Coronary Care Unit Patients Research Articles

Delirium and Associated Factors Among Older Patients in Coronary and Internal Medicine Intensive Care Units of a University Hospital

Delirium and Associated Factors Among Older Patients in Coronary and Internal Medicine Intensive Care Units of a University Hospital

The neutrophil-lymphocyte ratio: A promising predictor of mortality in coronary care unit patients — A cohort study

BackgroundSevere inflammation causes poor outcomes in coronary care unit (CCU) patients. The neutrophil-lymphocyte ratio (NLR), a biomarker used to monitor inflammation and the immune response, can predict a poor prognosis in various diseases. However, it remains unclear whether the NLR is associated with all-cause mortality in CCU patients. This study investigated the association between the NLR and CCU outcomes. MethodsClinical data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database, which contains health data for over 50,000 patients. The primary outcome was 30-day mortality and the secondary outcome was 90-day mortality. Cox proportional hazard models were used to reveal the associations between NLR and outcomes. Multivariate analyses were used to control for confounders. ResultsWe enrolled 3563 CCU patients. For 30-day mortality, the hazard ratio (HR) (95% confidence interval [CI]) for the second (NLR 4.80–10.08) and the third (NLR ≥ 10.09) tertiles were 1.57 (1.24, 1.97) and 2.76 (2.23, 3.41), respectively, compared to the first tertile (NLR < 4.80). In the model adjusted for multiple confounders, the fifth quintile (NLR ≥ 14.17) showed a slightly lower mortality risk [HR (95% CI) 1.44 (1.07, 1.94)] compared to the fourth (NLR 8.82–14.16) [HR (95% CI) 1.55 (1.15, 2.10)]. A similar trend was observed for 90-day mortality. The interactions between the acute kidney injury, respiratory failure, and pneumonia subgroups and 30-day mortality were significant. ConclusionsThe NLR was an independent predictor of 30- and 90-day mortality for CCU patients. The NLR is a promising clinical biomarker as an integrated, readily available predictor of CCU mortality.

Step-down units are cost-effective alternatives to coronary care units with non-inferior outcomes in the management of ST-elevation myocardial infarction patients after successful primary percutaneous coronary intervention.

Percutaneous coronary interventions (PCIs) within a door-to-balloon timing of 90min have greatly decreased mortality and morbidity of ST-elevation myocardial infarction (STEMI) patients. Post-PCI, they are routinely transferred into the coronary care unit (CCU) regardless of the severity of their condition, resulting in frequent CCU overcrowding. This study assesses the feasibility of step-down units (SDUs) as an alternative to CCUs in the management of STEMI patients after successful PCI, to alleviate CCU overcrowding. Criteria of assessment include in-hospital complications, length of stay, cost-effectiveness, and patient outcomes up to a year after discharge from hospital. A retrospective case-control study was done using data of 294 adult STEMI patients admitted to the emergency departments of two training and research hospitals and successfully underwent primary PCI from 1 January 2014 to 31 December 2015. Patients were followed up for a year post-discharge. Student t test and χ2 test were done as univariate analysis to check for statistical significance of p < 0.05. Further regression analysis was done with respect to primary outcomes to adjust for major confounders. Patients managed in the SDU incurred significantly lower inpatient costs (p = 0.0003). No significant differences were found between the CCU and SDU patients in terms of patient characteristics, PCI characteristics, in-hospital complications, length of stay, and patient outcomes up to a year after discharge. The SDU is a viable cost-effective option for managing STEMI patients after successful primary PCI to avoid CCU overcrowding, with non-inferior patient outcomes as compared to the CCU.

