as well as staffing and surgical demand planning over a short time horizon.