Prevalence Of Organ Failure Research Articles

Non-convulsive seizures in the encephalopathic critically ill cancer patient does not necessarily portend a poor prognosis

BackgroundNon-convulsive status epilepticus (NCSE) is present in 10–30% of ICU patients with altered mental status (AMS) and is associated to poor outcomes. To our knowledge, there is no data describing the prevalence and outcomes of critically ill cancer patients with AMS associated to non-convulsive seizures (NCS) or NCSE. We aim to describe the outcomes and risk factors of critically ill cancer patients with encephalopathy associated with non-convulsive seizures (NCS).MethodsThis is a 3-year prospective observational study in a mixed oncological ICU at MD Anderson Cancer Center. Data of ICU patients with moderate to severe encephalopathy (Glasgow Coma Score < 13) that underwent EEG monitoring to rule out NCS were collected. Multivariate logistic regression was performed to identify risk factors and outcomes.ResultsOf the 317 patients with encephalopathy who underwent EEG monitoring, 14.5% had NCS. Known risk factors such as sepsis, CNS infection, antibiotics, and cardiac arrest were not associated with increased risk of NCS. Patients with NCS were more likely to have received recent chemotherapy (41.3% vs 21.4%; p = 0.0036), have a CNS disease (39% vs 24.4%; p = 0.035), and abnormal brain imaging (60.9% vs 44.6%; p = 0.041). Patients with lower SOFA scores, normal renal function, and absence of shock were likely to have NCS as the cause of their encephalopathy (p < 0.03). After multivariate analysis, only abnormal brain imaging and absence of renal failure were associated with NCS. Mortality was significantly lower in patients with non-convulsive seizures when compared to those without seizures (45.7% vs 64%; p = 0.022); however, there was no significant association of seizures and mortality on a multivariable logistic regression analysis.ConclusionsNCS in critically ill cancer patients is associated with abnormalities on brain imaging and lower prevalence of organ failure. Diagnosis and treatment of NCS should be a priority in encephalopathic cancer patients, as they can have lower mortality than non-seizing patients. Opposite to other populations, NCS should not be considered a poor prognostic factor in critically ill encephalopathic cancer patients as they reflect a reversible cause for altered mentation.

Prevalence of organ failure and mortality among patients in the emergency department: a population-based cohort study

ObjectivesThe aim was to describe population-based incidence and emergency department-based prevalence and 1-year all-cause mortality of patients with new organ failure present at arrival.DesignThis was a population-based cohort study of...

Prevalence and prognosis of acutely ill patients with organ failure at arrival to hospital: protocol for a systematic review

BackgroundAcutely ill patients are a heterogeneous group, and some of these suffer from organ failure. As the prognosis of organ failure improves with early treatment, it is important to identify these patients as early as possible. Most studies on organ failure have been performed in intensive care settings, or on selected groups of patients, where a high prevalence and mortality have been reported. Before patients arrive to the intensive care unit, or the general ward, most of them have passed through the emergency department (ED), where diagnosis and treatment has been initiated. The prevalence and prognosis of acutely ill patients, with organ failure, at arrival have been studied in some selected groups, but methods and results differ. This systematic review aims to identify, summarize, and analyze studies of prevalence and prognosis of new onset organ failure in acutely ill undifferentiated patients, at arrival to hospital. The result of the review will assist physicians working in an ED, when assessing patients’ risk of organ failure and their associated prognosis.MethodsThe information sources used are electronic databases, PubMed, Cochrane Library, EMBASE, and CINAHL; references in included studies and review articles; and authors’ personal files. One author will perform the title and abstract screening and exclude obviously ineligible studies. By an independent full-text screening, two authors will decide on the eligibility for the remaining studies. Eligible studies will include an unselected group of acutely ill adult patients at arrival to hospital, with one or more organ failures (respiratory, renal, cerebral, circulatory, hepatic, or coagulation failure). Included studies will have assessed the prevalence or prognosis, defined as mortality or ICU transfer, of new onset organ failure. From included studies, bibliographical and study description data, patient characteristics, and data related to prevalence of organ failure and prognosis will be extracted. We will assess risk of bias in included studies using the Quality in Prognosis Studies tool for prognostic studies and the Newcastle-Ottawa Scale for observational studies. We expect heterogeneity and to conduct a qualitative synthesis of the results. If, however, heterogeneity is low, we will conduct a random effects meta-analysis stratified by basic study design.DiscussionThis review will summarize and analyze studies of prevalence and prognosis of acutely ill patients, with organ failure at arrival to hospital, assist ED physicians assessing the risk of organ failure in unselected patients, and guide recommendations for further research.Systematic review registrationPROSPERO CRD42017060871

Atlanta, revised Atlanta, and Determinant-based classification – application in a cohort of Portuguese patients with acute pancreatitis

Acute pancreatitis (AP) represents a complex and potentially fatal disease with a highly variable clinical course. Three classification systems for assessing the severity in AP have been validated for clinical use. The aim of the present study was to evaluate the performance of the Atlanta and Determinant-based classifications in predicting severe clinical outcomes in patients with AP. In this retrospective study we reviewed the treatment and follow-up records of 525 patients with AP admitted to our unit between the years of 2003 and 2014. Outcomes included mortality, admission to the ICU, need for interventional procedures or nutritional support, and duration of hospital and ICU stay. The prevalence of organ failure and persistent organ failure in our cohort was 23.0 and 10.7%, respectively, and the mortality rate was 5.9%. Higher grades of severity were associated with worse outcomes in all classification systems. The revised Atlanta and Determinant-based classifications performed similarly in predicting outcomes, and both proved to be superior to the former classic Atlanta classification. Recent classifications proved to be more accurate in predicting important clinical outcomes in patients with AP.

The prevalence of organ failure and its risk factors in patients with severe acute pancreatitis

Objective To determine the prevalence of organ failure and its risk factors in patients with severe acute pancreatitis(SAP). Method A retrospective analysis was conducted in 186 patients, who were hospitalized in the intensive care unit of Jinzhong First People's Hospital with SAP between March 2000and October 2009. SAP patients met the diagnostic criteria of SAP set by Surgery Society of Chinese Medical Association in 2006. The variables included age, gender, etiology of SAP, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis, CT Severity Index ( CTSI ), abdomen compartment syndrome (ACS) ,the number of organ failure and the number of death. The prevalence and mortality of organ failure were calculated. The above-mentioned variables were analyzed by unconditional multivariate logistic regression analysis to determine the independent risk factors for organ failure in SAP. Results Of 186 patients, 96had organ failure. In 96 patients with organ failure, 47 died. There was a significant association between the prevalence of organ failure and age, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis, CTSI, ACS. An increase in age, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis correlated with an increase in the number of organ failure. Age, the number of comorbidit, APACHE Ⅱ score,CECT pancreatic necrosis, CTSI and ACS went into the unconditional multivariate logistic regression equation. Conclusions Organ failure occurred in 51.6% of 186 patients with SAP. The mortality of SAP with organ failure is 49.0%. Age, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis,CTSI and ACS are independent risk factors of organ failure. Key words: Severe acute pancreatitis; Organ failure; Prevalence; Risk factor; Age; Comorbidit; APACHE Score; Pancreatic necrosis; Abdominal compartment syndrome