Impact of chronic obstructive pulmonary disease on the outcome of patients admitted to the coronary care unit

Background The prevalence of chronic obstructive pulmonary disease (COPD) varies between countries and age groups but is estimated to be between 15 and 20% in the European adult populations over 40 years. COPD is accompanied with increased risk of multiple, chronic comorbidities. One of those chronic illnesses that shows a higher probability to coexist with COPD is cardiovascular disease. Objective Assessment of hazards of COPD on the management and outcome of patients admitted to coronary care unit (CCU). Patients and methods A case–control study was designed between September 2015 and March 2016, including 100 consecutive patients admitted to the CCU for more than 24 h in Rail Way Hospital in Cairo, Egypt. Two groups with equal number of cases were recruited in the study (COPD patients and non-COPD patients). All of them were admitted to the CCU for more than 24 h due to several cardiac emergencies. Follow-up and monitoring the management of either COPD or non-COPD patients in CCU was done. Results Both groups were matched for age and sex. Several causes were the reason for admission to the CCU with no significant differences among both groups. No significant differences existed regarding cardiac interventions. More than 48% of the patients in the COPD group had needed to change their medications during their CCU stay which ranged from 1 to 3 agents. More patients in the COPD group required SpO2 monitoring inside the CCU (P Conclusion COPD had several cardiovascular adverse effects. Management of COPD can lead to significant ischemic attacks and serum K level abnormalities. Chest infection was a serious and frequent consequence of inflammatory cascade occurred to COPD patients admitted to the CCU. No significant difference had been existed between both groups regarding the length of hospital stay and incidence of cardiac arrhythmia.

Effect of milk-honey mixture on the sleep quality of coronary patients: A clinical trial study

Admission of patients in coronary care units can lead to sleep disorders due to advanced monitoring and interventions. Inappropriate sleep quality in cardiac patients may be influenced by their health status. So, this study was performed to detect the effect of Milk-honey mixture on sleep status of acute coronary syndrome patients in the coronary care unit. A clinical trial study (registered under IRCT.ir with identifier no. IRCT201309285134N7) was conducted with 68 hospitalized patients with the acute coronary syndrome in the coronary care unit of a referral hospital in Semnan, Iran. After hospitalization of patients and selected eligible patients, sleep status of them was measured by Richards-Campbell Sleep Questionnaire in range of 0 to 100 score. Then patients were divided into the intervention and control groups randomly. Patients in the intervention group were received milk-honey mixture twice a day for three days. The control group patients were received routine care. In the third day, sleep quality of patients in the two groups was measured again. Finally, the data were analyzed by descriptive and inferential statistics. The mean and standard deviation of patients' age was 63.12±32.63. There was no significant difference in sleep scores on the first day of admission between the two groups (P=0.914). But, on the third day of admission, there was a significant difference in sleep scores between the intervention and the control groups (P=0.001). The mixture of milk and honey improves the sleep status of patients. So, it can be considered as an effective and affordable intervention to enhance the sleep quality of patients with the acute coronary syndrome in coronary care units.

Koroner Yoğun Bakım Hastalarının Hasta Öğrenim Gereksinimlerinin Belirlenmesi

Giriş: Bu çalışma koroner yoğun bakım ünitesinde yatan hastaların, taburcu olmadan önce öğrenim gereksinimlerinin belirlenmesi amacıyla yapılmıştır. Yöntem: Tanımlayıcı tipteki bu araştırma bir Devlet Hastanesi Koroner Yoğun Bakım Ünitesinde 15 Aralık 2016- 15 Şubat 2017 tarihleri arasında yatan ve taburculuğu planlanan 141 hasta ile gerçekleştirilmiştir. Verilerin toplanmasında hasta bilgi formu ve Hasta Öğrenim Gereksinimleri Ölçeği (HÖGÖ) kullanılmıştır. Tanımlayıcı analiz yapılıp sürekli veriler Mann Whitney U ve Kruskal Wallis testleri ile karşılaştırılmıştır. Bulgular: Araştırmaya katılan hastaların yaş ortalamasının 60.8±11.4 yıl olduğu, %63.1'inin erkek, %85.1'inin evli, %46.1'inin ilkokul mezunu, %31.2'sinin emekli olduğu belirlenmiştir. Hastaların, %63.1'inin ek hastalığı olduğu, ek hastalığı olanların da %26.2'sinin hipertansiyon olduğu bulunmuştur. %90.1'i evde kendilerine bakacak biri olduğunu, %59.6'sı taburculuk eğitimi almadığını ve %53.2'si taburculuk eğitimini hemşireden almak istediğini ifade etmiştir. HÖGÖ puan ortalaması 193.6 ±19.8 bulunmuştur. Ölçek alt boyutlarında en yüksek önemlilik düzeyi ilaçlar ve yaşam aktiviteleri, en düşük önemlilik düzeyi ise duruma ilişkin duygular, toplum ve izlem alt boyutlarında bulunmuştur. Hastaların yaşları ile HÖGÖ toplam puan ortalamalarına bakıldığında, 60 yaş altındaki hastaların tüm alt boyutlara ilişkin puan ortalamaları 61 yaş ve üzerine göre yüksek çıkmıştır (p &amp;lt; 0,05). Evlilerde öğrenme gereksinimi ilaçlar, yaşam aktiviteleri, tedavi ve komplikasyonlar bakımından bekarlara göre daha yüksektir (p &amp;lt; 0,05). Ayrıca daha önceden taburculuk eğitimi almış olan hastaların duruma ilişkin duygular,yaşam kalitesi, cilt bakımı alt boyutlarına ait puan ortalamaları yüksek çıkmıştır (p &amp;lt; 0,05). Sonuç: Hastaların taburculuğa ilişkin bilgi gereksinimi yüksek düzeyde bulunmuştur. Araştırma sonucunda lise ve üzeri eğitim düzeyine sahip, evli, yaşları 60 ve altında olan hastaların öğrenim gereksinimlerinin yüksek olduğu bulunmuştur. Hastaların sosyodemografik özelliklerine göre öğrenim gereksinimlerinin farklılık gösterdiği bulunmuştur; hastalara taburculuk eğitimi planlanırken bu durumun göz önüne alınarak eğitim verilmesi yaşam kalitelerini artıracaktır.

The development of a prediction score of in-hospital death in coronary care unit patients

Objective To identify the risk factors of in-hospital death in coronary care unit patients and to develop a score for relevant risks. Methods Totally 1 067 patients from the coronary care unit between February 2013 and December 2016 were retrospectively selected from the medical record system of He'nan Provincial People's Hospital. The univariate and polychotomous Logistic regression analysis was used to identify the independent risk factors of death in coronary care unit patients. A Logistic regression model was built, and its performance in prediction and identification was tested by the area under the curve (AUC) of receiver operating characteristic (ROC) , Hosmer-Lemeshow goodness-of-fit (GOF) and O/E value. Results According to the polychotomous Logistic regression analysis, finally six risk independent risks factors were included in the score model, and they were scored as follows: age (1) , history of coronary heart disease (CHD, 1) , admission cardiac function level (2) , consciousness (1) , systolic pressure (2) and oxygen saturation (2) . The test suggested that the score's identification and calibration for the occurrence of in-hospital death among coronary care unit patients was high (AUC=0.97; Hosmer-Lemeshow GOF: P=0.995; O/E value=1.13) . Conclusions The final death risk score includes six risk factors, each scored between 1 and 6, and the total score is 21. The patients scored lower than 7 is defined as the low-risk group; the patients scored between 7 and 10 is defined as the medium-risk group; the patients scored between 11 and 14 is defined as high-risk group; and the patients scored higher than 15 is defined as the extremely high-risk group. This death risk score can predict the occurrence of in-hospital death among coronary care unit patients accurately. Key words: Death; Patients; Coronary care unit; Risk prediction

The Effect of Use of Earplugs on Sleep Quality in Coronary Care Units Patients

The Effect of Use of Earplugs on Sleep Quality in Coronary Care Units Patients

Elevated lipoprotein(a) and familial hypercholesterolemia in the coronary care unit: Between Scylla and Charybdis.

Elevated lipoprotein(a) (Lp[a]) and familial hypercholesterolemia (FH) are inherited lipid disorders. Their frequencies, coexistence, and associations with premature coronary artery disease (CAD) in patients admitted to the coronary care unit (CCU) remain to be defined. Elevated Lp(a) and FH are commonly encountered among CCU patients and independently associated with increased premature CAD risk. Plasma Lp(a) concentrations were measured in consecutive patients admitted to the CCU with an acute coronary syndrome (ACS) or prior history of CAD for 6.5 months. Elevated Lp(a) was defined as concentrations ≥0.5 g/L. Patients with LDL-C ≥ 5 mmol/L exhibited phenotypic FH. Premature CAD was diagnosed in those age < 60 years, and the relationship between this and elevated Lp(a) and FH was determined by logistic regression. 316 patients were screened; 163 (51.6%) had premature CAD. Overall, elevated Lp(a) and FH were identified in 27.0% and 11.6% of patients, respectively. Both disorders were detected in 4.4% of individuals. Elevated Lp(a) (32.0% vs 22.2%; P = 0.019) and FH phenotype (15.5% vs 8.0%; P = 0.052) were more common with premature vs nonpremature CAD. Elevated Lp(a) alone conferred a 1.9-fold, FH alone a 3.2-fold, and the combination a 5.3-fold increased risk of premature CAD (P = 0.005). Elevated Lp(a) and phenotypic FH were commonly encountered and more frequent with premature CAD. The combination of both disorders is especially associated with increased CAD risk. Patients admitted to the CCU with ACS or previously documented CAD should be routinely screened for elevated Lp(a) and FH.

Periodic evaluation of drug utilization in intensive coronary care unit patients in a tertiary care hospital

Background: A wide and gradual variation exists periodically in the patterns of pharmacotherapy among patients admitted with CVDs in CCU. Periodic evaluation of drug utilization in the CCU is necessary for optimization of health care system, proper use of resources and making prescription policy.Methods: It was retrospective and prospective study. Study was carried out at Tertiary care hospital in Mangalore. Retrospective study period was from 1/07/2010 till 31/12/2010 and Prospective study duration was from 1/01/2016 till 30/06/2016. Patients from CCU were participants of this study.Results: Data of total 278 patients were taken, out of which 138 patients from 2010 and 140 patients in 2016 were analyzed respectively and were compared among drug therapy for IHD - Nitrates, dual antiplatelet therapy (aspirin and clopidogrel), dyslipidemic drugs and beta blockers remain drug of choice in both retrospective and prospective study. But, anticoagulant (heparin/ LMWH) use increased in prospective studies. In Heart failure - nitrates, antiplatelet, dyslipidemic drugs followed by inotropes and diuretics was used in both study. Cardiomyopathy was managed with diuretics, ACEIs, and nitrates in both retrospective and prospective study.Conclusions: In conclusion, predominance of male gender and poly-pharmacy were observed. However, it has identified areas to further rationalize and optimize patterns of polypharmacy and evidence based use of medications like beta blockers, anticoagulants/antiplatelet agents and antiarrythmisc. The results on the major determinants of cardiovascular drug use in CCU matched with the existing indications and cautions for use with each drug class.

Effects of nature sounds on sleep quality among patients hospitalized in coronary care units: A randomized controlled clinical trial

Background: Sleep disorders are a source of stress for patients hospitalized in coronary care units (CCUs). Objective: The aim of this study was to investigate the effects of nature sounds on sleep quality among patients in CCUs. Methods: This randomized controlled trial was conducted on 93 patients hospitalized in the CCUs of three teaching hospitals in Tehran, Iran. Patients were randomly allocated into three groups, namely, nature sounds, silence, and control groups. Patients in the nature sounds group listened to nature sounds for 30 min in two consecutive nights while their counterparts in the silence group only wore mute headphones. Patients in the control group neither listened to nature sounds nor wore headphones. The Richards–Campbell sleep questionnaire was used for the evaluation of the patients' sleep quality two days before and during the intervention. The mean scores of sleep quality at the first two and the last two nights, respectively, were considered as the pretest and the posttest sleep quality. Cohen's d, one-way analysis of variance, paired-sample t, Chi-square, Fisher's exact, and the Scheffe post hoc tests were used to analyze the data. Results: Posttest-pretest mean differences of the sleep depth, the number of awakenings, and the returning to sleep domains of sleep quality in the control group were significantly less than nature sounds group (P 0.05). Conclusion: Both nature sounds and silence can significantly improve sleep quality among patients in CCUs. Nurses can use these strategies to improve the sleep quality of a patient in these units.

Urine Cofilin-1 Detection for Predicting Type 1 Cardiorenal Syndrome in the Coronary Care Unit: A Gold Nanoparticle- and Laser-Based Approach

Background: Type 1 cardiorenal syndrome (CRS) is a severe complication for acute decompensated heart failure patients. This study aimed at evaluating the feasibility of using the gold nanoparticle-based localized surface plasmon-coupled fluorescence biosensor (LSPCFB) to detect urine cofilin-1 as a biomarker for predicting CRS among patients in the coronary care unit (CCU). Methods: A total of 44 patients were included with prospectively collected urine and blood samples. Both LSPCFB and conventional enzyme-linked immunosorbent assays (ELISAs) were used to measure urine cofilin-1 at admission to the CCU. The occurrence of CRS was judged within 7 days after admission. The discrimination presented as the area under the receiver operating characteristic curve (AUROC) and calibration of both detection methods were used to assess the predictive ability of urine cofilin-1 measured by the LSPCFB and ELISA. Results: Thirteen patients were diagnosed with CRS, while the other 31 patients were classified into a non-CRS group. For predicting CRS by measuring urine cofilin-1, the LSPCFB had higher accuracy (AUROC: 0.707, p = 0.031; overall accuracy: 79.55%) than the ELISA (AUROC: 0.479, p = 0.827; overall accuracy: 53.27%). The positive and negative predictive values of the LSPCFB were also higher than those of the ELISA (positive predictive value: 70.0 vs. 34.8%; negative predictive value: 82.4 vs. 76.2%). Conclusions: The gold nanoparticle-based immunoassay LSPCFB could exploit the potential of urine cofilin-1 as a single biomarker to predict CRS among CCU patients.

Prevalence of Familial Hypercholesterolaemia in Acute Coronary Syndrome Patients in a Large Regional Coronary Care Unit

Familial hypercholesterolaemia (FH) is an under-recognised cause of coronary artery disease, despite the proven reductions in risk with early detection and treatment [ [1] Versmissen J. et al. BMJ. 2008; 337: a2423 Crossref PubMed Scopus (548) Google Scholar ]. Studies have estimated that the prevalence of FH in patients with coronary disease range from 1–19% [ [2] Pang J. et al. J Clin Lipidol. 2015; 9: 703-708 Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar ].

Efficacy of topical chamomile on the incidence of phlebitis due to an amiodarone infusion in coronary care patients: a double-blind, randomized controlled trial

BackgroundAmiodarone is a useful antiarrhythmic drug. Phlebitis, caused by intravenous amiodarone, is common in patients in coronary care units (CCUs). ObjectiveThe aim of this study was to evaluate the effect of topical chamomile on the incidence of phlebitis due to the administration of an amiodarone infusion into the peripheral vein. Design, Setting, Participants and InterventionsThis was a randomized, double-blind clinical trial, conducted on 40 patients (n = 20 per group) in two groups—an intervention group (chamomile ointment) and a control group (lanoline, as a placebo), hospitalized in the CCUs and undergoing an amiodarone infusion into the peripheral vein over 24 h. Following the cannulation and commencement of the infusion, placebo or chamomile ointment was rubbed in, up to 10 cm superior to the catheter and repeated every eight hours for three days. The cannula site was then assessed based on the phlebitis checklist. Main Outcome MeasuresThe incidence and time of occurrence of phlebitis, relative risk, severity of phlebitis were the main outcome measures. ResultsNineteen patients (19/20) in the control group had phlebitis on the first day of the study and one patient (20/20) on the second day. In the intervention group, phlebitis occurred in 13 cases (13/20) on the first day and another two (2/7) was found on the second day. The incidence of phlebitis was significantly different between two groups (P = 0.023). The cumulative incidence of phlebitis in the intervention group (15/20) is significantly later and lower than that in the control group (20/20) during two days (P = 0.008). Two patients in the intervention group did not develop phlebitis at all during the 3-day study. Also, the relative risk of phlebitis in the two groups was 0.68 (P = 0.008 5). A significant difference was not observed with regard to phlebitis severity in both groups. ConclusionIt seems that phlebitis occurred to a lesser extent and at a later time frame in the intervention group compared to control group. Topical chamomile may be effective in decreasing the incidence of phlebitis due to an amiodarone infusion. Trial RegistrationThis protocol was registered in the Iranian Registry of Clinical Trials (IRCT2014042017361N1).

070 ACUTE KIDNEY INJURY IN CORONARY CARE UNIT: PREVALENCE, AETIOLOGIES AND OUTCOMES

Category: Research in AKI (Basic, translational, clinical including clinical trials) Presenter: Dr MIN HUI TAN Keywords: Acute kidney injury, coronary care unit, prevalence, aetiology Acute kidney injury (AKI) is an independent risk factor for mortality in the critically ill patients. While many studies are conducted in the Intensive Care Unit setting, little is known about AKI in the Coronary Care Unit (CCU) patients. Furthermore, data on Asian patients are limited. To determine the prevalence, aetiologies of AKI and clinical outcomes of these patients. This was a prospective observational study looking at patients who were admitted in CCU and Cardiac Rehabilitation Ward (CRW) Kuala Lumpur Hospital from February 2017 to April 2017. AKI was defined by increase in serum creatinine > 0.3mg/dL (26.5μmol/L) within 48 hours. There were 195 admissions; of which 22 (11.3%) patients fulfilled criteria for developing AKI while in CCU and CRW. Two thirds were male; mean age was 53.4 years (SD 13.4). Heart failure was the main diagnosis of admission (68.2%) therefore accounted for the most common aetiology of AKI (72.7%). Although AKI resolved in 15 patients (68.2%), only 14 (63.6%) survived the hospitalisation. All 8 patients who died were male (p=0.022). Comparing patients who survived and died, length of hospital stay was longer (8 vs 19.5 days, p=0.05), glomerular filtration rate was lower (27.5 vs 18.3 ml/min, p=0.026) and more patients required renal replacement therapy (p=0.01) in the mortality group. Conversely, there were no associations between survival of the patients with mechanical ventilation, inotropic support and use of medications like renin angiotensin system blockers and diuretics. AKI is common and has high mortality rate. Limited by the small sample size due to short duration, this study provides an early insight into the prevalence, aetiologies and risk factors for AKI in CCU patients.

Nursing Diagnoses for Heart Failure Patients in Coronary Care Unit and Evaluation of NANDA Compliance

Nursing Diagnoses for Heart Failure Patients in Coronary Care Unit and Evaluation of NANDA Compliance

Evaluation of Antimicrobial use in Ventilated Patients in Coronary Care Unit of a Tertiary Care Hospital

In developing countries, excess and indiscriminate use of antibiotics in community and hospital settings can lead to adverse effects primary to prolongation of therapy, harbour antibiotic resistance bacteria, rise in health expenditures and decrease quality of life. Antimicrobial resistance in the intensive care unit (ICU) has emerged as an important problem in this scenario. Recent studies revealed that antibiotic use is roughly ten times larger in ICU than in general wards. Research studies are required to gain suitable information concerning the use of antimicrobials (AMA) in ventilated patients which helps in improving the prescribing pattern of antimicrobial and also in executing infection control strategies in the therapy modification of such patients. There is barely limited data on antibiotic prescribing pattern in ventilated patients from India hence this study was carried out with an objective to know more about the antibiotic prescribing pattern and to analyze rationality among the prescriptions. This retrospective study was conducted in the Coronary care unit (CCU) of tertiary care hospital in South India from June 2014 to December 2014. The prescribing pattern of antimicrobials in patients aged between 10-90 years was studied. Total 33 AMA preparations were used either single or in combination. In the study, the commonly used AMAs were beta-lactam antibiotics, particularly ceftriaxone, levofloxacin followed by piperacillin + tazobactam (extended –spectrum penicillins + s-lactamase inhibitor) as single or combination therapy. Combination of AMAs was used in 54.3% of patients. In order to achieve good outcome right use of antibiotic at right time and right dose is required, based on general AMAs prescribing pattern and susceptibility pattern of pathogens, which aid to minimize the irrational employ of antibiotics and extra pressure for resistance.

Serum Cystatin C Predicts AKI and the Prognosis of Patients in Coronary Care Unit: a Prospective, Observational Study

Background/Aims: Acute Kidney Injury (AKI) is a serious clinical state associated with high morbidity and mortality, particularly in critical ill patients. We investigated the hypothesis that serum Cystatin C (sCysC) is a good predictor for AKI and may affect the short-term prognosis of coronary care unit (CCU) patients. Methods: In this prospective, observational study, we screened 412 adults admitted to the CCU from January 1, 2014 to June 1, 2015 at Zhongnan Hospital of Wuhan University. Serum samples were obtained at the time of admission, and sCysC was quantified through nephelometry. AKI was defined based on KDIGO-AKI criteria. After the patients’ hospital discharge, the survivors in this study were followed up for up to 2 years. The primary endpoint was the incidence of AKI stratified by severity stage, while the second endpoints included 2-year mortality, rehospitalization and failure in renal recovery rates, as well as the progression of AKI to CKD. Results: According to the KDIGO-AKI criteria, AKI occurred in 130 (31.6%) patients. After multivariate adjustments, the highest quartile of sCysC was associated with a 9-fold increased risk of incident AKI compared with the lowest quartile. For predicting AKI, sCysC [area under the receiver operating characteristic curve (AUC=0.842)] outperformed β2-micro globulin (AUC=0.813) and the clinical model (AUC=0.777), and a cutoff of 1.255 mg/L yielded good sensitivity and specificity. After a median 19.8-month follow-up, 112 (27.2%) patients died within 2 years after admission. The sCysC independently predicted the risk of 2-year mortality [adjusted odds ratio (OR), 4.955; 95% confidence interval (95% CI), 2.853 to 8.603] and rehospitalization (OR, 3.128; 95% CI, 2.011 to 4.867), as well as renal recovery failure (OR, 3.618, 95% CI, 1.753 to 7.463). Conclusions: Serum CysC is a strong predictor of AKI and the short-term prognosis of CCU patients.

Enteral Nutrition Support in Coronary Care Unit Patients Receiving Extraocorporeal Membrane Oxygenation: An Observational Case Study

Enteral feeding remains controversial in patients receiving extracorporeal membrane oxygenation (ECMO), particularly in those treated with a high-dose vasopressor. This study examined the safety and feasibility of enteral nutritional support for patients undergoing ECMO in a cardiac care unit (CCU).

Comparing the Effect of Foot Reflexology Massage, Foot Bath and Their Combination on Quality of Sleep in Patients with Acute Coronary Syndrome.

Introduction: Many patients in coronary care unit (CCU) suffer from decreased sleep quality caused by environmental and mental factors. This study compared the efficacy of foot reflexology massage, foot bath, and a combination of them on the quality of sleep of patients with acute coronary syndrome (ACS). Methods: This quasi-experimental study was implemented on ACS patients in Iran. Random sampling was used to divide the patients into four groups of 35 subjects. The groups were foot reflexology massage, foot bath, a combination of the two and the control group. Sleep quality was measured using the Veran Snyder-Halpern questionnaire. Data were analyzed by SPSS version 13. Results: The mean age of the four groups was 61.22 (11.67) years. The mean sleep disturbance in intervention groups (foot reflexology massage and foot bath groups) during the second and third nights was significantly less than before intervention. The results also showed a greater reduction in sleep disturbance in the combined group than in the other groups when compared to the control group. Conclusion: It can be concluded that the intervention of foot bath and massage are effective in reducing sleep disorders and there was a synergistic effect when used in combination. This complementary care method can be recommended to be implemented by CCU nurses.